Introduction to health, development and Primary Health Care
Welcome to Unit 3!
So far we have analysed the causes of ill-health and concluded that in order to effectively and sustainably address health problems we need to not only address the physical/biological causes butalso the underlying socio-economic, cultural and political root causes so as to make a lasting impact on the health of nations. In this unit we will assess the impact of colonialism, industrial capitalism, monopoly capitalism and imperialism on underdeveloped countries. Most people believe that the negative effects far outweigh the benefits. The results were underdevelopment, increased poverty, a system of dominant and dominated economies, as well as widening social inequality between groups of people based on class, race and gender.
Study sessions
There are two Study Sessions in Unit 3:
Study Session 1The impact of colonialism, capitalism and underdevelopment on health care
Study Session 2The Declaration of Alma Ata and the Primary Health Care Approach
Intended learning outcomes
By the end of this session, you should be able to:Public Health Outcomes
- Discuss how colonialism, capitalism and underdevelopment have impacted on Africa
- Explore how development impacts on the health status of the population
- Describe the origins, evolution and main features of Primary Health Care (particularlyComprehensive Primary Health Care)
- Take notes
- Compare information in texts
- Interpret, compare and draw diagrams to represent information
- Read critically, read for a purpose, identify key points, classify and summarise information
- Work out the meaning of terms
- Draw conclusions from texts
Unit 3 – Study Session 1
The impact of colonialism, capitalism and underdevelopment on health care
Introduction
In the first study session of Unit 3, we focus on events that took place in Britain during the 19th century with the growth of capitalism and industrialisation. We examine the effects on the pattern of disease and death, and how Britain managed to improve the health of the people through the distribution of some of the resources created by the new capitalist system – a system based significantly on colonial exploitation. Ironically, these processes contributed to the unequal development of countries of the North and South, and a system of dominant and dominated economies. Historically, a more equitable distribution of power and resources nationally and internationally has been achieved through various forms of popular struggle.
Session contents
1Learning outcomes of this session
2Readingsand references
3Capitalism and colonialism
4A brief history of colonialism and underdevelopment
5How colonialism impacted on health systems
6The evolution of health policies in underdeveloped nations.
7Community-based approaches and national health systems
8Session summary
Timing of this session
There are two readings for this session and five tasks. It should take you about 5 hours to complete.
1LEARNING OUTCOMES OF THIS SESSION
By the end of this session, you should be able to:Public Health Outcomes
- Discuss how colonialism and capitalism impacted on development.
- Discuss how the legacy of colonialism and capitalism impacts on health care in Africa
- Compare health services and expenditure in developed and underdeveloped countries
- Explain the inequitable distribution of health care resources and measures taken to address this
- Explain the basic needs approach
- Preview texts
- Take notes
- Compare information in texts
- Interpret, compare and draw diagrams to represent information
- Read critically, read for a purpose, identify key points, classify and summarise information
- Work out the meaning of terms
- Draw conclusions from texts
2READINGSAND REFERENCES
The two readings for this Study Session are listed below. You will be directed to them in the course of the Study Session.
Author/s / Reference detailsWerner, D. & Sanders, D. / (1997). Ch 2 - The Historical Failures and Accomplishments of the Western Medical Model in the Third World. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights: 13 -17.
Sanders, D & Carver R. / (1985).Ch 3 - Health, Population and Underdevelopment. In The Struggle for Health. London: Macmillan: 54-70.
3CAPITALISM AND COLONIALISM
In preparation for the main readings in this session, clarify your understanding of the concept of capitalism.
TASK 1 – Clarify concepts1. On a mind-map, brainstorm as many key words as you can think of to do with capitalism.
FEEDBACK
Capitalism is an economic system in which private owners control the means of production, including industrial, agricultural and financial resources, with the aim of making a profit.
In history, capitalism has surfaced in different forms– merchant capitalism, industrial capitalism and monopoly capitalism.
Merchant capitalism
Merchant capitalism started in the 16th century when European traders travelled to the Middle East, the Far East and Africa to obtain spices, precious metal and ivory. They soon also began to trade cloth, guns, beads and other goods for slaves, who were shipped and sold in the East Coast of South America, the CaribbeanIslands and the southern parts of what is now the United States of America.These slaves worked on plantations producing cotton, sugar and tobacco. These raw materials were taken back to Britain and sold at a vast profit. Some of the traders later invested their profit in industrial production and coal mining in Britain at the time of the ‘Industrial Revolution’. The growth of industry became known as Industrial capitalism.
Industrial capitalism
Industrial capitalism is based on the private ownership of machines, factories, industries and the employment of wage earners. The capitalist invests in capital, such as land, raw materials, machinery and labour, to produce goods that will be distributed and sold at a profit. In its pure form, industrial capitalism is based on the principle of ‘free competition’, whereby a large number of producers compete with each other to produce, buy and sell goods or services in the market. The market operates according to the laws of supply and demand, which regulates the supply and price of goods and services. Put very simply, when there is more produced or available than can be sold, the price falls. Conversely, when there is not enough produced to meet the demand, there is a shortage, and so the price rises.
Monopoly capitalism
When large companies dominate national or international markets this is called monopoly capitalism. These companies are referred to as ‘conglomerates’, ‘transnationals’ (TNCs) or ‘multinationals’ – the latter two operating in and across many countries. When giant producers have no more room to expand in their own national markets,they set up production in other parts of the word, to export their capital and to conquer new markets for their finished goods. Together, TNCs control most of world trade. They have no particular commitment to the countries in which they operate, and their main commitment is to making a profit, using the available resources and labour. Although they create jobs in these countries, they strive to keep wages as low as possible. TNCs sometimes have enormous power and leverage over the governments of these countries.
monopoly
the complete possession or control of something by one group or singleproducer
conglomerate
a large company that owns companies in different industrial sectors, suchas mining, or manufacturing
multi-nationals/transnationals
huge companies, usually with their headquarters in a First World country,and factories, mines and offices in developing counties
The map below shows the extent of the operations worldwide of the transnational Unilever.
The extent of the wealth of TNS and multinationals is enormous, particularly when
compared to the budgets of Third World countries, as illustrated in the table below.
State and Corporate Power, 1994(US$ billions)
Country or corporation / Total GDP or corporate salesGeneral Motors / 168.8
Ford / 137.1
Toyota / 111.1
IBM / 72.0
Unilever / 49.7
Nestle / 47.8
Sony / 47.6
Indonesia / 174.6
Turkey / 149.8
South Africa / 123.3
Norway / 109.6
Malaysia / 68.5
Venezuela / 59.0
Pakistan / 57.1
Egypt / 43.9
Nigeria / 30.4
(Adapted from Fortune Magazine, 1996, World Bank, 1995d and UNRISD 1995)
Colonial domination of large parts of the world was one result of the growth of monopoly capitalism at the end of the 19th Century. During this period, countries from the North conquered territories in the South, exploited their wealth, exported capital to them, and established new industries. We now take a closer look at colonial domination and how it impacted on the social conditions, health and health care of the colonised people.
4A BRIEF HISTORY OF COLONIALISM AND UNDERDEVELOPMENT
TASK 2 – Check your knowledge of colonialism
- What does colonialism mean? What was its purpose?
- Who were the colonisers? Which continents and countries did they colonise? Jot down your ideas.
FEEDBACK
Colonialism is the imposition of the power of one state over the territories of another, (often through military conquest) for political or economic ends. Early colonialism refers to the period during the 16th century when Latin America was colonised by Spain and Portugal. However, the main period of colonial expansion was in the late 19th – 20th centuries and is known as the ‘scramble for Africa’. During this period, European missionaries, explorers and traders came to Africa. They soon realised the potential wealth in Africa and saw African countries as a source of cheap, raw materials and an outlet for the sale of manufactured goods from Europe. Thus, colonialism was geared towards serving the interests of European industrial capitalism. Although there was extensive resistance from Africans, by 1900, the whole continent was divided up andnew national and political boundaries were formed, ruled by various European countries.
The process of colonisation usually happened as follows:
The two maps below show Africa before and after colonisation. Before colonisation, parts of Africacontained independent African states and kingdoms, where people of similar ethnic, tribal or religious origins lived. After colonisation, new national boundaries were formed for most of the continent, ruled by various European countries.
Source: openlearn.open.ac.uk
Capitalism and colonialism went hand in hand, disrupted traditional social systems, and created new social classes of capitalist landowners, managers and workers. Although these changes led to the development of industry and infrastructure and the provision of services for some, they also served to exacerbate social inequality between groups of people, based on class and race.
Read this oral history account of colonisation in Tanzania.
Tanzania: Colonialism and capitalism
My name is Shantsi and I live in Tanzania. This story was passed on to me by my grandfather. It was told to him by his father who was a young man during the 1880s when the colonists arrived.
When the whites first came to our country, they came on huge boats made of iron. We Africans had never seen this before. At first we were curious to meet these strange white people, but soon we started to hate them. The whites changed all our traditional ways of living. They forced us to grow crops which we could not eat, like cotton. They needed these crops in their own country. They turned our chiefs into overseers or supervisors and made them whip us if we didn’t plant the white man’s crops. Many families died of hunger because they weren’t allowed to use their own land to grow food.
The white missionaries told our women to cover their bodies instead of wearing traditional clothing. They changed our beliefs and forced us to become Christians. We lost our land, our cattle and our youth, who went to work on the mines and in the new towns. Many never came back.
(Adapted from ASECA, Development in Africa, Sached Trust, 1995: 3)
Colonisation in Tanzania did very little to develop the country. Traditional social, political and economic life was totally disrupted. People died resisting colonialism, some died from hunger, and others provided cheap labour for European-owned industries. With little infrastructure and an economy built upon cash crops such as cotton, Tanzania was poor and underdeveloped when independence came.
Most African countries achieved political independence during the 1950s and 1960s. The last countries to gain independence were Zimbabwe, Namibia and South Africa. Although politically independent, most African countries did not achieve economic independence. Some countries, such as Nigeria, inherited huge political problems that have crippled progress and development. Other countries, such as Tanzania, inherited weak economies and have been unable to develop themselves.
The poverty and underdevelopment experienced by post-independent countries, can be partly be explained by historical processes around their economic and political exploitation through colonialism and capitalism. However, politically independent countries remain poor and underdeveloped today and are particularly vulnerable to other forms of economic domination. Can you think of some ways in which these countries continue to be dominated economically today? Read this extract about Tanzania after independence.
Tanzania – Post-independence
After independence, Tanzania chose to follow a socialist path of development and self-reliance. This was difficult. Although Tanzania restricted investment by foreign countries, the government was forced to enter into agreements with some companies, in order to develop Tanzania’s infrastructure, which in turn would support the growth of trade and industry.
Here are two examples of what happened:
Britain offered to build a highway in Tanzania for US$110 million. Of this, only $10 million was spent in Tanzania. The rest of the funding was paid to British firms to plan and build the road. Only eight Tanzanians were involved in building the road.
Tanzania asked a Canadian international development agency to build a new bread factory in Tanzania.The construction cost Tanzania much more than they had estimated. Only 60 Tanzanians were employed on this project. Canadian machinery was used to build the factory, which meant that when it broke down, the Tanzanians had to pay the Canadian company to fix it.
(Adapted from ASCA, Development in Africa, Sached Trust, 1995: 46.)
You can see from this extract that Tanzania had to depend on aid from the developed world in order to build the infrastructure it needed. However, the aid really benefited the developed countries more than Tanzania. So, as during colonialism, the developed world continued to profit from the underdeveloped world, while the underdeveloped world lacked power to develop itself. Many African countries found themselves in the same position as Tanzania. For example, they depended on loans from organisation like the World Bank, in order to develop their countries. However, these loans came with conditions that had negative consequences. (For more information on the negative consequences of these loans refer to IPH, Unit 3, Study Session 3.)
Political independence had not solved the economic problems of the Third World countries. In fact, Third World countries have remained underdeveloped, and in some cases have grown even poorer as a result of ongoing exploitation and domination by more powerful First World countries. Sometimes this is termed ‘neo-colonialism’.New forms of exploitation and dominance operate in the global world context today.
5HOW COLONIALISM IMPACTED ON HEALTH CARE
The readings that follow provide an overview of how broader social and economic developments in different periods impacted on the health of people, and the health policies and health care approaches that were adopted in the countries of the South. The first reading brings together and summarises many of the ideas discussed in this session so far. It also provides useful examples and illustrations of these ideas. The second readings provides an insight into the underdevelopment of the South, the influence of the Western medical model, and the eventual rethinking of health care strategies with a focus on meeting the basic needs of people and addressing the social determinants of poor health.
TASK 3 – Preview the textREADINGS
Sanders, D. & Carver R. (1985). (1985). Ch 3 - Health, Population and Underdevelopment. In The Struggle for Health. London: Macmillan: 54-70.
Werner, D. & Sanders, D. (1997). Ch 2 - The Historical Failures and Accomplishments of the Western Medical Model in the Third World. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights: 13-17.
- Quickly preview the whole of chapter 3 of the first reading (Sanders & Carver, 1985). Then read it carefully and make your own notes.
- Preview the second reading (Werner & Sanders, 1997) Now read the first paragraph of the chapter. It tells us what the aim or purpose of the chapter is. Use your own words to write down the main aim of the chapter. (Why are we looking at the history of social and economic development in the Third World?)
a. Who has directed the development of the undeveloped, less developed or developing colonies in the South since colonial times?
b. What did development planners emphasise in the late 1960s and early 1970s? Why was this trend reversed and what was the consequence?
c. By the end of the colonial period, what was the Third World’s health care approach modelled on? What was the main problem of this model?
d. In the 1970s what new health care strategy emerged? What programme emerged from this and what kind of methods were used?
e. What plan was formulated by health ministers from around the world in 1978?
4. The notes you have made should provide you with a good summary of the main ideas in this second reading. Compare these with the notes you made for the first reading? Are they more or less useful, do you think? Why is this? How can you improve your skills of making notes while reading?
FEEDBACK
Below is an example of our brief summary of the main ideas in the reading: