# Health and medicine Public health, hospitals, workforce flows, reproductive politics, and the fight over who gets care. *This story parallel: Population control: policy, coercion, and conspiracy* *This story part of: The World Health Organization: power, failure, and the funding leash* *This story parallel: The care drain: recruiting the world's health workers* *Eugenics and scientific racism part of this story* *The pillars of modern power part of this story* *The oppression of Mexican Americans part of this story* *The oppression of Native Americans part of this story* *Eugenics and forced sterilization in America part of this story* *South America: from the Inca to independence part of this story* *The World Health Organization: power, failure, and the funding leash part of this story* *The care drain: recruiting the world's health workers part of this story* ## 1869 — Galton publishes Hereditary Genius Francis Galton argued in Hereditary Genius that talent and character were inherited and could be strengthened across generations through selective breeding of people. The book laid the groundwork for the eugenics movement. ## 3 March 1873 — US Comstock Act criminalizes contraceptive information The 1873 Comstock Act made it a federal crime to send contraceptives or information about them through the mail. It set the legal barrier that Margaret Sanger and the birth control movement spent decades fighting. ## 1883 — Francis Galton coins the term eugenics British scientist Francis Galton coined the word eugenics in 1883, proposing that human reproduction be guided to increase desirable traits and reduce undesirable ones. The idea became the intellectual root of later movements to control who was allowed to reproduce. ## 1907 — British Eugenics Education Society founded The Eugenics Education Society was founded in London in 1907 to promote the study and application of eugenics in policy. It became a leading voice arguing that the state should influence which people had children. ## 1907 — Indiana passes the first compulsory sterilization law Indiana enacted the world's first compulsory sterilization law in 1907, authorizing the forced sterilization of people held in state institutions. It opened the way for similar laws in more than thirty US states. ## 1909 to 1979 — California's eugenic sterilization program California forcibly sterilized about 20,000 people held in state institutions between 1909 and the 1970s, the most of any US state. Many were poor, disabled, or Latina women sterilized without meaningful consent. ## 1910 to 1939 — Eugenics Record Office opens at Cold Spring Harbor Charles Davenport founded the Eugenics Record Office to collect family data and promote eugenic policy. Its flawed research was used to support sterilization laws and immigration restrictions that harmed thousands. *Source: Cold Spring Harbor Laboratory and the Place of Science in U.S. History* ## 24 July 1912 — First International Eugenics Congress meets in London Scientists and officials from many countries gathered to promote eugenics as a global movement. The congress helped spread policies of sterilization and racial ranking that had no sound scientific basis. ## 16 October 1916 — Margaret Sanger opens the first US birth control clinic Margaret Sanger opened the first birth control clinic in the United States in the Brownsville section of Brooklyn in 1916. Police shut it down within days and arrested her, but it marked the start of the organized US birth control movement. > "She was arrested again in 1916 for providing information about birth control through a clinic in Brooklyn" > — Building the Population Bomb ## c. 1919 to c. 1939 — Sanger's eugenics affiliations and statements Margaret Sanger promoted birth control partly in eugenic terms, arguing it could reduce reproduction among those she called unfit, and she addressed a women's Ku Klux Klan group in 1926 and endorsed some eugenic sterilization. She did not support race-based extermination, and her record is documented and remains contested rather than a simple caricature. ## 1921 — Sanger founds the American Birth Control League Margaret Sanger founded the American Birth Control League in 1921 to campaign for legal access to contraception. The organization was later renamed and became the Planned Parenthood Federation of America. > "the 1921 establishment of the American Birth Control League (ABCL), which aimed to attach scientific authority to birth control advocacy" > — Building the Population Bomb ## 17 March 1921 — Marie Stopes opens the first UK birth control clinic Marie Stopes opened Britain's first birth control clinic in London in 1921, offering free contraceptive advice to married women. Stopes was also an outspoken eugenicist who tied birth control to limiting reproduction of the poor. ## 1922 — Harry Laughlin drafts the Model Eugenical Sterilization Law Eugenicist Harry Laughlin published a Model Eugenical Sterilization Law in 1922 that many US states adopted and that later influenced Nazi legislation. It gave the movement a legal template for forcibly sterilizing people judged unfit. ## May 1924 — US Immigration Act of 1924 enacts eugenic quotas The Immigration Act of 1924 set national-origin quotas that eugenicists backed to limit immigration from southern and eastern Europe and Asia. Eugenic testimony about inferior stock helped shape the law. ## 1926 — American Eugenics Society founded The American Eugenics Society was founded in 1926 to popularize eugenic ideas through exhibits, contests, and lobbying. It reflected a broad elite consensus in the era that reproduction of the unfit should be discouraged. ## 2 May 1927 — Buck v. Bell upholds compulsory sterilization The US Supreme Court ruled 8 to 1 in Buck v. Bell that states could forcibly sterilize people deemed unfit, with Justice Holmes writing that three generations of imbeciles are enough. The decision gave legal cover to tens of thousands of coerced sterilizations and has never been formally overturned. ## 1933 to 1977 — North Carolina Eugenics Board sterilizations North Carolina's Eugenics Board ordered the sterilization of about 7,600 people between 1929 and 1974, increasingly targeting poor Black women in the postwar years. The state began paying compensation to survivors in 2013. ## 14 July 1933 to 1945 — Nazi Germany's forced sterilization law The Nazi Law for the Prevention of Hereditarily Diseased Offspring, enacted in 1933, led to the forced sterilization of roughly 400,000 people deemed genetically unfit. The program drew directly on American eugenic laws and preceded the regime's mass murder of disabled people. ## 1935 to 1976 — Sweden's state sterilization program Sweden sterilized around 63,000 people, most of them women, under laws in force from 1935 to 1976, with many procedures coerced. The program showed that eugenic sterilization extended well beyond Nazi Germany into liberal welfare states. ## c. 1937 to c. 1970 — Puerto Rico's mass sterilization of women Under US-backed policy from the late 1930s, so many Puerto Rican women were sterilized that by the 1960s about a third of women of childbearing age had undergone the procedure, the highest rate in the world. Many were poorly informed and the practice became known simply as la operacion. ## 1939 — Sanger launches the Negro Project In 1939 Sanger's organization began the Negro Project to expand birth control access in the segregated South, working with Black ministers and doctors. Her private writings about the effort are frequently quoted in later debates, sometimes accurately and sometimes out of context. ## 1942 — American Birth Control League renamed Planned Parenthood The organization Sanger founded was renamed the Planned Parenthood Federation of America in 1942, dropping the phrase birth control for a broader family planning identity. It grew into the largest reproductive health provider in the United States. ## 1948 to 1996 — Japan's Eugenic Protection Law sterilizations Under Japan's Eugenic Protection Law of 1948, about 25,000 people were sterilized, roughly 16,500 of them without consent, many because they were disabled. Japanese courts later ruled the program unconstitutional and ordered compensation. ## 7 April 1948 — The WHO constitution comes into force The World Health Organization is established as a specialized agency of the United Nations when its constitution enters into force. The founding document defines health as a state of complete physical, mental and social well-being and sets the goal of the highest attainable standard of health for all peoples. The date is marked each year as World Health Day. ## 24 June 1948 — The first World Health Assembly meets Delegations from member states hold the first World Health Assembly, the WHO's supreme decision-making body. The Assembly meets each year to set policy, approve the budget, and elect the Director-General. Authority in the organization formally rests with its member states, each holding one vote. ## c. 1948 — The United States draws in Filipino and other foreign nurses The US Exchange Visitor Program, opened in 1948, brought Filipino nurses to American hospitals for training, and many stayed. Later immigration laws widened the door, and foreign-trained nurses and doctors became a fixture of the US health system. Filipino nurses in the US have long earned many times what they could at home. ## November 1952 — International Planned Parenthood Federation founded The International Planned Parenthood Federation was founded at a conference in Bombay in 1952 to coordinate family planning worldwide. It became a central organization in the global spread of contraception and population programs. ## 9 May 1960 — FDA approves the contraceptive pill Enovid The US Food and Drug Administration approved Enovid as the first oral contraceptive in 1960, research that Margaret Sanger and heiress Katharine McCormick had funded through Gregory Pincus. The pill gave women reliable control over reproduction and reshaped family planning worldwide. ## 1961 — Fannie Lou Hamer and the Mississippi appendectomy Civil rights leader Fannie Lou Hamer was sterilized without her consent during unrelated surgery in Mississippi in 1961, a practice so common against Black women that she called it a Mississippi appendectomy. Her case exposed widespread coerced sterilization in Southern hospitals. ## 7 June 1965 — Griswold v. Connecticut legalizes contraception for married couples The US Supreme Court struck down a Connecticut ban on contraception in Griswold v. Connecticut in 1965, finding a constitutional right to marital privacy. The ruling established the privacy reasoning later used in reproductive rights cases. ## 1967 — WHO launches the Intensified Smallpox Eradication Programme The World Health Assembly commits new funding and a global campaign to wipe out smallpox, a disease then still killing around two million people a year. The strategy combines mass vaccination with surveillance and containment of every outbreak. The effort becomes the largest coordinated public health campaign of its era. ## c. 1970 to c. 1976 — Sterilization of Native American women by the Indian Health Service A 1976 US government study found that the Indian Health Service had sterilized thousands of Native American women in the early 1970s, often without proper consent, amounting to a large share of women of childbearing age in some communities. The findings documented a serious pattern of coercion. ## c. 1971 to c. 2004 — Forced sterilization of Roma women in Czechoslovakia and its successor states From the 1970s onward, Roma women in Czechoslovakia and later the Czech Republic and Slovakia were sterilized without proper consent, sometimes during childbirth. The Czech government apologized in 2009 and set up a compensation scheme in 2021. ## 22 January 1973 — Roe v. Wade establishes a constitutional right to abortion The US Supreme Court ruled in Roe v. Wade in 1973 that the constitutional right to privacy protected a woman's choice to have an abortion. The decision stood as national law until it was overturned in 2022. ## 9 March 1973 — Pert and Snyder identify the brain's opiate receptor Candace Pert and Solomon Snyder at Johns Hopkins demonstrate the receptor in nervous tissue to which opiate drugs like morphine bind. Published in Science, the finding explained how opiates act on the brain. It pointed the way to the discovery of the body's own opioid molecules, the endorphins, a few years later. ## 16 March 1973 — Lauterbur produces the first magnetic resonance image Chemist Paul Lauterbur publishes in Nature the first image made with nuclear magnetic resonance, a technique he called zeugmatography. By adding magnetic field gradients he turned NMR signals into a spatial picture. The method became magnetic resonance imaging, or MRI, and earned Lauterbur a share of the 2003 Nobel Prize in Medicine. ## June 1973 — Relf sisters case exposes federally funded sterilizations Two Black sisters aged 12 and 14 were sterilized without informed consent in Alabama in 1973, prompting a lawsuit that revealed federal funds had paid for tens of thousands of such procedures on poor and minority Americans. The case led to new federal consent rules. ## c. 1973 — The EMI CT scanner enters clinical use worldwide Godfrey Hounsfield publishes his full description of computed tomography in the British Journal of Radiology, and the EMI head scanner begins spreading from its British birthplace to hospitals abroad. The first units reached the United States in 1973, including one at the Mayo Clinic. CT let doctors see cross-sections of the living brain for the first time, transforming diagnosis. ## c. 1974 — The Philippines builds a state system to train nurses for export Under President Ferdinand Marcos the Philippines set up state machinery, later the Philippine Overseas Employment Administration, to send workers abroad and earn foreign currency. Nursing schools geared toward overseas jobs, and the country became the largest single source of migrant nurses, supplying roughly a quarter of the world's overseas nurses. Remittances now fund a large share of the national economy. ## 1975 to 1977 — India's mass sterilization campaign during the Emergency During Indira Gandhi's Emergency, roughly 6 to 8 million mostly poor men were sterilized in 1976 alone under aggressive quotas, with widespread coercion including denial of pay, permits, and services. It stands as one of the largest coercive sterilization drives in history. ## 1979 to 2015 — China's one-child policy China limited most couples to one child from 1979 to 2015, enforcing the rule through fines, mandatory contraception, and documented cases of forced abortion and sterilization. The policy prevented many births but produced grave human rights abuses and a skewed sex ratio. > "some 35 million Americans kiss their loved ones goodby, pick up their lunch pails and books, and leave to spend their day in that collection of enclosures (totalling about one million) known as elementary school classrooms" > — Life in Classrooms ## 8 May 1980 — Smallpox is certified eradicated The World Health Assembly formally declares smallpox eradicated worldwide, the first and still only human disease driven to extinction by deliberate effort. The last natural case had occurred in Somalia in 1977. The achievement stands as the WHO's landmark success and the strongest argument for coordinated global health work. ## c. 1990 to c. 2024 — WHO's budget splits into small dues and large earmarked gifts Over decades the WHO comes to rely less on the assessed dues member states owe and more on voluntary contributions from governments and private donors. Most of that voluntary money is earmarked for specific programs chosen by the donor. Assessed dues make up a minority of the budget, leaving the organization dependent on funds it does not fully control. ## 1996 to 2000 — Peru's forced sterilizations under Fujimori Under President Alberto Fujimori, a state family planning program sterilized more than 270,000 people, mostly poor Quechua-speaking Indigenous women, many through coercion, deception, or without consent. Peruvian prosecutors have pursued the case for decades as a crime against the victims. ## 2000 — The NHS Plan turns to overseas recruitment England's NHS Plan set targets for thousands of new doctors and nurses and backed active recruitment from abroad to meet them. It opened a sustained drive to hire staff trained in other countries. Britain has relied on internationally trained health workers ever since. ## c. 2000 — Gulf states recruit health workers at scale Wealthy Gulf states built much of their hospital workforce by hiring abroad, drawing nurses and doctors from the Philippines, India and across Africa and the Middle East. The United Arab Emirates alone employs tens of thousands of Filipino nurses. Private recruitment agencies handle much of the hiring. ## 2006 to 2010 — Sterilizations in California prisons An investigation revealed that about 150 female inmates in California prisons were sterilized between 2006 and 2010 without proper consent or required approvals. The disclosure led California to ban the practice and later offer compensation. ## 7 April 2006 — The World Health Report names a global health-worker shortage WHO's 2006 report, Working Together for Health, estimated that the world was short about 4.3 million doctors, nurses, midwives and support workers. It named 57 countries with critical shortages, 36 of them in Africa. The report tied the gap to failures in childhood immunization, safe childbirth and treatment for HIV, malaria and tuberculosis. ## 11 June 2009 — WHO declares an H1N1 swine flu pandemic The WHO declares the H1N1 influenza outbreak a full pandemic, prompting governments to buy antiviral drugs and vaccines on a large scale. The illness proved milder than feared. Afterward the WHO faced conflict-of-interest criticism, including from a Council of Europe inquiry and the British Medical Journal, over advisers who had ties to drug companies that stood to profit; the WHO said its guidance was not improperly influenced. ## 8 August 2014 — WHO admits it was too slow on West Africa Ebola The WHO declares the West Africa Ebola outbreak a public health emergency months after it began spreading across Guinea, Liberia, and Sierra Leone. More than eleven thousand people died. The WHO itself later acknowledged that it had reacted too slowly, and independent reviews faulted its early handling and its emergency capacity. ## 2016 — A UN commission projects a shortfall of millions of health workers by 2030 The UN High-Level Commission on Health Employment and Economic Growth projected a worldwide shortfall of about 18 million health workers by 2030, concentrated in low- and lower-middle-income countries. WHO later revised the projected 2030 gap to roughly 10 million. Both figures point to demand growing fastest where staff are already scarce. ## c. 2017 to c. 2020 — Reports of birth suppression among Uyghurs in Xinjiang Research and news investigations reported that Chinese authorities sharply cut Uyghur birth rates in Xinjiang after 2017 through mass placement of IUDs, sterilizations, and penalties, with official birth rates falling steeply. China denies coercion, while several governments and researchers describe the measures as forced birth suppression. ## c. 2018 — The Gates Foundation rises to the top tier of funders The Bill and Melinda Gates Foundation becomes one of the two largest contributors to the WHO, rivaling entire national governments. Counted together with Gavi, the vaccine alliance the foundation helped create and funds, the private philanthropic footprint in global health is larger still. Nearly all of this money is earmarked for chosen priorities such as vaccines and polio. ## c. 2019 — The United States becomes the largest single contributor For most of the WHO's history the United States is its single biggest funder, supplying both assessed dues and large voluntary grants. In recent years American contributions have covered on the order of a fifth of the organization's total funding. That scale gives Washington outsized weight in what the WHO can afford to do. ## 30 January 2020 — WHO declares a COVID-19 emergency and praises China The WHO declares the novel coronavirus outbreak a public health emergency of international concern. In late January, Director-General Tedros Adhanom Ghebreyesus and senior officials publicly praised China's transparency and response after meeting its leadership. Critics later argued this early praise was misplaced given questions about China's early data and cooperation. ## 11 March 2020 — WHO declares COVID-19 a pandemic The WHO characterizes COVID-19 as a pandemic, weeks after the virus had already spread across continents. Critics said the label came late and that the organization's earlier messaging, including on travel and on human-to-human transmission, had lagged events. The declaration triggered emergency measures worldwide. ## c. 2020 — Earmarked money lets donors steer WHO priorities Because most WHO funding is tied to specific programs, the donors who give it shape which diseases and projects get attention. This is a documented feature of the budget, not a hidden one. Critics go further and argue the WHO is effectively captured or controlled by its biggest funders, whether the United States, Gates philanthropy, or others; the organization's defenders answer that policy is still set by the full membership at the World Health Assembly, where each country has an equal vote. ## May 2021 — The Independent Panel finds failures on all sides The Independent Panel for Pandemic Preparedness and Response, co-chaired by Helen Clark and Ellen Johnson Sirleaf, reports that the COVID-19 catastrophe could have been prevented. It faults the WHO for not declaring an emergency sooner and for a lost month of global inaction, while also blaming national governments and the wider alert system. Its verdict spreads responsibility across the WHO and its member states alike. ## c. 2023 — Foreign-trained staff become central to the NHS By the 2020s a large share of NHS staff had trained or been born abroad. Non-UK nationals made up roughly a third of hospital doctors and close to a third of nurses, and about a quarter of nurses on the UK register had trained overseas. The health service depends on this inflow to keep running.