INTRODUCTION

On 27 April 1994 the first democratic elections were held in South Africa, marking the country's official transition from more than 300 years of authoritarianism and institutionalized racism to a free and democratic society. In the 19 years since, the country has made progress in improving rule of law, governance, and public health. South Africa now ranks well above its neighbours in sub-Saharan Africa in economic and human development indicators (UNDP, 2011). Yet, despite localized economic growth, South Africa experiences persistently high levels of unemployment (an average of 25 per cent in 2000–12), income inequality, systemic corruption, and unequal economic and social transformation. These challenges are so severe that they risk undoing recent gains.

Similarly, South Africa's health outcomes remain much lower than those of other middle-income countries that are not at war—in fact, lower than in many poorer countries (Coovadia et al., 2009, p. 817). The nation continues to struggle with high levels of armed violence, with a homicide rate about four times the global average—among the world's highest (Geneva Declaration Secretariat, 2011, pp. 51–53). Research suggests that persistently high levels of armed violence and underperformance in health and development are related (Bellis et al., 2010; OECD, 2009; Geneva Declaration Secretariat, 2008). South Africa appears to be a case in point.

This chapter explores South Africa's dilemma, namely that its incremental progress and growth are undermined by ongoing and systemic armed violence and inequality.