Iris Borowy

Road traffic injuries: social change and development.

In the course of the twentieth century road traffic injuries (RTIs) became a major public health burden. RTI deaths first increased in high-income countries and declined after the 1970s, and they soared in low- and middle-income countries from the 1980s onwards. As motorisation took off in North America and then spread to Europe and to the rest of the world discussions on RTIs have reflected and influenced international interpretations of the costs and benefits of ‘development’, as conventionally understood. Using discourse analysis, this paper explores how RTIs have been constructed in ways that have served regional and global development agendas and how ‘development’ has been (re-)negotiated through the discourse of RTIs and vice versa. For this purpose, this paper analyses a selection of key publications of organisations in charge of international health or transport and places them in the context of (a) the surrounding scientific discussion of the period and (b) of relevant data regarding RTI mortality, development funding, and road and other transport infrastructure. Findings suggest that constructions of RTIs have shifted from being a necessary price to be paid for development to being a sign of development at an early stage or of an insufficiently coordinated development. In recent years, RTI discussions have raised questions about development being misdirected and in need of fundamental rethinking. At present, discussions are believed to be at a crossroads between different evaluations of developmental conceptualisations for the future.

Crisis as opportunity : International health work during the economic depression

The economic depression of the 1930s represented the most important economic and social crisis of its time. Surprisingly, its effect on health did not show in available morbidity and mortality rates. In 1932, the League of Nations Health Organisation embarked on a six-point program addressing statistical methods of measuring the effect and its influence on mental health and nutrition and establishing ways to safeguard public health through more efficient health systems. Some of these studies resulted in considerations of general relevance beyond crisis management. Unexpectedly, the crisis offered an opportunity to reconsider key concepts of individual and public health.

Book Review: Health and medicine in rural Europe (1850–1945)

Historically, the world has been overwhelmingly rural, yet proportionally, rural history has received little attention. This includes the “rural dimension of health and health care”, which, as Steven Cherry succinctly notes, has remained a “relatively neglected research area” (p. 19). Therefore, the volume he and Josep Barona have edited deserves credit for addressing an important topic about which we do not know nearly enough. The book results from a cooperative project between the Universities of East Anglia and Valencia, which explains the focus on Spain and England that form the subject of ten out of sixteen contributions. In addition, Northern Russia, Norway, Bavaria and the League of Nations are studied in the papers. Collectively, they present a variety of aspects ranging from public health administrations, via the work of rural practitioners, medical topographies and anti-malaria campaigns to child care facilities. The articles demonstrate that “rural” is a diffuse concept. In nineteenth-century Norway, it denoted any community of up to 200 people whose houses were more than 50 metres apart, so that most Spanish, English or Russian villages were urban by Norwegian standards. But all regions perceived as “rural” in their societies shared key characteristics. During the nineteenth and early twentieth century emerging bacteriology and germ theory upset conceived notions of health, and the encounter of traditional with modern forms of medicine runs through most of the contributions as a central theme. In the process, the rooted view of the pure, wholesome countryside of fresh air, open space and uncorrupted people was joined by a new perception of backwardness, ignorance and superstition. The complementary rural perspective on modern medicine becomes less clear, since the volume inevitably reflects the main difficulty of the topic: peasants generally give little testimony about themselves, which leaves historians with few sources. Thus, the papers rely on documents by administrators and physicians or on legal texts, which tend to portray rural communities as objects rather than subjects of their own histories. But the descriptions from various places suggest that the perception was probably similarly ambiguous. Rural communities often resisted modern medicine, experienced as an intrusion from a strange urban culture focused on hygiene and social control. Meanwhile, physicians in Bavaria and Russia despaired at superstition and the exasperating peasant stubbornness regarding even the most elementary hygienic measures, whose incompatibility with the necessities of rural life they often failed to appreciate. As a rule, circumstances were marked by extreme poverty, isolated and remote dwellings, forcing an inadequate number of underpaid and underrated doctors to spend a large part of their time on the road (if there was one). Efforts to educate rural people usually failed unless coupled with improvements in public health infrastructures that offered tangible benefits for peasants. However, mutual distrust was tempered by pragmatism, and modern medicine tended to complement traditional healing instead of supplanting it. In Spanish medical topographies the shift from miasmatic to germ theory appeared as change in terminology rather than concept, and in Majorca ideas of modern medicine spread through elaborate monastic and kinship networks. In various ways, politics and economics intervened in the process: evolving democratic structures shaped local responsibilities for public health in Norway, Northern Russia and Spain, capitalism spurred anti-malaria campaigns, Spanish liberalism stimulated international studies on rural hygiene, and changes of government through dynastic heritage or revolution could spell the end or the beginning of energetic public health efforts in most areas. This volume is certainly not the last word on rural health. But it is an important contribution to the field and, hopefully, it will inspire numerous follow-up publications.

Health in interwar Palestine: ethnic realities and international views.

This paper analyses the developments of the separate Jewish and Arab health systems and health realities. It is found that the activities of charitable institutions, the attitude of the British mandate government and different traditions of medical policy all played a part in the emergence of two separate health worlds. The influx of foreign funding for private health institutions, in particular, played a prominent part in establishing different service levels of healthcare for Jewish, Arab Christian and Arab Moslem communities. Thus, the medical sphere both reflected and interacted with wider political events.