Review of Palmer's "Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation" by K. Nehls for H-Environment

Steven Palmer. Launching Global Health: The Caribbean Odyssey of the

Rockefeller Foundation. Ann Arbor University of Michigan Press,

2010. xi + 301 pp. $70.00 (cloth), ISBN 978-0-472-07089-3.

Reviewed by Kathi Nehls

Published on H-Environment (January, 2011)

Commissioned by David T. Benac

Negotiations in Paradise: Rockefeller Health and the "Culture of


Before the Rockefeller International Health Board (IHB) sent its

emissaries of modern medicine into places like Brazil, Mexico, and

the Philippines, the organization initiated several pilot programs in

small and politically friendly locations scattered throughout the

Caribbean. Steven Palmer has written a compelling study of early

Rockefeller health work that focuses collectively on six places "as

an ensemble ... a laboratory" from which the IHB initiated its global

campaign against hookworm disease: British Guiana, Trinidad, Costa

Rica, Guatemala, Nicaragua, and Panama (p. 1). In an analysis that in

some ways is a reversal of north-south technology transfer, Palmer

argues that the IHB initiated its international work in this

periphery because local medical professionals had already established

hookworm programs and research initiatives on which the U.S.

organization could build its own public health project.

Palmer's thesis is sure to spark significant debate. He challenges

the consensus in recent Rockefeller scholarship by authors Warwick

Anderson (_Colonial Pathologies: American Tropical Medicine, Race,

Hygiene in the Philippines_ [2006]), Anne-Emanuelle Birn (_Marriage

of Convenience: Rockefeller International Health and Revolutionary

Mexico_ [2006]), John Farley (_To Cast Out Disease: A History of the

International Health Division of the Rockefeller Foundation,

1913-1951_ [2004]), and others (including contributors to Marcos

Cuerta's edited collection _Missionaries of Science: The Rockefeller

Foundation & Latin America_ [1994]), all of whom argue that Western

elites universally imposed their particular brand of medicine in a

top-down, donor-driven process that often conflated disease and race.

According to the author, local actors and indigenous medical programs

were central to the construction of public health in the region.

Rather than imposing a clear-cut set of health policies and practices

on the people of these Caribbean nations, the IHB operated what

Palmer called "a culture of experimentalism" (p. 210). He

convincingly argues that the IHB's work was a highly negotiated

process, not only between Rockefeller field workers and local

populations, but also between the IHB officials and the region's

medical officers and politicians. According to Palmer, early programs

initiated throughout the Caribbean were adaptations of both the host

countries' practices and the institutional prerogatives of the IHB.

Rather than being wholly Western or wholly indigenous, the programs

reflected a synthesis of the two.

The narrative's focus on the grassroots pushes the discussion beyond

the top-down, institution-driven perspective the author acknowledges

contributed to "a certain homogeneity in the scholarly literature on

Rockefeller public health philanthropy" (p. 246). His work draws on

the manuscript collections of the Rockefeller Archive Center, the

National Archives of Great Britain, and several other institutional

and private paper collections. What really sets this work apart,

however, is extensive research in the national archives of Costa Rica

and Guatemala and his exploitation of a rich collection of

Spanish-language manuscripts, local and regional periodicals, and

medical and scientific journals. In addition to showing how

indigenous medical professionals actively shaped early programs,

these documents also provide insight on the cultural and political

meanings local people ascribed to U.S. health efforts and to the

diseases that ravaged native populations.

Cooperative arrangements were a hallmark of the Rockefeller

philanthropies and often enmeshed field personnel in local politics

and policy squabbles. Field administrators frequently acted in a

diplomatic capacity meeting with heads of state, even accepting

appointments within the health system of the host state to accomplish

their goals. Rockefeller personnel adapted easily to local social,

cultural, and political conventions, even if at times their work bore

little resemblance to their institutionally approved corporate models

and goals. Palmer demonstrates handily that in more cases than not,

local influences trumped those of the IHB. Nonetheless, Rockefeller

physicians, throughout the Caribbean, drew significantly on models

first developed in the U.S. South, where scholars like William A.

Link and John Ettling have shown that Rockefeller representatives

also followed local conventions of culture and race and involved

themselves in provincial politics as necessary.[1] Perhaps, then, the

question Palmer's account raises is whether we have built up an

artificial wall between health policy development in the metropole

and colony. This question deserves further research; as Palmer's

account ably demonstrates, more studies are also needed on how policy

played out at the local level.

Palmer contributes a much-needed comparative perspective to this

growing body of scholarship, which previously has been dominated by

single nation studies. One of the most compelling comparisons he

draws is not between Caribbean countries, or even between host

countries and the United States, but between the medical personnel of

the United States and Great Britain. His inclusion of British

colonial possessions illuminates the somewhat contentious rivalries

between British and American medical personnel and the way in which

World War I acted as an engine of change. His narrative suggests that

as American physicians replaced British personnel called home to

serve on the Western Front, "even if only in this one limited domain

of public policy--[the effect] registered an early passing of the

imperial baton" (pp. 88, 206). Palmer intriguingly posits that

British and American approaches to hookworm treatment reflected the

political character of their respective state apparatus. British

treatment of hookworm disease entailed repeated small doses of Thymol

(the substance used to treat hookworm infestations) over an extended

period of time, whereas the preferred IHB treatment used stronger,

sometimes potentially fatal, doses that effected a cheaper and more

immediate cure. Palmer suggests that the slower process used by

British physicians reflected their long-term, historically coercive,

colonial relationship to the indigenous population. The Americans

preferred instead to map the population of a region and quickly move

methodically across a geographic grid. According to Palmer, this

systematization reflected the IHB's policy for planned obsolescence

in health projects, and also signaled a more democratic, corporate,

managerial, and mass-produced approach to health that sought to

exploit economies of scale.

Although not an environmental history per se, Palmer's

work--particularly the first chapter--fits comfortably among recent

studies by Linda Nash, Gregg Mitman, and Paul Sutter that examine the

intersections of environmental change and health. Citing construction

of St. Gothard's Tunnel and the Panama Canal as examples, Palmer

locates the spread of hookworm disease at sites where capitalist

trade networks intersected with large-scale technological disruptions

of socio-ecological systems. The author tracks hookworm along global

trade networks where concentrated populations provided labor for

export agriculture; industrial capitalism; and the construction of

rail systems, tunnels, bridges, and canals. As in Panama, American

personnel operating in tropical regions often failed to account for

environmental differences, and their actions sometimes produced

unintended consequences.[2] Similarly, Palmer explains how the number

of malaria cases in Costa Rica increased following the building of

privies as part of public health efforts to combat hookworm disease.

The newly installed latrines attracted mosquitoes and tended to flood

during the Costa Rican rainy season. Public health officials had

failed to take the region's abundant rainfall into account, thus

creating a different, but equally insalubrious, situation for

residents. The local people reacted to the new problem by destroying

the vaults after public health officials moved on to their next


In his conclusion, Palmer does not attempt to address the success or

failure of the programs. Rather, he looks for patterns of what worked

and what did not, and the adaptations that grew out of a negotiated

range of practices and treatment procedures. In so doing, he

concludes that IHB personnel developed "a repertoire of international

institutional methods and knowledge" (p. 210). I thought this choice

of assessment was satisfying and in keeping with his larger argument

that hookworm and public health programs which developed in these

earlier pilot programs were the product of a negotiated process,

rather than simply imposed on local populations. Moreover, the

ability to adapt to local conditions gets to the heart of what made

the Rockefeller philanthropies a major player in the construction of

global public health throughout much of the twentieth century. While

individual programs varied in method, what stayed constant was the

ability to work well with local socioeconomic conventions, the

ability to be flexible in terms of institutional objectives, and the

willingness to engage significantly in local politics. This volume is

a welcome contribution to the growing body of literature on the

Rockefeller philanthropies and will be important for early

twentieth-century scholars studying the history of medicine, public

health, capitalism, labor, and empire.


[1]. William A. Link, _The Paradox of Southern Progressivism,_

1880-1930 (Chapel Hill: University of North Carolina Press, 1992),

212-222; and John Ettling, _The Germ of Laziness: Rockefeller

Philanthropy and Public Health in the New South_ (Cambridge: Harvard

University Press, 1981), 135-151.

[2]. Paul Sutter, "Nature's Agents or Agents of Empire: Entomological

Workers and Environmental Change during the Construction of the

Panama Canal," _Isis_ 98, no. 4 (December 2007): 740.

Citation: Kathi Nehls. Review of Palmer, Steven, _Launching Global

Health: The Caribbean Odyssey of the Rockefeller Foundation_.

H-Environment, H-Net Reviews. January, 2011.