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
Experimentalism"
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
destination.
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.
Notes
[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.