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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.