The perception of risk: Policy-making on infectious disease in India (1892-1940)

Long before the terms global health, biosecurity, and public health preparedness came into existence, European and colonial governments struggled to contain and prevent the spread of epidemic diseases from India to the western world. The significance of India to Europe---commercially, epidemiologically, strategically---meant that India occupied a prominent position in debates on the control of epidemic diseases throughout the late nineteenth and early twentieth centuries, becoming the focus of international concern and regulation. During the cholera and plague epidemics of the 1890s, the Government of India recognized that infectious disease outbreaks posed certain economic, political, and epidemiological risks. Perceptions of risk, both globally and within India, played a critical role in policy-making at the all-India level. This study analyzes how a variety of factors and assumptions---international public health diplomacy, epidemiology, trade protection, imperial governance, new medical technologies, and cultural norms---operated within larger conceptions of risk to shape the Government of India's infectious disease policies. While several factors structured policy discussions and outcomes, there were also financial, political, administrative, and ideological obstacles to the prevention and control of epidemic and endemic disease.;This study focuses on four diseases---cholera, plague, malaria, and yellow fever---and uses a case study method to make comparative analyses of policy decisions. Plague and cholera presented epidemiological, economic, and political threats to both Europe and India. Malaria was an internal public health problem, which ravaged India more than any other disease, while yellow fever was a purely external risk, which had yet to infect India. The histories of these three disease scenarios are utilized as prisms through which to analyze the Government of India's rationale for its infectious disease policies. They show the necessity of situating public health policy in India in a larger imperial and international context and demonstrate that government perceptions of economic, political, and public health risk fundamentally shaped infectious disease policies in colonial India. To understand policy development in India, archival sources and published works were consulted, including medical journals, international conventions, and published and unpublished documents of governments, international organizations, medical congresses, and scientific experts.