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Andrija Štampar - founder of the Yugoslav Public Health Service and Yugoslav ambassador to the WHO

Dušan Petar Kuljančić

UNIVERSITY OF NOVI SAD, FACULTY OF MEDICINE, HAJDUK VELJKOVA 3, NOVI SAD; CLINICAL CENTER OF VOJVODINA, CLINIC FOR PSYCHIATRY, HAJDUK VELJKOVA 1, NOVI SAD

Andrija Štampar was born more than 130 years ago in a small Slavonian village (Croatia) in the area of the Austro-Hungarian monarchy. His father was a teacher, and because of his service, the family often moved. So Stampar had a lot of time to observe the everyday life of ordinary people. At that time, there were no doctors or medical services in the villages in the Balkans. We are talking about the backward society of peasants immersed in ignorance, which had great negative consequences for the health of the people. From 1898 to 1906 he attended the Gymnasium in Vinkovci, which he finished as an excellent student. He began his medical studies in 1906 in Vienna, then the most important medical center in the world [1]. He completed them in just 5 years and 2 months, on December 23, 1911. While a student, he published over 70 articles and brochures, mostly aimed at health education, and gave a series of public lectures in Vienna and his homeland. Most importantly, however, it was during this period that he formed his clear views on social medicine. He was simply a man who knew exactly what he wanted, and at the same time energetic, persistent, uncompromising, self-confident [2]. In 1909, in Nova Gradiška, he founded his own journal called the Public Health Library, in which he wrote articles on numerous topics on health and disease prevention. After finishing his studies, Dr. Štampar was first employed in Karlovac, and then he was transferred to Nova Gradiška and promoted to municipal doctor [3]. During World War I, he worked as a doctor in a prison camp in Mathausen, Austria [2]. After the end of the war, as one of the few highly educated people in the newly formed state of the Kingdom of Serbs, Croats and Slovenes, he was appointed a health advisor in the Social Welfare Commission of the National Council in Zagreb [4]. In 1919, he gave a lecture on children's health at the Congress of Allied Countries on Social Hygiene in Paris. Even then, he clearly showed that he has a clear concept of organizing a public health service [3].
As a man of such a rich reputation, even then, in May 1919, he began his career in Belgrade. Dr. Milan Jovanović Batut, then an old renowned doctor in Belgrade, recognized the talent and interest in social medicine and hygiene in the young Štampar. That is why, at the age of only 31, Štampar manages to get a job in the Ministry of Public Health, and that would not be any job, but an assistant minister, that is. Head of the Department of Racial, Public and Social Hygiene. His quote with which he appeared before Batutum is well-known: "I have no personal acquaintances or friends here, I make no oral or written recommendations." But Batut won with his mature thinking and deep conviction about the values of health for the human community [2].
With the limited material and logistical resources at his disposal, in a newly formed country, poor, backward, composed of various peoples and nationalities and different geographical areas, devastated after the recently ended wars (Balkan and World War I), with a population tormented by hunger and diseases, burdened with social problems, and with insufficient doctors and medical staff, Štampar took on the task of organizing a health service. It was just a challenge for him [2].
However, with great personal commitment and enthusiasm, he managed in the first 5 years in the position of the Ministry of Public Health until 1924 to establish as many as 250 social and medical institutions throughout the then Kingdom of Serbs, Croats and Slovenes: from public health homes and health stations, through bacteriological and antimalarial stations, tuberculosis dispensaries, sexually transmitted diseases clinics, school polyclinics, institutions for infants and young children, all the way to the Central Hygiene Institute in Belgrade and the Hygiene Institute with the School of Public Health in Zagreb. At the same time, he worked on training the missing health staff - schools for nurses were established in Zagreb, Belgrade, Ljubljana and Skopje. The program of the Medical Faculty in Belgrade and Zagreb includes classes in social medicine and hygiene. Guided by his ideal of public enlightenment, Štampar, within the School of Public Health, organized an innovative so-called "Peasant University", within which multi-month seminars on health issues in rural areas are held [1,2,4].
Following his ideal, prof. Dr. Andrija Štampar created advanced medicine, based on evidence whose only purpose was to serve the people. However, as his ideals at the time were characterized as social democratic and leftist in the early 1930’s he came into conflict with the government. In 1931, therefore, he failed to obtain the consent of the authorities for the election to the title of full professor of hygiene and social medicine at the Medical Faculty in Zagreb [2].
Therefore disappointed, he turns to the fight for public health at the international level. From 1931 to 1933 he worked as a full-time member of the Health Organization of the League of Nations. He is engaged in a completely new, but also close to him job, education of health personnel. Traveling through Europe, as a visiting professor, he lectures at medical faculties and schools in the Netherlands, Spain, Greece, Poland, Hungary, and Germany. He also visits the United States and Canada as a guest of the Rockefeller Federation. In 1938, he gave numerous lectures at renowned medical schools throughout the United States, such as Harvard and the University of California, where he worked as a professor during 1938/39. He also visited China, where from 1933 to 1936 he remained as an advisor to the Chinese government and worked on organizing health services after the catastrophic floods of 1931 [1,2,3,4,5].

Picture number 1. Andrija Štampar (on the right) in Lanchow, China, in 1930’s [6]

After the political changes in the then Kingdom of Yugoslavia, Štampar returned to Zagreb in 1939, where his election as a full professor of hygiene and social medicine was finally confirmed. As the most mature and most experienced teacher, he was elected dean of the Medical Faculty in Zagreb the following year, and thus dedicated himself to reforming teaching within the medical profession. This fruitful work was soon interrupted again by the German invasion of Yugoslavia in 1941. Immediately after the establishment of the Ustasha regime, Štampar was arrested and once again, as politically unfit, was interned in a camp in Graz, where he was liberated in 1945 [2].
After returning to his homeland, in May 1945, he again took over the professorship, the Faculty of Medicine, the University of Zagreb and the administration of the School of Public Health. Then the successes in his professional career in the newly formed communist Yugoslavia are reduced. In 1947, he became an academician and a regular member of the Yugoslav Academy of Sciences and Arts, whose president he would be until his death in 1958 [2].
As well as at home, Štampar is also successful at the international health level in the world after World War II. What is perhaps the most important achievement of Andrija Štampar is his key role in the formation of the World Health Organization [1]. In 1946, the development of an international health organization within the United Nations began. In 1946, he was elected the first vice-president of the UN Economic and Social Council and the president of the Provisional (Interim) Commission, which performed the duty of that organization until the ratification of the constitution of the World Health Organization [3]. Within this commission, Štampar himself has the task of preparing a constitutional act of the future World Health Organization, known as the "Magna Carta of Health" and famous for its idealistic definition of health. "Health is a state of complete physical, mental and social well-being illness and exhaustion. " [1]. In the period from 1945 to 1948, he chaired all the sessions of this international health body. Then, at a session from June 24 to July 24, 1948 in Geneva, chaired by Stampar, as an anonymously elected president, the Constitution was adopted, which was drafted by a commission under his leadership, and the World Health Organization was established [3]. The printer remained active in the World Health Organization, dedicated to promoting and advancing the health of the world's population until his death on June 26, 1958 [1].

Picture number 2. The Interim Commission met in Geneva in 1946. From left, Dr Štampar, a president to the commission [6]

At the eighth regular session of the World Health Organization in 1955 in Mexico City, Andrija Štampar was awarded the recognition of the Leon Bernard Foundation for all work and achievements in the field of public health and social medicine [3].
Today, the work of prof. Dr. Andrija Štampara has not been forgotten both in his homeland and in the world. In the Republic of Croatia, the University of Zagreb awards an annual prize to individuals and organizations for their scientific results, promotion of science and profession, and transfer of knowledge and education of young experts in the field of biomedical sciences named after this famous professor [7]. Every year, the European Association of Schools of Public Health awards a prestigious recognition at a regular meeting, which is also named after Andrija Štampar for his achievements in the field of public health [8].

SUMMARY

Life and work of prof. Dr. Andrija Štampara are extremely important for the young generations of doctors and scientists from this area. Despite various economic and political turmoils and obstacles in the hilly Balkans, his diligent work, perseverance and dedication led Dr. Stampar to unprecedented successes in the international health field. Dr. Štampar even twice created a health service in his homeland out of nothing. His ideology was a belief in the primary social role of health and in the possibility of improving it with social and medical measures, because, as he said more than once, "everyone has the right to health" [2].

Conflict of interest: Dušan Kuljancic- None.

LITERATURE:

1. Brown TM, Fee E. Andrija Stampar: charismatic leader of social medicine and international health. Am J Public Health. 2006;96(8):1383. doi:10.2105/ AJPH.2006.090084
2. Dugački V., Žižak M., 2020. Medicinski fakultet Zagreb | Andrija Stampar - STUDMEF. [online] stariweb.mef.hr. Available:http://stariweb.mef.hr/studmef/znanost/ucimo-znanost/andrija-stampar-2.html [Accessed 25.10.2020.].
3. En.wikipedia.org. 2020. Andrija Štampar. [online] Available from:https://en.wikipedia.org/wiki/Andrija_%C5%A0tampar#cite_ref-HE_1-3 [Accessed 25.10.2020.]
4. Štampar, Andrija. Hrvatska enciklopedija, mrežno izdanje. Leksikografski zavod Miroslav Krleža, 2020. Available from:http://www.enciklopedija.hr/Natuknica.aspx?ID=59892 [Accessed 25.10.2020.].
5. Grmek MD, ed. Serving the Cause of Public Health: Selected Papers of Andrija Stampar. Zagreb, Yugoslavia: Medical Faculty of the University of Zagreb; 1966:16.
6. Croatia.org. Zagreb, 2020. Andrija Stampar, Croatian Scientist, Father Of The World Health Organization. [online] Available from:http://www.croatia.org/crown/articles/9595/1/Andrija-Stampar-is-the-father-of-the-World-Health-Organization.html [Pristupljeno 25.10.2020.].
7. Konecki, M., 2020. Nagrada Andrija Štampar. [online] Unizg.hr. Available from:http://www.unizg.hr/istrazivanje/istrazivanje-i-inovacije/nagrade-za-posebna-postignuca/nagrada-andrija-stampar/ [Accessed 25.10.2020.].
8. Aspher.org. 2020. ASPHER - ANDRIJA STAMPAR MEDAL. [online] Available from:https://www.aspher.org/andrija-stampar-medal.html [Accessed 25.10.2020.].