International and public dimension of health

International and public dimension of health

The French health expert, Raymon Gautier, said on 1944: “Health is more than absence of disease: the word health means something positive; psychical, mental and moral well-being. That is the goal we must achieve, even though it it goes beyond the possibilities of curative and preventive medicine”. The words of Gautier are on the foundational text of the World Health Organization (1948) and explain the social and political transcendence of the coronavirus crisis.


This crisis has shaken us when we believed the myth of that we had disease easily under controlled and we could easily get over them. It has shaken us when we believed that great epidemic disasters, as well as hunger and wars disasters, were things of another darker times and other places.


We have forgotten the high price of the article 25 of the Universal Declaration of Human Rights (Geneva, 1948) which proclaims universal right to health: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”


We have forgotten about the historical process in which workers strikes and social reforms gave a political answer to the right of health. We have forgotten that we have moved from the idea of charity and beneficence for poor people to trying to ensure access to health and social protection in the face of poverty and helplessness.


At the beginning of the 1920's, in Spain, a health commission was created for the Hurdes to eradicate hunger and its consequences, cretinism. Illustrious doctors participated like Gregorio Marañón and Ángel Pulido, King Alfonso XIII himself and the archbishop of Plasencia. Ensuring an agrarian economy, fighting hunger and iodizing drinking water provided great results.


Only after the II World War (1945) was when the national systems of health tried to make health universal for everyone, promoting the state of well-being. After two world wars, the new national health systems put its hospital institutions at the core of the assistant model, as a space for the specialization of professionals and technological innovation.


We have forgotten about the difference between price and value. The crisis makes us to rediscover the value of hospitals. We though it was only an expense and we had forgotten about the value that this has for sick people or potential sick people, as well as for all humanity, thanks to the value its discovers has for everyone.


We have forgotten about the words the anthropologist, politic and German doctor Rudolf Virchow in which they said that: “medicine is a social science and politics is nothing more than medicine on a big scale” (1848). The disease has not only an organic or biological dimension, also a psychological, social and labor one. We have also forgotten about the necessary universal dimension of health.


In the mid-19th century, cholera and yellow fever epidemics led to restrictive national regulations on the trafficking of people and goods. Lazarettos and sanitary cordons prevented free international trade. This was the starting point for a new diplomacy that initiated international health conferences and hygiene congresses that emphasized the political dimension of health. In 1907, an International Office of Public Hygiene was established in Paris and, in 1920, a Committee on Hygiene in the League of Nations (1920) was set up to alleviate the devastating effects of the epidemics and famine caused by World War I. In 1921, when an immense typhus pandemic was devastating the border territories between Poland and Russia, the Hygiene Committee of the League of Nations promoted a congress and an international commission on epidemics that stopped the threat of extension throughout Europe by overcoming diplomatic tensions. They created an ambitious international health program funded by the Rockefeller Foundation to train public health experts, create an International Epidemiology Service and a Global Public Health Documentation Center, and boost programs to prevent malaria, malnutrition, tackle opium use and infant mortality. The international public health experts of the League of Nations were the founding core of the World Health Organization (Geneva, 1946), as the international advisory body to the United Nations on health matters. [1]


We will only rise up form this crisis with public responsibility and social and international cooperation.


Fco. Javier Alonso, president of JP Spain

[1] Acknowledgement: Josep L. Barona-Vilar [Institutd'Història de la Medicina i de la Ciència López Piñero (Universitat de València)], "Biomedicine and publichealth in the 20th century".