ABOUT THIS BOOK

The first critical book on “appropriate technology,” Developing to Scale shows how global health came to be understood as a problem to be solved with the right technical interventions.

In 1973, economist E. F. Schumacher published Small Is Beautiful, which introduced a mainstream audience to his theory of “appropriate technology”: the belief that international development projects in the Global South were most sustainable when they were small-scale, decentralized, and balanced between the traditional and the modern. His theory gained widespread appeal, as cuts to the foreign aid budget, the national interests of nations seeking greater independence, postcolonial activism, and the rise of the United States’ tech sector drove stakeholders across public and private institutions toward cheaper tools. In the ensuing decades, US foreign assistance shifted away from massive modernization projects, such as water treatment facilities, toward point-of-use technologies like village water pumps and oral rehydration salts. This transition toward the small scale had massive implications for the practice of global health.

Developing to Scale tells the history of appropriate technology in international health and development, relating the people, organizations, and events that shaped this consequential idea. Heidi Morefield examines how certain technologies have been defined as more or less “appropriate” for the Global South based on assumptions about gender, race, culture, and environment. Her study shows appropriate technology to be malleable, as different constituencies interpreted its ideas according to their own needs. She reveals how policymakers wielded this tool to both constrain aid to a scale that did not threaten Western interests and to scale the practice of global health through the development and distribution of technical interventions.

AUTHOR BIOGRAPHY

Heidi Morefield is a historian of medicine and global health. She currently works for a global consultancy.

REVIEWS

“The first comprehensive history of advocacy for ‘appropriate technology’ for global health, Developing to Scale provides a fresh analytical route into understanding the enduring enthusiasm for cheap technological fixes for fundamental problems of global health inequalities. With an extraordinary combination of scholarly rigor and narrative lucidity, the book works across scales to provide a careful account of key individuals, groups, and encounters, while also illuminating anew the broader social and technological field of global health in an era of emerging postcolonial aspirations and complexly intertwining neoliberal endeavors.”

— Anne Pollock, King’s College London

“The concept of ‘appropriate technology,’ Janus-faced, has been used both to inspire and to prevent technological assistance to people in resource-poor communities. Morefield’s Developing to Scale provides a fascinating and surprising global history of the origins of the idea and its far-reaching influence on international health and development worldwide. Who should decide what technology is right for whom? What social systems do technologies require to succeed? These questions remain vitally important today.”

— David S. Jones, Harvard University

“With engaging prose and illuminating detail, Developing to Scale provides a crucial history of appropriate technology in international aid. Anyone nursing a clever fix to improve the world should first read this book.”

— Peter Redfield, University of Southern California

"Morefield has decades of experience in aid agencies dedicated to improving global health, and she offers impressive insights about the conflicting agendas of governments, transnational corporations, and other interested parties in the West as opposed to those of various stakeholders in the Global South. There are, however, two blind spots in her analysis. Morefield says virtually nothing about the decades-long tendency of Western agencies to push contraception or sterilization (voluntary or coerced) as a supposedly appropriate technology for global health. Moreover, her penultimate chapter, while containing trenchant criticisms of current aid projects in global health, nevertheless heralds the (often arrogant and bumbling) efforts of the Gates Foundation as a panacea."

— Choice

TABLE OF CONTENTS

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