Awards

• Winner of A CHOICE Outstanding Academic Title.

Overview

Dismal spending on government health services is often considered a necessary consequence of a low per-capita GDP, but are poor patients in poor countries really fated to be denied the fruits of modern medicine? In many countries, officials speak of proper health care as a luxury, and convincing politicians to ensure citizens have access to quality health services is a constant struggle. Yet, in many of the poorest nations, health care has long received a tiny share of public spending. Colonial and postcolonial governments alike have used political, rhetorical, and even martial campaigns to rebuff demands by patients and health professionals for improved medical provision, even when more funds were available. No More to Spend challenges the inevitability of inadequate social services in twentieth-century Africa, focusing on the political history of Malawi. Using the stories of doctors, patients, and political leaders, Luke Messac demonstrates how both colonial and postcolonial administrations in this nation used claims of scarcity to justify the poor state of health care. During periods of burgeoning global discourse on welfare and social protection, forestalling improvements in health care required varied forms of rationalization and denial. Calls for better medical care compelled governments, like that of Malawi, to either increase public health spending or offer reasons for their inaction. Because medical care is still sparse in many regions in Africa, the recurring tactics for prolonged neglect have important implications for global health today.

Full Product Details

9780190066192

Table of Contents

Reviews

Messac has created an engaging and lively study of how powerful people make scarcity look inevitable. By carefully examining how international and national policy has affected health care spending in a single state, he's able to show both the human cost of longstanding patterns of underfunding and the means by which people have sometimes forced their leaders - colonial and postcolonial - to do better. * Claire Wendland, University of Wisconsin-Madison * In this masterful contribution to the emerging subdiscipline of global health history, Luke Messac examines the trajectory of health care in the former British colony of Malawi from the late nineteenth century to the present. Fascinating and methodologically meticulous. * Ted Schrecker, Newcastle University * Based on an insightful and sensitive handling of a rich range of sources, No More to Spend represents a significant contribution to several fields, including the history of medicine and global health. This is an impressive analytical discussion of the wide ranging effects of the social construction of scarcity and the impact of new, effective medication in colonial and postcolonial Malawi (Nyasaland). * Markku Hokkanen, University of Oulu * No More to Spend is an important book on the political origins of scarcity in health care among the world's poor. Messac's original analysis explains how the people of Malawi came to be deprived of appropriate levels of spending and care over the past 100 years. This is a wonderfully thought-provoking book. * Steven Feierman, University of Pennsylvania * No More to Spend is a beautifully rendered social history, but it is also a superb and humane ethnography. Like a good historian, Messac advances while looking backwards. Like a good anthropologist and a superb doctor, he casts his eyes, and his thoughts, on people like Francis, trudging forwards against long odds not of his own making. * Paul Farmer, Harvard University and Partners In Health * In global health, there are still too many excuses for inaction. Through fieldwork and archival research, Luke Messac's book exposes the origins of arguments - ones I have heard far too often - for why we must value some human lives more than others. To win the fight for global health equity, we must first understand the colonial-era roots of the denial of quality health care to the world's poor. * Agnes Binagwaho, University of Global Health Equity, Rwanda * Messac's work is a brave and important book, one that asks, with cold clarity and detailed historiographic work, the 'politically uncomfortable questions of distribution' that many only touch on. Through painstaking detail, the book convincingly shows how the narrative of scarcity in African health care was produced and has become reified, and the challenge it sets us as to why we have come to (largely) accept this, cannot be ignored. * Thandeka Cochrane, Social History of Medicine *

Messac has created an engaging and lively study of how powerful people make scarcity look inevitable. By carefully examining how international and national policy has affected health care spending in a single state, he's able to show both the human cost of longstanding patterns of underfunding and the means by which people have sometimes forced their leaders - colonial and postcolonial - to do better. * Claire Wendland, University of Wisconsin-Madison * In this masterful contribution to the emerging subdiscipline of global health history, Luke Messac examines the trajectory of health care in the former British colony of Malawi from the late nineteenth century to the present. Fascinating and methodologically meticulous. * Ted Schrecker, Newcastle University * Based on an insightful and sensitive handling of a rich range of sources, No More to Spend represents a significant contribution to several fields, including the history of medicine and global health. This is an impressive analytical discussion of the wide ranging effects of the social construction of scarcity and the impact of new, effective medication in colonial and postcolonial Malawi (Nyasaland). * Markku Hokkanen, University of Oulu * No More to Spend is an important book on the political origins of scarcity in health care among the world's poor. Messac's original analysis explains how the people of Malawi came to be deprived of appropriate levels of spending and care over the past 100 years. This is a wonderfully thought-provoking book. * Steven Feierman, University of Pennsylvania * No More to Spend is a beautifully rendered social history, but it is also a superb and humane ethnography. Like a good historian, Messac advances while looking backwards. Like a good anthropologist and a superb doctor, he casts his eyes, and his thoughts, on people like Francis, trudging forwards against long odds not of his own making. * Paul Farmer, Harvard University and Partners In Health * In global health, there are still too many excuses for inaction. Through fieldwork and archival research, Luke Messac's book exposes the origins of arguments - ones I have heard far too often - for why we must value some human lives more than others. To win the fight for global health equity, we must first understand the colonial-era roots of the denial of quality health care to the world's poor. * Agnes Binagwaho, University of Global Health Equity, Rwanda *

Author Information

Luke Messac is a resident in emergency medicine at Brown University. He received his M.D. and Ph.D. (History and the Sociology of Science) from the University of Pennsylvania.

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