- The Colonial Politics of Global Health: France and the United Nations in Postwar Africa by Jessica Lynne Pearson
Pearson's new book The Colonial Politics of Global Health shows how the World Health Organization's origins and development in Africa and the politics of the postwar period of decolonization were intimately intertwined. Based on extensive use of diplomatic and institutional archival material from France, Senegal, and Geneva, Pearson paints a compelling portrait of how colonial priorities and fears shaped the early development of the WHO, including the location of the Africa Regional bureau in Brazzaville, the selection of health priorities (maternal and infant health, nutrition, and disease eradication campaigns), and, ultimately, limited the scope and effectiveness of the WHO's efforts in Africa during the 1950s. [End Page 308]
Why did the French (and other colonial powers) fear the WHO? With its authority to collect data on the health conditions of people in non-autonomous territory and "engage with populations that had no official voice at the UN" (p. 68), the WHO's presence potentially threatened to expose adverse conditions, undercut colonial authority, and stoke anticolonial agitation. France's response was to keep close watch on the WHO by successfully advocating for the location of the Africa Regional Office in Brazzaville, the capital of the AEF (Afrique Equatoriale Française), fostering closer ties with other colonial powers (especially Belgium and Portugal), and hosting conferences and supporting organizations that highlighted French medical expertise and achievements in the African colonies while excluding African voices. France's advocacy prevailed, most notably over Liberia—the only independent country in Africa, which proposed Monrovia as a location for the new Regional Office.
Despite French efforts to keep "'close surveillance' of all WHO activities in the region, with the goal of 'blocking its extension, within the constraints of our limited means'" (p. 104), the new leadership at the WHO Regional office described the shortcomings of Brazzaville as an unhealthy location and exposed French colonialism to widespread critique. French reactions to the negative reports were angry. As a 1949 internal French memo indicated, "We would like to note that all of our fears about the installation of the WHO in Africa have now been confirmed" (p. 89). As Pearson explains, the loss was not just to the French empire, but more critically to the WHO's ability to focus on health. While other WHO Regional Committees discussed screening technologies for tuberculosis or strategies for malaria elimination, the Regional Committee for Africa spent its time on petty decisions, such defending its decision to hire a Public Information Officer.
The structure of the new WHO offices indirectly supported anti-colonialism by aligning to geography rather than to imperial boundaries. WHO's different regional offices subdivided the overseas French territories, and reoriented the African territories towards each other rather than towards the metropoles, with the outspoken Liberian delegates as examples of an independent African country. In addition, by collecting worldwide data on the health and well-being of populations, the WHO provided a method for evaluating the success of colonial regimes and holding them accountable. Maternal and infant mortality data indicated much higher levels of mortality than in developed regions—and highlighted the adverse consequences of colonial rule. Despite the efforts of French-supported institutions such as the CIE (Centre international de l'enfance) to frame poor child health in French African territories as an inevitable problem of modernization and industrialization, critics such as Eugénie Eboué-Tell seized on these data to tell a story of hardship, social and economic inequality, and "psychological disequilibrium" imposed by colonialism (p. 129). She was one of the few Africans to attend a CIE conference. CIE's three-year courses on social pediatrics also reinforced the same message of "poor health outcomes and social instability as unfortunate but natural products of industrialization, urbanization, and economic development" (p. 140).
The tensions between colonial authorities and the WHO played out in the major health efforts of...