Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives

Abstract

Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives. Edited by Ruth J. Prince and Rebecca Marsland. Athens: Ohio University Press, 2014. Pp. 292; notes, bibliography. $79.95 cloth, $32.95 paper.The nine essays collected in this volume range widely in topic, providing an in-depth and useful snapshot of public health configurations in five African countries. The result of a 2008 workshop at the University of Cambridge, the collection is East African- (six chapters) and Anglophone-heavy (eight chapters), and yet it manages to offer such an array of approaches and capture such diverse experiences that it feels much more comprehensive than location alone would suggest.Taken as a whole, this book makes an important contribution to African public health scholarship by providing more contemporary contexts and newer dynamics in the shaping of health and healing in the selected countries. These include the increasing prominence of transnational, NGO, and private health care facilities in the midst of wholly inadequate government-funded institutions; contemporary political dynamics influencing the expectations for government facilities; the increased influence of market relations in accessing health care; a rise in foreign-funding going to programs that are narrowly focused on disease or health emergencies rather than national comprehensive medical care; and the new, if narrow, opportunities that contemporary programs offer to African patients and health professionals. Presumably, these constitute the "rethinking" of public health that Ruth Prince's Introduction promises.Despite the subtitle's reference to "historical perspectives,' this is a present-oriented collection written by anthropologists, although most chapters are nicely historicallysituated. Only one piece, by Noemi Tousignant, really intends to contribute to knowledge on a particular historical period. The same focus on the present and on anthropology is evident in Prince's Introduction. Historical work is surely present, but the chapter's clear purposes are to trace trends in the anthropological literature and to flesh out contemporary dynamics rather than to engage deeply with the historiography of health and healing. Still, the chapters that include the most significant attention to history- Murray Last, Rebecca Marsland, Tousignant, Hannah Brown-ably demonstrate the power of historically contextualizing present realities. These provide readers with insight into the past, present, and their interrelation.Of particular interest are the ways in which these essays offer rich descriptions of public health related actors. Not only are there public health officials and citizens with health obligations and expectations, but patients, professionals, and a hybrid category that has emerged with HIV/AIDS care wherein a patient becomes a community health volunteer. Not surprisingly, the first section, "Whose Public Health?" emphasizes the first two actors. These essays offer the most diverse set of experiences by drawing on different kinds of political obligations and expectations in Nigeria, Tanzania, and Senegal. …