Birn A E, Solórzano A
Milano Graduate School, New School for Social Research, New York, NY 10011, USA.
Soc Sci Med. 1999 Nov;49(9):1197-213. doi: 10.1016/s0277-9536(99)00160-4.
The origins of US international health endeavors are intertwined with the Progressive Era's faith in science as arbiter of humankind's secular problems. No agency better exemplifies the period's confidence in science than the Rockefeller Foundation's International Health Board (IHB), which set out to export the new public health theory and practice around the world. An examination of the IHB's hookworm program in Mexico in the 1920s demonstrates that, notwithstanding the Rockefeller Foundation's (RF) self-conscious commitment to scientific neutrality, its programs continuously engaged political criteria, exhibiting the competition, coexistence, and inseparability of the worlds of science, politics, and international health policy. Analysis of the program's quotidian decisions and larger strategies further reveals the protean quality of RF science-politics, which enabled responses to parochial and broadly-conceived needs at multiple levels. In the focus on hookworm, the selection of campaign sites, hookworm diagnosis methods, treatment procedures, definition of cure, and the assignment of responsibility for prevention, scientific and political considerations were inextricably bound. The science-politics paradox was molded by the hookworm program's constituencies in Mexico, including political leaders, health bureaucrats, physicians, business interests, public health workers, peasants, and Rockefeller officers. The multiple, often contradictory, roles of the RF's hookworm campaign are characteristic of the policy paradoxes that emerge when science is summoned to drive policy. In Mexico the campaign served as a policy cauldron through which new knowledge could be demonstrated applicable to social and political problems on many levels. The repeated pledge of scientific neutrality belied the hookworm program's inherent aim of persuading government officials, the medical community, business interests, and the populace of the value of investing in public health as a means to improve social conditions, further a medical model of health and sickness, increase economic productivity, and promote good relations between the US and Mexico.
美国国际卫生事业的起源与进步时代对科学的信念紧密相连，当时人们相信科学是解决人类世俗问题的仲裁者。没有哪个机构比洛克菲勒基金会国际卫生委员会（IHB）更能体现那个时代对科学的信心了，该委员会着手在全球推广新的公共卫生理论与实践。对20世纪20年代洛克菲勒基金会国际卫生委员会在墨西哥开展的钩虫防治项目的考察表明，尽管洛克菲勒基金会自觉秉持科学中立的原则，但其项目却不断涉及政治标准，展现出科学、政治和国际卫生政策领域的竞争、共存与不可分割性。对该项目日常决策和宏观战略的分析进一步揭示了洛克菲勒基金会科学与政治的多变特质，这种特质使其能够在多个层面回应局部和宽泛的需求。在钩虫防治工作中，从防治地点的选择、钩虫诊断方法、治疗程序、治愈的定义到预防责任的分配，科学考量与政治考量都紧密交织。科学与政治的矛盾在墨西哥钩虫防治项目的相关各方中形成，这些相关方包括政治领袖、卫生官员、医生、商业利益集团、公共卫生工作者、农民以及洛克菲勒基金会的工作人员。洛克菲勒基金会钩虫防治运动的多重且往往相互矛盾的角色，是当科学被用以推动政策时出现的政策矛盾的典型特征。在墨西哥，这场运动成为了一个政策熔炉，通过它可以证明新知识适用于多个层面的社会和政治问题。对科学中立的反复承诺掩盖了钩虫防治项目的内在目标，即说服政府官员、医学界、商业利益集团和民众，让他们认识到投资公共卫生对于改善社会状况、推广健康与疾病的医学模式、提高经济生产力以及促进美墨良好关系的价值。
