Humanities, criticality and transparency: global health histories and the foundations of inter-sectoral partnerships for the democratisation of knowledge

Historians of medicine have made significant contributions to the broader movement highlighting the relevance and social benefits of historical and humanities research to contemporary policymaking in a number of very distinctive contexts. In terms of health policy, as well as helping policy makers extract real lessons from the past, historical perspectives are considered particularly useful because questions about what it is to be healthy and to suffer disease or disability are interwoven in culturally, socially and politically complex webs of meaning. Historians probe these meanings critically, the complex negotiations that underpin them, and evaluate decisions concerning the impact of administrative contexts, moral calculations and formal ethical protocols, often working alongside colleagues from other disciplinary backgrounds to better integrate the humanities, social sciences, biomedical sciences, medicine and public health. Several scholars argue that without history, thinking about health policy in our complex present would be an impossible task, and that public and global health are unimaginable without insights from the social sciences. These examples are part of an increasingly global conversation about the fundamental benefits of historical research to policy. This article discusses the opportunities and challenges in bringing health history and international health policy together through the case study of the long-running World Health Organization (WHO) Global Health Histories (GHH) project. GHH was founded within WHO Headquarters (WHO HQ) on the principle that academic history could contribute productively to present-day debates about health challenges, and whilst the project's title has remained unchanged, for several years it has also invited and embraced a variety of perspectives from different disciplinary backgrounds, to look at the past by drawing on diverse kinds of sources and voices. Established in late 2004, mainly through the energies of Dr. Ariel Pablos-Mendez, the series' enduring rationale has been that understanding the history of health helps the global public health community to respond to the challenges of today, thereby shaping a healthier future. GHH has sought to do this by bringing together researchers and policy-makers through seminars, meetings and engagement events held at WHO offices and venues around the world, using presentations and resulting discussions to stimulate a fusion between historical evidence and current approaches. It has sought to help construct new and enduring bridges between academia and global health policy, while at the same time promoting public engagement and raising awareness around key issues in global health. The benefits of increased dialogue, knowledge sharing, and collaboration between historians (and indeed scholars across the humanities and beyond) and policymakers have been widely acknowledged. However, this enthusiasm comes with important caveats. The history in question needs to be rigorously practiced and independently prepared: historians must be allowed to uphold their criticality in order to capture the widest possible range of voices, opinions and experiences, and avoid producing hagiographies or simplistic narratives of unchallenged progress. Institutional histories are often triumphalist, highlighting the work of a relatively small number of actors to the exclusion of others and the many complex administrative structures involved in healthcare delivery, including large international and global health programmes that only succeeded due to significant regional cooperation and national government contributions. There are enduring scholarly anxieties about research potentially being misappropriated and misrepresented in subjective political and public health contexts to justify specific, contemporary policy choices. Commentators caution against 'historian free data', whereby history is used without the involvement of historians, and note that policy popularity of history can lead some policymakers to feel they can do it themselves. A UK report concluded that understanding what history is and how it can help is important for making good policy decisions, but that a more systematic approach to embedding history within the policy process is required. How to convince policy partners of the value and relevance of history, and create inter-sectoral partnerships to allow productive collaborations to flourish, have been at the forefront of debate for years (often focused on national contexts rather than the more intricate networks of international and global health). There also needs to be a realistic appreciation of what history can bring and how it can be used effectively to challenge assumptions, stoke debate, conceptualise alternative approaches, and enable a democratic sharing of policy-relevant findings across complex administrative constituencies. While 'lessons' in the form of thoughtful narratives about complex official and societal attitudes and actions from the past may be expected by audiences, it is erroneous to believe that historical research can yield simple instructions about what worked or failed and use these schematically for future planning. Getting research noticed by administrators and establishing collaborations is rarely straightforward. Questions about how these collaborations are evidenced have intensified as impact requirements have grown. Historians can struggle to evidence the extent of their research, particularly when it falls outside mainstream definitions of impact, risking not being captured or valued. Ultimately, whilst there is a strong record of historians engaging policy effectively and ethically, what forms collaborations should take, and how impact should be measured and quantified, are still being worked out. The purpose of this article is to consider connected points of concern. Can academic historians really make a difference to inter-connected regimes of national, regional, international and global health work today? How can they ensure that the voices of the few from one location are not simplistically presented as the universally accepted view or solution? How can historians help differentiate between distinct and complex processes of policy design, implementation and evaluation, which take place at multiple sites involving actors across the political and health spectrum? The article also speaks to wider questions about attempts to bypass institutional myths about top-down imposition of unified ideas and principles, and to study large, multi-faceted organisations and their interconnections in the greatest possible complexity. The nuanced study of the genesis of plans and projects, and the implementation sciences underpinning them, play an enabling role in forming inter-sectoral partnerships for the democratisation of evidence collection and use, involving data collected from and in partnership with local governance and target populations. This article reflects on challenges associated with convincing policy partners involved in the GHH project of the value of critically conceived historical methodologies, which push back against over-generalisation, simplification and exclusion in collecting qualitative data about health planning and administration. Above all, it unpacks how such projects can contribute to the democratisation of evidence collection and knowledge production about health and medical policy. This builds on, and contributes to, the idea of 'healthy publics' as dynamic collectives of people, ideas and environments that can enable health and well-being. These publics may be geographically diverse but bring a range of expertise, materials, relationships and experiences to question received approaches to health. The work with WHO partners rejected efforts at creating subjective norms presented as universally valuable; thoughtful humanities and social science work valuable for creating democratic spaces in health policies emphasises studying diverse contexts in their own terms. History can be an effective way of making key issues in science, medicine and public health more accessible to different audiences, as well as helping explore and understand complex issues. Digital tools have expanded methods and strategies for engagement, though social media is not an unproblematic route to engagement. Engagement should strive for an involved, collaborative approach. Innovative projects help ensure that people feel part of and able to contribute to the research process, making teams and outcomes more immediate and accessible. Rather than simple dissemination, interaction, engagement and institutional uptake are the watchwords, using multi-pronged approaches that combine lectures and exhibitions with more hands-on approaches. GHH has reached out extensively since it was founded, and this article reflects on the potential, pitfalls, and consequences of different strategies for doing so. In preparing this article the views and opinions of twenty-two individuals connected to the GHH project from within and outside of the WHO were invited (thirteen provided responses). They were requested to be honest and critical about the opportunities presented by the series and the challenges that it has faced. Some agreed for anonymity to be waived when informed consent was obtained. In analysing them we approached these reflections critically, recognising that some recall decisions and events more than a decade old. They convey satisfaction at involvement but also reflect on problems of maintaining influence, negotiating a multifaceted and ever-changing organisation, and demonstrating impact. The interviews supplement published contemporary reflections and are used to reflect on the project and offer what historians might take away from this example of negotiating and speaking with non-historians. We hope the discussion provides useful information to those involved in, or seeking to establish, similar projects, as well as those looking to engage policy individually.

The paper does not present a standalone literature review section, but engages a body of scholarship on the role of history and the humanities in health policy. It references arguments that history is essential for contemporary health policy thinking and that public/global health require social science insights (e.g., Stevens, Rosenberg and Burns 2006; Pickersgill et al. 2018). It discusses concerns about misuse of historical evidence in policy (“historian free data”: Berridge 2008) and the tendency of some policymakers to bypass professional historians (Sheard 2018). It cites a UK AHRC/Institute for Government report calling for systematic embedding of history in policy (Haddon et al. 2015), and addresses challenges of evidencing impact in the humanities (Hazelkorn 2015; King and Rivett 2015). The article also situates institutional histories’ frequent triumphalism within broader historical critiques (e.g., Bhattacharya 2006, 2013; Bhattacharya and Campani 2020), and builds on concepts of ‘healthy publics’ (Hinchliffe et al. 2018).

The article is a reflective case study of the WHO Global Health Histories (GHH) project using: - Qualitative interviews: 22 individuals connected to GHH from within and outside WHO were invited to contribute reflections; 13 provided responses. Participants were encouraged to be honest and critical about opportunities and challenges. Anonymity was offered; some participants consented to attribution. Informed consent was obtained from all participants. - Ethical approval: University of York’s Arts and Humanities Ethics Committee approved the research. - Documentary and archival sources: The authors drew on oral and archival history underlying GHH seminars and training events; internal project reports; WHO materials; seminar recordings; and published contemporary reflections (e.g., in Wellcome History) to triangulate and contextualise interview insights. - Analytical approach: A critical analysis acknowledging recall bias (some events more than a decade earlier) and organisational context, aimed at identifying strategies, challenges, and impacts of historian–policy collaborations within WHO. - Data availability: To protect confidentiality and privacy, datasets from interviews are not publicly available.

- Scale and trajectory of GHH: Established in late 2004 within WHO HQ; over nearly 15 years it surpassed 138 events, involving hundreds of WHO staff, government officials and academics, with thousands more engaged in person, online, and via exhibitions and publications. - Evolution of format and reach: - Early years: Geneva-based, small internal budget, minimal public record (slides online). Demonstrated appetite among WHO staff for critical historical insights. A landmark seminar featured former DG Halfdan Mahler with 150+ attendees. - 2009–2014: Thematic series (e.g., Tropical Diseases 2009), inclusion of WHO staff discussants, inter-departmental engagement, and first sustained live broadcasting and open access recordings, enabling broader global participation. - 2010–2013: Formalisation within WHO (OSER status), move of academic coordination to University of York, Wellcome Trust support, creation (2013) of a WHO Collaborating Centre for Global Health Histories at York. - 2013 onward: Expansion beyond HQ to regional and country offices (EURO 2013; EMRO 2014; Sri Lanka country office 2016; Brazil/Fiocruz 2016). The 100th seminar (2017) was livestreamed in English and Spanish. - Interdisciplinarity and democratisation: - Broadened disciplinary participation beyond history to social sciences and related fields; increased number of panellists; shorter contributions with more discussion; use of social media and livestreaming to enhance transparency and access. - Emphasis on critical, independent scholarship—no vetting of academic critiques of WHO—fostering open debate including by serving and retired WHO/UN officials. - Knowledge production and dissemination: - Multi-lingual, accessibly written, open-access short histories (on tuberculosis, tropical diseases, universal health coverage, leprosy, mental health) synthesized seminar insights and were used globally for advocacy, education, exhibitions, and public engagement, including support for the WHO ePORTUGUÊSe network. - Exhibitions and media coverage (e.g., Huffington Post, Hyperallergic) extended reach and reuse (e.g., UN City Culture Night screening of Seminar 110 on polio, immunization, UHC). - Organisational impact and learning: - Enhanced inter-departmental dialogue and collaboration across WHO silos; served as an eye-opener for new staff on global health issues; facilitated connections with other UN agencies and external partners (e.g., World Council of Churches). - Recognised by WHO leadership as impactful, contributing to knowledge management goals, building a learning organisation, and legitimising qualitative, historically informed approaches alongside quantitative evidence. - Practical challenges: - Internal resistance from some middle management; perception of HQ-centricity; selection of timely topics; technological hurdles for broadcasting/recording; limited staff time and resources; competing priorities (duty travel, crises); logistical complexities of scheduling across WHO and university calendars; evidencing impact beyond simple metrics (view counts) and across time zones. - Tension between demand for rapid outputs and historians’ longer research timelines; constraints on producing exhibitions/publications for all requested topics. - Interview-based insights: - 22 invited, 13 respondents; reflections highlighted value in fostering collaboration, learning from diverse perspectives, and democratizing access to policy debates; acknowledged difficulties in measuring mindset change and sustaining long-term engagement.

The case study demonstrates that academic historians can meaningfully contribute to contemporary national, regional, international and global health work when collaborations safeguard critical independence, embrace interdisciplinarity, and prioritise transparency and inclusion. GHH shows that historical analysis can: - Illuminate the complex socio-political and administrative contexts shaping health policies, differentiating between design, implementation and evaluation across multiple sites and actors. - Challenge institutional myths and triumphalist narratives by incorporating diverse voices (including retired officials and local/national perspectives) and by openly debating WHO’s performance, thus reducing the risk of propagandistic uses of history. - Democratise evidence and knowledge production by expanding participation (global livestreaming; multilingual outputs) and enabling publics to directly question policymakers. - Shift institutional cultures by legitimising qualitative and historical methods within an organisation traditionally anchored in quantitative and clinical/epidemiological paradigms, thereby fostering cross-departmental collaboration and learning. At the same time, the work underscores persistent constraints: organisational scepticism, resource and technological limitations, mismatched timelines between policy and academia, difficulties in measuring impact beyond engagement metrics, and challenges in maintaining momentum across reforms and personnel changes. These findings speak directly to the article’s guiding questions, indicating that historians can make a difference when embedded in respectful, multi-level alliances, while cautioning against universalising solutions and emphasising context-specific approaches.

The oral and archival history research carried out for all WHO Global Health Histories seminars and training events, as well as this article, shows how all academics keen to engage and partner national, international and global health programmes need toolkits to develop a full understanding of the great complexity of each of these contexts. The WHO, as it exists in Geneva, the Regional and Country Offices, and its partner governmental organisations at each of these levels are not monolithic organisations. WHO offices, and national and sub-national health ministries, are composed of multiple divisions and departments whose structure, staff and functions continue to change through processes of restructuring and reform. For academic bodies to consistently work on research and evidence-based policy management, it is, therefore, important that broad-ranging and robust alliances, built on mutual self-respect and trust are put into place. The WHO GHH project has been no exception. It has benefitted from developing lasting connections with multiple WHO Divisions, Clusters and Departments around the world, even though it has only been anchored within one Division at any specific point of time. This network of WHO alliances helped, in turn, to create wide-ranging links to national governments, which have been indispensable to the expansion and strengthening of the project's many activities. This network of alliances is, perhaps, the principal determinant of WHO GHH's longevity, representing the WHO's longest-running, publicly-facing programme of work. Whilst we have focussed on the WHO, a primary lesson from this article for future, similar activities is to develop robust understandings of and relationships with multiple departments and their personnel so that sudden reform, or departure or retirement of key collaborators does not diminish a collaborative programme or force it to close down. The development of deep, well-informed and mutually respectful relationships also promotes the democratic co-production and communication of research, enabling the articulation and recording, for future training and planning work, of the widest possible range of voices and viewpoints. Such an approach is reliant on the use of multiple languages, eschews the imposition of any social and cultural over-generalisations and Euro-centric norms, and is able to study polities and administrations in their own terms and consider context-specific understandings of problems and solutions. WHO GHH has consistently sought to underline the great significance of celebrating diversity and inclusion, and promote all forms of equalities and access during discussions about major challenges to health and well-being. It is this ever-expanding, all embracing nature that has been one of the strengths of the WHO GHH project, and continues to define current activities and future plans. Working internationally with a range of leading universities, policy think tanks, government agencies, and learned colleges in medicine and public health, where all these organisations have contributed expertise and resources has been a boon. Increasingly, as these collaborations have developed, the York WHO Collaborating Centre's role has been to help create links between WHO offices, member state governments, and leading regional and national universities, so that lasting cooperation can develop between them. The goal has been for them to work independently on delivering evidence-led considerations of the recent past and connections to present day challenges, and the development of thoughtful political and policy engagement on the basis of the knowledge created in collaboration. The ability of GHH to create new synergies, to democratise the production of (and access to) policy-relevant knowledge, to encourage new forms of inter-disciplinary research that connects academic and policy actors, and to optimise opportunities for inter-sectoral policy collaboration have been administratively useful in resource constrained contexts where external assistance in welcomed. Importantly, this is especially true when such engagement is inclusive and respectful of the existence of a multiplicity of viewpoints within each national, regional and international context, and the willingness to engage each in its own terms as collaborative, international efforts at health promotion is promoted within wide-ranging economic contexts. It is our hope that the information and reflections within this article will contribute to the enduring challenges of engaging and bringing together diverse perspectives and backgrounds to tackle pressing health issues. As identified by Hinchliffe et al., this conversation is ongoing and the strategies for forming the conditions for healthy publics will need to learn from and add to honest accounts of working together.

- Interview and recall bias: Reflections include recollections of events over a decade earlier; authors acknowledge potential inaccuracies and subjectivities. - Data availability: To protect confidentiality and privacy, interview datasets are not publicly available. - Measurement of impact: Difficulties in evidencing long-term mindset change and capturing diverse forms of engagement; reliance on imperfect metrics (e.g., livestream views) that do not fully reflect influence. - Resource and logistical constraints: Limited staff time and funding within WHO and academic teams; competing priorities (duty travel, emergencies); technological challenges in broadcasting/recording; time-zone and scheduling issues between WHO/government offices and universities; inability to meet all requests for exhibitions/publications. - Organisational resistance and scope: Variable buy-in across WHO (some middle management scepticism); early perceptions of HQ-centricity requiring additional outreach to regions and countries; constraints in topic selection to balance timeliness, relevance, and audience interest. - Generalisability: Findings derive from a single, long-term WHO-based initiative; while internationally expansive, specific organisational contexts may limit transferability without adaptation to local conditions.