Disease and Social Diversity: The European Impact on the Health of Non-Europeans (review)

“In many ways this is a deeply personal book,” Stephen Kunitz tells us in the preface to Disease and Social Diversity (p. viii). The book resulted from his own rich experience of different cultures and societies, which began when he was appointed medical officer responsible for extramural community programs provided by the Indian Health Service hospital, serving both Navajo and Hopi Indians. He was subsequently drawn into social and epidemiological research, being most recently associated with the National Centre for Epidemiology and Population Health at the Australian National University. His medical background is clearly evident in his approach to the history of European impact on the health of non-Europeans, which is very different from the way a historian would have tackled the same subject. In undertaking a series of comparative studies, Kunitz aims to assess the importance of certain variables by setting up controls. He explains, “once disease ecology has been held roughly constant, one can see more clearly the ways in which colonial policy and political institutions have shaped the affairs of indigenous peoples. And once policy has been held constant, one can see more clearly how culture can make a difference. And once culture has been held constant, once can see how gender and status make a difference” (p. 177). For example, in chapter 3 he maintains that Polynesia, with its biological and cultural similarities, “lends itself to the method of controlled comparison, which is as close as the observational scientist can come to an experimental situation” (p. 44).

Kunitz reveals himself to be very well aware of the complexities of the societies and interactions he is studying. Nevertheless, there is a very real danger that by analyzing certain factors to the exclusion of others the end result is ahistorical. In the case of the Maori, he highlights the role of colonial policies in improving Maori health in the twentieth century, stressing the importance of the incorporation of Maori physicians into the fledgling Department of Health in the early twentieth century, and the social policies of the Labour Government of 1935–49. Yet the impact of these policies has been questioned recently by historians. This is not to say that social policies are not considered important to improving health status (Kunitz rightly points out that to deny the importance of medical interventions, as Thomas McKeown did, “provided legitimacy for those wishing to reduce the costs of care, which usually translates into reducing access to care for the poor” [pp. 182–83]). Rather, the focus on governmental policies undervalues the role played by other health initiatives, particularly by those of the Maori themselves. Kunitz’s heavy reliance on the demographer Ian Pool perhaps led him to underestimate the historical complexity in this instance.

Stephen Kunitz has tackled a large subject, and he makes many valuable points about “traditional” versus “modern” societies and the process of modernization, warning against a simplistic view that has been too prevalent in the past. Particularly enlightening, given the dearth of published material to date, is his chapter on Australian Aborigines in Queensland. His book is undoubtedly a valuable contribution to the historiography of medicine and colonization, and we can hope that it will lead to more detailed studies of the individual societies Kunitz discusses.