In colonial health care debates during the shadow-boxing era, one recurrent theme was the persistent conflict over what would be the dominant culture of health and healing in the emergent state of Kenya. Another feature was the dire need for dialogue to facilitate accommodation and compromise in order to find solutions to the myriad health and healing challenges facing the state and groups and individuals in the country. During this period, the foundation of Kenya's colonial economy, which was to have far-reaching effects on the form and structure of health care, was laid. Participation in the colonial economy became critical in determining the developmental course of health care, both at the workplace and in the areas from which labor was recruited and to which it was returned. The outbreak of World War I in 1914 revealed the biased nature of colonial policies which failed to consider the health care needs of those who did not fall directly within the orbit of the colonial economy. By its end in 1918, the war had further contributed to the destruction of human lives through the spread of influenza.

Chapter 3 examines the impact of the economy, labor, and World War I on the development of colonial health care through African, European, and Asian voices. The role of the colonial commissions of inquiry is examined against the backdrop of the conflicts that characterized the evolution and development of colonial health care policies. I also show how the colonial commissions provided a forum in which various grievances were ventilated and decisions that were instrumental in shaping the form and structure of colonial health care in Kenya were reached.

The challenge that confronted the colonial state in its desire to institutionalize the colonial economy in Kenya was not just the need for an improved infrastructure but also the procurement of labor and its sustenance at the workplace. The Kenyan economy was based on agriculture. It was a labor-intensive economy in which both the settler and the peasant sectors competed for African labor. This competition for labor intensified during the first three decades of the twentieth century due to a number of factors ranging from the alienation of land and the establishment of the settler economy to the vibrant peasant sector that was also in need of labor as it became drawn into the colonial capitalist economy.