By Sanjoy Bhattacharya, Professor in the History of Medicine at the University of York Department of History, Director of the Centre for Global Health Histories, and Head of the WHO Collaborating Centre for Global Health Histories.
The historiography of international health after the Second World War is now rich and extremely well populated. And yet, significant sections of this body of work remain stubbornly and peculiarly focussed upon the views and actions of relatively small numbers of people within North America and Western Europe, even when the events and activities being described relate to regions and countries far afield. The biggest problem is that this body of work is rooted in unmoving assumptions about the importance of a small set of nations in the post-war era and insufficiently tested presumptions about their dominance over the negotiations that led to the creation of new post-war institutions (such as the United Nations). Post-war agencies are, in turn, described simplistically, where their Europe- and USA-based headquarters are presented as all powerful and capable of dictating the actions of representatives all over the world. Furthermore, this is done with suspiciously limited research, with almost no attention being paid to the birth of regional and national branches of UN organisations and their intricate negotiations with governments of newly independent, assertive countries who were willing to invest heavily, both financially and through new international alliances, in the modernisation of health, science and technology.
These academic attitudes seem to me to be deeply entrenched in present-day notions of the hierarchies of specific nations, races, languages and educational backgrounds, and their supposed worth in the creation of the so-called post-war policies of internationalism and consensus. Such predetermined notions of pre-eminence are then fed back to inform assessments of past experience, which has helped to entrench deeply problematic assumptions. These trends are often promoted and sustained by cosy relationships between historians, other medical humanities experts, social scientists, and the officials of government and international agencies that they are writing about. The resultant lack of analytical independence, which has limited scholarly criticality and reduced the commitment to study situations and contexts in all their complexity, has stymied more democratic and realistic assessments of the intricacy of health programmes on the ground.
Indeed, very few academics have dared challenge these historiographical trends by publicly discussing the factors underpinning them, perhaps for fear of isolation from the established, high profile and powerful academic networks that have considerable say in publication, grant making and prize selection processes. Sadly, and to compound problems for those seeking to promote the adoption of a wider and more equitable analytical frame, many elements of such academic formations have, for some time, become far too comfortable about quoting work authored by friends in their network. Exacerbating the problem, these scholars do not read widely enough, refuse to study non-European and non-contexts in their own terms, and rarely carry out research in non-European languages or, perhaps more importantly, working with academics with the necessary skills, creating exclusionary and harmful hierarchies of academic worth. All of this goes a long way in helping to explain why several academics choose to focus on a small number of historical actors’ ideas and reports on how others responded to them, rather than the numerous, complex processes wherein a set of recommendations, from new specialist agencies associated to the United Nations would be discussed, negotiated, reworked, implanted and reshaped both regionally and nationally in wide-ranging ways.
Therefore, we have a situation where histories purporting to describe the impact of the ‘Cold War’ on international and global health projects consider it sufficient to describe debates and discussions between representatives of the USA and the Soviet Union on the basis of extremely narrow research (generally, for example, by focussing on US government reports on the USSR’s representatives’ arguments and positions, with no effort being made to study Soviet papers, in Russian, on these negotiations). Similarly, histories of the worldwide eradication of smallpox – widely regarded as the 20th century’s greatest achievement in international public health, interpretations of which continue to be considered in policy and academic circles, and presented as proof of the WHO’s ability to offer ‘global’ leadership – choose to focus on the roles played by small groups of people. In doing this, these bodies of work ignore or downplay ideas, activities and work carried out independently in important contexts such as India and the People’s Republic of China. This trend is particularly inexplicable, considering that these regions had significant populations, large and well-established administrative frameworks, were marked by great cultural and social diversity, wielded great regional political importance, and were regarded as important politically both by the USSR and USA, and the international alliances they spawned, at different historical junctures. That these attributes and determinants in South and South East Asia have been considered largely unimportant by generations of academics is a powerful indicator of the damaging nature of US- and Euro-centric scholarship about the birth and expansion of international health after 1945.
The WHO is not, and has never been a monolithic organisation, and many of its workers in offices around the world have shaped international engagements in health in significant ways. From this perspective, the support that the WHO Global Health Histories initiative has received from within many quarters of a complex organisation is unsurprising; many of its officials have recognised and supported the initiative’s ability to promote inclusivity, and collect information transparently and collaboratively. As these open-minded and democratically-inclined WHO officials work with talented academics from all over the world, who are united in seeking to study the widest range of voices and actions to develop intricate and realistic historical mosaics of internationalism in health, they create new forms of discussion and debate that mobilise and support new coalitions for equity in health. This inter-sectoral cooperation does not, of course, go unopposed within the complex maze of the structures of international and global health programmes. There are, for instance, those who seek to ensure the dominance of the English language in health research and its communication. However, as major health problems persist, leading many thoughtful and independent analysts to increasingly query the overshooting of targets and budgets in major programmes such as Global Polio Eradication Initiative, and the barriers created by the unwillingness of UN- and US-led initiatives to use multi-lingual research to properly understand and engage local populations threatened by new pandemic emergencies (Ebola being a good case in point), the imperium of those seeking to promote work in the English language and then label this as being the most important for all future responses everywhere is being challenged. The unmistakable shifts in the world’s political and economic orders are an important contributory factor and new international alliances, such as the BRICS nations, are becoming assertive in unprecedented ways.
As their representatives within the UN work ever harder to ensure that their voices are heard and the contributions of a wider range of countries is recognised as major, new health initiatives are rolled out, it may well be that conditions will be created for a more equitable, non-US and non-Eurocentric historiography, based on careful research in multiple languages. The election of the first ever WHO Director General from Africa, on the basis of a vote that involved all national member states, represents an important and, hopefully, lasting shift that will promote complex, open-minded engagements between policy managers, academic allies and target populations. However, to thrive and make an impact, any reforming agenda needs to avoid the pitfalls of what it displaces: the imposition of select nationalisms on deeply international bodies; racially informed superiority complexes and attendant hierarchies of worth; and the denial of sufficient space to describe and assess a multiplicity of voices from the regions and countries. If such reforms are to empower future generations of scholars, allowing them to come up with innovative new research in unfettered ways, then resultant socially-, culturally- and politically-sensitive historical work is much more likely to be able to engage those involved in delivering health and development policy around the world on a day to day basis.
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