Soc Sci Med. 1987 ; 24(3): 197-208.

Public health in pre-colonial east-central Africa.

Waite G.

This study is the first of its kind to suggest that a rich public health tradition existed in east-central Africa before the twentieth century, and that the tradition can be reconstructed historically. It breaks with earlier studies of public health history for the region in that it does not define public health on the basis of western institutions and activities. The definition of public health that is used in this study makes a simple equation between politics and medicine. It includes all activities that ruling authorities undertake to promote the well-being of the societies over which they have charge. Thus rainmaking and sorcery control, the principal services in traditional African societies, are the focus of this study. Evidence is presented here of the control exercised by kings, chiefs, priests over these services in various societies located in southeastern Zaire, southern Tanzania, Zambia, Malawi, northern Mozambique, and Zimbabwe. The cases are all set in the pre-colonial period, before the twentieth century and the beginning of most written records. The evidence is derived primarily, though not exclusively, from non-written sources, such as archaeology, linguistic, and ethnographic records. The best data are those that come from cultural exchanges between people, for historical records are created in this way. Therefore, the cases discussed here all involve contacts between immigrant and autochthonous groups. The political histories of these contacts are already known. What this study does is link up those traditions with independently-acquired evidence of change in medical traditions. Political change often, but not always, led to change in public health institutions. The control of ruling elites over health services is thus made apparent by the manner in which new medical institutions were implanted when new political authorities arose.