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

At the time of writing this review the World Health Organization is in the final stages of appointing a new Director General. The field has been narrowed down from six candidates to three, who will now go forward for selection by the World Health Assembly in May. By the time this review is published the new Director General, the eighth since 1948, will be in position, and the organisation will be preparing to mark its seventieth anniversary. The WHO and its partners around the world can look back on successes such as the landmark eradication of smallpox and improvements in health for millions around the world, but also much unfulfilled promise. The world is still reeling from the mismanagement of the Ebola crisis, diseases such as malaria or polio have yet to be eradicated despite considerable resources being aimed at these goals, and the rising burden caused by noncommunicable diseases continues to cause alarm around the world. In all, this is an important time to survey the landscape of global health history.

'A History of Global Health' begins with the most recent Ebola outbreak, which is painted as a 'symptom of a larger, global health-care crisis' (p. 5). But Randall Packard argues that Ebola and many health issues of the more recent past 'have a history', with the 'central motivations, organizing principles and modes of operation' which characterize present day global health assistance stretching back to the early twentieth century (p. 7). There are for Packard many continuities, such as an enduring obsession with magic bullet solutions; health interventions developed outside of the countries where the health problems exist; little attention given to supporting the development of basic health services; and an imperative to act fast at the expense of building health infrastructure and training personnel. The book's avowed aim is to provide an historical context for understanding the current global health-care crisis and explain why, despite the investment of billions of dollars aimed at improving global health, basic health services, public health infrastructure, and the underlying social and economic determinants of ill health have received so little attention. Divided into seven parts, the sixteen core chapters provide a detailed account of efforts directed at improving health from the early twentieth century up to the present day. The reader is introduced to the interconnections between colonial medicine and international health, the subsequent establishment of the League of Nations Health Organization and attempts to propagate a worldview of health as a broader means of achieving peace. The burgeoning progress towards social determinants of health is described as well as its disruption by the Second World War, which in turn heralded a narrowing vision of international health based on science and technology influenced by Cold War politics. The book then changes gear to focus on disease-specific programmes against malaria and smallpox, and initiatives aimed at population control. The revisualisation of health centred on the movement for primary health care in the 1970s and 1980s is treated in detail, before closing out with a rapid account of the birth of global health and the Ebola response.

The stated aim is to produce a book for all interested in global health, be they students, academic historians, program managers and policymakers. It undoubtedly achieves this, providing a highly readable and engaging account, which succeeds in giving a critical historical overview of international health matters across the twentieth century and into the twenty-first. As the author notes it is largely 'synthetic', based on earlier research conducted during the author's long career in the field, his own experience serving as a Peace Corps volunteer in the 1960s, and drawing together scholarship from multiple disciplines on an area which in the last twenty years has witnessed an explosion of interest. Written in an accessible and appealing style, the book follows a reasonable course weaving the...