Colonial Medical Reform under Cold War: A Comparative-historical Analysis of the Cases of Hong Kong and Singapore


Student thesis: Doctoral Thesis

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Awarding Institution
Award date3 Jan 2023


This thesis investigates the origin of colonial medical reform and its institutional legacy in Singapore and Hong Kong through comparative-historical analysis. British colonial rule and Cold War politics set the reform process in motion. Despite a time lag, both colonial ports developed a tax-based and state-centred health system in the early Cold War. However, political transition locked the two cities onto divergent paths of long-term development, culminating in contrasting developmental trajectories of health systems.

Singapore’s medical reform stemmed from a path-dependent process. It was not only part of the hearts and minds campaign under communist threat but also a result of the rise of state-led developmentalism in nineteenth-century Britain. Nevertheless, changes in sovereignty interrupted Singapore’s reform path. Unlike the British, the new ruling elites made a concerted effort to promote industrial development and develop defence capacity at the expense of medical development. The health system developed its path-dependent momentum after American Cold War policy transformed Singapore into an industrial city.

On the other hand, Hong Kong’s medical reform resulted from ad hoc factors and political compromises related to Cold War politics and colonial institutions. The partial internationalisation of the Hong Kong refugee crisis acted as a critical juncture by opening a window of opportunity for institutional change. When Hong Kong’s economy benefited from American foreign economic policy, the colonial government absorbed Chinese newcomers by reforming the health system. Medical officers compromised the standard of services due to fiscal conservatism among government officials.

The China factor also exerted a lock-in effect on Hong Kong’s reform path. In preparing for the Sino-British negotiations over Hong Kong’s future, the British resolved to conquer hearts and minds by making path-dependent changes to the existing system. Accordingly, government officials hesitated to increase medical charges, even though the colonial state stepped up its reform efforts by centralising voluntary hospitals.