Health and development in history: from disease control to health systems – new Lecturer John Manton

John Manton

From its foundation in 1932, and especially after the end of World War Two in 1945, the Leprosy Centre at Uzuakoli, Nigeria, was a medical site of global significance, offering home and shelter to its rejected residents, and carrying out groundbreaking research into dapsone and clofazimine, drugs still used to treat leprosy. The research and rehabilitation programme continued and grew in scope and fame until interrupted by catastrophic civil war in 1967.

Jointly administered by the Nigerian government (both colonial and independent) and the Methodist Church, much of its renown is as home to Ikoli Harcourt Whyte (1905-1977), a leading choral composer who transformed his experience of suffering and segregation into songs of worship and wonder, and whose school at Uzuakoli attracted choirmasters from across Nigeria.

In making the radio documentary Uzuakoli in Music and Medicine, I drew on and assembled found and field recordings, including original vinyl and remastered recordings of Harcourt Whyte’s choir; contemporary recordings of Harcourt Whyte’s work arranged by his scholarly biographer Achinivu Kanu Achinivu; oral historical testimony; and field recordings of sung and spoken passages of Harcourt Whyte’s music.

This cultural output of leprosy control, drawing on a life scarred by ill health and wartime experience, remind us that war, famine, pestilence, and death are rarely simple phenomena and are never devoid of historical context and depth. All too often, it is next to impossible to retrieve this context. These four horsemen rampage through historical memory and the means of preserving it. Neither paper nor the heightened recollection of crisis is a reliable indicator of how people go about their lives, or how systems persist and develop.

John Manton image

Still, even where there is no doctor, routinely neglected health issues intermittently swing into focus, through one mechanism or another, and briefly command the attention of media and opinion makers, leaving a documentary trail, and echoing through the recollections of those involved in resolving or concealing the highlighted issues. Most recently, Ebola virus disease has sharpened our focus on the war-wracked health systems of Guinea, Liberia, Sierra Leone, and the supposedly fragile capacity of neighbouring states in West Africa.

As the epidemic recedes, and we are left with themes such as resilience, preparedness, community mobilization and so on, together with the promise of better concepts, better programmes and better futures. Amid persistent poverty and vulnerability, it is worth investigating how the contrary themes of fragility, ill-preparedness, and the rejection of public health responses are produced and reproduced historically, and how these purportedly counter-productive phenomena have impacted the historical framing and functioning of system responses to service provision and crisis response in health.

Returning to LSHTM (where I previously worked on histories of disease control, and traces and remains of medical research in Africa), I am joining a group of researchers at CHiPH, led by Martin Gorsky, examining these themes, among others, in an investigation of the origin and impact of health systems thinking and policy through the mid and late twentieth century. I’ll be working in the Philippines and Congo, as well as coordinating research in Nigeria, bringing insights from the historical experience of health systems and systems strengthening in the global South to bear on a global history of ideas, planning and financing in health over the past century.