The first World Health Assembly, held in June 1948 and attended by 53 delegates from WHO's 55 member states, approved a program of work that listed its top priorities as malaria, maternal and child health, tuberculosis, venereal diseases, nutrition and environmental sanitation.
Today, in spite of significant improvements in human health, great burdens of suffering and disease are still with us. Lessons learned in eradicating and controlling diseases, expanding health care coverage and making the best use of available resources have guided the world community, including WHO, on the way to further progress.
The Need for a World Health Organization
At the end of the second world war, the majority of the world's people were still living in extreme poverty and suffering from chronic malnutrition, communicable diseases and parasitic infections, to name a few. Many existing health services were severely disrupted and huge segments of the population were excluded from them. The imperative need was therefore recognized for a new world body capable of grouping resources for health, concentrating on health goals and providing a forum for the exchange of health information. The result was the setting up by the United Nations of a specialized agency to fulfill that need-the World Health Organization.
Declaring War on Disease
WHO's first two decades were dominated by mass campaigns to control diseases such as leprosy, malaria, smallpox, syphilis, tuberculosis and yaws. Between 1950 and 1965, for instance, 46 million patients in 49 countries were successfully treated with penicillin against the tropical disease yaws, making it no longer a significant public health problem in most of the developing world. By 1955, the number of malaria cases worldwide had dropped by at least one-third; but by 1970, eradication of the disease was seen to be impracticable.
The same was not true of smallpox. An eradication campaign that began in 1966, when up to 2 million people a year were dying of smallpox, ended in 1980, when the disease had disappeared from the face of the earth.
These mass campaigns against single diseases gave way to WHO's Expanded Program on Immunization aimed at protecting by the year 2000 all children against six vaccine-preventable diseases-measles, diphtheria, pertussis, tetanus, poliomyelitis and tuberculosis. Global coverage with the vaccines reached its peak in 1990, when the goal of immunizing 80 percent of all children by the age of 1 year was achieved. The long-term goal of the multiagency Children's Vaccine Initiative, launched in 1990, is to achieve a world in which all people at risk are protected against vaccine-preventable diseases, if possible by means of a single procedure.
Health for All
In 1979, the World Health Assembly unanimously endorsed the Declaration of Alma-Ata, which stated that primary health care was to be the key to attaining the goal of health for all by the year 2000.
Consequently, global targets for health were established and have since been the norms against which all health development efforts have been measured. The strategy of health for all has been endorsed at the highest political level, but a gap remains between what is preached and what is practiced.
Setting the Standards
The establishment of standards in such fields as vaccines, drugs and laboratory tests has been a permanent part of WHO's work. The WHO Expert Committee on Biological Standardization has met every year since 1951 to formulate standards which are recognized worldwide. The scientific credibility of WHO provides a guarantee that everyone accepts.
Training physicians, raising the standards of medical schools in developing countries and helping countries organize schools for nurses and midwives has also been a permanent feature of WHO's work. The concept of primary health care has switched much of the emphasis to training directed towards a wide range of health care workers at the community level, particularly in developing countries, rather than towards health professionals as such.
The Way Ahead
WHO's general programs of work, now covering periods of six years, set out principles and policies for the functioning of the organization. They also provide a framework for detailed workplans and budgeting. Over the years the programs have responded to, and often anticipated, the major health concerns of member countries. The ninth program (1996-2001) fixes goals and targets for WHO's global health action. It focuses on the lessening of inequities in health, control of rising costs, the eradication or elimination of selected infectious diseases, the fight against chronic diseases and the promotion of healthy behavior and a healthy environment.
The challenge for the future is to mobilize WHO's member states to adopt policies and plans that will guarantee the provision of comprehensive integrated health services to each and every member of the community.
By: Dr. Hiroshi Nakajima, Director-General World Health Organization.
