Public Health in Asia and the Pacific

Nine lines on page four capture the essence of the volume. As the editors argue:

The chapters do not constitute a comprehensive survey of public health in Asia and the Pacific. Rather, they are linked together in significant ways by the thematic continuity of interacting histories, cultures, environments, disease patterns, inter-regional population migrations and medical practices. Despite identifiable differences that exist between these countries as well as between regions, a more integrated view of public health and preventative medicine in the region that takes into account the various factors that gave rise to these developments will hopefully take shape.

The volume—published in 2008—was one of the first of its kind at the time to facilitate a meaningful dialogue between history and policymaking. Somewhat overambitious in its scope, the volume attempts to capture the continuities and changes in public health across Asia and the Pacific between the turn of the twentieth century and the present. Unfortunately, availability of archival data for reconstructing the social history of disease across Asia is asymmetrical and is biased towards the colonial period.  The bias in the archives towards the colonial period and epidemic diseases is particularly true of South and Southeast Asian nations. As a result, capturing the continuities and changes in public health and disease control across the region from either a comparative or a transnational perspective becomes challenging.

Kerrie Macpherson’s chapter explores the epistemological wrangling between Chinese and Western medicine in Hong Kong and China related to the control of epidemic diseases and briefly traces the trajectory of public health between the British acquisition of Hong Kong (1842) and the present. Masahira Anesaki’s descriptive chapter chronologically traces the factors that contributed to Japan’s emergence as the healthiest nation in the world by the 2000s. Likewise, In-sok Yeo’s contribution delineates the continuities and changes in Korean public health between the last quarter of the nineteenth century to the present.

Radhika Ramasubban’s chapter investigates the legacy of colonial public health policy upon the present and brings out the paradox that despite independent India’s economic growth, progress in public health remains negligible. Paul T. Cohen captures the transformation of Thailand’s public health from a plural medical system centred on the body of the monarch during the nineteenth century to one that policed the population. Laurence Monnais’ chapter examines the imprint of French colonial medicine—particularly its coercive aspects, e.g., management of leprosy patients through social control—for the continuation of leprosy as a social problem in Vietnam today. Terence Hull highlights the tension between the Rockefeller Foundation’s educational approach to hygiene, on one hand, and the relatively authoritarian approach of the colonial government in the Dutch East Indies, on the other. The following three contributions teleologically narrate the growth of public health in Timor-Leste, Malaysia and Singapore from the colonial period to the present.

Willie T. Ong uses the Philippine cholera epidemics as a lens to understand the aetiological differences between the American and Filipino cosmologies of illness. Furthermore, Ong observes continuities between the cholera epidemics of the early 1900s and the El Tor epidemic of the 1960s. Like the rigorous American sanitary measures before them during the first four decades of the twentieth century, the Filipino health administration during the 1960s framed cholera as a problem created by the non-cooperation of people living in slum areas.

In his chapter, Milton Lewis examines the influence of British Fabian socialism on the development of Australia’s political culture of health. Vicky Luker, with respect to Papua New Guinea, paradoxically observes that population growth has helped undermine a medical system that engineered it. Richard Taylor examines the impact of colonialism and globalisation on public health in the Pacific Island nations. Taylor points out that globalisation has placed a constraint on governmental action in the prevention of non-communicable diseases through price manipulation of healthy and non-healthy products due to the prevailing neoliberal orthodoxy and the incompleteness of statistics regarding the prevalence of these diseases.

Two recurring themes which find expression in most chapters of the volume are: (a) the epidemiological transition in the Asia and the Pacific from communicable and non-communicable diseases; and, (b) social factors such as ethnic, economic, and gender inequalities that affect health outcomes within countries. Globalisation is a theme that is universally reflected in all chapters. From the volume as a whole, it can be inferred that globalisation not only constrains but also creates opportunities for the spread of infectious diseases.

A number of questions remain unaddressed in the volume. The editors miss out on the larger picture, namely the impact of the Cold War (1945-1991) and the influence of the World Health Organisation and the UN agencies on international health.  With the exception of Hull’s chapter on Indonesia, very little is known about the role of indigenous physicians regarding the appropriation and transformation of biomedicine in non-Western contexts. The volume as a whole could be better organised thematically.  For example, the notion of medical pluralism is a common theme evident in the chapters by Macpherson and Ong, and not others. The volume fails to draw a contrast between various forms of government in the early twentieth century in the Asia and the Pacific— i.e., crown colonies, settler colonies, protectorates, and independent states—each form of governance having its own ramifications for the nature of public health intervention. Lastly, the taken- for-granted assumption that Western sanitary science was synonymous with colonial medicine needs to be problematized, given the appropriation and transformation of Western medicine in a Japanese context by the Shogunate government by 1868 and Japanese biomedical presence in East Asia during the 1930s.

Vivek Neelakantan (vivekneelakantanster@gmail.com)