League of Nations Health Organisation

The LNHO is barely mentioned in most books on the League; there is no Wikipedia page on it.  Yet League secretary general Eric Drummond, in 1930, called it: “one of the most important elements in the activities and success of the League", and historians who have studied it agree. 

The formation of the LNHO

In the years after WWI, populations weakened by scarcity fell prey to waves of epidemics – especially Spanish Flu (which killed at least 15 million people), but also cholera, plague, smallpox & typhus … especially in the Far East, European Russia, and areas with large numbers of refugees (eg Greece). 

In 1921, therefore, the League set up the LNHO – the first international health organisation with a broad mandate and global responsibilities.  Although the USA was not a member of the League, American academics and organisations (notably the Rockefeller Fund) worked with the LNHO. 

It was quite a small Commission – originally formed of 26 senior health experts from various members’ public health services (eg one of the experts was George Buchanan, senior medical officer of the British Ministry of Health) and even by 1933 it had only 18 technical officers and 35 officers, and called upon 100 experts. 

The work of the LNHO

Under its Medical Director Ludwik Rajchman, however, the work of the LNHO was HUGE!

1.  Its Epidemic Commission (1920-23) went into areas where there were epidemics (including Poland, Soviet Russia and Ukraine, Latvia, Greece and China) to work with the local authorities.  It developed an anti-epidemic scheme, which centred on publishing information about the spread of the diseases (so local authorities could respond quickly), inoculation … and also setting up health centres to deal with minor ailments such as skin diseases an eye complaints, which sapped people’s own immune system. 

Its intervention in China resulted in a modern new hospital at Nanjing, the eradication of cholera from the Shanghai area, and a central health institute for research. 

2.  It collected the latest research and information on infectious diseases from all the League’s member countries, analysed it, and published weekly reports.  These were particularly useful for ports, which were therefore able to update their quarantine arrangements before it was too late. 

3.  It worked closely with the ILO (on occupational diseases) and the International Sanitary Convention (on quarantine arrangements in ports and airports)

4.  A Permanent Commission on Biological Standardization worked to establish an international code of medical statistics (eg on pharmaceuticals, painkillers such as morphine and cocaine, serums, vitamins, etc.) with examples held in Copenhagen and shared on request. 

5.  It organised exchanges, which allowed medical professional to see best practice in other countries.  By 1934 the LNHO had organised 35 study tours to 31 countries attended by 587 health officials from 61 countries.  In addition, 175 health officials had been on individual exchanges to medical centres of excellence. 

6.  It organised research studies and conferences on a wide range of diseases and problems, including:

     •    Malaria – notably conducting campaigns to kill mosquitoes, and exploring alternatives to quinine (which was very expensive)

     •    Tuberculosis (including a conference on BCG)

     •    Cancer (esp.  the use of radiotherapy)

     •    1922 study of sleeping sickness in Africa

     •    An International Rabies conference (1927)

     •    A conference in South Africa 1932 on yellow fever, plague & smallpox

     •    A 1937 Conference in Dutch Indonesia on ‘rural hygiene’

     •    Reports on heart disease, welfare of the blind, infant mortality, school hygiene, scarlet fever, diphtheria, milk, the fumigation of ships, and smoking. 

7.  It supported an anti-leprosy centre in Rio de Janeiro and a Far Eastern Epidemiological Intelligence Bureau in Singapore. 

8.  By the late 1930s, the LNHO was working in 148 different countries. 

A ‘social model’ of medicine

As time went on the LNHO’s approach was increasingly intersectional – considering all the associated problems – and increasingly moved away from a disease-centred model of sickness, to a ‘Social Medicine’ approach. 

After spending three years in China, Commission expert Andrija Stampar commented:

“successful health work is not possible where the standard of living falls below the level of tolerable existence … it follows that the best health programme is to raise the standard of living”. 

The Malaria Commission declared malaria a ‘social disease’, as did a 1932 study of the health effects of economic depression in the USA, which directly equated disease such as rickets, tuberculosis, skin diseases and nervous affections with poverty. 

In the 1930s, therefore, the LNHO conducted studies on nutrition (Japan, Italy, Chile, USA) and housing (Berlin). 

The demise of the LNHO

As time went on, the LNHO began to acquire enemies:

     •    Local medical authorities did not like what they saw as ‘interference’, particularly objecting to the LNHO’s advice on spending large sums on research centres in a time of economic depression. 

     •    Britain, France and the Netherlands were suspicious of the LNHO’s work in their colonies, seeing the LNHO’s insistence on listening to the native peoples as potentially subversive. 

     •    Right-wing governments coming to power in the late 1930s did not agree with social medicine; in Greece – after the LNHO had spent four years at the invitation of the liberal government developing a new public health system, the new conservative government which came to power in 1932 did not overturn the LNHO recommendations ..  but they slashed the public health budget by 90%, which effectively put paid to it. 

     •    LNHO officials were gradually forced to resign (and ultimately Rajchman himself in 1939) and were replaced by more right-wing officials. 

When WWII broke out, the work of the LNHO effectively ceased.  By 1940 only two medical officers remained, and in 1942 the Far Eastern Bureau was closed.  Only the weekly Epidemiological Record continued through the war.