A brief history of World Health Day

WHO headquarters on World Health Day

WHO headquarters on World Health Day

The 65th annual celebration of World Health Day took place last week on 7th April, with a global launch of the Small Bite: Big Threat campaign against vector-borne diseases at the WHO’s Geneva headquarters. Over half of the global population is at risk of diseases such as malaria, dengue and yellow fever, all of which are preventable but which but have the biggest impact on some of the world’s poorest people. To highlight the risks to travellers, WHO staff installed a 3-D illustration of a giant mosquito at Heathrow Airport and distributed World Health Day boarding passes to passengers, drawing attention to the danger of vector-borne diseases and the simple measures they can take to protect themselves.

‘World Health Days’, the WHO’s Director-General Margaret Chan told visitors to the launch event in Geneva, ‘provide an opportunity to focus world attention on a health problem or issue that deserves special attention.’ Celebrations over recent years have focussed on antimicrobial resistance, climate change and road safety among other issues.

The first World Health Day took place in 1949, not on 7th April but instead on 22nd July, the date that 61 nations had signed the charter of the World Health Organization at New York in 1946. Documents in the WHO archives suggest that the goal of these early events was less to raise awareness of specific health issues, and more, in the words of the first Director-General Brock Chisholm, ‘to encourage public interest in and support of the aims of the Organization.’[1]

World Health Day Stamp PalestineIn 1949, individual governments were charged with organising events in their own countries and they took up the challenge with varying degrees of zeal. New Zealand led the way with a range of national and local events organized by branches of its United Nations Association. Ireland, Turkey, Austria, Italy and South Africa also responded, organising radio and cinema broadcasts, concerts, press releases and government-directed bible readings amongst other activities. The WHO headquarters in Geneva provided information about the organisation’s early success in combatting malaria in Italy and Greece, providing tuberculosis vaccines in India and responding to a typhus epidemic in Afghanistan. It also distributed a range of publicity materials and suggestions to national government, including a call to issue commemorative postage stamps (a perennial favourite of international organisations at the time).

Not everyone greeted the event with such enthusiasm however. Some countries felt they hadn’t had enough time to prepare suitable activities, whilst others sensibly pointed out that holding such a celebration when most children were on school holidays would severely blunt its impact. The WHO agreed, and the Second World Health Assembly decided that from 1950 World Health Day would be celebrated on April 7th, to commemorate the date in 1948 when the WHO constitution had officially come in to force.

The decision to link World Health Day to the foundation of the WHO highlights some interesting tensions in the early history of the organisation. In 1949 the US and Venezuela protested that they had been successfully celebrating Pan-American Health Day on 2nd December ever since the foundation of the Pan-American Sanitary Bureau (PASB) in 1902, both suggesting that World Health Day should share the same date. The relationship between the PASB and the WHO was one of the biggest areas of debate at the 1946 New York conference that drew up the WHO constitution. Whilst many delegates, particularly from Europe, emphasised the importance of having a single global health organisation, American states were keen to see the work of the PASB continue. The debate around the issue created significant divisions within the conference, including between Britain and the US. Eventually it was agreed that the PASB would continue as the WHO’s regional office for the American continent, although the exact timescale for its incorporation was left deliberately vague.

Implicit in the connection between World Health Day and the foundation of the WHO was the idea that action in the realm of global health somehow began when the organisation was founded, potentially underestimating the legacy of the various international health bodies such as the PASB which had preceded it. To mark this year’s World Health Day, the in-house magazine for the WHO and the UN in Geneva, UN Special, published an article on the birth of the WHO. It focusses on the meeting between three medical men, Szeming Sze, Geraldo de Paula Souza and Karl Evang, at the United Nations Conference on International Organization in San Francisco in 1945. It quotes Szeming Sze’s memoirs as saying the formation of the WHO “all came about quite accidently”, with the first mention of a new health organisation at the conference coming from Dr. Evang at a lunch meeting between the three men, and that it was their efforts to persuade other delegates that led to the decision to create a world health body.

Microfiche copy from the WHO archives of an early WHO document written on an old League of Nations template

Microfiche copy from the WHO archives of an early WHO document written on an old League of Nations template

Whilst this account is perfectly accurate, it somewhat downplays the extensive debates that had been taking place for at least the previous three years about the design and role of a future international health body, both within Allied governments and international organisations such as UNRRA. Central to these debates was the example of the League of Nations Health Organization, a body which had made significant contributions to the field of international health in the interwar period and which ultimately provided much of the template for the design of the WHO. It had continued to function in a much reduced form throughout the Second World War and its leading members were active participants in the debate about the shape of a post-war world health body. When the WHO Interim Commission began its work in 1947, it based itself in the same building as the League’s health section, employed many of the same personnel, and as we can see from the document above, even used the same stationery.

Indeed the same vector-borne diseases that the WHO was and is working to combat were also a key focus for the League, which established its own malaria commission in the 1920s. The fact that after nearly a century of international activity these diseases remain such a problem highlights the relevance of this year’s World Health Day campaign.

 

Further Reading:

Yves Beigbeder et al., The World Health Organization (Dordrecht: Nijhoff, 1998)

Iris Borowy, Coming to Terms with World Health: The League of Nations Health Organisation 1921-1946 (Berlin: Peter Lang, 2009)

Neville Goodman, International Organizations and Their Work (Edinburgh: Churchill Livingston, 1952)

Szeming Sze, The Origins of the World Health Organization: A Personal Memoir 1945-1948 (Boca Raton: L.I.S.Z. Publications, 1982)

Paul Weindling (ed.), International Health Organisations and Movements, 1918-1939 (Cambridge: Cambridge University Press, 1995)



[1] Documents relating to the history of World Health Day can be found in the WHO archives, Centralized Files First Generation, section 400-1-2. All unattributed material from this post comes from these files.

Agents of Internationalism: First Internationalism Workshop at Birkbeck College

19 to 20 June 2014

This workshop is the first in a series of events organised under the umbrella of The Reluctant Internationalists, a four-year project which examines the development and institutionalisation of international collaboration in twentieth-century Europe.

The workshop programme is now available at http://www.bbk.ac.uk/reluctantinternationalists/events/

The workshop is co-hosted by Contemporary European History and has three main aims:

  • First, it attempts to look beyond the self-declared liberal elites to identify other groups who built or dismantled international institutions. The workshop aims to shed light on who these (inter)national agents were, and why, when, and with what results they argued that some form of internationalism was practicable, necessary, or unavoidable.
  • Second, the workshop seeks to bring into focus alternative chronologies and periodizations of European history. We wish to revisit and revise the by now standard narrative of internationalism’s rise, decline and rise – from its rediscovery in the aftermath of the First World War, and a new enthusiasm for international institutions in the subsequent decade; to its spectacular failure in the era of protectionism, racial conflict and the destruction of the international architecture; to its triumph in the second post-war era; and, after the worst of the Cold War freeze, the flourishing of a new global era in the 1970s. We wish to re-examine variations of this narrative, and recover nuances and pinpoint different trajectories for different international projects.
  • Third, the workshop seeks to foreground Europe’s place in the history of internationalism. We are particularly interested in how international cooperation has evolved within European nation-states, and how concepts have differed within different parts of Europe and European peripheries.

Each of the seven panels will examine one group with international connections (relief workers, women, children, refugees, collaborators, soldiers, and ‘experts’) and identify continuities and disjunctures in the appeal and application of different internationalist programmes and agendas.

Attendance is free but places are limited. Please contact Ana Antic a.antic@bbk.ac.uk to reserve a space.

New Publication on Public Hygiene in Eastern Europe

Reposted from CEEHM Network:

Katharina Kreuder-Sonnen

We are happy to announce the publication of a special issue about Public Hygiene in Eastern Europe with Jahrbücher für Geschichte Osteuropas, edited by Andreas Renner and Katharina Kreuder-Sonnen.

The articles, published in English and German language, deal with the history of epidemics, public health policies and institutions, the  popularisation of hygiene, and eugenics in the 19th and 20th century. The regional focus is on Poland, Tsarist Russia and the Soviet Union. The issue covers a wide range of topics, from anti-cholera campaigns in the Kazakh steppe in the 19th century by Anna Afanasyeva, through the relationship of science and policy in an effort against malaria in Soviet Azerbaijan by Matthias Braun, to German hygienic institutions and colonial agenda in the turn of the 20th century by Justyna A. Turkowska. Katrin Steffen explores  the role of experts in developing public health in Poland, Angelika Strobel analyses hygiene propaganda efforts and the evaluation of their effectiveness in Russian provinces, while Birte Kohtz focuses on eugenics in the Soviet Union.

For a complete table of contents and abstracts see  http://www.steiner-verlag.de/programm/zeitschriften/jahrbuecher-fuer-geschichte-osteuropas/jgo-6120134.html

Taking the Waters in Sochi

 

Patients on their way to the Matsesta baths from the Sanatorium Krasnaia Moskva in 1928 or 1929. From Sochi: Stranitsy proshlogo i nastoiashchego, ed. A.V. Guseva (Sochi: Muzei istorii goroda-kurorta Sochi, 2007).

Patients on their way to the Matsesta baths from the Sanatorium Krasnaia Moskva in 1928 or 1929. From Sochi: Stranitsy proshlogo i nastoiashchego, ed. A.V. Guseva (Sochi: Muzei istorii goroda-kurorta Sochi, 2007).

The Olympic website for Sochi 2014 (http://torchrelay.sochi2014.com/en/city-sochi) and media coverage occasionally detail the history of the development of Sochi, tying it in the main to the growing popularity of sea bathing in Russia in the early twentieth century. The rise of sea bathing certainly did increase the popularity of the resort, in the context of the rise of tourism on the entire Black Sea coast. But that is only part of the story. The resort was also developed, after the discovery of the presence in Sochi of sulpheric mineral waters at the source “Matsesta,” as a resort for mineral water cures. Many of the first tourists to Sochi were actually patients.

While “taking the waters” is  unfamiliar  to many people, it was at the time of the first and second waves of development in Sochi – in the 1910s and mid-1930s –  still mainstream medical therapy throughout Europe, and continues to be in many places to this day. The mid- to late-nineteenth century saw the rise of the baths, tied to the spread of the railways and increasing accessibility of  travel to an expanding bourgeoisie. The circulation of visitors to baths in Central Europe increased dramatically in the 1850s, in the wake of railway construction. The leading baths of Central Europe were Wiesbaden and Baden-Baden, which saw about 30,000 visitors a year each in the 1850s. In Imperial Russia, the railway reached from Rostov-na-Donu to the Caucasian Mineral Waters, an established military resort, in 1875, leading to a burst in the construction of hotels, dachas (summer cottages) and restaurants. That decade the railways also reached the baths of the Austro-Hungarian Empire. In 1888, the railway reached the Black Sea port of Novorossiisk, opening the Black Sea coast of the Caucasus, where Sochi is located, to a new wave of development. As the railways reached out into the flesh of the empires, circulation began to flow domestically and internationally.

As today, the development of the Black Sea coast was spurred by state intervention and investment. The region was in the early twentieth century scarcely populated, and attempts to settle peasants from other places in the empire there as farmers, through various economic and social incentives, were not a success. A particular problem was that malaria was endemic to the region. In the late nineteenth century, Tsar Nicholas II began to ponder targeting the coastline as a site for the development of tourism. But what would draw people to the region?

In 1912, the Tsar sent a large delegation of scientists, including the leading balneologists of the empire, to the region to search for mineral water sources. If mineral waters could be found, perhaps they could serve as a nucleus to draw tourists to the region (and away from rival baths in Central Europe). The delegation reported back that their greatest hopes had been answered. The region was laden with rich deposits of mineral waters, largely untapped. The scientists compared the baths of Matsesta  to the baths of Aachen in Western Germany, due to their sulpheric content, a mineral water source called the Kaiserquelle.

The news of the riches of the region, and imperial approval for their development,  spread quickly. The first development of the Matsesta waters rested on private capital. A joint stock company was formed to fund the development of the Matsesta mineral waters and in 1912, the first bath house there was opened. Sochi-Matsesta was an ingénue among resorts – aristocrats largely remained loyal to the more established Crimean resort of Yalta or the Caucasian Mineral Waters resort. The Black Sea Coast was particularly attractive to a middle class health resort patient, or kurortnik, as well as patients of the Jewish faith (whose presence was banned  at established Imperial Russian resorts). Dachas and villas as well as modest pensions and inns began to be built and there was even some land speculation. Sochi-Matsesta boomed, very briefly, and the development of spa medicine improved when imperial resorts served the front during World War I. The resorts on the Black Sea coast grew from almost nothing at the beginning of the twentieht century through the help of speculators and developers to receive 75,000 visitors in 1912.

 

A Patient at the Matsesta bath house in the 1920s. From L.G. Gol’dfail’ and I.D. Iakhnin, Kurorty, Sanatorii i doma otdykha SSSR 1928 (Moskva: Gosudarstvennoe izdatel’stvo, 1928).

A Patient at the Matsesta bath house in the 1920s. From L.G. Gol’dfail’ and I.D. Iakhnin, Kurorty, Sanatorii i doma otdykha SSSR 1928 (Moskva: Gosudarstvennoe izdatel’stvo, 1928).

With the Bolshevik revolution of 1917, the fate of the resorts of the empire seemed unclear. In the nearby Weimar Republic in Germany, for example, despite revolution, the celebrated baths remained largely in the hands of the elite segments of society, beyond the reach of the state. But the Communist party and  state was determined to develop health resorts “for the workers.” In 1919, Lenin signed a decree nationalizing all health resorts, which reserved them for the use of the workers, peasants and Red Army soldiers in first order, for medical treatment. Filling the old Tsarist palaces with workers and peasants had obvious propaganda value. In Sochi, sanatoria were established in pre-revolutionary villas, hotels and private clinics (see Figure 1). But the level of state investment in the network of health resorts, and of medical services there, make it clear that this was not a mere “Potemkin village.” The state, and particularly the committed physicians at the head of the new, state public health ministry, the Commissariat of Public Health, took health resort medicine seriously, not least mineral water treatments, as a way to improve the health of the entire population.

The use of the Matsesta waters increased dramatically, largely due to patients sent for a “cure” by the Commissariat of Public Health (See Figure 2). In the 1920s, a cure usually lasted from four to six weeks, and included from 15 to 30 baths with Matsesta waters. Physicians sent patients  to Matsesta to cure chronic eczema and other skin conditions, gout, various nervous ailments, syphilis, chronic rheumatism, gynecological ailments and ailments of the heart, circulation and digestion, but patients also took the waters of their own accord, “off label,” for whatever ailed them. The number of patients using the Matsesta waters increased from 67 in 1920, to 3,921 patients in 1925. The most rapid expansion, however, came during the years of industrialization of the late 1920s and 1930s: from 1927 to 1932 the number of patients taking the Matsesta cure increased from  7,980 patients to 48,574 patients. The number of baths taken increased from 1921 to 1932 from 1,345 baths  to 731,218 baths. A second bath house was built. But demand outpaced supply. By 1937, the Matsesta bath houses were working from 6 a.m. until 11 p.m.

The Soviet leaders were justifiably proud of their accomplishment, but rather overstated their role in developing the resort. Frequently not included in Soviet statistics were numbers from the pre-Revolutionary period: 18,604 baths were administered in 1913, 17,395 baths in 1914, 16,982 baths in 1915 and 21,586 baths in 1916.  Indeed, the pre-revolutionary peak in 1916 was not reached in the Soviet Union until 1923. In the 1920s and 1930s, as now, the idea that  the resort was “new”  served the  symbolic project of treating their development as a  display of state power. Patients continue to take the cure at the Matsesta waters  to this day (See Figure 3). 

 

The bath house “Staraia Matsesta” in 2009. Photograph taken by the author

The bath house “Staraia Matsesta” in 2009. Photograph taken by the author

 

For Further Reading:

Diane P. Koenker, Club Red: Vacation Travel and the Soviet Dream (Ithaca: Cornell University Press, 2013).

Mirjam Zadoff, Next Year in Marienbad: The Lost Worlds of Jewish Spa Culture (Philadelphia: University of Pennsylvania Press, 2012).

Douglas Peter Mackaman, Leisure Settings: Bourgeois Culture, Medicine and the Spa in Modern France (Chicago: Chicago University Press, 1998).

John K. Walton, ed., Mineral Springs Resorts in Global Perspective: Spa Histories (London: Routledge, 2013).

Eric Thomas Jennings, Curing the Colonizers: Hydrotherapy, Climatology and French Colonial Spas (Durham: Duke University Press, 2008).

New World War I website by the British Library

The British Library has launched a new website on the history and culture of World War I and its legacy. The website is rich in visual sources, drawing on the extensive collections of the Library. The site explores eight key themes (such as Life as a soldier, Civilians, Race, empire and colonial troops, Representation and memory) through nearly 500 historical sources and over 50 articles on the history of WWI.

europe satirical map

In terms of understanding the international context in the turbulent years of the war and its aftermath, the website addresses a number of important turning points and examines key actors that remain central to internationalism throughout the 20th century. While some articles, like Julie Anderson’s Wounding in World War One have a particular national focus, many pieces aim to provide an international overview. Peter Gatrell’s article titled Europe on the move: refugees and World War One analyses the refugee crisis on the continent triggered by enemy occupation and forceful deportation. Articles on women’s roles, the psychological effects of war on soldiers and children’s experiences give us a glimpse at the issues at stake for social groups who become increasingly visible in both receiving and organizing international interventions. Prisoners of war are the focus of several articles, including Heather Jones’s piece on the treatment of prisoners and Jenny Tobias’s Evolution and expansion: the International Committee of the Red Cross in World War One, discussing the establishment of the International Prisoners of War Agency.

Articles and sources can be found through the key themes, through browsing and through the search tool of the website. The project also includes an extensive section on teaching resources with downloadable packs for class discussion, including reading suggestions, key questions and suggested activities. 

To Hungary with Love

Dora Vargha’s blog post on November 25th discussed the current financial difficulties faced by the Peto Institute in Budapest in the context of historical approaches to disability in Hungary. The Institute may be familiar to British readers who remember its rise to prominence in the late 1980s and its role in the debate around conductive education in the treatment of children with neurological disorders. The links between the UK and the Peto Institute provide a fascinating example of patient-led transnational history in Cold War Europe.

Princess Diana at the Peto Institute (1990)

The Institute first came to public attention following the broadcast of the BBC documentary Standing up for Joe in April 1986. The documentary followed the story of the Hadley family who had taken their severely disabled son to Budapest for treatment. The Institute pioneered the system of conductive education developed by its founder, Andras Peto, in the aftermath of the Second World War, which involved an intensive programme of physical and speech therapy under the supervision of “conductors” combined with very high expectations of the progress children could achieve.

The documentary, broadcast at prime time on BBC1 and watched by over five million people, caused a national stir. The BBC received 11,000 letters of enquiry, questions were asked in parliament, and a lobby group, the Foundation for Conductive Education, was set up to promote its use in the UK. The system was presented in the media as more holistic than the medicalised approach to treatment in the UK, and many parents were attracted by the positive expectations it had of potential progress against a perceived negativity and conservatism amongst UK medical staff. Over the following years UK families flocked to Budapest, often supported by national and local campaigns to raise funds for treatment. The Times estimated that over 600 UK children had visited the centre by 1990.

However, the treatment was not without controversy. Many within the British medical establishment felt that the claims for its success were overblown, and that the appearance of progress owed much to the fact that the Institute was selective in the cases it accepted. The Chartered Society of Physiotherapy published a report in 1988 questioning many of the Institute’s claims, whilst the Spastics Society, initially wary of the programme, was picketed by the Foundation for Conductive Education over claims that its own conductive education schemes weren’t the real thing.

One of the most interesting features of the coverage of the Institute is its presentation in the context of the Cold War. Andrew Sutton, the Director for the Foundation for Conductive Education, described it as a ‘Len Deighton Cold War story, coming from a street near you’, with the media frequently describing families moving “beyond the iron curtain”. It certainly represents one of the most widespread and high profile instances of UK residents experiencing life in the Eastern Bloc prior to the end of communism. The BBC’s follow-up documentary to Standing up for Joe broadcast in 1987, which tracked the story of the British families who had followed in the Hadley’s footsteps, was entitled To Hungary with Love.

The Peto Institute also played a role in Anglo-Hungarian relations during the transition to democracy. In December 1989 the UK government announced £5 million of funding for the Institute’s new international centre to guarantee places for British children and pay for training of a group of British conductors. This funding was discussed as part of a wider package of support when Hungarian Prime Minister Miklos Nemeth visited Margaret Thatcher on December 14th. In an article on the 6th January, The Times presented the funding as part of a range of government measures to form closer medical and scientific links with the Soviet Union and Eastern Bloc countries. Following the first free elections in March 1990, Princess Diana made a high profile visit to the Institute as part of a four-day tour of Hungary where she presented an honorary OBE to its director, Dr Maria Hari.

The controversy around conductive education has never entirely gone away. In 1993 the government-commissioned Birmingham Project indicated that it was no more effective than comparable UK treatments, a claim that continues to be challenged by its adherents, whilst in 2003 Peter Randall from Kent attempted to sell his kidney on ebay to fund conductive education for his daughter. Although conductive education is now more widely available in the UK, British children continue to visit to Peto Institute for treatment.