Shifting Boundaries of Public Health: Europe in the Twentieth Century (review)

European public health and health policy in the interwar years of the twentieth century has been a lively area of historical endeavor in recent years. The editors of Shifting Boundaries of Public Health: Europe in the Twentieth Century bear witness to that vitality when they introduce the volume with the story of how a debate at a conference on European social medicine held in Vienna in 2002 gave birth to a series of interactions and meetings that would be held in both Europe and North America in the following years. This book is the result of these interactions. Its focus is the “shifting boundaries” of the title, not just the role of the national state, the international organization, or the local community, but, rather, the interaction between them and the shifting patterns and influence of ideas and expertise over time. Health, space, and place and their interconnection is the interest here.

Although framed by two overview papers by Peter Baldwin and Dorothy Porter that raise more contemporary issues, the bulk of the collection concerns the interwar years, with a few papers on the war and its immediate aftermath. The “international” section of the book includes a paper by Paul Weindling in which he examines the role of international foundations, pointing out that organizations other than the Rockefeller need examination, and that these corporations often preferred to deal with localities rather than the nation-state. Iris Borowy looks at how the League of Nations Health Organization maneuvered within a gradually diminishing operational space during World War II. James Gillespie argues that postwar agencies such as the World Health Organization and its regional offices in the former colonies reshaped the role of international health agencies away from previous European concerns and toward a role in the colonies in Africa and Asia. “Within a decade,” he comments, “international health agencies moved from threatening the legitimacy of colonial rule to taking up the responsibilities of the departing overlords” (p. 115).

In the “local” section of the book, historians examine both local traditions of public health and how they were shaped by political realities but also by the transition from the local to wider stages. Lion Murard examines the genesis of international conferences on rural health care in the 1930s and shows a type of “contagion effect” among local health demonstrations with grassroots participation in a variety of different countries. These projects were refracted from the local to the international level and then into another locale. Sabine Schleiermacher contrasts the public health systems built in occupied Germany by the British and Russians after World War II. The occupying powers built radically different systems according to their political aims. Graham Mooney relates the role of science—in this case, demography—in the local, with the history of attempts to reduce the distorting impact of local population structures on the measurement of mortality via standardization. Susan Gross Soloman contrasts U.S. and Russian approaches to public health fact finding; the U.S. foundations used a standard template, whereas the Russians used “representatives” embedded in different countries who collected information. In the volume’s final paper, Patrick Zylberman contrasts two approaches to dealing with malaria: the League of Nations Malaria Commission saw it as a “social” disease linked to underdevelopment, whereas U.S. malariologists believed it to be a local disease dependent on insects and human geography.

This is a fascinating collection, although the selection of papers could have included some focusing on eras other than that between the 1920s and the 1940s—only Gillespie’s contribution really deals with international organizations in the postwar years. Some of the processes analyzed here were replicated in the response to HIV in the 1980s, when local initiatives fed into national, then international, and back to national and local areas again. “Shifting boundaries” of...