Economical epidemiology, pathological populations, and the long history of the Demographic and Health Survey.

Abstract

This article examines the history of population health surveillance in modern Africa, considering the Demographic and Health Survey (DHS) programme as a bridge between twentieth and twenty-first century epidemiology. Tracing this tradition of surveillance from pre-war Britain, through its extension into the British Empire, and its subsequent employment in post-colonial demography, this article makes two related arguments. The first, that surveys like the DHS complement and encourage economic logics in medicine. Focussing initially on questions of human capital, cross-sectional surveys have tended to promote and promise efficiency in terms of medical research and interventions, thereby reducing the need for extensive and expensive infrastructure. In Africa, this utility has meant that cross-sectional surveillance gained particular traction in the context of colonisation and again following the widespread implementation of Structural Adjustment Programmes from the early 1980s. The second argument takes that the collection of demographic and social data means that these surveys represent a unique form of surveillance medicine, one which encourages associations between illness, family, and society at large. Epidemiology drawn from these data promotes this pathologisation of population, binding the epistemology of contemporary Global Health to old ideas, and siting subaltern families and communities as a prime locus of disease.