1-20 of 37 Results

  • Keywords: global health x
Clear all

Article

Kelley Lee and Julia Smith

Patterns of health and disease have been relevant to international studies for as long as human populations have migrated across large territorial spaces. After World War II, international health cooperation was accepted as a key function of the newly established United Nations system, with the creation of the World Health Organization (WHO) as the UN specialized agency for health alongside other UN bodies. However, social science scholarship paid little attention to the perceived technical field of health, and thus international health organizations, until the 1970s. The limited scholarship produced during the postwar period was largely by those engaged with international health organizations and was primarily descriptive of technical and legal issues. It was not until debates emerged about the role and effectiveness of WHO, beginning in the 1980s, that scholars began considering the politics of international health cooperation. The adoption of the Declaration of Alma Ata, List of Essential Drugs, and International Code of Marketing of Breast-Milk Substitutes spurred debates about the “politicization” of WHO’s technical mandate. Public health practitioners and social historians contributed reflections on how structural inequalities shape health outcomes, and international organization scholarship introduced critical theoretical approaches to the study of health institutions. Scholars began to locate patterns of health and disease within the broader international political economy. The subsequent proliferation of new institutional arrangements for collective action on health issues, involving both state and non-state actors, generated studies of the distribution of power and responsibilities in an increasingly complex institutional landscape. This led to the concept of global health governance (GHG), with health becoming located within globalization processes, encouraging scholarly links across international relations, social policy, law, and anthropology. A wider range of international organizations, with health-related impacts, were incorporated into GHG scholarship. Concurrently, new theoretical approaches to understanding collective action for global health emerge, notably realist notions of global health security and critical approaches to the construction of GHG. The study of international organization and health since the mid-2000s has focused intense attention on the reform or creation of new institutional arrangements amid major global health crises, acute health inequities, and shared risks. This increasingly rich literature has been informed by diverse normative perspectives.

Article

Throughout history, knowledge and practices on the health of populations have had different names: medical police, public health, social medicine, community health, and preventive medicine. To what extent is the Brazilian collective health, established in the 1970s, identified with and differentiated from these diverse movements that preceded it? The analysis of the socio-genesis of a social field allows us to identify the historical conditions that made possible both theoretical formulations and the achievement of technical and social practices. Collective health, a product of transformations within the medical field, constituted a rupture in relation to preventive medicine and public health and hygiene, being part of a social medicine movement in Latin America that, in turn, had identification with European social medicine in the 19th century. Focused on the development of a social theory of health that would support the process of sanitary reform, collective health has been built as a space involving several fields: scientific, bureaucratic, and political. Thus, it brought together health professionals and social scientists from universities, health care services, and social movements. Its scientific subfield has developed, and the sanitary reform project has had several successes related to the organization of a unified health system, which has ensured universal coverage for the population in Brazil. It has incorporated into and dialogued with several reformist movements in international public health, such as health promotion and the pursuit of health equity. Its small relative autonomy stems from subordination to other dominant fields and its dependence on the state and governments. However, its consolidation corresponded to the strengthening of a pole focused on the collective and universal interest, where health is not understood as a commodity, but as a right of citizenship.

Article

Michele Eggers-Barison and Lalit Khandare

Global health has been gradually gaining more traction in social work education. Global health addresses prevalent health vulnerabilities and collective responsibilities that transcend national borders. Global health is a multidimensional issue, which elicits an interdisciplinary multidimensional response. Various disciplines are in search of definitions, theoretical frameworks, and practice methodologies, including the development of competencies to meet global health needs. The need for social workers to critically engage in health inequities within social, cultural, economic, and political contexts globally is essential to bring effective change in the lives of those most marginalized and impacted by global health inequities. Social work is well positioned to address these needs through international social work practice and professional global standards to advocate for just policies and practice and to enhance equity and inclusiveness to promote social justice and human rights.

Article

The end of the Cold War brought far-reaching world changes in many areas, including the health field. A number of “new” terms emerged (such as global health, global governance, and global health governance or global governance for health), among them global health diplomacy (or health diplomacy). There is no single, consensual definition of this term, and still less are there theoretical and analytical frameworks or empirical data to help understand its meaning and practice more clearly. Global health diplomacy is a sociopolitical practice involving the global health policy community, which promotes the interrelationship between health and foreign policy both at the national level, through cooperation projects or international actions and, in international arenas, by acting in global political space in the widest range of spheres, whether health-sector-related or otherwise.

Article

Ravi Narayan, Claudio Schuftan, Brendan Donegan, Thelma Narayan, and Rajeev B. R.

The People’s Health Movement (PHM) is a vibrant global network bringing together grass-roots health activists, public interest civil society organizations, issue-based networks, academic institutions, and individuals from around the world, particularly the Global South. Since its inception in 2000, the PHM has played a significant role in revitalizing Health for All (HFA) initiatives, as well as addressing the underlying social and political determinants of health with a social justice perspective, at global, national, and local levels. The PHM is part of a global social movement—the movement for health. For more than a century, people across the world have been expressing doubts about a narrowly medical vision of health care, and calling for focus on the links between poor health and social injustice, oppression, exploitation, and domination. The PHM grew out of engagement with the World Health Organization by a number of existing civil society networks and associations. Having recognized the need for a larger coalition, representatives of eight networks and institutions formed an international organizing committee to facilitate the first global People’s Health Assembly in Savar, Bangladesh, in the year 2000. The eight groups were the International People’s Health Council, Consumer International, Health Action International, the Third World Network, the Asian Community Health Action Network, the Women’s Global Network for Reproductive Rights, the Dag Hammarskjold Foundation and Gonoshasthaya Kendra. All these groups consistently raised and opposed the selectivization and verticalization of Primary Health Care (PHC) that followed Alma Ata leading to what was called Selective PHC (i.e., not the original comprehensive PHC). These groups came together to organize the committee for the first People’s Health Assembly and then to form the Charter Committee that led to the People’s Health Charter, which finally led to the actual PHM. Within PHM, members engage critically and constructively in health initiatives, health policy critique, and formulation, thus advancing people’s demands. The PHM builds capacities of community activists to participate in monitoring health-related policies, the governance of health systems, and keeping comprehensive PHC as a central strategy in world debate. The PHM ensures that people’s voices become part of decision-making processes. The PHM has an evolving presence in over 80 countries worldwide, consisting of groups of individuals and/or well-established PHM circles with their own governance and information-sharing mechanisms. It additionally operates through issue-based circles across countries.

Article

Rebecca Katz, Erin Sorrell, and Claire Standley

The last 30 years have seen the global consequences of newly emerging and re-emerging infectious diseases, starting with the international spread of HIV/AIDS, the emergence of Ebola and other hemorrhagic fevers, SARS, MERS, novel influenza viruses, and most recently, the global spread of Zika. The impact of tuberculosis, malaria, and neglected tropical diseases on society are now better understood, including how these diseases influence the social, economic, and political environment in a nation. Despite international treaties and norms, the specter of intentional use of infectious disease remains present, particularly as technological barriers to access are reduced. The reality is that infectious diseases not only impact population health, but also have clear consequences for international security and foreign policy. Foreign policy has been used to coordinate response to infectious disease events and to advance population health around the world. Conversely, collaboration on infectious disease prevention, preparedness, and response has been used strategically by nations to advance diplomacy and improve foreign relations. Both approaches have become integral to foreign policy, and this chapter provides examples to elucidate how health and foreign policy have become intertwined and used with different levels of effectiveness by governments around the world. As the scope of this topic is extensive, this article primarily draws from U.S. examples for brevity’s sake, while acknowledging the truly global nature of the dynamic between infectious diseases and foreign policy, and noting that the interplay between them will vary between countries and regions. In 2014, U.S. President Barak Obama called upon global partners to, “change our mindsets and start thinking about biological threats as the security threats that they are—in addition to being humanitarian threats and economic threats. We have to bring the same level of commitment and focus to these challenges as we do when meeting around more traditional security issues”. With world leaders increasingly identifying disease as threats to security and economic stability, we are observing infectious diseases—like no other time in history—becoming an integral component of foreign policy.

Article

Marie Thoma, Jasmine Fledderjohann, Carie Cox, and Rudolph Kantum Adageba

Infertility remains a neglected area in sexual and reproductive health, yet its consequences are staggering. Infertility is estimated to impact about 10–25% (estimates range from 48 to 180 million) of couples of reproductive age worldwide. It is associated with adverse physical and mental health outcomes, financial distress, severe social stigma, increased risk of domestic abuse, and marital instability. Although men and women are equally likely to be infertile, women often bear the societal burden of infertility, particularly in societies where a woman’s identity and social value are closely tied to her ability to bear children. Despite these consequences, disparities in access to infertility treatment between low- and high-income populations persist given the high cost and limited geographic availability of diagnostic services and assisted reproductive technologies. In addition, a considerable proportion of infertility is a result of preventable factors, such as smoking, sexually transmitted infections, pregnancy-related infection or unsafe abortion, and environmental contaminants. Accordingly, programs that address the equitable prevention and treatment of infertility are not only in keeping with a reproductive rights perspective but can also improve public health. However, progress on infertility as a global concern in the field of sexual and reproductive health and rights is stymied by challenges in understanding the global epidemiology of infertility, including its causes and determinants, barriers to accessing quality fertility care, and a lack of political will and attention to this issue. The tracking and measurement of infertility are highly complex, resulting in considerable ambiguity about its prevalence and stratification in reproduction globally. A renewed global focus on infertility epidemiology, risk factors, and access to and receipt of quality of care will support individuals in trying to reach their desired number and spacing of children and improve overall health and well-being.

Article

Linda Dahlberg, Alexander Butchart, James Mercy, and Thomas Simon

An important function of public health is to prevent injuries or to lessen their impact when they occur. An estimated 251,000 people worldwide die each year from a firearm-related death and many more suffer nonfatal injuries with consequences that can last a lifetime. Firearm injuries, which include those that are intentionally self-inflicted, unintentional, or from an act of interpersonal violence, are heavily concentrated in the Americas, driven largely by firearm homicides. Firearm-related deaths and injuries disproportionately impact males and younger populations and are associated with factors such as access, substance use, adverse childhood experiences, involvement in high-risk social networks, drug trafficking, density of alcohol outlets, and neighborhood and social disadvantage. While progress is being made to understand firearm injuries and how to effectively prevent them, much more needs to be done to improve the availability and timeliness of data; apply the knowledge that is generated to effectively reduce firearm-related injuries, deaths, and costs; strengthen the scientific infrastructure; and move countries closer to achieving the violence-related targets in the 2030 Sustainable Development Goals.

Article

Jessica Euna Lee

Within its 150-year history, public health has grown from a focus on local communities to include countrywide, then international, and now global perspectives. Drawing upon the United Nations Sustainable Development Goals, this article provides an overview of global public health within the broadest possible context of the world and all of its peoples. Also provided are the global burden of disease as measured in disability-adjusted life years, global health statistics, current health priorities, and recommendations for action by social workers and other health professionals.

Article

The COVID-19 crisis—the most catastrophic international public health emergency since the Spanish influenza 100 years ago—provides impetus to review the significance of public and global health in the context of Sustainable Development Goal (SDG) achievement. When countries unanimously adopted the 17 SDGs in September 2015, stakeholders had mixed views on global health goal SDG 3 (Good Health and Well-Being). Concern arose over the feasibility of achieving SDG 3 by 2030 when countries pursued its nine targets and four means of implementation with sixteen other ambitious global goals. Nonetheless, health surely cuts across the SDG framework: for instance, the underlying health determinants are expressed in many goals as is urban and planetary health. Although health (and its different constructions) is central to overall SDG achievement, SDG success depends on a paradigm shift toward whole-of-government policy and planning. Indeed, the 2030 Agenda echoes calls for a Health in All Policies (HiAP) approach to public health programming. This depends on another paradigm shift in public health tertiary education, practitioner training, and policy skills development within and beyond ministries of health. Added to this are the underlying problematics around SDG health financing, human resources for health, health target and indicator localization for equitable country responses that leave no one behind, strengthening civil registration and vital statistics systems for inclusive and accountable health implementation, and the sidelining of human rights from SDG metrics. While COVID-19 has derailed SDG efforts, it could also be the ultimate game changer for intergenerational human and environmental health transformation. Yet strong global health governance and rights-based approaches remain key.

Article

Since the mid-20 century, corporations have gained increasing political and economic power to shape the living conditions, lifestyles, governance processes, and environmental exposures that determine global patterns of health and disease. Globalization, the growth of the financial sector, deregulation, and increasing corporate control of science and technology have provided corporations with new power to influence the mechanisms that determine human and planetary health. A growing body of public health and social science scholarship analyzes how corporate use of this economic and political power has become a fundamental determinant of the most serious health crises facing the world. In response, governments, civil society groups and social movements have developed new strategies to challenge corporate power to shape global health governance, protect public health, and reduce health inequities.

Article

Richard Smith and Johanna Hanefeld

Global trade—the movement of goods, services, people, and capital between countries—is at the center of modern globalization. Since the late 20th century trade has also become established as a critical determinant of public health. As the raison d’être of trade is to increase both wealth and the availability of goods and services, changing trade patterns will inevitably impact many of the known determinants of health, including employment, nutrition, environmental factors, social capital, and education. Trade will also impact the health sector itself, most clearly through direct trade in health-related goods and services (such as pharmaceuticals, health workers, foreign direct investment in health services, and mobile patients), but also more broadly in determining tax receipts and thus overall public expenditures. It is also the case that trade—especially rapid and widespread movement of people, animals, and goods—may facilitate the rapid and widespread spread of disease. Trade, and associated policies governing and responding to that trade, has thus become increasingly recognized as a critical driver of health issues. The design of trade policies that reduce the potential health risks associated with freer trade while maximizing the positive impact of trade liberalization on the social determinants of health is still in its infancy. There remains a lack of sound empirical evidence demonstrating how trade liberalization links directly and indirectly to health. Even though the positive link between increased trade, poverty reduction, and economic growth is widely accepted, evidence regarding the impact of trade liberalization on the social determinants of health varies from one national context to another. Hence, adapting trade liberalization to national conditions is important in ensuring desired outcomes. Yet although evidence is necessary, it is not sufficient to ensure that health is more integrated in trade negotiations and decision-making. There is a substantive requirement for those with a health remit to engage in negotiation with those from other sectors and from other geographic locations.

Article

Doug Henry and Lisa Henry

This article details the contributions of applied anthropology to public health, focusing on complementary and divergent interests, orientations, and methods. We emphasize areas where productive collaborations have occurred around convergent topics such as infectious and chronic disease, policy, interventions, and analysis of the social, political, and economic contexts that structure the conditions of health. Public health’s emphasis on community and advocacy provides a natural entry point for anthropology’s ethnographic method that emphasizes spending time with a community and understanding aspects of culture and health from its peoples’ perspectives. When a multidisciplinary team meets on a common interest, such as improving public health, everyone’s interests become better served if each discipline’s perspectives and values are recognized. Anthropologists with careers in public health can expect to engage in formative research to help develop the most appropriate health interventions, evaluate community uptake or rejection of public health initiatives, or critically examine the effects of national or global policies on local populations.

Article

José Gomes Temporão and Carlos Augusto Grabois Gadelha

The health economic-industrial complex concept was developed in Brazil in the early 2000s, integrating a structuralist view of the political economy with a public health vision. This perspective advances, in relation to sectoral approaches in health industries and services, toward a systemic approach to the productive environment, focusing on the dimensions of innovation and universal access to health. Health production is seen in an interdependent way, recognizing that the different industrial and service sectors have strong articulations that need to be integrated. The shift toward a universal care model that focuses on human and social needs requires a productive knowledge base that favors promotion, prevention, and local and permanent healthcare, requiring new productive patterns of goods and services and innovation. Therefore, these dimensions are not conceptually apart from each other, considering an analytical and political point of view. The production, care, and sustainability of universal health systems are understood in an integrated and systemic way. Within this vision, a cognitive leap is presented in relation to the traditional health economics, linked to the allocation of scarce resources, to a vision of health political economy that favors the development, expansion, and transformation of the health system and its economic and industrial base. Health is conceived as a moral right of citizenship and a vital space for the development of countries (and for global health), generating social inclusion, equity, innovation, and a possibility for the cooperation between countries and peoples. The Brazilian experience is an exemplary case of association between the development of theoretical conception and its implementation in the national health policy that led to the link between economic development policies and social policies. It was possible to advance both conceptually in terms of a vision of health and social well-being and in contributing to a new paradigm of public policies. This perspective allowed the guidance of guide industrial development and services toward the human needs and universal health systems, considering the challenges brought by the context of an ongoing fourth technological revolution.

Article

Juan Garay, David Chiriboga, Nefer Kelley, and Adam Garay

There is one common health objective among all nations, as stated in the constitution of the World Health Organization in 1947: progress towards the best feasible level of health for all people. This goal captures the concept of health equity: fair distribution of unequal health. However, 70 years later, this common global objective has never been measured. Most of the available literature focuses on measuring health inequalities, not inequities, and compare health indicators (mainly access to health services) among population subgroups. A method is hereby proposed to identify standards for the best feasible levels of health through criteria of healthy, replicable, and sustainable (HRS) models. Once the HRS model countries were identified, adjusted mortality rates were applied to age- and sex-specific populations from 1950 to 2015, by calculating the net difference between the observed and expected mortality, using the HRS countries as the standard. This difference in mortality represents the net burden of health inequity (NBHiE), measured in avoidable deaths. This burden is due to global health inequity, that is, unfair inequality, due to social injustice. We then calculated the relative burden of health inequity (RBHiE), which is the proportion of NBHiE compared with all deaths. The analysis identified some 17 million avoidable deaths annually, representing around one-third of all deaths during the 2010–2015 period. This avoidable death toll (NBHiE) and proportion (RBHiE) have not changed much since the 1970s. Younger age groups and women are affected the most. When data were analyzed using smaller sample units (such as provinces, states, counties, or municipalities) in some countries, the sensitivity was increased and could detect higher levels of burden of health inequity. Most of the burden of health inequity takes place in countries with levels of income per capita below the average of the HRS countries, which we call the “dignity threshold.” Based on this threshold, a distribution of the world’s resources compatible with the universal right to health—the “equity curve”—is estimated. The equity curve would hypothetically be between this dignity threshold and a symmetric upper threshold around the world’s average per capita GDP. Such excess income prevents equitable distribution is correlated with a carbon footprint leading to >1.5º global warming (thus undermining the health of coming generations), and does not translate to better health or well-being. This upper threshold is defined as the “excess accumulation threshold.” The international redistribution required to enable all nations to have at least an average per capita income above the dignity threshold would be around 8% of the global GDP, much higher than the present levels of international cooperation. At subnational levels, the burden of health inequity can be the most sensitive barometer of socioeconomic justice between territories and their populations, informing and directing fiscal and territorial equity schemes and enabling all people within and between nations to enjoy the universal right to health. HRS models can also inspire lifestyles, and political and economic frameworks of ethical well-being, without undermining the rights of others in present and future generations.

Article

Peter McIntyre and Tony Walls

From the first vaccine (cowpox, developed by Edward Jenner in 1796), more than 100 years elapsed before additional vaccines for broad population use (diphtheria toxoid, tetanus toxoid, and whole cell pertussis) became available between 1920 and 1940. Then followed inactivated polio vaccine in the 1950s, and live attenuated vaccines for measles, mumps, rubella, and polio in the 1960s. In 1979, global elimination of smallpox was formally certified, with the last human case occurring in Somalia, almost 200 years after Jenner administered cowpox vaccine to James Phipps. In 2019, global elimination is tantalizingly close for maternal and neonatal tetanus and polio. Despite recent outbreaks, elimination has also been achieved at country and regional levels for measles and rubella and, if achieved globally, will offer, as it has for smallpox, large reductions in child mortality and morbidity and in health system costs. Short of elimination, it is important to define the public health impact of vaccines broadly and at the population level. These broader impacts include benefits to families flowing from prevention of long-term sequelae of infection in children, and to populations and health systems from reduced transmission of infection. Importantly, well-delivered vaccination programs will have a substantial impact by improving equality in health outcomes across populations. Broader impacts include reductions in syndromic disease beyond laboratory-proven infection (e.g., diarrhea and pneumonia), indirect reductions in disease in those not immunized (within and beyond age cohorts targeted by vaccine programs), and improvements in other health services driven by the infrastructure for vaccine delivery. Measurement of these broader impacts can be challenging and must also acknowledge the potential for trade-offs, such as replacement disease due to non-vaccine strains, as documented for pneumococcal infection. The realization of the benefits of vaccines globally for all children began with the Expanded Program on Immunization (EPI) initiated by the World Health Organization (WHO) in 1974. The EPI focused on improving coverage of six already available but grossly underutilized vaccines—diphtheria–tetanus–pertussis (DTP), polio, measles, and Bacille Calmette–Guerin (BCG). Through the EPI, estimated global coverage for 3 doses of DTP increased from around 20% to over 85%. Subsequent to the EPI, the Global Alliance for Vaccines and Immunization (GAVI), the Global Immunization Vision and Strategy (GIVS), and, most recently, the Global Vaccine Action Plan (GVAP) have aimed to improve access to additional vaccines in the poorest countries. These include Haemophilus influenzae type b (Hib), hepatitis B, pneumococcal conjugate, rotavirus, and human papillomavirus (HPV) vaccines, all introduced in high-income countries from the 1990s. In this chapter, the scope and methodological issues in measuring public health impact are reviewed, and estimates of the global public health impact of individual vaccines in children summarized, concluding with potential future benefits to global child health from expanded maternal vaccination and vaccines under development.

Article

For the first half century of industrial, work, and organizational psychology’s (IWOP’s) existence, the role of culture has been ambiguous at best. Attention to culture in IWOP started to take form in the 1970s, and in the last 20 years culture has begun to be integrated into IWOP research more generally. This integration has led to explorations of culture in the workplace far beyond the initial focus on organizational management theories and practices to looking at cultures’ relationships with all aspects of organizational and employee experiences. Most cross-cultural studies in IWOP research clearly show the importance of understanding societal culture’s impact on organizations, institutions, work, and workers. Merely transferring existing theories and practices of IWOP to new contexts without a clear understanding of whether those theories and practices make sense across cultures is unlikely to be successful. Through globalization and the multiculturalization of workforces, employees are increasingly interacting with people of varying cultural backgrounds on a far more regular basis than in the past. This change has spurred attention to how culture has impacted theories, research, and practices in some key IWOP theoretical domains, including leadership; occupational safety, stress, and health; precarious and decent work; trust and trustworthiness; and diversity, equity, and inclusion in the multinational organization.

Article

Maria Helena Machado, Renato Penha de Oliveira Santos, Pedro Miguel dos Santos Neto, Vanessa Gabrielle Diniz Santana, and Francisco Eduardo de Campos

The greatest challenge in the development of universal health systems worldwide is to increase organization, training, and regulation of the health workforce (HWF). To accomplish this, the World Health Organization (WHO) has pointed out several strategies utilized since the beginning of the 2000s. One of the world regions with the greatest internal HWF disparities is the Americas, more specifically Latin America and the Caribbean. Brazil is another of the countries in this region that presents great inequities in its HWF distribution, although its Unified Health System (Sistema Único de Saúde, or SUS), created after 1988, is one of the largest universal health systems in the world. It is worth noting that Latin America, the Caribbean, and Brazil historically have high levels of social inequality and have recently become regions severely affected by the COVID-19 pandemic. Despite some advances in the formation and distribution of HWF in Latin America and the Caribbean in the last 10 years, structural problems persist in the health systems of several countries in this region, such as Brazil. The COVID-19 pandemic aggravated some problems such as the distribution of specialized health workers in intensive care units and the precarious working conditions in several public health services that were organized to face the pandemic.

Article

Mohan Jyoti Dutta

Amid the large scale inequalities in health outcomes witnessed globally, communication plays a key role in reifying and in offering transformative spaces for challenging these inequities. Communicative processes are integral to the globalization of capital, constituting the economic conditions globally that fundamentally threaten human health and wellbeing. The dominant approach to global health communication, situated within the global capitalist logics of privatization and profiteering, deploys a culturally targeted and culturally sensitive framework for addressing individual behavior. The privatization of health as a commodity creates new market opportunities for global capital. The extraction of raw materials, exploitation of labor, and the reproduction of commoditization emerge on the global arena as the sites for reproducing and circulating health vulnerabilities. By contrast, the culture-centered approach to global health foregrounds the co-creative work of building communicative infrastructures that emerge as sites for resisting the neoliberal transformation of health care. Through processes of grassroots democratic participation and ownership over communicative resources, culture-centered interventions create anchors for community-level interventions that seek to transform unhealthy structures. A wide array of social movements, activist interventions, and advocacy projects emerging from the global margins re-interpret the fundamental meanings of health to create alternative structures for imagining health.

Article

Disease control and public health have been key aspects of social and political life in sub-Saharan Africa since time immemorial. With variations across space and time, many societies viewed disease as the result of imbalances in persons and societies and combined the use of materia medica from the natural world, spiritual divination, and community healing to redress these imbalances. While early encounters between African and European healing systems were still marked by mutual exchanges and adaptations, the emergence of European germ theory-based biomedicine and the establishment of racialized colonial states in the 19th century increasingly challenged the value of African therapeutic practices for disease control on the continent. Initially, colonial states focused on preserving the health of European soldiers, administrators, and settlers, who were deemed particularly vulnerable to tropical climate and its diseases. Around 1900, however, they started paying more attention to diseases among Africans, whose health and population growth were now deemed crucial for economic development and the legitimacy of colonial rule. Fueled by new insights and techniques provided by tropical medicine, antisleeping sickness campaigns would be among the first major interventions. After World War I, colonial health services expanded their campaigns against epidemic diseases, but also engaged with broader public health approaches that addressed reproductive problems and the social determinants of both disease and health. Colonial states were not the only providers of biomedical healthcare in colonial Africa. Missionary societies and private companies had their own health services, with particular logics, methods, and focuses. And after 1945, international organizations such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) increasingly invested in health campaigns in Africa as well. Moreover, Africans actively participated in colonial disease control, most notably as nurses, midwives, and doctors. Nevertheless, Western biomedicine never gained hegemony in colonial Africa. Many Africans tried to avoid or minimize participation in certain campaigns or continued to utilize the services of local healers and diviners, often in combination with particular biomedical approaches. To what extent colonial disease control impacted on disease incidence and demography is still controversially debated.