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Macfadyen, David (2014) The genealogy of WHO and UNICEF and the intersecting careers of Melville Mackenzie (1889-1972) and Ludwik Rajchman (1881-1965). MD thesis. http://theses.gla.ac.uk/5625/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Glasgow Theses Service http://theses.gla.ac.uk/ [email protected] The Genealogy of WHO and UNICEF and the Intersecting Careers of Melville Mackenzie (1889-1972) and Ludwik Rajchman (1881-1965) David Macfadyen MB ChB (Glasg), MSc (London), FRCP Edin. A thesis submitted to the University of Glasgow for the degree of Doctor of Medicine Centre for the History of Medicine College of Medical, Veterinary and Life Sciences University of Glasgow September 2014 Page 1 of 323 Summary This thesis traces the antecedents of the World Health Organization (WHO) back to 1920, when a new type of international health organization emerged following the establishment of the League of Nations, one that was based on collective action by nation-states. The 1946 Constitution of WHO specifies two prime functions for the Organization – technical assistance to countries and cooperation with governments to strengthen national health services. The thesis analyses how international health work in the interwar years moved towards these tasks and shows how country- centred aspects of international health work developed, by studying the intersecting careers of Melville Mackenzie and Ludwik Rajchman. They succeeded in expanding international health work beyond measures to control contagious diseases when they initiated ambitious cooperative programmes to tackle over-all health problems on a wide front and on a long-term basis through the creation of health services. Classical texts on the history of public health note that in the 1920s and 1930s the League of Nations' Health Organisation (LNHO) assisted countries to develop national health services. Only one historian, however, has given an account of such work by LNHO within individual countries. The present analysis builds on this research of Iris Borowy and explores how relations between international health organizations and individual nation-states evolved. The argument of the thesis is that post-World War Two action to advance global health and protect the world's children was shaped by the cooperation that developed in the 1920s and 1930s between international health organizations and nation-states. The analysis begins with relief and reconstruction in Russia in 1921- 1923, extends to technical assistance to Greece and Bolivia in 1928-1930 and concludes with technical cooperation with China over the period 1930 to 1941. Rajchman was virtually unknown until Marta Balińska published a biography in 1995. Mackenzie, likewise, was unknown until Zoe Sprigings published a biographical essay in 2008. Sprigings observed that interpersonal relations played a role in the development of international health collaboration and described Mackenzie's relationship with Rajchman as one of antipathy. In the present analysis, evidence of a more complex relationship emerges. The thesis provides an observer's account of how the practices, policies and structures of global health emerged in the first half of the Twentieth Century. The observer was Mackenzie and the main Page 2 of 323 source of the research is a family archive of correspondence, reports and unpublished documents that the author located in 2010. Mackenzie's son lodged these with the Wellcome Library, which posted an on-line catalogue in December 2013. Archives of the League of Nations and of the Institut Pasteur were consulted in Geneva and Paris, respectively, in order to provide a broader context to the events that Mackenzie recorded. The viewpoint of the thesis is that of international staff working within the borders of sovereign states. The thesis shows that the first formal permission to allow international personnel to work within a nation-state was an agreement made by Lenin's Russia in 1921. The first mutually- conceived programme of technical cooperation between an international health organization and a nation-state is shown to have been established with China in 1930. Dorothy Porter observed that 'the health of the citizen of Planet Earth' began to be placed on the agenda of international politics when WHO emerged from the United Nations after the end of World War Two. The present analysis shows that concern for the wellbeing of humanity surfaced earlier in the century and led to a view, expressed at LNHO in 1943, that the prime objective of an international health organization is 'the promoting of health for all'. The thesis also shows that the Constitution of WHO, including its frequently-quoted definition of health, originated from LNHO policy documents drafted between 1943 and 1945. Competing concepts for establishing an international public health organization were put forward by Mackenzie and Rajchman during World War Two. Rajchman's proposal for a United Nations' Health Service was considered radical and he was excluded from preparatory events leading to the establishment of WHO, thus denying him a platform to argue for alternative funding arrangements for the Organization. Mackenzie presented the WHO Constitution for approval to delegates attending the 1946 International Health Conference in New York and signed it on behalf of the United Kingdom, with authority that was unprecedented for a physician. It is shown, further, that an intervention by Mackenzie in the course of the Conference, concerning the regional organization for the Americas, contributed to WHO becoming a body that incorporates six geographic regions. The question is addressed as to whether a regional structure provides a competitive advantage to the Organization in terms of its support to nation-states. Page 3 of 323 Rajchman channeled his energy into establishing UNICEF. The thesis uses a genealogical metaphor to explore the origins of UNICEF and WHO. This shows the lineage of the former going back to generously funded agencies which supplied countries with health resources and resident international personnel. WHO, which originated from agencies that received scaled contributions from governments, lacked funds to engage, significantly, in technical cooperation with individual countries in the immediate postwar period. The analysis shows that it was UNICEF that had the resources to bring the benefits of wartime scientific advances to countries. When UNICEF began to cooperate with nation-states in the health field, it was perceived to have strayed into the domain of WHO. The thesis shows that, in 1948, an enduring and effective cooperation was established between UNICEF and WHO as a consequence of the rivalry, and that Mackenzie and Rajchman were at the heart of this. As each agency grew, pathways set in their beginnings predominated. A 2011 review of international agencies by the United Kingdom Government praised UNICEF for its 'results at country level' and ranked WHO less favourably in this domain. The perceived difference between the agencies is shown to be rooted in the first steps that they took in the aftermath of World War Two. The thesis suggests that a way to improve performance at the country level is to study the interwar experiences of LNHO, particularly those initiated in Greece by Mackenzie and in China by Rajchman. Page 4 of 323 Content Summary...............................................................................................................................................2 Acknowledgements ............................................................................................................................. 6 Author's Declaration.............................................................................................................................8 Abbreviations....................................................................................................................................... 9 Definitions.......................................................................................................................................... 10 Timeline of key events, 1920-1953.................................................................................................... 11 Introduction........................................................................................................................................ 14 Background, purpose and methods........................................................................................... 14 Historiography of International Health Organizations..............................................................19 The Protagonists, Melville Mackenzie and Ludwik Rajchman................................................ 24 Global Health: advancing the wellbeing of humanity...............................................................30 Structure of the thesis................................................................................................................33 Section One: Relief and reconstruction in Russia, 1921-1923...........................................................35
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