Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico

This examination of the Rockefeller Foundation's foray into public health in Mexico between 1921 and 1951 is the latest analysis of the impact of that organisation's philanthropy. This is a growing field as recent monographs were published by John Farley, Jeffrey D. Brison, Marianne P. Fedunkiw and Christopher Lawrence respectively, which deal with the influence of the Foundation in the first half of the twentieth century. The idea for Birn's monograph originated with her doctoral dissertation, ‘Local Health and Foreign Wealth: The Rockefeller Foundation's Public Health Programs in Mexico, 1924–1951’, completed in 1993 at Johns Hopkins University. This followed Armando Solorzano's now published dissertation, The Rockefeller Foundation in Mexico: Nationalism, Public Health, and Yellow Fever 1911–1924 (University of Wisconsin, Madison, 1990). Birn divides her monograph into five chapters followed by an epilogue. She writes that, what she calls the ‘RF-Mexico liaison’ started with a yellow fever campaign and then morphed, in 1924, into an anti-hookworm initiative that reached hundreds of thousands of Mexicans in smaller towns in Veracruz, Chiapas and Oaxaca. The ‘marriage of convenience’ that characterised the public health initiatives of the Rockefeller Foundation in Mexico continued to expand and to be transformed, and ranged from the new permanent local health services of the late 1920s, to cooperative health units in larger towns and a statewide demonstration project in Morelos in the 1930s, and finally to collaborative efforts to combat malaria, and health units in northern Mexican states, in the 1940s. Each of these stages is given a chapter in the monograph. Birn, like Marcos Cueto, has noted that Latin America was one of the largest beneficiaries of Foundation aid, in part because results were easy to track, both from a public health standpoint as well as in economics. Although Latin America, and particularly Brazil, received a disproportionate amount of the IHD's budget, Mexico, Birn argues, was also important to the Foundation. The evidence for this, she writes, is the IHD's constancy as it worked through good times and bad, ‘amidst binational tensions, domestic turmoil, institutional soul-searching and a history of suspicion and resentment’ (p. 2). Part of the reason for the Foundation's continuing commitment was one of proximity: diseases did not respect borders and a healthier Mexico ensured a greater chance of a healthier America, especially in those states on the frontier between the two. Part of the drive for cooperation, Birn notes, came from the acknowledgment by Mexican professionals and government that the time was right to benefit from a combination of local expertise and international knowledge in order to meet Mexico's growing social demands, not the least of which was better health for its citizens. The Foundation was more than willing to help but, working within the parameters of targeted giving, often dictated the terms. For example, in an appendix, Birn lists 67 Mexican men and women who received RF Public Health Fellowships between 1920 and 1949. The overwhelming majority studied at Harvard or Johns Hopkins with only nine taking fellowships elsewhere. Their positions, upon their return to Mexico, were almost uniformly leadership positions; many became directors of public health units or chief laboratory scientists. This is in keeping with Birn's position that the RF's most important legacy was that ‘virtually all subsequent international health activities have been influenced on some dimension by … deeply-embedded principles’. First, donor interests set the agenda in international health initiatives; second, matching funds from the recipient country are needed to ‘buy-in’ to a cooperative endeavour; third, ideas of disease control are defined by biological understanding of disease and the technological tools available; fourth, the cooperative, well-funded projects have a time limit, at least for the donor; finally, those professionals at the heart of an international initiative benefit from both local knowledge and foreign (often American) training and education that they then take home to implement (pp. 269–73). Birn's monograph gives another perspective on the growing scholarship about the history of public health as well as providing a case study of philanthropy. One strength of the book that adds a layer to the text are archival charts such as the 1928 and 1938–9 DSP organisational diagrams (pp. 104 and 217); contemporary tables also help readers to set data in context or help in the analysis of key points. The best of these is a table (5.1) that outlines the IHB/D expenditures in Mexico by year and dollars over two decades. This clearly shows how the IHB/D shifted their funding from yellow fever, to hookworm, to local health and then concurrently public health administration and, more sporadically, anti-malaria campaigns (pp. 244–5). The monograph is also greatly enriched by 55 photographs, including excerpts from public health propaganda pamphlets, field photos, and shots of facilities such as the toilets in hookworm facilities (p. 114). For anyone interested in twentieth-century Mexico, public health, or philanthropy, Marriage of Convenience will be a valuable addition to their library.

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