The World Health Organization, or WHO, was established as a specialized agency of the United Nations (UN) in 1948. It was declared officially in existence on April 7 of that year, after more than half of the UN members signed its constitution. That date is now celebrated as World Health Day.
The objective of WHO is ambitious, stated as "the attainment by all peoples of the highest possible level of health," with health being very broadly defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO works to reach this lofty goal by directing and coordinating international health work.
WHO has been instrumental in eradicating smallpox, once among the most feared diseases, and has helped contain old diseases such as cholera and typhoid and relatively new ones such as SARS and HIV. WHO has led efforts in health-related fields like sanitation, injury prevention, and public health, and is currently working to combat tobacco use and chronic diseases like cancer and diabetes.
In this article, we'll examine how WHO functions and look at its impact on people's health around the world.
The History of WHO
WHO is the first global health organization. It replaced or absorbed many regional and national health bodies.
In the latter half of the 19th century, after several severe cholera epidemics, a series of international sanitary conferences were held in Europe to coordinate policy and practice around quarantine and disease management. The League of Nations established a health organization in 1920, and there were regional bodies as well. But the establishment of the United Nations in 1945 marked a period of aggressive internationalism and international organization-building, and though health was not initially thought to be under the U.N.'s purview, a motion by the Brazilian and Chinese delegates to establish an international health organization was unanimously accepted. A group of health experts who were working on emergency relief in the wake of World War II were charged with the task of drafting a constitution to define the structure and mandate of the body that would become known as the World Health Organization.
The work of WHO is mainly carried out by a secretariat; secretariat staff are led by a director-general and work in areas identified by an executive board and ratified by an assembly.
The secretariat consists of thousands of health and other experts and support staff who work at headquarters, regional offices, and in member countries around the world. At the top of this bureaucracy is the director-general, who is elected for a five-year term. A new director-general, Dr. Jong-Wok Lee, was nominated by the executive board and elected by the assembly in May 2003. This native of South Korea was trained as a medical doctor in Seoul and completed a Masters of Public Health in Hawaii. He worked for WHO for 19 years before being elected to his current post.
The World Health Assembly
The World Health Assembly is the main governing body of WHO. It's made up of delegates from all member nations, currently totaling 192. The assembly meets in May each year, usually at WHO headquarters in Geneva, Switzerland.
At this meeting, it reviews and approves the budget for the coming year, decides where WHO will direct its attention for that year, and, if necessary, elects the executive board and the director-general. The matters that come before this central policy-making body are decided by the executive board.
The executive board is composed of members elected from among the assembly for three-year terms. They are technically qualified in the health field, and are usually doctors. They hold their main meeting in January, at which they decide on the agenda and the matters to be pursued at the May assembly meeting.
The board advises the assembly and facilitates its work; it nominates the director-general and recommends focus areas. The board and assembly's work is in turn facilitated by the secretariat, which sees to all the day-to-day tasks that ensure that the decisions of the assembly are acted upon.
WHO's funding comes from two sources: assessed contributions from member states and voluntary contributions from members and others. Assessed contribution came to about $850,000,000 for 2002-03; voluntary contributions for the same period totaled over $1,380,000,000. WHO publishes its proposed budget each year, describing in detail how funds are to be spent.
One of the primary areas that WHO has worked in since its inception is disease prevention, and its most notable success has been against smallpox.
Smallpox is a highly infectious disease that causes severe scarring and blindness and, in as many as 30% of cases, death. By the 10th century, the Chinese had discovered that variolation, a process of introducing material from smallpox lesions into the body of the healthy, usually induced immunity to the disease, though it caused a scar and occasionally resulted in death. In 1798, the English country doctor Edward Jenner proved that immunity could also be caused by inoculation. He used the much less severe cowpox in his work, and hence "vaccination" (vacca is Latin for cow) was born. Though the method was very effective, the smallpox vaccine was not readily available in many parts of the world until WHO launched a multi-million-dollar global vaccination campaign in 1967.
The aggressive campaign was successful, and the last natural case of infection by smallpox occurred in 1977. WHO stipulates that after a three-year period in which no naturally occurring infections occur, an area can be declared disease-free. WHO officially announced the world smallpox-free in 1980.
In 1988, WHO launched a campaign against polio, with the goal of eradicating the disease by 2005. Poliomyelitis is highly infectious and can cause paralysis within hours; it chiefly strikes children under the age of five, and can be prevented through vaccination.
Once endemic on all continents, polio is now confined to Africa and South Asia; the Americas were declared polio-free in 1994, followed by the Western Pacific region in 2000 and Europe in 2002.
WHO has had less success overcoming infectious diseases for which there are no effective vaccines, particularly malaria, tuberculosis, and HIV. The WHO goals for these diseases -- halve the global burden of malaria and tuberculosis and cut the number of new HIV infections by a quarter by 2010 -- are more modest than those for vaccine-preventable diseases. The goals probably reflect a realistic assessment of the difficulty of combating diseases when what is required is the interruption of insect carriers (malaria), an improvement in living conditions (tuberculosis), or a change in social behavior (HIV). WHO has called for the development of innovative strategies to deal with these still-rampant diseases, and continues to fund research into developing effective vaccines.
The recent outbreak of sudden acute respiratory syndrome (SARS) highlights WHO's strengths and weaknesses as a central body working to overcome disease. This new disease originated in China but spread quickly to other Asian countries and to Canada, aided by global air travel. WHO-employed and -affiliated epidemiologists were able to mobilize from regional offices and track the spread of the disease; in many areas, they were successful in mapping the spread of the disease from a single carrier. But because they have no legal authority to force nations to allow them to work inside their borders, scientists had to wait until the Chinese government relented and let them into the country before they could assess the extent of infection in that huge nation and identify the first known case of SARS.
WHO also monitors the global incidence of a wide range of diseases and provides advisories for travelers, recommending which inoculations and other preventive measures they need when traveling to particular areas.
Criticisms of WHO
While WHO's detractors support its focus on disease prevention and eradication, many argue that success has often been elusive because the organization is too bureaucratic and centralized to effectively and efficiently target funds and efforts. WHO has faced strong criticism for its purported inefficiency, and recent director-generals have pledged that improved efficiency and effectiveness will be top priorities.
Far more controversial than its focus on infectious disease prevention has been its efforts in the area of public health. Public health (a.k.a. social health, social medicine, and population health) proceeds from the assumption that society as a whole should attempt to boost the health of its population through:
WHO's commitment to public health is enshrined in its constitution, which (as mentioned previously) recognizes that health is "not merely the absence of disease or infirmity" but also "a state of complete physical, mental and social well-being." But some read this broad definition as "totalitarian," and argue that it leads WHO to undertake activities in areas where it has no business.
A recent example of WHO working in areas that critics say should be beyond its scope is the unanimous adoption, at the 2003 World Health Assembly meeting, of a treaty aimed at curbing tobacco-related disease and death. The agreement, called Framework Convention on Tobacco Control, attempts to restrict tobacco advertising, sponsorship, and promotion; establish labeling controls; establish indoor "clear air" controls; and reduce tobacco smuggling.
Some critics decry what they see as WHO's totalitarian infringement into personal liberty and choice. They argue that people have a right to choose to engage in risky behaviors such as smoking if they so desire, and WHO has no right to legislate against them.
Interestingly, the same arguments have been made by critics of vaccination. When the practice was first spreading in England, an outspoken critic named George Gibbs compared state-legislated compulsory vaccination to "spies forcing their way into the family circle," and legislation was ultimately changed to allow "conscientious objectors" to refuse inoculation.
Ultimately, judgements on the role of the World Health Organization rest on personal viewpoints as to the role of global governments. Whether efforts in the field of public health are for the good of all or are Draconian is a matter of interpretation. But critics and supporters alike celebrate the eradication of smallpox and look forward eagerly to the elimination of other dangerous diseases. In this, at least, WHO has made a big difference in the world.
For more information on the World Health Organization and related topics, check out the link on the next page.
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