World Health Organization

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On the web: http://www.who.int

The World Health Organization (WHO) is the United Nations' agency for health. The organization focuses on four main areas, led by health intervention efforts, such as control and prevention of HIV/AIDS, malaria, and tuberculosis. Other WHO priorities include support for government health programs; development of health policies, products, and systems; and efforts related to determinants of health, such as food safety and nutrition. The WHO operates from six regional offices worldwide and national offices in about 150 countries. Budget and policy oversight for the organization is provided by the World Health Assembly, which includes representatives of more than 190 countries. The WHO was founded in 1948.

Officers:
Chairman Executive Board: Nimal S. de Silva
Deputy Director-General and Assistant Director-General, HIV/AIDS, TB and Malaria: Anarfi Asamoa-Baah
Director-General: Margaret Chan

The World Health Organization (WHO) was created in 1948 by member states of the United Nations (UN) as a specialized agency with a broad mandate for health. The WHO is the world's leading health organization. Its policies and programs have a far-reaching impact on the status of international public health.

Defined by its constitution as "the directing and coordinating authority on international health work," WHO aims at "the attainment by all peoples of the highest possible standard of health." Its mission is to improve people's lives, to reduce the burdens of disease and poverty, and to provide access to responsive health care for all people.

Responsibilities and Functions

WHO's responsibilities and functions include assisting governments in strengthening health services; establishing and maintaining administrative and technical services, such as epidemiological and statistical services; stimulating the eradication of diseases; improving nutrition, housing, sanitation, working conditions and other aspects of environmental hygiene; promoting cooperation among scientific and professional groups; proposing international conventions and agreements on health matters; conducting research; developing international standards for food, and biological and pharmaceutical products; and developing an informed public opinion among all peoples on matters of health.

WHO operations are carried out by three distinct components: the World Health Assembly, the executive board, and the secretariat. The World Health Assembly is the supreme decision-making body, and it meets annually, with participation of ministers of health from its 191 member nations. In a real sense, the WHO is an international health cooperative that monitors the state of the world's health and takes steps to improve the health status of individual countries and of the world community.

The executive board, composed of thirty-two individuals chosen on the basis of their scientific and professional qualifications, meets between the assembly sessions. It implements the decisions and policies of the assembly.

The secretariat is headed by the director general, who is elected by the assembly upon the nomination of the board. The headquarters of the WHO is in Geneva. The director general, however, shares responsibilities with six regional directors, who are in turn chosen by member states of their respective regions. The regional offices are located in Copenhagen for Europe, Cairo for the eastern Mediterranean, New Delhi for Southeast Asia, Manila for the western Pacific, Harare for Africa, and Washington D.C. for the Americas. Their regional directors, in turn, choose the WHO representatives at the country level for their respective regions. There are 141 WHO country offices, and the total number of WHO staff, as of 2001, stands at 3,800. WHO is the only agency of the UN system with such a decentralized structure. The Pan American Health Organization (PAHO) existed before the birth of WHO and serves as WHO's regional office for the Americas.

The founding fathers of the UN purposely set aside a network of specialized agencies with their own assemblies, intending that technical cooperation among member states would be free of the political considerations of the UN itself. It has not always worked out this way, however. WHO could not escape entirely the political fights that occurred in the specialized agencies, and the assembly's deliberations have often reflected the political currents of the time.

The decentralized structure of WHO has added a political dimension that has its pluses and minuses. Many of the resources are assigned to the regional centers, which better reflect regional interests. On the other hand, the regional directors, as elected officials, can act quite independently—and occasionally they do. This has given rise to the impression that there are several WHOs.

Moreover, because the regional directors are elected, they need to give consideration to the requirements of reelection. Since the regional directors choose country representatives in their regions, the dynamics of personnel interaction in WHO's administration is quite unique in the UN system. Regional control over country offices is strong, leaving the WHO country representatives with limited authority or leeway for program implementation.

Accomplishments and Challenges

The second half of the twentieth century saw remarkable gains in global health, spurred by rapid economic growth and unprecedented scientific advances. WHO has played a very pivotal role in setting health policies, as well as providing technical cooperation to its member states. Life expectancy rose from 48 years in 1955 to 69 years in1985. During the same period, the infant mortality rate fell from 148 per 1000 live births to below 59 per 1000. Population growth has been slowed dramatically in many of the most populous countries. Smallpox, the ancient scourge, has disappeared. Other successes include the control of lice-borne typhus and yaws. Polio and guinea worms are on the verge of total elimination. A number of other communicable and tropical diseases, including onchocerciasis and schistosomiasis, are in retreat. With universal salt iodization in place, the prospect of virtually eliminating iodine deficiency disorders (IDD), the major cause for brain damage among young children, is also in sight.

Absolute poverty is still spreading in many parts of the world, however. Disparities in health and wealth are growing between and within countries. More than one billion people are without the benefits of modern medical science. One out of five persons in the world has no access to safe drinking water. Infectious diseases alone account for 13 million deaths a year, most of them in the developing countries. Seventy percent of the poor are women. The chance of an expectant mother in the world's poorest country dying of childbirth is 500 times greater than her counterpart in the richest country.

Excessive consumption and pollution practices have produced profound climatic changes that impact on the environment and the health of human beings. Globalization of trade and marketing has led to a sharp increase in the use of tobacco, alcohol, and high fat foods, along with unhealthy lifestyles.

The Early Years of Who

Initially, WHO devoted much of its resources to the fight against the major communicable diseases. Mass campaigns were waged against malaria, trachoma, yaws, and typhus, among others. Malaria turned out to be a more complex problem than anticipated, and early efforts at eradication had to be scaled back to the level of control. Efforts to improve maternal and child health services included the training of traditional birth attendants—an approach advocated by UNICEF, WHO's close partner in all child-health projects—to reduce infant and maternal deaths. WHO also followed up on the work done by its predecessor organizations on sanitary conventions. It adopted, in 1951, the International Sanitary Regulations, later (in 1971) renamed the International Health Regulations.

Beginning in the 1960s, WHO began an effort to extend health services to rural populations. In 1974, recognizing the underutilization of existing technologies to fight childhood diseases, WHO launched an expanded immunization program against polio, measles, diphtheria, whooping cough, tetanus, and tuberculosis.

Hfa and Phc

Widespread dissatisfaction with health services in the later 1960s and early 1970s led to an effort to find an alternative approach to standard health care, and eventually the joint WHO/UNICEF conference in Alma-Ata in 1979.

The goal of Health for All (HFA), adopted by member states at the 1977 World Health Assembly, called for the attainment by all people of the world of a level of health that will permit them to lead a socially and economically productive life. In 1978, WHO and UNICEF cosponsored the historic International Conference on Primary Health Care (PHC) in Alma-Ata, at which the international development community adopted PHC as the key to attaining the goal of Health for All by the year 2000.

PHC, as defined at the Alma-Ata conference, called for a revolutionary redefinition of health care. Instead of the traditional "from-the-top-down" approach to medical service, it embraced the principles of social justice, equity, self-reliance, appropriate technology, decentralization, community involvement, intersectoral collaboration, and affordable cost. The Alma-Ata Declaration on PHC envisaged a minimum package of eight elements:(1) education concerning prevailing health problems and the methods of preventing and controlling them; (2) promotion of food supply and proper nutrition; (3) an adequate supply of safe water and basic sanitation; (4) maternal and child health, including family planning; (5) immunization against the major infectious diseases; (6) prevention and control of locally endemic diseases; (7) appropriate treatment of common diseases and injuries; and (8) provision of essential drugs. Where appropriate, the employment of lay health workers from the community should be trained to tackle specific tasks, including education, and to provide first-level care, with appropriate referrals to secondary and tertiary health facilities.

Though few, if any, countries have successfully followed all the precepts of PHC as enunciated at Alma-Ata, PHC has since provided the philosophical linchpin for virtually all subsequent international health activities. In the 1960s and early 1970s, community health workers and traditional birth attendants were grudgingly accepted by many, though only as second-class health care providers, and they were scorned by others, especially by some traditionally trained allopathic medical practitioners. With Alma-Ata, however, plus the exemplary success of the work of "barefoot doctors" in China, PHC precepts and programs became respectable.

Eradication of Smallpox

After an exhaustive and intensive effort, the last cases of smallpox were identified and treated in East Africa. In 1979 a global commission certified the worldwide eradication of this ancient scourge. The cost over the decade-long campaign came to $300 million, a small price to pay for the elimination of the disease, for which the annual cost of vaccination worldwide was close to $1 billion. No ordinary victory, this was humankind's first conquest of a deadly malady, and a clear demonstration that investment in health begets economic benefit as well as humanitarian relief.

Global Strategy for Hfa

In 1979 the World Health Assembly adopted the Global Strategy for HFA, which was subsequently endorsed by the UN General Assembly. The UN resolution was the health community's attempt to mobilize the world community at large to take collaborative actions to improve the status of the world's health. The main thrust of the strategy was the development of a health-system infrastructure, starting with PHC, for the delivery of countrywide programs that would reach the entire population. The strategy called for the application of the principles of the Alma-Ata Declaration and the development of the minimum package of the eight PHC elements.

HFA was conceived as a process leading to progressive improvement in the health of people and not as a single finite target, though some indicators were recommended. It aims at social justice, with health resources evenly distributed and essential health service accessible to everyone, with full community involvement.

While member states all voted to adopt HFA via PHC, implementation lagged far behind, as economic crises loomed and political and military conflicts flared. Natural disasters also intervened. The rapid rise of the urban poor and weaknesses in the organization and management of health services resulted in waste and misuse of meager resources. Above all, poverty, its deep-rooted causes unresolved, undermined various efforts in the slow march towards HFA.

Csdr, Bamako, and Ari

In the early 1980s, UNICEF launched its Child Survival and Development Revolution (CSDR) with four inexpensive interventions: growth monitoring, oral rehydration, breastfeeding, and immunization programs (commonly referred to as GOBI). After some initial reservation, and with assurances that GOBI efforts would be within the context of PHC, WHO became an active player in CSDR, which has made impressive inroads in reducing infant deaths, especially through the immunization campaign and the oral rehydration program for the control of diarrhea, which also benefited from water and sanitation programs.

WHO also joined UNICEF in launching the Bamako Initiative in the 1980s, which aimed at the provision of essential drugs and their rational use in the context of PHC, initially in African countries but later expanded to other regions. The initiative introduced the element of cost recovery as well as community management of drug supplies and sales. Indeed, in spite of the retrogressive economic situation in Africa south of the Sahara in the 1980s, infant mortality and life expectancy continued to improve gradually in Africa. These gains, however, have since been brutally reversed by the spread of HIV/AIDS.

The 1980s also saw WHO initiating a broad-scale attack against acute respiratory infections (ARI), a major cause of child mortality, and implementing the Safe Motherhood program, designed to reduce maternal deaths—which stood at 500,000 avoidable deaths, almost all in the developing countries. In these efforts, WHO was joined by UNICEF and the World Bank, which had begun to turn some of its attention to the social aspects of development. In the later 1990s, the Integrated Management of Childhood Illness program was launched to bring together a number of programs for a more rational approach.

Though there was progress, the PHC implementation was found to be limited to a number of countries and some specific areas. The principles of PHC, however, were found to be the only viable option even in the most difficult circumstances, with some adjustment of the approaches and strategies necessary in country-specific situations. The effort to introduce district-level PHC did succeed in bringing the services closer to the people who need them.

The Hiv/Aids Pandemic

Although HIV/AIDS first raised its ugly head in the public eye in North America, it soon became clear that the AIDS epidemic was to become a pandemic. Under pressure from WHO, a number of governments, and various developments agencies, the pharmaceutical industry has agreed to allow the price of AIDS treatment drugs to drop from around $15,000 a year per patient in the industrialized countries to $350 in the developing countries. This will encourage more people to come forward for screening in some countries, and in other countries, with help from international organizations, programs of treatment are now a possibility. However, the principal way to fight AIDS is still prevention through education and behavioral change, as work towards an effective vaccine is making very slow progress. While no part of the world is free of the AIDS threat, AIDS spread fast and wide in Africa, especially in countries south of the Sahara. In Asia, where the population pools are much greater, the number of HIV/AIDS cases is expected to exceed that of Africa by 2005.

In fighting AIDS, development agencies of the UN system have joined together to form UNAIDS, in which WHO plays the lead technical role. The pandemic is now such a serious threat to entire societies that it has been brought to the UN Security Council as a matter of grave security concern.

Year 2000 Goals

In 1990, WHO joined with UNICEF in urging the UN Summit for Children to set Year 2000 goals. These goals included increased immunization rates; reduction of infant, under five, and maternal mortality rates; water and sanitation, as well as education for all; the reduction of malnutrition; and the elimination of micronutrient disorders.

After the end of the Cold War, the hope for a "peace dividend" from disarmament did not materialize. On the contrary, with a few exceptions, since that time the volume of development funds from the industrialized countries has shrunk. The 2001 session of the UN General Assembly is likely to be disappointing in its review of the summit goals. The water, sanitation, and education for all goals will certainly fall far short of target. There is still hope, however, for the elimination of polio and guinea worms, as well as the virtual elimination of iodine deficiency disorders.

Health Promotion and Other Activities

In 1982 WHO undertook a reorientation of health education, designed to expand its community approach and include communication theories and practice. In 1987 the term "health education" was changed to "health promotion" to denote a broader, ecological approach to the work of facilitating "informed choices" by people on health matters.

The first international consultation on this subject was held in Ottawa in 1986, followed by consultations in Adelaide in 1988, Sundsvall in 1991, and Jakarta in 1997. WHO's new approach calls for broader societal involvement, and in the eastern Mediterranean region, member nations adopted social mobilization as the strategy for health promotion. Individual programs, such as the tuberculosis and micronutrient elimination programs, adopted similar stances.

WHO publishes a number of technical journals, the most important of which is the WHO Bulletin, and maintains a media and public relations unit. Every year, World Health Day is observed on April 7, the day, in 1948, when WHO came into being. Each World Health Day is devoted to a particular theme, and material is made available for member states to commemorate the day with a program focus.

Noteworthy, but less publicized, activities of WHO include its worldwide efforts in mental health, oral health, food safety (including the FAO/WHO Codex Alimentarius Commission), health in the work place, elder care, chemical safety, veterinary health, cancer, cardiovascular diseases, and health and the environment. Its essential drug program has had a major impact on the rational use of medicines in developing countries.

WHO maintains a network of collaborating centers, which engage in work in various specific fields. It also maintains a working relationship with a large number of nongovernmental organizations involved in health and development. These organizations are accredited and approved by the World Health Assembly.

Year 2020 Goals

The World Health Assembly has adopted the following set of new goals to be reached by, or before, 2020:

• By 2005, health equity indices will be used within and between countries as a basis for promoting and monitoring equity in health.
• By 2010, transmission of Chagas' disease will be interrupted, and leprosy will be eliminated.
• By 2020, maternal mortality rates will be halved; the worldwide burden of disease will be substantially decreased by reversing the current trends of incidence and disability caused by tuberculosis, malaria, HIV/AIDS, tobacco-related diseases, and violence; measles will be eradicated; and lymphatic filariasis eliminated.
• By 2020, all countries will have made major progress in making available safe drinking water, adequate sanitation, food and shelter in sufficient quantity and
• quality; all countries will have introduced and be actively managing monitoring strategies that strengthen health-enhancing lifestyles and weaken health-damaging ones, through a combination of regulatory, economic, educational, organization-based, and community-based programs.
• By 2005, member states will have operational mechanisms for developing, implementing, and monitoring policies that are consistent with the HFA policy.
• By 2010, appropriate global and national health information, surveillance, and alert systems will be operational; research policies and institutional mechanisms will be operational at global, regional, and country levels; and all people will have access throughout their lives to comprehensive, essential, quality health care, supported by essential public health functions.

WHO has also launched a series of initiatives, including programs to roll back malaria, stop the spread of tuberculosis, fight the AIDS pandemic, and curtail tobacco use. A breakthrough in the drastic reduction of the cost of AIDS treatment drugs is likely to impact the AIDS fight. Negotiation for a tobacco-control convention may lead to greater success for WHO's Tobacco-Free Initiative. With additional resources from private foundations, WHO, in partnership with the World Bank and UNICEF, has launched an ambitious Global Alliance for Vaccines and Immunization (GAVI). Malnutrition, which accounts for nearly half of the 10.5 million deaths each year among preschool children, will continue to be a priority item in the years to come.

WHO has also undergone a number of reorganizations, the latest resulting in nine clusters, each covering a number of programs.

In addition to the two clusters on management and governing bodies, the program clusters are: communicable diseases, noncommunicable diseases, sustainable development and health environments, family and community health, evidence and information for policy, health technology and pharmaceuticals, and social change and mental health.

Directors General

There have been a total of five directors general. Dr. Brock Chisholm, a psychiatrist from Canada, was the first. He was succeeded by Dr. Marcolino Candau of Brazil, who ran the organization for twenty years. Dr. Halfdan Mahler, a tuberculosis specialist from Denmark, took the helm after Candau. Mahler oriented the organization towards development, launched the PHC movement, and confronted the infant formula and pharmaceutical industries on health grounds. After fifteen years, he was succeeded by Dr. Hiroshi Nakajima of Japan, who ran the organization for ten years. The current director general is Dr. Gro Harlem Brundtland, a physician from Norway and a former prime minister of that country. Brundtland has placed considerable emphasis on advocacy at the political level.

(SEE ALSO: Alma-Ata Declaration; Barefoot Doctors; Blood-Borne Diseases; Communicable Disease Control; Famine; Global Burden of Disease; Health Promotion and Education; HIV/AIDS; Immunizations; Infant Mortality Rate; International Health; Iodine; Maternal and Child Health; Poverty; Sanitation in Developing Countries; Smallpox; Thyroid Disorders; Tropical Infectious Diseases; UNICEF; Waterborne Diseases; World Bank)

— JACK CHIEH-SHENG LING

The World Health Organization (WHO) is the principal international organization managing public health-related issues on a global scale. Headquartered in Geneva, the WHO is comprised of 191 member states (e.g., countries) from around the globe. The organization contributes to international public health in areas including disease prevention and control, promotion of good health, addressing disease outbreaks, initiatives to eliminate diseases (e.g., vaccination programs), and development of treatment and prevention standards.

In 2003, WHO began to coordinate global efforts to monitor the outbreak of the virus responsible for Severe Acute Respiratory Syndrome (SARS). WHO officials also directed aspects of research efforts to identify the specific virus responsible. In addition, WHO officials issued specific recommendations with regard to isolation and quarantine policy and issued alerts for travelers.

Just after the end of World War I, the League of Nations was created to promote peace and security in the aftermath of the war. One of the mandates of the League of Nations was the prevention and control of disease around the world. The Health Organization of the League of Nations was established for this purpose, and was headquartered in Geneva. In 1945, the United Nations Conference on International Organization in San Francisco approved a motion put forth by Brazil and China to establish a new and independent international organization devoted to public health. The proposed organization was meant to unite the number of disparate health organizations that had been established in various countries around the world. The following year this resolution was formally enacted at the International Health Conference in New York, and the Constitution of the World Health organization was approved.

In its constitution, WHO defines health as not merely the absence of disease. A definition that subsequently paved the way for WHO's involvement in the preventative aspects of disease.

From its inception, WHO has been involved in public health campaigns that focused on the improvement of sanitary conditions. In 1951, the Fourth World Health Assembly adopted a WHO document proposing new international sanitary regulations. Additionally, WHO mounted extensive vaccination campaigns against a number of diseases of microbial origin, including poliomyelitis, measles, diphtheria, whooping cough, tetanus, tuberculosis, and smallpox. The latter campaign has been extremely successful, with the last known natural case of smallpox having occurred in 1977. The elimination of poliomyelitis is expected by the end of the first decade of the twenty-first century.

Another noteworthy initiative of WHO has been the Global Program on AIDS, which was launched in 1987. The participation of WHO and agencies such as the Centers for Disease Control and Prevention is necessary to adequately address AIDS, because the disease is prevalent in under-developed countries where access to medical care and health promotion is limited.

Today, WHO is structured as eight divisions addressing communicable diseases, noncommunicable diseases and mental health, family and community health, sustainable development and health environments, health technology and pharmaceuticals, and policy development. These divisions support the four pillars of WHO: worldwide guidance in health, worldwide development of improved standards of health, cooperation with governments in strengthening national health programs, and, development of improved health technologies, information, and standards.

Further Reading

Electronic

World Health Organization. May, 2003.<http://www.who.int/en/> (May 10, 2003).

A specialized agency of the United Nations, established in 1948 and headquartered in Geneva, whose mission is to prevent the international spread of diseases, such as cholera, malaria, and poliomyelitis.

The specialized agency of the United Nations that is concerned with human health on an international level; abbreviated WHO. The agency was founded in 1948 and in its constitution are listed the following objectives.
'Health is a state of complete physical and social well being, and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standards of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all’.
The major specific aims of the WHO are as follows:
(1) To strengthen the health services of member nations, improving the teaching standards in medicine and allied professions, and advising and helping generally in the field of health.
(2) To promote better standards for nutrition, housing, recreation, sanitation, economic and working conditions.
(3) To improve maternal and child health and welfare.
(4) To advance progress in the field of mental health.
(5) To encourage and conduct research on problems of public health.
In carrying out these aims and objectives the WHO functions as a directing and coordinating authority on international health. It serves as a center for all types of global and health information, promotes uniform quarantine standards and international sanitary regulations, provides advisory services through public health experts in control of disease and sets up international standards for the manufacture of all important drugs. Through its teams of physicians, nurses and other health personnel it provides modern medical skills and knowledge to communities throughout the world.

An agency of the United Nations concerned with worldwide and regional health problems. Its functions include furnishing technical assistance, stimulating and advancing epidemiologic investigation of diseases, recommending health regulations, promoting cooperation among scientific and professional health groups, and providing information and counsel relating to health matters.

• Business and Practice of Medicine - World Health Organization: WHO; United Nations agency for improvement of physical and mental health of world’s people

"WHO" redirects here. For other uses, see Who (disambiguation).

World Health Organization منظمة الصحة العالمية 世界卫生组织 Organisation mondiale de la Santé Всемирная организация здравоохранения Organización Mundial de la Salud
Flag of the World Health Organization
Org type	Specialized agency of the United Nations
Acronyms	WHO OMS
Head	Dr. Margaret Chan
Status	Active
Established	7 April 1948
Headquarters	Geneva, Switzerland
Website	www.who.int
Parent org	ECOSOC

The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that is concerned with international public health. It was established on 7 April 1948, with headquarters in Geneva, Switzerland and is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

The constitution of the World Health Organization had been signed by all 61 countries of the United Nations by 22 July 1946, with the first meeting of the World Health Assembly finishing on 24 July 1948. It incorporated the Office International d'Hygiène Publique and the League of Nations Health Organization. Since its creation, WHO has been responsible for playing a leading role in the eradication of smallpox. Its current priorities include communicable diseases, in particular, HIV/AIDS, malaria and tuberculosis; the mitigation of the effects of non-communicable diseases; sexual and reproductive health, development, and ageing; nutrition, food security and healthy eating; substance abuse; and drive the development of reporting, publications, and networking. WHO is responsible for the World Health Report, a leading international publication on health, the worldwide World Health Survey, and World Health Day.

Its links with the IAEA and distribution of contraception have both proved controversial, as have guidelines on healthy eating and the 2009 flu pandemic.

Contents 1 History 1.1 Establishment 1.2 Operational history 2 Current projects 2.1 Overall focus 2.2 Communicable diseases 2.3 Non-communicable diseases 2.4 Life and lifestyle 2.5 Emergency work 2.6 Health policy 2.7 Governance and support 2.8 Other work 2.9 Data handling and publications 3 Structure 3.1 Membership 3.2 Assembly and Executive Board 3.3 Regional offices 3.4 People 3.5 Country and liaison offices 3.6 Financing and partnerships 4 Controversies 4.1 IAEA – Agreement WHA 12–40 4.2 Condom promotion, religion and AIDS 4.3 Intermittent preventive therapy 4.4 Diet and sugar intake 4.5 2009 influenza pandemic 5 See also 6 References 7 External links

History

Establishment

Main article: Establishment of the World Health Organization

The League of Nations Health Organization was established following the First World War inside the League of Nations framework. According to the League's Covenant, it was to "endeavour to take steps in matters of international concern for the prevention and control of disease".^[1] Its efforts were hampered by the Second World War, during which United Nations Relief and Rehabilitation Administration also played a role in international health initiatives.^[2] During the United Nations Conference on International Organization, references to health had been incorporated into the United Nations Charter.^[3]

During the United Nations Conference on International Organization, references to health were incorporated into the United Nations Charter and it passed a declaration that an international health body would be set up.^[3] In February 1946, the Economic and Social Council of the United Nations helped draft the constitution of the new body.^[2] The use of the word "world", rather than "international", emphasised the truly global nature of what the organization was seeking to achieve.^[2] The constitution of the World Health Organization had been signed by all 61 countries of the United Nations by 22 July 1946. It thus became the first specialised agency of the United Nations to which every member subscribed.^[3] Its constitution formally came into force on the first World Health Day on 7 April 1948, when it was ratified by the 26th member state.^[4] The first meeting of the World Health Assembly finished on 24 July 1948, having secured a budget of US$5 million (then GBP£1,250,000) for the 1949 year. Dr. Andrija Stampar was the Assembly's first president, and Dr. G. Brock Chisholm was appointed Director-General of WHO, having served as Executive Secretary during the planning stages.^[2] Its first priorities were to control the spread of malaria, tuberculosis and sexually transmitted infections, and to improve maternal and child health, nutrition and environmental hygiene. Its first legislative act was concerning the compilation of accurate statistics on the spread and morbidity of disease.^[2] The logo of the World Health Organization features the Rod of Asclepius as a symbol for healing.^[5]

Operational history

WHO established an epidemiological information service via telex in 1947, and by 1950 a mass tuberculosis inoculation drive (using the BCG vaccine) was under way. In 1955, the malaria eradication programme was launched, although it was later altered in objective. 1965 saw the first report on diabetes mellitus and the creation of the International Agency for Research on Cancer. WHO moved into its headquarters building in 1966. The Expanded Programme on Immunization was started in 1974, as was the control programme into onchocerciasis – an important partnership between the Food and Agriculture Organization, the United Nations Development Programme, and World Bank. In the following year, the Special Programme for Research and Training in Tropical Diseases was also launched. In 1976, the World Health Assembly voted to enact a resolution on Disability Prevention and Rehabilitation, with a focus on community-driven care. The first list of essential medicines was drawn up in 1977, and a year later the ambitious goal of "health for all" was declared. In 1986, WHO started it global programme on the growing problem of HIV/AIDS, followed two years later by additional attention on preventing discrimination against sufferers and UNAIDS was formed in 1996. The Global Polio Eradication Initiative was established in 1988.^[6]

Three former directors of the Global Smallpox Eradication Programme read the news that smallpox had been globally eradicated, 1980

In 1958, Professor Viktor Zhdanov, Deputy Minister of Health for the USSR, called on the World Health Assembly to undertake a global initiative to eradicate smallpox, resulting in Resolution WHA11.54.^[7] At this point, 2 million people were dying from smallpox every year. In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort and adopted a new disease surveillance method.^[8][9] The initial problem the WHO team faced was inadequate reporting of smallpox cases. WHO established a network of consultants who assisted countries in setting up surveillance and containment activities.^[10] The WHO also helped contain the last European outbreak in Yugoslavia in 1972.^[11] After over two decades of fighting smallpox, the WHO declared in 1980 that the disease had been eradicated – the first disease in history to be eliminated by human effort.^[12]

In 1998, WHO's Director General highlighted gains in child survival, reduced infant mortality, raised life expectancy and reduced rates of "scourges" such as smallpox and polio on the fiftieth anniversary of WHO's founding. He, did, however, accept that more had to be done to assist maternal health and that progress in this area had been slow.^[13] Cholera and malaria have remained problems since WHO's founding, although in decline for a large part of that period.^[14] In the twenty-first century, the Stop TB partnership was created in 2000, along with the UN's formulation of the Millennium Development Goals. The Measles initiative was formed in 2001, and credited with reducing global deaths from the disease by 68% by 2007. In 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria was drawn up to improve the resources available.^[6] In 2006, the organization endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed the basis for a global prevention, treatment and support plan to fight the AIDS pandemic.^[15]

Current projects

Overall focus

The WHO's constitution states that its objective "is the attainment by all people of the highest possible level of health."^[16]

WHO identifies its role as one of six main objectives:^[17]

• providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
• shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
• setting norms and standards and promoting and monitoring their implementation;
• articulating ethical and evidence-based policy options;
• providing technical support, catalysing change, and building sustainable institutional capacity; and
• monitoring the health situation and assessing health trends.

The 2012–2013 budget further identified thirteen areas among which funding was distributed.^[18]

Communicable diseases

Two of those thirteen areas related to communicable diseases: the first, to reducing the "health, social and economic burden" of communicable diseases in general; the second to combat HIV/AIDS, malaria and tuberculosis in particular.^[18]

In terms of HIV/AIDS, WHO works within the UNAIDS network and considers it important that it works in alignment with UNAIDS objectives and strategies. It also strives to involve sections of society other than health to help deal with the economic and social effects of the disease.^[19] In line with UNAIDS, WHO has set itself the interim task between 2009 and 2015 of reducing the number of those aged 15–24 years who are infected by 50%; reducing new HIV infections in children by 90%; and reducing HIV-related deaths by 25%.^[20]

Although WHO dropped its commitment to a global malaria eradication campaign in the 1970s as too ambitious, it retains a strong commitment to malaria control. WHO's Global Malaria Programme works to keep track of malaria cases, and future problems in malaria control schemes. WHO is to report, likely in 2015, as to whether RTS,S/AS01, currently in research, is a viable malaria vaccine. For the time being, insecticide-treated mosquito nets and insecticide sprays are used to prevent the spread of malaria, as are antimalarial drugs – particularly to vulnerable people such as pregnant women and young children.^[21]

WHO's help has contributed to a 40% fall in the number of deaths from tuberculosis between 1990 and 2010, and since 2005, it claims that over 46 million people have been treated and an estimated 7 million lives saved through practices advocated by WHO. These include engaging national governments and their financing, early diagnosis, standardising treatment, monitoring of the spread and impact of tuberculosis and stabilising the drug supply. It has also recognised the vulnerability of victims of HIV/AIDS to tuberculosis.^[22]

WHO aims to eradicate polio. It has also been successful in helping to reduce cases by 99% since the Global Polio Eradication Initiative was launched in 1988, which partnered WHO with Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF), as well as smaller organizations. It works to immunize young children and prevent the re-emergence of cases in countries declared "polio-free".^[23]

Non-communicable diseases

Another of the thirteen areas is aimed at the prevention and reduction of "disease, disability and premature from chronic noncommunicable diseases, mental disorders, violence and injuries and visual impairment".^[18][24]

Life and lifestyle

WHO also works to "reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals"^[18][25]

It also tries to prevent or reduce risk factors for"health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets and physical inactivity and unsafe sex".^[18][26][27]

WHO works to improve nutrition, food safety and food security and to ensure this has a positive effect on public health and sustainable development.^[18]

Emergency work

When any sort of disaster or emergency occurs, it is WHO's stated objective to reduce any consequences it may have on world health and its social and economic implications.^[18]

Health policy

WHO also addresses government health policy with two aims: firstly, "to address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, genderresponsive, and human rights-based approaches" and secondly "to promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health".^[18]

In terms of health services, WHO looks to improve "governance, financing, staffing and management" and the availability and quality of evidence and research to guide polciy making. it also strives to "ensure improved access, quality and use of medical products and technologies".^[18]

Governance and support

The remaining two of WHO's thirteen identified policy areas relate to the role of WHO itself: firstly, "to provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda" and secondly "to develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively".^[18]

Other work

In addition, the WHO has also promoted road safety.^[28] Each year, the organization marks World Health Day focusing on a specific health promotion topic, timed to match the anniversary of WHO's founding. Recent themes have been drug resistance (2011) and ageing (2012).^[29] As part of the United Nations, the World Health Organization supports work towards the Millennium Development Goals.^[30] Of the eight Millennium Development Goals, three – reducing child mortality by two-thirds, to reduce maternal deaths by three-quarters, and to halt and begin to reduce the spread of HIV/AIDS – relate directly to WHO's scope; the other five inter-relate and have an impact on world health.^[31]

Data handling and publications

The organization relies on contributions from renowned scientists and professionals to inform its work, such as the WHO Expert Committee on Biological Standardization,^[32] the WHO Expert Committee on Leprosy,^[33] and the WHO Study Group on Interprofessional Education & Collaborative Practice.^[34] WHO has also worked on global initiatives in surgery, including emergency and essential surgical care,^[35] trauma care,^[36] and safe surgery.^[37] The WHO Surgical Safety Checklist is in current use worldwide in the effort to improve patient safety.^[38]

WHO runs the Alliance for Health Policy and Systems Research, targeted at improving health policy and systems.^[39] WHO aims to improve access to health research and literature in developing countries such as through the HINARI network.^[40] The organization has published tools for monitoring the capacity of national health systems^[41] and health workforces.^[42] The World Health Organization works to provide the needed health and well-being evidence through a variety of data collection platforms, including the World Health Survey covering almost 400,000 respondents from 70 countries,^[43] and the Study on Global Ageing and Adult Health (SAGE) covering over 50,000 persons over 50 years old in 23 countries.^[44] The WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the WHO Quality of Life Instrument (WHOQOL), and the Service Availability and Readiness Assessment (SARA) provide guidance for data collection.^[45] Collaborative efforts between WHO and other agencies, such as through the Health Metrics Network, also aim to provide sufficient high-quality information to assist governmental decision making.^[46] WHO promotes the development of capacities in member states to use and produce research that addresses their national needs, including through the Evidence-Informed Policy Network (EVIPNet).^[47] The Pan American Health Organization (PAHO/AMRO) became the first region to develop and pass a policy on research for health approved in September 2009.^[48]

The organization develops and promotes the use of evidence-based tools, norms and standards to support member states to inform health policy options. It oversees the implementation of the International Health Regulations, and publishes a series of medical classifications; of these, three are overreaching "reference classifications": the International Statistical Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Interventions (ICHI).^[49] Other international policy frameworks produced by WHO include the International Code of Marketing of Breast-milk Substitutes (adopted in 1981),^[50] Framework Convention on Tobacco Control (adopted in 2003)^[51] and the Global Code of Practice on the International Recruitment of Health Personnel (adopted in 2010).^[52] The WHO regularly publishes a World Health Report, its leading publication, including an expert assessment of a specific global health topic.^[53] Other publications of WHO include the Bulletin of the World Health Organization,^[54] the Eastern Mediterranean Health Journal (overseen by EMRO),^[55] the Human Resources for Health (published in collaboration with BioMed Central),^[56] and the Pan American Journal of Public Health (overseen by PAHO/AMRO).^[57]

Structure

The World Health Organization is a member of the United Nations Development Group.^[58]

Membership

Countries by World Health Organization membership status

As of 2012^[update], the WHO has 194 member states, including the Cook Islands and Niue.^[59] As of 2009^[update], it also had two associate members, Puerto Rico and Tokelau.^[60] Non-members of the WHO include Liechtenstein and other states with limited diplomatic recognition.^[59] Several other entities have been granted observer status. Palestine is an observer as a "national liberation movement" recognised by the League of Arab States under United Nations Resolution 3118. The Holy See also attends as an observer, as does the Order of Malta.^[61] In 2010, Taiwan was invited under the name of "Chinese Taipei".^[62]

WHO Member States appoint delegations to the World Health Assembly, WHO's supreme decision-making body. All UN Member States are eligible for WHO membership, and, according to the WHO web site, "other countries may be admitted as members when their application has been approved by a simple majority vote of the World Health Assembly."^[59]

In addition, the UN observer organizations International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies have entered into "official relations" with WHO and are invited as observers. In the World Health Assembly they are seated along the other NGOs.^[61]

Assembly and Executive Board

WHO Headquarters in Geneva

The World Health Assembly is the legislative and supreme body of WHO. Based in Geneva, it typically meets yearly in May. It appoints the Director-General every five years, and votes on matters of policy and finance of WHO, including the proposed budget. It also reviews reports of the Executive Board and decides whether there are areas of work requiring further examination. The Assembly elects 34 members, technically qualified in the field of health, to the Executive Board for three-year terms. The main functions of the Board are to carry out the decisions and policies of the Assembly, to advise it and to facilitate its work.^[63]

Regional offices

Regional offices and regions of the WHO:

  Africa; HQ: Brazzaville, Congo

  Americas; HQ: Washington DC, USA

  Europe; HQ: Copenhagen, Denmark

  Eastern Med.; HQ: Cairo, Egypt

  South East Asia; HQ: New Delhi, India

  Western Pacific; HQ: Manila, Philippines

The regional divisions of WHO were created between 1949 and 1952, and are based on article 44 of WHO's constitution, which allowed the WHA to "establish a [single] regional organization to meet the special needs of [each defined] area". Many decisions are made at regional level, including importance discussions over WHO's budget, and in deciding the members of the next assembly, which are designated by the regions.^[64]

Each region has a Regional Committee, which generally meets once a year, normally in the autumn. Representatives attend from each member or associative member in each region, including those states that are not fully recognised. For example, Palestine attends meetings of the Eastern Mediterranean region. Each region also has a regional office.^[64] Each Regional Office is headed by a Regional Director, who is elected by the Regional Committee. The Board must approve such appointments, although as of 2004, it had never overruled the preference of a regional committee. The exact role of the board in the process has been a subject of debate, but the practical effect has always been small.^[64] Since 1999, Regional Directors serve for a once-renewable five-year term.^[65]

Each Regional Committee of the WHO consists of all the Health Department heads, in all the governments of the countries that constitute the Region. Aside from electing the Regional Director, the Regional Committee is also in charge of setting the guidelines for the implementation, within the region, of the health and other policies adopted by the World Health Assembly. The Regional Committee also serves as a progress review board for the actions of WHO within the Region.

The Regional Director is effectively the head of WHO for his or her Region. The RD manages and/or supervises a staff of health and other experts at the regional offices and in specialized centres. The RD is also the direct supervising authority—concomitantly with the WHO Director-General—of all the heads of WHO country offices, known as WHO Representatives, within the Region.

Regional Offices of WHO

Region	Headquarters	Notes	Website
Africa	Brazzaville, Republic of Congo	AFRO includes most of Africa, with the exception of Egypt, Sudan, South Sudan, Tunisia, Libya, Somalia and Morocco (all fall under EMRO).[66][67]	AFRO
Europe	Copenhagen, Denmark.	EURO includes most of Europe and Israel.[67]	EURO
South-East Asia	New Delhi, India	North Korea is served by SEARO.[68]	SEARO
Eastern Mediterranean	Cairo, Egypt	EMRO includes the countries of Africa that are not included in AFRO, as well as the countries of the Middle East, except for Israel. Pakistan is served by EMRO.[69]	EMRO
Western Pacific	Manila, Philippines.	WPRO covers all the Asian countries not served by SEARO and EMRO, and all the countries in Oceania. South Korea is served by WPRO.[70]	WPRO
The Americas	Washington D.C., USA.	Also known as the Pan American Health Organization (PAHO), and covers the Americas.[71]	AMRO

People

Former Directors-General of WHO^[72]

Name	Years of tenure
Brock Chisholm	1948–1953
Marcolino Gomes Candau	1953–1973
Halfdan T. Mahler	1973–1988
Hiroshi Nakajima	1988–1998
Gro Harlem Brundtland	1998–2003
Lee Jong-wook	2003–2006
Anders Nordström*	2006
*Acting Director-General following the death of Lee Jong-wook while in office

The head of the organization is the Director-General, appointed by the World Health Assembly.^[63] The current Director-General is Margaret Chan, who was appointed on 9 November 2006.^[73] On 18 January 2012, Chan was nominated by the WHO's Executive Board for a second term. If confirmed by the World Health Assembly in May 2012, Dr Chan will remain Director-General until the end of June 2017.^[74]

WHO employs 8,500 people in 147 countries.^[75] In support of the principle of a tobacco-free work environment the WHO does not recruit cigarette smokers.^[76] The organization has previously instigated the Framework Convention on Tobacco Control in 2003.^[77]

The WHO operates "Goodwill Ambassadors", members of the arts, sport or other fields of public life aimed at drawing attention to WHO's initaitves and projects. There are currently five Goodwill Ambassadors (Jet Li, Nancy Brinker, Peng Liyuan, Yohei Sasakawa and the Vienna Philharmonic Orchestra) and a further ambassador associated with a partnership project (Craig David).^[78]

Country and liaison offices

The World Health Organization operates 147 country offices in all its regions.^[79] It also operates several liaison offices, including those with the European Union, United Nations and a single office covering the World Bank and International Monetary Fund. It also operates the International Agency for Research on Cancer in Lyons, France, and the WHO Centre for Health Development in Kobe, Japan.^[80] Additional offices include those in Pristina; the West Bank and Gaza; the US–Mexican Border Field Office in El Paso; the Office of the Caribbean Program Coordination in Barbados; and Northern Micronesia office.^[81] There will generally be one WHO country office in the capital, occasionally accompanied by satellite-offices in the provinces or sub-regions of the country in question.

The country office is headed by a WHO Representative (WR). As of 2010^[update], the only WHO Representative outside Europe to be a national of that country was for the Libyan Arab Jamahiriya ("Libya"); all other staff were international. Those in the Region for the Americas, they are referred to as PAHO/WHO Representatives. In Europe, WHO Representatives also serve as Head of Country Office, and are nationals with the exception of Serbia; there are also Heads of Country Office in Albania, the Russian Federation, Tajikistan, Turkey, and Uzbekistan.^[81] The WR is member of the UN system country team which is coordinated by the UN System Resident Coordinator.

The country office consists of the WR, and several health and other experts, both foreign and local, as well as the necessary support staff.^[79] The main functions of WHO country offices include being the primary adviser of that country's government in matters of health and pharmaceutical policies.^[82]

Financing and partnerships

The WHO is financed by contributions from member states and outside donors. As of 2012^[update], the largest annual assessed contributions from member states came from the United States ($110 million), Japan ($58 million), Germany ($37 million), United Kingdom ($31 million) and France ($31 million).^[83] The combined 2012–2013 budget has proposed a total expenditure of $3,959 million, of which $944 million (24%) will come from assessed contributions. This represented a significant fall in outlay compared to the previous 2009–2010 budget, adjusting to take account of previous underspends. Assessed contributions were kept the same. Voluntary contributions will account for $3,015 million (76%), of which $800 million is regarded as highly or moderately flexible funding, with the remainder tied to particular programmes or objectives.^[84]

In recent years, the WHO's work has involved increasing collaboration with external bodies.^[85] As of 2002^[update], a total of 473 NGOs had some form of partnership with WHO. There were 189 partnerships with international non-governmental organization (NGO) in formal "official relations" – the rest being considered informal in character.^[86] Partners include the Bill and Melinda Gates Foundation^[87] and the Rockefeller Foundation.^[88]

Controversies

IAEA – Agreement WHA 12–40

Demonstration on Chernobyl disaster day near WHO in Geneva

In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency (IAEA). The agreement states that the WHO recognises the IAEA as having responsibility for peaceful nuclear energy without prejudice to the roles of the WHO of promoting health. However, the following paragraph adds: "whenever either organization proposes to initiate a programme or activity on a subject in which the other organization has or may have a substantial interest, the first party shall consult the other with a view to adjusting the matter by mutual agreement."^[89] The nature of this statement has led some pressure groups and activists (including Women in Europe for a Common Future) to believe that the WHO is restricted in its ability to investigate the effects on human health of radiation caused by the use of nuclear power and the continuing effects of nuclear disasters in Chernobyl and Fukushima. They believe WHO must regain what they see as "independence".^[90][91][92]

Condom promotion, religion and AIDS

Main article: Roman Catholic Church and AIDS

In 2003, the WHO denounced the Roman Curia's health department's opposition to the use of condoms, saying: "These incorrect statements about condoms and HIV are dangerous when we are facing a global pandemic which has already killed more than 20 million people, and currently affects at least 42 million."^[93] As of 2009^[update], the Catholic Church remains opposed to increasing the use of contraception to combat HIV/AIDS.^[94] At the time, the World Health Assembly President, Guyana's Health Minister Leslie Ramsammy, condemned Pope Benedict's call, saying he was trying to "create confusion" and "impede" proven strategies in the battle against the disease.^[95]

Intermittent preventive therapy

The aggressive support of the Bill & Melinda Gates Foundation for intermittent preventive therapy of malaria which included the commissioning of a report from the Institute of Medicine triggered a memo from the former WHO malaria chief Dr. Akira Kochi.^[96]

Diet and sugar intake

Some of the research undertaken or supported by WHO to determine how people's lifestyles and environments are influencing whether they live in better or worse health can be controversial, as illustrated by a 2003 joint WHO/FAO report on nutrition and the prevention of chronic non-communicable disease,^[97] which recommended that sugar should form no more than 10% of a healthy diet. This report led to lobbying by the sugar industry against the recommendation, to which the WHO/FAO responded by including in the report the statement "The Consultation recognized that a population goal for free sugars of less than 10% of total energy is controversial", but also stood by its recommendation based upon its own analysis of scientific studies.^[98]

2009 influenza pandemic

Main article: 2009 flu pandemic

In 2007, the WHO organized work on pandemic influenza vaccine development through clinical trials in collaboration with many experts. A pandemic involving the H1N1 influenza virus was declared by Director-General Margaret Chan in April 2009.

By the post-pandemic period critics claimed the WHO had exaggerated the danger, spreading "fear and confusion" rather than "immediate information".^[99] Industry experts countered that the 2009 pandemic had led to "unprecedented collaboration between global health authorities, scientists and manufacturers, resulting in the most comprehensive pandemic response ever undertaken, with a number of vaccines approved for use three months after the pandemic declaration. This response was only possible because of the extensive preparations undertaken in during the last decade."^[100]

See also

United Nations portal

• Global health
• Global Mental Health
• Health For All
• Health promotion
• Drinking water quality standards
• Public health
• High 5s Project, a patient safety collaboration
• Healthy city / Alliance for Healthy Cities, an international alliance
• Health Sciences Online, virtual learning resources
• Open Learning for Development, virtual learning resources

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