The Legacy of Colonial Medicine in Central Africa

By Sara Lowes*

My dissertation explores the origins and consequences of variation in culture and institutions in sub-Saharan Africa. The first paper is described here.

The second paper in the dissertation (with Eduardo Montero), “The Legacy of Colonial Medical Campaigns”, explores how historical health interventions shape present day trust in and engagement with the health sector (Lowes and Montero, 2019). Between the 1920s and 1950s, French colonial governments undertook extensive medical campaigns in sub-Saharan Africa aimed at managing tropical diseases. In Cameroon and former French Equatorial Africa (present day Central African Republic, Chad, Republic of Congo, and Gabon, henceforth AEF), the colonial governments organized campaigns against a variety of diseases. The most extensive of these campaigns focused on sleeping sickness, a lethal disease spread by the tsetse fly. Over the course of several decades, millions of individuals were subjected to medical examinations and forced to receive injections of medications with dubious efficacy and with serious side effects, including blindness, gangrene, and death. The sleeping sickness campaigns constituted some of the largest colonial health investments, and for many, these campaigns were their first exposure to modern medicine.

We digitize archival data on the locations of campaign visits for the AEF and Cameroon. We match the historical data with present day data from the DHS. Our primary outcomes of interest are vaccination rates for children under five and willingness to consent to a free and non-invasive blood test for either HIV or anemia. We interpret the blood test refusal as a revealed preference measure of trust in medicine. We find several key results using OLS and an instrumental variables strategy. First, greater exposure to the historical medical campaigns is associated with children having fewer completed vaccinations. Second, greater medical campaign exposure is also associated higher blood test refusal rates. Finally, we find that World Bank Health projects receive lower project ratings in areas with greater campaign exposure.

The final paper of the dissertation (with Eduardo Montero), “Concessions, Violence, and Indirect Rule: Evidence from the Congo Free State,” explores how rubber concessions granted in the Congo Free State (present day Democratic Republic of Congo) affect long-run development (Lowes and Montero, 2018). All colonial powers granted concessions to private companies to extract natural resources during the colonial era. Within Africa, these concessions were characterized by indirect rule and violence. We use the arbitrarily defined borders of rubber concessions granted in the north of the Congo Free State to examine the causal effects of this form of economic organization on development, the accountability and performance of local leaders, and pro-sociality. We use the well-defined boundaries of the concessions and a geographic regression discontinuity to design and find that historical exposure to the rubber concessions causes significantly worse education, wealth, and health outcomes. To examine mechanisms, we collect survey and experimental data from individuals near a former concession boundary. We find that village chiefs inside the former concessions provide fewer public goods, are less likely to be elected, and are more likely to be hereditary. However, individuals within the concessions are more trusting, more cohesive, and more supportive of sharing income. The results are relevant for the many places that were designated as concessions to private companies during the colonial era.

Lowes, Sara. “Matrilineal Kinship and Spousal Cooperation: Evidence from the Matrilineal Belt.” 2018.
Lowes, Sara and Eduardo Montero. “The Legacy of Colonial Medicine in Central Africa.” 2019.
Lowes, Sara and Eduardo Montero. “Concessions, Violence, and Indirect Rule: Evidence from the Congo Free State.” 2018.

* Sara Lowes won the 2019 Ronald H. Coase Dissertation Award of SIOE. In this post, she continues to describe the content of her award-winning PhD thesis. Sara is a Postdoctoral Fellow at King Center on Global Development at Stanford University currently and will be starting as an Assistant Professor of Economics at UCSD in the summer.