ndif]>

            The next important health system for combating the problems of disease in a global setting was the creation of the Health Organization of the League of Nations in 1923.[59] The League made great international public health accomplishments until their activities ended with World War II.[60] They organized a Service of Epidemiological Intelligence which distributed data on the prevalence and movement of communicable disease; this data center covered approximately eighty percent of the world’s population.[61] The League was also involved with the fields of biological standardization, nutrition and health promotion.[62]

            The Institute of Inter-American Affairs was a government agency established under the Good Neighbor Program by the United States in 1942 to promote health programs in Latin America.[63] The Institute collaborated with fourteen Latin American countries to facilitate activities, such as (1) public health and preventative medicine carried out through health centers, (2) environmental sanitation, (3) control of specific diseases, (4) health education, (5) assistance in the construction, equipping, and administration of hospitals, and (6) training of nationals of the host country in health and sanitation work.[64]

III.       The World Health Organization (WHO): the Role, Regulation and Respect

of WHO in Public Health

 

A.     History of the WHO

At the end of World War II, it became apparent a new health system was needed

to continue the mission of the League, and thus the World Health Organization was created by the United Nations.[65] The Constitution was adopted by the representatives of 61 states on July 22, 1946 by the International Health Conference which convened in New York and entered into force on April 7, 1948.

 

 

B.     Objective and Functions

The objective of WHO is the attainment by all peoples of the highest possible level of health. The WHO Constitution defines health as “complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”[66] In order to achieve this objective, the World Health Organization has been designed to perform the following functions[67]:

(a)  to act as the directing and coordinating authority on international health work; (b)  to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations, professional groups and such other organizations as may be deemed appropriate;

(c) to assist Governments, upon request, in strengthening health services;

(d) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments;

(e) to provide or assist in providing, upon the request of the United Nations, health services and facilities to special groups, such as the peoples of trust territories;

(f) to establish and maintain such administrative and technical services as may be required, including epidemiological and statistical services;

(g) to stimulate and advance work to eradicate epidemic, endemic and other diseases;

(h) to promote, in cooperation with other specialized agencies where necessary, the prevention of accidental injuries;

(i)  to promote, in co-operation with other specialized agencies where necessary, the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene;

(j) to promote co-operation among scientific and professional groups which contribute to the advancement of health;

(k) to propose conventions, agreements and regulations, and make recommendations with respect to international health matters and to perform such duties as may be assigned thereby to the Organization and are consistent with its objective;

(l) to promote maternal and child health and welfare and to foster the ability to live harmoniously in a changing total environment;

(m) to foster activities in the field of mental health, especially those affecting the harmony of human relations;

(n) to promote and conduct research in the field of health;

(o) to promote improved standards of teaching and training in the health, medical and related professions;

(p) to study and report on, in co-operation with other specialized agencies where necessary, administrative and social techniques affecting public health and medical care from preventive and curative points of view, including hospital services and social security;

(q) to provide information, counsel and assistance in the field of health;

(r) to assist in developing an informed public opinion among all peoples on matters of health;

(s) to establish and revise as necessary international nomenclatures of diseases, of causes of death and of public health practices;

(t) to standardize diagnostic procedures as necessary;

(u) to develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products;

(v) generally to take all necessary action to attain the objective of the Organization.

 

C.     Organizational Structure of WHO

The Organization consists of three main organs: (1) the Health Assembly, (2) the

Executive Board, and (3) the Secretariat.

   i.          The World Health Assembly

The World Health Assembly is the supreme decision-making body of WHO.

It meets in May each year in Geneva, Switzerland and is attended by delegates from all 192 member states. The Assembly’s main functions are to (1) establish WHO policies; (2) appoint Director-General; (3) supervise WHO financial policies, and (4) renew and approve the budget. Additionally, the Health Assembly reviews reports from the Executive Board, which it instructs in regard to matters upon which further action, study, investigation or report may be required.

   ii.         The Executive Board

The primary functions of the Board are (1) to give effect to the decisions and

policies of the Health Assembly, (2) to advise it, and (3) to facilitate its work. It is composed of 32 members, technically qualified in the field of health, who are elected by the Health Assembly to three-year terms. The Board meets in January to set the agenda for the upcoming Health Assembly. During this meeting, the Board also adopts resolutions that will be forwarded to the Health Assembly. In May, the Board meets again following the Health Assembly to address administrative matters.

   iii.        The Secretariat

This organ of WHO, headed by the Director-General, is staffed by

approximately 3,500 health and other experts and support staff. They work on fixed-term appointments at WHO headquarters, in the six regional offices and in various countries. The Director-General is the chief technical and administrative officer of WHO and is responsible for preparing and submitting financial statements and budget estimates to the Board.[68]

D.    Membership & Governance

i.          Membership

WHO is the largest public health agency in the world, with 192 member States. Any country who is a member of the United Nations may become a member of the Organization by accepting the Constitution. Non-UN member countries may also be admitted as members by a simple majority vote of the Health Assembly to approve their application. Furthermore, territories not responsible for the conduct of their international relations may be admitted as Associate Members upon application; these applications must be submitted on their behalf by the Member or other authority responsible for their international relations. All member states are grouped into six regions, each with its own Regional Office (see Table 2).

 

 

Table 2. World Health Organization – Six Regional Offices and their Member States

Regional Office

Member States

Regional Office for Africa

located in Brazzaville, Congo

 

http://www.afro.who.int/

 

Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, and Zimbabwe

Regional Office for the Americas

located in Washington, D.C., USA

 

http://www.paho.org/

 

Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, United States of America, Uruguay, and Venezuela

Regional Office for South-East Asia

located in New Delhi, India

 

http://w3.whosea.org/index.htm

Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste

Regional Office for Europe

located in Copenhagen, Denmark

 

http://www.euro.who.int/

 

Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia and Montenegro, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, United Kingdom, Uzbekistan

Regional Office for the Eastern Mediterranean

located in Cairo, Egypt

 

http://www.emro.who.int/index.asp

Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, Yemen

Regional Office for the Western Pacific

located in the Philippines

 

http://www.wpro.who.int/

 

Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao People’s Democratic Republic, Malaysia, Marshall Islands, Micronesia, Mongolia, Nauru, New Zealand, Niue, Palau, Papua new Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu, Vietnam

Source: World Health Organization, 2005

 

ii.                  Governance

The Health Assembly, the Executive Board and the Secretariat operate under the

provisions of the WHO Constitution. Additionally, all member states of the Organization are bound to abide by its principles. The Constitution drafted under the auspices of the Charter of the United Nations, assigns responsibility for the provision of adequate health and social measures to member states. The WHO defines health as “complete physical, mental and social well-being.”[69] Within the Constitution, health is considered a fundamental right of every human being.

The Constitution is divided into 19 categorical chapters. The first chapter, containing only Article 1, states the objective of the WHO is the “attainment by all peoples of the highest possible level of health.”[70] Chapter II, Article 2, lists the various functions of the WHO employed to achieve its objective. Some of the functions include acting as authority on international health work, assisting governments in building health services, working to eliminate epidemic, endemic and other diseases, and promoting and conducting research in the field of health.[71] Articles 3 through 8 making up Chapter III pertain to membership and associate membership of the WHO. Membership is open to all states by approval from a simple majority vote of the Health Assembly.

The organs of the WHO, namely the Health Assembly, the Executive Board, and the Secretariat are listed in Chapter IV, Article 9, and are defined in Chapters V, VI, and VIII, respectively. Articles 10 through 37 outline the make-up, roles, and responsibilities of the three organs of the WHO. The WHO can be further broken down into committees, when deemed necessary, by proposal from the Director-General or direction fro the Health Assembly. The creation of committees is authorized in Chapter VIII, Articles 38, 39, and 40. Additionally, the Health Assembly or the Executive Board may organize conferences to address any matters within the scope of the WHO. Chapter IX, Article 41, suggests the WHO may provide for the representation of international organizations and national organizations, governmental or non-governmental.[72] Chapter X, Article 43, specifies the location of the WHO headquarters.

Chapter XI, containing Articles 44 through 54, pertains to the establishment of the regional organizations within the WHO. Regional organizations are desirable to meet the needs of member states on more focused and individualized level; however, there may only be one regional organization in each area. The provisions in this chapter describe the process to establish such regional bodies, their structure, functions, and responsibilities to the member states and to the WHO.

The next three chapters refer to administrative and procedural matters. As specified in Chapter XII, the budget and expenses are initially prepared by the Director-General, submitted to the Executive Board, and are then forwarded to the Health Assembly along with the Board’s recommendations. Voting procedures are outlined in Articles 59 and 60 of Chapter XIII. Each member of the WHO is entitled to one vote in the Health Assembly and most decisions require a two-thirds majority vote of attending members.[73] Chapter XIV discusses the rules pertaining to reports submitted by member states to the WHO, which includes an annual report on any action taken and progress achieved in the improvement of each state’s population.[74]

The legal capacity, privileges and immunities are permitted by Articles 66 through 68 of Chapter XV. The legal capacity extends to any level necessary to achieve the objective of the WHO and in performing its functions.[75] The WHO is granted equal flexibility of privileges and immunities.[76]

Chapter XVI guides relations with other organizations, including other inter-governmental organizations, international organizations, and governmental and non-governmental national organizations.[77]

The final three chapters of refer to the structure and force of the Constitution. Any amendments to the Constitution must be made in accordance with Chapter XVII, Article 73. The interpretation of all provisions contained in the document must be resolved in compliance with Articles 74 through 77 found in Chapter XVIII. Any disputes should be negotiated or settled by the Health Assembly; however, if the matter is not resolved, it can be referred to the International Court of Justice for further judgment on the manner in which the Constitution should be interpreted.[78] Lastly, the Constitution takes entry-into-force pursuant to Articles 78 through 82 of Chapter XIX and remains open for signature and acceptance to all states.[79]               

E.     WHO Programs

Several major WHO programs started in the mid-70’s and have continued into the

Present; these programs include the Expanded Programme on Immunization (EPI), the Special Programme for Research and Training in Tropical Diseases, and the Essential Drugs program.[80] All existing programs are subject to evaluation, revision, and reorganization and new programs are frequently being implemented.[81] Programs are designed to address issues of service delivery, coverage, access, management information systems, logistics, and disease surveillance with an emphasis on countries and people in greatest need.[82]

F.      Publication and Research

In addition to their extensive number of programs, WHO also conducts a

considerable amount of research and data analysis. Publications range from weekly epidemiological reports to journals to drug information databases to an annual World Health Report. WHO also maintains an online library of all of there past and current publications (WHOLIS). Additional research tools include a guide to statistical data (WHOSIS), classifications of diseases, geographical information tools, and media archives.

G.    The Future of International Public Health

Historically, public health primarily addressed issues of housing, sanitation, water supply, and communicable diseases; however, there is now a focus on additional areas including the environment, economic security, domestic problems, childcare, and health education.[83] Moreover, in the last couple of decades, there has been a shift toward strengthening primary care; as a result, the number of WHO programs devoted to primary care has increased dramatically.[84]

At present, the World Health Organization has been revising the International Health Regulations, which will be submitted to the World Health Assembly in May for approval. The Regulations are a set of standards established to ensure security against the international spread of diseases with minimum disruption of world traffic.[85] The revisions are being conducted in response to the changing nature of public health risks—increases in international traffic and trade, introduction of new microbes and re-emergence of old diseases.[86]

Currently, WHO also devotes a tremendous amount of its resources toward disease outbreaks and emergencies, such as the recent Cholera outbreak in Senegal, the Marburg haemorrhagic fever in Angola, and the Tsunami that devastated several countries in South Asia in December.

 

 



[1] Whaley, R.F. and Hashim, T.J., A Textbook of World Health: a Practical Guide to Global Health Care (Parthenon Publishing Group, 1995), 3

[2] World Health Organization, Intersectoral Action for Health: the Role of Intersectoral Cooperation in National Strategies for Health for All (World Health Organization, 1986), 13

[3] Id.

[4] Id. at 14

[5] Id.

[6] Id.

[7] Whaley, R.F. and Hashim, T.J, supra note 1, at 3

[8] World Health Organization, supra note 2, at 17

[9] Id. at 89

[10] Id.

[11] Paul Basch, Textbook of International Health (Oxford University Press, 1999), 242

[12] Whaley, R.F. and Hashim, T.J, supra note 1, at 17

[13] Id. at 16

[14] Id.

[15] Paul Basch, supra note 11, at 242

[16] Whaley, R.F. and Hashim, T.J, supra note 1, at 16

[17] Id.

[18] Id.

[19] Id.

[20] Id.

[21] Id.

[22] Id. at 16-17

[23] Id. at 17

[24] Id.

[25] Id.

[26] Id.

[27] Id. at 22

[28] World Health Organization, http://www.who.int/water_sanitation_health/en/factsfigures2005.pdf

[29] World Health Organization, supra note 2, at 93

[30] Whaley, R.F. and Hashim, T.J, supra note 1, at 17

[31] Id. at 18

[32] Id.

[33] Paul Basch, supra note 11, at 247

[34] Whaley, R.F. and Hashim, T.J, supra note 1, at 19

[35]Id. at 19

[36] Id. at 20

[37] Id.

[38] World Health Organization, supra note 2, at 82

[39] Id.

[40] Id.

[41] Paul Basch, supra note 11, at 158-59

[42] Id. at 159

[43] Merson, M.H, Black, R.E., Mills, A.J., International Public Health (Aspen Publishers, 2001), 57

[44] Id. at 58-59

[45] Id. at 58

[46] Id. at 59-60

[47] World Health Organization, supra note 2, at 98

[48] Merson et al., supra note 43, at 422

[49] Id.

[50] Kohn, R. and White, K. L., Health Care: An International Study, Report of the World Health Organization/International Collaborative Study of Medical Care Utilization (Oxford University Press, 1976), 1

[51] Id.

[52] Winslow, C.E.A., International Co-operation in the Service of Health, Annals of the American Academy of Political and Social Science, Vol. 273 (1951), 192

[53] Id.

[54] Id.

[55] www.paho.org

[56] Winslow, C.E.A., supra note 52, at 192

[57] Id. at 193

[58] Id.

[59] Id. at 194

[60] Id.

[61] Id.

[62] Id.

[63] Oral History Research Office, Columbia University Libraries, http://www.columbia.edu/cu/lweb/indiv/oral/guides/iiaa.html

[64] Winslow, C.E.A., supra note 52, at 195

[65] Id.

[66] World Health Organization, Constitution (1948)

[67] World Health Organization , http://www.who.int/en/

[68] World Health Organization, Constitution (1948)

[69] supra note 18

[70] Id.

[71] Id.

[72] Id.

[73] Id.

[74] Id.

[75] Id.

[76] Id.

[77] Id.

[78] Id.

[79] Id.

[80] Paul Basch, supra note 11, at 303-304

[81] Id. at 304

[82] Id. at 305

[83] Mackenzie, M.,  International Collaboration in Health, International Affairs (Royal Institute of International Affairs), Vol. 26, No. 4 (Oct. 1950), 516

[84] Paul Basch, supra note 11, at 306

[85] World Health Organization , http://www.who.int/en/

[86] Id.