PREFACE
Financing Health for All. What is the most practicable system of charging people for health care ….
… Thirteen years after the Health-for-All programme [Alma Ata 1978] was launched, the availability of the necessary finance remains a formidable obstacle to future progress in many developing countries. The hope that governments would increase spending on health care to 5% of the national income is in most cases unlikely to realize. Nor is there evidence that donors are willing to increase their aid to developing countries or to divert more of it to the health sector. Ministries of health are being left to find their own solution. Is the way forward to be found in user charges, community financing, private insurance, or some system of formal compulsory insurance? How does one decide which are the more promising options for a particular country? What has been learned from the experience of countries which have tried to go down particular roads?
Brian Able-Smith (1991)
“Financing Health-for-All” World Health Forum, Vol 12
The public sector of all western developed countries has become increasingly involved in financing health care during the past century. Today, 13 OECD countries have passed landmark legislative reforms that call for compulsory prepayment and universal entitlement to comprehensive services, while most of the others achieve similar coverage through a mixture of public and private voluntary arrangements. This study carried out a
detailed analysis of why, how and to what effect governments became involved in health care financing in eight of these countries.
During the early phase of this evolution, reliance on direct out-ofpocket payment and an unregulated market mechanism for the financing, production and delivery of health care led to many unsatisfactory outcomes in the allocation of scarce resources, redistribution of the financial burden of illness and stabilization of health care activities. This forced the state to intervene through regulations, subsidies and direct provision of services. Expansion in prepayment of health care gradually occurred through private insurance, social insurance and general revenues in response to different socio-economic, political and bureaucratic forces. Although improving health may have been the ultimate goal, offering universal access to affordable health care was the way the countries examined achieved this objective.
Universal comprehensive coverage was associated with a decade of stable public expenditure on health care compared with GDP, total government expenditure and government consumption expenditure. There were no disproportionate increases in health care expenditure or displacement of public funds away from social programs that depended on cash transfer payments. Nor do the countries that offer such social protection have higher public debt or poorer economic performance compared with the rest of the OECD. Measures of health status are unfortunately still not sufficiently developed or standardized to permit a detailed analysis of this aspect of outcome through cross-national comparisons. Furthermore, the countries examined may be more vulnerable to political backlash because of the high visibility of their government involvement in health care financing.
ABOUT THE AUTHOR
Professor Alexander S. Preker is a globally recognized expert on the economics of investing and financing health systems, health care policy, governance and health care reform. He has been an advisor to Ministers of Health and senior policy makers throughout the world on capital investment in the health sector, health financing, health insurance, public–private partnerships and the political process of health care reform. And he is on the executive board of several private health care companies.
Professor Preker is a Commissioner with the Global Commission on Pollution, Health and Development. He is an Honorary Member of the International Hospital Federation, a Member of the Board of the USA Health Care Alliance and several other organizations that deal with health policy and health reform.
Professor Preker is an Adjunct Associate Professor for Health Care Management at the Mailman School of Public Health at Columbia University in New York. He is an Adjunct Associate Professor of Public Policy at New York University’s Robert F. Wagner Graduate School of Public Policy and he is an Executive Scholar at the Icahn School of Medicine at Mount Sinai in New York.
In addition to his health policy and academic work, Professor Preker is also active in the private health sector. He is President and CEO of Health
Investment & Financing Corporation, a New York based firm that specializes in investment and advisory services for small and medium size health care businesses. He is one of the founding members of the New York Chapter of the Keiretsu Forum, a crowd funding platform with over US$800 million in investments, and a LLP with Keiretsu Capital, a US$10 million early stage investment fund. He is an active investor in the OurCrowd Health and Life Sciences Portfolio and Landmark Angels and he manages the New York Due Diligence Fellowship program for the Keiretsu Forum at Columbia University.
Prior to his current work, Professor Preker had a distinguished career, working at different times for International Bank of Reconstruction and Development (IBRD), International Development Association (IDA), International Finance Corporation (IFC) and World Health Organization (WHO). From 2007 to 2012, he was head of the Health Industry Group and Investment Policy for the International Finance Corporation (IFC). In this position, he and his team set up a US$1 billion investment facility for health to support expansion of small and medium size business in the Africa. Prior to his work at the IFC, Professor Preker was the Chief Economist for the health sector in the World Bank Group at a time that the annual lending pipeline was about US$3 billion and a total portfolio value in the range of US$15 billion.
While at the World Bank career, Professor Preker worked with both Lawrence Summers (former Director of the National Economic Council under the Obama Administration) and Joseph Stiglitz (recipient of the Nobel Memorial Prize in Economic Sciences) during their respective tenures as Chief Economist for the World Bank Group as well as many Ministers of Health, Finance Economic Development and other senior officials in the client countries he served.
Professor Preker is a prolific writer and has published extensively, having authored and co-authored over 20 books, many scientific articles and has been the primary author of a wide range of institutional reports and policy briefs. While at the World Bank, he was a member of the Editorial Board for the World Bank’s External Operations Publication Department and Editor in Chief of its health care publications.
Professor Preker’s training includes a Ph.D. in Economics from the London School of Economics and Political Science, a Fellowship in Medicine from University College London, a Diploma in Medical Law and Ethics from King’s College London, and a M.D from University of British Columbia.
ACKNOWLEDGMENTS
Guidance and wisdom from late Professor Brian Abel-Smith, London School of Economics and Political Science, provided the main inspiration for looking in detail at the political economy of health care reforms leading to successful implementation of universal access to affordable health coverage. Special recognition is given to Professor Rudolf Klein, University of Bath, whose constructive comments led to a critical revision of the original draft manuscript and more rigorous comparative and social policy analysis.
Countless others contributed insights over the years on the application of the original work to developing countries and elaboration of a comprehensive analytical framework for cross-country comparative studies and performance evaluation in health care policy and financing reforms.
Notably Professors Dov Chernichovsky (Ben Gurion University), André-Pierre Contandriopoulos (University of Montreal), Alain Enthoven (Stanford), Robert Evans (University of British Columbia), Mark V. Pauly (Wharton School, University of Pennsylvania), Uwe Reinhardt (Princeton), Richard M. Scheffler (Berkeley), Joseph E. Stiglitz (Columbia University), Wynand P.M.M. van de Ven (Erasmus University), and Peter Zweifel (University of Zurich) provided the intellectual underpinnings for exploring the economics of private and public approaches to health insurance.
Over the past 30 years, deep insights were gained on the topic of universal health coverage from the global and country level collaboration among the World Bank Group, the International Labour Organization
(ILO), and the World Health Organization (WHO). Notable bilateral players committed to improving health financing include the Australian Agency for International Development (AusAid), the British Department for International Development (DFID), Canadian International Development Agency (CIDA), the Danish International Development Agency (DANIDA), the Dutch Government, the French Agence Française de Développement (AFD), the German Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), the Japanese International Cooperation Agency (JICA), the Norwegian Agency for Development Cooperation (NORAD), the Swedish International Development Cooperation Association (SIDA), and the US Agency for International Development (USAID).
The International Federation of Health Plans (iFHP), countless other bilateral, non-governmental and academic organizations, and national governments carrying out health financing reforms contributed valuable insights.
Appreciation is expressed for the collaboration and deeper understanding on the approaches to universal health care gained insights over the years from: Olusoji O. Adeyi, Chris Atim, Ladi Awosika, Cristian Baeza, Enis Baris, Nicholas Barr, Mark C. Bassett, Hortenzia Beciu, Paolo Belli, Peter A. Berman, Ricardo Bitrán, Reinhard Busse, Guy Carrin, Mukesh Chawla, Michael Cichon, Jorge A. Coarasa, Catherine Connor, Rafael Cortez, Daniel Cotlear, Agnes Couffinhal, Diana Dennett, François Diop, Richard G.D. Feachem, David M. Dror, Yohana Dukhan, Bjorn O. Ekman, Guy Ellena, Maria Louisa Escobar, David B. Evans, Scott D. Featherston, David de Ferranti, Julio Frenk, Hernán L. FuenzalidaPuelma, Jacques van der Gaag, Sherry Glied, Pablo Gottret, Ian GrantWhyte, Charles C. Griffin, Ralph Harbison, April Harding, Loraine Hawkins, Richard Hinz, Peter S. Heller, Jürgen Hohmann, William C. Hsiao, Melitta Jakab, Dean Jamison, Vijayasekar Kalavakonda, Daniel Kress, Gerald M. La Forgia, Gina Lagomarsino, John C. Langenbrunner, Rodney Lester, Maureen Lewis, Marianne E. Lindner, James Christopher Lovelace, Caroline Ly, Hans Maarse, Marty Makinen, Theodore R. Marmor, Anne Mills, Henry Mintzberg, Philip Musgrove, Somil Nagpal, Stefan Nachuk, Allyala Nandakumar, Charles Normand, Kieke Okma, Nathaniel Otoo, Mead Over, Ariel Pablos-Mendez, Ok Pannenborg, Oscar Picazo, Jean-Pierre Poullier, Khama Rogo, Eric de Roodenbeke, Aaltje de
Roos, Jeffrey Sachs, Thomas Sackville, Xenia Scheil-Adlung, Onno P. Schellekens, George Schieber, Agnes Soucat, Michael S. Sparer, Nicole Tapay, Robert Taylor, Edit V. Velenyi, Adam Wagstaff, Hong Wang, Marie-Odile Waty, Alan Williams and Ke Xu.
Appreciation is expressed to Herbert Moses, Shreya Gopi, Anthony Alexander, Nisha Rahul and Ranjana Rajan at World Scientific for their diligence during the editorial process in preparing the manuscript and to Kathleen A. Lynch, independent consultant and developmental editor, and to members of the World Bank publication department for the editorial support provided over the years. I am also very grateful to my family, friends, and feline companions for their unconditional love, support and wise counsel.
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United States, not including cost of past wars
76,295,220 152,068,100
100,000 1,520.00 1.99 80,034,335 1.04 233,102,435 3.03
United States, including cost of past wars 76,295,220 306,762,392
100,000 3,067.00 4.02 80,056,135 1.04 380,818,527 5.06
Congressional Record, February 15, 1901, pages 2707-2709.
The following is an abstract of the British Army estimates for 1901-1902, submitted to Parliament in March, 1901, compared with those of the previous year. They cover, of course, the extraordinary expenditure incident to the South African war:
NET ESTIMATES. 1901-1002. 1900-1901.
I. NUMBERS.
Total
Total Numbers. Numbers. Number of men on the Home and Colonial Establishments of the Army, exclusive of
those serving 111 India. 450,000
430,000
II. EFFECTIVE SERVICES. £ £
Pay, &c., of Army (General Staff, Regiments, Reserve, and Departments). 21,657,500
18,450,000
Medical Establishment: Pay,&c. 1,083,600
908,000
Militia: Pay, Bounty, &c. 2,662,000
2,288,000
Yeomanry Cavalry: Pay and Allowances. 375,000
141,000
Volunteer Corps: Pay and Allowances. 1,230,000 1,730,000
Transport and Remounts. 15,977,000
19,800,000
Provisions, Forage and other Supplies. 18,782,000 18,200,000
Clothing Establishments and Services. 4,825,000
5,530,000
Warlike and other Stores: Supply and Repair. 13,450,000 13,200,000
Works, Buildings, and Repairs: Engineer Services. 3,281,000
4,730,700
Establishments for Military Education. 119,200
113,800
Miscellaneous Effective Services 218,200
200,900
War Office: Salaries and Miscellaneous Charges. 305,000 275,000
Total Effective Services. 83,970,500 85,573,400
III. NON-EFFECTIVE SERVICES.
Non-Effective Charges for Officers, &c. 2,271,000 1,861,000
Non-Effective Charges for Men, &c. 1,485,000 l,379,000
Superannuation, Compensation, and Compassionate Allowances. 188,500
186,000
Total Non-Effective Services. 3,944,500
3,426,000
Total Effective and Non-Effective Services. 87,915,000 88,999,400
NOTE. The provision for Ordinary and War Services is as follows:
1901-02. 1900-01.
For War Services:
South Africa 56,070,000 61,286,700
China 2,160,000 3,450,000
Total 58,230,000 64,736,700
For Ordinary Services 29,685,000 24,262,700
Total 87,915,000 88,999,400
The British navy estimates for 1901-1902 amount to a net total of £30,875,500, being an increase of £2,083,600 beyond the amount of £28,791,900 voted for the year 1900-1901. The total number of Officers, Seamen and Boys, Coastguard, and Royal Marines, proposed for the year 1901-1902 is 118,635, being an increase of 3,745.
The following statistics of the numerical strength and ratio to population of the armies of twenty-two nations, compiled in the War Department of the United States, were cited in the debate in the United States Senate on the bill to increase the strength of the United States Army, January 15, 1901. They differ in some particulars, but not greatly, from the corresponding figures given by Mr. McClellan:
"War Department, Adjutant-General's office, Washington, August 28, 1900. According to the latest available sources, which are considered fairly reliable, the peace and war strength of the armies of the nations mentioned below is stated to be as follows:
NATION. PEACE STRENGTH. WAR STRENGTH.
Officers. Men.
Austria-Hungary, 1899. 26,454 335,239
1,872,178
Belgium, 1899 3,472 48,030
163,000
Brazil, 1897 2,300 25,860
China 300,000
1,000,000 (a)
France, 1900 29,740 586,735
2,500,000 (b)
(a) Estimated.
(b) Available men liable to military service.
{697}
NATION. PEACE STRENGTH. WAR STRENGTH.
Officers. Men.
Germany, 1899 23,230 562,266
3,000,000 (c)
Great Britain, 1900 11,904 241,237 (d)
503,484
Italy, 1898 14,084 310,602
1,304,854
Japan, 1898 6,356 115,673
407,963
Mexico, 1898 2,068 30,075
151,500
Persia 24,500
105,500
Portugal, 1899 1,804 30,000
157,126 (e)
Roumania 3,280 60,000 171,948
Russia, 1900 36,000 860,000
3,500,000 (f)
Servia, 1897 160,751 353,366
Spain, 1899 98,140 183,972
Sweden, 1899 2,513 37,639
327,000
Switzerland, 1899 (g)
509,707
Turkey, 1898 700,620 900,000
United States, 1900. 2,587 65,000 100,000
(c) Estimated on present organization to have over 3,000,000 trained men. War strength not given.
(d) Of this number 74,288 are Indian troops.
(e) In addition there are maintained in the colonies 9,478 officers and men.
(f) Approximately.
(g) No standing army.
"War Department, Adjutant General's office, Washington, December 8, 1900. Peace strength of the armies, population, and percentage of former to latter of the principal countries of the world. This table is not strictly accurate at the present time, because the dates of censuses vary. In preparing this table the latest published census has been taken for population, and the countries are arranged in order of their percentages:
NATION. Peace Strength. Population. Percentage. France
1.54
1.1
1.1
31,856,675 1
2,433,806 1
.97 Austria-Hungary
5,062,918 .79
6,669,732
.77
Russia. 896,000 128,932,113 .69
Great Britain and Ireland. 259,141 38,104,975 .68
Turkey. 244,000 38,791,000 .63
Portugal
5,049,729 .62 Spain
17,565,632 .56
Netherlands
5,074,632 .54
Denmark 9,769 2,185,335 .45 Japan
.30 Mexico
.25
.19
.089
Switzerland (h) 3,119,635
(h) Switzerland has no standing army, but every citizen has to bear arms. The first Class (élite), composed of men between the ages of 20 and 32, has from forty to eighty days' training the first year, and every second year thereafter sixteen days. About 18,000 men join the elite annually.
In December, 1900, the British Board of Trade issued a return, for the year 1899 (except as stated otherwise), of the "Naval
expenditure and Mercantile Marine" of leading nations, from which the following table is taken:
COUNTRIES. Aggregate Aggregate Aggregate Naval Revenue
Tonnage of Expenditure Mercantile on Seagoing Marine. Force. £ £ Tons.
Great Britain (United Kingdom)
26,145,599 119,839,905 9,164,342 (1898-99) (Year ended 31st March, 1900)
Russian Empire 8,306,500 165,905,000 554,141
Germany 6,672,788 76,309,000 1,639,552 (1899-1900) (1898)
Netherlands 1,133,664
10,416,000 302,224 (1899-1900) (1898)
France 13,796,033
142,021,000 957,756
Portugal 749,226
11,474,000 129,522 (Year ended (1898)
30th June, 1900)
Spain 1,133,664
34,633,000 637,924 (Year ended (1898-99) (1897)
30th June, 1900)
Italy. 4,617,034
70,181,000 815,162 (Year ended (Year ended (1898)
30th June, 1900) 30th June, 1899)
Austria-Hungary 1,403,441
Austria. 66,171,000 164,506 (1898) (1898)
Hungary.
42,903,000 66,072
United States (year ended 30th June)
9,840,912
127,288,000 848,246 (b). (1900)
Japan
5,076,294
22,017,000 (a) 648,324 (1899-1900) (1898)
NOTE.
(a) Includes the Chinese indemnity.
(b) Registered for foreign trade only.
WAR DEPARTMENT, The United States: Investigation of its conduct in the war with Spain.
See (in this volume) UNITED STATES OF AMERICA: A. D. 1898-1899.
WASHINGTON, D. C.: A. D. 1897. Completion of the building for the Library of Congress.
See (in this volume) LIBRARY OF CONGRESS. {698}
WASHINGTON, D. C.: A. D. 1900 (December). Celebration of the Centennial Anniversary.
The 100th anniversary of the removal of the national capital from Philadelphia to Washington was fittingly celebrated on the 12th of December, 1900, by an imposing military parade and by a notable assemblage in the House of Representatives, where addresses were delivered and the principal exercises took place. The President and the Vice President elect, members of all branches of the public service, the Governors and delegates from all the States and Territories, and various other dignitaries, were present. The day of celebration was not precisely that of the anniversary, but one chosen for convenience to represent it. Under the law in 1800 the two houses of Congress began their regular winter session about two weeks earlier than they do now, and November 17 was set as the date on which the VIth Congress should reassemble at the new seat of Federal power. As neither house could have taken part this year in anniversary ceremonies held on November 17, a day was naturally chosen which should allow the legislative branch its proper share in the centennial celebration. The Executive Departments had, in fact, been partially installed in the new District some time before the members of the VIth Congress found their way to the unfinished Capitol. President Adams, leaving Philadelphia on May 27, and travelling by a circuitous route through Lancaster and Frederick, reached Georgetown on June 3, 1800. He inspected the single wing of the original Capitol, then far from finished, visited Alexandria, at the southern extreme of the District, and after a ten days stay in Georgetown departed for Massachusetts. The President and Mrs. Adams returned to occupy the White House early in November of the same year.
WAZIRIS, British-Indian wars with the.
See (in this volume)
INDIA: A. D. 1894, and 1897-1898.
WEI-HAI-WEI, Lease of the harbor of, by Great Britain.
See (in this volume)
CHINA: A. D. 1898 (MARCH-JULY).
WELLMAN, Walter: Second Arctic Expedition.
See (in this volume) POLAR EXPLORATION, 1898-1899.
WELSH CHURCH: Failure of Disestablishment Bill.
See (in this volume)
ENGLAND: A. D. 1894-1895.
WEST AFRICA: A. D. 1895. Appointment of a Governor-General of the French possessions.
See (in this volume)
AFRICA: A. D. 1895 (FRENCH WEST AFRICA).
WEST AFRICA: A. D. 1899. Definition of British and German boundaries.
See (in this volume) SAMOAN ISLANDS.
WEST INDIES, The British: A. D. 1897. Report of a Royal Commission on the condition and prospects of the sugar-growing colonies.
A state of increasing distress in most of the British West India colonies, caused by the depression of the sugar-growing industry, led to the appointment, in December, 1896, of a Royal Commission "to make an inquiry into the condition and prospects of the colonies of Jamaica, British Guiana, Trinidad
and Tobago, Barbados, Grenada, St. Vincent, St. Lucia, and the Leeward Islands, and to suggest such measures as appeared calculated to restore and maintain the prosperity of these colonies and their inhabitants." In the August following the Commission made its report, with the following summary of conclusions:
"a. The sugar industry in the West Indies is in danger of great reduction, which in some colonies may be equivalent or almost equivalent to extinction.
"b. The depression of the industry is due to the competition of other sugar-producing countries and in a special degree to the competition of beet sugar produced under a system of bounties. It is also affected by high protective tariffs, and by the competition of cane sugar, the production of which is specially encouraged by the Governments concerned. The causes of the depression may be described as permanent, inasmuch as they are largely due to the policy of foreign countries, and there is no indication that that policy is likely to be abandoned in the immediate future.
"c. It is not due in any considerable degree to extravagance in management, to imperfection in the process of manufacture, or to inadequate supervision consequent on absentee ownership, and the removal of these causes, wherever they exist, would not enable it, generally, to be profitably carried on under present conditions of competition. …
"d. The depression in the industry is causing sugar estates to be abandoned, and will cause more estates to be abandoned, and such abandonment is causing and will cause distress among the labouring population, including a large number of East Indian immigrants, and will seriously affect, for a considerable time, the general prosperity of the sugar-producing Colonies, and will render it impossible for some, and perhaps the greater number of them, to provide, without external aid, for
their own government and administration.
"e. If the production of sugar is discontinued or very largely reduced, there is no industry or industries that could completely replace it in such islands as Barbados, Antigua, and St. Kitts, and be profitably carried on and supply employment for the labouring population. In Jamaica, in Trinidad, in British Guiana, in St. Lucia, in St. Vincent, and to some extent in Montserrat and Nevis, the sugar industry may in time be replaced by other industries, but only after the lapse of a considerable period and at the cost of much displacement of labour and consequent suffering. In Dominica the sugar industry is not at the present day of great importance. We think it right to add that in all Colonies where sugar can be completely, or very largely, replaced by other industries, the Colonies in question will be in a much sounder position, both politically and economically, when they have ceased to depend wholly, or to a very great extent, upon the continued prosperity of a single industry.
"f. The total or partial extinction of the sugar industry would, in most places, very seriously affect the condition of the labouring classes for the worse, and would largely reduce the revenue of the Colonies. In some places the loss of revenue could be met to a limited extent by economies, but this could not be done universally nor in a material degree in most of the Colonies. Some of the Colonies could not provide the necessary cost of administration, including the relief of distressed and necessitous persons, or of the support and repatriation (when necessary) of the East Indian immigrants, without subventions from the mother country. Jamaica, Trinidad, and Grenada may be expected to meet from their own resources the whole of the expenditure that is likely to fall on them.
{699}
"g. The best immediate remedy for the state of things which we have shown to exist would be the abandonment of the bounty system by continental nations. This change would in all probability enable a large portion of the sugar-cane cultivation to be carried on successfully, and would certainly reduce the rate at which it will diminish. Looking, however, to what appears to be the policy of the United States of America, to the great cheapening of the cost of production of beet sugar, and the fact that many countries appear to have singled out the sugar industry as one which ought to be artificially stimulated in various ways, it is not clear that, even if the bounties were abolished, another crisis of a similar character might not arise in the West Indies at a future day.
"11. A remedy which was strongly supported by witnesses interested in the West Indian sugar estates was the imposition of countervailing duties on bounty-fed sugar when imported into the United Kingdom. …
"i. The special remedies or measures of relief which we unanimously recommend are
(1.) The settlement of the labouring population on small plots of land as peasant proprietors.
(2.) The establishment of minor agricultural industries, and the improvement of the system of cultivation, especially in the case of small proprietors.
(3.) The improvement of the means of communication between the different islands.
(4.) The encouragement of a trade in fruit with New York, and, possibly, at a future time, with London.
(5.) The grant of a loan from the Imperial Exchequer for the establishment of Central Factories in Barbados.
The subject of emigration from the distressed tracts also requires the careful attention of the various Governments, though we do not find ourselves at the present time in a position to make recommendations in detail.
"j. We estimate the cost of the special remedies recommended in (2) (3) and (4) of i, at £27,000 a year for ten years, the expenditure to be borne by the mother country. We estimate the amount of the loan to Barbados for the erection of central factories at £120,000. This measure no doubt involves the risk of loss. Grants will be required in Dominica and St. Vincent for roads, and to enable the settlement of the labouring population on the land to be carried out, and their amount may be taken at £30,000. A further grant of about £60,000 is required to clear off the floating debt in some of the smaller islands. In addition, the smaller islands should receive grants to enable them to meet their ordinary expenditure of an obligatory nature. The amount may be placed at £20,000 a year for five years, and possibly a reduced amount for a further period of five years. The expenditure which we are able to estimate may be summarized as follows:
(1.) A grant of £27,000 a year for ten years.
(2.) A grant of £20,000 a year for five years.
(3.) Immediate grants of £60,000 and £30,000, or £90,000 in all.
(4.) A loan of £120,000 to Barbados for the establishment of central factories."
On a proposal for the federation of the West India colonies the Commission reported unfavorably, for the reason that the colonies are too widely scattered and differ too greatly in conditions for an efficient or economical common government.
"Nor does it seem to us," says the report, "that the very important Island of Jamaica, which is separated by many hundreds of miles of sea from all the other West Indian Colonies, could dispense with a separate Governor, even if there should be a Governor-General; whilst the circumstances of British Guiana and Trinidad almost equally demand the constant presence and attention of an Administrator of Governor's rank. It might be possible, without disadvantage, to make some reduction in the number of higher officials in the smaller islands, and we are disposed to think that it would be conducive to efficiency and economy if the islands of the Windward Group, that is, Grenada and the Grenadines, St. Vincent and St. Lucia, were again placed under the Governor of Barbados, as they were for many years previous to 1885. We are also disposed to think that the Island of Dominica, which is not much further than Grenada from Barbados, and which, in its physical, social and industrial conditions partakes more of the character of the Windward Islands than of that of the other Leeward Islands, might be placed under this Government instead of being considered one of the Leeward Group. It might, indeed, be found possible to bring the whole of the Leeward Islands under the same Government as Barbados and the Windward Islands, and thus effect a further economy."
Great Britain, Parliamentary Publications (Papers by Command; C.-8655, 1897, pages 69-70, and 23).
With the sanction of Parliament, most of the recommendations of the Commission were promptly carried out. Provision was made for the construction of roads in the islands; for subsidising steamer lines between the several islands and between Jamaica, Canada and London; for developing the cultivation of fruits and other crops by a botanical department; for establishing model factories for the better and cheaper working of sugar cane; and for wiping off certain debts which were a cause of distress to some of the poorer islands. In these measures the imperial government undertook obligations which might, it was said, involve the payment of £200,000.
WEST INDIES: A. D. 1899-1901. Reciprocity arrangement with the United States.
See (in this volume)
UNITED STATES OF AMERICA: A. D. 1899-1901.
WESTERN AUSTRALIA.
See (in this volume) AUSTRALIA; and CONSTITUTION OF AUSTRALIA.
WEYLER y NICOLAU, General: At Barcelona.
See (in this volume)
SPAIN: A. D. 1895-1896.
WEYLER y NICOLAU, General:
Administration in Cuba.
See (in this volume)
CUBA: A. D. 1896-1897.
WEYLER y NICOLAU, General: Appointed Captain-General of Madrid.
See (in this volume)
SPAIN: A. D. 1900 (OCTOBER-NOVEMBER).
WHEATON, General: Military operations in the Philippine Islands.
See (in this volume)
PHILIPPINE ISLANDS: A. D. 1899 (JANUARY-NOVEMBER).
WHITE, Andrew D.: American Commissioner to the Peace Conference at The Hague.
See (in this volume)
PEACE CONFERENCE.
WILDMAN, Rounseville: Report of proposals from Philippine insurgents in 1897.
See (in this volume)
UNITED STATES OF AMERICA: A. D. 1897 (NOVEMBER). {700}
WILHELMINA, Queen of the Netherlands: Enthronement and marriage.
See (in this volume)
NETHERLANDS: A. D. 1808, and 1901.
