The persistent underdevelopment of health in the Third World belies the optimism of the "Health care for all by the year 2000" campaign. In order to understand the underdevelopment of health, it is essential to examine the historical evolution of specific health systems. These ideas are developed in a case study of health care in Kano State, Nigeria. The nature and contemporary development of the health care system, which includes state voluntary agency and private sector outlets for Western scientific medicine and a large and varied traditional medicine sector, are examined. Although the deepening health care crisis may potentially spur a reconsideration of priorities and strategies, past experience suggests that a stubborn retention of a pared-down and increasingly unjust version of the present system is more likely.