International Health Division

The Start of Something Big

The International Health Commission (IHC) was created on June 27, 1913, charged with the “ … promotion of public sanitation and the spread of knowledge of scientific medicine … ”[1] Throughout its history, the organization underwent a variety of mandate and name changes, becoming the International Health Board (IHB) in 1916 and the International Health Division (IHD) in 1927.  Ultimately, the organization initiated programs in over 80 countries.

Rockefeller Foundation Field Office, Brazil

The IHD was the successor organization to the Rockefeller Sanitary Commission (RSC).  Unlike the RSC, which had focused its activities in the southern United States, the IHD tackled public health issues on a global level. The IHD mirrored the successful model of the RSC. First, the agency collaborated with local governments to address specific diseases. Second, the agency sought to use specific diseases as catalysts to build a permanent network of public health agencies. As with other Rockefeller Foundation (RF) initiatives the IHD aimed to achieve long-term results.

Setting Principles

The first director of the IHD was Wickliffe Rose.  As a former director of the RSC, Rose well understood the important intersections between health and education.  Rose firmly believed that education was the most useful tool in combating major diseases and that public health education was required for physicians, nurses, health agencies and local populations.

Under Rose’s tenure (1913-1922), the basic principles of the IHD were established:

1. Public health work is fundamentally a function of the government.
2. IHD can be of use by helping government agencies organize and by providing expert advice, financial resources and facilities for the education of health professionals.
3. IHD aid is temporary and must be withdrawn when governments can control their own public health operations.
4. All IHD aid must be given with the aim of creating or strengthening government health agencies.[2]

The IHD recognized early the value in adapting its practices to accommodate the customs and traditions of local populations. Successful public health education relied on speaking to people in terms that they understood and that made sense in their daily lives.  As the 1916 Annual Report of the RF noted, “Experience derived from working in many countries, with their great diversity of races, languages, and racial prejudices, is gradually evolving working methods adapted to diverse conditions.”[3]

Rockefeller Foundation Clinic, Guerrero, Mexico 1950

When setting its public health agenda, the IHD looked for diseases with a global health impact and a global economic impact (diseases that stunted a country’s economic growth by reducing the productive capacity of its citizens).[4] The first overseas venture for the IHD was a cooperative project with British colonial authorities to bring a hookworm eradication program to British Guiana. The success of this campaign allowed the IHD to expand its international hookworm programs very quickly and to initiate campaigns against other diseases, most notably tuberculosis, yellow fever and malaria. The research and control of these four diseases comprised 90% of the disease budget of the IHD.[5]

Changing Course

Frederick Russell succeeded Rose as IHD Director from 1923 to 1935. Russell’s tenure marked an important transition for the organization to a greater research mandate. Both directors sought to eradicate preventable diseases on an international level. While Rose advocated the delivery of already acquired public health knowledge to greater numbers of people, Russell encouraged the discovery of new knowledge.  As a 1928 memorandum on the future of the IHD explained:

… in order to preserve and to develop the inquiring attitude of mind in the working of the staff of the IHD, from the highest to the lowest, it is essential that investigation should be carried on within the organization itself and comprise an important part of its activities.  The staff of the IHD is supposed to be composed of scientific men.  Every effort must be made to keep them such … What is needed is a somewhat less wide dispersal of the activities of the Division, an increased emphasis to be laid on the importance of research both in the field and in the laboratory, and an attempt to cultivate the spirit of investigation in the members of the staff.[6]

Scouts looking for larvae, Brazil

 IHD research during this era was dominated by the search for causes of diseases, paths of transmission and possible vaccines.  The Rockefeller laboratories in New York City, established under Russell’s tenure, became a center for respected medical research and the site of the discovery of the yellow fever vaccine.

The War Encroaches

Russell was succeeded by Wilbur Sawyer, who from 1935 to 1944 maintained Russell’s research mandate but was also forced to deal with the complications brought on by World War II. In 1941 the IHD was forced to suspend operations in Europe, and the resources previously devoted to Europe were largely redirected to South America. Shortly before this the Rockefeller Foundation Health Commission was created in 1940 to address wartime health needs, including growing problems with refugees, food shortages and epidemics. According to a RF Review of the IHD, the commission was “… an effort to contribute to the war and postwar needs by salvaging existing health activities and personnel.  Within the general framework of Foundation policies and objectives, the aim was to make a constructive contribution without becoming involved in the support of relief activities.”[7] 

The war had a tremendous impact on the IHD.  Postwar concerns led to the growth of government funding of health initiatives and multilateral organizations devoted to public health. Among these new organizations was the World Health Organization (WHO), formed in 1948. The final director of the IHD, George Strode, shepherded the organization through these last years.  In 1951 the IHD was subsumed into the RF’s Division of Medicine and Public Health. An increasing amount of emphasis was placed on medical education, including funding for professional education, medical faculties and individual fellowships. 

Documenting the Work

During its history, the IHD counted a number of influential field staff and scientists among its ranks, including Lewis Hackett, its longest serving member. Hackett was recruited in 1914, and his impressive career in disease investigation and public health promotion spanned 35 years and involved work in 17 countries before his retirement.

Dr. Lewis Hackett traveling, Brazil

Hackett faithfully documented his own experiences, producing an extensive photograph collection throughout his travels. During his retirement, Hackett began work on a definitive history of the IHD; however, the work was not completed before his death in 1962. The unfinished manuscript, available at the Rockefeller Archive Center (RAC), remains an invaluable tool for researchers.

Passing the Torch

By the time of its demise, the IHD had allocated over $94 million and had established a global reputation of excellence in public health and research. The organization fought the major diseases of its time, trained a cadre of health professionals and helped to establish public health agencies worldwide.  Furthermore, the legacy of the IHD influenced the WHO in many concrete ways, especially the WHO’s Global Malaria Eradication Program, begun in 1955.