Gorsky Martin, Sirrs Christopher
Centre for History in Public Health. London School of Hygiene and Tropical Medicine.
Dynamis. 2019;39(1):205-233. doi: 10.30827/dynamis.v39i1.8672.
This article discusses the early postwar history of international engagement with the strengthening of health services by the World Health Organisation (WHO). Standard narratives emphasise that the WHO prioritised vertical programmes against specific diseases rather than local capacity-building, at least until the Alma Ata Declaration of 1978 launched a policy focus on primary health care. There was, however, a longer lineage of advisory work with member states, and our aim is to examine this intellectual and policy history of health services planning and administration. We begin by surveying the relevant secondary literature, noting that this theme appears only briefly in the institution's first official histories, with minimal contextualisation and analysis. We then proceed chronologically, identifying an early phase in the 1950s when, despite its marginalisation at the WHO, the interwar European social medicine tradition kept alive its ideals in work on health planning. However, the sensitivities of the USA and of the colonial powers meant that consideration of social security, health rights and universal coverage was absent from this discussion. Instead it was initially concerned with propounding Western models of organisation and administration, before switching to a focus on planning techniques as an aspect of statecraft. In the 1960s such practices became incorporated into economic development plans, aligning health needs with infrastructure and labour force requirements. However, these efforts were entangled with Western soft power, and proved unsuccessful in the field because they neglected issues of financing and capacity. In the 1970s the earlier planning efforts gave rise to a systems analysis approach. Though in some respects novel, this too provided a neutral, apolitical terrain in which health policy could be discussed, void of issues of rights and redistribution. Yet it too foundered in real-world settings for which its technocratic models could not account.
本文探讨了战后初期国际社会通过世界卫生组织（WHO）参与加强卫生服务的历史。标准的叙述强调，至少在1978年《阿拉木图宣言》将政策重点转向初级卫生保健之前，WHO优先考虑针对特定疾病的垂直项目，而非地方能力建设。然而，与成员国进行咨询工作的历史更为悠久，我们的目的是审视卫生服务规划与管理的这一思想和政策历史。我们首先梳理相关的二手文献，注意到这一主题在该机构的首批官方历史中只是 briefly提及，背景介绍和分析极少。然后我们按时间顺序展开，确定20世纪50年代的一个早期阶段，当时，尽管在WHO中处于边缘地位，但两次世界大战之间的欧洲社会医学传统在卫生规划工作中延续了其理想。然而，美国和殖民列强的敏感态度意味着，此次讨论没有涉及社会保障、健康权和全民覆盖等问题。相反，它最初关注的是宣扬西方的组织和管理模式，之后转向将规划技术作为治国方略的一个方面。在20世纪60年代，此类做法被纳入经济发展计划，使卫生需求与基础设施和劳动力需求相匹配。然而，这些努力与西方软实力纠缠在一起，在实地证明并不成功，因为它们忽视了融资和能力问题。在20世纪70年代，早期的规划努力催生了一种系统分析方法。尽管在某些方面具有创新性，但这种方法也提供了一个中立、无政治色彩的领域，在其中可以讨论卫生政策，而不涉及权利和再分配问题。然而，它在现实世界的环境中也遭遇了失败，因为其技术官僚模式无法解释这些环境。
