Andrija Stampar Research Articles

Half century of the Association of Schools of Public Health in the European Region: A significant contribution to public health education

The Association of Institutions Responsible for Advanced Teaching in Public Health and of Schools of Public Health in Europe was established in 1966. It was in response to the initiative of the World Health Organization (WHO)Regional Office for Europe as part of a worldwide initiative to set up Regional Associations of Schools in every WHO region as a channel for initiating innovative policies. The Organisation’s name was later changed into Association of Schools of Public Health in the European Region(ASPHER). ASPHER has established atradition in terms ofan annual award named Andrija Stampar, whichhasbecome a prestigious European reward for merits in public health.A significant contribution to public health education has been made during half century and the Association is today stronger than ever before

Health Literacy regarding people with intellectual disability 'Our right to a healthier future'

Abstract Background People with disabilities make 10,1% of the City of Zagreb society in 2019. Intellectual disability makes 4,8% of total disability population. One of the main goals of Zagreb Strategy of Equal Opportunities for People with Disabilities from 2017 to 2020 is the accessibility to health care and services. Andrija Stampar Teaching Institute of Public Health undertaken public health initiative “Our right to a healthier future” in the City Zagreb in 2019. Objectives The aim was to recognize the need for early risk factors prevention, to increase health literacy and to improve access to health-care for adults with intellectual disability in Social-humanitarian organization and Daily Center Ozana. Results In order to assess the health status and health-related lifestyle attributes a multidisciplinary approach was carried out including a total od 53 adults with intellectual disability in Center Ozana. Activities included preventive exams, conducted workshops with individual counseling about healthy and unhealthy lifestyles. Hypertension was found in 14,9% adults with intellectual disability using standard diagnostic criteria (i.e. BP ≥ 140/90 mm Hg). High blood sugar was found in 15,7% adults. Body mask index (BMI) was calculated. The awerage was slightly higher in woman (28.8) then in man (27.6). Conclusions Healthcare service have predominantly focused on the primary disability. The multidisciplinary approach and collaboration could help to achieve better health for people with intellectual disability. Obesity is a significant health problem for people with intellectual disability. Causes are multifactorial and obesity leads to a higher risk of developing chronic conditions, such as diabetes and heart disease. It is important to understand where and how they need help and support in health terms and what resources and assets they already have or can access if needed. Key messages The health literacy concept for people with intellectual disabilities should not be dominated by specific perspectives, such as functional health literacy. Caregivers, family and supporters are a very important factor for health-related decision-making and health literacy for people with intellectual disabilities.

Analiza rezultata Europskoga zdravstvenoga potrošačkog indeksa od 2014. do 2017. – s posebnim osvrtom na pokazatelje preventive

U radu su, na temelju analize istraživanja koje je pod nazivom Europski zdravstveni potrošački indeks (Euro Health Consumer Index – EHCI) provela renomirana švedska tvrtka Health Consumer Powerhouse, uspoređeni mjerljivi pokazatelji kvalitete i učinkovitosti zdravstvene skrbi u Republici Hrvatskoj s ostalim zemljama Europe. Spomenuta tvrtka svake godine objavljuje novu ediciju EHCI-ja kojom prati kretanja pojedinih pokazatelja ili cjelina pokazatelja u svakoj zemlji. S obzirom na tekovinu Andrije Štampara i njegovih istomišljenika, Hrvatska je u europskim i svjetskim okvirima prepoznata kao pionir postojećega europskog modela primarne zdravstvene zaštite i preventivnih aktivnosti. Zbog nedovoljnih financijskih ulaganja te nesustavnoga pristupa edukaciji populacije, Hrvatska je u spomenutoj analizi najlošije pokazatelje zdravstvene zaštite ostvarila upravo u području preventive. Istaknuti su kao važni i farmakoekonomski učinci ulaganja u prevenciju i primarnu zdravstvenu zaštitu jer je općepoznato kako je jedna kuna uložena u preventivu ekvivalentna iznosu od deset kuna uloženih u kurativu.

Refleksija Štamparove javno-zdravstvene djelatnosti na području Slavonskoga Broda

Aktivnost javnozdravstvene službe u Slavonskom Brodu započinje već u vrijeme Vojne granice, kada je organiziran sanitarni kordon i karantena da bi se spriječilo prenošenje opasnih zaraznih bolesti preko Save. Ipak, razvijenija preventivna djelatnost slijedila je u vrijeme djelovanja Andrije Štampara, jer se osniva Školska poliklinika, održavaju javnozdravstvena predavanja, započinje rad Antituberkuloznoga dispanzera, Ambulante protiv veneričnih bolesti te Stanice protiv bjesnoće. Velik je napredak učinjen 1946. godine osnivanjem Sanitarno-epidemiološke stanice kao zasebne institucije. Pokazala se vrlo uspješnom u suzbijanju poslijeratne epidemije trbušnoga tifusa, eradikaciji malarije i uvođenju masovnoga cijepljenja protiv dječjih zaraznih bolesti. Kroz četrdesetgodišnje razdoblje, u okviru Medicinskoga centra slijedila je izvjesna stagnacija, napose u usporedbi s velikim progresom kliničkih i dijagnostičkih grana medicine. Osnivanjem Županijskog zavoda za javno zdravstvo 1994. godine preventivna djelatnost doživljava znatni razvitak. To se posebno odnosi na praćenje i suzbijanje kroničnih degenerativnih bolesti, malignih tumora, zaštitu školske djece i mladeži, kao i na osvješćivanje sve češće prisutne bolesti ovisnosti u mladoj populaciji.

Dom narodnoga zdravlja u Osijeku

Velikim zalaganjem Andrije Štampara 1920-ih i 1930-ih došlo je do reorganizacije i unaprjeđivanja zdravstvene službe. Pri tome je golemo značenje imala njegova zamisao o potrebi osnivanja i otvaranja domova zdravlja diljem Kraljevine Srba, Hrvata i Slovenaca, tj. potonje Kraljevine Jugoslavije. Otvaranjem Doma narodnoga zdravlja u Osijeku s brojnim službama, napose dispanzerskom i protuepidemijskom, osigurana je u gradu na Dravi bolja zdravstvena zaštita stanovništva. Rad Doma narodnoga zdravlja odvijao se potpuno u skladu s tadašnjim programom socijalne medicine koju je zastupao Štampar, koji je do 1930. u nekoliko navrata boravio u Osijeku. U sastavu novootvorenoga Doma narodnoga zdravlja djelovale su gradska i školska poliklinika, sanitarna inspekcija, anti-TBC i kožno‑venerični dispanzer, antitrahomska i antirabična stanica, dječji dispanzer, zubni odjel i Higijenski zavod, dok su pokusne životinje, potrebne za rad zavodskoga bakteriološkog laboratorija, držane – do izgradnje posebne dvorišne zgrade (1958/59) – u dvorišnoj zgradi koja se nalazila uz zgradu u kojoj je danas Odjel neurologije, dakle u sklopu osječke Opće bolnice.

A public health campaing – health promotion in Roma minority population in the City of Zagreb

Abstract Background Researchers into health inequalities consistently show disadvantages in health status for various ethnic minority groups. Socially and economically Roma are one of the most vulnerable and disadvantaged groups. The Roma population of Zagreb approximates 2.755 according to the 2011 census. “Health promotion in Roma minority” is public health initiative undertaken in the City of Zagreb in 2018. Objectives The aim was to recognize the need for early risk factors prevention, to increase health literacy and to improve access to health-care in Roma minority. The stakeholders involved in this program were Roma NGOs, Andrija Stampar Institute of Public Health, local Medical Centre and City office for health. The role of Roma activist was inportant for including Roma population. Results In order to assess the health status and health-related lifestyle attributes a multidisciplinary approach was carried out including a total of 141 members of the Roma minority living in three different quarters. Activities included preventive exams, conducted workshops “Reproductive health”, “Access right to health-care”and “Healthy lifestyles”. Hypertension was found in 15,6% Roma using standard diagnostic criteria (i.e. BP ≥ 140/90 mm Hg). High blood shugar was found in 16,3% Roma. Screening mammography exams were also carried out including 73 Roma women over 50. BI-RADS 3 category was found in 17 women (23,3%) and BI-RADS 4 + 5 category was found in one woman. Conclusions The multisectoral collaboration and the involment of Roma activist could help to achieve better inclusion of Roma population, better perception of the health messages and behavioural changes. Health sector should promote and advocate for healthier lifestyle, but community and policy are to support and complement the actions. Access to health care cannot be discussed in isolation from other problems this population group experiences, such as poverty, restricted access to education and social exclusion. Key messages The empowerment is an outcome of health literacy, but does not automatically lead to empowerment. Individual’s social and cultural context must be in focus. The involment of Roma activist could help to achieve better results.

The Most Influential Scientists in the Development of Public Health (4): Andrija Stampar (1888-1958).

Andrija Stampar (Drenovac, September 1, 1888–Zagreb, June 26, 1958) was a distinguished scholar in the field of Social medicine from Croatia. He enrolled at the Medical School in Vienna in 1906, which was at the time the most important medical center in the world. As a medical student, he initiated the editing of medical papers and wrote pamphlets and articles with the intention of educating people in health matters. In 1909 in Nova Gradiska he started publishing the series called Public Health Library discussing numerous topics regarding health and prevention. On 23 December 1911, he was awarded the title of Doctor of Universal Medicine (doctor medicinae universae). On 1 January 1912, Dr. Stampar started working at the town hospital at Karlovac and remained at this post till 8 August 1913.

Use of System Dynamics Modeling in Medical Education and Research Projects.

The paper reviews experiences and accomplishments in application of system dynamics modeling in education, training and research projects at the Andrija Stampar School of Public Health, a branch of the Zagreb University School of Medicine, Croatia. A number of simulation models developed over the past 40 years are briefly described with regard to real problems concerned, objectives and modeling methods and techniques used. Many of them have been developed as the individual students' projects as a part of their graduation, MSc or PhD theses and subsequently published in journals or conference proceedings. Some of them were later used in teaching and simulation training. System dynamics modeling proved to be not only powerful method for research and decision making but also a useful tool in medical and nursing education enabling better understanding of dynamic systems' behavior.

Offline: The case against (and for) public health

When you walk into the atrium of WHO in Geneva, and if you look carefully, you will discover the head of Andrija Stampar. His face is strong, dignified, and wise. He commands your respect. His presence is rightly prominent. Stampar was the first President of the World Health Assembly in 1948. He dedicated the final decade of his life to WHO, and to what we now call global health. His contribution was inestimable. Through his work as a young district medical officer in Croatia, and then as director of public health for the new Kingdom of Yugoslavia, he showed how nations could build effective public health systems around a common vision for health and wellbeing. He also put what The Lancet described as his “alarming temper” to good use in addressing the injustices he saw. We could do with more of that “alarming temper” in public health today. For if Stampar was with us now, I think he would be both pleased and disappointed by the state of public health. Pleased, because public health, or social medicine as he preferred to call it, has matured into a powerful field of inquiry with a long list of respected achievements to its credit. But disappointed because public health has failed to take advantage of the full range of opportunities before it. It has privileged technical success over political struggle. Too often, public health has retreated from urgent engagement in the public sphere. It has seen its capacities and capabilities constricted. Its objectives have been reduced to the mindless metrics of academic output. Its social impact has been blunted. Its professional workforce is enduring a profound crisis of contraction. Its divorce from medicine has deepened. Its organisations have been weakened by broken leadership. And its vision has been corrupted by collusion with conservative regimes and states. We may therefore ask: what is public health today? Does public health live up to Andrija Stampar's hopes and expectations? These questions come at a moment of emergency in the idea of the global: a period of social, economic, and political disruption unseen since World War 2; peoples enraged by anxiety, alienation, and discontent; political norms shattered; economies plagued by unemployment and low growth; societies jeopardised by terrorism and insecurity; migration as one of the most powerful—and feared—social forces of our times; an unexpected fear of knowledge; attacks on the independent institutional foundations of nation-states—such as the judiciary and the press; a media withered and partisan, a megaphone for plutocrats; governments paralysed by the threat of populism; and the conditions for fascism—let us call it what it is—flourishing: unbridled nationalism, authoritarianism, violence, the demonisation of minorities, belligerent foreign policies, and the application of power to extinguish criticism. The world has faced similar moments before—for example, in the early 19th century, at the time of The Lancet's birth. The 17th-century Enlightenment promised much. In d'Alembert's introduction to Diderot's Encyclopaedia, knowledge was to contribute “new advantages to society as a whole”. But by the beginning of the 19th century, that certainty had been destroyed. The Industrial Revolution brought poverty and workhouses, inequality and deprivation. Science had accelerated, not ameliorated, this terrifying fracture. The reaction came to be called Romanticism—a movement that expressed itself in literature, art, music, philosophy, politics, and science. Romanticism, lasting from the late 18th to mid-19th centuries, was about improving the quality of society. It was about reconnecting Humanity to Nature, rewriting the purpose of politics, and creating a new philosophical radicalism—one dedicated to a progressive realisation of justice and a reinvigorated humanitarianism. Romanticism would address, in Byron's words, the “endless torments and perpetual motion” of the world. The Lancet was part of this extraordinary moment. The revival of a radical tradition succeeded in the early 19th century because of uncontainable social pressure: unprecedented levels of rural poverty and urban hardship. It also depended on a new generation of remarkable young men and women. Science, medicine, and public health in the hands of this new generation was distinguished by an unappeasable social commitment translated into political action. So what are the lessons for today? Nothing less than to grasp the necessity of re-evaluating the entire purpose of public health in the 21st century.

Recipe from the past for the future: public health intervention represent a process for century.

In the poor Bosnia, in the early 20th century endemic syphilis was widespread. Combating this disease entailed the necessity of etiology research, diagnosis and clinical nature of the disease, as well as the insight into the epidemiological image of this unresolved health problem. Thanks to the visionary, the enthusiasm and persistence of the expert team of doctors from that time in Croatia, School of Public Health and the Rockefeller Foundation as financial support, conditions were created to conduct population monitoring and research called “survey”. The team of experts from Croatia and Bosnia led by Dr. Ante Vuletic began this important public health intervention in Central Bosnia underneath the mountain Vlasic 1934. In villages of mountain Vlasic people were living in very difficult social and unsanitary conditions. “Interviewers” worked in makeshift clinics in the rural schools Opare, Rankovici, Vitovlje Mehorica, Turbe, Bila and Gornji Vakuf. A hundred years later, a team of university professors from the School of Public Health “Andrija Stampar” led by Professor Silvije Viletic followed the footsteps of century “survey” on Vlasic in the summer of 2014. They determined that with the integrated approach to population monitoring and testing endemic syphilis in Bosnia was successfully suppressed.

In Memoriam: Prof. Luka Kovacic, MD, PhD (1940 - 2015)

Luka Kovacic Luka, MD, PhD, passed away in Zagreb on April 21st, 2015. He was specialist in Social medicine and organization of health care. Luka Kovacic graduated from the School of Medicine in Zagreb in the year 1965, and after a few years of medical practice he joined the Andrija Stampar School of Public Health in Zagreb. He earned both, MSc and PhD degree from the University of Zagreb School of Medicine in 1972 and 1983, and he advanced in academic career from the assistant position in the Chair for hygiene, social medicine, and epidemiology to full professorship in 2003. He was also trained in Sweden (1964), Scotland (1966), USA (1968 and 1971 when he was trained in Public Health, Epidemiology and Research Methods at the Johns Hopkins School of Hygiene and Public Health in Baltimore), Finland (University of Kuopio, 1977) and Alma-Ata (WHO training in Planning and Management in 1985). He paid study visits or served as a consultant in the UK, the USSR, Kazakhstan, Sudan, Cameroon, India, Iran (UNDP), Nigeria (WHO) and elsewhere. At the Andrija Stampar School of Public Health he used to held numerous posts and responsibilities: he was a head of the Department for Hygiene, Social Medicine and Epidemiology 1993-1997 and continued to head the Department for social medicine and organization of health care and was director of the Andrija Stampar School of Public Health till his retirement in 2006; he was deputy coordinator from 1984 and coordinator 1997-2000 of the WHO Collaborating Centre for primary health care; he served as an assistant to the director and deputy director (1984-2004). He served firstly as the coordinator and later as director (1990-1996) of the International 9-week course “Planning and management of primary health care in developing countries” which was held 16 times between 1978 and 1996 at the Andrija Stampar School of Public Health with the support of the Government of the Netherlands and had altogether more than 350 participants coming form 66 countries. His activities and duties were so numerous both within his institution and in the broader Croatian and international public health and medical community that we mentioned only those mostly pronounced or internationally visible. Luka was gifted and dedicated teacher, mentor of six MSc theses and one PhD dissertation as well as altogether more than 200 diploma works for medical and nursing students at the School of Medicine and School of Applied Health Sciences. He was principal investigator in many domestic projects and played a leading role in several international projects and networks. He actively participated in the work of the European network of districts “Tipping the Balance Toward Primary Health Care” (TTB) from 1987, being also its Chairman of the Board and president of the Assembly from 1997 to 2005 and the coordinator of the whole network and the project “TTB Second Decennial Survey of the Health Needs and Health Care for Older People in Europe”, which was implemented in five European countries including Croatia in 2005-2006. He was also a member of the European Society for Public Health and its Scientific Committee since 2000. Professor Luka Kovacic had coordinative role and contributed enormously to the establishment of the Forum for Public Health in South Eastern Europe (FPH-SEE) as a network of academic institutions aimed for the reestablishment of professional cooperation between public health teachers and professionals in SEE. As the result of this cooperation six books were prepared and published between 2004 and 2010 encompassing altogether more than 4300 pages, containing some 250 teaching modules authored by more than 200 authors, among them professor Kovacic co-edited the volume “Management in Health Care Practice” and authored four modules only within it. He has published almost 200 scientific and professional articles and edited several books and authored a few textbooks, among them also a textbook in Social Medicine. He coordinated a number of national and international projects and networks, has organized numerous national and international conferences in the field of public health and health care organization. As Public health expert and educator Luka Kovacic has been a person with great treasure of warmth and experiences. He was right person from whom always you can ask advice for solving a problems. Everybody of us will miss his friendship and honesty and his students will miss his great educational lectures. Sarajevo, September 2015

World book night - School of Public Health “Andrija Stampar” [Zagreb, 23 April 2013

World book night - School of Public Health “Andrija Stampar” [Zagreb, 23 April 2013

Person-centered health education and training

During the last decade, a series of new models have transformed our understanding of the concept of health and of the implementation of health care systems. Person-centered medicine (PCM) model is one of them (1). The International College of Person-Centered Medicine (ICPCM) promotes medicine of the person, for the person, by the person, and with the person. The ICPCM emerged from the ongoing annual Geneva Conferences as a strong international network of dozens of leading world-wide medical organizations and institutions (2-4). The first Geneva Conference on Person-Centered Medicine was held in May 2008, under the auspices of ten global institutions, including medical organizations, international bodies of health professionals, and associations of patients and families. Starting with the Fifth Geneva Conference, a Geneva Declaration was regularly issued, focusing on the conference’s main theme and was widely distributed (5,6). The First International Congress of the ICPCM was held in Zagreb, Croatia on November 7-10, 2013. The main theme was the Whole Person in Health Education and Training. Zagreb was chosen due to the enduring legacy of professor Andrija Stampar, president of the first WHO World Health Assembly, founder of Zagreb University’s School of Public Health, and pioneer of personand people-centered care. Gathering participants from 29 countries, the Congress was a true example of an interdisciplinary collaboration. The emphasis was on establishing strong links between experts dealing with science, clinical work, and art in medicine, as well as between experts and patient groups (and patients themselves along with their families). Students also had an important role and contemporary teaching methods were promoted, eg, the use of trained actors as simulated patients, and patients as teachers. Also the integration of all fields of health care when working with patients and their families was emphasized, which is a relationship which must truly be a collaborative partnership. As health care in general is a very complex and dynamic system, reflecting social changes, in recent decades great attention has been paid to the quality of communication in medicine and medical interview (7-9). When we talk about different forms of communication in medicine, we must never forget the importance of communication through art (10). Person-centered management takes into account psychological, physical, social, and spiritual aspects of health and disease. Therefore, education in medicine must be interdisciplinary and directed toward the person rather than the symptom, diagnosis, or disease, with the emphasis on experiential learning. In a community, whether local, national, or international, we must work together toward the same goal: a culture of person-centered medicine and public-centered health care.

The role of the European Academy of Teachers in General Practice and Family Medicine in family medicine education in Europe – the experience of the University of Maribor

Primary health care is important item of political agendas since Alma Ata conference in 1978. West Balkans share common history in development of primary care since 1920s when Andrija Stampar introduced social and community based primary care concepts. The first known specialist training in general practice in the world started in former Yugoslavia in the early 1960s. Since then, much has been done in the field of general practice and family medicine and this is reflected in The European Academy of Teachers in General Practice and Family Medicine (EURACT), which is a network organisation within World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Region Europe (WONCA Europe). Its aim is to foster and maintain high standards of care in European general practice by promoting general practice as a discipline by learning and teaching. EURACT developed several documents and teachers courses which can serve the development of family medicine curricula in new established departments of medical schools. This is also the case at Maribor Medical School, where learning outcomes and teaching methods are in concordance with EURACT teaching agenda, but also some innovative approaches are used, such as art and e-learning environment as teaching methods.

Iris Borowy and Anne Hardy (eds), Of Medicine and Men: Biographies and Ideas in European Social Medicine between the World Wars (Frankfurt am Main: Peter Lang, 2008), pp. 224, £27.30, paperback, ISBN: 978-3-631-58044-8.

When a group of scholars from the Wellcome Institute in London and academics from public health education set up the Society for Social History of Medicine in 1970 their stated goal was to broaden a discipline in order to address the relationship of medicine and society. And that meant redefining an academic discipline that had been more or less practised by associations such as the Osler Society of London as the intellectual history of great men in medicine. For some decades subsequently the role of biography in the history of health and medicine was even more disparaged than intellectual and political biographies were by the broader world of academic historical scholarship. However, as Patrick Zyberman comments in a fascinating essay on ‘A Posthumous Audit’, the death of biography in the social and cultural history of health, medicine and science was much exaggerated with a ‘spectacular upsurge’ in biographical publications in the mid-1980s. As Iris Borowy points out in her introduction to this excellent volume, perhaps the continued value of biography as a means of excavating the past and as a heuristic for interpreting pivotal historical transformations is because it remained a genre that could communicate to audiences both within and beyond the world of academic scholarship. Because if, at its most axiomatic, history is the lives of socially interacting and organising individuals then all history is as much narrative as it is structural analysis. Zyberman emphasises, though, that contemporary biographical inquiry does not reproduce the eulogic trope of the great man. Instead biographies of individuals, involved, for example, in public health, are more likely nowadays to be accounts of what Zyberman persuasively refers to as ‘epistemic communities’, and the role played by their interconnections and interactions in transformative historical junctures and disjunctures in which they significantly participated. It would be hard to find a better example of what Zyberman is describing than this volume of essays on a group of actors between the wars who were critical figures in the development of public health internationalism as an interdisciplinary discourse and practice. Perhaps the most intriguing issue brought out by this book is that this group of health internationalists agreed intellectually about the political nature of improving population health while possessing a widely disparate range of ideological beliefs. As Borowy points out, they all linked population disease and health management to political action while their ideological beliefs, actions and associations varied hugely at a time of volatile national and international relations. Those in continental Europe who were socialists or social democrats fell foul of fascism in Germany and Spain. One such was the Jewish public health expert, Franz Goldman, who escaped to save his life. The Minister of Public Health in Yugoslavia, a communist sympathiser and tireless champion of social justice, Andrija Stampar, was more or less exiled by his government as the result of pre-war political intrigue but during the war was imprisoned by the German occupying forces. While all the figures in the volume shared beliefs about the effects of inequality upon population health, some—such as the pathologist Bela Johan in Hungary, and the German social hygienist Otto Olsen—found it possible diplomatically to co-operate with war-time fascism. Others within Germany, such as Fritz Rott, became National Socialists embracing racial hygiene. The brilliant German statistician, Emile Roesele, a communist, remained alive because of his unique indispensability. In neutral Denmark, the eminent serologist, Thorvald Masdan, retreated from the fray to his laboratory. He was accused by some of possessing pro-Axis sentiments. At least one of the internationalists in the collection, Gustavo Pittaluga, was dismissed from his public health role by totalitarian and democratic governments in Spain becoming a refugee in Cuba following the Second World War. Melville Macenzie, the public health lecturer at the London School of Hygiene and tireless champion of the LNHO, became stuck in British imperialist philosophy. As Borowy comments, despite these mixed fortunes, all collectively contributed to what Martin Dubin has termed ‘a biomedical/public health episteme’ that characterised international health co-operation between the wars. Perhaps the unifying element was that each of the public health campaigners was supported by funding from the Rockefeller Foundation and had links with a critical figure explored by Socrates Listios, Selskar ‘Mike’ Gunn. The Director of the Foundation’s Paris Office from 1922–32 facilitated the expanded visions of public health possessed by others explored in the volume but largely in contradiction to the limited strategic goals of the institution he represented. While all these short biographies reflect intriguing contrasts in the relationship between political ideology and public health philosophy, all demonstrate what Iris Borowy compellingly argues has been the role that collective action undertaken in pursuit of population health played in contributing toward the mission to construct a global civil society.

“Society as an Organism:” Metaphor as Departure Point of Andrija Štampar’s Health Ideology

Andrija Stampar (1888-1958) was one of the most charismatic figures of the 20th century public health and a typical representative of social medical ideology at the turn of 20th century. He was the founder of many health-related institutions in Croatia and world-wide. In 1927, with the help of a large grant from the Rockefeller Foundation, he opened the School of Public Health and the Institute of Hygiene in Zagreb.

Care for Health Cannot Be Limited to One Country or One Town Only, It Must Extend to Entire World: Role of Andrija Štampar in Building the World Health Organization

World War II and the early post-war era saw the rise of state social and economic interventionism in Europe. A gradually developing “Welfare State” aimed at increasing both the proportion of participating population and the number of social rights they enjoyed (1). These developments also included reforms of educational and health care systems. This important and dynamic period for international health began by the enactment of the World Health Organization (WHO) Constitution on April 7, 1948 (2). This essay discusses the initial activities between 1946 and 1948 that led to restructuring of the international public health system and founding of the WHO. A key agent in these developments was Croatian physician and public health reformer Andrija Stampar (1888-1958) (Figure 1; Box 1). We studied his role and contributions that resulted in the foundation of the WHO in the period immediately before the Cold War and global polarization of the world. We did not analyze the political situation of the time in detail, but rather focused primarily on the activities of Andrija Stampar. Figure 1 Andrija Stampar, lecturing at the Zagreb School of Medicine, 1953. (copyright Division for the History of Medicine, Croatian Academy of Sciences and Arts). Box 1Andrija Stampar's biography 1888 September 1, born in the village of Drenovac, Croatia 1911 Graduated from the University of Vienna, Medical School 1918 Appointed as health adviser to the Croatian Commission for Social Welfare 1919 Appointed head of the Department of Public Health in Belgrade 1926 Establishment of the School of Public Health in Zagreb 1927 Opened the new building of the School of Public Health and the Institute of Hygiene in Zagreb. The building was financially supported by the Rockefeller Foundation 1931 Dismissed from his position as head of the Department of Public Health in Belgrade 1931 Working in the Health Organization of the League of Nations. Between 1931 and 1938, he traveled extensively as a lecturer and expert around Europe, United States, and China 1938 Lectured on hygiene and social medicine at several major universities in the United States and Canada 1939 Appointed chairman of Hygiene and Social Medicine Zagreb School of Medicine 1940-1941 Appointed dean of the Medical School, University of Zagreb 1941 Interned in Graz, Austria, until the arrival of the Russian army in 1945 1945 Resumed his professorship at the Zagreb Medical School 1945-1946 Appointed rector of the Zagreb University 1946-1948 Critical engagement in the creation of the World Health Organization 1947-1958 Appointed the president of the Yugoslav (today Croatian) Academy of Sciences and Arts 1947-1958 Appointed director of the School of Public Health in Zagreb 1948 Presided over the inaugural Assembly Meeting of the World Health Organization 1952-1957 Appointed dean of the Medical School, Zagreb University 1958 June 26, died in Zagreb The essay is based on the material from the WHO Archives in Geneva, including sources available online (3), materials from the Rockefeller Archive Centre in New York, and newspaper articles and Stampar’s reports and reflections about the work of the Interim Commission and the WHO.

The Bandoeng Conference of 1937: A Milestone in Health and Development

The Bandoeng Conference of 1937: A Milestone in Health and Development

Iris Borowy and Wolf D Gruner (eds), Facing illness in troubled times: health in Europe in the interwar years, 1918–1939, Frankfurt am Main and New York, Peter Lang, 2005, pp. xiv, 424, £41.90 (paperback 3-631-51948-6).

“Troubled times” seems a bland summary of the interwar years, and experts—statisticians, scientists and doctors—rather than individual or collective sufferers are “facing illness” in this volume. That said, this is an informative collection with a comprehensive introduction worth further expansion. The editors highlight the ambiguities surrounding health as a public issue in this period, with the repositioning of voluntary and charitable effort and increasing state involvement suggesting responsibility for individuals but exercising authority over them. Health matters took on greater significance in the formation and conceptualization of nations; integrating or excluding, helping to define borders and to forge identities. They were the focus of new and influential international bodies (notably the League of Nations Health Organisation, and the Rockefeller Foundation) and of scientific expertise, with developments in bacteriology, nutrition, eugenics, and social medicine interacting with contending political viewpoints. A healthy citizenry featured in varied ideologies offering “the promise of empowerment and uplift which included the option not only of a new position for the common man but of a new man per se, strengthened by improved education and status and significantly improved health” (p. 7). Differing interpretations of health, seen here as “neither an objective reality, nor a cultural construction but a synthesis of both” (p. 8), require allowance for conceptualization and contextualization by contemporaries and by historians. This involves the interaction of problem-laden objectification of certain “realities” and of their political, social or ideological usage. Most contributors are content to focus upon data or policy issues, however, and the book divides along these lines. Part One needed a summary of changes in mortality in European countries, as this cannot be established from individual chapters. Robert Lee's examination of causes of mortality, specifically defects in the quality of data and the limited implementation of an international classification system, demonstrates that “more” did not necessarily mean “better” in data provision. Mortality is a poor approximation for health and Paul Weindling reviews studies based on insurance, school and family records, and efforts to quantify morbidity and to utilize health indicators. Iris Borowy also evaluates problems surrounding the compilation and use of the League of Nations' International Health Yearbooks (1924–9) for comparative purposes. Central and south-eastern Europe, where health featured strongly in nation building, are well-represented. Hana Masova and Petr Svobodný survey health care in the new Czechoslovak Republic and the awkward combination of public health arrangements, an established sickness insurance scheme, and voluntary and state institutions with interests in social medicine. They see inclusionary innovations in social hygiene (combating “civilisation diseases”) and hospital provision before the Munich Agreement and subsequent invasion. Yugoslavia suggests contrasting interpretations. Željko Dugac focuses upon Andrija Stampar, at the Ministry of Health and working closely with the Rockefeller Foundation, who ascribed a pivotal role to public health and health education but was removed in 1931 by self-interested private physicians and ethnically-motivated anti-centralisers. Patrick Zylberman's study of the anti-malarial campaign in Macedonia depicts this as a form of border consolidation and “Serbianisation”, whereas Esteban Rodriguez-Ocana's parallel Spanish study suggests the limitations of international bodies and new medical technologies when faced by suspicious local physicians and powerful, unsympathetic landowners. Thorsten Halling, Julia Schafer and Jorg Vogele consider German infant mortality in the contexts of the epidemiological transition and of attempts to measure “human capital” assets (or, on racial or eugenicist grounds, liabilities). Sylvelyn Hahner-Rombach's examination of depictions of TB sufferers as “anti-social” is germane to this, though her comparison of medicine and scientific discourse with earlier social labelling of such “threats” seems compartmentalized. A disturbing parallel may lurk in the influence of Zionist ideology and the medical selection of Jewish migrants to Palestine, discussed by Nadav Davidovitch and Shifra Shvarts. Generally the approach is “top-downwards” in national or local studies, with some privileging of doctors, scientists or institutions as principal actors shaping health policy or medical campaigns (Lion Murard on Jaques Parisot in Nancy or Emilio Quevedo on the Rockefeller Foundation and the London School of Hygiene and Tropical Medicine). However Martin Gorsky and Bernard Harris build on James Riley's work, using Hampshire Friendly Society records to suggest that rising claim rates were driven by an ageing population, specifically the over-fifties. This offers a rare glimpse of ordinary people facing illness in a none the less valuable and informative collection.

Andrija Stampar

ANDRIJA STAMPAR, ONE OF the most charismatic and beloved figures in 20th century public health, was born in the village of Drenovac, Croatia, on September 1, 1888. His father was a schoolteacher who, because of his liberal views, had to move frequently to escape the consequences of his political convictions.1 Young Andrija absorbed his father’s values and, though a brilliant student, sometimes came into conflict with his teachers when he asserted his right to be a “free thinker.”2 After graduating from gymnasium in 1906, he enrolled at the University of Vienna Medical School. There he was attracted to Ludwig Teleky’s lectures on social medicine, which made a deep impression.2 Stampar graduated from medical school in 1911 and worked for a while as a hospital physician and as a district health officer. At the end of the First World War, he moved to Zagreb to take up an appointment as Health Adviser to the Croatian Commission for Social Welfare. He became intensely involved with health policy, publishing a book and a series of outspoken articles in the journal Jugoslavenska njiva, one of which is excerpted here. At age 31 he was appointed Head of the Department of Public Health in Belgrade, in the newly constituted country of Yugoslavia.3 Stampar’s inspiring personality, as well as his powerful and progressive ideas, attracted a dedicated group of young health workers. By 1930, his department had created more than 250 health-related institutions, from central research and policy institutes in each of the provinces to hundreds of “health stations” in rural areas.4 In 1927, with the help of a large grant from the Rockefeller Foundation, he opened the School of Public Health and the Institute of Hygiene in Zagreb.5 Among its many progressive features was the “Peasants University,” specially designed health seminars for rural villagers conducted for several months at a time in the Public Health School.6 In 1930, as the politics of Yugoslavia shifted to fascism, Stampar was removed from his position as Head of the Department of Public Health in Belgrade. In response, he turned his attention to international health. He went to work full-time for the Health Organization of the League of Nations and from 1931 to 1933 traveled extensively in Europe and the United States, then from 1933 to 1936 in China.2 Back in Europe in 1936 and 1937, he prepared an official report on European schools of public health and studied the most effective methods of maternal and child protection. In 1938 and 1939, he toured the United States and Canada and lectured on hygiene and social medicine at several major universities. In 1939, as political events shifted once again in Yugoslavia, Stampar returned to Zagreb to take over the Chair of Hygiene and Social Medicine.2 He was elected Dean of the Medical School for the 1940–1941 academic year, but the invasion of Yugoslavia by Germany in April 1941 ended his tenure and led to his imprisonment. He was interned in Graz, Austria, until liberated by the arrival of the Russian army in 1945. In May of that year, he resumed his professorship at the Zagreb Medical School and became Director of the School of Public Health. He was Rector of Zagreb University for the 1945–1946 academic year, and Dean of the Medical School from 1952 to 1957. In what was perhaps his most heralded contribution, Stampar played a critical role in the creation of the World Health Organization (WHO). Planning for the WHO began in earnest in early 1946 under the aegis of the Economic and Social Council of the emerging United Nations organization. Elected Vice President of the Council, Stampar was also appointed to the Technical Preparatory Committee, charged with creating a constitution and initial agenda for the as-yet-unnamed international health organization. Stampar helped draft the constitution, most notably its famous Preamble, which has been called “the Magna Carta of health.”7 The WHO’s constitution was provisionally adopted at an International Health Conference in New York City in the summer of 1946, and that same conference created an Interim Commission to manage the functions of the WHO until formal ratification of its constitution. Stampar chaired the Interim Commission until the first World Health Assembly, called in the summer of 1948 upon ratification of the constitution. He presided over the inaugural Assembly meeting as its unanimously elected president. Stampar remained active in the WHO until his death on June 26, 1958.