UNITED STATES MEMBERSHIP IN THE WORLD HEALTH ORGANIZATION FRIDAY, JUNE 13, 1947 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON NATIONAL Washington, D. C. The subcommittee met at 10 a. m., Hon. Frances P. Bolton (chairman of the subcommittee) presiding. Mrs. BOLTON. We will come to order, please. The committee will hear testimony this morning on House Joint Resolution 161, a joint resolution providing for the membership and participation by the United States in the world health organization and authorizing an appropriation therefor. House Joint Resolution 161 will be included in the record at this point. (H. J. Res. 161 is as follows:) [H. J. Res. 161, 80th Cong., 1st sess.] JOINT RESOLUTION Providing for membership and participation by the United States in the World Health Organization and authorizing an appropriation therefor Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That the President is hereby authorized to accept membership for the United States in the World Health Organization (hereinafter referred to as the Organization), the constitution of which was adopted in New York on July 22, 1946, by the International Health Conference for the Establishment of an International Health Organization, and deposited in the archives of the United Nations. SEC. 2. The President shall designate from time to time to attend a specified session or specified sessions of the World Health Assembly of the Organization not to exceed three delegates of the United States and such number of alternates as he may determine consistent with the rules of procedure of the World Health Assembly. One of the delegates shall be designated as the chief delegate. Whenever the United States becomes entitled to designate a person to serve on the Executive Board of the Organization, under article 24 of the constitution of the Organization, the President shall designate such person who shall be entitled to receive compensation at a rate not to exceed $12,000 per annum for such period or periods as the President may specify, except that no Member of the Senate or House of Representatives or officer of the United States who is thus designated shall be entitled to receive such compensation. The President may also designate such alternates as may be deemed necessary. SEC. 3. There is hereby authorized to be appropriated annually to the Department of State, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary for the payment by the United States of its share of the expenses of the Organization, including those incurred by the Interim Commission, as apportioned by the Health Assembly in accordance with article 56 of the constitution of the Organization, and such additional sums as may be necessary to pay the expenses incident to participation by the United States in the activities of the Organization, including (a) salaries of the officials provided for in section 2 hereof, and appropriate staff, including personal services in the District of Columbia and elsewhere without regard to the civil-service and classification laws; (b) travel expenses without regard to the Standardized Government Travel Regulations, as amended, the Subsistence Expense Act of 1926, as amended, and section 10 of the Act of March 3, 1933, as amended, and, under such rules and regulations as the Secretary of State may -prescribe, travel expenses of families and transportation of effects of the United States officials provided for in section 2 hereof and other personnel in going to and returning from their post of duty; (c) allowances for living quarters. including heat, fuel, and light, as authorized by the Act approved June 26, 1930 (5 U. S. C. 118a), and similar allowances for persons temporarily stationed abroad; (d) cost of living allowances under such rules and regulations as the Secretary of State may prescribe, including allowances to persons temporarily stationed abroad; (e) services as authorized by section 15 of Public Law 600, Seventy-ninth Congress; (f) official entertainment; (g) local transportation; and (h) printing and binding without regard to section 11 of the Act of March 1, 1919 (44 U. S. C. 111), and section 3709 of the Revised Statutes, as amended. Mrs. BOLTON. An identical measure has been introduced in the Senate as Senate Joint Resolution 98, by Senators Vandenberg and Connally. The clerk will read the message from the President. Mr. CRAWFORD. The President's message is as follows [reading]: I am transmitting herewith for your consideration a suggested joint resolution, providing for United States membership and participation in the World Health Organization. I also am enclosing a memorandum from the Secretary of State, with reference to United States membership in the World Health Organization. I have been impressed by the spirit of international good will and community of purpose which have characterized the development of the constitution of this Organization. I am sure that it will make a substantial contribution to the improvement of world-health conditions through the years. In view of the significance and urgency of international health problems, I consider it important that the United States join the World Health Organization as soon as possible. Therefore, I hope that the suggested joint resolution may have the early consideration of Congress. Mrs. BOLTON. I will ask the Clerk to read a letter received by Chairman Eaton from the Secretary of State: Mr. CRAWFORD. The letter is dated June 13, 1947. [Reading:] I am writing at the request of Mrs. Frances P. Bolton, Chairman of subcommittee No. 5 of the Foreign Affairs Committee which I understand is beginning public hearings on Friday, June 13, at 10 o'clock on the bill to authorize the United States to participate in the World Health Organization. As you know, the views of the Department of State on this matter were set forth in a memorandum which was transmitted to the Congress on March 21, 1947. I should like to emphasize that the World Health Organization is intended to provide the international machinery needed to bring about conditions of health essential not only to the welfare of the United States but to a stable world order. Certainly the economy of those countries in which this Government is vitally interested cannot be established on a firm basis until health has been restored to those populations which have suffered from the war and until health conditions in general have been improved. The efforts which individual countries have been making to rid themselves of debilitating diseases such as tuberculosis and malaria must, however, be supplemented by the concerted action of all nations. The World Health Organization provides the opportunity for such action under circumstances unusually favorable for the encouragement of friendly understanding among nations. The General Assembly of the United Nations has recognized the importance of this Organization by recommending that all Members of the United Nations accept this Constitution at the earliest possible date. I hope, therefore, that the Congress will take early favorable action in this matter, so that this Government may participate fully in this important international program. Mrs. BOLTON. In addition to these letters, we will insert in the record the memorandum spoken of by the Secretary of State, the Constitution of the World Health Organization, the arrangements concluded by the governments recommended at the International Health Conference which established an Interim Commission, concerning the Office International d'Hygiene publique and such other documents as are pertinent to the business at hand. (The documents are as follows:) DEPARTMENT OF STATE, Washington, March 21, 1947. MEMORANDUM Subject: United States Membership in the World Health Organization. The attached joint resolution authorizes the President to accept the constitution of the World Health Organization so that the Organization may be established and begin its work at an early date. The United States Senate expressed itself in favor of the early formation of such an Organization in adopting Senate Joint Resolution 89, Seventy-ninth Congress, First session, on December 20, 1945: 64 * That there should be the speedy convening of an International Health Conference and the early formation of an International Health Organization as one of the objectives of the United Nations Organization, and that the President is hereby requested, on behalf of the Government of the United States, to urge upon the United Nations Organization the prompt convening of such Conference and the formation of such an Organization." The Senate committee report on this resolution stated: "There is today no international health agency organized or equipped to cope with many of the health problems of the rapidly changing world. This committee believes that the creation of such an agency is an urgent necessity for the well-being of every American citizen as well as for world health. ** * * "Disease does not respect national boundaries. Particularly in our shrinking world, the spread of disease via airplane or other swift transport across national boundaries gives rise to ever-present danger." Since the adoption of this resolution by the Senate, an International Health Conference has been held, a constitution of a World Health Organization signed by 61 states, and an Interim Commission established. Because of the urgent need for an International Health Organization, the General Assembly of the United Nations adopted on December 14, 1946, a resolution recommending to all members of the United Nations the acceptance by them of the constitution of the World Health Organization at the earliest possible date. Further, the Twelfth Pan-American Sanitary Conference, meeting in Caracas, Venezuela, January 12-24, 1947, adopted a resolution recommending to the Governments of the American Republics approval of the constitution of the World Health Organization signed in New York City on July 22, 1946, in accordance with their respective constitutional processes. In the opinion of the Department of State, a broad-gaged international organization in the field of health, such as the World Health Organization, is absolutely essential to attack diseases at their source, to prevent their spread until brought under control, and to raise the health level of peoples, in this and every other country. No one nation has a monopoly of medical skills and talents. Our own present high standards of medical technique stem from contributions made by scientists in all parts of the world. Microscopic life was discovered by a Netherlander, antiseptic technique by an Englishman, the germ theory of disease and immunization by a Frenchman. We owe to other countries some of the most powerful weapons against disease which we used to good effect during the recent warpenicillin, the sulfa drugs, DDT, and atabrine. Cooperation of medical scientists and public-health experts of all countries will advance the study of disease and the development of means of control. All countries, the more advanced in medical science and public health as well as those in which progress has been slower, stand to gain from international cooperation in the field of health. Through the machinery of the World Health Organization, the United States, which is one of the countries far advanced in medical science and public health, can play an important role in improving the health conditions of more backward states. The World Health Organization, however, is a joint enterprise and, like other states, the United States stands to gain significantly from participation in it. Some of the very real ways in which we stand to gain, in addition to protection against invasion of disease, may be briefly stated as follows: Opportunities will be provided for our scientists to make intensive studies of diseases which, although not present in the United States, constitute a threat to us, and of diseases which, although present here, are not sufficiently common to offer adequate research opportunities. Results of research performed on an international basis, a field of activity which deserves intensification, will be immediately available to us. We shall receive a constant flow of information concerning health and medical advances throughout the world. Demands will be created for American skills, scientific and technical equip ment and diagnostic and therapeutic products through world-wide familiarity with them. The development of international standards for drugs and biologicals by the World Health Organization will have important advantages for our pharmaceutical industry which is prepared to supply other countries with products of high quality. In the field of disease control, we have been accustomed to rely on international quarantine for our protection. Such control becomes ineffective when international travel can be accomplished, as it is today, within the incubation, or undetectable, period of disease, and within the infectible period of healthy carriers of such diseases as cholera. Even where there are grounds for suspecting the presence of disease, a traveler coming from Africa in 20 hours will scarcely want to submit to 6 days' isolation. It is the consensus among public-health experts and medical authorities, generally, as repeatedly expressed at the International Health Conference, that the control of the international spread of disease can rest now only upon the development of strong national health services capable of controlling epidemic disease at its source. Such development, it is believed, can best be stimulated and brought to fruition by an international health organization, broad in its scope, dedicated to the strengthening of national health services and of such standing as to merit the confidence of governments and invite consultation by them. There is no such organization at the present time. The Pan American Sanitary Bureau is geographically limited by its regional character, the Health Organization of the League of Nations has been dissolved and its functions transferred to the Interim Commission established by the International Health Conference; the International Office of Public Health, which has operated in the technical field of international exchange of epidemiological information, is awaiting formal dissolution while its functions are being assumed by the Interim Commission; and the Health Division of UNRRA, an important but temporary agency, is disbanding. Recognition of the need for a new international health organization prompted the calling of the International Health Conference which met in New York, June 19-July 22, 1946. This, the first international conference convened by the United Nations, was the largest and most representative international conference ever held in the field of health being attended by representatives of 64 states. The official delegations to the Conference were for the most part composed of technically qualified persons, such as ministers of health, chiefs of national health services, distinguished practicing physicians, and medical educators. The constitution of the World Health Organization, which was formulated by the International Health Conference and signed by representatives of 61 states, provides for a single International Health Organization with which existing international health organizations will be integrated. The constitution presents the objectives of the new Organization as "the attainment by all people of the highest possible level of health" (art. 1). It sets out the means by which the Organization shall seek to realize its objective. Probably the most important function given to the Organization is that of assisting states, at their request, in strengthening their national-health services. The immense value of this type of international action in the health field has been dramatically demonstrated by the Health Organization of the League of Nations and the Pan American Sanitary Bureau. This does not mean that the Organization will have, in any way, authority to intervene in the administration of health or medical care in any state. The functions of the Organization include, further, the collection and improvement of world-wide disease statistics; the centralization, consolidation, and distribution of health and medical knowledge; the promotion and conduct of research in the field of health; the continuation and further development of the highly important work done by the League of Nations in the standardization of drugs and biological preparations; and the promotion, in cooperation with other international organizations, of the improvement of nutrition, housing, sanitation, recreation, economic or working conditions, and other aspects of environmental hygiene (art. 2). Thus the Organization will engage in activities such as the above-mentioned Senate committee report envisaged: "Health conditions do not improve automatically, but only as the result of organized, concerted activity. It is not enough to control the spread of disease. In the long run it will be necessary to eradicate their causes, and this can be done only through united international effort. * * The maintenance of good health is not only a matter of quarantine and vaccinations. It is also essential that the social and economic bases for healthful living be established; income adequate to maintain at least a decent standard of living; good nutrition, housing, clothing, and working conditions; and education and cultural opportunity must be included as goals in any effective health program. For this reason a close relationship between the Economic and Social Council of the United Nations Organization and the proposed Health Organization is necessary." One of the most significant advances in the constitution of the World Health Organization is the authority given to the Organization to adopt regulations in certain prescribed technical fields. Under these provisions of the constitution the right of any government to reject regulations which it finds unacceptable is fully protected. The regulatory provision was inserted in an effort to create a mechanism which would permit rapid general application of new scientific techniques to the control of the international spread of disease. This is in accord with a suggestion made in the Senate Foreign Relations Committee, when considering the sanitary conventions of 1944, that some way be found to accomplish this purpose without the necessity of referring to the Senate new treaties drawn solely to incorporate new technical procedures into existing agreements (arts. 21-22). As to the structure of the World Health Organization, the constitution provides for (1) a Health Assembly, on which all member states shall be represented by from one to three delegates; (2) an Executive Board, composed of 18 persons designated by as many states; and (3) a Director-General and a Secretariat (chs. V, VI, and VII, respectively). The Organization will be supported by contributions from member states. The Health Assembly will approve the budget and apportion the expenses among the members in accordance with the scale which it determines (arts. 55–57). The constitution anticipates the establishment of close working relations between the Organization and other international organizations with related interests. It provides that the Organization shall be brought into relationship with the United Nations as a specialized agency, by special agreements (arts. 69-70). The development of the constitution has taken place in a continuous atmosphere of international good will, mutual respect, and singleness of purpose. The history of effective international action in the field of health during the past half century and the harmonious development of the present constitution are convincing evidence that health offers a field in which international cooperation can contribute substantially to the welfare of mankind and to harmony among nations. It is clear that the World Health Organization will have a larger initial membership than has been the case with other specialized organizations. The constitution was signed on behalf of all members of the United Nations and of nine states, nonmembers of the United Nations. Representatives of 61 states signed the arrangement which established the Interim Commission. The constitution will come into force and the Organization will be established when 26 members of the United Nations have notified the Secretary-General of the United Nations of their acceptance of the constitution. Six members of the United Nations have thus far taken the necessary action (China, Canada, Iran, New Zealand, Syria, United Kingdom). The constitution was signed by representatives of the United States, subject to subsequent approval by this Government. United States approval given subsequent to the adoption by both Houses of Congress of the attached joint resolution, which authorized the President to accept the constitution on behalf of the United States and authorizes appropriations for United States participation, will speed the establishment of the Organization and the convening of the |