Book review about "A History of Global Health: Interventions into the lives of other peoples" by Randall M. Packard (2016)
Essay 2020 5 Seiten
“A History of Global Health: Interventions into the lives of other peoples”
by Randall M. Packard (2016)
The history of international health is the main topic of this book. Since the 1900s billions of dollars have been spent on programs to improve global health. Historian Randall Packard examines why people in developing countries do not have the access to sanitation, clean water and hospitals even though billions of dollars have been invested in global health programs since the last century. The book starts and ends describing how the Ebola outbreak has started in West Africa and led to the global healthcare crisis due to the lack of basic health services such as underpaid staff, drug shortages, test laboratories, basic equipment (gloves, syringes, bandages) and hourly paid doctors became infected with a greater fear of losing a job rather than losing a life.
Global healthcare is funded by big international organizations such as World Bank, WTO, UNICEF, by bilateral organizations of China, the US, the UK and by private investing of philanthropies such as Bill and Melinda Gates Foundation. These organizations send researchers, physicians, project officers, health educators, pharmaceutical and chemical corporations supported by dozens of NGOs to developing countries. All this multi-billion dollar investment and the army of educated staff have developed vaccines, vitamin A, to attack specific health problems but have failed to invest in building the infrastructure for managing the health problems of local populations. The author claims that this trend is not new, it has been repeatedly stretched back throughout the history from early 20th century.
Early interventions by international-health organizations were developed from the traditions of colonial rule which were based on ideas of “the pathology of native populations” (p. 19). Basically, colonial people couldn’t improve their own health, so this fact was followed by the development of international health. Part 1 of the book describes how America’s colonies such as the Caribbean, Panama and the Philippines formed certain practices, attitudes and staff that would form the foundation of international health institutions in the past century. R. Packard brought up the example of the movement of colonial medical officers into the Rockefeller Foundation’s IHB and how these workers played a main role against hookworm and yellow fever. Their knowledge, ideas and expertise helped to train other international health workers through schools of tropical medicine in Asia, Europe, Latin America and the US which led to the formation of the world of international health.
Part 2 shows how LNHO moved from collecting statistics to developing of technological solutions of health issues such as a rural hygiene and nutrition in Europe right after WW1. The author argues that there were big chances to improve international health back then, but achievements were failed due to a limited understanding of local cultures. They were mostly concentrated on the “scientific solutions such as effectiveness of tuberculosis vaccine rather than addressing the structural conditions of patterns of bacterial deceases” (p. 69)
Part 3 describes how epidemics and a low access to food after WWII in Europe and Asia required immediate responses that could not wait for long-term strategies. During the post war crisis international health enthusiasts created a new technologies and innovations such as discovery of DDT which allowed to address malaria, the plague and typhus. Furthermore, the founders of UNRRA, FAO and WHO were committed to a new vision of international health improvements such as setting principles that 1. Health isn’t just absence of illness/disease, it’s overall well-being. 2. Everyone has the right to access a good health care. 3. Governments have the responsibility to provide a health care.
In part 4 the author examines the history of campaigns against malaria and small-pox which were dominated in international health activities in the 1960s. The eradication of these two campaigns were launched despite many technical concerns, a low budget and resources. The decisions were made as a political strategy and biomedical technology than actual research and planning. The campaigns had different outcomes – SEP had a better administrative assistance led by D. Henderson that helped to adapt the programs into local and cultural conditions in India, Pakistan and Bangladesh. Also, the strategies of the campaign refocused attention from technologies to solve health problems. In comparison MEP lacked “flexibility and adaptability, developed poor planning without knowing the biological challenges it faced” (p. 165).
In part 5 R. Packard explores the growth of world population which became a central element of technical assistance from the 1960s to the 1980s. He points out that WHO and UN agencies did not coordinate efforts to modify reproduction programs and population issues in developing countries for political reasons. Most work was done by NGOs and local-planning associations which were funded by private foundations and multilateral agencies. Later on, the US became the largest sponsor of family-planning programs in the world. These programs simply showed a value of small families by using contraceptives which changed the vision of international health. By the 1980s US, UNFPA and World Bank decided to withdraw financial support for family-planning programs, so they became less about limiting populations and more about protecting health of women and children by the 1990s.
Part 6 describes a revolutionary vision of international health at the Alma-Ata Conference which represented a radical change from the standard technical assistance to commitment to community participation in addressing social and cultural sides of health. Unfortunately, this strategy of PHC model didn’t live long than 5 years due to expenses of human resources requirements which led to selective PHC. Moreover, during global recession in the 1980s it was difficult for states to invest because they were borrowing from IMF which required to follow structural adjustment policies and reduce spending in health services.
The final part 7 shows how in the 1990s and the 2000s the international health turned to be “a set of practices, organizations and ideas” (p. 273). More programs against HIV/AIDS and more funding by World Bank were prioritized for global health field. NGOs and private sector were more useful than national governments. Finally, the growing role of biomedical technologies contributed to evidence-based medicine which led to return to roots of medicalization of international health system. This medicalization and commodification led to weakening of the health services in Liberia, Sierra Leone, Guinea and many other countries.
This book gives an interesting discourse about history of international health. It has been started from the changing the landscape of the global health with colonial practices, narrowed technological approaches to eliminate illnesses, having pressure from the main donors, tied funding, politicized decisions of international organizations to a former version of the system. R. Packard stresses that decisions on global health have always been made from locations that are from the affected locations. “It’s wrong to send initiatives to developing countries being outside of developing countries or “parachuting the agent” to help solving health issues without the cultural and social background” (p. 241). The book also describes how international organizations are slow in making decisions because of political demand. For example, it took a while when WHO called COVID 19 as a pandemic and didn’t respond fast and effectively.