Public Health, Social Medicine and Disease Control: Medical Services, Maternal Care and Sexually Transmitted Diseases in Former Portuguese West Africa (1920–63)

• Published in: Medical history Vol. 62; no. 4; pp. 485 - 506
• Main Author: Havik, Philip J.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.10.2018
• Subjects: Africa, Western; Disease control; Economic policy; Epidemiology; Female; Health services; History, 20th Century; Humans; Maternal & child health; Maternal Health Services - history; Medicine; Nutrition; Pregnancy; Public health; Public Health - history; Sexually transmitted diseases; Sexually Transmitted Diseases - history; Sexually Transmitted Diseases - prevention & control; Social Medicine - history; STD; Africa, Western; West Africa
• ISSN: 0025-7273; 2048-8343
• DOI: 10.1017/mdh.2018.44

[...]the notion of social hygiene, which was to develop into an ill-defined concept of social medicine, would leave its mark on public health programmes in the interwar period. 1 After 1945, as the World Health Organization (WHO) redefined the relationship between public health, disease control and social medicine, Cold War politics would, however, obfuscate social determinants in favour of a more epidemiological approach. 2 Although it largely remained an ‘elusive concept’, social medicine’s basic tenets were associated with a multidisciplinary focus on the social determinants of health in order to counter health inequalities and inform policy, medical practice and research. 3 Its historical roots go back to mid-nineteenth century ideas on medicine as a social science put forward by in Germany and France by Virchow, Neumann, Leubuscher and Guérin. 4 Over time, the concept would shift from an emphasis on socio-economic policy reform towards an evidence-based perspective on the correlations between hygiene, health, illness, nutrition, education and housing. [...]it occupied a transitional field covering public and community health, while manifesting a tension between the dimensions of illness and holistic focus on the person. 5 The development of social medicine in different political contexts, for example in Europe, North America and Latin America in the 1930s and 1940s, also had an – albeit limited – impact in Africa from the 1940s onwards. 6 In the interwar years, some national governments and international organisations such as the League of Nations Health Organization and the Rockefeller Foundation’s Health Division were to embrace the notion, which remained strongly associated with the idea of prevention. 7 As the fields of bacteriology and epidemiology developed and new methods were introduced towards disease control and eradication of endemic diseases, tropical regions under colonial control were transformed into ‘living laboratories’ in search of new scientific tools and ‘magic bullets’. [...]they would have significant implications for public health and epidemiology, and in particular for policies regarding maternal health and STDs. [...]maternal/child health and STDs would bring services into the intimate, private sphere while being obliged to increase their effective coverage and improve outcomes, above all for rural populations. 20 Different threads have been identified with regard to the historiography of maternity in Africa, ie. marriage, education and midwifery on the one hand, 21 and issues such as contagion, African (female) sexuality and moral order in the case of STDs on the other. 22 From ‘colonizing the womb’ to ‘making mothers’, and ‘sexual control’ to ‘moral policing’, the literature has largely centred on official narratives with regard to sanitising, modernising and civilising society. An excessive focus on urban centres had left African communities in the interior practically bereft of medical assistance. [...]the native’ needed to be targeted with mobile services, while medical staff was expected to act both as clinical and social agents. 101 PG would follow developments in Angola, albeit with some delay.