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  • La salud y el Estado: El movimiento sanitario internacional y la administración española (1851–1945)
  • Ana María Carrillo
Josep L. Barona and Josep Bernabeu-Mestre. La salud y el Estado: El movimiento sanitario internacional y la administración española (1851–1945). València: Universitat de València, 2008. 366 pp. Ill. (paperbound, 978-84-370-6974-6).

Written by two well-known historians of public health in contemporary Spain, this book has as its objective an analysis of the relations between the Spanish state and international public health. One of the work’s central ideas is that Spain’s incorporation into an international context favored the modernization of its sanitary policies and their evaluation.

The book is divided into ten chapters, with a prologue and an epilogue. Chapters 1 to 5 concern the origins of the international sanitary movement, including the International Sanitary Conferences, the International Welfare Congresses, the International Hygiene and Demography Congresses, and the International Public Health Office. Here, the authors describe the discussions and agreements reached at such international forums and emphasize Spain’s ongoing participation through papers read by its delegates at such meetings and reports presented by their delegations back home. Significant here are the contradictions that existed between hygienists and diplomats.

In chapters 6 and 7, the authors explore the relationship between the Rockefeller Foundation International Health Division and the League of Nations Health [End Page 298] Organization, on one hand, and, on the other, public health in Spain. Questioning the thesis of such authors as Brown and, to a degree, Weindling, that the League and the Foundation served the political and economic interests of imperialism, Barona and Bernabeu-Mestre argue that their work was actually of a philanthropic nature and promoted the values and strategies of the welfare state.

In chapter 8, the authors turn their attention to the sanitary reforms of the Second Republic; chapter 9 deals with nutritional problems during the Civil War, and the final chapter with Spanish exiles and their relation to international health. In these three sections—perhaps the most original ones—Barona and Bernabeu-Mestre show that sanitary organization was, for the Republicans, a political question of the first order, though its process of construction was interrupted by the Civil War and the repression that followed the triumph of franquismo. The group of health professionals, most of whose members remained loyal to the republican government, was severely punished. Most specialists went into exile, where they went on to play active roles in Venezuela, Mexico, Cuba, the World Health Organization, and the Pan American Health Organization. In these final chapters, the authors change their perspective to focus primarily on events in the fields of public health and sanitary organization in Spain itself, though they also mention reports by Spanish delegations to international organisms and surveys that they conducted in Spain.

The volume ends with two indexes. The work presents an impressive amount of information, including several novel aspects. The authors made use of many published works and numerous primary sources, and include boxes with interesting information, for example, lists of the Rockefeller Foundation’s fellowship holders and twenty-five photographs of key figures and places.

However, the book is not without its shortcomings: the bibliography does not include Balaguer and Ballester’s pioneering work on the International Sanitary Conferences, nor are certain Spanish historians of public health and the sanitary professions sufficiently represented. Also, there are editorial flaws, such as not indicating the location of the photographs and omitting from the bibliography some of the sources cited in the body of the text. Above all, the analysis could be more nuanced; for instance, not much is said of the contradictions between the policies promoted by international agencies in Spain and the country’s people, sanitary authorities, and health professionals.

Until the publication of this book, there were no studies devoted completely to Spain’s participation in the international sanitary movement and its influence on public health there. The authors hope that their book will prove useful to historians of medicine, demographers, and social historians. It will certainly be an important reference work for many of those specialists, but it will also appeal...

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