The Lasting Legacy of Colonialism on Healthcare Structures
Photo by Subhash Nusetti on Unsplash
Photo par Subhash Nusetti sur Unsplash
Keshan Ramdeo
(FR) L'article suivant fournit une analyse approfondie des raisons pour lesquelles certaines nations post-coloniales ont un système de santé durable et efficace tandis que d'autres possèdent un système catastrophique. Les systèmes de santé sont analysés et classés grâce à l'indice de qualité des soins de santé et de l'accès qui évalue le système de santé d'un pays à travers ses performances par rapport aux 32 causes évitables les plus courantes de décès prématuré. À travers une lentille post-coloniale, l'article identifie et examine de nombreuses raisons liées à la fois aux périodes coloniale et post-coloniale expliquant pourquoi les pays développés ont de meilleurs systèmes que les pays en développement et sous-développés. En outre, l'article présente les prochaines étapes pour assurer le développement de tous les systèmes de santé dans le monde.
Background
Throughout modern history, colonialism has played a significant role in the establishment and development of many current nations. Over one hundred current nations have been colonized by a vast array of empires. Systems of colonialism allowed the ruling powers to establish an industrial hub in the colonies where they could accumulate great wealth, often at the expense of the local inhabitants. During such times, the colonial governing bodies established health systems aimed at maintaining the health quality and well-being of its subjects. Nevertheless, after the emergence of independence movements at the conclusion of the world wars, these newly independent nations were left with the task of maintaining their own healthcare systems and addressing public health issues with the systems and practices which were implemented by the former colonial powers.
Healthcare & Access Quality Index
The current state of post-colonial healthcare systems varies to certain degrees. Developed nations such as Australia, Canada, Ireland, and New Zealand all rank in the top 20 on the healthcare and access quality index created in 2016. These four nations all rank higher than their colonizing/administrative power the United Kingdom, which lies just outside of the top 20 at 23rd place. The healthcare and access quality index focuses on the log transformation of age/risk standardized death rates of the 32 most common preventable death causes and assesses a score out of 100 to rank the given nation on its performance (Fullman et al 2018). Many former countries of the Spanish colonial empire are ranked in the middle as average nations, while nearly all the African nations which were formerly colonized have the worst performing healthcare systems.
Analysis of Rankings
Top-ranking healthcare systems in former colonies like Australia, Canada, Ireland, and New Zealand are a result of the state of the nation after independence from the United Kingdom. All these nations had some sort of parliamentary governing system in place during the colonial period that transitioned to the new governing system which oversaw open debates and voting on healthcare bills and health practices which were enacted into law (McEwan 2009). In addition, such nations have experienced numerous healthcare system reforms and have shifted away from focusing on communicable disease to non-communicable disease (McKeown 2009). Former Spanish colonies such as those in South and Central America have also shifted away from non-communicable disease and are now strengthening their institutions to better accommodate those suffering from communicable diseases. Finally, former colonies in Africa continue to suffer from health issues related to non-communicable diseases, the most impacted being the former French colonies in Sub-Saharan Africa which consistently rank the lowest in nearly all healthcare categories.
Colonial & Post-Colonial Influences
Issues rooted in colonialism and post-colonialism which explain why some former colonies are doing better than others can be seen throughout the Industrial Revolution and the Cold War era. The Industrial Revolution oversaw a widespread period of growth and productivity in wealthy colonies such as Australia and Canada, which shifted the economies of such nations from resource-intensive to that of economically stable industrial powers. This coupled with effective self-governing greatly improved the economic stability of such nations, which in turn benefitted their healthcare systems prior to the First World War. Countries with average healthcare systems, such as those in Central and Latin America, did not experience a widespread industrial revolution. Instead, such nations underwent numerous social reforms and various political movements, which were often marred by widespread corruption, but nevertheless led to a shift from majority communicable to majority non-communicable disease (McEwan 2009). African nations experienced the slowest growth as they were considered colonial possessions well into the 1960’s, and often had their valuable resources stripped by their overseeing colonial power. Healthcare systems in post-independence nations were also not very effective due to widespread corruption, conflicts, and inefficient planning.
Next Steps
It can be rather easy for healthcare practitioners and policy makers to provide suggestions and next steps such as SDGs for nations with underdeveloped healthcare systems to improve in the coming years. But the main issue which has yet to be addressed by the world is the role in which colonialism continues to play in the healthcare systems of formerly-colonized nations. The legacy of colonialism plagues such countries to this day and prevents any real progress from being made. Until such accountability and reconciliation are taken, true progress will never be made.
Keshan Ramdeo, HBSc, is a graduate from the University of Toronto, where he majored in Human Biology and Health Studies. He has previously interned at the IHPME at Dalla Lana school of public health and is currently a mobile lab assistant at LifeLabs.