The agency of the United Nations responsible for health. Formed in 1948 during a period of aggressive and optimistic international organization-building, the objective of the World Health Organization (WHO) is nothing less than "the attainment by all peoples of the highest possible level of health". The constitution of WHO defines health very broadly: "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". WHO works to attain this ambitious goal by guiding and coordinating international health efforts.

WHO's budget consists of regular contributions from members - about US$850,000,000 in 2002/03 - and voluntary contributions from members and others for specific, time-limited projects - about US$1,380,000,000 for the same period. WHO publishes its prospective program budget each year; you can see the one for 2004/05 at www.who.int/gb/EB_WHA/E/E_docPB2003.htm

What WHO Does

Perhaps the best-known - and least controversial - type of work that WHO engages in is combatting infectious diseases. WHO's biggest successes have been against diseases for which effective vaccines exist, most particularly smallpox.

Smallpox is a highly infectious disease that causes severe pockmarks and blindness and, in up to 30% of cases, death. It was once one of the most feared diseases in the world, despite the fact that the Chinese have known how to induce immunity to it since the tenth century. They discovered variolation, a process whereby matter from smallpox lesions is introduced into the body of a healthy person; though it could cause illness and local scarring, and occasionally death, those who survived were immune to smallpox. An English country doctor, Edward Jenner, discovered in 1789 that he could induce immunity using material from the much less severe cowpox, and so vaccination (vacca is Latin for cow) was born. Though effective, the practice of vaccination was not common until WHO embarked on an aggressive global immunization campaign in 1967. The last naturally-occuring smallpox infection occured in 1977. WHO stipulates that no natural infections must occur for three years before a declaration of eradication can be made, and so in 1980 the world was declared smallpox-free. The only infections since 1977 have been the result of laboratory accidents, though there are fears that bioterrorism could result in an outbreak.

Currently WHO is attempting to wipe out polio by 2005. This highly infectious disease can cause paralysis within hours, and chiefly strikes those under the age of five. The Americas were declared polio-free in 1994, the Western Pacific area in 2000, and Europe in 2002. Once endemic, polio is now found only in parts of Africa and South Asia.

WHO also tracks the incidence of diseases around the world. They issue travel advisories for travellers, recommending what inoculations are needed for those visiting particular regions. They monitor outbreaks of new diseases such as SARS, tracking its spread from the original case to farflung countries around the globe.

WHO has made some impressive gains, but critics point out that WHO has had less success against diseases for which there is no vaccine, most notably malaria, tuberculosis, and HIV. And they complain that WHO is too bureaucratic and centralized, and could do much more with its huge budget to combat these deadly diseases. The past and the current directors-general pledged to increase efficiency and effectiveness, but WHO is a huge bureaucracy, and anyone who studies such beasts can testify that they have an inertia and a will to power that is difficult to counter.

More controversial than its disease prevention activities have been WHO's efforts to improve public health through activities such as the recent anti-tobacco treaty, unanimously adopted at the 2003 assembly. Libertarian critics scream that WHO's vision of health as "a state of complete physical, mental and social well-being" is totalitarian, and that WHO's efforts to achieve this state lead it to infringe upon personal liberty. In this view, smoking is a right and a personal choice, and no level of government - local, national, or international - has a right to interfere with that right.

Where you stand on issues like this comes down to your personal viewpoint of the role of social organizations and the place of the individual in society. I leave that up to you. But I hope we can all agree that attaining health, however defined, is a laudable goal, as is living a life free of the threat of smallpox.

Organizational Structure

For those who like public administration:

Like the UN itself, WHO is a huge organization with an enormous budget. Headquartered in Geneva, the daily work of WHO is carried out by a secretariat consisting of thousands of staff who work out of headquarters, regional offices, and in member countries. This bureaucracy is headed by a director-general who is nominated by an executive board and elected by a general assembly. The director-general serves a five-year term; at their annual meeting in Geneva this month, a new director-general was chosen, Dr. Jong-Wok Lee. This medical doctor from South Korea has been employed by WHO in various capacities for almost two decades; he replaces Dr. Gro Harlem Brundtland, also a physician and former prime minister of Norway.

The World Health Assembly is the main ratifying body of WHO, and consists of delegates from each member state, of which there are currently 192. The assembly usually meets in May in Geneva; they review and approve the budget and the policy and program directions for the coming year. If necessary (as this year) they elect a director-general and members of the executive board. Although said to be the main policy-making body for WHO, really they just rubber stamp recommendations that have flowed from the secretariat to the executive board.

The executive board is made up of members, currently 32, elected from among the assembly. Their main meeting is in January, at which they approve the agenda and directions for the coming year. If necessary, they nominate the director-general. Although they have more influence than the assembly on the directions WHO pursues, they are substantially guided by the work of the secretariat.

WHO also has regional offices for Africa, Europe, the Americas, South-East Asia, the Eastern Mediterranean, and the Western Pacific. Some of these - notably the Pan-American Health Organization or PAHO - were existing regional entities when WHO was created. Unwilling to disband in favour of WHO, PAHO agreed to become part of the WHO/UN structure only if they retained a large degree of autonomy. Other regional centres were able to reach similar agreements when they joined or were formed. Such a degree of independence is rare in UN circles, and has meant that WHO cannot force regional organizations to work to the central organizations' priorities.

Interestingly, countries can choose which regional organization - if any - they want to join. This has resulted in some odd bedfellows: Thailand, for example, is a member of the south-east Asia regional organization, as you might expect, but its immediate neighbour to the south, Malaysia, decided to join the western Pacific region.

Finally, WHO designates academic or health institutions as collaborating centres for a period of four years. Though funded by national governments, these collaborating centres contribute to the research and program priorities of WHO.

www.who.int/en/
immunisation.org.uk/index.html
reason.com/0201/fe.bd.who.shtml
www.kings.cam.ac.uk/histecon/docs/amrith_WHO.pdf
www.laskerfoundation.org/news/ihealth.html
www.afronets.org/archive/200211/msg00061.php
www.latrobe.edu.au/publichealth/sphabout.html

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