Histories of Global Health, Medicine & Disease - Session 1 Notes

Introduction to Global Health, Medicine & Disease

Course Information

  • Lecturer: Jeroen Lorist PhD
  • Times:
    • Monday: 13:15 - 15:00 (Room 3.00)
    • Thursday: 09:15 - 11:00 (Room 3.09)
  • Session 1: Tue 9 April 2025

Agenda

Part I
  • Introduction: Getting to know each other
  • Structure of the Course
  • Assessment
  • Discussion of the Green et al. Chapter
    • Group discussion and Q&A
    • Key Concepts
Part II
  • Group Work – Experiential learning
  • Running and Malaria Eradication NGO

Motivations for Studying Global Health

  • Students to get to know each other.
  • Students have been going to school together for at least two years.

Course Objectives

  • Think critically on Global Health, Medicine, and Disease within different contexts and how thinking about health has developed over time.
  • Learn about the continuities that affect Global Health institutions, knowledge, and practices today (e.g., racism, colonialism).
  • Take different perspectives on how we can study Global Health.
  • Explore different diseases such as HIV, Polio, and Tuberculosis.
  • Explore decolonial perspectives on Global Health, Medicine, and Disease.
  • Explore how we could build better Global Health futures.

Course Structure

  • Week 1:
    • 9 April: Introduction to Global Health
    • 11 April: Case Study – Dutch Sexual Health Interventions
  • Week 2:
    • 16 April: What is Critical Global Health
    • 18 April: Good Friday – PUBLIC HOLIDAY – No class
  • Week 3:
    • 23 April: Case Study – Polio behind the Iron Curtain
    • 25 April: History of bio-medicine
  • Week 4:
    • 30 April: History of HIV
    • 2 May: Decolonializing Global Health
    • First essay due by 23:59 Sunday 4th of May
  • Week 5:
    • 6 May: Group presentations
    • 9 May: How to study Global Health
  • Week 6:
    • 14 May: Tuberculosis – Guest Lecture
    • 16 May: No lecture
    • Second essay due at 23:59 on Sunday 18th of May.
  • Week 7:
    • 21st May: History of Mental Health
    • 23rd May: Global Health Futures
  • Final Exam: To be determined

Assessment

  • Engagement (Participation): 10%
  • Group Presentation: 15%
  • Two short essays: 17.5% each (1000 words max)
  • Final Exam: 40% (multiple choice and open questions)

Key Concepts and Historical Perspective

  • Continuity of historical processes like racism.
  • Simplistic single vector focus (only killing the mosquitos).
  • Exclusion of economic, social, and political contexts and social determinants of health.
The Health Historian
  • Why is a historical perspective important for Global Health Today?
Key Quote (Green et al 2013)
  • “Colonial medicine’s legacy is not only in the infrastructure left behind, but in the ways that disease and health continue to be framed in technical and apolitical terms.”

Discussion of Chapter 3 - Colonial Medicine and Its Legacies (2013)

  • Authors: Jeremy Greene, Marguerite Thorp Basilico, Heidi Kim, Paul Farmer
  • Jeremy A. Greene is the William H. Welch Professor of Medicine and the History of Medicine at Johns Hopkins School of Medicine.

Importance of Historical Perspective in Global Health

Key Quote
  • “Critical social history seeks to accomplish three goals:
    1. to render the present unfamiliar, and therefore open to social critique;
    2. to emphasize the role of continuity between, for example, current global health efforts and former colonial rule;
    3. and to work to understand the rifts and discontinuities that account for meaningful social change.”

Key Takeaway Points: Colonial Medicine and Its Legacies (Chapter 3)

  • By Jeremy Greene, Marguerite Thorp Basilico, Heidi Kim, and Paul Farmer
1. Colonial Medicine as a Tool of Empire:
  • Medicine played a central role in the colonial project, often serving as a justification for imperial expansion.
  • Colonial health interventions were frequently motivated by economic and military interests rather than humanitarian concerns.
  • Disease control efforts were often designed to protect European settlers and workers rather than indigenous populations.
2. Racialized and Hierarchical Medical Practices
  • Colonial medical policies reinforced racial hierarchies, often prioritizing the health of colonizers over colonized populations.
  • Indigenous healing systems were often marginalized or dismissed as "unscientific," despite their efficacy.
3. The Impact of Colonial Medicine on Public Health Systems
  • Many contemporary global health infrastructures were shaped by colonial-era policies, which led to fragmented and under-resourced health systems.
  • Some postcolonial nations inherited medical institutions that were designed primarily for colonial elites, leading to unequal access to healthcare.
4. Epidemiological Transformations and Disease Control
  • Colonization influenced the spread and management of diseases such as malaria, tuberculosis, and smallpox.
  • The focus on tropical medicine reflected colonial priorities, often addressing diseases that threatened European administrators rather than those affecting local populations most.
5. Continuities in Postcolonial Global Health
  • Many inequalities in modern global health can be traced back to colonial histories, with persistent disparities in access to healthcare, medical research priorities, and disease burden.
  • International health organizations, NGOs, and foreign aid programs sometimes replicate colonial power dynamics, perpetuating dependency rather than fostering self-sufficiency.
  • Next week’s case-study shows how these colonial power dynamics, i.e., historical racialist norms are invisibly reproduced through knowledge power (Foucault) within Dutch funded sexual and reproductive health programs.
6. Resistance and Indigenous Knowledge
  • Postcolonial movements have sought to reclaim indigenous knowledge and decolonize healthcare systems.
  • Colonized populations did not passively accept colonial medical practices; many resisted, adapted, or integrated aspects of Western medicine into their own healing traditions.
  • Next week’s case-study also shows Dutch funded colonial power dynamics and knowledge/power (Foucault) are resisted in context in Uganda and Zambia.

Post-Development and Post-Colonial Perspective

  • Arturo Escobar is a highly influential scholar in post-development and post-colonial thought.
  • His book “Encountering Development: The Making and Unmaking of the Third World” (1995) is a landmark.
  • His main contribution is a radical critique of development as a Western project that perpetuates colonial power structures and imposes Eurocentric norms on the Global South.
Development as a Discourse
  • Escobar applies Foucault’s concept of discourse to argue that "development" isn't just a set of policies or aid programs—it's a system of knowledge and power that constructed the "Third World" as:
    • Poor
    • Underdeveloped
    • In need of Western intervention
  • This discourse:
    • Frames Western ways of life as the ideal.
    • Depicts other cultures as "lagging behind."
    • Justifies economic and political control under the guise of helping.
  • “The problem with development was not that it failed to deliver what it promised, but that it was the wrong promise to begin with.”

Homework - Key Concepts

  • Global Health

  • International Health

  • Colonial Medicine

  • Tropical Medicine

  • Missionary Medicine

  • Develop working definitions using today’s reading and internet research.

  • Email definitions to: h.h.j.lorist@luc.leidenuniv.nl by Thursday 16:00.

Group Work: Running your own Malaria NGO

  • Based on the historical lessons learned from the Greene et al Paper: What would your Western Funded NGO’s strategy be to eradicate Malaria in Ghana?
    • What is the name of your NGO?
    • Who is the CEO?
    • Who takes notes?
    • Who presents?