Birth of the World Health Organization

For many thousands of years, people have exchanged remedies and diseases without really thinking of ways to work together to promote health that could go beyond purely parochial concerns. Early attempts at international cooperation in health were limited to small groups of countries, which discussed a few obviously contagious diseases such as cholera and smallpox, and strategies such as quarantine to keep them at bay. Although 11 international sanitary conferences were held in Europe between 1851 and 1903, it was not until 1907 that a worldwide international institution—the Office International d'Hygiene Publique—was founded to prepare and administer international sanitary conventions and to provide national health administrations with an opportunity for regular contacts and discussion.

The terrible epidemics which raged through Europe at the end of World War I, coupled with the mass movement of liberated prisoners of war, constituted a menace to Europe of such magnitude as to require coordinated international effort. The League of Red Cross Societies, created in 1919, attempted the task but quickly realized that intergovernmental action was essential to cope with a problem of such magnitude. As the charter of the Office International d'Hygiene Publique did not give enough power for action in individual countries, provision for necessary measures had to be made by the League of Nations, then in the process of creation.

The Geneva-based League, during its short and unhappy history between the two world wars, had been the first to invoke international health cooperation to deal with many kinds of health problems. In the same period, the Pan American Sanitary Organization, originally established in 1902, continued to work in its own geographical sphere. (In 1958 it became the Pan American Health Organization (PAHO), which serves as WHO regional office for the Americas (see below).)

In 1945, the UN Conference on International Organization, meeting in San Francisco, unanimously approved a proposal by Brazil and China to establish an autonomous international health organization within the UN system. The following year, an international conference held in New York set up an interim commission and approved the Constitution of the World Health Organization. This came into force on 7 April 1948, when the 26th government, out of a total of 61 signatories, formally ratified it in its national parliament. Since then, 7 April is celebrated every year as World Health Day, when attention around the globe is focused on a theme of major international public health importance. Today, the health agency based in Geneva, Switzerland, is owned and operated by the governments of 191 countries, representing almost the entire population of the world, as reflected in its emblem (Figure 1).

Figure 1 WHO emblem.

The Task Entrusted to WHO

WHO is defined by its constitution as the directing and coordinating authority on international health work. Its aim is 'the attainment by all peoples of the highest possible level of health,' which is 'one of the fundamental rights of every human being.' The constitution lists specifically a number of responsibilities. These include the following:

• to stimulate the eradication of epidemic, endemic, and other diseases;

• to promote improved nutrition, housing, sanitation, working conditions, and other aspects of environmental hygiene;

• to propose international conventions and agreements in health matters;

• to promote and conduct research in the field of health;

• to develop international standards for food, biological, and pharmaceutical products;

• to assist in developing an informed public opinion among all peoples on matters of health.

The agreed policy of WHO is a determined and structured effort by all countries to bring health within the reach of everyone. 'Health' is defined by WHO's constitution as a 'state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.' It is seen as a shared responsibility, calling for a high degree of self-reliance from the individual, the family, the community, and, of course, the nation as a whole. Because the determinants of health are so broad, the efforts of the health sector must be supported and augmented by those of many other related sectors, including agriculture, water and sanitation, finance, industry, planning, communication, and education.

WHO provided the first truly global framework for setting international standards to promote and protect health. In keeping with postwar faith in the power of technology, WHO initially operated as a technical organization, fuelled by advances in bio-medical research and the belief that new medical discoveries would bring spectacular improvements in health. One of its first tasks was to develop mechanisms, still in effect today, for identifying urgent research needs and then linking the world's leading specialists and research institutes in a concerted attack on the problem. Tangible results came in the form of new diagnostic tests, therapeutic drugs, and vaccines. WHO also standardised the classification of diseases, terminology, nomenclature, reporting systems, research protocols, and quality and safety specifications for foods, drinking water, and pharmaceutical products. Consumers the world over benefit from these standards, which are continually revised in the light of new knowledge.

As research advances produced the means for conquering one disease after another, WHO shifted its emphasis to problems of logistics. Research took on social and ethical dimensions as the organization sought ways to extend the benefits of modern medicine to the world's populations. The early promise that sophisticated technology would bring spectacular improvements in health paled, however, against the reality of the millions of people who had no access to basic medical services. Given its constitutionally defined universal mandate and humanitarian mission, WHO began advocating changes that would eventually revolutionize the way public health was perceived. In a world that remained dis-easeridden and suffering despite unprecedented technical advances, it became a matter of equity and social justice to make health progress available to all people through new approaches, new strategies, and better management of resources.

High technology as an end in itself was replaced by the concept of appropriate technology, affordable and culturally acceptable to the people who would use it. To come to terms with the soaring costs of medical care in affluent countries as well as the lack of funds in developing countries, WHO placed preventive—as opposed to curative—medicine in the forefront. The concept of primary health care, with its emphasis on individual responsibility for health and its conviction that the best help is self-help, began to take shape.

The age of technical paternalism came to a formal close in 1979 when the member states of WHO unanimously adopted the goal of 'Health for All by the Year 2000,' founded on the principles of primary health care that had been elaborated in 1978 during the International Conference on Primary Health Care at Alma-Ata (Kazakstan). Commitment to this time-limited goal guided much of the organization's work over the next decade, though the promotion of research, particularly on disease prevention and control, continues in full force as part of WHO's global plan to push the world forward through the protection and promotion of health (see below).

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