Julia Cummiskey is Assistant Professor of the History of Medicine at Johns Hopkins University and a 2023-2024 Consortium Research Fellow.
With the support of a Research Fellowship from the Consortium for History of Science, Technology, and Medicine in 2023-2024, I was able to make significant progress on a new project on the history of health communication and public health marketing in East Africa. The project puts late-20th and early 21st-century social marketing campaigns into the context of older efforts to persuade East Africans to adopt products, services, and behaviors. The project shows how these campaigns to “sell” health and wellness have shaped and been shaped by local, regional, and global cultures and politics. As more conversations take place about the difficulty of translating public health expertise into credible and compelling messages for the public, it is essential to understand how past campaigns have been planned, executed, and evaluated by both public and private interests. I contend that contemporary debates about the role of social media, misinformation, and mistrust in health experts are only the most recent iteration of more than a century of competing approaches to health communication on the continent.
This project explores the intersection of three major fields: health in Africa, communication studies, and business history and it engages with the relatively recently defined domain of the commercial determinants of health. I aim to put public and private actors into the same arena to show that, while the formal entanglement of finance and health is a relatively recent development at the global scale, consumers of health information and products have always encountered both. Innovations and practices in academia, public policy, and business have influenced one another and can only be understood together. By tracing the history of the academic and applied fields of health communication and marketing alongside the artifacts from various campaigns to promote products, services, and behaviors, this project will offer a cohesive narrative about the ways people within and beyond Africa have attempted to shape Africans’ understanding of their health and the steps they needed to take to restore or safeguard it.
With the support of the Consortium, I was able to conduct research at the Wellcome Library, the Chesney Medical Archives, the Welsh Medical Library, the Rockefeller Archive Center, and the Hagley library. In the archives, I am tracing the evolution of health communication programs and the forms of expertise that have informed them, including medical, educational, psychological, and commercial. My archival work also provided foundation for oral history interviews with people who have been directly involved in health marketing and communication in the past several decades.
The outstanding collections of the Rockefeller Archive Center allowed me to identify a number of health communication projects in Africa funded by the Rockefeller Foundation and the Ford Foundation. The collections also contained several examples of materials created for those projects, which have helped me to establish an understanding of the range of media these campaigns produced. At the Hagley Library, a less familiar destination for me as I venture into the territory of business history, I got an introduction to the kinds of materials archived by corporations and consultants. I was able to study the forms of market research pioneered by major corporate entities and later adopted by public and non-profit groups for studying populations targeted for health-related campaigns.
One of the highlights of my visit to the Wellcome Library was visiting the storage area with one of the archivists to browse the collection of hundreds of health posters collected across the African continent. Together, we examined exemplars from Tanzania, Kenya, and Uganda, and I noted that some of them were signed. One of the paths I intend to pursue when I do more research in East Africa is to try to identify some of the individuals who created the original artwork. Looking at the physical posters, rather than just the digital images of posters I had been able to consult remotely, also drew my attention to the more technical aspects of their production. In some cases, I could see traces of the technologies and techniques used to reproduce them. In addition to collecting valuable examples of the kinds of visual materials I was looking for, I was prompted to consider additional research questions related to the materiality of the posters.
The most exciting discovery from my fellowship research was the collection of papers from the Center for Communications Programs at Johns Hopkins University held at the Chesney Medical Archives. This unprocessed collection only came to my attention through my correspondence with the archivists in advance of my visit. In my first visit to the collection, made possible by the fellowship, I discovered it holds well over 100 boxes of materials related to the scope, operations, funding, evaluation of projects all over the world, including many in East Africa. Following my relocation to Johns Hopkins in the year after my fellowship, I have been able to continue to work with this collection, which recently expanded to include several dozen additional boxes, including the contents of the CCP library of health communication materials. This collection has given me a core of materials related to a single entity that played a major role in the field of health communication from the 1970s to the present, as well as connections to countless related organizations and individuals. As I continue to pursue these leads, I am beginning to “populate” my project with people whose stories will animate the history of health communication in East Africa.
While I was at Johns Hopkins, I also spent time reviewing the holdings of the Welsh Medical Library, especially the East African Medical Journal and its advertisements. My preliminary evaluation showed that there was a marked change in the way advertisers framed their products for readers of the journal that corresponded to the political and economic changes in the region. I plan to compare the ads in the East African Medical Journal to contemporaneous ads in Lancet and other medical journals to see if, and when, the same companies developed copy specifically for an East African audience and when they used the same copy regardless of the region. The opportunity to consult the physical collection was imperative, as many digital repositories of medical journals do not include advertisements.
At each of my destinations, the staff of the libraries and archives went out of their way to make me welcome and to help me make the best use of my time with them. With each visit, I am more appreciative of the critical work done by reference archivists and curators and the importance of networks, like the Consortium, that connect them to researchers. Their knowledge and generosity made it possible for me to achieve major progress during the period of my fellowship and in the months since. Because I am tracing the history of a set of practices and ideas that has gone by different names and been claimed by different experts, I have found that relevant archival materials are widely dispersed and not always easily identified in collection descriptions. The assistance of knowledgeable archivists and collection managers has been critical for this work. The opportunity to consult these collections confirmed for me the viability and importance of a project on the history of health communication in East Africa, a field which has garnered enormous resources and left a considerable archival “trail” but attracted relatively little scholarly historical attention.
