At the World Economic Forum in Davos, Switzerland in January 2003, Bill Gates Jr. announced a $200 million dollar grant partnership between the Gates Foundation and the US National Institutes for Health to address what he called the “Grand Challenges in Global Health.” The fourteen “challenges”—enumerated in October of that year after the foundation’s scientific board publicly consulted with scientists and institutions around the world—focus overwhelmingly on the development of new technologies. How did the field of global health come to be understood largely as a problem to be solved with the right technology? In the face of critiques of over-medicalization in the global North and the under use of technology in the global South, the channeling of hundreds of millions of dollars annually into finding solutions to the health problems of the world’s poor may seem a welcome equalizer. Yet, as I show in my dissertation, "Developing to Scale: Appropriate Technology and the Making of Global Health," what may appear to be a 21st century phenomenon of techno-centrism has built heavily on an earlier movement—that in favor of appropriate technology.
The concept that there was an “appropriate” level of technology, between the traditional and the modern, which would lead to better social and economic development, originated in the writings of economist E.F. Schumacher in the mid-1960s. It gained considerable prominence in the 1970s, after the publication of his 1973 treatise, Small is Beautiful. Though different stakeholders interpreted “appropriate” differently, a relatively high-tech model eventually won out. I argue that the appropriate technology movement, and the model of novel technological development which gained favour among funding agencies in the 1980s, formed the techno-centric structure of the global health enterprise today. Though the movement itself faded into the background of donor agency’s prerogatives beginning in the mid-1980s, appropriate technology has had a lasting impact on how technology, health, and development are perceived to interact and, moreover, on how this interaction became central to defining global health and development practice today.
Over six chronological chapters, I trace how appropriate technology was theorized, interpreted, mobilized, institutionalized, and eventually banalized from the immediate post-war period to 2014. In doing so, it examines how appropriate technology policies fit into and were enthusiastically adopted into neoliberal reforms underway in 1970s agencies such as the US Agency for International Development (USAID); how different meanings of “appropriate” technology were negotiated between institutions and between developed and developing countries; how appropriate technology for health was often very gendered in its implementation; how localized and indigenous appropriate technology programs in the developing world, and Southern Africa in particular, gave the movement a new meaning and purpose which sustained it throughout the 1980s and 1990s; and how the model of novel appropriate technology development went from the signature of one Seattle-based government contractor, the Program for Appropriate Technology in Health (PATH), to the operating agenda of the largest player in the global health arena today, the Gates Foundation.
Multiple and overlapping contexts are relevant to this history. The Cold War contests between the United States and Soviet Union, particularly in attempting to win power and influence in the Third World, had a major impact on both multilateral and bilateral aid programs. At the same time, as the newly independent states of Africa and Asia began to assert their positions at the World Health Organization and with bilateral foreign donors, they were able to negotiate for the types of technologies they wanted transferred. In the 1970s and 1980s, as discussions about appropriate technology began appearing in the Southern African medical literature, South Africa was under the tight control of the apartheid regime, while Zimbabwe was in the midst of a civil war. These conflicts informed the way that appropriate technology was interpreted and mobilized by Southern Africans fighting for independence who saw technology as a means of gaining self-sufficiency. Finally, the global economic downturn following the 1973 oil shocks which lasted into the 1980s drastically affected the budgets available from major donor countries for health and development programs. The concept of appropriate technology was sufficiently flexible to be leveraged as a means for donors to overcome these financial limitations, while at the same time it offered recipient nations the space to negotiate for their own modernizing priorities. In examining these shifts, this study brings together the literature of Cold War development theory, the history of capitalism, the history of biomedicine, and the history and philosophy of technology to explore how making technology “appropriate” transformed the practice of international health, development, and American foreign aid.