1. Trade, disease, and international health HI269 Week 12

2. Internationalising illness How, when and why did disease – and its control -- become the focus of international attention? What tools, technologies, and forms of action emerged from this new focus? How did disease come to affect models of nationhood and national identities?

3. Guiding principles of international interventions in health/disease ‘Westphalian’ system: based on principle of non- intervention in domestic affairs (1648, Treaty of Westphalia) Specifically intended to protect TRADE and to prevent the spread of disease across borders, NOT to force states to improve health within their borders. However ‘pre-emptive interventions’ and ‘nation- building’ exercises (generally supported and funded by western international bodies) were still sanctioned against ‘weak’ (generally non- European) states.

4. Internationalising Illness: a very partial timeline,19 th c 1851 First International Sanitary Congress, organized by France 1865 pan-European cholera epidemic, spread along hajj routes to Egypt and then trade routes to Europe 1866 France initiates restrictive measures which develop into rigorous militarized quarantines imposed on pilgrims/ships coming from pilgrimage sites before travelling on to Europe. Sanitary Conference in Constantinople imposed 10 quarantines for plague, cholera, yellow fever. 1869 Suez canal opens, bringing Europe closer to India, China – up to a 63% reduction in travel time, making it within incubation period for new set of diseases) 1878 Yellow Fever reaches US via maritime contacts 1892 First International Sanitary Convention (the formal resolution), but only covers cholera 1897 ‘Sanitary zones’ codified, International Sanitary Convention on plague adopted 1898 Spanish American War (US first encounters tropical diseases in its new possessions)

5. Internationalising Illness: a very partial timeline, 20 th c 1902 First General International Sanitary Convention of the American Republics held in Washington, DC. Establishes International Sanitary Bureau (now PAHO) and goal of reducing need for quarantine 1903 First International Health Convention (the official gathering) in Paris; specific measures, based on new germ theory, imposed for each ‘pestilential’ disease, and replaced quarantine with disinfection and surveillance 1904 US controls Panama zone to build Canal 1911 Europeans explicitly impose European oversight on health measures/controls in ‘Eastern’ and ‘far Eastern’ nations ‘pre-emptive interventions’ 1914 Panama Canal opens; US spearheads yellow fever eradication campaign to protect international health 1919 League of nations establishes its own Health Organization 1926 International Health Convention revised to include typhus and smallpox as well as cholera, plague, and yellow fever 1938 Last International Sanitary Convention held in Paris 1948 WHO founded 1969 International Health Regulations established, covering smallpox, relapsing fever, typhus, cholera, plague and yellow fever 1977 Smallpox eradicated in international effort launched by WHO in 1967

6. Responding to the ‘immigrant threat’: the role of states Strategies: Isolate Exclude Select Assimilate But why not JUST exclude?

7. Empire building (esp. US) shaped by: –‘White Man’s Burden’ –‘Hygienic Citizenship’ –Industry/Agribusiness –Inspection and Assimilation Resistance to empire shaped by: –Fears of miscegenation, dilution, infection –Labour concerns –Isolationism/Nativism International health and Empire: ‘Hygienic Imperialism’

8. “Take up the White Man's burden-- Send forth the best ye breed-- Go, bind your sons to exile To serve your captives' need; To wait, in heavy harness, On fluttered folk and wild-- Your new-caught sullen peoples, Half devil and half child.” Rudyard Kipling, ‘The White Man’s Burden’ 1899 The White Man’s Burden

9. "The White (?) Mans Burden" The "white” colonial powers being carried as the burden of their "colored” subjects. First printed in Life, March 16, 1899. Whose burden?

10. New Technologies, New Connection … ‘New’ Diseases Epidemiology of globalisation New transit routes = new transmission routes SPEED of global travel & trade => new obstacles to excluding transmissible diseases

11. Tropical medicine and the ‘war’ on disease

12. Images of international illness: health for all or …

13. …a new age of epidemics?

15. The more things change?

16. International Illness and Contemporary Identities Seeing SARS

17. Points to think about In an ever more global world, and one in which disease outbreaks can spread from continent to continent in hours, rather than months and days, how have medical technologies influenced national policies and identities? Compare and contrast historical and contemporary relationships between trade, disease and public health. Have perceptions (of risk, of migrants, of state and private responsibilities) and strategies changed? So how does history help us think about national and group identities?