A History of Global Health: Interventions into the Lives of Other People by Randall M. Packard (review)

A History of Global Health: Interventions into the Lives of Other People is an intriguing account of the twentieth-century development of global health initiatives, which, in Packard’s opinion, despite many successes, have ultimately failed to improve the overall health of many people and communities across the world. Packard’s study begins with a timely account of the recent Ebola outbreaks. He uses this as a catapult for arguing that such problems, and the responses to them, have a long history that stretches back to colonial times. Packard concedes that the current scale and complexity of global health assistance is unprecedented. However, he insists, quite convincingly, that the central motivations, organizing principles, and modes of operation that characterize present-day global health initiatives are far from new and are, in many ways, a legacy of earlier global interventions, successful or otherwise. This book is about the history of these interventions – of what has been invariably called technical assistance, development assistance, international health, and, before that, tropical and colonial medicine. Packard’s key stated aim is to explain why, despite billions of dollars having been invested in global health programs, basic health services, public health infrastructures, and the underlying social and economic determinants of ill health have been so neglected over time.

Packard does not set out to relentlessly critique. Moreover, he refrains from telling a story of unhelpful Western oppression. Instead, he offers a nuanced, but ultimately critical, account of global health initiatives. While balanced, it is an account of an unwillingness or inability of successive governments to fund health services, particularly in rural areas. It is also a long history of neglect on the part of multinational and bilateral aid donors whose financial aid, Packard argues, was rarely directed toward training health workers or building suitable health-care infrastructures. In Packard’s opinion, too little attention was given, historically, toward the social determinants of ill health. Clinics were certainly built, but these could only ease the broader unresolved problems caused by a lack of sanitation and access to clean water. Packard also questions efforts by Western (or Global North) governments and organizations that focused primarily on a faith in Western biomedical technologies – be they vaccines, anti-retroviral drugs, insecticide-treated bed nets, or Vitamin A tablets. These vertically organized programs were usually only loosely connected to the recipients’ national health systems. Packard’s final criticism is that health interventions were too often planned only in crisis environments.

To tell the history of all of this in a concise book was undoubtedly challenging. Nonetheless, despite its ambitions, A History of Global Health is a highly accessible and readable book. Spread over 16 chapters and seven different sections, Packard provides what is certain to be a key text for academics and students alike in this important subject area. The book opens in colonial times and argues that the knowledge produced in colonial settings was subsequently transferred into the world of twentieth-century international health. Over time, the intersection of colonial medicine and international health transformed colonial ideas into a kind of international enterprise about the health problems of the “tropical” or “developing” world. Colonial ideas became naturalized as global health science.

Although social medicine initially informed global health initiatives, Packard argues that, from the 1950s, the World Health Organization mostly advanced programs intent on delivering biomedical technologies with the aim of eliminating diseases, one at a time. As Packard’s exploration of smallpox and malaria eradication demonstrates, these met with varying degrees of success. Packard then argues that the twentieth-century emphasis on population control and family planning activities (worryingly stemming from earlier eugenic ideas) diverted attention and resources away from efforts to build and strengthen health-care systems or address the underlying determinants of health. Subsequent sections examine areas such as primary health-care initiatives of the 1970s and an ever-growing reliance on the use of biomedical...