No Peace without Social Justice.

By Martin Gorsky, Professor of History.

I talked in my first blog for the Armistice about the importance of understanding the feelings of ordinary soldiers who served in the First World War.  On Remembrance Sunday a film was televised that allowed us to do just that, Peter Jackson’s They Shall Not Grow Old.  Consisting of black and white war footage now digitally enhanced and coloured, and with dialogue recreated by lip readers and dubbed in regional accents, it brought the Western Front alive as though it were yesterday.  Beneath was a commentary entirely by participants, culled from oral history recordings in the Imperial War Museum archive.

This brilliantly captured the pride and patriotism, the camaraderie of army life and the adventure of combat.  But it also showed the fear, the horrors of violent death and wounding, the troops’ utter war-weariness, and their realization, at the end, that their German counterparts were decent people exactly like them.  It was impossible not to be moved by their fortitude and sense of duty, but also by their suffering, not least at the war’s close, when they came home to unemployment and a largely thankless nation.  For me this prompts reflection on the peace treaties that followed the Armistice, and whether they honoured the sacrifice made by the troops.

Manifestly they did not.  The next twenty years were marked by further political breakdown in Europe and Asia, with economic depression, famine, mass unemployment, totalitarianism, ethnic persecution, and conflicts in Ethiopia, China and Spain, all culminating in the Second World War (1939-45).  From a public health perspective then, the most basic question is why postwar leaders failed to create a stable political and economic system in which healthy lives could thrive.

The answer is that instead of emphasizing internationalism and solidarity, the world system of competing nation states remained.  Some intentions were good: the new states arising from the ashes of the Ottoman and Austro-Hungarian Empires would gain sovereignty. A novel international organisation, the League of Nations, would provide a forum for governments to resolve their differences without resort to war.  However, the imperial powers strengthened their own positions, carving up German and Ottoman colonial possessions as ‘mandates’ of Britain, France, Belgium and Japan.  They also punished Germany, which lost territory and had to accept the humiliation of ‘war guilt’.  It also faced a huge ‘reparations’ bill that would stymie its industrial recovery, and contribute to the hyper-inflation that wrecked family savings in the early 1920s.  All this was fertile psychological ground for the aggressive, populist nationalism trafficked by Hitler and the Nazis.

In terms of the genealogy of global health however, the settlement did mark a shift in thinking. The Covenant of the new League of Nations set out a strategy to ‘promote international co-operation and to achieve international peace and security’.  Along with arms control and dispute resolution, it would ‘take steps in matters of international concern for the prevention and control of disease’, and ‘secure and maintain fair and humane conditions of labour’.  These goals led to the creation of two agencies which were to lay the foundations of global health: the League of Nations Health Organisation and the International Labour Organisation.

The League of Nations Health Organisation can be thought of as the predecessor to the WHO.  It was not genuinely global, in that it was dominated by Europeans, and lacked representation from countries still under colonial control.  Nor did the US government, then going through an ‘America first’ period, participate.  However, the LNHO did put in place the foundations of international health activity, such as world epidemic disease surveillance, an international classification of diseases, public health system building in countries like Greece and China, and the promotion of social medicine programmes, combining rural health care with development activities.

The International Labour Organisation, which represented trade unions, employers and governments had as one of its constitutional goals ‘… the protection of the worker against sickness, disease and injury arising out of his employment’.  In the 1920s it passed Conventions aiming to persuade member states to create sickness insurance systems for industrial and agricultural workers.  Then in 1944, just as the tide of the Second World War was turning to the Allies, it went further in its Philadelphia Declaration, which contained the first global aspiration to Universal Health Coverage.  The Declaration asserted that ‘all human beings … have the right to pursue … their material well-being … in conditions of freedom and dignity, of economic security and equal opportunity’. One component of these rights would be ‘the extension of social security measures to provide … comprehensive medical care’.

The philosophy underlying all this was that enunciated in the Preamble to the ILO’s constitution, that ‘universal and lasting peace can be established only if it is based upon social justice’.  In other words, both preventive public health, and access to health services by right, and not according to income, were deemed to be essential for a stable world order, free of the discontent that breeds violence.  Looking back on all that has happened since, it’s easy to say that this was hopelessly idealistic.  Yet – as a final Remembrance thought – we might also recall that these aims – ‘Sustainable Development Goals’ in modern parlance – arrived on the global agenda in response to the anguish and heroism of the ordinary people caught up in the First World War.