Book: Public health in the arab world section: the context of public health chapter: Public health, the medical profession and state building–a historical …

Book: Public health in the arab world section: the context of public health chapter: Public health, the medical profession and state building–a historical …内容摘要：

Book: Section: Chapter: Authors: Public health in the Arab world The context of public health Public health, the medical profession and state building – A historical perspective Longuenesse E., Chiffoleau S., Kronfol N., Dewachi O. As the opening chapter in this volume, it is perhaps appropriate to look at history as this can provide insights about the progress that public health has made, the challenges that it still faces today, and the options for future action. This chapter traces the main contributions to the development and evolution of public health policies in the Arab world. In so doing, several key themes, among many others, emerge: the impact of colonialism and encounter with Western medicine, the relation of public health to the state building and modernization project, the role of the medical profession and changing policies in relation to changing political and economic realities. We intend to develop these themes and show their complex interactions in laying the foundations for modern public health. We will argue that public health was a principal tool in the modernization project (seen as an ideological and sociopolitical project) which emerged in the late Ottoman period, and later subjected to the interests of colonial powers. The newly independent Arab states relied on promoting social ‘progress’ and providing access to benefits of development, with health at the heart, as a foundation of legitimacy. This is translated in health system financing and organization and education, regulation, and large scale employment of health professionals. We focus on the medical profession, as it played a central role in both the public health and modernization projects. As champions of health, physicians have gained immense prestige commensurate with their responsibilities and their relation to the state and its political choices. Approach Health and disease are socially constructed concepts that vary in time and place based on the experiences, practices and representations of social and professional groups, including physicians (Becker 1961; Freidson 1970; Boltanski 1971) Such concepts are useful in observing social change (Augé 1983). In many industrialized countries, research has examined the representation of health and disease, health systems organization, hospital management, medical practice, and the inter-relationships among health professionals, patients and governments. Foucault’s work demonstrated medicine’s role in society, disciplining the body as an instrument of power. In the Arab world, research on the history and sociology of health and medicine remains limited. While medieval Arab medicine has long interested historians of science, the history of modern public health in the region has received less attention. Researchers have examined epidemics (Watts 1999) and changes in medical practice during the 19th century (Gallagher 1983; Jagailloux 1986), colonial times (Turin 1971), and in the 20th century (Chiffoleau 1997). Several other volumes and research studies, referenced throughout this chapter, have attempted to fill the gaps. This chapter builds on prior works to provide a sociohistorical perspective of the processes (social, economic and political) processes that have greatly influenced health, and the development of public health, in the Arab world. This has led us to recognize several distinct, but overlapping rather than discontinuous, eras and corresponding processes. 1 Historians might argue, perhaps rightly, that the Arab world, like other regions and cultures, modern public health has old historical seeds (Watts 2003). Obviously, this would depend on what we assign to the definition of public health. For example, management of disasters of public health proportion was done well early in the Arab-Islamic civilization. Health systems, including hospitals for the mentally ill (bimaristans), and healthy administration of public space were reasonably developed in the peak of the Arab-Islamic empire. The principles of social justice and the right of all to protection are enshrined in religious principles and organizational set-ups in the region. While recognizing the importance of these historical seeds, our analysis is grounded in seeing public health as a modern development, emerging principally in reaction to health problems associated with urbanization and industrialization in 19th century Europe, and thus rooted in social reform movements and emergence of modern states. Public healt