126 / 210
126
Introduction
Much has been written about the early years of WHO and
the impact of the Cold War on its programs. John Farley’s
book Brock Chisholm, theWorld Health Organization & the
ColdWar, provides a comprehensive account of the trials and
tribulations encountered in the creation of the Organization
and in its early development [1]. Randall Packard, in his vari-
ous works, has described how Cold War politics played an
important role in forcing WHO away from its original vi-
sion. In particular, ColdWar “tensions limited the ability of
the postwar international organizations to carry out their
early commitments to broad based integrated approaches
to health and development, and encouraged instead reliance
on narrow technical programs, made possible by advances in
technology and science during the war” [2: 112].
Particular attention has been given to how the ColdWar af-
fected WHO’s global malaria control/eradication campaign.
Prior to the advent of DDT, it was believed that successful
control would require attention being given to broader ap-
proaches to health and development; with the arrival of DDT,
“the association of rural malaria control with rural economic
(agricultural) development radically diminished” [3: 256].
Rural hygiene, as such, is not discussed in Farley’s book,
which in some ways is not surprising as he paid little atten-
tion to the legacy of the League of Nation’s Health Organi-
zation (LNHO), where rural hygiene had developed into a
major program before the onset ofWorldWar II.The lack of
attention to the work of the LNHO is also understandable
as Farley published his book in 2008, one year before Iris
Borowy’s authoritative and detailed account of the work of
the LNHO was published [4].
One purpose of this paper is to make more complete Far-
ley’s history, first by summarizing the LNHO program on
rural hygiene before looking at how it faired duringWHO’s
early years.What emerges does not contest the general view
of the negative impact of the Cold War on WHO’s work.
On the contrary, by focusing on rural hygiene, we get to
see in greater detail the obstacles that WHO faced at that
time, ones that severely limited and narrowed its immediate
development. Given the fact that the LNHO rural hygiene
policy was resurrected as part of the primary health care
movement that enveloped the organization some 20 years
later, one can only lament what was lost.
LNHO heritage
Rural hygiene was a major program in the League of Na-
tion’s Health Organization (LNHO). It emerged in the late
1920’s following a comparison of model areas in Western
Europe, “where problems of rural hygiene had been satisfac-
torily solved”, with areas of in Southern and Eastern Europe,
“where problems were still acute” [4: 200].
Subjects addressed were healthful living (nutrition, drink-
ing water, sewage and waste disposal, milk and housing) and
sanitary administration (district level organization of medi-
cal services, school health, infant welfare, anti-TB campaign,
etc.). A European Conference on Rural Hygiene, held in
1931, was followed by the gathering of information on these
conditions using study tours and interchanges.
Steps were taken almost immediately to organize conferenc-
es on rural hygiene in Africa and in Asia. Two Pan-African
Conferences were held in South Africa in 1932 and 1935.
That of Asia was held in 1937 in Bandoeng, Indonesia. Its
scope was broadened to include elements of rural recon-
struction, particularly agriculture, education, and coopera-
tive movements.
The Bandoeng Conference approached the problems of
rural hygiene from an “intersectoral and interagency per-
spective and focused not only on the need to improve ac-
cess to modern medicine and public health but also on the
fundamental challenges of educational uplift, economic de-
velopment, and social advancement” [5: 42]. The subjects
addressed were health and medical services; rural recon-
struction and collaboration of the population; sanitation
and sanitary engineering (housing, water supply, disposal
of house refuse and other wastes, and fly control); nutri-
tion, and measures for combatting certain diseases in rural
districts (malaria as well as plague, hookworm, tuberculo-
sis, pneumonia, yaws, leprosy and mental diseases). Each
subject was dealt with by a Commission or sub-Commis-
sion. Given its scope, no attempt is made to even sum-
marize its outcome, especially as much had been written
about its importance [2,4]. Nevertheless, note is taken of
some recommendations, especially those that pertain to
poor rural areas of the world, least covered by any form
of organized health services, i.e. the problematic faced by
WHO at its creation.
Concerning health and medical services, the Conference
concluded that:
•
Preventive medicine is the cheapest means of improving
the health conditions of the population in the rural areas, and
it is along preventive lines that the effort should be princi-
pally directed.
•
It is absolutely necessary to bring medical and health
services as near to the population as possible, but the de-
centralization of activities should be guided and supervise by
a central body in order to maintain efficiency and ensure a
uniform policy.
Concerning the use of auxiliary staff, emphasis was placed
on the necessity for ensuring that all members of the auxil-
iary staff receive adequate training in hygiene and preventive
medicine (training to be as simple and practical as possible,
care to be taken that training does not make them lose touch
with the people, etc.), while concluding that the composi-
tion of the auxiliary staff relative to the kind of work they are
called upon to do will vary in different areas.
Políticas e redes internacionais de saúde pública no século XX