Post Colonial Developments and Health

Post-colonial development met and continues to meet the challenges of high fertility and mortality rates, health environmental issues, poverty and its impact on segments of post-colonial populations, acute respiratory infections, diarrheal diseases, vaccine-preventable infectious diseases, malaria, and other tropical vector-borne diseases. In fact, the persistence of these health issues is considered the bio-historical facts of under-development that are also the targets of development. Any positive changes in these and other health measures of progress brought about by development signal successful movement toward takeoff. Post-colonial governments, along with a wide variety of other governments, international aid agencies, and non-governmental organizations have targeted the health and demographic measures of progress for which Europe and the United States provide the gold standards in terms of achieving their pinnacle stage of development.

The health profiles of developing countries bore out in demographic profiles are based on national census data collected by post-colonial state bureaucracies. This important activity of the state provided the targets toward which development projects could be applied. The demographic profiles of non-Western industrialized countries were and continue to be the comparative measures used to track a developing country's movement toward becoming a developed country. Returning to the Congo, relying on statistics collected in 1959, Janzen reveals a demographic profile for the Lower Zaire in which life expectancy at birth only reached 37.64 years for males and 40 years for females. The infant mortality rate stood at 180 deaths per 1,000, half of what it had been 20 years earlier, but nevertheless still a high rate of death. He noted constant but high fertility rates, and a declining mortality rate overall. Similarly, Indonesia just after Independence (1950) experienced life expectancy rates at birth of 35-40 years. Infant mortality rates at this time stood at 200 deaths per 1,000 (Ananta & Arifin, 1990). As in the case of central Africa, Indonesia also continued to exhibit high fertility rates as well as high rates of maternal mortality.

Demographic measures and profiles are significant in that they become the measures of development, or lack thereof, for post-colonial regimes on the pathway toward becoming developed nations. The Indonesian government's National Census Bureau (Biro Pusat Statistik) figures document various demographic changes that indicate the changing shape of Indonesian society—a development the New Order regime in Indonesia was proud to take credit for. Demographic profiles appear to be at the point of "transition." Life expectancy at birth has increased from a 1950 expected age of death between 35 and 40 years to a 1990-95 rate of 61-64 years (Ananta & Arifin, 1990). Infant mortality rates have fallen from a 1950 rate of 200 deaths per 1,000 to a 1993 rate of 65 deaths per 1,000, with projected rates continuing to decrease (Ananta & Arifin, 1990). Fertility rates have declined as health care measures and family planning campaigns take effect. The distribution of population in Indonesia by age is changing rapidly, becoming older overall, and beginning to mirror the population distributions of developed countries.

This demographic transition, often referred to as the epidemiological transition, the health transition, or in some cases the risk transition, is the result of postcolonial development efforts brought about through family planning programs, public health and sanitation programs, wider access to health as well as shifts in economic conditions and improvements in nutrition for national populations overall. The health costs of development are the "Western diseases" of affluence and "civilization" that include the chronic degenerative diseases associated with over-nutrition, increasing age, and other behaviors, for example smoking and alcohol consumption.

Of course, not all segments of post-colonial society experience the health benefits and costs of development. In the "least developed countries" 20% of children still die before age 5 compared with 1% in "developed countries" (WHO, 1997). Women in developing countries face high risks for iron deficiency anemia, protein-energy malnutrition, death from pregnancy-related complications, and health conditions related to increasing poverty especially among rural communities (WHO, 2000). In spite of trends toward risk transition from "traditional hazards associated with lack of development" to "modern hazards" related to development, vital statistics indicate that public health efforts should be maintained toward reducing poverty, improving the provision of sanitary services, improving water supplies, providing adequate housing, insuring safety in the workplace, and decreasing exposure to pathogens and toxins from foods and in soils. Medical anthropology continues to play an applied role in addressing and documenting the persistence of these "traditional" health hazards.

Development organizations, and especially the WHO, have identified three diseases that now dominate the "global burden of disease" causing more than 5 million deaths every year. These include HIV/AIDS, tuberculosis, and malaria which, as a group, represent a disease profile of newly emerging infectious diseases. For postcolonial societies these diseases represent a mix of the old and the new as the HIV/AIDS pandemic has taken hold in developing countries with tragic and devastating consequences. In Africa and Asia, HIV/AIDS has become a major health problem that has motivated the marshaling of health care provisions in the same way that colonial medicine was provided to treat epidemics such as sleeping sickness in the Congo.

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