## Abstract Global threats to public health in the 19th century sparked the development of international health diplomacy. Many international regimes on public health issues were created between the mid-19th and mid-20th centuries. The present article analyses the global risks in this field and the international legal responses to them between 1851 and 1951, and explores the lessons from the first century of international health diplomacy of relevance to contemporary efforts to deal with the globalization of public health. ## Introduction > International cooperation on the control of global risks to human health did not begin until the mid-19th century, due to infectious diseases. During the next 100 years this facet of diplomacy expanded as states, international organizations, and non-state actors tackled global threats to public health through international law and institutions. The history of public [[health is]], in fact, that of the processes of increasing interconnectedness between societies such that events in one part of the world have health effects on peoples and countries far away. Public health risks that acquired global significance during the 100-year period were associated with infectious diseases, opium and alcohol, occupational hazzards, and transboundary pollution. ## Global public health risks, 1851-1951 ### Infectious diseases > International health diplomacy began in 1851, when European states gathered for the first International Sanitary Conference to discuss cooperation on cholera, plague, and yellow fever. During this period, railways and construction of faster ships increased pressure on national quarantine systems. However, disease control became a subject of diplomatic discussion as a result of the cholera epidemics that swept through Europe in the first half of 19th century. National policies failed to prevent the spread, and created discontent among merchants, who bore the brunt of quarantine measure. By the end of 1951 this scientific and diplomatic process had produced the World Health Organization and a single set of international legal rules on infectious disease control, the [[International Sanitary Regulations]]. Over the course of a century, the global threat of infectious diseases had produced processes, rules, and institutions for global health governance. ### International trade in narcotic drugs and alcohol Basically, first international conference(s) due to social and health effect of opium and alcohol trade. ### Occupational safety and health The mistreatment of workers by industrial enterprises became a global phenomenon that produced efforts to create international labour standards. Concerns about occupational safety and health continued into the 20th century and led to the creation of the [[International Labour Organization (ILO)]] in 1919. The ILO’s constitution emphasized the global nature of the threat to occupational safety and health, in asserting ‘‘conditions of labor exist involving such injustice, hardship, and privation to large numbers of people as to produce unrest so great that the peace and harmony of the world are imperiled; and an improvement in those conditions is urgently required’’ ### Transboundary water pollution Treaties regulating the uses of international rivers and lakes, observed that "early European practice frequently prohibited industrial or agricultural pollution harmful to river fisheries or domestic use" Transboundary air pollution was the subject of the 1938 Trail Smelter Arbitration, whereby Canada was held responsible for damage caused in other country (USA). ### International law, international institutions and global public health risks When a state needs to cooperate with other countries to confront a threat, international law often becomes a central instrument in the crafting of a common approach. Globalization undermines a state’s ability to control what happens in its own territory. Consequently, it is necessary to construct procedures, rules, and institutions through international law. Arguments about the importance of international legal regimes to the production of global ‘‘public goods’’ underscore the importance of international law in dealing with global problems (22). A great quantity and diversity of international legal regimes on global health risks emerged during the 1851–1951 period. ### Infectious diseases The series of [[International Sanitary Conferences]] together with other diplomatic efforts, produced many treaties on infectious disease control. Four organizations emerged during the 1851-1951 period as the development of international legal regimes on infectious diseases created international health organizations with a mandate to facilitate cooperation on infectious diseases: Pan American Sanitary Bureau in 1902, the Office International de l'Hygiène publique in 1907, the Health Organisations of the League Nations in 1923, and WHO in 1948. ### International trade in narcotic drugs and alcohol > States also used treaties and international organizations to control international trade in opium and alcohol. ### Occupational safety and health The founding of the [[International Labour Organization (ILO)]] in 1919 catalysed the creatino of international labour law because this body adopted numerous treaties on the improvement of standards. ### Transboundary air pollution Treaties on transboundary air pollution did not, however, develop in the 18511951 period. The best-known international legal dispute on transboundary air pollution in this period, the Trail Smelter Arbitration (1938), involved the application of customary international law rather than a treaty. The arbitral panel held that ‘‘no state has the right to use or permit the use of its territory in such a manner as to cause injury by fumes in or to the territory or the properties or persons therein, when the case is of serious consequence and the injury is established by clear and convincing evidence’’ ## Non-state actors and the globalization of public health, 1851-1951 A feature of contemporary globalization is the growing importance of multinational corporations and nongovernmental organizations on both global health problems and global governance. The growth in the importance of nongovernmental organizations in global health between 1851 and 1951 can be demonstrated by comparing the treaties establishing the Office International de l’Hygie`ne Publique and WHO. The 1907 treaty creating the Office International de l’Hygie`ne Publique contains no mention of nongovernmental organizations or of the possibility that it could collaborate with them (27). On the other hand, WHO’s constitution provides that it can consult and cooperate with nongovernmental organizations (28). While not as robust as the ILO constitution in respect of the use of non-state actors, WHO’s constitution recognizes the importance of public–private partnerships between international health organizations and nongovernmental organizations. ## Effectiveness of [[global health governance]] regimes, 1851-1951 Domestic sanitary and public health reforms were more significant than treaties in reducing morbidity and mortality attributable to infectious diseases in many Western countries during the first half of the 20th century. [[Open Question]] What about now? [[Has the significance of national public health reform shifted to international law or treaties in reforming public health?]] Since policy space for health in national level is getting smaller and smaller. ## Conclusion: lesson for the contemporary globalization of public health The following characteristics marked this period of global health governance: 1) a tendency for health risks to become global because of the growth in international commerce; 2) a need for states to cooperate through international law in order to confront global threats to health; 3) the involvement of nongovernmental organizations and multinational corporations; and 4) mixed results achieved by international legal regimes. [[Has the significance of national public health reform shifted to international law or treaties in reforming public health?]] 1. The 1851–1951 period of global health governance exhibits the same paradox as has been identified by the contemporary analysis of the globalization of public health: globalization jeopardizes disease control nationally by eroding sovereignty, while the assertion of national sovereignty can frustrate disease control internationally. 2. The first 100 years of international health diplomacy proved how vulnerable global health governance was to the machinations of states and the volatile dynamics of international politics. 3. Economic and technological interconnectedness in the period caused public health risks to become global more effectively than they fostered international cooperation to control them. 4. [[Power asymmetry]] Furthermore, the behaviour of the great powers undermined global health governance. Imperialism, two world wars, and a global economic depression weakened international cooperation on public health. The efforts of Western states to regulate the Asian opium trade and the trafficking of liquor to Africa seem hypocritical when one considers the exploitation of Asians and Africans at the hands of these countries. [[global health governance]] in the 21st century faces problems not seen in the first 100 years of international health diplomacy, e.g. those relating to [[genetic engineering]] and [[access to essential drugs]]. New technologies, such as the Internet, provide [[Non-state actors]] with more powerful resources with which to influence the direction of global health governance. For these and other reasons, looking backwards can offer lessons of only limited value. States, international health organizations, and non-state actors confront such 21st-century challenges with tools of global health governance that have remained largely unchanged since the 19th and early 20th centuries. ==This suggests that, in the final analysis, the tools are unlikely to bring about the differences that are needed. These are more likely to be achieved if states internalize public health effectively as an interest and value==.