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Posted by C3W Admin on November 19 2021

“Connecting three worlds: socialism, medicine, and global health after WWII”


Hybrid Workshop

International House, Freie Universität Berlin

The inaugural event at the UNAM offices in Berlin (Freie Universität Berlin) provided a friendly environment for the first international meeting of the project, enabling intellectual and personal connections among project members, collaborators and advisors. The workshop consisted of short presentations of the project members by regional panels (Latin America, Asia, Africa), serving as anchors for semi-structured conversations around global health, medical research, internationalism and politics. A roundtable followed the panels with project collaborators, who briefly outlined their research and discussed emerging points of intersection. Finally, the Advisory Board concluded the event by reflecting on the two days’ conversations. Following the structure of the event programme, this report reflects the most critical ideas that circulated in the event, developing a point of reference for members to reflect on in the development of each strand of research.

The introductory panel  consisted of an overview of the project by the principal investigators. Each PI briefly described their research strand, on which they work with postdoctoral and doctoral researchers. During the panel, the PIs emphasized the project’s aim to rewrite, within a global perspective, the history of socialist medicine. The “three worlds” in the title refers to bringing together various analytical categories and concepts i) in its geographical focus: the tripartite division into First, Second and Third worlds, which is characteristic of the Cold War; ii) in its thematic focus: three fields in health and medicine: public health, biomedical sciences and mental health; and finally iii) in its methodological and conceptual approaches: STS, history of science and history of medicine. Dora Vargha’s (Humboldt/University of Exeter) presentation focused on the establishment of East Asian healthcare systems as they intersected with colonial legacies in the region and the engagement with Eastern European countries and international agencies like the WHO. Sarah Marks (Birkbeck, University of London)  explored global socialist links that transformed mental health practices in Africa, the implications of socialist reforms on the field, and frameworks/models for national institutions (i.e. Kwame Nkrumah’s pan-African inspired plans for the Pantang Psychiatric Hospital). Edna Suarez-Diaz’s (UNAM) presentation referred to case studies that expand the boundaries of polarization, problematizing multiple dichotomies such as preventive/public health associated with socialism vs curative/biomedical medicine linked to capitalism. Instead, biomedicine played a crucial role during the Cold War for both the socialist and capitalist camps.

Panel Discussion: Latin America

Andrea Espinoza Carvajal’s (King’s College London) presentation introduced her project, an enquiry into how feminism, oftentimes in connection with socialism, has shaped and continues to shape sexual and reproductive health rights in Latin America, specifically in Ecuador and Peru. Her research places particular interest in the circulation of political discourses from governments and political leaders vis-à-vis narratives created by feminist unions and socialist committees. In that sense, her project considers that there might be a dynamic of disconnection but constant interaction between state and non-state actors. This project aims to historicize the expansion of infrastructure and coverage of public health services in connection with the health cultures produced by socialism.  Finally, Andrea highlighted that her analysis aims to be a feminist exploration, using gender as an analytical lens. One core question arising during the Q&A was how we define state and non-state actors, and how we might think about the region’s particularities and the historical tension and confrontation between the state apparatus and social movements. Further questions aimed to understand: what it would mean to challenge discourses of colonial power and make visible power structures in research regarding sexual and reproductive health rights; and how we could reconcile talking about socialism with a somewhat intermittent experience of socialism and with people calling themselves socialist, or people and systems developing practices that resonate with socialist discourse, but do not identify as socialist. In his presentation, Sebastian Fonseca (University of Exeter) outlined his research, which is framed under the umbrella term of ‘social medicine,’ responding to the region’s violent socioeconomic and political context during the Cold War. ‘Social medicine’ is utilised as a proxy to the idea of socialist health given the ostracization of the latter term in this period. The term is defined broadly as alternative and resistance models of health to hegemonic, US-based, technocratic and capitalist biomedical perspectives. Sebastian’s case study addresses unexplored health models of territories under the control of the former FARC army in Colombia from the 1960s. Specifically, articulated with the NGO Red SaludPaz, the project will collect empirical data from Florencia, Caqueta – a region historically controlled by the guerrillas that harbours a large forced migration community. Within the community, collectives maintain traditional healing and plant medicine as practices to link back to their original territories and sponsor a type of ‘decolonisation’ of everyday life, in line with the framework in health enacted by the FARC domination. Exploring plant medicine practices will establish the situated epistemologies underlying the idea of decolonisation in health (presumed to be  a way to operationalise socialist health); seek to understand the historical conditions that enabled and produced this form of subject; and unearth the tensions of the approach. Several important issues arose in the discussion, among them “war medicine’ as a vehicle of delivering primary care and chronic disease care for the population, and national liberal armies as ‘laboratories of social medicine’ brewing alternative knowledges, practices and resources that could circulate in the future of global health.

Panel discussion: Asia

Lu Chen (University of Exeter) proposed in her presentation to study the conceptualization, transformation, and global connections of Chinese primary health care. She discussed the complex connections between Eastern European countries and China in this regard, and the influence of Chinese socialism and socialist medicine on Third World countries. She is interested in looking at a range of socialisms in Asia and Africa, including those linked to Soviet Leninism, socialist internationalism as proposed by Khrushchev, and the more bureaucratic Communism that came with the rise of Brezhnev, apart from the distinct strand of Maoism. This range of influences created political divergences that impacted on ideas of health and well-being, state management of the sphere of human existence and the space given to communities being served in relation to decision-making. Her research will contribute to the understanding of conceptual and practical complexities of social medicine through the case of Chinese primary health care, and increase the awareness of the impact of socialist internationalism in co-producing global health in the 20th century, from the lens of East Asia. Liang Wan’s (University of Exeter) talk introduced his PhD topic as a part of the C3W project. Provisionally titled “Golden Needle: Chinese Acupuncture’s Socialist Transformation and its International Communication ca. 1945-1989”, he will focus on the reinvention as well as global promotion of Chinese acupuncture during the period of Socialist China. Liang argued that the contemporary popularity of Chinese acupuncture (in China and some other areas) was inseparable from a series of medico-political activities by the Chinese Communist government during the second half of the 20th century. In the presentation, he first discussed the theoretical re-demonstration of acupuncture after the introduction of Soviet medicine from 1953. In his research, Liang will explore global communication of Chinese acupuncture, and he discussed how the WHO were deeply involved in the promotion and standardization of Chinese acupuncture from the 1960s, and how Chinese medical teams introduced acupuncture in Africa. Liang’s research will focus on the popularity of Chinese acupuncture from a global perspective that involves geopolitics and medical economy, as well as the international exchange of medical knowledge and personnel.

Panel discussion: Africa

David Bannister (University of Oslo/Birkbeck) introduced his research on South Africa and the African National Congress (ANC) political party, looking in particular at the role of the socialist world in constituting the present in national and global health, and at the transformation of socialist orientations in healthcare in memory and practice over time. David’s research hopes to trace the influences of a broadly-defined socialist world, and of socialism as a political philosophy, in the approach of South Africa’s ANC (and its members) towards state healthcare from 1960 to the present, in tension with competing influences and contrary political and economic ideas. David noted that although the ANC was formally banned in South Africa from the 1950s, it continued to receive direct funding, training and material support from the Soviet Union from the late 1950s until the early 1990s; from China in different decades; from Tanzania and Mozambique, as independent socialist African states; and also from Cuba, the GDR, Czech Republic, Hungary and Bulgaria, among others. The project particularly focuses on ideologies of public health among members of the pre-Apartheid ANC, and the transformation of these ideologies after becoming South Africa’s governing party.  Sarah Howard’s (University of Birmingham/ Birkbeck) presentation introduced her project on transnational socialist and post-socialist health in Ethiopia. Her focus will be on three intertwined areas: community health workers and gendered care; socialist internationalism and knowledge transfer; and negotiating post-socialist legacies in public health. She discussed the temporal and ideological ways in which Ethiopia’s trajectory towards and under the Derg differed from other socialist nations in Africa, while at the same time highlighting that healthcare in socialist Ethiopia was neither conceived of nor implemented in isolation. Soviet funding and influence was substantial; other sources of technical and financial support from socialist and non-aligned nations pre-dated the revolution of 1974, as mentioned by participants Gisela Matos (Mexico) and Bogdan Iacob (Yugoslavia). What historian Bahru Zewde calls the ‘quest for socialist utopia’ introduced structures and techniques of governance and participation that  endured throughout the rule of the Marxist-Leninist-influenced EPRDF government, and into the uncertainty of Abiy Ahmed’s post-2018 era. Many of these legacies relate to the large-scale harnessing of women’s labour in public health programmes, such as the ‘women’s development army’. The prominent narrative on public health in Africa is that the ‘era of the developmental state in Africa was short-lived’, with ideals about health for all largely abandoned. Ethiopia provides a counterpoint to this narrative in many ways, making it a valuable case study for the project’s aim of tracing the legacies of socialist era health  into the present day.

Roundtable discussions

The workshop gave an opportunity for project collaborators to meet the team and the project’s critical friends, and to explore directions for research. Through the case of the new Cuban COVID vaccine and its trials in Iran, Maziyar Ghiabi (University of Exeter) raised important questions about connections among revolutionary governments and political systems, and the importance of political ideology in transnational collaborations. Mary Brazelton (Cambridge University) brought our attention to the distinction between regional and provincial cases, and the small groups forming connections at the micro level (down to the domain of villages or local groups). Additionally, Mary highlighted other crucial questions to consider, particularly how the Connecting Three Worlds project aligns with calls to decolonise global health. Gisela Mateos’s (UNAM) crucial questions begin with understanding how the WHO became empathic to a socialist perspective in health during the 1970s. In so doing, she seeks to answer concerns such as how we can comprehend alliances at the WHO during the Cold War, and the impact of technical assistance programs in the expert networks of the time, between economic blocs. Stefan Pohl (Universidad del Rosario) focused on flagging the local processes of developmental policies and ideas of progress, upon which he used the ‘food problem’ as an entry point. Food studies, as he rightly pointed out, is a very complex and interdisciplinary field that enables a more profound understanding of community-based medicine and community development. Harry Yi-Jui Wu (National Cheng Kung University) emphasised  the potential of C3W to contribute to understanding changes in medical knowledge and practices arising from transnational connections.

Starting off the Advisory Board members’ concluding remarks,   Matthew Smith (University of Strathclyde) warned against reinstating centralising narratives that merely substitute Eastern Europe, for Western Europe and the US in global health history. John DiMoia (Seoul National University) invited us to consider propaganda as an integral part of a multifaceted analysis, and highlighted underlying tensions between area studies and the history of science, medicine and technology and the potential for research to break down silos. Christos Lynteris (University of St. Andrews) highlighted the implications of Dialectical Materialism for the current research, with impact on qualitative research approaches (such as ethnography) and the theoretical underpinning of the project. Susan Lindee (University of Pennsylvania) directed attention to the entanglement between capitalism and biomedical approaches and raised questions of how the personal experiences of historical actors might have influenced these connections. Raúl  Necochea (University of North Carolina) addressed questions of chronology, emphasizing connections between the USSR, East Asia, and Latin America that reached back to before the Cold War and continue to play important roles today. In multiple contributions, James Mark (University of Exeter) pointed to the importance of connecting discussions on health and medicine to broader questions, particularly to issues around race in Second and Third World encounters, and the significance of economic and trade networks.

Final discussions addressed terminology; most prominently, how we can define socialism and socialist health, and how it was placed in practice at each region, and even local projects. Underlying these concerns are the relationship between developmental policies and ideas of modernity as reframed by socialist collectives. Socialism is also linked with efforts to establish frameworks that establish and stabilise connections among regions, and represented a type of knowledge and practice emerging from workers in marginalised communities. It is also worth noting, as brought up in the discussion, that socialist health always developed in opposition to something, and then morphed into its own system of thought and institutions on the coming to power of  socialist collectives. This transformation in the ideas of socialism, dependent on the political status of collectives, is highly relevant for C3W’s future research;  it is important  to comprehend not merely the ways that socialism changes ideas about population health, but also how these ideas impacted socialists concepts and practices.

Moreover, different ideas within socialism bring up questions as to whether the political stance is necessarily anti-capitalist. Consequently, a broader definition of socialism may be warranted; for instance, considering socialism as a framework for resistance, and  complicating ideas about socialism as a specific political ideology linked to Marxist theory. Socialism in many areas of the global south  represented narratives of opposition to specific forms of oppression. Finally, the link between socialism and social medicine ought to be revised in light of the latter’s historical association with other non-socialist viewpoints including  eugenics and preventive medicine.

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