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BOOK REVIEW: 'ERADICATION'

Friday, 20th of July 2012

• BOOK REVIEW: ‘ERADICATION’ 

From The Lancet Infectious Diseases

, Volume 12, Issue 5, Page 372, May 2012

 

Eradication: ridding the world of diseases forever?

Original Text

Salmaan Keshavjee

Eradication: Ridding the World of Diseases Forever?

Nancy Leys Stepan, Reaktion Books, 2011, £25·00, pp 312 ISBN-978-1861898616

In this well researched and well written book, historian Nancy Leys Stepan uses the diaries and aspirations of Fred Soper—former Director General of the Pan American Health Organization, described in the book as an arch-eradicationist—to recount a social history of public health. In so doing, she critically analyses the very idea of eradication, exposes the weak scientific basis of many of the past century's greatest battles against disease, and provides lessons for the challenges that lie ahead.

Stepan argues that the drive for eradication of disease was linked to the reliance on scientific solutions to social problems—the triumph of technology over disease—and the idea that eradication would improve economies, rather than the other way around. After World War 2, Stepan contends that the absence of the Soviet bloc from participation in WHO until 1958 allowed politicians to use a very narrow interpretation of international health in which social, political, and economic determinants of disease took a back seat to technocratic, vertically structured eradication campaigns that did not require the involvement of political or economic life. This approach continued after the Declaration of Alma Ata with selective primary health care and a health agenda dominated by the World Bank.

For those involved in addressing the diseases of our time, Stepan's work is a must-read. Her analysis of the public health successes and missteps of the past century serves as a thorough examination of dos and don'ts that are to be ignored at great peril. For example, Stepan links the failure to eradicate yaws, despite years of effort, to the neglect of latent, sub-clinical cases, the absence of health services capable of taking over vertical programmes on a routine basis, lack of grass-roots support, and failure to address patients' economic and political circumstances (eg, rural poverty, poor housing, poor sanitation, and other structural factors). This is familiar territory for those engaged in the daily struggle for access to treatment for HIV, tuberculosis, malaria, and other communicable and non-communicable diseases.

Sadly, Stepan does not end on a high note. She suggests that although some models of integration exist—moving us beyond the narrow scope of the eradicationists and towards more comprehensive health care—little has changed in the global health architecture. We live in a world with weak international health institutions and dominated by so-called philanthro-capitalist foundations that still believe in technological solutions as a panacea to the ills and diseases of poverty. I hope that Stepan's lesson on the recent history of public health will provide much needed food for thought.