Global Histories of Health, Disease, and Medicine from a “Zig-zag” Perspective

Mark Harrison’s essay explores the relevance of global perspectives in writing histories of health, disease, and medicine (HDM). Harrison’s wide-ranging scholarship on colonial power, medicine, disease, and commerce makes him well poised to inquire into the place and potential of global histories of HDM.¹ His broad premise is that “global” historical perspectives offer opportunities to map interconnected networks of health and disease that are not constrained by the boundaries of the nation-state and its geopolitics and can yield an interpretative synthesis that could illuminate “the central problems of our field” (p. 687). Even as he concedes that the “global” in histories of HDM is often elusive to define, his own characterization and understanding of a global approach or “scale” is mostly as a long-distance history of networks of “peoples and places” beginning chronologically with European colonialism, conquest, networks of trade and military engagements, and the related mobility of pathogens and disease.

As is inevitable in a sweeping survey of historical scholarship and discussion of the global dimensions to histories of HDM, there are some gaps in Harrison’s account. I mention this as a starting point to my comments because some of these aspects may have offered a different set of conceptual and methodological perspectives. Harrison organizes his overview under sections on medicine, disease, health, and global configurations. His account begins with an exploration of the diverse origins of the making of Western medical knowledge beyond the West and the traffic and flows of pathogens, goods, and plants as “localities … were drawn into a global web” (p. 654). He unfolds a complex analysis of HDM in its early and late colonial context in particular, and explores the “global” in terms of intertwined encounters between Western medicine and other medical cultures, such as Ayurveda, Tibb, and Chinese medicine that often made “a virtue of locality” (p. 663).

This article, however, mainly emphasizes flows between the West and the rest. It neglects alternate “scales” such as regional circuits of knowledge and exchange that often circumvented geopolitical dichotomies, and even resisted and complicated “global” encounters. The emphasis on goods, people, and places by Harrison also leads to underestimating histories of ideas, intellectual exchanges, and the “geographies of power” and boundaries that underlie global histories of HDM.² I refer partly to continuities of colonial and postcolonial ideologies that have shaped and also limited current global health configurations. And also to the significance of postcolonial alignments and visions, that were characterized by an understanding of modernization that was not always in tandem with “Western” models and norms regarding disease, medicine, and technology. I shall elaborate upon these arguments through a discussion of some aspects of “postcolonial” histories of HDM.³

No doubt, Harrison’s discussion is limited by what has been published so far in this field. This results mostly in a narrative of actors, institutions, and interventions “from above,” such as medicine and disease campaigns after World War II that were inspired by large international institutions ranging from the League of Nations to the United Nations, global disease eradication campaigns, and Cold War rivalry. These years, however, were also marked by more complex ideological and medical interactions between and within decolonized regions that allow us to decenter a West-rest dialectic of HDM and to look beyond the exigencies of U.S.-Soviet-dominated Cold War alignments alone.⁴ Collaborative medical research between Asia and Africa or Latin America and technology exchanges were increasingly prominent, as were migrations of health and medical diaspora between ex-colonies in Southeast Asia and exchanges of medical technology mediated by smaller donor countries and local philanthropy.⁵ This also poses an inevitable question, namely, if international institutions, U.S.-led philanthropies or aid programs and global infectious disease programs are indeed the most significant and complete representations of HDM in the decades of decolonization. What about ideologies, diseases, and populations that did not fit or embody this “master narrative” of modernity or deviated from it?

To illustrate some of these regional flows, I shall draw upon some of my ongoing...