This paper analyzes the World Health Organization's record as a global health institution, tracing its origins from 19th-century sanitary conferences through its formal establishment in 1948. It evaluates WHO's major successes, particularly the eradication of smallpox, against persistent failures including poor communication, time management issues, and health disparities between developed and developing nations. The paper discusses the organization's structure, funding mechanisms, and future goals, concluding that while WHO faces significant challenges such as emerging infectious diseases and poverty-related health crises, strengthened systems and commitment to primary healthcare can enable progress toward global health objectives.
The World Health Organization did not begin as a simple institutional idea. It originated from the International Health Cooperation, first formalized through the International Sanitary Conference held in Paris, which opened on July 23, 1851. The objective of this conference was to harmonize and reduce to a safe minimum the conflicting and costly maritime quarantine requirements of different European nations. The first international sanitary convention, addressing cholera, was ratified and came into force at the seventh International Sanitary Conference in Venice in 1892. Further conferences in Dresden in 1893 and Paris in 1894 resulted in two additional conventions relating to cholera. The next conference in Venice in 1897 adopted a new international convention dealing with prevention of the spread of plague. All four of these conventions were consolidated into a single International Sanitary Convention in 1903.
At the 1903 conference, it was agreed in principle that a permanent international health bureau should be established. At that time, the American republics had already established the International Sanitary Bureau in 1902 in Washington, later renamed the Pan American Sanitary Bureau. At a meeting of government representatives in Rome in 1907, the final decision was taken to establish an Office International d'Hygiène Publique (OIHP) in Paris, with a permanent secretariat and a permanent committee of senior public health officials of member governments. This committee first met toward the end of 1908 and thereafter twice a year, except during World War I.
The League of Nations was created as an aftermath of World War I, and one of its tasks was to "endeavor to take steps in matters of international concern for the prevention and control of disease." All existing international bureaus were to be placed under the direction of the League. It was assumed that the OIHP would be incorporated within the administrative framework of the League; however, at the last moment, the United States, which was a member of the OIHP but not of the League, vetoed this fusion. Thus, in the years between the two world wars, two independent international health organizations coexisted in Europe: the OIHP and the Health Organization of the League of Nations. These two organizations consulted and cooperated with one another, along with the Pan American Sanitary Organization (now the Pan-American Health Organization). With the outbreak of World War II, international health work came almost to a standstill.
In April 1945, during the Conference to establish the United Nations held in San Francisco, representatives of Brazil and China proposed that an international health organization be established and a conference to frame its constitution be convened. On February 15, 1946, the Economic and Social Council of the UN instructed the Secretary-General to convoke such a conference. A Technical Preparatory Committee met in Paris from March 18 to April 5, 1946, and drew up proposals for the Constitution, which were presented to the International Health Conference in New York City between June 19 and July 22, 1946. On the basis of these proposals, the Conference drafted and adopted the Constitution of the World Health Organization, signed July 22, 1946, by representatives of 51 members of the UN and 10 other nations.
The Conference established an Interim Commission to carry out certain activities of the existing health institutions until the entry into force of the Constitution of the World Health Organization. Article 80 of the Constitution provided that the Constitution would come into force when 26 members of the United Nations had ratified it. The Constitution did not come into force until April 7, 1948, when the 26th of the 61 governments who had signed it ratified its signature. To bridge the gap, the Interim Commission continued the work previously undertaken by the Health Organization of the League and the OIHP. For several years, the Health Division of the United Nations Relief and Rehabilitation Administration (UNRRA) and the Interim Commission of WHO took over responsibility for international sanitary conventions and international epidemiological reporting.
The first Health Assembly opened in Geneva on June 24, 1948, with delegations from 53 of the 55 member states. It decided that the Interim Commission was to cease to exist at midnight on August 31, 1948, to be immediately succeeded by WHO. The World Health Organization was officially established in 1948 to deal with major health issues of the world. Some of the tasks the organization oversees are coordinating medical research, monitoring and combating the infectious diseases of the world, and helping developing countries arrange adequate health services. At present, the WHO has over 150 member countries, with its headquarters in Geneva, Switzerland.
The aim and purpose of the WHO is to help people attain the highest possible levels of health. Health, as defined in the WHO Constitution, is a state of complete physical, mental, and social well-being and not merely the absence of disease or weakness. This aim breaks down into a wide range of functions to enable the WHO to maintain its main objective:
These functions include acting as the directing and coordinating authority on international health work; promoting technical cooperation; assisting governments, upon request, in strengthening health services; promoting and coordinating biomedical and health services research; stimulating and advancing work on the prevention of epidemic, endemic, and pandemic diseases; promoting proper teachings and training in health and medical-related professions; furnishing appropriate technical assistance with emergencies and any necessary aid upon request and acceptance by governments; establishing and stimulating international standards for biological, pharmaceutical, and similar products, and standardizing diagnostic procedures; and fostering activities in the field of mental health, especially those affecting the harmony of human relations.
This comprehensive mandate reflects WHO's understanding that sustaining a healthy lifestyle requires not only treating disease but eradicating and overcoming all obstacles that endanger human health.
The World Health Organization, like many other large institutional bodies, has a complex organizational structure. The headquarters is based in Geneva, Switzerland, and there are six regional offices located around the world and 147 individual country offices. The importance of this structure lies in the fact that the regional offices can focus on health matters of concern in their particular region and can act as a liaison with their local country offices to further develop and implement policies. In contrast, the headquarters is concerned with more general matters likely to affect all parts of the world.
As of now, there are 194 member states that make up the World Health Organization. All countries which are members of the United Nations may become members of WHO by accepting its Constitution. Other countries may be admitted as members when their application has been approved by a simple majority vote of the World Health Assembly. These member states come from multiple regions including the European Union, ASEAN, African Union, and others.
Three main principal bodies compose the structure of the World Health Organization and help define its overall agenda in the world: the World Health Assembly, Executive Board, and the Secretariat, which is headed by the Director-General. All WHO members are represented in the World Health Assembly. Each member has one vote but may send three delegates. According to the WHO Constitution, the delegates are to be chosen for their technical competence and preferably should represent national health administrations. Delegations may include alternates and advisers. The assembly meets annually, usually in May, for approximately three weeks. Most assemblies have been held at WHO headquarters in Geneva. A president is elected by each assembly. The World Health Assembly determines the policies of the organization and deals with budgetary, administrative, and similar questions. By a two-thirds vote, the assembly may adopt conventions or agreements.
While these conventions are not binding on member governments until accepted by them, WHO members have to take action leading to their acceptance within 18 months. Thus, each member government, even if its delegation voted against a convention in the assembly, must act—for example, submitting the convention to its legislature for ratification, then notifying the WHO of the action taken, and if unsuccessful, notifying WHO of the reasons for non-acceptance.
The Secretariat deals with arrangements of daily tasks within the WHO and is headed by the Director-General. The Executive Board operates differently but serves the same overall purpose. The World Health Assembly may elect any 32 member countries (the only rule being equitable geographical distribution) for three-year terms, and each of the countries elected designates one person "technically qualified in the field of health" to the WHO Executive Board. The countries are elected by rotation, one-third of the membership being replaced every year, and may succeed themselves. Board members serve as individuals and not as representatives of their governments. The Executive Board meets twice a year for sessions of a few days to several weeks, but it may convene a special meeting at any time. One of its important functions is to prepare the agenda of the World Health Assembly. The WHO Constitution authorizes the board "to take emergency measures within the functions and financial resources of the Organization to deal with events requiring immediate action. In particular, it may authorize the director-general to take the necessary steps to combat epidemics and to participate in the organization of health relief to victims of a calamity."
The WHO has two main sources of funding: government funds and voluntary contributions. The percentage of annual income from voluntary contributions and financial aid from member states changes frequently. Voluntary contributions normally come from the United States and the Gates Foundation, as they have deep connections with the private sector and use their influence to represent its interests. Government funding comes from all member states; however, the proportion of funding from member states is divided into four mutually supporting categories: essential health interventions, health systems and policies and products, determinants of health, and effective support of member states. This financial aid is distributed to regions that require greater assistance than others, allowing WHO to increase research efficiency, create a more effective environment to combat diseases, and assist developing countries in arranging adequate health services.
Decision-making within WHO does not take place at a single moment but rather as a sequence of sub-decisions made by different actors and stakeholders in different rounds during the whole policy or project process. It is useful to distinguish between different policy stages: policy preparation, decision, implementation, and evaluation. However, the separations between these stages are not absolute, and decision-making continues in the implementation and evaluation stages. Furthermore, decision-making should involve weighing several interests, of which the health interest is not always the most important. This distinguishes policy-making from research, and decision-makers and researchers do not always recognize this difference.
As the years have progressed, the World Health Organization has achieved notable successes on a global scale. One of the greatest successes achieved by the WHO is the eradication of smallpox. Smallpox was the first disease to be fought on a global scale, starting in 1966 and defeated by 1980. Although this represents a large time gap, the eradication was accomplished through a combination of focused surveillance and ring vaccination. Ring vaccination is the concept of finding anyone who may have been exposed to a smallpox patient and vaccinating that person or group as soon as possible.
Smallpox proved to be an ideal candidate for eradication. First, the disease is highly visible: smallpox patients develop a rash that is easily recognized. The time from exposure to initial appearance of symptoms is fairly short, so the disease usually cannot spread very far before it is noticed. WHO workers found smallpox patients in outlying areas by displaying pictures of people with the smallpox rash and asking if anyone nearby had a similar rash. Second, only humans can transmit and catch smallpox. Some diseases have an animal reservoir, meaning they can infect other species besides humans. Yellow fever, for example, infects humans but can also infect monkeys. If a mosquito capable of spreading yellow fever bites an infected monkey, the mosquito can then give the disease to humans. So even if the entire population of the planet could somehow be vaccinated against yellow fever, its eradication could not be guaranteed. The disease could still circulate among monkeys and re-emerge if human immunity waned. Smallpox, by contrast, has no animal reservoir and no way to hide beyond the human population. Equally important is the ability to protect individuals against infection. People who survived smallpox naturally developed lifelong immunity against future infection. For everyone else, vaccination was highly effective. WHO trained vaccinators quickly, and they could immunize large groups of people in a short time.
The eradication of smallpox raised hopes that the same could be accomplished for other diseases, with many named as possibilities: polio, mumps, and dracunculiasis (also known as Guinea worm disease). Malaria has also been considered, and its incidence has been reduced drastically in many countries. However, malaria presents a challenge to the traditional idea of eradication in that infection does not result in lifelong immunity, as smallpox does. It is possible to fall ill with malaria many times, although individuals may develop partial immunity after multiple attacks. Additionally, despite promising steps, no effective malaria vaccine yet exists. Rinderpest has also been eradicated, generally due to vaccination, with characteristics similar to smallpox except that it affects only livestock rather than humans.
"Communication gaps, health inequities, emerging disease threats"
"WHO's 2020 goals and the role of global commitment"
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