Summary of the impact

Dr Sunil Amrith's research has enhanced understanding of the historical roots of many contemporary policy problems, making him a leading expert on the history of public health in South and Southeast Asia. The critical success of his monograph Decolonizing International Health, and its positive reception among non-academic specialists in the field, led to his involvement in dialogues with policymakers in international NGOs and invitations to contribute a historical perspective to discussions about public health issues in the developing world. His work has influenced policy development and shaped capacity building programmes.

Underpinning research

Dr Amrith's research has re-interpreted the history of public health in Asia, raising questions of deep relevance to contemporary international development and health policy considerations. Decolonizing International Health (Ref 1), submitted for the last RAE, and supplemented by further research (Refs 2-5), addressed issues of enduring importance: why `top-down' health campaigns have often failed to meet their goals; why India continues to suffer from very high rates of mortality and morbidity despite economic growth; how social and environmental factors have acted as a constraint on policy interventions in Asia. Decolonizing International Health showed the importance of international organizations, such as the World Health Organisation (WHO), in shaping health policy in South and Southeast Asia. By examining the historical roots of institutions that still dominate the policy landscape, Dr Amrith's work highlights their strengths and weaknesses. Professor David Arnold (Centre for the History of Medicine, University of Warwick) wrote that his book deserved a `wide and appreciative audience' and that it conveyed `an immediate, personal quality to the developments he describes without thereby losing sight of high-level decision-making by the League of Nations or WHO' (Journal of Contemporary History).

Amrith's research has explored the temptation and the limitations of technological solutions to malnutrition and disease control. He illustrates this through the history of the global campaign to eradicate malaria using DDT in the 1950s and 1960s. Decolonizing International Health shows that despite rapid success in India, the malaria eradication campaign was confronted with deepening social and ecological constraints, including the emergence of insecticide-resistant strains of the disease. Amrith shows the pitfalls of the decision to emphasize the economic rationale for malaria control: when the economic benefits could not be substantiated, support for the programme evaporated. He traces the disappearance of a perspective that was once more persuasive: the idea that health was an intrinsic value and a fundamental right. The story Amrith's research uncovered has significant policy implications at a time when malaria is still responsible for a large share of the burden of disease in South and Southeast Asia.

Similarly, Amrith's investigation of nutritional policy in Asia — research that appears in Decolonizing International Health, and in a later essay (Ref 2) — shows that in the aftermath of the 1930s' depression, innovative solutions to the problems of under-nutrition in South Asia emerged that emphasized the need for a broad-based approach to combat rural poverty. However, the schemes were difficult to enact at a time of economic austerity; as a result of this missed opportunity, nutrition faded from the policy agenda in postcolonial South Asia. Today, over 40 per cent of the world's malnourished children live in South Asia.

Beyond its empirical findings, Amrith's research has pioneered an approach to studying health and health policy in Asia that is relevant to understanding contemporary conditions. Decolonizing International Health was based on research in archives in India, Indonesia, Sri Lanka, Malaysia, and Singapore; and in the archives of international institutions (the WHO, the League of Nations and the Rockefeller Foundation). Amrith's approach shows that in the past, as much as in the present, the movement of people, ideas, goods, and pathogens across national borders were important drivers of change in population health: the challenges and opportunities these cross-border movements present to policymakers today need to be understood in historical perspective.

References to the research

Details of the impact

Dr Amrith's research has been recognised as offering an important contribution to understanding international development policy beyond academia. Indicating the book's international impact and policy relevance, leading Japanese economist, Professor Kohei Wakimura (Osaka City University) wrote, `The publication of this fascinating book is very timely. Both historians and contemporary experts in international health would be well served by reading it' (International Review of Asian Studies, 2009). Amrith's work was also referenced extensively by influential Indian entrepreneur and chairman of Infosys, Nandan Nilekani, in the chapter on `Changing epidemics: from hunger to heart disease' in his book, Imagining India: The Idea of a Renewed Nation. (Source 5)

Amrith's research has challenged policymakers concerned with issues of health and welfare in South Asia and in the developing world more broadly to rethink their approach to public health policy development. By emphasizing the importance of a historical perspective in understanding why particular health policies have succeeded or failed, he has influenced policy thinking in several influential organisations — the China Medical Board (CMB), the World Bank, the Rockefeller Foundation and the United Nations Foundation. They have recognised his expertise, and invited him to participate in influential forums to explore how historical perspectives can inform the development of public health policy in the developing world, and to promote wider understanding of these issues as part of capacity building programmes. (Testimonial 1)

China Medical Board

In 2010 Dr Amrith was invited by CMB to be joint coordinator of a project on the history of public health in Southeast Asia, to coincide with the CMB's hundredth anniversary in 2014. As a leading non-governmental organization involved in public health work in China and across Southeast Asia, with an annual budget of over US$10 million, the CMB has recently `begun a planning process to... refine the CMB's mission and strategies for its second century.' Dr Amrith's project is one of three projects informing CMB's strategic planning. (Testimonial 1 and Source 6)

Dr Amrith has participated in a series of planning and discussion meetings in the US, UK and Indonesia, with members of the CMB's Board of Directors and senior public health policymakers based at institutions in China and Southeast Asia. Amrith's work on the history of philanthropic interventions in health in Asia has been of interest to the CMB in evaluating the successes and shortcomings of their policies over the past century. The CMB has been particularly interested in Amrith's focus on the long-term social, cultural and environmental factors that influence health. This historical perspective has helped to explain the unintended consequences of particular policy interventions. Amrith's documentation of the movement of pathogens and policies across Asia's borders makes his work relevant to the CMB's planning, in a context where new cross-border links between South, Southeast, and East Asia are reshaping the health landscape.

China Medical Board continues to draw on Dr Amrith's expertise. It has commissioned him to edit a volume of essays with Dr Tim Harper (Cambridge University), on the history of public health in Southeast Asia, to inform policymaking. The President writes, `Our initial review of the work suggests high policy relevance of these studies for contemporary health challenges informing both our work as well as health policies in the region, including epidemic control, the balancing of modern and traditional medicine, health care system development, and other key policy parameters.' He adds: Amrith's `work illuminates the institutional history of the very health institutions that our China Medical Board has supported for nearly 100 years. Of practical value have been insights on the broader forces that shape the performance of these institutions, how transnational linkages have impacted on their capacity, and ultimately the translation of knowledge into good health.' (Testimonial 2)

Building knowledge and understanding among medical policymakers and students of policy in the developing world

Amrith's research has provided the basis for developing organisational knowledge that enables policymakers to take into consideration local and regional historical factors that influence the effectiveness of policies.

In April 2008, Amrith addressed a workshop on History and Development Policy at the Brooks World Poverty Institute, University of Manchester, attended by senior policymakers from the World Bank's headquarters in Washington DC. Amrith's contribution became one of ten essays in History and Development: A Necessary Dialogue (2011), for policymakers in the field of international development. The volume was described as a `hugely important and valuable book' by Oxfam's Head of Research, Duncan Green, and as a `set of engaging dialogues' between historians and policymakers, by the Director of the UN Research Institute for Social Development. One of the co-founders of the independent History and Policy think-tank (connecting historians, policymakers and the media) which organised the seminar, writes that Amrith's contribution played a key role in its impact on the policymakers who attended, and on the success of the subsequent book: `Amrith's chapter was commented upon by ..., a senior development specialist, as showing how central federal state policies, even when well-funded showed little staying-power in improving public health in India, by contrast with the record of those sub-national states with a long-standing participatory culture, such as Tamil Nadu.' (Testimonial 3)

Amrith drew on his research as a co-director of a year-long project funded by the Rockefeller Foundation in 2009-10, on Economic Crises and Health, and designed to promote dialogue between historians, anthropologists, and policymakers, and to bring historical perspectives to discussions of the present global economic crisis. He was one of the lead organizers of two workshops — one in Cambridge, UK (June 2009), and one at Harvard (May 2010) — with participants including the editor of The Lancet and advisors to the World Health Organization, the Rockefeller Foundation, and the Bill and Melinda Gates Foundation. (Source 7)

Since 2008, Amrith has delivered six lectures and seminars for the Joint Centre for History and Economics (JCHE), Harvard University, attended by policy-makers, health professionals, and development experts as well as Harvard students and faculty. The United Nations Foundation commissioned a video-recording of the first lecture for use in its online open source, curriculum on UN History, posted on Vimeo and used in Harvard courses (Sources 8 and 9). Amrith's lecture emphasized the importance of Asia in the development of the UN's health and welfare programmes, and helped to place the UN's history in a wider global perspective as an aid to public understanding of the organization's work. Director of JCHE writes, `The [first] lecture became a central component of the program on United Nations History based at the Harvard Asia Center, supported by the United Nations Foundation. The lecture was webcast, and also used in Harvard courses in subsequent years; it has been the basis for the public health component of the widely used UN History website, which was launched in 2012.' She further adds, `He has been invited to return to Harvard on five separate occasions since 2008, in connection with a wide variety of research and policy programs.' (Testimonial 4)

The China Medical Board asked Dr Amrith to organize (with Dr Tim Harper of Cambridge University) a two-week intensive summer school in 2013 for selected junior scholars from Southeast Asian universities to improve research capacity in the region, and to foster dialogue between academics and policymakers in the field of public health. In early July 2013, seven Masters and doctoral students from Southeast Asian universities were selected to participate in a series of intensive workshops and master-classes led by Dr Amrith and Dr Harper on the relationship between health, history, and policy. A senior professor reporting on the seminar observed the summer school and wrote that: `As an effort in capacity-building for this field, the Summer School has been very successful. My thirty plus years of teaching at the tertiary level did not prepare me to see the kind of growth I saw in the six participants within my short two weeks there.' (Source 10)

Sources to corroborate the impact

Testimonials

1. Lead Social Development Specialist, World Bank, Washington DC (Factual statement)
2. Statement from President of China Medical Board (Factual statement)
3. Statement from Convenor of World Bank project on History and Development Policy and Director of History and Policy think-tank (Factual statement)
4. Statement from Director of the Joint Centre for History and Economics, Harvard University (Factual statement)

Other sources

5. Nandan Nilekani (leading entrepreneur; chairman of Infosys), Imagining India: The Idea of a Renewed Nation (Penguin, 2009)
6. China Medical Board website: describes the project in which Amrith is named as one of the coordinators
7. Information about the Economic Crises and Health project (2009-10) can be found here and here.
8. Film of the Harvard lecture May 2008 commissioned by the United Nations Foundation;
9. Film of another seminar that Dr Amrith was invited to present at Harvard University, as part of the United Nations Foundation-funded initiative to bring the UN's history to a wider public audience.
10. Available on request: CMB seminar report 2013