Whereas the development of welfare states has been the subject of sustained academic scrutiny, international aspects of welfare have been much neglected. It is possible for national systems to retain a diversity of locally administered elements (for example, involving municipalities, social insurance corporations or occupational health schemes) while providing centralised funding and administrative and legal frameworks. But international organisations have vital roles and demand far greater attention from historians and social scientists than they have hitherto received.

As any localised system could suffer from inequalities and lack resources, and states could manipulate health and welfare issues for the purposes of political expediency, international organisations became an attractive option for promoting reforms. International bodies may remedy local deficiencies, set optimal standards and improve the quality of the systems of care and the training of personnel. While some of these functions can be fulfilled by the state, it should be recognised that the state as a provider of welfare can be problematic, because its multifunctional character may render health and welfare low political priorities, or distort welfare as caught up in the politics of interest groups and financial expediency. The interwar rise of fascist and kindred authoritarian regimes that perverted welfare systems for purposes of political discrimination and genocide was in marked contrast to the humane ideals of internationalists.