Heidi Morefield, <i>Developing to Scale: Technology and the Making of Global Health</i> Chicago: University of Chicago Press, 2023. Pp. 232. ISBN 978-0-226-82863-3. $30.00 (paper).

In the 1960s, American aid and development agencies started talking about delivering 'appropriate technology' to what was then called the Third World: donating small-scale technologies fitting local needswater pumps, grain mills, bamboo cartsor as a Haitian priest famously framed it, 'shit for the poor' (p.2).Transferring technology appropriate to local rural economies, proponents argued, would enable self-sufficiency, social stability and happiness, whereas large-scale technological systems would import the ills of industrial life, such as urbanization and mass unemployment.Half a century later, in 2014, Bill Gates made headlines by downing a glass of water produced by the Omniprocessor, a high-tech plant for turning human waste into clean drinking water for use in low-and middle-income countries.Funded by the Bill and Melinda Gates Foundation, the so-called 'Gates Poo Machine' has been sold affordably to local entrepreneurs in Senegal, India and elsewhere.Although the humanitarian goal of health for all has remained constant, the technologies usedand their framing, packaging, transferral and receptionhave changed in important ways.Morefield offers the first scholarly account of how the appropriate-technology movement was adopted in international health discourse and transformed into the field of global health.The first two chapters provide an intellectual history of the idea of appropriate technology, recounting the well-known biography of the economist Ernst F. Schumacher, his intellectual circle and his most famous work -Small Is Beautiful: Economics as if People Mattered (1973).With a counterintuitive mix of Keynesian macroeconomics and smalltown values, Schumacher argued for cultivating what he called 'intermediate technology' in developing countriesrather than transferring large-scale technology from highly industrialized countries, the focus should be on educating the predominantly rural population to help locals develop their own small-scale technological solutions.In Chapter 3 the narrative expands horizontally to examine practical contemporaneous translations of Schumacher's ideaswithin various countercultural environmentalist and feminist networks, with a particular focus on the importance of print media, catalogues and handbooks in spreading technology for social change.The following two chapters shift back to the world of politicians and bureaucrats and enter the historical focal point of the narrative: the UN Conference on Science and Technology for Development in Vienna in 1979.The Carter administration's adoption of 'appropriate technology' in 1977 was primarily an economic response to budget cuts to international aid and aligned with the UN's focus on low-cost primary health care interventions.But in Vienna, the US position diverged towards a more biomedical and industry-driven policy.Morefield