Summary of the impact

As a result of research by Prof. Sanjoy Bhattacharya since October 2010 at York into the history of disease control, the social determinants of health, and primary healthcare, the Department of History's Centre for Global Health Histories (CGHH) was invited to formalize and develop the WHO's Global Health Histories (GHH) project, including its annual flagship seminar series in Geneva. This research programme has had a major impact on institutional practice within the WHO headquarters and its regional offices: (i) through the promotion of greater transparency and openness toward internal and external stakeholders; (ii) in leading the WHO to use historical research for staff training and development; (iii) by leading the WHO to encourage partner governmental and non-governmental organizations to make greater use of historical research in developing and running health policies. Due to the success of GHH in these areas, historical analysis has now been designated an Office Specific Expected Result for departments within the WHO HQ. It is now an officially required and audited activity for evaluations of major campaigns and for teams planning new projects.

Underpinning research

Bhattacharya's (at York since 2010, Reader, then Professor) research has set out a new framework for understanding the development and workings of global health policy, one which rejects "top-down" approaches and which reveals how public health and public health policy are the result of complex interactions within international institutions, government bodies and local societies.[1] This work has been developed in the major research projects at the University of York (Oct 2010-July 2013) which led to Bhattacharya being invited to work closely with the WHO's GHH project:

(1). Bhattacharya's Wellcome Trust (WT) funded project [Oct 2010-Apr 2013] http://www.york.ac.uk/history/research/majorprojects/smallpox-eradication/ on the history of the global smallpox eradication programme in the South Asian sub-continent has enabled the preparation of detailed case studies from Bangladesh, Pakistan, Bhutan and Afghanistan to understand how local political and economic factors affected the implementation of immunisation projects at different levels of state and society.[4] This work has revealed wide-ranging variations in official and civilian attitudes within administrative formations inside national boundaries in South Asia, and highlighted the importance of careful research and preparation before the deployment of large-scale immunisation projects. This scholarship has complemented critical research into the history and contemporary workings of the Global Polio Eradication Initiative in India, with special reference to civilian and official resistance towards its campaigns, the ethical standards adopted during the targeting of religious minorities, the challenges of running general disease surveillance schemes and the impact of anti-polio drives on other vaccination programmes.

(2). Bhattacharya's WT funded project `The Local Bases of Global Health: Historical and Contemporary Perspectives on Primary Healthcare in South Asia' [Oct 2010-Sep 2015] investigates the history and contemporary workings of the WHO, and its role in developing and supporting the Social Determinants of Health Initiative globally.[2, 3] This examines the varied ways in which the Social Determinants project has been received by departments within the WHO and its sister UN organizations, national governments and NGOs. This work has been used by WHO departments as feedback for the development of country-specific advocacy programmes and policies.

(3). Bhattacharya's WT Senior Investigator Award [Oct 2012-Sep 2017] on the history and contemporary workings of the campaigns for primary healthcare in India, Sri Lanka and Bangladesh. This work is revealing the links between the campaigns for primary healthcare and the WHO's efforts to create a global campaign for Universal Health Care in the 1970s and the 2000s, the effects of the competition between different WHO and national health projects for finite financial, infrastructural and personnel resources, and the variety of social and political responses in South Asia to the provision of state-funded healthcare.

References to the research

[5] Wellcome Trust Grants: The Local Bases of Global Health: : Primary Health Care in South Asia and beyond, 1945-2010, Fellowship, £388,407.00, 093346/Z/10/Z; The Local Bases of Global Health: Primary Health Care in South Asia and beyond, 1945-2010, Senior Investigator Award, £1,049,652.00, 097737/Z/11/Z. Grants supported research & awarded competitively. [*Submitted to REF 2]. Publications without a DOI are available on request.

Details of the impact

The WHO is the UN's pre-eminent health agency, employing 8000 staff at its Geneva headquarters, its six Regional Offices worldwide and its Country Offices. The WHO's activities encompass the 194 member nation states, whose official delegates are brought together annually through the World Health Assemblies to vote on policy, future budgets and identify priorities.

In 2010, Bhattacharya, who had been involved with the GHH project since its inception, was recruited to augment the York Department of History's research expertise in the history of medicine and create a Centre for Global Health Histories (CGHH}, launched May 2011, http://www.york.ac.uk/cghh. It promotes interdisciplinary research across the HEI, leads new research efforts into the history of global health, and strengthens the Department's external engagement with health organisations around the world. On 1 October 2010 the WHO appointed Bhattacharya as the principal external collaborator and advisor to its GHH project, and requested he lead the expansion, formalization and transformation of its previously small-scale operations. Thomson Prentice, then editor of the World Health Report, reported in an article on the WHO website that: "The establishment of the Centre for Global Health Histories at the University of York (CGHH) in mid-2011 has been the most important development of the year in the continuing and expanding relationship between the University and Global Health Histories project (GHH) based at the World Health Organization headquarters in Geneva, Switzerland.... Support from the Wellcome Trust has been instrumental in allowing CGHH to work with the WHO on some 50 lunchtime seminars in Geneva, bringing in eminent historians social scientists and other experts from many countries to share presentations with WHO counterparts. The aim has been to bring together researchers and policy-makers to stimulate a fusion between historical evidence and current approaches to many of the most urgent health issues of today. The common goal is to construct new and enduring bridges between academia and global health policy, while at the same time promoting public engagement. In this regard, seminar audiences and participants, including those taking part through live internet broadcasts, have been able to contribute to the discussions. One result of this has been the steady development of a unique web-based archive that now contains presentations from almost all the seminars."[7]

Bhattacharya was requested to develop mechanisms within the WHO that made available to its departments a range of research prepared by leading historians and social scientists. Dr. Hooman Momen, the co-ordinator of WHO Press and the WHO GHH initiative, writes that: "we see 2010 as an important marker for our collaboration...Since then, it is undeniable that these seminars have had a great impact inside the WHO, and it has been very great pleasure to work with you on organising events on themes widely considered to be of importance from a policy point of view."[1]

Bhattacharya developed mechanisms that have expanded the GHH project and has put together a global network of historians and social scientists, who have presented in Geneva on specific subjects and engaged with WHO officials on an ongoing basis.[3] From 2011 the GHH seminars fed into the preparation of the World Health Report, a premier publication of the WHO. Thomson Prentice reported to the WHO that: "Although the Report has invariably drawn on history in its coverage of global health issues since its launch in 1995, this is the first time it will have a formal link with GHH.... Through the seminars, publications and other initiatives, GHH promotes closer links and exchanges between health policy-makers and decision-takers, and historians, researchers, scientists, academics, students and the general public.... GHH has been building an international network of health historians with expertise in a wide variety of areas. The network now extends to all of WHO's six regional offices and boasts many of the best-known names in health history." [8]

Bhattacharya's £1 million WT Senior Investigator Award has helped to consolidate the significance and reach of all these activities within the WHO HQ and Regional Offices. These events have contributed to a substantial change in the WHO's institutional practice, promoting greater transparency and openness both within the WHO and towards its external stakeholders. Referring to this, Hooman Momen writes: "These GHH seminars have fostered a completely new form of activity within the WHO, leading to unprecedented openness in fostering inter- and intra-departmental discussions about subjects of great importance for contemporary global health, which, over time, have flowered into something even greater and more exciting than envisaged originally: the opening up of these self-critical and significant seminars to external attendees and to interested constituencies through the internet. There can be no doubt that our collaborative activities have helped foster and sustain and [sic] environment of openness, setting new standards for alliances between those involved in global health policy design and implementation, and academics, NGOs and Civil Society Organisations who monitor health trends and can be important collaborators in the evaluation of projects and policies. My colleagues and I are greatly encouraged by the wide-ranging external interest in GHH activities and seminars, which have attracted attendees, in person and over the net, from at least 72 countries and is attracting the attention of the international media."[1]

Prior to the GHH project, the WHO did not have any established processes to disseminate independent historical analysis of its health programmes. In contrast, the GHH seminars were designed to encourage frank and free discussions about what history tells us about past and present policy difficulties. They were made open to the public — an innovation for the WHO — allowing academics, journalists, members of think tanks and charities to attend. The reach of this innovation was global, allowing individuals in government, healthcare and academia, as well as teams in hospitals and clinics to link up to the events via the internet. A report on the WHO website noted that: "2012's seminars boasted a truly global reach, enhanced by social media and the ability to broadcast the seminar to participants around the world via webinar technology. Colleagues from seventy-four nations `tuned in' to the seminars... over the course of the series, a figure which highlights GHH's global interest and range of topics covered. A total of 420 subscribers, from as far apart as Costa Rica and Myanmar, were able to attend the seminars thanks to the webinar. As well as allowing colleagues to sign up and listen, the facility even allows users to send in questions to the speakers from their own offices. This ensures that the important discussions arising in and from the presentations are widely available, but also that they can be archived and made freely obtainable to all on the WHO website and the Centre for Global Health Histories' University of York website. Greater interest was inspired through social media, and at certain seminars listeners could pose questions via Twitter."[9]

Dr. Najeeb al-Shorbaji, the WHO's Director of Knowledge Management and Sharing, describes the organization's perception of this work: "learning from history is our prime objective in relation to the GHH project. There are many lessons in global health that need to be shared and understood to avoid making the same mistakes. Knowledge is made of science and experience. Experience is often the best teacher in the case of health. We want to document and share this experience for present and future generations of health researchers, practitioners and policy makers. The impressive archive of recordings of the GHH seminars that we have developed in association with your Centre for Global Health Histories has been an invaluable source of information and training tool [sic]."[2]

Archives were created within York's CGHH and WHO GHH websites to provide continued access to presentations and debates and the events — including question and answer sessions — have been made freely available as podcasts. [5, 6] For the first time, an external agency, CGHH, has been allowed to create an external archive of WHO materials (the recording of the GHH seminars in Geneva); this trust and willingness to share information is an indicator of the importance accorded to the CGHH's collaborative activities with the WHO.[4] Within the WHO, GHH-generated resources have become an important training tool. Referring to this, Dr. Hooman Momen notes that: "These resources are crucial tools for training young WHO officials and interns, as we want to ensure that they develop a comprehensive understanding of the history of the organisation, its many projects, and the national- and local-level histories of projects that were implemented with WHO assistance and advice in different countries. There can be no doubt that these online resources, like the GHH seminars, are widely popular within WHO networks and are winning over growing levels of support at all levels of the agency."[1] An important marker of the significance of the programme has been growing enthusiasm within WHO frameworks for using historical research as a component of global health policy.[1] The principles and methodology of the GHH project have been exported to the WHO Regional Offices, and thus to the 194 WHO Country Offices.[2] For example, the WHO Regional Office for Europe invited Bhattacharya to organise GHH activities within their offices: the first GHH seminar (on anti-microbial resistance) took place in January 2013. This led to an expanded and regularised programme of seminars in Copenhagen.[6]

The WHO's assessment of the overall impact of Bhattacharya's work on its operations is demonstrated by the fact that the application of historical analyses has now been designated as an Office Specific Expected Result for all departments within the WHO HQ.[8] All WHO departments in Geneva therefore now need to develop a critical understanding of the historical background of the themes covered through their projects; this work has to be carried out professionally in association with independent historians, and these activities are audited annually by WHO and UN assessors. This is a profound shift. WHO policy had previously been almost completely reliant on scientific and statistical insights, without historical input. The development has further accelerated the organisation's commitment to openness in working with a wider range of external partners. According to Dr Al-Shorbaji: "this ability of the GHH project to encourage discussion and debate, both inside the WHO and in the larger global health community, is a key strength of the project. It has helped foster greater openness all round. Presenting the history of public health through this global collaboration administered from our offices in Geneva and York provides an excellent opportunity for academicians, researchers and practitioners. It allows them to discuss and share with the new generations of public health professionals, policy-makers and health workers questions about what has worked, what has not worked, and the reasons for both successes and failures".[2]

As a result, the WHO invited Bhattacharya to make the expertise available within CGHH at York to its Compendium of National Expertise. This online platform is the primary port of call for WHO officials searching for support for the `development, implementation, monitoring, and evaluation of national health policies, strategies and plans'. In recognition of its impact, and in order to ensure the long-term effectiveness and security of the GHH project, CGHH was formally appointed on 1 October 2013 as a WHO Collaborating Centre for Global Health Histories, the first such institution of its kind in the world. Collaborating Centre status is only offered by the WHO to select institutions based around the world, with a view to strengthening specific organizational activities with the help of external expertise.[10]

Sources to corroborate the impact

[1] Letter, Co-ordinator, WHO Press & GHH Project, WHO, April 2013.

[2] Letter, Director, Department of Knowledge Management and Sharing, WHO, April 2013.

[3] WHO official video: http://video.who.int/streaming/health_histories_v2.wmv

[4] WHO GHH Seminar Archives:http://www.york.ac.uk/history/global-health-histories/seminars/

[5] WHO GHH Seminar Archives: http://www.who.int/global_health_histories/en/

[6] Ms Zsuzsanna Jakab, WHO Regional Director, Europe: http://www.youtube.com/watch?v=jq6tplklNdQ. video time range 00.00 - 08:00 minutes

[7] `Global Health Histories and the University of York', WHO HQ website:
http://www.who.int/global_health_histories/report_2011_part_1.pdf

[8] `The WHO Global Health Histories project: New seminars and more initiatives for 2011':
http://www.who.int/global_health_histories/seminars/seminars2011.pdf

[9] `Global Health Histories seminars in 2012 and new directions for the year ahead':
http://www.who.int/global_health_histories/GHH2012_recap_and_forthcoming_in_2013.pdf

[10] WHO Collaborating Centre nomination papers. Confidential: available on request.