Comrades in Health: U.S. Health Internationalists, Abroad and at Home ed. by Anne-Emmanuelle Birn and Theodore M. Brown (review)

A central and recurring theme in this edited volume is clearly expressed in the foreword by Vicente Navarro, an eminent Marxist health analyst and journal editor. He pointedly draws a distinction between humanitarian health action—now a very well-funded and dominant aspect of “global health”—undertaken by health aid workers and seen as noble and unexceptionable and health work consciously carried out “in conjunction with political forces committed to liberation of peoples” (p. xii). He notes that “Medical care and public health are very political interventions” (p. xi), underlining the notion that health care, while a basic human right and public good, is never neutral in its practice and ideology: it usually (unwittingly) supports the status quo by reinforcing the dominant (medical) thinking that ill health is a natural misfortune, rather than a result of poverty, inequality, and oppression, themselves rooted in unfair social, economic, and political structures. This book vividly documents—in their own words—the experiences of U.S. health internationalists, who, through their involvement in struggles in diverse contexts and different periods of history, came to understand and challenge the political and power arrangements affecting the health of individuals and populations both at home and abroad.

The book’s co-editors elaborate on Navarro’s distinction by defining “health leftists” as “different from today’s more typical global health volunteer[s] or professional[s]” (p. 4). The history of U.S. health internationalism is little known, its invisibility a result of the repressive McCarthy era and its lingering effects, the weight of “medical consciousness,” and the recent ascendancy of technical service-provision and philanthropy in global health action and discourse.

In chapter 2, Birn and Brown trace the origins of health internationalism to two roots: social medicine and proletarian internationalism. Social medicine, founded on the recognition that ill-health was associated with poor living and working conditions, emerged during Europe’s industrial revolution and was disseminated to the United States, Latin America, and beyond. Simultaneously, proletarian internationalism was codified in The Communist Manifestoof 1848 and prosecuted by the First and Second Internationals. In the 1920s and 1930s proletarian internationalism fused with social medicine, resulting in “health internationalism.”

The book is structured by the stories of four generations of health leftists, born respectively in the periods 1870–1910, 1920–1930, 1940–1960, and 1960–1970.

The first generation included John Kingsbury, whose story Susan Gross Solomon examines in chapter 3. Kingsbury was supported by the Milbank Memorial Fund to study Soviet health care. His book, co-authored with Sir Arthur Newsholme, entitled Red Medicine: Socialized Health in Soviet Russia(New York: Doubleday, 1934), was acclaimed by Henry Sigerist and others, but his proposals for state medicine in the United States were attacked by the American Medical Association (AMA) and eventually disowned by Milbank. A defining episode for this generation, as detailed by Walter Lear in chapter 4, was the heroic role of the 140 U.S. health internationalists in the Spanish Civil War led by a core group headed by Edward Barsky, a communist physician who provided free medical care to many families impoverished by the Depression.

The generation born in the 1920s and 1930s experienced the Depression, World War II, and the Cold War. McCarthyism’s impact moderated the framing of political causes away from explicitly anti-capitalist terms to those of “human rights, international learning and exchange” (p. 101). The civil rights movement domestically and African liberation struggles abroad as well as nuclear threat inspired this generation. Exemplary and influential among this generation was Jack Geiger, who tells of becoming immersed in early civil rights struggles in chapter 6. As a premed student in Chicago, he organized campaigns against a racist admissions policy. Geiger’s epiphany, the realisation that socio-economic and political...