The Balkan region has suffered through wars, occupation, epidemics, radioactive fallout, socioeconomic disasters, earthquakes and flooding. The disintegration of the former Yugoslavia resulted in humanitarian tragedy; human suffering with grief (missing, killed) and psychological impact (displaced, wounded, hurt) followed by crime and corruption, drug and human trafficking. In 1999, Albania and the Former Yugoslav Republic of Macedonia experienced a major influx of refugees as a result of conflict in Kosovo. At the dawn of the 21st Century a serious chemical spill of cyanide precipitated an environmental disaster.
During so called transition (1990s), armed conflict, the future of Bosnia Herzegovina, Kosovo, its ultimate unilateral proclamation of independence and the deep wounds of ethnic cleansing were aggravatingly present. As the region fell under the shadow of the global financial crisis and the effects of climate change, many Balkan problems were pushed aside. Not so much so, the state of regional fragility. Today, Bosnia slowly progresses, Kosovo is partially achieving its aims and the region has an evolving network for health (SEEHN), which recently signed the Chisinau Pledge (2017) to celebrate 15 years of alliance for health and well-being in South Eastern Europe. With the hurts of religious intolerance and war slowly easing, migrants entering the Balkans for Europe face conditions different by far from those at other periods. Having run the gauntlet of criminal networks operating between the Horn of Africa, Yemen, North Africa, Italy and Greece and the dangerous ordeal in crossing the Mediterranean they now face European resistance in the Balkan corridors.
The first conflict prevention strategy for the Balkans came through the European Union Stability Pact. In parallel, it precipitated significant activities in public health driven mainly through existing Schools of Public Health, within and outside of the region. activities evolved based on position papers [Athens and Zagreb], a response from Ohrid to the abominable terrorist attack upon the peoples of the USA and the enormous promise implicit in the Dubrovnik Pledge (2001). The overall aim was to reduce vulnerability in South Eastern Europe using public health. One take-off platform was the Skopje Declaration: Public Health, Peace, and Human Rights, and it attracted international participation. It emerged from an event in Skopje conducted by Doncho Donev.
It was an earlyoutcome of the Public Health Collaboration Network in South Eastern Europe (PH-SEE Network, 2000) whose leadership resided in the Universities of Bielefeld (Ulrich Laaser, Principal investigator) and Zagreb (Luka Kovacic) and was generously funded through Germany. Inspiration came from Slobodan Lang’s theory of goodness and significant support added through the Greek INTERREG programme (Principal investigator, John Kyriopoulos). Its highest level aim was to fashion a more equal, stable and democratic world and to integrate the issues of war and peace and human rights into the practice and scholarship of public health in the Balkan region. One important initiating and neighbourly dialogue prompt came from Greece in collaboration with the Council of Europe and the WHO-EURO.
The participants of the PH-SEE Network believed that implemention of its aim could only be accomplished by reinvigorating Schools of Public Health and encouraging new ones but with the support of regional leadership. This Network was the precursor to several later ones with a pedigree relating to the Association of Schools of Public Health in the European Region (ASPHER, 1966).
The Network fullfilled a well recognised need to reconstruct postgraduate public health training and prompt research based on regional specificities and following international standards. The resulting Consortium under the disciplined direction of Laaser published more than 3000 pages of teaching materials for public health science, organized annual summer schools throughout the former Yugoslavia and neighbouring countries, produced handbooks for teachers, researchers and health professionals. On a personal note it provided me with an opportunity to develop a teaching unit in the history of public health.
From Prizren, Kosovo and Brioni Island, Croatia the European Center for Peace and Development, Belgrade urged actions to implement the principles of human security and health diplomacy in the Balkans. Its minimum goal was to shift the negative metaphor of the Balkans as a powder keg to an image much more commensurate with its rich diversity, multicultural background and special historical heritage. It still remains a Herculean task.
Human security promotion is hampered by an absence of a culture for peace, peace studies, and a cadre of well trained human resources with related competencies; barriers as a result of division, for example membership or not in the European Union; a scarcity of well designed interventions and projects for socioeconomic growth, as well as continued tension between states and state entities, hatreds and animosities exacerbated by faltering reconciliation and tolerance, issues related to refugees and internally displaced persons (social services, health care, education). The reservoir of unconsolable aftermath grief, emergent wrath and still drying tears with respect to missing people and the absence of restitution is a substantial obstacle.
These down sides to which is added those stemming from world shattering events makes a revisit to the Skopje Declaration necessary. In the turmoil of the Balkans it has been ignored. A return to Skopje is undertaken in the belief that the international community still lacks an understanding of the multicultural Balkans, that Balkan leadership still retains a limited knowledge of the health status of the people and that the European Union’s emphasis on public health has fallen short of its aspirations as a tool for economic and human development. Even public health’s professional and scientific organisations are failing the Balkans.
A recent public health editorial on ethics calls for a stronger voice for the advocacy of population health and drawing upon philosophical theory. Richard Horten's opininon that public health leadership in England is failing, is restated. I would add that public health leadership is failing almost everywhere. I do so recalling two aspects of Skopje, namely, that public health is about politics and a figurative logo- slogan that proclaimed that public health is, a catalyst for peace and an instrument for socioeconomic development.
The Skopje Declaration and the Dubrovnik Pledge express a commitment to making a difference in the health status of the peoples of South Eastern Europe (SEE). They were an expression of social conscience, proclaimed a union between public health, peace and human rights and called for support for the ethics and value systems of the United Nations, World Health Organisation and the Council of Europe. The Declaration stated its conviction that public health constitutes one basic element and practical ingredient, for mankind’s hope for the future. The particiipants believed that a better Balkans could be built and I drew from a poetic stanza closer to the human heart’s desire.
Did we succeed? The answer lies in the grounds of one recipe for preparing Turkish coffee, “Yes and No”. In a recent call to European politics the Skopje Declaration was restated on ASPHER’s 50th Anniversary in the Athens ASPHER Accord (2016). Many declarations or warnings can be cited. A most recent one (2017) relates to Migration and human solidarity and to MENA. From Geneva it urged and with good reasons that the Sahel region of Africa be given priority by the international community.
In a chessboard model of reality the Balkans and Africa would be given different weights. In a network model, inter-connectivity would receive greater emphasis and inter-relationships and interdependencies more relevant than detailed and spherical descriptions. An International Round Table (Belgrade, 2017) on Peace and Democratic Multilateralism brought the Balkans and Africa together; in both regions greenhouse gas emission must be limited and additional instruments must be developed to rein in the many local and regional vulnerabilities.
Public health must be strengthened here and now and more than ever while health diplomacy must become a reality. Youth must be supported better and mother and child health vigorously promoted. The alternative may be a river of crusades; children’s, youth, middle aged, the elderly. Security in the Balkans and in Africa requires coalescing functions of disaster management and public health within a framework of population equality as well as bio-defence instruments to protect food supplies and deal with wildlife threats to agriculture.
When the Balkan dots between 2000 and 2017 are connected it is obvious that a lot has been accomplished but much remains undone. Societal preparedness against threats is still limited in scope, human security remains unwieldy and health diplomacy as yet to be deployed. The way forward is through efforts of peace keeping, protection of health and promotion of human rights harmonised in a new way of thinking from chessboard to network and by the circumvention of political obfuscation, denial and mystification. A World Assembly of politicians should be given the Skopje Declaration to study.
Neighbors in the Balkans: Initiating a dialogue for health (2000) Editors, A. Ritsatakis, J.Levett, J. Kyriopoulos, WHO/INTERREG, Exandas Press, Athens (used by Council of Europe leading up to Dubrovnik Pledge)
Levett J. (2001), A public health curriculum for peace and development. Internet JPHE A5-9
Donev, D., Laaser, U., Levett, J. Skopje Skopje Declaration on Public Health, Peace & Human Rights Dec 2001. Croat Med J. 2002; 43(2): 105–6 Adopted by World Federation of Public Health Associations, 2003
ECPD International Conference: New knowledge for new development. Skopje, Macedonian Academy of Sciences and Arts, October 7, Proceedings 2015: 115-34, 2013 (See papers by Donev and Levett).
SEEHN Chisinau Pledge (Moldova) 15 years of alliance for health and well-being in South-Eastern Europe, 2017
United Nations International Mountain Day: Mountains under Pressure: climate, hunger, migration, 2017 (Pledge of 60 countries and over 200 civil society organisations to strengthen resilience on the mountains in the face of climate change, hunger and migration)
Geneva declaration: Mobility and human solidarity, a challenge and an opportunity for Europe and the MENA region, 2017
Levett, J. Evelyn Ruth Scott, Champion of the Indigenous 2017
Levett, J. Democratic Failings, Muddied Governance, Events in Belgrade Report Oct 2017
Nature Climate Change 3, 52–58 doi:10.1038/nclimate1633 (2013)
Neighbors in the Balkans: Initiating a dialogue for health, (2000) Editors, A. Ritsatakis, J.Levett, J. Kyriopoulos, WHO/INTERREG, Exandas Press, Athens
Donev, D., Laaser, U., Levett, J. Skopje Declaration on Public Health, Peace & Human Rights Dec 2001. Croat Med J. 2002; 43(2): 105–6
WFPHA. WFPHA [Declaration on Public Health, Peace & Human Rights] May 2003
Donev D. Peace building and stabilization of the South Eastern Europe Region through Public Health Cooperation Stability Pact Project Network
ECPD-MASA International Conference: New knowledge for new development. Skopje, Macedonian Academy of Sciences and Arts, October 7, 2013. Proceedings 2015: 115-34
Chisinau Pledge (Moldova, 2017) 15 years of alliance for health and well-being in South-Eastern Europe
Levett, Jeffrey, Migrants in the Med:Beneficial and Sparse Pastures of Greece, 2017
John Coggon, Farhang Tahzib. Guest Editorial, Journal of Public Health | pp. 1–2 | 2017 doi:10.1093/pubmed/fdx104