Struggles Over Health in Colonial Jamaica


A review of Health and the Politics of “Improvement” in British Colonial Jamaica, 1914-1945, by Darcy Hughes Heuring.

The health of the Jamaican population was central to imperial, colonial, and nationalist debates in interwar Jamaica and Britain. In fact, the struggle over health in Jamaica played an important role in the process of British imperial decline, and it was a key part of the growing nationalist movement in Jamaica. As Darcy Hughes Heuring skillfully argues in her dissertation, we must examine the relationship between health, politics, economics, and society in a specific colonial context to understand the lived experiences of colonial subjects. But imperial, colonial, and local efforts to improve the physical health of the Jamaican population were steeped in cultural, racial, and class terms. As Heuring writes, “One of the key aims of this dissertation is to demonstrate the ways in which efforts to improve the physical health of Jamaicans were closely tied to considerations of ‘civility’ and ‘morality’ and more broadly to definitions of what it meant to be ‘Jamaican’” (p. 17). Heuring shows that a British white cultural hegemony was taken up by the mainly colored (mixed-race) middle class that sought to distance themselves from the black and “uncivilized” masses. The middle and upper classes sought to improve the lives of the “laboring” classes, and health was a central tenet of these efforts. In the end, tensions over on-the-ground health experiences in a “backwater” of the British Empire actually influenced changes in imperial policy and precipitated Britain’s imperial decline.

Heuring clearly places the struggle over health in Jamaica within the larger history of British colonial and imperial policies. Yet she also situates this fight in the specific cultural, social, and economic realities of interwar Jamaica. Her focus on the lived experiences of colonial subjects gives us a snapshot of life in colonial Jamaica. Specifically, she responds to three historiographical trends. First, Heuring shows how imperial studies have participated in the cultural “turn,” moving away from political and economic histories, and instead focusing on the private arena and how race, class, and gender shaped colonial rule (Stoler 1989; Stoler 2002; Levine 2003). But this tendency has also shown the British Empire as homogenous and has neglected the lived experiences of colonial subjects in favor of discourse analysis. Heuring makes a crucial intervention by using health to show the local intricacies of imperial rule and how these complexities influenced larger British imperial policy. In doing so, she gets at the material realities of colonial citizens. Secondly, Heuring positions her study within the historiography of colonial medicine, which initially focused on social and cultural identities and has since moved to medicine’s influence on politics in specific locations (Anderson 2006; Bashford 2004; Briggs, 2002; Arnold 1993; Vaughan 1991). The British Caribbean has been absent from these analyses. Thus, Heuring provides the first detailed study of health and empire in colonial Jamaica. Finally, Heuring shows us that issues over health were important in the rise of the nationalist movement in Jamaica. Scholars studying Jamaican nationalism have focused on the role of labor (Bakan 1990; LaGuerre 1982; Post 1978; Post 1981; Stolberg 1989). In doing so, they have erased the social and cultural influences behind this movement. This study is an original contribution that examines health in conjunction with the rise of nationalism. Heuring’s dissertation expertly examines colonial subjects’ lived experience with health within larger national, colonial, and imperial histories. She provides both a top-down and bottom-up look at the role of health in Jamaica and the British imperial project.

To provide this comprehensive look at health, Heuring relies mainly on institutional records. She uses British and Jamaican imperial and colonial government records at various bureaucratic levels, accounts from philanthropic organizations, and the writings from Jamaican nationalist and working-class groups. She also employs health records, such as annual medical reports and medical institution records. Heuring, like many scholars who aim to understand the experiences of the lower classes, found a dearth in sources produced by the Jamaican “masses.” As a result, she has employed the method of “reading-through” sources produced by the middle and upper classes. Using race, class, and to a lesser extent gender as categories of analysis, Heuring provides us with five specific contests over Jamaicans’ health. She highlights the root of each struggle, how it ended, and its implications. The dissertation is thus organized thematically, although somewhat chronologically.

After the Introduction (Chapter 1), Heuring’s first body chapter (Chapter 2) provides an overview of the colonial medical system in interwar Jamaica. She shows that British imperial policy neglected Jamaica’s medical system because it saw Jamaica as a “backwater” in the larger Empire. The author continues by arguing that this neglect played a key role in Jamaican popular uprisings in the late 1930s. Thus, Jamaica’s forgotten status actually propelled it to the front of the debate over the British Empire at the beginning of WWII. What improvements were implemented were made in the arena of public health at the expensive of curative services. Heuring argues that “… ill-health, disease, physical pain, and the need for medical care that was not adequately met by Jamaica’s colonial medical service were a critical part of the suffering and anger that led to the landmark riots of the late 1930s” (p. 55).

Chapters 3, 4, 5, and 6 each highlight a specific struggle over health. Chapter 3 looks at the partnership between the Rockefeller Foundation and the colonial government to control tuberculosis in Jamaica between 1928 and 1940. This campaign portrayed laboring black Jamaicans and not the disease itself as the problem. I particularly enjoyed her discussion of education propaganda aimed at lower-class Jamaican children, where Heuring provides a fascinating discussion of how cultural values are imparted through education in a class- and race-based society (pp. 129-133). Chapter 4 examines the fight against venereal disease between 1914 and 1945. This struggle was based in the wishes of middle- and upper-class Jamaicans to implement compulsory reporting of venereal disease against the desires of the colonial government. Middle- and upper-class Jamaicans used this struggle to call for self-government, while simultaneously accentuating race and class divides.

Chapter 5 looks at the efforts to improve and expand the Kingston Lunatic Asylum (1914-1915). It shows that progress was not accomplished due to failures at the imperial, colonial, and local levels, highlighting the chasm that existed between British imperialism and the realities of Jamaican society. Chapter 6 looks at how discussions over birth control played a crucial role in nationalist struggles between 1938 and 1944. The middle class saw birth control as crucial to ending the perceived crisis of “overpopulation” of the lower classes. It would make Jamaica into a “morally” fit nation. The working class, on the other hand, argued for a reorganizing of colonial policies around the needs of the masses in which contraception played no part. In these body chapters, I appreciated the detailed discussions of the physical realities of diseases such as tuberculosis and syphilis. These medical descriptions give a reader not well-versed in medicine an idea of how a disease is spread, treated, and experienced by the patient.

Heuring presents an expertly argued dissertation that explores the political intricacies of British imperialism on all levels while still focusing on colonial subjects’ lived experiences. By showing in her conclusion that healthcare remains a contested area in Jamaican society, Heuring connects historical processes to modern inequalities. This dissertation is an excellent example of how to show the importance of health within larger historical struggles while remaining invested in understanding day-to-day realities.

Cassia P. Roth
Department of History
University of California, Los Angeles

Primary Sources

British National Archives, London, United Kingdom
Wellcome Library for the History and Understanding of Medicine, London, United Kingdom
Institute for Commonwealth Studies, University of London, United Kingdom
Jamaica Archives and Records Department, Spanish Town, Jamaica
The Rockefeller Archive Center, Sleepy Hollow, New York, USA

Dissertation Information

Northwestern University. 2011. 403 pp. Primary Advisor: Alexandra Owen.


Image: Cover of “Seven Months in the Kingston Lunatic Asylum and What I Saw There” (1860), by Ann Pratt. National Archives of the United Kingdom.

1 comment
  1. this is a nice theses, me too am writing on colonial health policies in nigeria, so i need an assistance from the author

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