Founding of Major Health Organizations
Founding of Major Health Organizations
Three major heath initiatives were founded in 1948—the National Institutes of Health (NIH), the National Health Service in the United Kingdom, and the World Health Organization (WHO). Each of these organizations has a background with different missions, and each would develop in completely different directions. While the National Health Service administers health care for all citizens in the United Kingdom, NIH provides for research into major areas of medicine and health, and WHO seeks not only the elimination of worldwide disease, but the well-being of all nations.
The history of the medical profession up to the end of the nineteenth century was a jumble of patient-doctor relationships. Doctors were self-employed with little support, back-up, or help. They may have met briefly at a college or social gathering, but basically it was each unto himself. A major change occurred in 1883. Chancellor Bismarck of Germany set up state-run medical insurance, and politicians immediately seized upon the issue as a service appealing to an entire electorate.
Before 1900, organized medical practice was just beginning. Individual doctors and hospitals operated without much direction and with little government intervention. But as medicine became more complex and new developments, techniques, and technologies grew, it became evident that governing policies and initiatives were necessary.
In 1887 a small, one-room laboratory was set up with the Marine Hospital Service (MHS) in Staten Island, New York. The MHS had been created in 1798 to provide for the medical welfare of merchant seamen; 20 cents per month was deducted from the salaries of the seamen to pay for the services. In the 1880s Congress expanded the role of MHS to examine passengers arriving in the United States for dreaded diseases like cholera and yellow fever. With developing evidence that microorganisms caused disease, European scientists, especially in France and Germany, set up laboratories for the public's health.
The MHS authorized Joseph J. Kinyoun, a physician trained in the new bacteriology at the Marine Hospital in Stapleton, Staten Island, to form a Hygienic Laboratory. In 1884 Robert Koch (1843-1910) found the cause of cholera, the most feared communicable disease of the nineteenth century. Kinyoun almost immediately found this bacteria in suspicious cases and confirmed the diagnosis. Kinyoun and the Hygienic Lab initiated what would become the NIH. In 1891 the Hygienic Laboratory was moved to Washington, D.C., near the capitol, and for 10 years Kinyoun was its only full-time employee.
Before 1900, in Great Britain doctors practiced where they could find patients, and the development of hospitals was usually associated with religious groups or orders.
Epidemics and plagues cut across national borders. The hope of medical internationalism first emerged in 1859 at the International Sanitary Conference in Paris. Concern for the health of the world and developing nations grew out of the missionary tradition. The nineteenth century was known for the great missionary movement, and missionaries were responsible for bringing Western medicine to non-Western people throughout the world. They evoked the idea of compassion and caring for the world as well as its health.
The basic mission of organizations like the NIH, National Health Service, and WHO was not altogether new, however, it was not until the mid-twentieth century that conditions were ripe for the development of these organizations.
The 1948 establishment of the National Health Service in Great Britain can be traced to earlier developments. In 1911 the liberal politician Lloyd George launched a National Insurance scheme, modeled after Bismarck. Working wage earners would contribute four pence per week from their paychecks, the employer would give two pence, and the state three. The workers in turn would receive approved medical treatment from a "panel doctor" of their choice. The electorate loved the plan, as they received much for quite a little. However, National Insurance was a divisive issue; the conservatives were generally against it, while the labor party supported it. The first half of the twentieth century saw two major wars that devastated Great Britain. Despite the distractions of basic survival, the wars had shown British physicians that an organized, well-planned effort was much more efficient. The blueprint for total reform was written in 1942 by Sir William Beveridge (1879-1963), proposing a new health service be available to everyone.
In postwar Britain, the conservative party of Winston Churchill was defeated and Clement Attlee, a member of the Labor Party, became prime minister in 1945. Attlee appointed as minister of health Aneurin (Nye) Bevan (1897-1960), the son of a miner, who became leader of the left-wing group of the labor party called the Bevanites. A bill was introduced in April 1946, for the national health program. It was signed by the queen and began July 5, 1948.
Bevan became the architect of the National Health Service. The law provided free medical services to everyone. The person registers with a general practitioner, and the government pays a capitation, or head fee, according to the number of people enrolled with him or her. A physician may operate free of the National Health Service but few do. The maximum number of patients allowed for a physician is 3,500; the average is 2,500. Before about 1950 doctors visited patients in their homes, making as many as 15-20 calls a day, as well as seeing patients at the office in the evenings . This practice changed after the midpoint of the century.
Likewise, Bevan nationalized both municipal and charity hospitals under National Health, with government-paid specialists providing the services. The National Health Service is financed by general taxes, with some local and private fees. When implemented, NHS was powerful, popular, and cheap compared to other standards. However, with increased technology and more expensive and longer hospital stays, the system has recently become financially stressed.
A world health initiative has been the dream of many people. In 1909 twenty-three European nations established a permanent office called the International Office of Health. It established a permanent base in Paris. The mission was to collect knowledge about infectious diseases. After World War I, the Treaty of Versailles created the League of Nations, which, in 1923, set up a Health Organization to promote the "highest possible level of health" for all peoples. When Hitler invaded Poland in 1939, the League of Nations failed, but some retained the idea of an organization dedicated to helping every nation. In 1948 the French Organization Mondiale de la Santa, a specialized agency of the United Nations, was established. The organization, called the World Health Organization, now has headquarters in Geneva, Switzerland. Its three main purposes are: 1) to serve as a central clearing-house for research (member countries are informed of vaccines, cancer research, and other discoveries); 2) to control epidemics and endemic diseases by promoting mass education programs; and 3) to expand public health areas.
WHO is administered by a World Health Assembly, which meets annually and has a Secretariat with offices and field staff throughout the world. After 1951 the technical assistance program of the Untied Nations allotted money to WHO.
In the United States, the Hygienic Laboratory received recognition in 1901, along with $35,000 from Congress to build a new laboratory. The agency was renamed the Public Health and Marine Hospital Service (PH-MHS). Completed in 1904, the new building was located in Washington and provided for the investigation of infectious and contagious disease and matters pertaining to public health. As Congress was skeptical of the values of such bureaucracies, they reserved the option not to renew the funding if it did not work.
In 1912 another law shortened the name from PH-MHS to Public Health Service (PHS) and, in addition to contagious diseases, authorized the organization to study non-contagious diseases and the pollution of lakes and streams. One PHS researcher, Dr. Joseph Goldberger (1874-1929), identified pellagra as a dietary deficiency of poor Southerners and recommended a cure.
The delivery of medicine in the United States took a different path. Emphasis remained on the free market, not on the state. An organization of doctors, the American Medical Association, became a powerful force championing health causes. In 1912 a short-lived Progressive Party championed national health care but the free market idea prevailed and the national impetus became a system of supporting research.
In 1930 the PHS was renamed the National Institute of Health; the singular version of "Institute" was then used. Louisiana Senator Joseph E. Ransdell sponsored a bill that changed the name from the Hygienic Laboratory, and made its purpose to establish fellowships for research into basic biological and medical problems. Although the country was deep in the Great Depression at that time, this legislation, which became known as the Ransdell Act, marked a great change in attitude toward funding medical research.
The problem of cancer was attracting growing attention and, in 1937, every senator voted to fund the National Cancer Institute (NCI). A new campus was built in Bethesda, Maryland, to house the NCI and, in 1944, it was designated that the NCI would be part of the NIH.
World War II prompted the NIH to focus on war-related efforts and to improve conditions in the defense industry. After the war, Congress appropriated money to expand the NIH and, in 1948, the name changed to the plural National Institutes of Health. By 1998 the NIH had 24 institutes and centers.
Founded in the aftermath of World War II, all three major organizations—the NIH, National Health Service, and WHO—reveal the importance of cooperative medical care and a new commitment to public health on both a national and international scale.
EVELYN B. KELLY
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Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W. W. Norton, 1997.