Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation (review)

The Rockefeller Foundation's worldwide initiatives in public health have long been a topic of scholarly investigation, and historians have paid them particularly intense scrutiny over the past two decades—the Rockefeller Archive Center's list of works on the topic now runs some twenty pages. Up until now, however, the foundation's earliest efforts, its International Health Commission's programs against hookworm in Central America and the Caribbean, have not received sustained attention. In Launching Global Health, Steven Palmer has remedied that oversight.

As Palmer relates, even these first International Health hookworm programs did not enter unblazed terrain. The medical understanding of hookworm disease had developed in the latter half of the nineteenth century at the scientific periphery, in Italy, Egypt, and Brazil, locations where recent insertion into the global capitalist economy created at once dense populations and newly disturbed landscapes. Although hookworm infection had been present in human populations around the world for millennia, these two circumstances together provided settings in which individual infestations frequently reached such high levels as to be debilitating or even fatal. The condition drew the attention of local doctors and scientists, and various efforts to address it were already under way by the time the Rockefeller Foundation arrived on the scene in Costa Rica, Trinidad, and British Guiana.

In addition to the challenge of coming to terms with these existing local efforts, the International Health officers faced the need to build—and develop good working relationships with—their local staffs: aside from their wives, the program directors were the only Americans sent by the foundation. This, and the fact that directors had wide latitude in the pursuit of the program mission, meant that the local social and political landscapes had profound effects on the shape of each program and ultimately its effectiveness. In British Guiana and Trinidad, program directors relied heavily on black and East Indian locals to fill key positions, although this unfortunately also worked to limit the programs' influence with the British colonial administration. In these locations, the programs adapted to the colonies' diverse populations by distributing pamphlets crafted to convey the message of hygiene while appealing to customary storytelling conventions, most intriguingly in "The Demons That Turned into Worms," which was presented as a supplement to the traditional cycle of Hindi demon stories. In Costa Rica, local doctors played crucial collaborative roles, leading directly to the expansion of the program from fighting hookworm to providing school health and, in turn, to the creation of a national ministry of public health and social protection. Local doctors would prove decisive to the program in Guatemala as well, but in a very different fashion: the sharp ethnic divisions between the Spanish-heritage elite from which these doctors came and the indigenous population would prove insurmountable.

Palmer marshals an impressive array of detail in documenting the divergent paths of these four programs, convincingly demonstrating that the first steps toward global health do not fit the template of top-down, uniform, and tightly regimented operations described by scholars of later Rockefeller Foundation campaigns. Indeed the limited, even restrained, extent of the programs is striking in contrast to the ambition of the disease eradication efforts that followed. Also, the racialized views of disease and its prevention that historians have documented in Rockefeller Foundation efforts elsewhere were apparently largely absent in these first cases. Palmer has made an important contribution by revealing these differences between the initial forays of International Health and the widely held understanding of its later efforts. The process by which the characteristics of the initial approach of the Rockefeller Foundation to public health were later discarded—or whether some aspects of this approach in fact persisted as an undercurrent in subsequent years—will be a promising avenue for future research on the origins of global health.