The stages of international (global) health: Histories of success or successes of history?

Abstract

International1 health funders, leaders and researchers frequently cite ‘successes’ in this field as validation for past labours and justification for future endeavours. However, the question of what constitutes success – from both historical and contemporary perspectives – has been inadequately analysed. This paper reviews and periodises understandings of success in international/global health during the past century and a half, mapping out shifts and continuities over time. It then turns to the implications of these changing conceptualisations for current and future global health ideologies, strategies and activities. It concludes by arguing that historians of global health and policymakers need to interact further so that historians are exposed to the contemporary problems of global health and policymakers better understand the historical complexity of extracting ‘lessons’ from the past.

Keywords:

• history of international health
• global health success
• international organisations

Acknowledgements

Funding for the research and writing of this paper was provided by the Global Health Policy Research Network and the Canada Research Chairs Programme. These sponsors had no other role in the writing of the paper or in the decision to submit for publication, and the ideas expressed herein are mine alone. No conflicts of interest declared. Thanks go to Heather Gordon for background research assistance and to René Guerra Salazar and Sarah Stranks for preparation of references. I also wish to acknowledge the participants in the Global Health Histories conference held at the National Institutes of Health (November 2005) and the members of the George W. Corner Society for the History of Medicine, Rochester, New York (April 2006) for their helpful comments on an earlier version of this paper. I am most grateful to Theodore Brown, Prabhat Jha, Nikolai Krementsov, Stephanie Nixon, Yogan Pillay, and the anonymous reviewers for their comments, suggestions, and encouragement.

Notes

1. This paper uses the terms international health and global health according to general usage in the historical period under discussion. The term international health was likely coined in the early 20th century, emerging as the international sanitary conventions of the previous five decades gave way to permanent bodies addressing health concerns internationally. It was employed most prominently by the Rockefeller Foundation's International Health Commission (later Board and Division) launched in 1913. By the end of World War II, international health was in widespread use, but the new World Health Organisation (as a semi-independent specialised United Nations agency) crafted its own name around the unifying notion of ‘world health’. Still, the term international health retained its primacy. During the Cold War, the field of international health came to encompass the problems of health in underdeveloped countries and the efforts by industrialised countries and international agencies to address these problems. Global health – adopted broadly over the past decade – is meant to transcend past ideological uses of international health (as a ‘handmaiden’ of colonialism or a pawn of Cold War political rivalries) to imply a shared global susceptibility to, experience of, and responsibility for health. In its more collective guise, global health refers to health and disease patterns in terms of the interaction of global, national, and local forces, processes, and conditions in political, economic, social and epidemiologic domains. However, as Ilona Kickbusch (2002) has argued, this ‘new’ global health has also been used to assert US ‘global unilateralism’ that is, a tailoring of the world's health agenda to meet hegemonic US national interests and undercut bona fide internationalist efforts. Notwithstanding the invoked distinctions, there is considerable conflation between international health and global health, and the ‘new’ definition of global health bears many similarities to early 20th century understandings of international health.

2. The Marine Hospital Service's Weekly Abstracts of Sanitary Reports, later the Public Health Reports, published reports warning about yellow fever, plague, cholera and other disease outbreaks from US informants and local authorities in (port) cities around the world.

3. As leading Canadian hygienist Fitzgerald (1931: 267) later noted, ‘That some measure of success attended this first effort seems to be implied in the fact that a second gathering of the same sort was convened’.

4. The Soviet bloc's withdrawal, undoubtedly motivated by Cold War tensions, stemmed from dissatisfaction with the WHO's insufficient attention to its numerous postwar health needs (despite the USSR's considerable financial contributions).