Public Health, Policy, and Power

The health of communities is affected by a range of factors including social, political, and economic influences. Some scholars have argued that colonialism is a social determinant of health evidenced in inefficient bureaucracies and underdeveloped systems that are more of relic of former methods of administrative control than a model to address the concerns of people in need. These systems, the framework that their global models represent, and their limited scope of concern continues to adversely affect people living under the shadow of past colonization.

Uganda is a good case study to explore the legacy of colonization on public health. The country has a history demonstrates how social processes associated with colonialism—such as extractive economies, forms of unequal citizenship, cultural conflict, and the underdevelopment of labor talent–converge to impact health outcomes. These factors have undermined public health and the degradation of the public health care system through chronic underfunding and structural adjustment programs.

According to Anokbonggo (2004):

“Uganda began implementation of a structural adjustment programme (SAP) in July 1994 in order to improve social services. The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increase in the level of utilization of health facilities…the policy failed to improve drug shortages, inefficient utilization of resources, and low morale among hospital staff.

Anokbonggo WW, et. al. Impact of decentralization on health services in Uganda: a look at facility utilization, prescribing and availability of essential drugs. East Afr Med J. 2004 Feb;Suppl:S2-7. PMID: 15125109.

The outcomes in Uganda have been mixed with some successes. These mixed success and stubborn issues present questions about the degree to which a colonial legacy and a post-colonial context impact attempts to remedy the systems and improve health outcomes.