Chapter 5 INTERNATIONAL PUBLIC HEALTH  DR. EDWARD T. BRAYE

 

5.1 Objective:

To review historical aspects of international health and contemporary issues of global public health. 

5.2 Introduction and Historical Developments

International Health includes those cooperative ventures and works which take place among the nations of the world aimed at promoting the physical, social and mental well-being of the people of the earth.

WHO definition of Health:

"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Health is a fundamental right of every human being without distinction to race, religion, political belief, economic or social condition.

Difficulties in Accomplishing International Health:

• 1. Political differences
• 2. Lack of wealth
• 3. Cultural and/or ethnic practices
• 4. Lack of communications
• 5. Geographical barriers - not too valid today

 Historical

Early difficulties in getting nations together - most efforts in early years were directed toward devastating infectious diseases - plague & cholera.

Consider roles of the contagionists versus the non - contagionists - Efforts and results of The Paris Conference of 1851 Reasons for International Health and kinds of problems lending themselves to such work --

• 1. Disease eradication
• 2. Disease reporting

Require the following:

Cholera, Plague, Smallpox, Yellow Fever, Louse Borne Typhus, and Relapsing Fever

• 3. Standards 
  • (a) Terminology
  • (b) Drugs
  • (c) Quarantine
• 4. Cooperative research
• 5. Education
• 6. Sharing facilities - publications

 5.3 Organizations Working for International Health

5.3.1 WHO - World Health Organization --

Most influential - deeply affected by history - grew largely out of the need and work to control infectious diseases.

Discussions since World War I on such a need - Montreal meeting - 1944 Subsequent meeting 1946 (61 nations present) - Final establishment on September 1, 1948 - Today membership is 175. 

5.3.1.1 Structural Organization of WHO

Headquarters - Geneva, Switzerland 

5.3.1.1.1 Secretariat

Headed by Director or Secretary General 

Actually the active work force of WHO - over 3,000 public servants - doctors, nurses, engineers, veterinarians, sanitarians, etc. Day - to-day operations.

5.3.1.1.2 World Health Assembly

Consists of delegates representing member nations - It decides on the organization’s policy and program, adopts the budget, and drafts international health regulations. It meets once a year for about three weeks - USA representative is The Surgeon - General - Present budget is approximately 200 million - Funds obtained by prorated tax on members, special members, special member contributions, and United Nations Technical Assistance Board.

5.3.1.1.3 Executive Board

Consists of 24 health experts functioning in a personal capacity, meets twice/year. It applies the decisions of the Assembly, submits recommendations to it, and is empowered to take any emergency action that may be necessary between meetings of the Assembly - Recent consideration to expand to 30 members.

5.3.1.1.4 Expert Committees

These are formed from time to time to give special study to correct health problems. Reports are prepared after lengthy periods of study: Committees on Rabies, Tuberculosis, Cholera, Nutrition, Infant Care, Water Pollution, Antibiotics, Biologics, Radiation, etc.

5.3.1.2 WHO Regional Organization 

All are responsive to the Geneva Office 

Zone Headquarters Approx.People

• 1. Africa Brazzaville, Rep. of the Congo 180 million
• 2. Americas Washington, D.C. 480 million
• 3. Eastern Mediterranean Alexandria,Egypt 245 million
• 4. Europe Copenhagen, Denmark 675 million
• 5. South East Asia New Delhi, India 635 million
• 6. Western Pacific Manila, Philippines 970 million 

  5.3.1.3 WHO Health Priorities

• 1. Maternal and child health
• 2. Malaria control and eradication
• 3. Improvements in nutrition
• 4. Venereal disease control
• 5. Environmental sanitation 

  5.3.1.4 Functions of WHO 

• 1. To direct and co-ordinate International Health Work
• 2. To establish and maintain effective collaboration with the United Nations
• 3. To assist Governments in establishing, maintaining, and strengthening health services
• 4. To furnish appropriate technical assistance and in emergency to provide necessary aid at request of Governments
• 5. To establish and maintain such services as may be required, including epidemiological and technical services
• 6. To stimulate and advance the work of eradication of epidemic, endemic and other diseases
• 7. To promote inquiry into the prevention of accidents
• 8. To promote the improvement of the following: nutrition, housing, sanitation, recreation, working conditions and other aspects of environmental hygiene
• 9. To propose conferences, agreements, and regulations with regard to international health
• 10. To promote maternal and child welfare
• 11. To foster activities in the field of mental health
• 12. To promote improved standards of teaching and training in the health, medical and related professions; this it does by giving fellowships (nearly 1500 a year) and arranging courses
• 13. To study and report on administrative and social techniques affecting public health and medical care from preventive and curative points of view including hospital and social security
• 14. To provide information, advice and assistance in the field of health
• 15. To establish and revise as necessary international nomenclatures of diseases, of causes of death, and of public health practices
• 16. To standardize diagnostic procedures as necessary
• 17. To develop, establish and promote international standards with respect to food and for biological pharmaceutical, and similar products

5.3.2 Other Organizations 

• -U.N.I.C.E.F. - United Nations International Children’s Emergency Fund
• -I.L.O. - International Labor Organization
• -F.A.O. - Food and Agriculture Organization
• -U.N.R.R.A. - United Nations Relief and Rehabilitation Agency (mostly for Europe after World War II)
• -Rockefeller Foundation
• -U.S.A.I.D.- Agency of International Development
• -U.S.A. - International Health Division of the Public Health Service, Department of Health and Human Services, United States of America
• -U.N.E.S.C.O. - United Nations Educational, Scientific and Cultural Organization
• -Church Groups of various denominations
• -Kellogg Foundation

5.4 Current Health Problems of International Scope

5.4.1 Population Explosion

Current approximately 4.00 billion Predictions of 6 billion by 2000 Can this number be adequately fed, clothed and housed?

How do you legislate birth control? Large families mean survival in some parts of the world Some countries have declining birth rates - Japan - USA Is zero population growth possible?

5.4.2 Nutrition

In USA we live to eat, in some countries people eat to live Drought in East Africa Famine waves What are the world trends today? Can you forestall mass starvation?

Current establishments of world centers for study and research - Ibadan, Nigeria; Palmyra, Columbia; Manila, Philippines How can FAO influence?

5.4.3 Disease

• Current pandemic of cholera
• Malaria Rabies Protein Malnutrition
• Yellow Fever Hookworm TB
• Schistosomiasis Diarrheal Diseases Salmonellosis

Total eradication may be impossible, but bringing problems to reasonable control should be goal.

5.4.4 Pollution and Environmental Health

One bed out of four in hospitals is occupied by person related to water or filth borne disease 90% of world’s population doesn’t have safe or adequate water.

How do you keep polluted air or water from crossing international borders?

5.4.5 Lack of Personnel

• USA - 1 doctor per 500 persons
• Some areas in Asia and Africa - 1 per 50,000
• Some countries without veterinarians, engineers 

5.4.6 Narcotics

• Habit forming drugs
• What is the extent of crime associated with the problem?
• Who is affected?
• A job for Interpol

5.4.7 Radiological monitoring

• Science Technology vs. Health
• Nutritional defense of nation tied to weapons
• Dangers of global disaster
• Consideration of nuclear power for peaceful uses
• Who controls the atmosphere? 

5.5 Accomplishments on International Scale

WHO - Viable, but needs more funds - in-fighting among nations

Malaria Eradication - In progress - started 1955 - Experimental project after W. W. II - Eliminated from Sardinia

Uniform Quarantines -

Smallpox Eradication - Mass inoculations - Jet-Gun Improvements

Agricultural and Nutritional Universities -

International Reference Research Centers -

• Influenza London Atlanta
• Enteroviruses Prague Houston
• Cancer Lyon, France
• Biologics London Copenhagen

5.6 Words of Ancient Philosopher and Religious Leader

Four truths propounded by Gautama Buddha - 2500 years ago

• 1. There is disease and suffering in the world
• 2. There is a cause
• 3. There is a means of removing the cause
• 4. There is the path by which this can be accomplished