Medical anthropologists have frequently limited themselves to studying cultural factors in illness, curing or resistance to the acceptance of modern Western medical services. This prevailing “socioculturalist” approach has serious analytical shortcomings resulting from underestimating the importance of the social formations in which cultural factors occur. Consequently, the policy recommendations produced in medical anthropology are often crippled by theoretical limitations. It is argued that the historically specific constellation of social relations governing production and the appropriation and distribution of the economic surplus‐commonly embodied in the functions of the state‐have profound effects on the pattern of health and illness as well as on the availability of health services. In underdeveloped countries an analysis of the role of the state in health is especially important, since the organs of state power play a stronger role in health care than in countries with well developed markets for medical services.In the case of Sudan, the interests of the state in colonial and postindependence periods required a development strategy involving large‐scale irrigated agriculture utilizing seasonal migrant labor. The labor and health policies aimed at economic productivity and political stability are analyzed here in relation to the adverse health effects and serious maldistribution of health services which