Public health is a rare lamp pushing back the dark shadows of vulnerability, misfortune and poverty. JL
Worried because our work is considered unnecessary to decision makers and by those afraid of loosing crumbs from their opulent tables. AS
People are killed from infections and hardships in wartime and are the victims of poverty in peacetime. SBM
Millions suffer for one to enjoy. IM

The Association of Schools of Public Health in the European Region (ASPHER, 1966) is the key independent European organization dedicated to strengthening the role of public health and the hand of professionals by improving education and training for practice and research. Its headquarters today are in Brussels. Each year, it awards a prestigious Medal for excellence in the name of Andrija Štampar, a founding father of the World Health Organization (Geneva, 1948). The medal’s target was a distinguished individual and senior scientist whose “days of meddling” were over. There are about 25 Štampar Laureates each having made a personal and specific contribution. To them I say today, and in his words, continue to turn new and endurable furrows adding support the work of ASPHER. [1]

The choice of Andrija Štampar was relatively easy, first because of his implacable moral commitment to health and having demonstrated that progress comes from effective social policy and that the harshest consequences of poverty, is health. Secondly, he was considered one the greatest internationally minded physicians and a most effective organizer of public health. He saw the Academy as the highest reference point for art and science of a nation and a place where its past would be explored, its present kept in sharp and realistic focus and its future agonisingly considered.

Štampar grew up in a background of Croatian agriculture and the collapsing Ottoman Empire, Balkan wars (1912-22), the First World War (1914-18) and the global influenza pandemic (1918). Refugee trails were long and suffering incredible with millions of people homeless, undernourished, diseased, wounded and cold.

Andrija Štampar was a nonconformist and a self-actuated bear who wanted more honey for people suffering from tuberculosis (consumption), alcoholism (plum brandy) and syphilis (‘shadow over the land’). These were some of the factors implicit in social pathology. Vociferous always, Stampar fought quackery in all forms, condemned governments for being in the hands of gangsters and kidnappers and likened Balkan banditry to disease, especially malaria. He saw that malaria killed one tenth of the population annually and transformed fertile land into cemeteries. It is no less a miracle that with his gruff, staccato and simple non-grammatical English which dropped most articles from his speech that he was such a great communicator and was loved from the Americas to China.

Andrija Štampar (1888-1958) was a product of a rural background, which gave him earthly attributes in tandem with an extremely complex make up. He had a deep love of freedom and books. He disliked pessimism, nationalism and colonialism. Although born a Catholic he maintained a non-religious stance. He had his own theory of social function, emphasized the practical use of science for people and considered man’s fundamental needs to be physiological and social. He placed great importance on prevention, social insurance and the social dimension of medicine. He firmly believed that a physician should be a social worker and a teacher of the people.

No one can say that he knew his politics, simply because Štampar’s politics were the needs of people. As a medical adviser to Chiang Kai-shek he developed a Rural Health and Rehabilitation Program and was chastised by the Chinese authorities for meddling and praised for his services. While in China, his wife died at home in Yugoslavia and his emotions were revealed when he refers to her as my angel. His humanism and philosophy of life are found in the “the Magna Carta of Health” a preamble to the constitution of the WHO. He spent about 3 years in the predominantly agricultural country of China, and noted that the gentry had a dual role of money lender and landlord. If a farmer defaulted on a loan he lost farm and freedom and became a tenant. It contributed to social unrest; uprisings, smuggling of narcotics and a lucrative field service for farmers to ensure their heroin injections, especially at harvest time.

Leo Kaprio, Director-General of the WHO EURO, became the first Štampar Laureate (Bielefeld, 1993) and Donald Acheson, Chief Medical Officer of the United Kingdom was second (Krakow, 1994). The past two Laureates are Richard Horton (Vienna, 2016) and Elina Hemminki (2017) who will soon receive ASPHER’s prestigious award in Stockholm. Distinguished laureates have included Baron Peter Piot (Ebola), Halfdan Mahler (Alma Ata, Primary health care), Lennart Köhler (new public health), Richard Doll (Lung cancer and smoking) Ilona Kickbush (health diplomacy) and David Byrne (Tobacco control) as well as Julio Frenk (Mexico), George Soros (USA), Alexander Macara (UK) and Charles Mérieux (France). The medal has also gone to Canada, Greece and Hungary. ASPHER’s Stampar Laureate, Halfdan Mahler brought China into the WHO, excluded because of the Cold War politics.

Štampar arrived on the national scene of Yugoslavia because of his emphasis on rural medicine, at a time of growing faith in science to solve problems of poverty and the adversities of life. His arrival overlapped the entry of the Rockefeller Foundation into a Europe, devastated by war, convinced that good health was dependent on democracy and with and intent on disseminating the principles of public health organization. The Rockefeller Foundation stressed education, treatment, and the assumption of responsibility for health by local and state boards. A sotto voce and unannounced goal was to counter the re-emergence of German militarism and block the growth of communism. Andrija Stampar became its voice in Yugoslavia and became a social “meddler”.

That Andrija Štampar with communist leanings developed such a unique relationship with the Rockefeller Foundation, which worked so well, was nothing short of a miracle. It was a result of Štampar’s honesty and moral integrity as well as a catalytic chemistry and a coalescing of respective philosophies between himself and Wickliffe Rose (1862-1931). Rose, was the son of a wandering evangelistic preacher working with the Rockefeller Sanitary Commission in American southern states. Having found that forty percent of school-aged children were infected with hookworm the Foundation launched a Hookworm eradication program. The campaign stressed sanitation and use of sanitary privies to prevent children without shoes from standing where the larvae might reside. it gained momentum from fear of contagion by the affluent.

Štampar was disparaged by commercial-clinical elements in medicine and saw that many of his professional colleagues were incapable or ill-trained to understand his health focus on the community. He was denied due recognition as a physician. his “meddling” entered the Croatian vernacular as expressed in the phrase stamparia–schlamparia. It’s implication was that everything coming from him was rubbish or in the least inexact or doing things by halves. Several positive and negative corruptions come with Greek endings: Štamparofilija (much loved), Štamparofobija (much feared) and Štamparologija meaning both the words and sayings of Stampar. A term Štamparizam, is an indication that Stampar’s ideas and principles are being followed. One of his early sins was to reject military recruits based on their poor health for which he was sent to Mauthausen as a doctor of the notorious prison.

In 1930, and after a decade of service to Yugoslavia he was dismissed for incompetence by the King of Yugoslavia. One American novelist, nicknamed him Doctor Hercules and described his clean up of vast disease – ravaged regions of Yugoslavia in an amazingly short period of time was one of the most dramatic and noteworthy achievements in Europe, since WWI.

After his royal dismissal he might easily have faded from the health scene but for Ludwik Rajchman (1881 – 1965). Rajchman remembered his own exile (1906) as a result of socialist activities and his absence from Poland until he returned in 1918 and arranged Stampar’s first mission to China, through the League of Nations and the Rockefeller Foundation. Both Štampar and Rajchman saw the health consequences of disastrous flooding, disease, poverty and horrendous inequality in China. Their work there was interrupted as a result of Japanese protests over the League’s assistance to China.

As he left Yugoslavia in 1931, he received a wonderful letter from Milan Jovanovic Batut a most gracious man of small stature but a giant of public health - “I am pleased to see that there are people who do not think that the world begins (and ends) with them… I cannot comfort you… being older (86) and more experienced I can tell you that time heals wounds … I commend to your heart all the questions of public health and health promotion… you have a stretch of time in front of you and two serious tasks, to bring up your lovely children and to finish up the work you started... let them be the main content of your life”. And so it was.

Twenty years on, in the 1950’s, he saw the World Health Organization (WHO) as “an instrument which would make it possible for people to solve truly global problems in a spirit of true international cooperation to make the world better place to live in and in every respect healthier”.

At the same time Štampar was deeply conscious that the bright vista surrounding the drafting of the WHO constitution, and the mood of optimistic confidence, was not without its darker shadows.

Andrija Štampar had ernormous energy and enthusiasm, and was a confirmed world revolutionary. According to Time magazine he was a crusador for unanimity and one of the commanding figures of international health. With equal vigor, he promoted unity at home and social justice globally. An American doctor referred to him as the Balkan bear and said “there were times when we would have been glad to skin the "bear of the Balkans" and hang his hide high on a tree”.

Andrija Štampar’s life journey was a fascinating bridge between social medicine and global health. Its international course started in 1919 when he examined the condition of child health in a Paris Congress and continued through his work with the Rockefeller Foundation in the Balkans in China and elsewhere. He gave the Cutter lecture in Harvard (1938).

The 8th World Health Assembly took place in Mexico (1955) with an agenda of malaria eradication and the peaceful use of nuclear physics in medicine. In closing his acceptance speech for the prestigious Bernard Leon Prize, (which together with the Darling award are two awards of the WHO), he said: “the few years of active life that I have left will be dedicated, as those of the past, to our common aim: to world health”.

Three years later (1951) he died true to his early resolve to follow the voice of Batut, his teacher, who laid down the foundations of social medicine in Yugoslavia. He remained faithful to his early values expressed in a youthful publication, “there is no revival of public health without ethical revival” and having fulfilled the tasks set down for him on his way to exile (1931).

[1] The award was established during my Presidency of ASPHER. A list of Stampar Laureates can be found on its web-page. Luka Kovacic, Zagreb provided me with the “Štamparologija” after our first interaction in 1984 and from where the medal inscription was chosen. Ulrich Laaser, Bielefeld, who became a Stampar Laureate, cut the first medals. The award brought renewal to an Association in disarray.

MD Grmek. Serving the Cause of Public Heath. Selected works of Andrija Štampar, Zagreb, 1966 and published as the time of ASPHER’s birth in Zagreb.
J. Levett Political, Wall Flowers Butterflies for Global Health?
ASPHER web-pag
ASPHER’s 50th Anniversary Book Edited by: Anders Foldspang, Jacqueline Müller-Nordhorn, Vesna Bjegovic-Mikanovic, Robert Otok, etc.
Jacqueline Müller-Nordhorn
Vesna Bjegovic-Mikanovic
Robert Otok
© 2016 The Association of Schools of Public Health in the European Region (ASPHER)
J. Levett. Two Decades of the ASPHER Andrija Štampar Award-A Tribute to the Ever Current Štampar, Malta 2012