THE GEOPOLITICS OF HEALTH IN SOUTH AND SOUTHEAST ASIA: Perspectives from the Cold War to COVID-19 | Edited by Vivek Neelakantan

The new volume by Routledge, The Geopolitics of Health in South and Southeast Asia: Perspectives from the Cold War to COVID-19, brings together six papers on diverse issues related to health in South and Southeast Asia spanning a period of approximately 80 years (from the 1940s to 2023). With contributions by “an eclectic mix of medical historians, a medical anthropologist, and an international relations expert,” the volume emerged from a broader research project on primary healthcare in Southeast Asia, which centred on an earlier period, 1937–1978 (8). The volume purports to offer a “regional history of health in South and Southeast Asia from a transnational and comparative perspective” that seeks to show “how international aid agencies tailored health policies to suit local conditions in ways that were mediated by Cold War and national reconstruction in the post-World War II era” (9). The volume endeavors to offer a contribution that medical historians miss in their focus on the nation-state and which historians have missed in their more global focus.

The individual contributions in the volume are wide-ranging. In chapter 1, Vivek Neelakantan examines how the World Health Organization’s Southeast Asia Regional Office (SEARO) came to be headquartered in New Delhi. In Chapter 2, Shirish Kavadi investigates Indian efforts at self-sufficiency in the areas of medical education and pharmaceutical production post-independence in the broader context of the Cold War. Eva-Maria Knoll compares malaria eradication initiatives in the Maldives and Sri Lanka, two island nations, in chapter 3, highlighting the Maldives remarkable success at a time when so many other countries failed. In chapter 4, Davisakd Puaksom fills in gaps about the emergence of Thailand’s Rural Doctor Society and its contributions to addressing health inequalities in the 1970s and 1980s. In Chapter 5, Khoo Ying Hooi explores the contraction of civic space during the COVID-19 pandemic in maritime Southeast Asia, reflecting on the strengths and weaknesses of an ASEAN-led approach to infectious disease. The volume concludes with another chapter by Vivek Neelakantan on the tensions involved in the COVID-19 responses by the Indian-led South Asian Association for Regional Cooperation (SAARC).

At a time when the world is still grappling with the vestiges of COVID-19 and remains largely unprepared for the next pandemic amid simmering geopolitical tensions, I learned a lot in reading this timely volume, which was written largely by scholars either from the region and/or working in it. A scholar of Thailand myself, I appreciated how the volume troubled the way scholars take for granted Southeast Asia as a geopolitical construct, showing for instance how Cold War dynamics shaped the formation of a WHO SEARO region headquartered in country many don’t think of as in Southeast Asia (and why Manila became the base of operations for the WHO’s Western Pacific Regional Office). I likewise appreciated gaining more of an understanding of policies towards medical education and pharmaceutical development under Nehru (in the broader context of the aid landscape and organizations like the Rockefeller Foundation, UNICEF, and the WHO). Drawing out Maldivian success on malaria in comparative perspective was also a worthwhile endeavor at a time when success in malaria eradication was more the exception than the rule. I also appreciated the opportunity to learn about more about SAARC, which few people outside the region are familiar with.

The book’s sweeping scope is also its greatest weakness. It is simply impossible to account for and do justice to the many health issues over the eighty-year time span it takes on in all the countries it sets out to survey. While some of the individual contributions offer great value in terms of providing important historical details that will undoubtedly become important references, the broader work hangs together somewhat unevenly. The first two chapters group together fairly well in dealing with early history that centers India. The final two chapters share the theme of COVID-19. But knitting together the initial chapters’ themes with those of the middle chapters and final two proves difficult.

A number of important health issues, countries, and arguably, perspectives are missing, as is a concluding chapter that might help tie the chapters together more tightly and help cohere the broader argument of the volume. How does an examination of COVID-19, for example, towards the book’s end relate to the original impetus for the project on primary care? What of the relatively long and important period following the end of the Cold War up until COVID-19? How did factors that constrained and enabled particular health policies and possibilities shift over the 80 year period, and what changed in the broader architecture of power?

Additional chapters could have helped address these critical omissions and answered these questions. However, no book can do everything, and the authors and editor are to be commended for the valuable details they have added to many different parts of the historical record. The book adds richness that builds on the work of earlier edited volumes(such as Paul Cohen and John Purcal, The Political Economy of Primary Health Care in Southeast Asia, Australian Development Studies Network, ASEAN Training Centre for Primary Health Care Development, 1989).I look forward to the editor and authors’ future contributions.

Joseph Harris

Boston University, Boston