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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Bull World Health Organ vol.79 n.9 Genebra Jan. 2001 

The globalization of public health: the first 100 years of international health diplomacy

David P. Fidler1



Abstract Global threats to public health in the 19th century sparked the development of international health diplomacy. Many international regimes on public health issues were created between the mid-19th and mid-20th centuries. The present article analyses the global risks in this field and the international legal responses to them between 1851 and 1951, and explores the lessons from the first century of international health diplomacy of relevance to contemporary efforts to deal with the globalization of public health.

Keywords Public health administration/history; World health/trends; International cooperation/history; Diplomacy; Communicable disease control/history; Drug and narcotic control/history; Employment/standards; Alcoholic beverages/supply and distribution; Water pollution/prevention and control; International law; Treaties (source: MeSH).

Mots clés Administration santé publique/histoire; Santé mondiale/orientations; Coopération internationale/histoire; Diplomatie; Lutte contre maladie contagieuse/histoire; Contrôle drogues et stupéfiants/histoire; Emploi/normes; Boissons alcoolisées/ressources et distribution; Pollution eau/prévention et contrôle; Droit international; Traités (source: INSERM).

Palabras clave Administración en salud pública/historia; Salud mundial/tendencias; Cooperación internacional/ historia; Diplomacia; Control de enfermedades transmisibles/historia; Control de medicamentos y narcóticos/historia; Empleo/normas; Bebidas alcohólicas/provisión y distribución; Contaminación del agua/prevención y control; Derecho internacional; Tratados (fuente BIREME).




Contemporary analyses of public health make much of its globalization and the national and international impact of this. Commentators argue that globalization creates challenges for the governance of global health, including the need to construct international regimes capable of responding to global threats to public health. These problems are not new: the globalization of public health led to the development of international health diplomacy and international regimes for public health beginning in the mid-19th century. This article analyses the first 100 years of international health diplomacy in order to elucidate what lessons the past holds for the governance of global health today and in the future.

The term "globalization" has been introduced only recently into analyses of world affairs. Most definitions of globalization indicate that it refers to the process of increasing interconnectedness between societies such that events in one part of the world increasingly have effects on peoples and societies far away (1). The idea that events in one part of the world have health effects in countries far away is familiar to historians. Thus McNeill analysed the formation of a Eurasian and then a global infectious disease pool from 500 BC to 1700 AD (2). The quarantine practices of European states in the 14th century marked the beginning of modern public health (3, 4). The history of public health is, in fact, that of the processes of increasing interconnectedness between societies such that events in one part of the world have health effects on peoples and countries far away.

International cooperation on the control of global risks to human health did not begin until the mid-19th century. Today's commentators argue that the factors accounting for globalization, such as information technology, trade and the flow of capital, undermine the state's control over what happens in its territory (5). Globalization forces individual states to cooperate with each other and build partnerships with non-state actors, such as multinational corporations and nongovernmental organizations, in order to develop global governance. Experts distinguish international governance, defined as intergovernmental cooperation, from global governance, which involves the interaction of states, international organizations, and non-state actors to shape values, policies and rules (6). In public health, the shift from national to global governance began in the mid-19th century, when international health diplomacy emerged because of concern about infectious diseases. During the next 100 years this facet of diplomacy expanded as states, international organizations, and non-state actors tackled global threats to public health through international law and institutions.

The public health risks that acquired global significance during this period were associated with infectious diseases, opium and alcohol, occupational hazards, and transboundary pollution. These matters are discussed below, as are the legal and institutional responses of states and international organizations; the role of non-state actors in global health governance from the mid-19th century until the mid-20th century; the effectiveness of the global health governance regimes constructed in this period; and the lessons of the first century of international health diplomacy for people currently struggling with global risks to public health and the politics they generate.


Global public health risks, 1851–1951

Infectious diseases

International health diplomacy began in 1851, when European states gathered for the first International Sanitary Conference to discuss cooperation on cholera, plague, and yellow fever (7). These states had previously dealt with transboundary disease transmission through national quarantine policies. The development of railways and the construction of faster ships were among the technological advances that increased pressure on national quarantine systems (8). However, disease control became a subject of diplomatic discussion as a result of the cholera epidemics that swept through Europe in the first half of the 19th century. National policies not only failed to prevent the spread of the disease but also created discontent