Unhealthy development: the origins of health inequalities in Sub-Saharan Africa, 1900-1960

Most deaths from preventable diseases such as malaria and measles occur in Sub-Saharan Africa as many citizens lack access to basic healthcare and sanitation. This became even more pressing during the COVID-19 pandemic as demand for health services rose.

While the historical roots of low health-related investments are clear, little is known about what explains the substantial differences between countries in healthcare provision, especially before 1960.

This project studies the uneven establishment of healthcare and sanitation in colonial Africa during the period 1900-1960, when large-scale health infrastructures were established.

Using unexplored sources for both former French and British colonies, this research provides a new empirical foundation for 24 former colonies, to understand how the organization of colonial rule (centralized vs decentralized) determined the foundations of access to sanitation and healthcare in the region.

We hypothesize that healthcare provision under decentralized British colonial rule was better aligned with local circumstances but also led to more inequality in healthcare provision within and between countries, while French centralized rule led to more equal but less efficient healthcare provision across countries.

By considering the impact of historical and context-specific factors, we shed new light on the effectiveness of government-led strategies to promote healthy lives for all, a top priority of the Sustainable Development Goals (Goal 3).