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Pax Atlantica

NATO’s long-lasting relevance

A Larger Role for Unions

Organized labour may be shrinking but the rhetoric is still upbeat

This United League

Will not die, will not perish

WHO Is Brock Chisholm?

Sometimes being there is just not good enough

Michael Bliss

Brock Chisholm, the World Health Organization and the Cold War

John Farley

University of British Columbia Press

246 pages, hardcover

“That Canada, a country which prides itself on its support for the United Nations … no longer remembers that one of its own became the first director general of one of the UN’s most important agencies is a national disgrace.”

Thus John Farley, a veteran historian of science and medicine at Dalhousie University, justifies his book-length account of Dr. Brock Chisholm’s service in the early years of the World Health Organization. Fair enough in the sense that Chisholm has certainly been forgotten, both in Canada and everywhere else. The problem is that Farley, being an honest scholar, works against himself in showing that Chisholm has been deservedly forgotten. Both at the time and since, most people who paid attention to his career, including Canadians, thought that Chisholm himself was a bit of a second-rater. The role he played in the formative years of the WHO had nothing to do with Canada or Canadian health care, and does not seem to have been distinguished or decisive. The thought that we should celebrate the mere fact of a Canadian’s presence on an international stage belongs to what might be called the Peter Sellers school of nationalism: just being there makes you a kind of Canadian immortal.

Young Brock Chisholm’s better claim to a kind of immortality was as a soldier in the Canadian army during the Great War. From 1915 to 1918 he fought unscathed through all the major Canadian battles on the western front, earning the nickname “Nemo” after an indestructible comic-strip character. In this respect Chisholm was luckier than the man he was named after, General Isaac Brock, who fell in the War of 1812.

Chisholm graduated from the University of Toronto’s Faculty of Medicine in 1924, apparently without distinction. He was a general practitioner for several years in Oakville, Ontario, then studied psychiatry in England and the United States before beginning practice in Toronto as a Freudian psychotherapist. Not being particularly successful (Chisholm’s biographer, Allan Irving, notes that his application for privileges at Toronto General Hospital was rejected), he relied on membership in the Canadian militia for social advancement. In World War Two Chisholm was promoted very rapidly, becoming director general of medical services, mostly, it seems, because of his activities promoting psychological testing of recruits, a bureaucratic exercise of doubtful benefit to anyone. In 1944 Chisholm became deputy minister of health and welfare, a senior appointment in a then junior department.

Chisholm proceeded permanently to blot his copybook with speeches and comments of consummate silliness, mostly arising from simple-minded Freudian views about the profound importance of childhood education and the overriding need for honesty. Insisting that parents must never lie to their children, Chisholm went over the top:

Any man who tells his son that the sun goes to bed at night is contributing directly to the next war … Any child who believes in Santa Claus has had his ability to think permanently destroyed … He will become a man who has ulcers at 40, develops a sore back when there is a tough job to do, and refuses to think realistically when war threatens.

Asked to clarify these views, Chisholm told a reporter that “Santa Claus was one of the worst offenders against clear thinking and so an offence against peace.” In a footnote Farley mentions that Chisholm lied to his adopted son about his parentage in a manner that was “totally bizarre and inexcusable.”

The “Santa Claus man” became an instant, serious embarrassment to the government of Canada. Chisholm would almost certainly have been dismissed and then disappeared into obscurity had he not, after attending an international health conference in his official capacity, been appointed executive secretary of the interim committee that worked from 1946 to 1948 to create the World Health Organization. Canada was glad to be rid of a man who, Farley notes, many considered “a godless, opinionated, outspoken iconoclast with a propensity for putting his foot in his mouth.” Chisholm had nothing in common with the great mandarins of the golden age of the Canadian civil service.

On Farley’s evidence, Chisholm, who had no expertise in public health work, became the founding director general of the World Health Organization in 1948 mostly faute de mieux, the mieux being a far better qualified American who would have been discriminated against because of his nationality had he chosen to run for the position. During Chisholm’s tenure, Canadian delegates to the WHO seem to have been critical of his leadership, not particularly supportive of the organization (“the Canadian delegation cannot

be expected to be of much use,” Chisholm complained) and not especially keen that he take a second term.

There were no tears, in Canada or anywhere else, when Chisholm announced his retirement at age 57 in 1953. He was never invited to serve any government organization again, inside or outside Canada, made a fool of himself running as a Conservative in a British Columbia election, published a jumbled book recycling what Farley considers to have been “superficial and stereotypical” opinions and died in 1971. He was awarded one honorary degree by a Canadian university, the University of British Columbia, and in 1967 become one of the first recipients of the Order of Canada.

Most of Farley’s book is a study of the World Health Organization’s activities during Chisholm’s years. Although he has apparently ransacked the WHO archive, the author says almost nothing of Chisholm’s leadership style, commenting only that a man colleagues described as shy and quiet “must have shown leadership qualities as well as an aura of command.” Almost all of the circumstantial evidence Farley cites, however, is to the effect that Chisholm’s vision for the WHO was impractical and a failure. The organization evolved almost literally in spite of its director general.

Farley presents Brock Chisholm as a believer in a total, social approach to health care and in beneficent global organizations acting independently of nation-states. He apparently thought disease was mostly a function of poverty, to be attacked by attacking every aspect of poverty. The WHO ought to bring “social medicine” to the world, leading without fear or favour and serving the interests only of people, not governments (in his retirement years Chisholm was a prominent member of world federalist organizations).

In Farley’s narration Chisholm seems to lose every battle. The WHO almost immediately shelved all plans to promote “social medicine,” a wildly expensive and impractical proposition, in favour of discrete “magic bullet” campaigns to mobilize miracle drugs, such as penicillin and DDT, against specific diseases. Its greatest early battles were against tuberculosis, syphilis and malaria. A director general who once commented that “one cultural anthropologist is worth more than 100 malaria teams” was not well positioned to be in the forefront of the struggle, which was managed by trained epidemiologists and public health professionals. Nor did Chisholm’s well-known hostility to traditional religious beliefs or his support of sterilization of the unfit and family planning endear him or the WHO to the Roman Catholic church. Reducing public health to something approaching social farce, the Vatican would only condone WHO birth control programs based on the rhythm method.

Farley is unconvincing when he tries to argue that the evolution of the Cold War between the American and Soviet blocs was mostly at fault in dooming the WHO to becoming the pawn of nation-states. Certainly Cold War attitudes were important: the Americans, expected to put up most of the money, tended to play hardball with soft-minded idealists; the Soviets and their satellites mostly boycotted the WHO during Chisholm’s tenure; Canada was mostly content to play arcane and irrelevant status games. But Farley’s own evidence suggests that the key lines of division on WHO issues cut across the great ideological gap. Both communists and Catholics, for example, believed that their ideologies offered better answers than penicillin did for treating venereal disease. Why bother with symptoms, the true believers argued, when the real solution would simply be to end prostitution? On the other hand, no nation-state, communist or capitalist, believed that the WHO could possibly be above national and international politics. In this as in many other matters, Chisholm’s naiveté was stunning even by the standards of an often naive era.

In the end John Farley seems defeated by the evidence of Chisholm’s consistent mediocrity. He cites an anonymous reviewer who commented on an early outline of his book that Chisholm was just a “stop-gap” not worth writing about, and offers in rebuttal only the thought that the WHO’s survival of its first five years, and its modest growth, “surely reflects credit on Chisholm.” Trying to put the best face on the life of a man often out of his depth, Farley concludes by remarking on a spirit that survived Flanders fields and Picardy. For a Canadian it seems good enough to have been a Nemo.

Surely it is time to stop deluding ourselves about heroic Canadian achievers and achievements, especially in health care. The Chisholm story illustrates two of our least attractive penchants. First, there is nothing to be gained in the eyes of the world, or in the eyes of many of our own people, especially the young, by over-hyping the work of flawed figures such as Chisholm, Frederick Banting, Norman Bethune or even St. Thomas Douglas. Why spend large sums of private and public money promoting what my students used to refer to cynically as “Heritage Minutism”?

Second, we would do well to realize that the Canadian contribution to the solution of global health problems is probably no more than proportionate to the relatively small size of our population. In the past we did good work in sending medical missionaries abroad, and today many of our young physicians are internationally minded and support such neo-missionary organizations as Médecins Sans Frontières. We do fairly good medical research in Canada, and our people contribute generously to international disaster relief. We have exported a large number of highly talented doctors and nurses to the United States, thus considerably benefitting the health of Americans. I assume we pay our dues to the WHO and other international organizations, and we have given the UN Stephen Lewis, who may or may not be doing as much good in Africa as, say, Bill Gates.

Beyond that, Canada is mostly mired in the second tier when it comes to contributing models of excellence to the rest of the world. We are not on the forefront of serious public health debates, such as the real relationship between poverty and sickness (such diseases as epidemic malaria, for example, and now possibly AIDS, may be both cause and consequence of poverty). To hold down the costs of training our own people to be healthcare workers, we are shamelessly looting human resources from some of the world’s most needy countries. We are not global leaders in healthcare innovation, and our own distinctive national approach to socialized medicine, which we used to trumpet as a beacon to the world, has not been deemed worthy of imitation by any other country, not one. As Maclean’s has recently suggested, it may be that our system of veterinary medicine serves animals better than our healthcare networks serve humans.

In the introduction to Brock Chisholm, the World Health Organization and the Cold War, John Farley notes that the current director general of the WHO, Dr. Margaret Chan of China, earned her medical degree from the University of Western Ontario and holds a Canadian passport. This, it seems, has been a matter of national pride in the Canadian media. It is beyond Farley’s purview, but surely of interest, that Dr. Chan’s now mature organization, one of whose functions is to assess performance across national boundaries, ranks Canada’s healthcare system 30th best in the world, well below Great Britain’s, just behind Morocco’s, a little bit better than that of the United States. This may be absurd, but no more so than our incessant proclamation of our own excellence.

Misplaced national pride can be a powerful and dangerous opiate, masking situations of real national disgrace.

Michael Bliss’s books in medical history include The Discovery of Insulin,  Banting: A Biography, William Osler: A Life in Medicine, Harvey Cushing: A Life in Surgery, and The Making of Modern Medicine: Turning Points in the Treatment of Disease.

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