'Disease and development' or 'the underdevelopment of health': A critical review of geographical perspectives on African health problems

The article examines the legacy in geographical research of the comprehensive review by Hughes and Hunter, "Disease and 'development' in tropical Africa," which was published in 1970. Since then, there has been a fundamental shift away from developmentalist theories (modernization and neo-modernization theories) of socio-economic change in the Third World to theories of underdevelopment (dependency theory and Marxist theories of underdevelopment). This shift has important consequences for the analysis of ill-health; underdevelopment theorists recognize myriad health problems as being integral to the expansion of capitalism, rather than as unanticipated side-effects of development initiatives. The medical geographical literature on health and development/underdevelopment of the past 15 years has only weakly reflected these trends. Many studies of health problems related to development make no reference to these linkages. There is a large body of essentially developmentalist literature following in the Hughes and Hunter tradition. There has been relatively little work by geographers relating patterns of ill-health to capitalist underdevelopment. Medical geographers are urged to embrance a historical political economic framework in their studies of African health problems, and to re-orient their policy recommendations in order to support the interests of common people and states attempting to liberate themselves.