International Health Division Research Articles

‘Eradication was a dirty word’: Anti-gambiae campaign, between cooperation and rivalry (1938–1940)

ABSTRACT This article analyzes the efforts of the International Health Division of the Rockefeller Foundation (IHDRF) in its project initiative that resulted in the extermination of the African mosquito Anopheles gambiae from Brazil in 1940. This species, which originated in Dakar, Senegal, was identified in the Brazilian city of Natal in 1930, where insufficient local emergency sanitation actions enabled it to spread into the interior of the Brazilian northeast, causing an unprecedented malaria epidemic in the Americas in 1938, after years of silent spread. We will analyse the formation of Brazil’s Malaria Service of the Northeast (MSNE), discussing its political and scientific controversies and how the transition from the idea of extermination to the idea of eradication was consolidated in the political process of creating this successful sanitation campaign. In addition, we will discuss how the integration and transnational development of medical entomology at the time was a fundamental factor in the cooperation and challenges among scientists involved in this campaign. The international cooperation of scientists, albeit oriented towards the project of eradication of this mosquito, organised different research agendas and gained new insights into the global dissemination of mosquito-borne diseases.

„The Last Crusade“. International Contexts of the Fight against Tuberculosis in Bulgaria up to the Middle of the 20th Century

In Bulgaria tuberculosis considerably began to be viewed as a social problem at the end of the 19th century and all experts were on the same opinion: the fight against tuberculosis had to be preventive, that meant: improvement of hygiene and labor conditions, overall information about the disease aimed to reach widest circles of the population and last not least, medical treatment. In the early 20th century in Bulgaria 20 000 persons annually died from tuberculosis, which was one of the highest percentages in Europe at that time. The First World War marks a turning point in the overall orientation of Bulgarian antituberculosis efforts. The nation’s arsenal of dispensaries, sanatoriums, and related facilities — its “war on tuberculosis”, in the reformers’ military terminology – was subject to increasingly anxious inventory and scrutiny. Bulgarian reformers (doctors and hygienists) placed also special emphasis on personal responsibility in the fight against tuberculosis. Throughout the 1920s and 1930s the state started to introduce standards and common bureaucratic rules of social work and centralized the public health care, including the fight against tuberculosis. International models and standards influenced the tuberculosis control policies in Bulgaria – especially the activities of the League of Nations Health Organisation, the International Health Division of the Rockefeller Foundation and the American Near East Foundation.

Anopheles gambiae no Brasil: antecedentes para um “alastramento silencioso”, 1930-1932

The article analyzes the arrival and identification of the African mosquito Anopheles gambiae in Brazil in 1930, and the initial reactions of scientists and public health authorities against the epidemics of malaria caused by this species. Although this mosquito was recognized as a dangerous vector of malaria, its presence in Brazil was neglected after initial emergency actions in the city of Natal in 1932; this encouraged it to spread silently, resulting in a major malaria epidemic in 1938. This article examines scientific and political issues which caused the fight against mosquitoes to be pushed into the background until 1937 in cooperative efforts between the Rockefeller Foundation's International Health Division and the Brazilian authorities.

Battling Soil-Transmitted Intestinal Worm Disease: From the Hookworm Campaigns of the Rockefeller Foundation to Contemporary Mass Drug Administration

In the early twentieth century, the Rockefeller Sanitary Commission and the Rockefeller Foundation’s International Health Board (later, International Health Division) undertook campaigns in a number of world regions to treat hookworm disease and to promote ‘sanitation,’ that is, improved excreta disposal. The campaigners learned that chemical therapy would not clear all hookworm infections, and they were unable to mobilize the support of governments for the reform of open defecation practices. Some campaigns achieved successes in reducing disease, but they were discontinued in the 1920s on the understanding that sanitation programs were foundational for success in eliminating hookworm disease. In the first decade of the twentyfirst century, under the rubric of “Neglected Tropical Diseases,” global health organizations re-engaged the struggle against all three soil-transmitted helminth (STHs) infections – hookworm, roundworm, and whipworm. The new campaigners rolled out mass drug administration (MDA) programs to reduce the incidence of disease without programs to improve excreta disposal. This approach effectively ignored the lessons of the early twentieth century campaigns. Intestinal worm transmission continued, and the efficacy of the MDA programs was threatened by the emergence of helminthic drug resistance.

Ilona Kickbusch: global health reformer

Ilona Kickbusch: global health reformer

Private actors, global health and learning the lessons of history

Private business and philanthropic organizations have played a prominent role in the response to the Ebola outbreak in West Africa and the support of global health governance more broadly. While this involvement may appear to be novel or unprecedented, this article argues that this active role for private actors and philanthropies actually mirrors the historical experience of cross-border health governance in the first half of the twentieth century. By examining the experiences, roles and criticisms of the Rockefeller Foundation’s International Health Division and the Bill and Melinda Gates Foundation, it is possible to identify potential opportunities for better cooperation between public and private actors in global health governance.

The Rockefeller and Gates Foundations in Global Health Governance

The Bill and Melinda Gates Foundation (BMGF) is the world's wealthiest philanthropic organisation and a major player in global health governance. While its emergence may be dramatic, BMGF's role in global health mirrors the experience of the Rockefeller Foundation's International Health Division nearly 100 years earlier. Both organisations provoked fear and consternation, but their supporters argued that both offered innovative techniques and filled niches governments could not or would not address. This article examines the parallels in arguments for and against the global health activities between the Bill and Melinda Gates Foundation and the Rockefeller Foundation. It also calls into question larger questions about the role of private actors in global governance and whether their activities in recent years are really all that unprecedented.

Clinician's Commentary

In this issue of Physiotherapy Canada, Crawford et al.1 provide an excellent overview of the growing phenomenon of international clinical education in physical therapy (PT) education programmes in Canada. The increased availability of international clinical internships (ICIs) reflects the “internationalization” of higher education in Canada and beyond,2–4 defined as “an institutional process that in some way internalizes the concept of openness to the world in all the activities and organizational aspects of the university and that may even launch an internal transformation to prepare the university to act more directly on the international or global scene.”2(p.2) This process affects all elements of a university's mission, including teaching and service.2 Demonstrating the effect of internationalization on teaching in PT education programmes, Crawford et al.1 reveal that approximately 4% of graduates from Canadian PT programmes from 1997 through 2007 participated in ICIs and that the number of destination countries multiplied threefold during this time.1 A 2006 study of international service-learning in PT education programmes in Canada and the United States supported the idea that internationalization may have influenced the element of service as well.5 Unlike a traditional clinical internship, service-learning includes an equal focus on community service and student learning.5,6 According to the results of the 2006 survey, 50% of Canadian faculty respondents (n=4) reported offering international service-learning in the previous 10 years, as compared to 28% (n=24) of US survey respondents. However, a significant limitation of the study was that no questions were asked specifically about international clinical education, which means that ICIs may have been included in the service-learning data. Canadian PT education programmes have included international opportunities—whether ICIs, international service-learning, or a combination thereof—in PT curricula in a greater proportion than US programmes. A 2009 survey that specifically investigated the use of international clinical education in US PT education programmes6 found that only 41% (n=46) of US programmes offered international clinical education opportunities to their students,6 as compared to 86% (n=12) of Canadian programmes, as reported by Crawford et al.1 Discussions among members of the Canadian Physiotherapy Association's International Health Division (IHD) and their US colleagues on the American Physical Therapy Association's Cross Cultural and International Special Interest Group (CCISIG) discussion list have revealed some apprehensions about the growth and quality of international service and/or learning opportunities in PT education. A collaborative commentary by IHD member Shaun Cleaver and me summarized many of the concerns shared by IHD and CCISIG members on the list about sending students to international sites, especially in developing countries where power imbalances may place disadvantaged populations at greater risk of unintended harm.7 Echoing views expressed in the medical education literature,8 we called for a critical examination of the complex ethical issues in global health initiatives in PT education. We proposed that PT educators need to (1) develop a broad and ongoing dialogue about ethics, (2) incorporate formal programme evaluation for the protection of students and of the international community partner and its clients, and (3) participate in research in order to guide best practices in international service and/or learning in PT education.7 Dialogue among many IHD and CCISIG members is ongoing on the CCISIG discussion list, but not all physical therapists involved in global health initiatives in PT education are members of this list. Similarly, although Crawford et al.1 and others9,10 have offered recent input on how the PT profession may expand its role and its positive impact in the global health arena, the body of literature is limited, and best practice guidelines have not yet been developed. The need for further in-depth inquiry into PT's role in global health is clear. Canadian programmes are arguably the North American leaders in incorporating ICIs into PT education curricula. No doubt Canadian faculty and researchers will play a key role in future research and the development of best practices. Discussing the internationalization of higher education in Canada, Lemasson stated that “Canadian universities, far from being passive institutions buffeted about in a world beyond their ken or control, have been, and will always strive to be, full players in a broad process to which no one can remain indifferent.”2(p.2) These words are equally true with respect to Canadian PT programmes and their involvement in global health initiatives, including ICIs.

Public health and nutrition after the Spanish Civil War. An intervention by the Rockefeller Foundation.

We describe a nutritional intervention by the Rockefeller Foundation's International Health Division in Spain after the Spanish Civil War, delineating the relationships between the technicians sent by the Rockefeller Foundation and the Spanish health authorities. We analyze reports of the nutritional situation in Spain in the early 1940s and the design and outcomes of a nutrition survey conducted in a district of Madrid by American and Spanish nutritionists. This nutritional survey, which was based on food intake interviews and was complemented with anthropometric measurements, clinical examinations, and blood tests, found several symptoms and signs of malnutrition. The Rockefeller Foundation's nutritional research was an important historical precedent for later studies made in emergency situations or armed conflicts. Similar surveys have been carried out in the last several decades by distinguished academic departments of public health and epidemiology and by humanitarian aid agencies.

John B. Grant international statesman of public health.

JOHN B. GRANT WAS BORN to Canadian medical missionaries in Ningbo, China, in 1890. He graduated from Acadia College in Nova Scotia in 1912 and received his medical education at University of Michigan and his public health degree from the Johns Hopkins University. He would later often refer to Arthur Newsholme and Victor C. Vaughan (his professors in public health), together with George Newman, as the men who had most influenced his thinking about public health.1 Grant joined the International Health Board of the Rockefeller Foundation in 1918 and gained practical experience in a county health program in North Carolina. He went to China to conduct a hookworm survey in 1919. In 1921, Grant was appointed International Health Division representative in China and associate professor of public health of the Peking Union Medical College. Grant believed that public health was an integral part of socioeconomic progress and that health care could be best achieved by combining preventive and curative medicine through a community “health station.” In 1925, he created a health demonstration station, Beijing First Health Demonstration Station, as a “social laboratory” for training public health professionals and medical students of Peking Union Medical College. The station, a project of collaboration with Beijing Municipal Police in a ward of 95 956 people half a mile from Peking Union Medical College, had three divisions of activities: general sanitation, vital statistics and communicable diseases, and medical services. Besides regular teaching and investigative research, the station maintained a school health service for 1800 students and an industrial medical service for 1200 workers. It also served as a health center for a population of 45 000. The health station offered short training courses for traditional midwives and municipal sanitary police.2 The courses for the midwives developed into the First National Midwifery School in 1928, which represented a significant advance toward modern maternity and child health work in China. The health station experiment was extended into rural China in 1929 when Grant and his colleagues established a health station in Ding Xian, a county of 400 000 people west of Beijing. The Ding Xian experiment integrated health work into a comprehensive rural education and reform movement. It provided affordable health care to the peasants and short training courses for village health workers. These efforts provided the models for the training of barefoot doctors and rural health reforms in the 1950s to 1970s.3 Grant’s ideas of health work on a community basis constituted an innovative experiment in the 1920s, but they matured in the following decades as Grant applied the lessons learned in China to many other countries. In 1939, after 18 years of health work in China, Grant was appointed director of the All-India Institute of Hygiene and Public Health in Calcutta and served in this position until 1945. He was instrumental in shaping the recommendations of the Bhore Committee in 1944, which provided a blueprint for the organization of medical education and health care in India. After World War II, Grant worked with international and US governmental organizations including the Economic Cooperation Administration, President Truman’s Commission on the Health Needs of the Nation, and the World Health Organization. He conducted surveys of medical care plans in the United States, Canada, Asia, and Europe. From 1954 until his death in October 1962, Grant advised the Puerto Rican government on a plan for regionalization of their health services, showing how the hospitals and medical services belonging to different agencies could be coordinated into a smoothly working system to provide even the most isolated villages with access to excellent medical care. Grant also taught as professor of public health at the University of Puerto Rico.4 Many countries awarded Grant with high honors for his contributions to public health. China presented him with the Jade Order in 1940; Britain honored him with Commander of the Most Excellent Order in 1945, France with Chevalier de la Legion d’Honneur in 1952, and Denmark with Commander of the Order of the Elephant in 1952. The United States awarded him the Lasker Award in 1960 “in recognition of more than forty years of inspired leadership in promoting the health and well-being of mankind throughout the world.”5

John Lowell Kilgour

A civil servant and public health doctor who helped to eradicate smallpox John Kilgour was director of coordination at the World Health Organization and a major player in the smallpox...

John Farley, To cast out disease: a history of the International Health Division of the Rockefeller Foundation (1913–1951), Oxford and New York, Oxford University Press, 2004, pp. x, 323, illus. £39.50 (hardback 0-19-516631-0).

John Farley, To cast out disease: a history of the International Health Division of the Rockefeller Foundation (1913–1951), Oxford and New York, Oxford University Press, 2004, pp. x, 323, illus. £39.50 (hardback 0-19-516631-0). - Volume 49 Issue 3

Selskar Gunn and China: The Rockefeller Foundation's "Other" Approach to Public Health

The Rockefeller Foundation's program for rural development in China was developed by Selskar Gunn during the period 1932-34 and was initiated in 1935. It was multidisciplinary in nature, and its aim was to raise the educational, social, and economic standards of rural China. It was recognized by some at the time as an alternative to the International Health Division's approach to public health. This paper describes the program, what led Gunn to develop it in China, and the internal tensions that it created. Also addressed is the question of why this program had such limited impact on subsequent developments in the field of international health.

Aux origines de l'Inserm : André Chevallier et l'Institut national d'hygiène

Before Inserm : André Chevallier and The Institut national d'hygiène It was in 1941, under the Vichy government that the INH, later to become the Inserm, the first ongoing government organization was created for research in medicine and public health in France. One can presume that an authoritarian regime is more capable of establishing a health policy than a parliamentary democracy which is more sensitive to the protection of the individual and minorities, but it is also necessary to recognize the importance of American aid to France during WWII and in particular that of the International Health division of the Rockefeller Foundation. The first general manager of INH was Pr André Chevallier, a physician specialized in physiology of nutrition and vitamines in Marseille. From 1942 to 1946, the date when Chevallier resigned from the management of the INH in Paris for political reasons — too much collaborations not with the Germans but with the Americans! — , he placed the most emphasis on questions of prenatal care and pediatrics in response to the problems of food and vitamines shortages. Another sections of the INH was in charge of social diseases, such as tuberculosis, syphilis or cancer. In spite it had most difficulty in doing its work in epidemiology because of the tradition of corporatism and the silent resistance of French practitioners to social medicine, to the great satisfaction of the French Ministry of Health, the INH could publish the conclusions of its first survey before the war ended.

A land filled with mosquitoes: Fred L. Soper, the Rockefeller foundation, and the Anopheles Gambiae Invasion of Brazil

The success of Fred Soper and the Rockefeller Foundation's International Health Division in eradicating the anopheles gambiae mosquito from Northeast Brazil was a significant watershed in the history of malaria control. It revived faith in vector control strategies and paved the way for the application of eradication methods in the fight against malaria following World War II. Yet Soper's achievement needs to be re‐examined from a wider analytical perspective that takes account of the longer epidemiological history of malaria in northeast Brazil and the wider social and economic context within which malaria occurred. This wider perspective suggests that the origins of the 1938/39 malaria epidemic were much more complex than Soper acknowledged. By focusing narrowly on the anopheles gambiae mosquito and its eradication, Soper failed to understand this broader context. This myopia, in turn, permitted Soper to make claims for both the scale of his achievement and its importance for the future of malaria control which were unjustified.

Too few and too little: barricades to the pursuit of health.

Academic responsibilities in the field of international health are considered. Too often the instructional process neglects essential aspects of the natural history and the control of infectious diseases. Few scientists are able to teach from a background of practical experience in the field. Little emphasis is placed on the continuum of problems deriving from an ever-changing human ecology. The program of "Health for All" of the World Health Organization and the recognition by the World Bank of health as an integral component of the developmental process are salutary events. Yet, progress depends on dedicated, informed leadership. Past examples can be found in the global contributions of the International Health Division of The Rockefeller Foundation, at the national level in Costa Rica where disease preventable by immunization has disappeared, and at the community level in the successes of Drs. Warren and Gretchen Berggren in Haiti. While new "magic bullets" are to be anticipated, the resurgency of yaws, in spite of penicillin, emphasizes the need for leadership in achieving a sustained, societal effort based on sound ecologic considerations.

Refugee Medicine

The SciencesVolume 21, Issue 1 p. 14-15 Refugee Medicine The need for new approaches Derrick B. Jelliffe, Derrick B. Jelliffe Derrick and Patrice Jelliffe work in the Population, Family and International Health Division, School of Public Health, University of California, Los Angeles.Search for more papers by this authorE.F. Patrice Jelliffe, E.F. Patrice Jelliffe Derrick and Patrice Jelliffe work in the Population, Family and International Health Division, School of Public Health, University of California, Los Angeles.Search for more papers by this author Derrick B. Jelliffe, Derrick B. Jelliffe Derrick and Patrice Jelliffe work in the Population, Family and International Health Division, School of Public Health, University of California, Los Angeles.Search for more papers by this authorE.F. Patrice Jelliffe, E.F. Patrice Jelliffe Derrick and Patrice Jelliffe work in the Population, Family and International Health Division, School of Public Health, University of California, Los Angeles.Search for more papers by this author First published: January 1981 https://doi.org/10.1002/j.2326-1951.1981.tb01899.xCitations: 8 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume21, Issue1January 1981Pages 14-15 RelatedInformation

Appropriate Technology and Nutritional Assessment: A Synopsis*

DisastersVolume 4, Issue 3 p. 349-353 Appropriate Technology and Nutritional Assessment: A Synopsis* Derrick B. Jellife, Derrick B. Jellife Population, Family and International Health Division School of Public Health University of California Los Angeles CA 90024, U.S.A.Search for more papers by this authorE.F. Patrice Jelliffe, E.F. Patrice Jelliffe Population, Family and International Health Division School of Public Health University of California Los Angeles CA 90024, U.S.A.Search for more papers by this author Derrick B. Jellife, Derrick B. Jellife Population, Family and International Health Division School of Public Health University of California Los Angeles CA 90024, U.S.A.Search for more papers by this authorE.F. Patrice Jelliffe, E.F. Patrice Jelliffe Population, Family and International Health Division School of Public Health University of California Los Angeles CA 90024, U.S.A.Search for more papers by this author First published: September 1980 https://doi.org/10.1111/j.1467-7717.1980.tb00122.x † *The complete article is appearing in Advances in International Maternal and Child Health, Oxford University Press(1980). AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume4, Issue3September 1980Pages 349-353 RelatedInformation

Teleonomic Explanation

Journal Article Teleonomic Explanation Get access Derrick B. Jelliffe, Derrick B. Jelliffe Population, Family and International Health Division, School of Public Health, University of California, Los Angeles, CA 90024 Search for other works by this author on: Oxford Academic Google Scholar E. F. Patrice Jelliffe E. F. Patrice Jelliffe Population, Family and International Health Division, School of Public Health, University of California, Los Angeles, CA 90024 Search for other works by this author on: Oxford Academic Google Scholar BioScience, Volume 28, Issue 11, November 1978, Page 681, https://doi.org/10.2307/1307314 Published: 01 November 1978

The prevention of early vaccinia-virus-induced cytopathic effects by inhibition of protein synthesis.

SUMMARY Infection of LLC-MK 2 cells with the International Health Division strain of vaccinia virus caused rounding of all cells within 2 to 3 hr after infection. Puromycin, at a concentration of 330 µg./ml., completely prevented the early virus-induced cytopathological changes as well as virus multiplication; however, at 33 µg./ml. the compound did not prevent the cytopathic effects of vaccinia virus, in spite of the fact that virus multiplication was largely inhibited. Treatment of cells for 4 hr with puromycin at 330 µg./ml. did not alter the rate of cell division when the compound was removed. When the antibiotic (330 µg./ml.) was removed from infected cultures after a treatment period of 4 hr, virus-induced cell damage began almost immediately after removal and by 1 hr all cells were rounded. Actinomycin D, 5 µg./ml., also protected the cells from the early vaccinia-virus-induced cytopathic effects. At 0.5 µg./ml., although growth of virus was inhibited, no protection against viral cytopathic effects was observed. In LLC-MK 2 cells virus-induced morphological damage was not prevented by p-fluorophenylalanine, 5-fluoro-2′-deoxyuridine, and isatin-β-thiosemicarbazone—compounds known to inhibit the reproduction of vaccinia virus. Ultraviolet-irradiated virus, which had lost its infectivity, was still capable of causing early cell damage. These findings suggest that the early virus-induced cytopathological effects, previously considered the ‘toxic’ effects of the virus, are brought about by the synthesis of virus-induced protein(s).