Health Transitions in the Global South: Reflections from an LSE Workshop
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This post provides a brief overview of the 2025 workshop on Health Transitions in the Global South, which was hosted by the LSE Historical Economic Demography Group and supported by the Economic History Society.
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On 9–10 June 2025, the LSE Historical Economic Demography Group hosted a workshop on Health Transitions in the Global South, co-organised by Eric Schneider and Neil Cummins. The event, supported by the Economic History Society, sought to challenge the tendency to contrast a “late, fast, medicalised” transition in the Global South with the “early, gradual” pattern of the Global North. Instead, participants were asked to think comparatively across southern contexts. Over two days, the workshop produced lively debate and rich insights that underscored the diversity of health trajectories across Africa, Asia, the Caribbean, and Latin America.
Participants explored a set of questions that have too often been overshadowed in the literature on health transitions: why did mortality decline at different times and speeds across the Global South? How did colonialism shape those processes? And what were the key drivers of change—medicine, policy, infrastructure, or deeper social transformations?
The resulting discussions showed how varied the answers to these questions can be. Rather than a single “southern” health transition, the papers painted a picture of divergence, contradiction, and contingency.
Epidemics and Colonial Knowledge
The pandemic of 1918–19 provided one of the most striking examples of variation. In Java, Anggi Novianti showed that influenza killed upwards of one million people—about 3% of the population—with stark regional disparities between east and west. Yet, as she emphasised, the economic boom in plantation agriculture rolled on almost undisturbed, raising the puzzle of how such enormous mortality left so little visible economic imprint.
By contrast, Hampton Gaddy revealed how, in the Pacific, colonial officials misreported the same pandemic. Territories such as Papua New Guinea and the Solomon Islands were long thought to have escaped infection thanks to quarantine policies. In fact, epidemics tore through them. The misperception stemmed from officials’ own racialised assumptions and biomedical hubris as well as their trust in the most senior colonial officials rather than local officials on the ground.
Taken together, these papers made clear that colonial states often both mis-measured and misinterpreted health crises—whether by underestimating their economic significance (as in Java) or denying their very existence (as in the Pacific).
Infrastructure as Double-Edged
Several papers showed how infrastructure, introduced under colonial rule, could improve health in some respects while worsening it in others. Maanik Nath demonstrated that India’s expanding railways offered better access to markets and food supplies, cushioning populations against famine. At the same time, they facilitated the spread of infectious disease, raising mortality in newly connected districts.
The same ambivalence emerged in discussions of hospitals. Grietjie Verhoef highlighted the uneasy coexistence of missionary hospitals with indigenous medical systems, and how corporate providers entered the hospital market in the late 20th century. In both cases, the infrastructure was durable—railways, hospitals—but its benefits were distributed unevenly and often locked in long-term patterns of inequality.
Gendered Health Transitions
Another unifying theme was the gendered dimension of health change. Astrid Krenz’s analysis of Indian states found that as infectious diseases declined, male excess mortality actually widened, driven by differences in how infections affected biological ageing. Wen Su’s work on South Africa showed how the HIV epidemic reshaped the sex gap in life expectancy. And Eric Schneider added a child health dimension, documenting that gender disparities in child stunting rates were very heterogeneous across the Global South and did not match other indicators of female disadvantage.
These papers collectively suggested that the health transition was not simply about overall population-level improvements. As Shane Doyle reminded participants in his paper on maternal mortality, maternal mortality in Africa is not simply “behind” the North—it is internally diverse, and in places maternal death rates today are higher than those experienced by English women three centuries ago.
Campaigns, Capacity, and Contingency
A third theme emerged around health campaigns. Eric Strobl showed how the hookworm eradication campaign in Jamaica helped trigger one of the fastest life expectancy increases in modern history—the so-called “Jamaican paradox,” where dramatic health gains occurred despite stagnant living standards. By contrast, Leigh Gardner explained why Rockefeller Foundation programmes in Africa achieved much less: they depended on colonial states to maintain new infrastructure, but those states often lacked the capacity or the will to do so. Jeanne Cilliers’s study of Nigeria’s yaws campaign highlighted yet another factor—local health workers and trust within communities—that proved decisive to success.
Together, these papers suggested that medical innovation was not enough. Campaigns produced durable gains only when embedded in supportive social and political structures. The contrast between Jamaica and Africa, or between Nigeria’s successful yaws programme and other colonial efforts, underscored that the same technologies could yield very different outcomes depending on context.
Inequality and the Distribution of Progress
The final sessions highlighted how inequalities structured every stage of the transition. Dinos Sevdalakis showed that in colonial Saint-Louis, Senegal, French literacy significantly reduced infant mortality risks—evidence that proximity to colonial institutions mattered more than income or occupation. Johan Fourie’s work on Paarl, South Africa, revealed that early racial disparities in infant mortality persisted despite new legislation, suggesting that inequalities were systemic rather than accidental. And Nick Fitzhenry’s study of apartheid South Africa captured the paradox that antibiotics initially reduced racial disparities by disproportionately benefiting marginalised groups, even if longer-term convergence was constrained by entrenched segregation.
These findings reinforced a central insight of the workshop: progress was never evenly shared. Mortality decline could reduce some gaps while deepening others, and the distribution of health improvements often depended on structural inequalities far beyond medicine itself.
Conclusion
What the workshop made clear is that the “health transition” in the Global South was not a single, delayed version of the North’s story. It was instead a set of overlapping processes shaped by epidemics, colonial legacies, gender relations, and inequalities in access to infrastructure and campaigns. The most compelling lesson was comparative: by setting Java against the Pacific, Jamaica against Africa, or Senegal against South Africa, we saw how health transitions were contingent and context dependent.
The support of the Economic History Society was vital in bringing together scholars across disciplines to develop these ideas. The conversations in London demonstrated the power of South–South comparison not just to diversify our empirical base, but to fundamentally rethink the frameworks we use to understand health and mortality change.
The programme with titles and abstracts for the papers presented is available here, and you can learn more about LSE’s Historical Economic Demography Group here.
To contact the author:
Eric Schneider
London School of Economics
