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How shall we improve human health? One answer is: by eradication. The Gates Foundation announced in 2007 that their goal is malaria eradication; another of their priorities is polio eradication. Eradication means the complete elimination of a disease through deliberate human intervention. It stands for an absolute in public health.
This book by the award-winning historian of medicine Nancy Leys Stepan is an accessible, beautifully written, and deeply researched examination of one of the most controversial issues in public health today. The eradication of disease might seem like an absolute good. But critics of eradication argue that the huge resources needed to achieve eradication could be better allocated toward developing primary health services and general improvement in health.
This book aims to look at the benefits and drawbacks of single-minded efforts to rid the world of particular diseases, one at a time. The sweep of the book is impressive, from the origins of the idea of complete eradication in the early twentieth century until the present-day campaigns against polio, Guinea worm disease, and now malaria. The author places eradication's story in its many contexts, from imperialism, changing notions of public health, the history of medicine and its technologies, the development of international health agencies such as the World Health Organization, and the impact of the Cold War on the shift of attention to disease in developing countries.
At the center of this narrative is Dr. Fred Lowe Soper (1893–1977), a U.S.-trained doctor who became the arch-eradicationist of his time. His campaigns to eradicate hookworm disease, yaws, yellow fever, malaria, and smallpox are treated in compelling detail, as are the roles of international health agencies such as the Rockefeller Foundation and the World Health Organization.
Throughout the book Stepan draws attention to the way that the ideal of eradication has repeatedly arisen, phoenix-like, from its setbacks. In a powerful conclusion, she uses the example of the current campaign to eradicate Guinea worm disease to argue that, today, under the right circumstances, eradication and primary health care need not be in conflict, as they were in the past, but can form mutually reinforcing policies to improve the health and well-being of populations, especially the poorest and most disease-burdened populations of the world.
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Nancy Leys Stepan is Professor Emeritus of History at Columbia University. She is the author of Eradication, "The Hour of Eugenics": Race, Gender, and Nation in Latin America and Picturing Tropical Nature, all from Cornell.Review:
"In Eradication, noted medical historian Nancy Leys Stepan objectively explores the origin, development of, and controversy surrounding eradication programmes during the past century―warts and all . . . . This book should be required reading for all who are concerned with global health development; Stepan offers a uniquely knowledgeable insight into the evolution and controversies intrinsic to the important idea of eradication and its contributions to world health."―Donald A. Henderson, The Lancet
"Stepan uses a historical context to examine today's global infectious disease control efforts, the impact of the new 'philanthro-capitalists' on international health priorities and processes, and the push toward new eradication targets. She raises important questions about whether it is ethical to devote massive resources toward single-disease programs rather than supporting health infrastructure development more generally. This well-written, accessible book is about the future of global health as much as it is about the history of public health."―Choice
"Stepan has written an important and fascinating book on the evolution of disease eradication. She follows the concept from the early twentieth century, when science held huge promise, to the recent pledge by the Gates Foundation to eradicate malaria. The book serves as a reality check for anyone vulnerable to the seductions of noble goals and modern science. Stepan raises a series of provocative questions. For example, would the vast resources spent on eradication campaigns have bought more health if they had been devoted instead to strengthening health systems?"―Health Affairs
"Nancy Leys Stepan's monograph is an excellent study of the idea of eradicating disease and of the many efforts, mostly unsuccessful, to completely eliminate a variety of infectious diseases. The concept of eradicating disease grew out of discoveries of the disease-causing microbes subsequent to the nineteenth-century bacteriological revolution. Stepan raises the important question of whether disease eradication is possible or worth the effort."―Daniel J. Wilson, American Historical Review (2012)
"Stepan's history of eradication efforts gives you a good sense of how involved the work can get, how many different kinds of approaches have been tried without success, and how much we’ve learned from our failures. She writes in a fairly academic style that may make it hard for non-experts to get to her valuable arguments, but it’s worth the effort. You come away from it with a clearer sense of how we can use the lessons of the past to guide future efforts to save lives."―Bill Gates, "The Best Books I Read in 2015"
"It would be difficult to overestimate the value of this book. Clearly written and persuasively argued, Eradication should be required reading for anyone interested in global health past or present. Nancy Leys Stepan provides not only a significant account of the history of eradication but also deeper insight into the history of international health institutions, imperial and Cold War politics, medical funding and philanthropies, and the globalization of biomedicine. Because Stepan writes so accessibly and weds her analysis to astute contemporary commentary, her book speaks to multiple audiences, including practitioners themselves."―Helen Tilley, historian of medicine and author of Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870–1950
"It is very important finally to have a history of eradication, especially one of such quality and comprehensiveness that considers local, national, and international experiences. Nancy Leys Stepan is a celebrated scholar who has conducted pathbreaking research on malaria, yellow fever, and smallpox. To eradicate or not to eradicate has been and continues to be an issue of central concern in global health. Stepan's history forces us to ask, is it politically wise and socially useful and just to eradicate disease and, if so, what conditions and past experiences must we take into account in deciding which diseases to tackle?"―Steven Palmer, Canada Research Chair in History of International Health, University of Windsor
"Do focused disease eradication attempts or more broadly based primary health-care efforts produce better results? Stepan discusses this question in light of today's more foundation-driven public-health world, including the Gates Foundation's declared goal to eradicate malaria. Her conclusion is that 'eradication efforts should be exceptional and rare.' For those working in or interested in public health, this book offers a well-documented look at both the history and the current challenges of eradication."―Library Journal
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