Putting socialist countries in the global health picture
Primary Healthcare in the People’s Democratic Republic of Korea. Pyongyang, 1987. WHO archives, 18/370/2 KRD/R 8.
There has been a reluctance to acknowledge the extent of socialist countries’ participation in international and global health in the Cold War era, resulting in an incomplete historical analysis. Professor Dora Vargha, Dr Alila Brossard Antonielli, Dr Luis Aue and Dr Nils Graber are investigating the socialist world’s role in global health history. The current challenges facing the global health community cannot be understood without a deep knowledge of the historical background and contribution of different countries, societies and actors. The role of the socialist world in this respect has historically been underplayed, an imbalance the team behind the ERC-backed Socialist Medicine project are working to redress. “We aim to include ideas, practices and actors from the so-called socialist world in the analysis, and this is crucial for understanding global health history more broadly,” explains Dora Vargha, Professor of History and Medical Humanities at Humboldt University in Berlin, the project’s Principal Investigator. The socialist world in this sense includes the countries that formed the Eastern Bloc during the Cold War, as well as other nations from different parts of the world. “The socialist world in our analysis includes some East Asian countries, such as Vietnam and North Korea, as well as certain parts of India and South Asia, and also nations in Africa and Latin America, such as Mozambique and Cuba,” continues Professor Vargha. Researchers from these countries played key roles in major breakthroughs in the prevention of different diseases, yet in many cases they
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don’t form part of the conventional health narrative, which typically emphasises the role of Western nations and colonial powers. It is commonly thought for example that American organisations have been the major players behind the drive to eradicate polio, yet Professor Vargha says socialist countries made important progress several decades before the Global Polio Eradication Initiative was established in 1988. “Czechoslovakia was already pushing forward on polio eradication in the early ‘60s, and the method that was developed has its roots in research from Hungary, Czechoslovakia and Cuba,” she stresses.
Socialist medicine The project team are investigating healthcare structures in these and other socialist countries, as well as the new methods and technologies they helped develop, moving away from the conventional Western-centric narrative of global health history. The project is focused largely on the Cold War era (1947 -1991), with researchers conducting interviews with prominent figures from the period and examining archives, yet they are also looking at some earlier documents. “To understand the Cold War you may also need to look
at the work of socialist thinkers from the 19th century,” says Professor Vargha. Their ideas were reflected to a large extent in the structure of healthcare systems in socialist countries, including some newly independent African states. “Mozambique and Angola nationalised their healthcare systems when they gained independence, private medicine was abolished,” says Dr Alila Brossard Antonielli, a post-doctoral fellow working on the project. “In Mozambique for example the healthcare system was nationalised in 1975, followed by socialisation two years later, so almost all healthcare was free of charge.” A lot of emphasis is placed on providing universal access to healthcare under the socialist system, with a major role for the state. From a socialist viewpoint, health is always political, and issues around poverty, housing and working conditions were typically a major priority for the authorities. “From a socialist perspective, those are issues that should be addressed through medical interventions,” says Professor Vargha. Tuberculosis (TB) for example is often considered to be a disease of poverty, with people in poor living conditions more vulnerable. “Mozambique always had a TB programme, it’s a disease that can be treated effectively, part
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of a commitment to disease prevention,” says Dr Brossard-Antonielli. “While Mozambique had dedicated programmes to tackle specific infectious diseases, the emphasis was more on prevention, an approach which was extended beyond urban centres to rural areas. Doctors and nurses were highly active in these areas, while medical technicians and rural health agents would teach local people things like how to clean the water and dispose of rubbish in a way that mitigated the risk of people developing intestinal diseases.” This was done with the support of UNICEF and the World Health Organisation (WHO), as part of the international discussions on Primary Health Care in the 1970s. While the rivalry between the Soviet Union and the US was a core feature of the Cold War, Professor Vargha and her colleagues in the project are looking beyond the superpowers, and evidence shows there was a degree of collaboration and information-sharing between the capitalist and socialist worlds. “Many Eastern Europeans published work in mainstream western journals, in English. They would collaborate at conferences where they would meet other researchers and policy-makers, while they
and trans-national coordinating groups were formed in both the East and West to help spur the development of new treatments. “Clinical trials led to the development of new cancer treatments and protocols. I’ve found that new drugs were developed through these clinical trials, some of which socialist countries wanted to export to the West,” says Dr Graber.
Infectious diseases Research in oncology and other areas of medicine was not conducted exclusively in the countries that took a lead, rather the aim was to establish hubs or centres of excellence. This gave doctors the opportunity to learn about how diseases were treated in other countries, a major topic of interest in the project. “A lot of infectious diseases are related to the conditions under which people live,” says Dr Luis Aue, a post-doctoral researcher working in the project. In his research, Dr Aue is looking at tropical medicine in the GDR; the country had an extensive surveillance system to manage the threat of infectious diseases entering the country from abroad. “The system was really impressively detailed. This covered things like the way everybody who entered the GDR from
“We are trying to include the so-called socialist world into the analysis of global health, and to shift our understanding of what belongs in the historical narrative.” would work together at the WHO and other organisations,” she continues. There were also strong networks within the socialist world, and some countries worked together to coordinate medical research. “At annual health minister conferences plans were made about which country would take a lead on oncology for example, or on mother and child health issues,” says Professor Vargha. The Council for Mutual Economic Assistance (Comecon), an organisation which brought together many socialist countries, played a major role in encouraging international research cooperation and coordination. Chemotherapy and immunobiology groups were set up through Comecon in the ‘70s for example to coordinate research across member countries, spanning a wide geographical range. “These groups linked Cuban researchers with those from the USSR, as well as the German Democratic Republic (GDR), Poland and other Eastern European countries. Comecon’s coordinating role was really key in the ‘70s, in terms of conducting research and developing new drugs,” outlines Dr Nils Graber, a post-doctoral fellow investigating the role of Comecon as part of his work in the project. The early ‘70s was a period when clinical trials were becoming more standardised,
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abroad should be examined, how they should be prepared for their travels, and the system of surveillance for diseases that could come back to the GDR,” he explains. The planning was extremely thorough, yet economic realities meant there weren’t always sufficient resources available to treat people effectively. Nevertheless, the authorities in the GDR were proud of their surveillance system, while other features of the country’s healthcare system are viewed in a positive light by many people today. “There have been discussions about whether some of the GDR delivery models were abolished too quickly, especially the policlinic model, where state funded care providers worked together,” outlines Dr Aue. The project will help shine a light on these aspects of socialist medicine, with Professor Vargha and her colleagues planning to publish papers and help stimulate wider interest in the medical humanities. “This is primarily a historical project, but it brings together researchers from other disciplines as well, including sociology, anthropology and political science,” she continues. “We’re planning to write several books and articles on the basis of the project’s research, while we’re also organising events and pursuing new avenues of research.”
SOCMED Socialist Medicine: An Alternative Global Health History
Project Objectives
This project identifies the particular health cultures produced by socialism and explores the impact of socialist internationalism in co-producing global health in the 20th century. By centering the analysis on socialist countries and their global relations, this research changes our fundamental understanding on the history of the emergence of global health in the post-Cold War order.
Project Funding
The SOCMED project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Grant agreement No. 949639)
Project Team
https://socialistmedicine.com/the-teamsocialist-medicine-copy-2/
Contact Details
Project Coordinator, Prof. Dr. Dora Vargha Department of History Humboldt-Universität zu Berlin Unter den Linden 6, 10099 Berlin Germany T: +49 (030) 2093-70 588 E: dora.vargha@hu-berlin.de W: https://socialistmedicine.com/aboutsocialist-medicine/ Vargha, D. (2023). Missing pieces: Integrating the socialist world in global health history. History Compass, 21(7), e12779.
Prof Dora Vargha, Dr. Luis Aue, Dr. Alila Brossard Antonielli, and Dr. Nils Graber
Prof Dora Vargha is a historian of medicine, science and technology, with expertise in the history of epidemics, the politics of health, and Cold War history. Dr. Luis Aue received his PhD from Free University Berlin. His research focuses on the history of global and international health expertise. Dr. Alila Brossard Antonielli holds a PhD in Health and Social Sciences from the École des Hautes Études en Sciences Sociales. Dr. Nils Graber holds a PhD from the research centre Cermes3 at EHESS in Paris
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