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The political and economic systems that underpinned colonial rule not only disrupted people’s lives and livelihoods but also created enduring inequalities that laid the groundwork for more damage.
This was a period when germ theories of disease began to predominate in many parts of the world and pharmaceutical treatments and vaccination campaigns were on the rise [1, 2].
It was also a time when hygienic regimes in cities became more uniform .
What do we learn about ethics and international health systems when we look to the past?
This essay considers this question by examining the history of colonialism in sub-Saharan Africa, focusing on the harms of conquest and on the treatment and research campaigns sponsored by nascent medical services.
At over 11 million square miles, Africa is the second-largest continent (after Asia) and was the last massive region of the world that Europeans colonized (between 18).
The timing and scale of European colonization matter.
These new ideas and techniques increased people’s faith that diseases could be mastered and human lives extended, if only the new knowledge were applied.
By exploring the ethical dimensions of medicine in colonial Africa, we can begin to appreciate the moral complexity not only of past interventions but also of international health systems today, given their roots in imperial dynamics.
Yet Europeans’ efforts to ameliorate the health of imperial subjects were typically beset with contradictions both because disease burdens increased and because health conditions were more difficult to control than officials expected.
Conquest was violent and disruptive, radically altering landscapes and lives, and producing what medical specialist Patrick Manson aptly referred to in 1902 as a “pathological revolution” in tropical Africa .