Políticas e redes internacionais de saúde pública no século XX Anais do IHMT Rural hygiene in the early years of the World Health Organization: another casualty of the Cold War? A higiene rural nos primórdios da Organização Mundial de Saúde: outra vítima da Guerra Fria? Socrates Litsios Retired (1997) Senior Scientist, World Health Organization [email protected] Abstract Resumo Rural hygiene was a major program in the League of Nation’s Health A higiene rural constituiu um grande projeto da Organização de Saúde da Organization (LNHO). During WHO’s early years steps were taken to Liga das Nações. Os primeiros anos da Organização Mundial de Saúde foram develop rural hygiene programs in several countries and to incorpora- canalizados para o desenvolvimento de programas de higiene rural em vários te it as part of WHO’s priority program of environmental sanitation. países e para os incorporar como parte do programa prioritário do saneamento Nevertheless, by the early 1950s these initiatives failed to move for- ambiental da OMS. Todavia, nos primeiros anos de 1950, estas iniciativas não ward for various reasons, one of which was the growing importance of conseguiram avançar por vários motivos, entre os quais se situa a importância the Cold War in America’s foreign policy. crescente da Guerra Fria, na política externa dos Estados Unidos. Key Words: Palavras Chave: Rural hygiene, public health, environmental sanitation, Cold War, World Higiene rural, saúde pública, saneamento ambiental, Guerra Fria, Organi- Health Organization. zação Mundial de Saúde. An Inst Hig Med Trop 2016; 15:125-132 125 Políticas e redes internacionais de saúde pública no século XX Introduction Subjects addressed were healthful living (nutrition, drink- ing water, sewage and waste disposal, milk and housing) and Much has been written about the early years of WHO and sanitary administration (district level organization of medi- the impact of the Cold War on its programs. John Farley’s cal services, school health, infant welfare, anti-TB campaign, book Brock Chisholm, the World Health Organization & the etc.). A European Conference on Rural Hygiene, held in Cold War, provides a comprehensive account of the trials and 1931, was followed by the gathering of information on these tribulations encountered in the creation of the Organization conditions using study tours and interchanges. and in its early development [1]. Randall Packard, in his vari- Steps were taken almost immediately to organize conferenc- ous works, has described how Cold War politics played an es on rural hygiene in Africa and in Asia. Two Pan-African important role in forcing WHO away from its original vi- Conferences were held in South Africa in 1932 and 1935. sion. In particular, Cold War “tensions limited the ability of That of Asia was held in 1937 in Bandoeng, Indonesia. Its the postwar international organizations to carry out their scope was broadened to include elements of rural recon- early commitments to broad based integrated approaches struction, particularly agriculture, education, and coopera- to health and development, and encouraged instead reliance tive movements. on narrow technical programs, made possible by advances in The Bandoeng Conference approached the problems of technology and science during the war” [2: 112]. rural hygiene from an “intersectoral and interagency per- Particular attention has been given to how the Cold War af- spective and focused not only on the need to improve ac- fected WHO’s global malaria control/eradication campaign. cess to modern medicine and public health but also on the Prior to the advent of DDT, it was believed that successful fundamental challenges of educational uplift, economic de- control would require attention being given to broader ap- velopment, and social advancement” [5: 42]. The subjects proaches to health and development; with the arrival of DDT, addressed were health and medical services; rural recon- “the association of rural malaria control with rural economic struction and collaboration of the population; sanitation (agricultural) development radically diminished” [3: 256]. and sanitary engineering (housing, water supply, disposal Rural hygiene, as such, is not discussed in Farley’s book, of house refuse and other wastes, and fly control); nutri- which in some ways is not surprising as he paid little atten- tion, and measures for combatting certain diseases in rural tion to the legacy of the League of Nation’s Health Organi- districts (malaria as well as plague, hookworm, tuberculo- zation (LNHO), where rural hygiene had developed into a sis, pneumonia, yaws, leprosy and mental diseases). Each major program before the onset of World War II. The lack of subject was dealt with by a Commission or sub-Commis- attention to the work of the LNHO is also understandable sion. Given its scope, no attempt is made to even sum- as Farley published his book in 2008, one year before Iris marize its outcome, especially as much had been written Borowy’s authoritative and detailed account of the work of about its importance [2,4]. Nevertheless, note is taken of the LNHO was published [4]. some recommendations, especially those that pertain to One purpose of this paper is to make more complete Far- poor rural areas of the world, least covered by any form ley’s history, first by summarizing the LNHO program on of organized health services, i.e. the problematic faced by rural hygiene before looking at how it faired during WHO’s WHO at its creation. early years. What emerges does not contest the general view Concerning health and medical services, the Conference of the negative impact of the Cold War on WHO’s work. concluded that: On the contrary, by focusing on rural hygiene, we get to • Preventive medicine is the cheapest means of improving see in greater detail the obstacles that WHO faced at that the health conditions of the population in the rural areas, and time, ones that severely limited and narrowed its immediate it is along preventive lines that the effort should be princi- development. Given the fact that the LNHO rural hygiene pally directed. policy was resurrected as part of the primary health care • It is absolutely necessary to bring medical and health movement that enveloped the organization some 20 years services as near to the population as possible, but the de- later, one can only lament what was lost. centralization of activities should be guided and supervise by a central body in order to maintain efficiency and ensure a uniform policy. LNHO heritage Concerning the use of auxiliary staff, emphasis was placed on the necessity for ensuring that all members of the auxil- Rural hygiene was a major program in the League of Na- iary staff receive adequate training in hygiene and preventive tion’s Health Organization (LNHO). It emerged in the late medicine (training to be as simple and practical as possible, 1920’s following a comparison of model areas in Western care to be taken that training does not make them lose touch Europe, “where problems of rural hygiene had been satisfac- with the people, etc.), while concluding that the composi- torily solved”, with areas of in Southern and Eastern Europe, tion of the auxiliary staff relative to the kind of work they are “where problems were still acute” [4: 200]. called upon to do will vary in different areas. 126 Anais do IHMT Also: reasonable limits”; work was extended “slowly and only as results • A large body of adequately trained auxiliary personnel is im- justified extension” [9:3]. portant to ensure that the connecting link between the rural in- The detailed activities of each of the field stations that Hydrick habitant and the medical men may be as efficient as possible. established were carried out by hygiene mantris, midwives, and • It is essential to the proper functioning of a health service other members of the subordinate personnel. Mantris were that the emoluments offered be fully adequate so that the right health workers who initially were concerned with educating the type of man with proper training may be attracted and retained, public about hookworm before moving on to other problems. and enabled to devote his full time to the service. They were all males (at first), were literate, spoke well and in- spired confidence. Midwives entered the program at a later date. The Commission dealing with rural reconstruction called for the Hydrick arranged for their training to be conducted by experi- planning and execution of Government services to be coordi- enced midwives nated so as to be integrated, comprehensive and effective. Each The diseases that were most widespread where Hydrick worked village or group of villages should have an organization of its own were “those that belong to the great group of intestinal diseases – namely, a committee for conducting its affairs and promoting or filth borne diseases. In the ordinary living habits of the people its welfare in all directions. These committees in turn should be of the rural areas, the pollution of surface soil and streams is far advised by a committee of management consisting of Govern- more common than the use of latrines. Of all the diseases which ment experts, representatives of villages and other non-officials. are spread by soil and water pollution, the worm diseases are not The village committees may be entrusted with duties relating to only the easiest to explain and demonstrate, but are also the most water supply; sanitation, house improvement and village-plan- widespread over the East Indian Islands” [9: 4]. Activities carried ning; construction and maintenance of village roads and water- out concerning the prevention of soil and water pollution “were ways; social and recreational activities including playgrounds; so organized that they could be used as a basis for building up and education of adults, both men and women.