Internationalisation by appropriation: Expertise, empire, and nineteenth-century health governance

How did health governance get internationalised, and with what effects? In the early nineteenth century, a range of transregional sanitary councils were responsible for mitigating the pandemic spread of diseases such as cholera. The International Sanitary Conferences, first convened in 1851, centralised this arrangement but also discriminated against non-European public health expertise. This article argues that this was a case neither of imperial power politics alone nor simply of functional problem-solving, but of the appropriation of pre-existing governance structures. The article singles out epistemic and institutional appropriation as crucial twin dynamics that shaped nineteenth-century health governance. Analysis of the 1866 and 1892 sanitary conferences shows how Europeans systematically disqualified non-European expertise: they constructed and prioritised cholera as an ‘Oriental’ threat to Europe, and repeatedly claimed the superiority of French and German over Ottoman, Persian, and Egyptian experts. Inversely, expert-based resistance to European policy proposals was nominally welcomed, but in practice sidelined whenever expert-based objections did not reproduce the dominant Eurocentric interpretation of public health. By showing how imperial and racial hierarchies actively obscured the transregional origins of health governance, the article innovates International Relations’ understanding of what internationalisation empirically looks like and contributes a novel account of appropriation as a key means by which hierarchical relations get built into international organisations.