Whose Progress? The Language of Global Health

The barrier to global health most often noted in Western discourse is the enduring disparity of access to medical technologies. This assessment of the circumstances in global health fits well within a bioethic centered on the equitable distribution of access to medical goods. Yet through an interrogative consideration of two episodes in the marketing of progress, namely the Century of Progress Exposition in Chicago (1933–1934) and one post-war spin on atomic development in the National Geographic, I suggest that the language of medical advancement continues to trade on a division between civilized, rational, scientifically developed peoples and the atavism of peoples by whom Western science gauges its progress. I recommend unremittingly self-critical attention to the dynamics of language and legitimization used within the Western academy by those who seek ostensibly to be of use in regions (powerfully) labeled as “developing.”

Keywords:

• bioethics
• Darwin
• global health
• justice
• race

I INTRODUCTION—WHAT KNOWLEDGE? WHICH HUMANITY?

A The Co-Production of Poverty

Sheila Jasanoff aims her summons to study what she calls the “co-production” of science and societal ordering primarily at colleagues who study the production of scientific and technological knowledge (Jasonoff, 1996, 2004). By her assessment, the work of considering a particular thread of scientific pursuit with attention to the cultural threads intertwined is methodologically political:

Such work is political in the deepest sense, for it reshapes, however subtly or tentatively, the way we come to grips with the enduring problems of truth, power, agency, legitimacy, individual rights and social responsibility (Jasonoff, 1996, p. 397).

Her work may serve as a different kind of summons to those who write within the field of bioethics; Jasanoff’s description may bring to the fore the conventional nature of bioethics as often practiced. A purely procedural ethics inscribed within an unquestioned teleology of biotechnological progress shields from critical view the trajectory of scientific development. By eschewing the work of cultural anthropology and history, those practicing principally in medical ethics too often preserve through our very language the default cultural assumptions about the gauges of growth. One example may suffice for the purposes of this essay.

In a recent university lecture by a world renowned ethics scholar working in global health, the scholar used repeatedly the terms “developing” and “resource poor” to name peoples judged to be the target populations for redistributive justice in genomics. Assumed was a trajectory of high-end, scientific technology on which “developing” nations were, well … simply developing. They were somewhere down the slope up which humanity is aptly striving in efforts such as the Human Genome Project (genomics being the particular focus of the scholar’s talk). The goal of an ethicist concerned with global health, by this understanding, is to sketch the logistics whereby those in “developing” nations receive a fuller share of the biotechnology developed in already “developed” nations.

By one powerful post-colonial reading, however, the map on which the logistics of health care justice are sketched is already drawn according to a particular perception of the two-thirds world. The assumption that the goal of global health is to bring the people of India into the Genomic Revolution carries with it a particular reading of the moral terrain. In a recent essay, Vandana Shiva named the conjecture at play in many conversations about “developing” nations:

Culturally perceived poverty need not be real material poverty: sustenance economies, which satisfy basic needs through self-provisioning, are not poor in the sense of being deprived. Yet the ideology of development declares them so because they do not participate overwhelmingly in the market economy, and do not consume commodities produced for and distributed through the market even though they might be satisfying those needs through self-provisioning mechanisms (Shiva, 2005).

When applied to the matter of scientific medicine, the corresponding sense is that those peoples who do not participate in the production and consumption of Western biotechnology are in need of redistribution. By the rules of bioethics most often at work in Western academies, people within nations who are not privy daily to the global, market economy should be given the autonomous choice to participate in the biotech market. The task of Western bioethics in relation to global health becomes one of expanding access to the sorts of high-end technologies that have come to define development.

This assumption may undermine basic health by enervating the more urgent call to redistribute basic, indigenous resources for nourishment and hydration within what are too often labeled as “resource poor” nations. Shiva continues her account of the Western perception of poverty thus:

People are perceived as poor if they eat millets (grown by women) rather than commercially produced and distributed processed junk foods sold by global agri-business. They are seen as poor if they live in self-built housing made from ecologically adapted natural material like bamboo and mud rather than in cement houses. They are seen as poor if they wear handmade garments of natural fibre rather than synthetics. Sustenance, as culturally perceived poverty, does not necessarily imply a low physical quality of life. On the contrary, because sustenance economies contribute to the growth of nature’s economy and the social economy, they ensure a high quality of life measured in terms of right to food and water, sustainability of livelihoods, and robust social and cultural identity and meaning (Shiva, 2005).

As regions functioning with sustenance economies become industrialized, the justification grows for further, foreign technologies. To rescue those who are judged to be “resource-poor” (whose resources are mined by Western corporations) Westerners recommend solutions from emerging technologies. Again, one example may serve. When Chevron advertises in the front cover of Harper’s Magazine (February, 2006) with the warning “The world consumes two barrels of oil for every barrel discovered,” and a flag pinpointing Port Harcourt on a map of Nigeria, there is a powerful Western rhetoric of progress, technology, and custody assumed. The call for “technological improvements” in the Chevron advertisement reads above a (no-doubt carefully chosen) color photograph of about twenty African children, encircling the camera’s lens. Many of them reach toward the camera, and thus the magazine reader, with open hands. The purportedly sober assessment on the part of Chevron that “Inaction is not an option” in the realm of “World Energy Demand” is an assessment calculated through a particular moral/cultural reckoning of the situation in “the world.” The children of Nigeria are posed not so subtly as the pressing recipients of “our” rational action in the West. There is no adult Nigerian pictured in the entire advertisement. The children, like the land, are depicted as in need of a Western warden, able to order them and meet their needs in a methodical fashion. This is the implied “You” to whom the appeal for global development is addressed. The “economic prosperity” of the world is at stake, and it is not incidental that the advertisement lists Chevron’s highly invasive and polluting method of “streamflooding” in Nigeria as a crucial means to fuel the care of these children pictured. The application of distributive justice, applied to the questions of high end technology as defined by “developed” nations, may fail not only to discern the texture of life in what are deemed “developing” nations, but it may also undermine the claim by such countries to own and manage the resources for basic sustenance currently owned and managed by Chevron et al.

B Core Sample

In Jenny Reardon’s Race to the Finish: Identity and Governance in an Age of Genomics, she states the problem succinctly: “This modern age witnessed the entanglement of rules that govern what can count as knowledge with rules that determine which human lives can be lived” (2005, p. 5). When indigenous rights groups across the world protested the Human Genome Diversity Project as a new form of imperialism, the answer of the Western researchers was primarily to consider the ways that autonomy could be properly ensured in the midst of global, genomic research. The answer to the controversy over a project to record genetic diversity by culling the genomes of “isolated indigenous populations” was an answer pulled precisely from the language that rendered indigenous populations outside the realm of real knowledge, real rationality. The Western philosophical tradition on which principled bioethics depends began in part as an effort to sort out the rational from the irrational, with Immanuel Kant rendering most non-Western peoples as more animalistic, primal, and undeveloped. By Reardon’s narration, those who were protesting the Human Genome Diversity Project did so largely on the grounds that their lives, land, and very bodies had been deemed sub-rational by the Western philosophical tradition that scientific researchers now claimed would come to the rescue in the form of “bioethics.” By this reading, the principle of autonomy—whereby an individual human is deemed such due to his or ability rationally to choose the relevant details of his or her life—assumed both too much and too little. First, a bioethic tethered to autonomy brought with it the highly contested divisions by which a person is judged reasonably competent or incompetent. Second, a bioethic tethered to the usual procedures governing autonomy—un-coerced consent first among those—failed to interrogate the coercive weight of Western research itself. As Reardon explains, “By assuming the prior existence of a domain called science and a domain called ethics,” this effort to ameliorate the dangers of imperialism failed to note the ways that the “natural and moral order” were configured within the diversity project’s very conception (2005, p. 99). ¹

An ethic of procedural autonomy, combined with a procedural ethic of distributive justice, each remaining invisibly inscribed within a teleology of civilized progress, simply served to reassert the problem critics of the program sought to address. Bioethics as usual sought to ensure that the populations targeted by the research—“isolated indigenous populations”—would be given the chance autonomously to opt into the genomic research. The definition of autonomy at work, however, was a definition that included people inasmuch as they would, of course, rationally choose to be part of civilized, rational, progress. The “isolated indigenous populations” could opt into the “Project” as rational choosers if they were sufficiently rational to be judged to be autonomous—all as defined by a rationale heretofore invisible to the researchers themselves. Ironically, the presumed “primal” quality of the peoples to be studied was one of the reasons for the pursuit of the project itself—allowing researchers to look back into human origins by studying the genetic traits of culturally “isolated,” pre-technological people. What began as (at least in part) an effort to extend the assumed goods in the genomic offing to those outside the purview of biotechnology served to highlight the working supposition that there is a basic, rationally observed divide between those who are “scientifically unsophisticated” and those who were privy to genomics, a field which Western culture had declared to be no less than the “language in which God created life” (to quote then-President Clinton). ²

To take a cue from Shiva, Jasanoff, and Reardon, how might a bioethicist working today in the field of global health think more self-critically about the assumptions of Western progress? How might Western bioethicists be more aware of the ways that our language depends upon a set of assumptions about progress, rationality, and development? To put this in Reardon’s language, how might Western bioethicists’ intent to be useful in countries classified as within the two-thirds world be cognizant of the ways that we enforce through our language a set of “rules that govern what can count as knowledge”? How might our very efforts to be of use deal in deadly ways, reinforcing “rules that determine which human lives can be lived”? In order better to probe the ways that scientific sophistication and the development of progress are configured in the dominant Western (here, American) mind, it seems apt to move backward, to consider the ways that backward people are narrated as such during two episodes of marketed science. One of the conceits of bioethics is that our moral thought occurs in a vacuum. To suggest that Westerners assess the presumed goods of biotechnology thoroughly outside the rhetorics of success at play in the last century is to ignore the power of language to shape imaginations. Through use of cultural history, we may become more aware of the contours in which we speak and configure through language the “others” who would be the objects of research and the recipients of redistribution.

II “FORWARD! EVER FORWARD!”

A The Progress Medicine Has Made

The Century of Progress Exposition held in Chicago at the beginning of the Great Depression may serve as a strong example of the co-production of science and a newly globalized social order described by Jasanoff. The Exposition was meant to epitomize Progress itself, catapulting the heartland of America from its status as a local, agricultural, and tradition-bound region to an industrial, scientific runway of progress. The Century of Progress between the incorporation of Chicago as a city (in 1833) and the 1933 celebration involved the movement away from the world of Native America and toward the world of General Motors, General Electric, and Frigidaire. The Hall of Science, which claimed pride of place for the entire exposition, featured not only “The Transparent Man,” (a slim, Nordic figure, with his plastic arms raised to the stars, brought over from Dresden, Germany) but also an exhibit that contrasted “primitive” and scientific medicine. According to the guidebook, the fairgoer could view “the antics of an Indian medicine man, practicing his primitive medicine,” as well as “the progress medicine has made” (Chicago’s World Fair, 1933, p. 40). Key to movement of Progress was the traction provided by the carefully crafted depiction of the Past. In one of the official posters, a Native American with headdress serves as the backdrop for Lady Progress, beckoning. She is Greco-Roman, signaling that the Progress into which America moves through sheer will is on a trajectory consistent with the strength of Western culture. Her summons depends upon her contrast with the personification of the alternatively atavistic prior. Throughout the Exposition, the purveyors of progress sold to the public the responsibility of development, both at home and abroad. The force of their summons had much to do with the contrast conveyed in the poster. A responsible, autonomous citizen would participate in all that science could provide.

The motto of the Century of Progress was “Science Finds—Genius Invents—Industry Applies—Man Conforms [or Adapts].” This pronouncement was not merely verbiage, but was literally built into the Exposition itself. Regarding the architecture of the exposition, the official photographic record, published by the Encyclopedia Britannica in 1933, explained that the architecture “might be called, figuratively, athletic … because it is so fined down for efficiency, because it is in such beautiful condition (to continue with the athletic figure)” (Linn, 1933, p. 6). Those who attended the Fair were to have their thoughts about the nation’s future shaped by the configuration of intentionally crafted exhibits.

James Weber Linn described Chicago’s past and present with strong contrast, drawing a distinct line between, on the one hand, “recollection” and “sentiment” and, on the other, the working of true “imagination”:

A Century of Progress was planned, by architecture and arrangement as well as by exhibits, to throw the minds and the imaginations of men forward, into the future. It was not to look back, but onward. It was to be a projection, not a recollection. This book asserts and demonstrates the success of that daring intention as a whole, by giving innumerable examples of its success in detail. The “World’s Fair” of 1893 appealed directly to sentiment, A Century of Progress appeals to the imagination. It is the difference between a story and a prophecy (Linn, 1933, p. 5).

This was serious business. As summarized by three historians in their introduction to Fair America: World’s Fairs in the United States, the “veritable web” of world’s fairs beginning mid-nineteenth century lent “form and substance to the modern world” (Rydell, Findling, & Pelle, 2000, p. 1). The writers continue: “To say that world’s fairs have exerted a formative influence on the way Americans have thought about themselves and the world in which they live probably understates the importance of those expositions.” The millions of visitors who attended the various fairs across the United States were exposed to the very intentional, minutely planned messages of the fair’s organizers and contributors. Even those who did not attend were exposed to a fair’s aims in reports and in advertising in regional and national publications. The corporate and civic leaders organizing the various events did not perceive them primarily as a means for entertaining the public but rather as a means for shaping the civic imagination around a particular, chosen theme. The aim of the Century of Progress Exposition in Chicago was, from the outset, to expose the public to the promise of scientific progress. This was a crafted spectacle of national advance.

B Unquenchable Curiosity

One of the first images in the official pictorial record is a color drawing of the Travel and Transport Building, and the caption below echoes Linn’s emphasis on movement away from the traditions of the past into an unfettered tomorrow: “Larger than the dome of St. Peter’s or that of the Capitol in Washington, this sky-hung rotunda of the Travel and Transport Building strikes a new note in architecture—first application of the principle of the suspension bridge—the largest unobstructed area enclosed anywhere under a roof” (Encyclopedia Brittanica, 1933–1934, p. 11). The language of “new,” “first,” and “largest” ran throughout the fair’s exhibits and literature. Although the plans for the Exposition were well underway before the 1929 stock market crash, the insistent tone of “Forward! Ever Forward!” (again to quote Linn’s 1933 official commentary) seems magnified by the contrasting economic downturn occurring in the nation at the time. The way out of the morass was “Forward! Ever Forward!” and those sounding notes of concern or doubt needed not apply. “To forget the achievements of the past is impossible, to deny the inevitability of change absurd, to turn away from the immediate and from the promise of the future cowardly,” the Exposition warned. There would be space in the future only for the “determined and unquenchable curiosity” and the “spirit of scientific inquiry” that had “changed the world and set it on its new path of progress” (Linn, 1933, p. 5).

Many of the exhibits featured contrasts between the world of yesterday and the world of tomorrow; from bathing to canning to baking, displays of the ways of the future included also, in a mural or a corner show, displays of the clearly inferior ways of the past. There were advances in transportation, “From Wagons to Wings,” to quote the guidebook, signaled by the sleek Greyhound “auto-liner” buses (with the sleek Greyhound icon) that whisked people around the fair, as well as the airplanes that flew in formation overhead. The fair was replete with advances in foods and agriculture, such as the Wonder Bakery’s “truly perfect” (i.e., fully automated) assembly line, which baked breads “scientifically”—“never touched by human hands” (Gleisten, 2002, p. 70). General Electric presented a House of Magic, including a sparkling white Electric Kitchen in which the work of home cooking could be almost as sanitary and advanced as the Wonder Bakery. The Dairy Industry sponsored its own building at the exposition, with the cow featured in a drama depicting bovine progress, from “the bringing of the first cows to the Plymouth colony” to “today’s organized dairy industry” (Chicago’s World Fair, 1933, p. 77). A headline above the entrance to the exhibit read “A Vital Story of Human Progress.” The caption beneath the photograph published in the photographic record reflects the going assumption regarding the use of cow’s milk for infant feeding—in the imagery, both mother and Mother Nature had been methodically supplanted: “The Dairy Building, where is portrayed the story of the foster mother of mankind, the cow” (Encyclopedia Britannica, 1933–1934, p. 78).

C Human Mistakes and Mishaps

To understand fully the Exposition’s “Forward! Ever Forward!” theme, it is crucial to interpret the Exposition’s Midway, embedded right at the center of the 1933 map, with such attractions as Ripley’s Believe It or Not “Odditorium,” a sampling of “freak shows,” Oriental Village, Darkest Africa, and the Old Plantation Show. The positioning of the “odd,” “freakish,” “mysterious,” and “quaint” right in the midst of the overall message of the Century of Progress may seem at first counterintuitive. But at second, deeper glance, the arrangement makes sense. As “mankind” progressed upward, forward, and away from merely mortal limits, so it seemed necessary to those crafting the exposition to place at the center a Midway—a titillating reminder of the “uncontrollable” and “accidental” in nature and culture. The Midway offered eager fairgoers a chance to view the world beyond which the fully mechanical Wonder Bakery pointed.

To repeat, the theme of the Century of Progress was “Science Finds—Genius Invents—Industry Applies—Man Conforms [or Adapts].” Here was humanity left behind, humanity either incapable of or irrationally unwilling to “conform” or to “adapt.” The Midway represented recalcitrant or accidental humanity below the ken of scientific findings, inventive ingenuity, and the applied industry of Progress. From the Temple of Mystery to the Thrill House of Crime to the Old Plantation Show, this section of the fair displayed nonconforming and ill-adapted Man. The Thrill House of Crime allowed viewers to step inside a safely contained world of menace populated by clearly distinct types, including the “white slaver,” the “suicide,” the “coke addict,” the “kidnaper (sic),” the “fire bug,” the “drug slave,” the “bomber,” and the “maniac.” The apparent discord between the “odd” and “criminal” and the theme of Progress makes sense when viewed from a particular perspective. The various “other” peoples on display were indigestible examples of “incredible truths, wonders and paradoxes” (to quote the Ripley’s brochure for the fair) amidst the exposition’s overall “prophecy” of improvement. Science and methodically engineered industry were to eliminate “waste” along the “path of progress” (again quoting Linn on the fair).

At the close of his introduction to the fair’s official photographic record, Linn suggested that the exposition served, through its display of “miraculously developed mechanical ingenuity,” a “valuable work of demonstrating to the nation that it is a unified nation, a high-hearted nation, a nation undiscouraged and unafraid … [a nation] in oneness of hope and spirit” (Linn, 1933, p. 10). There were some fairly obvious, and rhetorically serviceable, fissures in this technological “oneness.” In its Midget Village, the exposition offered a glimpse at a down-scaled city where “sixty Lilliputians” lived in their “tiny houses” and conducted their “diminutive activities.” Viewed within the cultural assumptions of Haeckel’s Darwinian recapitulation theory, the Midget Villagers represented a kind of backwards, not-yet-fully-formed culture. They were the past of human evolution, away from which science was progressing. What the Midget Village portrayed overtly, various other villages suggested more subtly, by designed, exploitable differentiation. Among the “Foreign Participation,” the contrast between, on the one hand, British and Western European and, on the other hand, everyone else, was clear. There were cultures to visit as tourists of the dark, old, and exotic, and there were cultures capable of contributing more directly to the ingenuity of progress. While the Swedish Pavilion and the Moroccan Village were both featured in the fair, the former modeled “the simplicity and dignity … typical of the trend in modern Swedish architecture,” while the latter was described thus: “The streets are paraded by typical Moors in costume, who sell their barbaric wares in this wonderful reproduction of Northern Africa” (Chicago’s World Fair, 1933, p. 96).

D Oneness of Hope and Spirit

Many of the villages at the exposition were set up to accentuate the distance between the “World of Tomorrow” and the peoples of yesterday. After visiting the Ford Symphony and Park, fairgoers could, in quick succession, take in the sights of the Midget Village, the Old Plantation Show (with “60 Hand-Picked Colored Entertainers”), and the Living Wonders exhibit (presenting “Human mistakes and mishaps”—the “Largest collection of strange and curious people ever assembled”) (Chicago’s World Fair, 1933, p. 166). The Official Guide Book to the Fair explicitly linked the sites of the Midway, assuming associations that ran from the “breath-taking roller coaster” to the “tricks of magic” to the “beauties of the Orient [who] dance to strange tunes” to “glimpses of Cairo, Damascus, Tunis, Tripoli, and Algiers” to “the Siamese Twins, giant people, and other ‘freaks’ gathered from the four corners of the earth” (Chicago’s World Fair, 1933, p. 123). Many of the cultures represented in the various villages stood in for the “mistakes and mishaps” of retrogressive culture. The guidebook issued for the Fair’s 1934 continuation promised Hawaiian Village entertainment featuring the climactic “sacrifice of a Hawaiian girl” in the “flaming crater” of a volcano. ³ What the “mishaps” and midgets offered in individual form, the inhabitants of such Villages displayed in cultural form—serving as oddly reassuring reminders of the retrograde beyond which a Century of Progress could move.

The depiction of southern African Americans in the Old Plantation Show merely scratches the surface of the underlying racism involved at the Century of Progress. There were those workers who would be involved in harvesting the rubber for the high speed race of progress and those who would reap the benefits, as signified in one Firestone brochure. This was powerfully symbolized by the names assigned to the two towers holding up the famed Sky-Ride of the Century of Progress, which moved fairgoers from one side of the exposition to the other. They were dubbed “Amos” and “Andy,” after the characters from the radio minstrel show, which had originated in Chicago in 1928. ⁴ Almost unbelievably, one feature of the fair was “African Dips,” which gave visitors an opportunity to drop an African American into a tank of water by hitting a bull’s-eye with a ball (Rydell, Findling, & Pelle, 2000, p. 84). The depiction of “African” culture (as if it were a monolith) painted with bold strokes what was more subtly implied at the other villages. The exhibit was called “Darkest Africa” and featured shows of “Firewalkers” and “The Funny Native,” in which a “Native” and a white actor with academic demeanor portrayed a series of supposedly humorous miscommunications. Although the fair also featured exhibits from the National Urban League and a few African American colleges, the situation of race at the Century of Progress was deeply divisive.

The differential benefits of the fair were not merely symbolic. Some people would be in the process of Forward, while others would not. Chicago had been one of the primary destinations during what historians call the Great Black Migration. From 1910 to 1920, the African American population in Chicago had more than doubled, to 109,000, and from 1920 to 1930, it had grown to 234,000 (Lemann, 1991, p. 16).

As the authors of Fair America reveal:

“Virtually absent from the Century of Progress were African Americans…. Although the fair created many jobs, few went to African Americans during either the construction or the run of the fair. The only African American in the fair’s management hierarchy headed the toilet concession, and most African Americans who did work at the fair cleaned toilets; a few others worked as maids, police, and demonstrators in a few exhibits” (Rydell, 2000, pp. 83–84).

Linn’s language of “oneness” notwithstanding, the world of the Century of Progress was limited. The “Forward” by which the Exposition of Progress was configured was a specific forward along a carefully crafted trajectory. The telos of humanity as a whole was defined by the telos of technological advance. Those individuals or peoples who with recalcitrance refused to conform or adapt became, in the process, atavistic. Those who would “turn away from the immediate and from the promise of the future” as mapped by the Exposition became, at the very least, “cowardly” (Linn, 1933, p. 5) and were arguably rendered as sub-human. The cultures relegated to The Midway were not merely excluded. They served a rhetorical purpose. Without “the antics of an Indian medicine man, practicing his primitive medicine,” one would not be able fully to appreciate “the progress medicine has made” (Chicago’s World Fair, 1933, p. 40). The trajectory of progress required the presence and the exclusion of entire cultures.

The echoes of this division between serviceably strange and responsibly progressive reverberate today in much that passes for global health. During the Great Depression, when hungry children across the nation woke up with barely a breakfast to eat, citizens were told that the nation’s hope was based on the great leaps of progress. One facet of this Fair seems to have been a concerted call to a kind of drunkenness in technological Progress as Hope itself. Yes, there were peoples not privy to Progress, but they are displayed as people of a different sort, less fully evolved peoples beyond which Human Progress was to be gauged.

To overlay a transparency of distributive justice onto the map of the Exposition would be to miss this crucial interpretation of the Century of Progress. The problem with the Exposition was not simply one of distribution. While it is not beside the point that most fairgoers would be unable to afford General Electric’s House of Magic, to stop there is to miss the powerful language at play throughout the planned spectacle of a truly human future. The Exposition was designed to define what could count as the truly human. A culture not aspiring toward the telos of Western progress became part of the bizarre. People without the aspiration for the goods brought by science, genius, and industry became primitive. Without attention to the rivulets of culture created by such marketing of progress, Westerners eager to be of use for health care justice may find ourselves inadvertently going up the same stream. The supposedly all-purpose paddle of Western bioethics will hardly cause a ripple.

III THE WORLD AND ALL THAT IS IN IT

A Backwoods Japan

The Century of Progress Exposition sought to shape the minds of a generation who would then raise their own children as able, responsible stewards of the Atomic Age. World War II played no small role in ending the Great Depression, and the close of the war ushered in a new era of America’s movement FORWARD. Yet without spin, the American populace might have deemed the scientific achievement of nuclear weaponry to be instead a giant step in the wrong direction. The momentum for progress in 1947 again depended on the traction gained by pushing off those below the ascent. Americans needed a properly configured map of “the world and all that is in it” in order for the post-war period to become epitomized as progress.

This global map required an evolutionary interpretation accessible to the mainstream populace. As chronicled by John W. Dower in War Without Mercy: Race and Power in the Pacific War, the Japanese had already become, in the American imagination, a particular type—the “Monkey Folk.” “The most common caricature” of the Japanese during the war was, “without question,” simian (Dower, 1986, p. 84). ⁵ The New York Times, Detroit News, Washington Post, and many other publications had put Darwinism to good use by depicting the Asian enemy in particular as inherently sub-human. The peoples on whom the bombs had fallen were of a different sort. The new technology ringing in the Atomic Age would not undermine humanity, but properly divide those who were willing to conform or adapt and those who could be relegated to the dross of history.

Not yet two years after Hiroshima and Nagasaki, National Geographic took its readers into “Backwoods Japan During American Occupation.” The article is not only representative of the period but arguably a key component of the larger campaign to restore an almost limitless hope in technological progress as the marker of humanity. ⁶ The story is ostensibly about the Japanese area for which General MacArthur had set up a Forestry Division in October of 1945, but the essay features a running commentary that associates the “backwoods Japs” with the presumably “backwoods” people living in wooded regions of the United States.

Using various cultural cues, the narrator, himself an American forestry expert, takes readers on a tour of a people who “depend amazingly on their forests” in order “to build their wood and paper houses; to cook their food and keep themselves warm over their braziers; to ensure water for irrigating the valley rice fields.…” The article opens in this way, setting MacArthur as the industrious authority who brought in experts, such as the author, to “advise them on forest resources and forest products.” The writer employs humor to signal the superiority of the readers to those interpreted. The chauffeur who drove the officials to one meeting “seemed to use only horn and accelerator.… I doubt that he ever needed to have his brakes relined.” But even on the first page, the author quite explicitly notes for the reader the importance of maintaining a critical distance from the “backwoods” people who seem, at first glance, “hospitable and courteous.” The author warns: “In traveling away from the densely populated, heavily bomb-damaged centers such as Tokyo, Yokohama, Osaka, and Nagoya there always was the danger of forgetting that the people we saw in the villages and in the hills were also warmaking Japs” (Huberman, 1947, p. 491). Using the war-propaganda epithet “Jap” interchangeably with “Japanese” throughout was an overt signal to the readers that these seemingly peaceful, “eager” people whom MacArthur’s team were sent to assist represented the sub-human creatures to whom the United States was forced to respond with the advanced weaponry of modern science.

B To Lead the Way

The narrative is also interspersed with apparent indications of aesthetic and intellectual superiority. “No plant visit was complete without at least one cup of sugarless tea in a handleless cup. After such a tea party the host, with much bowing, would motion us to lead the way… .” (Huberman, 1947, p. 491). As the author and his team attempted to gather data, better to assist the “Japs” with their forest industry, they found that “questioning almost invariably produced divergent answers” (Huberman, 1947, p. 492). With bits of commentary on their interviews with personnel and management at the plants, the author brings the reader in on the joke, inviting families back home to chuckle and shake their heads at the frustration of dealing with such evasive strangers: “A time-consuming habit of the Japanese reminded us of a radio comedian’s gag…,” and “It was difficult for us to keep our faces straight during such proceedings, but the Japs never seemed to think it funny.” Again: “We were comically reminded of Gilbert and Sullivan’s The Mikado by one mayor [identified by the subheading as one of the “Pooh-Bahs of the Villages”] who was president of the local forestry association” (Huberman, 1947, pp. 492–493, 496–497). One picture, “By Their Saws You May Tell Yank and Japanese,” is characteristic. The standing Marine, with apparent patience, offers the superior tool to the primitive Japanese (Huberman, 1947, p. 498).

In addition to justifying the Manhattan Project, the narration of the Japanese people served also as a rhetorical argument for the American tutelage of Japan itself. America, as a developed nation, was to play a crucial role as grand strategist and master cartographer for the new Asia, serving to catapult a not fully evolved people forward. The piece places Japanese family life on the stage as a combination of Gilbert and Sullivan and (King Features Syndicate cartoon) Snuffy Smith. The author describes encountering “a charcoal burner and his wife about lunchtime.” The man “seemed to growl to his wife,” and she, by turns, “giggled” and obeyed her husband’s various commands (Huberman, 1947, p. 499). The homes of those visited are described with meticulous attention to the supposed lack of furniture and decorative detail: “The family sat on the floor, ate off trays on the floor, and slept on a futon, or quilts placed on the floor.”

In another caption, the “Backwoods” connection is blunt: “A Still in the Kyushu Backwoods Cooks, not Sour Corn Mash, but Fragrant Camphor” (Huberman, 1947, pp. 504–505). The depiction of the Japanese children as “runny-nosed, bright-eyed” beggars appealing to their occupiers for “Gummu” and “Chocolettu” lends to the narrated image of the “GI” as “a friendly gentleman” in the midst of little people. The mothers, “in response to the contagious grin of the big Americans,” “smilingly allowed their babies to have the sweets” (Huberman, 1947, pp. 514–515). The overall narration is clear: American occupation is a blessing to the people of “Backwoods Japan.” Without American occupation and the American victory enabled by nuclear weaponry, these backwoods people would have had little hope of moving out of their simple existence and into the twentieth century.

The default mode of bioethical reasoning is insufficient to interrogate the cultural configuration of scientific progress. Entire peoples have been narrated as objects of paternalistic sponsorship, and restating the principal of autonomy in this context is not only to leave the context unexamined. To speak the language of procedural consent is potentially to legitimize ethically a dehumanizing global system. The Nuremberg Code of 1949 is absolutely indispensable for the field of medical ethics, but to say that “the voluntary consent of the human subject is absolutely essential” is not to say that it is procedurally insurable. To speak as if the work of global health is primarily one of ensuring consent pushes the more radical work of global health justice outside the Western academy. The procedural task of distributive justice, as too often configured in the field of bioethics, serves also to reinforce the assumptions of Western marketed biotechnology. An unchastened account of distributive justice may be in one of two forms—calling either for the charitable distribution of discounted medical products or for the unfettered expansion of the medical market. But the arguments for charitable distribution and for economic access continue to assume that the task of the Western provider is to convey the non-Western consumer along the arc of progress. The FORWARD assumed still has as its telos the enculturation of “Darkest Africa” and “Oriental Village.”

For some on the radical left, this is all to state the obvious. It should come as little surprise that the Western academy is insufficiently courageous as to take on the patient, humble, small-scale, local work of learning basic health care together with people living in a post-colonial world. I have reason to hope otherwise, but I suspect the Western academy will be of little use without a daily dose of contrition. ⁷

IV CONCLUSION—ICONS OF KNOWLEDGE

A Wholly Beyond His Comprehension

The work of rendering peoples outside the Western, “developed” world as subtly less than human is still at play in the marketing of scientific progress to the middle-class in America. The very scientists who propose Western-style development seem too often unrepentant in their use of the language by which whole peoples have been labeled sub-human. In the Natural History issue of November 2005, Sean Carroll opens his essay on the “Origins of Form” with a quote from the Origin of Species (or The Preservation of Favoured Races in the Struggle for Life). The quote begins “When we no longer look at an organic being as a savage looks at a ship, as something wholly beyond his comprehension…” (Carroll, 2005, p. 58). What are we to make of this language today? As a savage looks at a ship? Carroll makes no apology for Darwin’s language, no explanation that Darwin assumed a split between civilized and uncultivated humanity that should not guide our work in the 21^st century. I would argue that this is because the marketing of science to interpret the world and all that is in it continues to play on this split.

Earlier in the same issue of Natural History, Harvard University Press advertises Sander Bais’s book entitled The Equations: Icons of Knowledge with the promise that the icons “reveal and embody the fundamental truths of physical reality.” This working definition of biological science as the proper means for comprehending not only a ship but also all of human existence runs through the entirety of the magazine, which is sent gratis to families across the nation with memberships at their local science museums.

How is one to perceive peoples who might configure their own existence differently than by the knowledge conveyed at the local museum of life and science? A “special advertising section” positioned at the center of Natural History entitled “Distinctive Destinations” suggests one answer to this question (2005, pp. 13–23). With an image of indigenous men from India alongside a tiger, the advertisement suggests that the tiger and these men must be preserved in all their local “colour” for the sake of travel, kept pure for the sake of Western curiosity. The advertisement reads “Incredible India” and promises that “dunes have a colour here, brilliant as gold. Skies have a colour here, deeper than ink. Valour has a colour here, on the faces of men. Beauty has a colour here, in the swaying of skirts. Incredible india [sic], infinite rainbows.” The men pictured in the advertisement seem, in context, to function as the primitive, prior, purer “colour” by which Westerners may contrast the rational, colorless knowledge that defines the “fundamental truths of physical reality.” The advertisement at the center of Natural History seems to function quite similarly to the “Oriental Village” of the Midway. The question remaining is whether or not they should remain a spectacle at the center of this new century of progress or instead be economically bombed into the genomic era.

B Ancient and Non-Technological

This same problematic dynamic seems at work in Laurie Garrett’s bestselling Betrayal of Trust: The Collapse of Global Public Health. Garrett’s work, along with the efforts of the Human Genome Diversity Project, may be read as a misguided, even hubristic, attempt on the part of Western researchers to be “of help” to peoples in the two-thirds world. The Washington Post review quoted on the cover of the 2000 paperback issue claims, “Reads like a Robert Ludlum thriller …” and sadly this description does not overreach. The thrill on the part of the Western reader is presumably to trace the menace of the diseases currently “contained” in the sites chronicled by Garrett, watching them move across borders and ever closer to the reader, her homeland, her nation, and her children. Through the titles of her first two chapters, Garrett names India as a site of “Filth and Decay,” and Zaire as a country (untranslatably) under the influence of “Landa-Landa” (Garrett, 2000). While Garrett’s ostensible aim is to engage Western readers in the debates over basic, global health care, her method plays into the language by which the two-thirds world is rendered backwards, chaotic, menacing, and potentially titillating.

By Garrett’s own wording:

… the basic factors essential to a population’s health are ancient and nontechnological: clean water; plentiful, nutritious, uncontaminated food; decent housing; appropriate water and waste disposal; correct social and medical control of epidemics; widespread—or universal—access to maternal and child health care; clean air; knowledge of personal health needs…(Garrett, 2000, p. 13).

Yet Garrett’s narration continues to position the peoples she covers as those woefully underneath the radar of what is considered civilized culture. With her story-telling power, the outbreak of pneumonic plague in India and of Ebola in Zaire reads like a macabre mystery set in the “Oriental Village” or “Darkest Africa.” The menace is “coming,” with her recounting taking the perspective of the Westerner reading, imagining in his mind’s eye the growing speck of menace on the outlying horizon. This rhetorical distance is powerful as she describes the need to bring Western medicine to these very regions to protect peoples in the two-thirds world from themselves. The pneumonic plague spreads, by her account, in the midst of a festival including “crowds of festive poor jam-packed into small spaces.” The way that this festival to the Hindu god Ganesh functions in her narrative is as if the plight of the people in Surat is in large part due to their unruly worship of an elephant-headed deity (Garrett, 2000, pp. 24–26). This goes on as well in her narration of the Ebola outbreak in Zaire. The region is deemed repeatedly as “medieval,” with those left behind as widows and orphans “flailing” and “jerking in spasmodic death dances.” ⁸

Garrett’s language for the people of Zaire in this chapter seems at times pulled straight out of Joseph Conrad’s The Heart of Darkness. This is in stark contrast to the protagonists of the “Landa-Landa” chapter. Garrett describes the two western scientists who save the day as being in control of even their own sweat. The “athletic, forty-something American [Szczeniowski] moved swiftly in the sweltering, 90 percent humidity torpidity”; he is described as “rarely seeming to break a sweat or smudge his spotless wire-rimmed glasses.” The Dutch Dr. Kiersteins is heroically “indefatigable” (Garrett, 2000, pp. 77, 79). It is as easy to read Garrett’s book as justifying Mr. Kurtz’s colonial solution to difference (in The Heart of Darkness) as it is to read it as a call for Westerners to attend to the voices of people outside their ken.

The configuration of contrast seems all but inherent to the language of global health, the initiatives embedded in an overall effort to extend Western influence in ways that benefit primarily those who have the power to name need and to assess merit and to provide largess and to extend markets. But rather than remain with that grim interpretation, I hope to suggest (and pray eventually to embody) an alternative model for engagement. Reardon recommends receptivity within a dialogic model of bioethics that is open to a lack of clarity and even a lack of “progress” as often numerically and yearly gauged in strategic initiatives at Western, high-pressure universities.

Emmanuel Katongole, who is a colleague at Duke, begins an essay on the task of African theology by referencing Conrad’s Dr. Kurtz. In Katongole’s diagnosis of the ways that Westerners on both sides of the prophylactic debate have led to the “condomization of Africa,” he calls for a thorough recalibration of thought. In all that he writes, Katongole advocates that those in the so-called “developed” world who would work on issues of global health care become attuned to the one-third world presumption at play in their various Projects and Strategies and Expositions. This will mean that Western scholars who are trained to bring (like so much L.L Bean baggage) their own preconceived and well-published answers instead arrive at the table ready to listen. One significant facet of this attention involves noting the “tactics” of survival and, yes, flourishing already at work in regions deemed by the discourse of development to be God-forsaken. Without a painstaking, self-critical stillness, Western scholars so intent on improvement will likely bring with them strategies to aid people in the two-thirds world only inasmuch as these people will to participate in technological solutions. Katongole describes the expected pattern of advance within many Western development initiatives as “leap frogging.” This pattern amounts to a kind of flight over concerns about human flourishing as locally construed—a flight over the nuances of lived life in the regions supposedly to be served. In Katongole’s words, “Given the frantic and desperate leap-frogging that is required if one is to catch up with the operation of [technology], it seems impossible, perhaps even out of step, to think about focusing on such ‘local’ issues as cassava, millet, or goats—the lifeline of the man and woman in Malube or Umutata (their ‘actual’, not their ‘virtual’ reality’)” (Katongole, 2000, p. 245).

Katongole’s diagnosis corresponds closely with Reardon’s concern about the biopolitics of technological progress: “This modern age witnessed the entanglement of rules that govern what can count as knowledge with rules that determine which human lives can be lived” (Reardon, 2005, p. 5). Without attention to the ways that scientific knowledge in the West has become entangled with the politics of Western development, scholars who soar across oceans on British Airways and American Airlines are likely to perceive when they land what they expect to find—people in need of a global custodian to help parent them into the realm of high end technologies (Katongole, 2000, p. 244). This need not be so.

A motto of General Electric during the Atomic Age was “Progress is our most important product.” One of the working assumptions driving an “outrageously ambitious” institution of higher education like my own is that we are akin to General Electric, serving as the purveyors of the product that is progress. To address honestly the patterns of disparity in basic global health, Western initiatives will need more fully to interrogate the rhetoric of our work. We will need to consider the manifold ways in which it has been serviceable to the West to name other people as below the ken of true knowledge. Bioethicists intent on being of veritable use in the midst of such contexts may need to be humbled by the language used in the past to render others “savages” warranting colonization, aware that the same dynamics may be at play in the efforts today to employ strategic plans in places beyond our own ken. A bioethic wherein justice skims along the top of the global terrain may simply lend its Western, default, moral legitimacy to a new form of biotechnological world order.

Notes

1. For an incisive discussion on the language of civilization as parasitic on the construction of the “primal,” see McGrane, 1989. I am grateful to Emmanuel Katongole for introducing me to the work of McGrane.

2. The language is from the North American Regional Committee from the first page of the Model Ethical Protocol of the project, quoted in Reardon, 2005, p. 147.

3. 1934 Official Guide Book to the Fair, cited in Gleisten, Chicago’s 1933–1934 World’s Fair, p. 92.

4. For more on the background of the radio beginnings of Amos and Andy, see Ely, 1991.

5. See also pp. 181–190. The imagery for the German threat was quite simply different, with the German war seen as a war against “the Nazis,” or more specifically against Hitler himself, rather than as against the Germans as an inherently treacherous people. See Dower, pp. 78–81.

6. To bring interested, aspiring Americans “the world and all that is in it” remains the unofficial motto of National Geographic, a slogan originated by early National Geographic Society leader Alexander Graham Bell in 1900. The linguistic power of the magazine should not be underestimated. The World and All That Is in It was interpreted for two million readers by 1950, with subscriptions numbering two million. The magazine served as the primary conduit of information regarding the role of American ingenuity in the postwar world.

7. This is something that Western Christian missionaries had to learn after nearly a century of ill-gotten gains.

8. For “medieval” see Garrett, 2000, pp. 16, 58, 235. The description of the death dance is at p. 91.

(February 2006). Harper’s, 312, (1869). The Chevron advertisement appears on the inside front cover and p. 1 of Harper’s.

(November 2005). Natural History, 114, (9). Advertisement by Harvard University Press, p.27