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Millions Saved: Proven Successes in Global Health

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This book provides a diverse set of 17 cases in which governments and international organizations succeeded in large-scale public health interventions. This is an excellent foil to the commonly circulating pessimism regarding the aid industry. (For an over-the-top example of that, see Graham Hancock's Lords of Poverty.) Drawing on both well-documented secondary sources and on interviews with key players in the cases, the authors make convincing arguments for causality between the intervention and the health improvement in most of the cases.

This book's strongest contribution is that it introduces the reader to important public health problems in the developing world and then shows how some of those problems can be solved. The book provides both an introduction to the science of the diseases (and their cures) and basic information about effective administration of large-scale public health interventions.

Some of the chapters that I thought were particularly important include Chapter 1 (Eradicating Smallpox), because it deals with a serious disease that was rampant (in 1966, it killed in over 50 countries) and has now been completely eradicated; Chapter 2 (Preventing HIV/AIDS and Sexually Transmitted Infections in Thailand), because AIDS is currently such an insidious disease, and successful examples of its control are essential; Chapter 6 (Controlling Onchocerciasis in Sub-Saharan Africa), because it shows the importance of and potential for strong leadership (including that of Robert McNamara, then president of the World Bank) and cooperation between organizations; and Chapter 8 (Improving the Health of the Poor in Mexico), because it gives the background for a development strategy that is currently growing in popularity and will probably be seen much more in the future. (That strategy consists of giving cash transfers to poor families, conditional on their complying with certain conditions, such as vaccinating their children and enrolling them in school.)

The authors also draw certain key lessons and give examples to illustrate. For example, they emphasize the importance of ongoing commitment, both from government leaders and international organizations. They give one example of a case in which the success of an intervention ironically threatened exactly that commitment (Chapter 11 - Controlling Chagas Disease) and another in which many players have shown impressive longevity of effort (Chapter 6 - Controlling Onchocerciasis in Sub-Saharan Africa).

Be warned that the book reads like a textbook, and some chapters are definitely stronger than others (both in their writing and in how strong the case is made for the effectiveness of the intervention). With that minor caveat, this is an important contribution and a worthy read.

Ruth Levine's Millions Saved: Proven Successes in Global Health is a valuable contribution to public health literature. By detailing numerous interventions which have been successful at addressing the problem they tackled, Levine exposes the reader to the possibility of cost-effective health interventions with real impact in lower-income countries. Too often public health writing focuses on the numerous barriers to successful health improvement, and for those public health workers working in developing countries, burnout and despair runs high. Levine puts the spotlight on what has been done, and in several cases shows how the success can be spread to other areas.

However, some of the cases are not as apparently successful to the critical eye. Levine sidesteps most ethical quandaries, or passes over them briefly, without elaborating on the issues that arise when multilateral research or interventions are being performed in lower income countries. Several of the cases, such as the measles immunization campaign in Southern Africa, run into such dilemmas, but Levine puts little to no focus on how public health professionals dealt with cultural reservations. There is very little coverage of debates over whether the interventions described in the book are the best use of resources: for example, when describing the spread of Oral Rehydration Therapy in Egypt to prevent child deaths from diarrheal disease, Levine doesn't touch on whether it would have been more expensive to prevent the disease in the first place, by spending the same resources on providing clean water and sanitation education for citizens.

This text is worthwhile for the public health student or professional who needs a reminder that there are successes in public health, often against overwhelming odds. But it's important to keep in mind that those successes must be negotiated while balancing cultural and ethical issues, as well as a budget.

This book is a positive effort to provide success stories in international public health and nicely balances the multitude of books which emphasize failures. Most of the stories included we would never hear about, but because of this book we are aware of them. The short chapters cover 17 case studies around the world, not only illustrating the specific case, but also informing us about the economic, social and political challenges facing developing nations and their health systems. It works especially well in a college classroom where the topic is Global Health.