Anne-Emanuelle Birn

Gates's grandest challenge: transcending technology as public health ideology.

The numbers are as plain as 1-2-3. Over one million annual deaths from malaria, almost two million from tuberculosis, and more than three million from HIV/AIDS, most of which occur in underdeveloped countries. 1 Among the young, the situation is even more jarring: 2·4 million children dead from perinatal causes, another 1·9 million from lower respiratory infections, 1·6 million from diarrhoeal diseases. And on and on. At the same time, the approximately US

The stages of international (global) health: histories of success or successes of history?

75 billion a year globally spent on medical research all but ignores the problems of the developing world, as expressed in the so-called 10/90 gap, whereby only 10% of health sciences’ research dollars address the health problems of 90% of the world’s population. 2,3 Moreover, only a small portion of this research is published in major medical journals. 4

Income redistribution is not enough: income inequality, social welfare programs, and achieving equity in health

Abstract International1 health funders, leaders and researchers frequently cite ‘successes’ in this field as validation for past labours and justification for future endeavours. However, the question of what constitutes success – from both historical and contemporary perspectives – has been inadequately analysed. This paper reviews and periodises understandings of success in international/global health during the past century and a half, mapping out shifts and continuities over time. It then turns to the implications of these changing conceptualisations for current and future global health ideologies, strategies and activities. It concludes by arguing that historians of global health and policymakers need to interact further so that historians are exposed to the contemporary problems of global health and policymakers better understand the historical complexity of extracting ‘lessons’ from the past.

Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop

Income inequality is widely assumed to be a major contributor to poorer health at national and subnational levels. According to this assumption, the most appropriate policy strategy to improve equity in health is income redistribution. This paper considers reasons why tackling income inequality alone could be an inadequate approach to reducing differences in health across social classes and other population subgroups, and makes the case that universal social programs are critical to reducing inequities in health. A health system oriented around a strong primary care base is an example of such a strategy.

Federalist flirtations: the politics and execution of health services decentralization for the uninsured population in Mexico, 1985-1995.

Rapidly rising interest - from national and international health organisations, governments, civil society, the private sector and myriad academic disciplines - in what has become known as the ‘social determinants of health’1 2 is welcome to the many, in and outside of public health, who have long held that issues of social justice and the publics health are inextricably linked (box 1).2 3 As inevitably happens, however, when an issue gets ‘mainstreamed’, a multiplicity of disparate voices enter the discussion, informed by not only different disciplinary vantages, but also divergent values, priorities and politics. ### Box 1 Political, historical, intellectual and economic context of a Latin American/North American discussion about societal determinants of between-country and within-country health inequities 1. Political, historical, and intellectual context 1. Explicit efforts to develop theories articulating the causal connections between political economy, social injustice and health inequities can readily be traced back to the mid-19th century.2–8 Examples include the European writings of Rudolf Virchow (1821–1902) and Friedrich Engels (1820–1895) in the 1840s, as linked to societal upheavals spurred by the rise of industrial capitalism, along with their subsequent elaborations in the early 20th century by European, North American and Latin American analysts and politicians, such as Chilean president Salvador Allende (1908–1973), variously concerned with the health impact of political and economic systems, and political and economic injustice, both within and across nations and regions.2–6 More recent antecedents include: A. the rise of critical science frameworks during the 1960s and 1970s, including within the health fields, as spurred by post-World War II national liberation and anti-imperialist movements along with the emergence of worldwide social movements regarding racism, indigenous rights, gender, sexuality, human rights and the environment (ecology), and B. since the mid-1990s, a …

Skirting the issue: women and international health in historical perspective.

Around the world health services delivery systems are undergoing decentralization, responding to pressure to increase equity, efficiency, participation, intersectoral collaboration and accountability. This study examines the Mexican health decentralization efforts of the past decade to discern the motivations for the reform, the context for its implementation, the politics of its downfall, and the reforms impact at subnational levels of government. Sparked by economic crisis and pressure from international creditors for fiscal reform; demands for greater democracy, equity, and quality; and technocratic impulses to rationalize health services delivery, the decentralization reform could not overcome the authoritarian centralism of the federal government and its corporatist clients. In the end, even in the most technically capable states, the reform was unable to overcome political obstacles to decentralizing fiscal power, redistributing resources in an equitable fashion, and eliminating the inefficiencies of separate but unequal health systems for social security recipients and the uninsured population.

O nexo nacional-internacional na saúde pública: o Uruguai e a circulação das políticas e ideologias de saúde infantil, 1890-1940

Over the last decades women have become central to international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of womens health. This article explores the origins of this paradigm as demonstrated in the emergence of womens health in the Rockefeller Foundations public health programs in Mexico in the 1920s and 1930s. These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles. Womens health and social advocacy movements in Mexico and the United States partially shaped this interest. Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundations underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor. The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt--or sidestep--major concerns that are integral to the health of women.

Public health policy paradoxes: science and politics in the Rockefeller Foundation’s hookworm campaign in Mexico in the 1920s

This paper examines the emergence of child health policy as a global concern from the perspective of Uruguays interaction with the international public health community in the early 20th century and its role in the circulation of child health ideas and practices. It considers two facets of national-international interplay: a) Uruguays exploration of and interrelationship with the international panorama of policies, research and lessons on the improvement of child health; and b) the translation of Uruguays domestic debates into the influential Instituto Internacional Americano de Proteccion a la Infancia - IIPI and the purveying of Uruguays policies, research, and lessons on child health improvement to other countries and to international health and welfare agencies.

Beyond patents: The GAVI Alliance, AMCs and improving immunization coverage through public sector vaccine production in the global south

The origins of US international health endeavors are intertwined with the Progressive Eras faith in science as arbiter of humankinds secular problems. No agency better exemplifies the periods confidence in science than the Rockefeller Foundations International Health Board (IHB), which set out to export the new public health theory and practice around the world. An examination of the IHBs hookworm program in Mexico in the 1920s demonstrates that, notwithstanding the Rockefeller Foundations (RF) self-conscious commitment to scientific neutrality, its programs continuously engaged political criteria, exhibiting the competition, coexistence, and inseparability of the worlds of science, politics, and international health policy. Analysis of the programs quotidian decisions and larger strategies further reveals the protean quality of RF science-politics, which enabled responses to parochial and broadly-conceived needs at multiple levels. In the focus on hookworm, the selection of campaign sites, hookworm diagnosis methods, treatment procedures, definition of cure, and the assignment of responsibility for prevention, scientific and political considerations were inextricably bound. The science-politics paradox was molded by the hookworm programs constituencies in Mexico, including political leaders, health bureaucrats, physicians, business interests, public health workers, peasants, and Rockefeller officers. The multiple, often contradictory, roles of the RFs hookworm campaign are characteristic of the policy paradoxes that emerge when science is summoned to drive policy. In Mexico the campaign served as a policy cauldron through which new knowledge could be demonstrated applicable to social and political problems on many levels. The repeated pledge of scientific neutrality belied the hookworm programs inherent aim of persuading government officials, the medical community, business interests, and the populace of the value of investing in public health as a means to improve social conditions, further a medical model of health and sickness, increase economic productivity, and promote good relations between the US and Mexico.

Child health in Latin America: historiographic perspectives and challenges

Comments on Donald Lights article from previous issue. http://www.landesbioscience.com/journals/vaccines/article/14919/