The League of Nations Health Organization

by

Tomoko Akami

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0039

Introduction

The League of Nations Health Organization (LNHO) was a technical organization of the League of Nations (1920–1946), and it was taken over by the World Health Organization (WHO) after World War II. Its executive body was the Health Committee (HC), one of the League’s permanent advisory committees. The HC was composed of medical and public health experts and advised the League’s Council on health-related matters, and it made decisions on international health operations. The Health Section (HS), a part of the League’s Secretariat, was the administrative body of the LNHO. Provisionally founded in 1921 and formally established in 1923, the LNHO was led by the HS’s medical director, Ludwik Rajchman (b. 1881–d. 1965), a Polish medical doctor and bacteriologist, from 1921 to 1939. It aimed for a better world by improving the health of people around the globe, and it carried out a broad range of work with a relatively small budget, which was funded by the Rockefeller Foundation (RF) and the League’s member states. Its work included epidemiological intelligence, compilation of public health statistics, standardization of biomedical substances, expert exchange programs, assistance to national public health administrations, and research on diseases. In the 1930s it conducted social medicine projects, including nutrition, housing, rural hygiene, and health insurance. Mobilizing experts in these broad fields, the LNHO enhanced the circulation of ideas among experts and networks across the regions. Its operations have been recognized as one of the most successful among the League’s work. The LNHO was, however, often frustrated by the parallel existence of the two other interstate health organizations, the Pan American Sanitary Bureau (PASB) at Washington, DC, founded in 1902, and the Office International d’Hygiène Publique at Paris (OIHP), founded in 1907. The HC co-opted the members of the OIHP’s executive committee, but this led to constant tension within the HC and between the LNHO and the OIHP. Furthermore, while an expert from the United States—a non-League member but a OIHP member—joined the HC, the PASB at times opposed the LNHO’s intervention in the Americas. The WHO, established in 1948, was set up therefore as the single global health organization, taking over from the LNHO and the OIHP, and the PASB became one of its regional offices in 1949. Although the LNHO has been criticized as Eurocentric, it had a vision for “world health.” It worked with the United States, Germany, and the USSR. Its projects also encompassed colonial Asia and Africa, leaving significant legacies for health projects undertaken by the WHO and other UN agencies on behalf of the Global South.

General Overviews

While the LNHO was regarded as an “international health organization” and the predecessor of the WHO (Goodman 1971), more recent works such as Birn 2009; Farmer, et al. 2013; and Packard 2016 locate it in the development of the post–World War II “global” (or world) health governance. This reflects a greater attention to international organizations in globalization and a reassessment of the League of Nations. Pedersen 2007 argues that the League was a harbinger of global governing norms for the UN and its agencies. Works on the LNHO after the late 2000s examine its role in shaping the norms and institutions for governing health for the world. Weindling 1995a, however, needs to be mentioned, as it collates the pioneering works on interwar international health organizations, demonstrating the centrality of the LNHO (Dubin 1995) among them. While it contextualizes the LNHO in the development of welfare organizations in Europe, it includes chapters on LNHO’s works in Latin America and Asia. Building on these works, Borowy 2009a is the first (and still the only) monograph on the LNHO. Based on archival sources, this comprehensive study covers its structure, main projects, key personnel, and relations with national governments and other organizations. It argues that the LNHO aimed to make a better world by improving health and promoting a broader notion of health and social medicine, and it stresses its direct legacy in the WHO. Although an analytical terminology shifted to global health, scholars vary over how best to characterize the LNHO. Structurally, it was an interstate, not supra-state, organization. Like the League, it was based on national sovereign entities. It, however, also worked with colonial administrations, and it mobilized nongovernmental organizations; thus, in that sense, it was an agency that existed beyond the labels “international” and “interstate.” Bashford 2006 argues that the LNHO and the League’s Economic and Financial Committee (EFC) were the first to identify the globe as its governing scope for population management. Borowy 2009a also argues that the LNHO aimed for world health. The geographical scope of the LNHO, although run largely by Europeans, could be claimed as “global.” This “globality,” however, needs to be scrutinized, especially with regard to the nature of its involvement in the countries under colonial rule. Such assessment seems crucial in the face of recent calls for “decolonizing global health” (e.g., Forsberg and Sundewall 2023), when “global health” is understood as health projects dealing with postcolonial states and peoples.

• Bashford, Alison. “Global Biopolitics and the History of World Health.” History of the Human Sciences 19.1 (2006): 67–88.

  DOI: 10.1177/0952695106062148

  Proposes to see histories of world health and population management as sites for thinking about global biopolitics. Argues that the LNHO, along with the League’s Economic and Financial Committee (EFC), was the first organization which saw the “globe” as the scope for this biopolitics. Also points out fields in which the LNHO did not work, namely, sex and reproduction.

• Birn, Amme-Emanuelle. “The Stages of International (Global) Health: Histories of Success or Successes of History?” Global Public Health 4.1 (2009): 50–68.

  DOI: 10.1080/17441690802017797

  Examines the “success” of international health actors in five historical stages (1851–1902, 1902–1939, 1946–1970, 1970–1985, 1985–present). The LNHO is referred in the second stage of “institution-building” along with the OIHP, the PASB, and the International Health Board/Division (hereafter referred as IHD) of the Rockefeller Foundation (RF). Suggests that the LNHO, together with these other organizations, was important in establishing supranational institutions for “planning and marshaling expertise to address world health problems” and assisting the national public health administrations of governments. Sees, however, that this attempt was “fragile,” “underfunded,” and fragmented, and it became a success only when the WHO was established.

• Borowy, Iris. Coming to Terms with World Health: The League of Nations Health Organization, 1921–1946. Frankfurt: Peter Lang, 2009a.

  This first (and still the only) monograph of the LNHO is the most important reference book for research on the LNHO. Based on the thorough archival research, the 463-page text covers the formation of the LNHO, the foundational period of the 1920s, the social medicine agenda and structural changes in the 1930s, and its wartime role and transition to the post–World War II organization.

• Dubin, Martin David. “The League of Nations Health Organisation.” In International Health Organisations and Movements, 1918–1939. Edited by Paul Weindling, 56–80. Cambridge, UK: Cambridge University Press, 1995.

  Elaborates upon the operational mechanism of the LNHO. Sees the LNHO, with its HC and the “professional proactive Secretariat, directed by the energetic visionary” (p. 73) Rajchman, as “innovative institutions.” Argues this was possible due to Rajchman’s leadership, his ability to enlist the Rockefeller Foundation fund, the LNHO’s organizational setup, and the competent expert staff. It suggests his socialist-leaning ideology was the source of his drive and inspiration and that of conflict within the League and beyond. This led to an HC reorganization in 1935–1937 and eventually to a “purge” of Rajchman in January 1939 by Secretary-General Joseph Avenol.

• Farmer, Paul, Jim Yong Kim, Arthur Kleinman, and Matthew Basilico. Reimagining Global Health: An Introduction. Berkeley: University of California Press, 2013.

  A comprehensive introduction to theories, criticisms, values, geopolitics, and cases of global health. Relates history to contemporary issues, covers broad geographical fields, and stresses the importance of an interdisciplinary approach. Chapter 3, “Colonial Medicine and Its Legacies” (pp. 33–73), has only a few lines about the HC but more on the RF. Discusses the colonial legacies in post–World War II health-related development programs.

• Forsberg, Birger C., and Jesper Sundewall. “Decolonizing Global Health: What Does It Mean for Us?” European Journal of Public Health 33.3 (2023): 356.

  DOI: 10.1093/eurpub/ckad001

  An action call for the European public health research community for decolonizing global health. Sees global health as the “North” providing health aid to the “South,” which originated in the colonial era. Argues for a “more equitable partnership and a better power balance” (p. 356) between the South and the North and urges the European public health research community, as a part of the North, to take an action for achieving a more equitable world.

• Goodman, Neville M. International Health Organizations and Their Work. Edinburgh: Churchill Livingstone, 1971.

  The first book to document the historical development of “international health organizations” and the second edition covers until 1970. Details the predecessors of the WHO, including the LNHO, while its latter half is devoted to the WHO. Sees the LNHO as significant but also as frustrated by the parallel existence of the OIHP. Distinct from the other works on the LNHO (and the WHO) published after the late 1990s as it refers little to the RF’s IHD, social medicine, and rural hygiene in the LNHO era.

• Packard, Randall M. A History of Global Health: Interventions into the Lives of Other Peoples. Baltimore: Johns Hopkins University Press, 2016.

  DOI: 10.56021/9781421420325

  Based on the context of the United States and its colonies, this book sees colonial medicine as the origin of global health. While it locates the LNHO in this genealogy, it also sees the LNHO and the RF’s IHD as having played a great role in developing social medicine and rural hygiene for places outside of Europe in the 1930s. It examines the failure of this approach and, then, during the Cold War, a brief revival as seen in the WHO’s Alma Ata Declaration in 1978, concluding in highlighting the significance of the socioeconomic approach to global health now.

• Pedersen, Susan. “Back to the League of Nations.” The American Historical Review 112.4 (2007): 1091–1112.

  DOI: 10.1086/ahr.112.4.1091

  Captures the momentum of the emerging new histories on the League of Nations. Rather than seeing the League as the failed first attempt at global collective security, which had been the dominant academic and popular perception, it argues that the League was a harbinger of the norms and institutions of global governance in the UN and its related agencies that followed. She thus defined a new framework for works on the League and its agencies, including the LNHO. Available online by purchase or subscription.

• Weindling, Paul, ed. International Health Organisations and Movements, 1918–1939. Cambridge, UK: Cambridge University Press, 1995a.

  Weindling edited this first book to examine international organizations that promoted health and welfare beyond national welfare states. It collates the pioneering works on the LNHO and its related nongovernmental organizations (NGOs). It identifies the interwar period as that of “the transition from treaties and conventions . . . to the establishment of a brave new world of international organizations.” It contrasts “the humane ideals of internationalists” to fascist regimes that “perverted welfare systems for purposes of political discrimination and genocide” (p. 1). Its chapters provide intellectual, institutional, social, and political contexts for the LNHO.