Public health and state power in Pakistan: case studies of medical interventions from British Raj to military rule

This thesis provides the first historical survey of medical interventions and public health policies implemented by the governments that ruled in the territories of Pakistan over the 20th century. It sheds light on the objectives and challenges of governance during this period with respect to population health and welfare, and seeks to contribute to our understanding of the impact of colonial rule in the territories which became Pakistanâwhich are not well-represented in the literature on the history of medicine of British Indiaâand to expand our knowledge of developments in the postcolonial period. The narrative begins with the twilight of colonial rule, when the British Indian government was hindered from undertaking public health reform due to the growth of nationalist and anti-colonial sentiment in the North-West Frontier, Bengal, and the Punjab. The demand for local autonomy and public accountability in health decision-making in these provinces came at a time when Indians were simultaneously resisting Britainâs political dominance over India. Even after independence, the conflict between provincial governments and successive central governments with respect to health policymaking persisted. Such tensions were exacerbated by the economic pressures of scarcity in Pakistanâs early years which worsened pre-existing social and political cleavages between different groups. This material deprivation along with the historical legacy of tropical medicine in Asia resulted in acceptance of the countryâs status as an underdeveloped, backwards state by the countryâs leaders in return for international health aid from richer nations. Pakistan subsequently became a laboratory for developed world experiments on poverty and population control. The developments in health over the period from 1900 to 1960 make evident the manifold challenges to the sovereignty and authority of the colonial, parliamentary, and military rulers as they attempted to intervene in the lives of subjects and citizens of British India and Pakistan.