Print version ISSN 0042-9686
Bull World Health Organ vol.87 n.1 Genebra Jan. 2009
BOOKS & ELECTRONIC MEDIA
S William A Gunn*
International Association for Humanitarian Medicine, 3 Chemin du Milieu, 1279 Bogis-Bossey, Switzerland
Author: John Farley
Publisher: University of British Columbia Press, Vancouver, 2008
ISBN: 978-0-7748-1476-8; hardback; 254 pages; US$ 85
On the occasion of WHO's 60th anniversary, Brock Chisholm, the World Health Organization, and the Cold War is a story of the institution's formative years and its first Director-General.
The book is a detailed study by medical historian, John Farley, who has sifted through voluminous documentation to elucidate the complex relationships between a new post-war sociopolitical organization, an idealistic leader and a cruel Cold War atmosphere. The account is neither a full biography of Brock Chisholm nor a complete study of WHO but, as the introduction states, the "story" of both during their respective first steps in a hostile world.
Farley records Chisholm's qualities, from his youth as a brave soldier to his growth as physician, psychiatrist, platoon commander, major-general, deputy minister of health, representative to the International Health Conference and, thence, to WHO. He notes that "Chisholm had been a surprising choice" yet, in the plethora of carefully referenced documents, there is no single statement or feeling supporting such a "surprise". Even if initially, in 1946, Chisholm might have been sent to the United Nations (UN) by virtue of his position in Canada's health administration, once in the international circuit, he constantly climbed with the votes of his peers, all experts such as Evang, Parran, Sand, Stampar and other Indian or Soviet influential figures. Such steady ascent from the Technical Preparatory Committee to the Interim Commission and up to the World Health Assembly cannot be a surprise or accident, especially as Chisholm never lobbied or asked for favours. Obviously he must have demonstrated superior mental, organizational and human qualities to have been repeatedly chosen as secretary, rapporteur, chairman and ultimately director-general. Dr Norman Howard-Jones, the historian of WHO, is categorical about this: "he was the natural choice".
The Cold War is not particular to Chisholm's leadership of WHO; four of his successors having faced similar difficulties, machinations and injustices in that period. But it was he who was the first to confront it and, given the incredible and maddening political complexities due to east-west animosity, it is all to the credit of the "first captain" that damage control remained effective and the "ship" maintained its course. Farley fully documents the nasty politicking of those years but, despite extensive bibliographic material, a true interpretation of the leader's strong image does not emerge. Indeed, whether through concern for neutrality or objectivity, the author appears undecided, by using such ambiguous terms as visionary (repeated at least six times), nationalism and citizenship, which are open to ambivalent interpretations. This sometimes works against Farley, unwittingly portraying his subject in a lesser light; "visionary", for example, becomes almost derogatory, showing Chisholm as a vague, impractical dreamer. Strong views on such issues as family planning, poverty reduction, social services, medical coverage and peace-keeping come out as dreamy and indeed may have sounded outlandish in those hot years of the Cold War yet, with time, most have proven to be right.
Organizationally WHO, even in those earliest years, suffered from its Member States' nationalistic interests and lack of commitment yet Chisholm's team led bravely and reasonably successfully. His public health experience has sometimes been questioned. Farley addresses this issue but draws no conclusion. Although Chisholm was not from a Ministry of Public Health, he was surrounded by public health giants like Stampar and Evang and, as his objective was the public's health rather than traditional public health, being outside the club should be seen as an advantage, as indeed it proved to be. Naturally, like any other person, Chisholm had his "pet" topics and weaknesses but he knew how to deal with colleagues, opponents and difficult situations. He chose his team well and had confidence in youth: his directors of finance (Siegel) and of publications (Howard-Jones) were both aged 38 when appointed. I recall, when he officiated at our medical graduation, his passionate message was: "safeguard your youthful vision and work health into social justice".
This book is an excellent study. Intentionally limited in time and scope, it leaves some issues in suspense. A postscript could perhaps have mentioned that those early visionary ideas have turned out to be not that illusory after all. Chisholm's hope of universal health services now guides WHO's Global Strategy for Health for All; his advocacy of a peacekeeping force is now reality, albeit weak, through the UN Blue Berets; his ideas on world federalism are partly translated in the European Union; his anti-nuclear stand has seen the Pugwash Conferences on Science and World Affairs receive the Nobel Peace Prize; and his poverty-disease link is key to UN Millennium Development Goals. Social medicine has become widely available and family planning has hugely contributed to China and India's progress; the American Medical Association and the Catholic Church had once "crucified" Chisholm for such heresy. Farley's book clarifies much and should be read by medical historians, health planners, social scientists, politologues and international administrators.