Kenneth Warren and the Great Neglected Diseases of Mankind Programme: The Transformation of Geographical Medicine in the US and Beyond by Conrad Keating (review)

Kenneth Warren is a largely forgotten name in global health (GH) circles. But during the 1970s and 1980s, he was a force to be reckoned with. A researcher of some note in the field of parasitology, he was appointed in 1978 as director of health sciences at the Rockefeller Foundation, marking that institution's return, after several decades absence, to intense activity and significant influence in international Health. Under his tutelage, two major programs were introduced. The Great Neglected Diseases of Mankind Program (GND) in 1977, conceived of and led by Warren himself, sought to stimulate sophisticated biomedical molecular research on diseases of the Global South. The program offered ten years of guaranteed funding for handpicked scientists in various fields to work on parasitic and other mainly tropical diseases, with required annual meetings of the entire network. The scientific results were impressive, according to some path-breaking, although critics claimed that Warren took credit for discoveries that had been mainly financed by other agencies, with only minimal contributions from GND. Meanwhile, his deputy, Kerr White, a pioneer of Health Services Research at Johns Hopkins University, set up the International Clinical Epidemiology Network, or INCLEN, to create and strengthen in medical schools training programs providing physicians with the expertise—first in epidemiology, and later also in health economic and social sciences—needed to manage scarce health resources in developing countries.

Outside the tropical disease research community, Warren is best remembered as co-author of an influential article offering an alternative to the flagship program of the World Health Organization. Under the direction of its charismatic director general, Halfdan Mahler, the organization developed a proposal for Primary Health Care (PHC) famously endorsed in the Alma Ata Declaration of 1978. This was an ambitious vision for bringing the essential conditions for good health—from sanitation and food supply to family planning and the treatment of common ailments—to even the poorest, of the world's populations. Soon after, Warren and Julia Walsh presented and then published a paper arguing that PHC, as formulated in Alma Ata, was not feasible "in an age of diminishing resources." They proposed an "interim" strategy, Selective Primary Health Care' (SPHC), for identifying a few priority measures on the basis of their low cost and high impact on widespread causes of morbidity and mortality. Although this strategy was taken up by several international donors, notably UNICEF, Warren and his supporters increasingly focused less on specific measures and more on methods of determining both priorities for research and action and the most effective and least expensive solutions to a large variety of health problems. Both judgments were best made through use of metrics. There is a direct link between SPHC and the World Bank's World Development Report of 1993, widely considered the most influential GH text of the 1990s.

Keating's book is a curious hybrid. On one hand it has been funded by a foundation headed by Anthony Cerami, Warren's close friend and colleague. It is clearly meant to re-establish Warren's reputation as a pioneering figure. On the other, it is very professionally done. Keating is Writer-Residence at the Wellcome Unit for the History of Medicine at Oxford University and author of a previous biography of Sir Richard Doll. The result is a book that is heavy on personal recollections of colleagues and friends, with lots of photos, many repetitious but a few quite priceless. (I think especially of the one of Warren in intense conversation with Halfdan Mahler on p.69.) There is much excessive detail based on these recollections. Few readers will care that his wife was an excellent gardener. On the other hand, there is the occasional witty and perceptive image; his friend and colleague Michael Sela said of him that "he was...