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

If the most timeless issue in the history of public health is the tension between individual rights and the public good, the timeliest issue may well be the relationship between the local and the global. Emerging diseases such as aids, Ebola, and sars have created a scalar rhetoric, according to which no epidemic is local in a globalized world. They demonstrate that there is little overlap or contiguity between political borders and the boundaries of a spreading disease. Although microbes have no respect for such borders, moving effectively via networks of trade, travel, and contact, policies for controlling diseases are often constrained by specific nation-states.

By the mid-nineteenth century, the rapid spread and global reach of epidemics such as cholera, typhus, and plague between colonial and metropolitan centers led to the establishment of a series of international sanitary conferences designed to overcome this tension. Such institutions in turn inspired the development of international health organizations with a larger reach, including the Office International d’Hygiène Publique (1907), the League of Nations Health Organization (1920), and the World Health Organization (1948). Yet most health policy has remained a decidedly local affair; specific political, social, economic, and cultural contexts evince dramatically different approaches to disease control.

This collection brings a collaborative and interdisciplinary perspective to these problems in a series of essays on health governance in twentieth-century Europe. Although the individual essays are uneven in quality and scope, collectively they advance a clear thesis and a clear chronology. Early initiatives, like the sanitary conferences, were largely informal discussions among select health officials and diplomats. By the 1920s, such activities became formalized and invested with scientific expertise; “internationalism” was the rule of the day. The 1930s witnessed a return to a local emphasis, as international organizations and foundations began to invest less in one-size-fits-all solutions to global health problems than in community-based organizations better-suited to pursue health concerns on the ground.

The postwar era gave rise to the World Health Organization as the de jure clearinghouse for international health affairs. But, in reality, this period returned the nation-state to prominence, as Cold War politics and other diplomatic phenomena pushed internationalism aside. Only the appearance of “emerging diseases” in the last decades of the twentieth century has effectively re-invested internationalism with significant importance; microbial networks have subsumed the nation-state’s boundaries as the critical frame for disease control. The essays collectively trace this chronology while also emphasizing critical themes: the relationship between state actors and nongovernmental organizations, the transportability or translatability of local health solutions into global contexts and vice versa, the tensions between cosmopolitan public-health policies and individual states’ political agendas, and the importance of environment and place-based approaches to global health governance.

Historians are the primary contributors to the volume (with the occasional political scientist or policy analyst thrown into the mix), and the book’s primary concerns are the origins and development of public-health policy debates in Europe. Discussion gravitates toward the early to mid-twentieth century; only a few essays move beyond the 1950s. That said, the book engages with contemporary as well as historical issues. Graham Mooney’s laudable essay on the uses of demography for epidemiological purposes in Britain, for example, traces the discipline from its nineteenth-century origins to the present, and Dorothy Porter’s and Peter Baldwin’s offerings discuss contemporary debates over obesity and aids, respectively.

The book will be a useful tool for historians interested in European health policy during the critical periods of its development, primarily in the aftermaths of the two world wars. Regrettably, the volume does not engage much with two of the essential problems facing European health policy at present—the crisis of the welfare state and the fading of European influence in the shaping of global-health discourse. But perhaps another volume can...