INTRODUCTION

The huge crisis caused by the Great War and the Interwar period radically
changed the international relations affecting the social, economic and political situation in many European countries.1 Health problems directly linked to
the impairment of the living conditions and the loss of quality of life standards
figured prominently as the authorities had to cope with the deep social crisis
suffered by European countries during the first decades of the twentieth century. The challenge required a shift from the traditional public health control
of plagues and infectious diseases to a more political issue represented by the
development of social hygiene and social medicine.2
Several important features were involved in this shift : first, the role of international health organizations as a new locus of expertise. The international context
determined the orientation of medical research and health policies anywhere in
the world. In addition, international organizations played an important role in
the standardization of research and clinical methods, and in the instructive programs for public health experts. These experts had an increasing influence on the
organization of research in the several aspects involved in public health, health
care and health policies at the national administrations and international agencies. Not only did experts and specialists acquire great scientific and political
legitimacy and influence, health itself became a prominent social and political
category during the pre-war years, during wartime and throughout the postwar period, a time when the State strongly emerged as a social regulator in most
liberal societies in order to palliate the negative effects of the so called market
failures.3 The growing influence of the international networks and organizations
on national health policies prompted the relevance of debates and negotiations
in the shaping of preventing diseases and implementing health care strategies.
Some historians have considered the role of international agencies in the promotion of social medicine for example, the Rockefeller Foundation (RF), the
League of Nations Health Organization (LNHO), the Red Cross and a series
of philanthropic and activist organizations in the field of health as a strategy
associated with Western imperialism, economic profit and political interests. A
meaningful part of the historiography has considered American philanthropy as

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The Rockefeller Foundation, Public Health and International Diplomacy 192045

a key agent in the global spreading of capitalism and in the Western imperialist
expansion.4 It has been highlighted that the interests of colonial powers, big corporations and financial trusts took priority in international politics over those
of native populations who were affected, assuming without any sort of criticism
that both shared the same idea of development and that their respective interests
were coincident. Indeed criticism is necessary to prevent the consideration that
Western philanthropic foundations and their activists were working to advance
good causes in a disinterested way. However, it has been recognized that most
philanthropic institutions, and particularly the RF, helped to modernize world
societies promoting public health policies, improvements in agriculture, giving impulse to scientific research and instruction-grant programs.5 As a matter
of fact, the international philanthropic intervention during the first half of
the twentieth century was so diverse that it not only promoted American and
Western capitalist expansionism, it also expanded the commitment of political
authorities and ideas of welfare and progress.6
However, the framing of several forms of technical expertise in this case
associated to state and international organizations became not only a reference
to legitimate international intervention and state policies, experts also became
some sort of independent authority.7 Humanitarian intervention and medical
activism, based on ethics and action, became a wide movement in Western countries at a time of crisis and conflict.8 As well as this, it was a matter of controversy
in the US during the first decades of the twentieth century.9 Some organizations
such as the Red Cross associated the fundamental spirit of mercy as an essential background of the medical practice, above and beyond assessments of moral
and political character. On the contrary, several other humanitarian associations
emerged during the Interwar period not only as matter of mercy, but as a sort of
activism in a time of extremes, participating in the struggle between democracy,
fascism and social revolutions.10 In that case, humanitarianism required a political involvement beyond neutrality and, to some extent, activists applied the
moral imperative of humanitarian relief to go beyond the limitations of states
foreign policy and, above all, their lack of commitment to uphold democratic
values, as in the case of the defence of the Spanish republic against fascism.
Recent historiography shows a wide debate about the aims and impact of
the American philanthropic movement, both in the domestic domain and in the
global dimension. Considered in the context of those debates, in my opinion, public health campaigns and public health experts of the RF cannot be reduced to the
role of simply hidden agents of American imperialist foreign policy at a time of
conflict and debate between isolationism and internationalism in American politics.11 In addition, health politics, in the way it was promoted by the International
Health Board of the RF and the Health Committee of the LNHO, contributed
to improving health and living conditions in many areas and also to an increased

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Introduction

engagement of the state administrations in the safeguard of public health. During

the interwar years, international agents, or agents who had been educated at internationally leading institutions, exerted technical and ideological influence which
increased the States involvement in health policies, something that can be considered as a point of departure of the Welfare State policies during the Cold War era.

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