Is Global Medicine under threat?

Medicine often has pictured itself as a kind of pacifist, internationally orientated profession, committed to preserving life everywhere. Humanity’s health in its entirety was its goal and doctors all over the world worked together to this end. But we know that the medical profession hasn’t always been so innocent or committed, and this is putting it mildly. In fact, medicine can be seen to mirror the zeitgeist: in moments of international cooperation, medicine has been internationalist, in times of state conflict medicine has been nationalistic. In the age of colonialism, medicine was colonialist.

Tropical medicine and the societies for tropical medicine date from colonial times. Set up around 1900, they purported to be universalist and international, with doctors from different countries working together in the research institutes of British India or the Netherlands East Indies. However, the drive behind setting up these national societies was nationalistic and imperialist: ‘We’ have to come up with cures for ‘our’ illnesses and treat ‘our’ patients. The research programs of colonial medical institutions were fitted into the colonial plans. Illnesses endangering the white elite – and the natives working for them – had preference. Racist ideas on illness were broadly discussed, shared and accepted.

To give but two examples: around nineteen thirties two of the employees of the famous Eijkman Institute were German national socialists who later in the nineteen thirties were responsible for setting up the Kolonial Blut Gesetz (colonial blood law). Nobody complained. Schools for preparing doctors who wanted to work in the tropics were placed in the ‘motherlands’ and not in the colonies, which would have been far more logical. Although often seen as points of pride by the former colonial powers, the tropical medical institutes practiced and promoted not so much tropical as colonial medicine.

Decolonisation changed this. Doctors wanting to work in the tropics found a new milieu; their workplace became truly global. The post-colonial ‘diaspora of tropical doctors’ turned out to be the cornerstone of emerging international healthcare. The foundation of the Alma Ata agreements, and medical policies like Primary Health Care and Health for All weren’t laid by medical-humanitarian impulses but rather by international politics. This resulted in a new kind of tropical doctor: no longer was a foreign country their home, but they went abroad for a couple of years after which they returned., but he and she went abroad for a couple of years after which they returned and/or sought a new location. These doctors still came largely from the former colonial powers. What these doctors did was no longer dictated by their own (largely former colonial) governments, but by the governments of the often newly independent countries in which they were working as well.

This certainly is one of the reasons that curing disease – the archetypical tropical medicine – although of major importance still, shifted to preventing disease, to attention for the socio-economic and political causes of disease. It shifted, in other words, to international healthcare, a shift politically influenced and set in stone by the Millennium Development Goals, the MDGs. This process was strengthened by the explosion of travel and communication means and by the fact that traveling the globe no longer was a Western prerogative. Doctors from the so-called ‘third world’ went to the former colonizing countries learning their trade (and often staying there), and, more importantly, many others went there as well (migrants, refugees, et cetera), bringing with them the formerly so-called ‘tropical’ medical diseases.

Globalization, aggravated by – and in part cause of – global warming, increases the risk of pandemics, making truly global medical and public health policies more important than ever. But international cooperation in healthcare continues to be constrained by national borders which, firstly, have only proliferated with decolonisation, and, secondly, are increasingly considered to be of more importance in the last few decades, especially in the Western world. Projects in low- and middle-income countries (LICs) have to be of national interest. Ministries for Development Aid vanish and Ministries of National Health and Family Values arise. Women’s and other human rights are under threat, annulled or simply denied.

Although it is too early to predict what the exact consequences of these processes will be, they undoubtedly will affect international healthcare and global medicine – and not for the better. Also, there will certainly be health professionals who agree with the above nationalistic, right-wing development. Let’s hope they do not succeed, and let us strive to ensure that these viewpoints do not spread and do not threaten what is the core essence of a truly global medicine.