The development of the Spanish public health system in the first three decades of the twentieth century was intimately bound up with the involvement of its administrators and experts in international health organisations, most notably the Rockefeller Foundation and the League of Nations Health Organisation. However, the public health system was severely disrupted during the Civil War at a time when disease and malnutrition were widespread, and many of its leading experts were forced into exile because of their political links with the Republican government.

At the end of the Second World War the Franco regime was isolated from the international community, but the onset of the Cold War and the subsequent thawing of relations with the US lead to its gradual reincorporation into the western Alliance and the international mainstream over the following decade. My research will investigate the involvement of Spanish health experts on the international stage during this period, looking primarily at how Spain’s political situation determined the pattern of international health cooperation. It will look at the engagement of Spanish experts with the WHO and UNICEF, as well as major international conferences, disease eradication programmes and professional bodies. It will also investigate their engagement with private voluntary organisations operating on the international stage including the Rockefeller Foundation, the ICRC and a range of international Catholic health organisations, as well as institutional links through universities, laboratories, hospitals, and professional exchange and training programmes.

Infant Nutrition: healthy babies, advertising Credit: Wellcome Library, London. Wellcome Images. CC BY 4.0

The project will address the attitude of leading political figures within the regime to Spanish involvement with international health and how such attitudes affected practical cooperation. Whilst Spain’s isolation often limited the ability of Spanish experts to engage with international health networks, the regime was also keen to use its involvement in transnational and international health projects as a means to further its political goals. By focussing on a country that was not fully integrated into the emerging post-war international architecture the research will highlight the role of public health experts and initiatives in maintaining and building international links where they are absent at a nation state level. It will also illustrate the role public health cooperation played in reconciling the international community to “pariah” nations joining the new international institutions.

My research will also examine the impact of internal political debate on patterns of international cooperation, particularly the ongoing tensions within the Franco regime between Catholic, military and Falangist factions. The politicisation of the Spanish healthcare system meant that the majority of leading health experts were closely aligned to one or other of these groups, which fought each other for control of the national health and welfare systems. I will examine how these alignments and conflicts affected both the engagement of experts with international health networks and their ability to implement international initiatives within a local setting.

In many cases the involvement of Spain in international health organisations was affected by the personal and political backgrounds of the professionals involved. Many leading figures in the Francoist healthcare systems came from a military or Falangist background and had been active participants in the Civil War. On the international stage, a number of exiled Republican health experts were heavily involved in the World Health Organisation and other post-war international health activities including Marcelino Pascua, former Director General of Public Health, Socialist member of parliament and Spanish ambassador to Moscow under the Second Republic, who later became Director General of Biostatistics at the WHO. The research will look at how the backgrounds of these experts and the personal relationships between them affected their attitudes towards the participation of Franco’s Spain in international health networks. In doing so it will address key questions around the role of experts and the apolitical ideal in international health, as well as the impact of ideology on individuals’ attitudes towards the epistemic community of international health experts.

David Brydan

David Brydan