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World Health Organization

Palais des Nations, Geneva, Switzerland

ORIGIN AND DEVELOPMENT

The World Health Organization (WHO) came into existence as a specialized agency of the United Nations on April 7, 1948, when the constitution on which it is based entered into force for the twentysixth member of the United Nations.19

Although the creation of a new international health organization had been the subject of informal discussion among the health authorities of several governments during the second World War, the first official step in this direction was not taken until May 1945 when the United Nations Conference on International Organization approved a declaration calling attention to the need for the early establishment of such an organization. In February 1946 the United Nations Economic and Social Council called a health conference to consider the question and appointed a Technical Preparatory Committee of 16 health experts from as many countries to submit proposals to the conference. This Committee, which met in Paris in the spring of 1946, submitted a report to the Second Session of the Economic and Social Council, May-June 1946, which in turn transmitted the report, together with its comments, to the International Health Conference convened in June 1946 in New York City.

The Constitution providing for the establishment of the WHO was drafted by the Conference and signed at its conclusion, July 22, 1946, by representatives of 61 states. On the same date representatives of these states signed an agreement (the Arrangement of July 22, 1946) 19 setting up an Interim Commission of 18 members to make preparations for the first Health Assembly to be convened within six months from the date the WHO constitution entered into force. The headquarters of this Commission was maintained in New York City although most of the activities were centered in the branch office at Geneva. Pending the establishment of a permanent

19 See Basic Texts and Publications, p. 262.

organization the Interim Commission was empowered to carry on certain essential international health work. It was authorized to arrange for the transfer to it or to the WHо the functions which were performed by the Health Organization of the League of Nations, the Health Division of the United Nations Relief and Rehabilitation Administration, and certain functions of the Office International d'Hygiene Publique in Paris (hereinafter called the Office).

The transfer of the activities of the League Health Organization was authorized by a resolution adopted by the General Assembly of the United Nations in December 1946. The Organization, like the Office, was an advisory body without executive power, authorized to collect and distribute technical information and act as a liaison organ between national health administrations. Its work, which related principally to epidemiological information, biologic standardization, research on specific diseases, and advisory services to governments, was closely related to that of the Office. The activities of both organizations formed the basis for the work now being done by the WHO. The transfer to the Interim Commission of the duties of the Health Division of UNRRA occurred on December 1, 1946, in accordance with an agreement concluded between the two bodies in October 1946. These duties, which previously had been assigned by earlier treaties to the Office, had been entrusted to UNRRA by two Sanitary Conventions of 1944, for a period of 18 months and were performed by that organization, with the assistance of the League's Health Organization and (after the liberation of Paris) of the Office. Protocols to the 1944 Conventions provided that these duties should be transferred to the new international health organization, if established by the end of 1946, or revert to the Office.

By an agreement between UNRRA and the Interim Commission, concluded the latter part of 1946, the functions of UNRRA in furnishing technical advice and other assistance in the field of health, to the countries in receipt of assistance from UNRRA, were transferred to the Interim Commission as from January 1, 1947, in Europe and April 1, 1947, in the Far East.

In addition steps have been initiated for the integration of the Pan American Sanitary Organization (q. v.) as the regional organization of the WHO in the Western Hemisphere.

Also, the responsibilities of the International Commission for the Decennial Revision of the International Lists of Disease and Causes of Death have been assumed by the WHO, with the adoption of regulations on July 24, 1948.

Owing to the unexpected slowness with which states accepted the constitution of the WHO, the Interim Commission was compelled to

undertake functions beyond those connected with preparations for the first Health Assembly. This work was financed by loans from the United Nations and by grants from UNRRA, the latter being used exclusively to continue the advisory services to governments.

The Interim Commission was formally dissolved at midnight, August 31, 1948, by virtue of the decision of the first Health Assembly of the WHO, which met in Geneva June 24–July 24, 1948.

MEMBERSHIP

Membership in the WHO is open to all states. Members of the United Nations may become members of the WHO by signature or by depositing an instrument of acceptance of its constitution with the Secretary-General of the United Nations. Nonmembers of the United Nations who were invited to send observers to the International Health Conference in New York in 1946 became members if they deposited their instruments of acceptance before the opening of the first Health Assembly. States which have not become members by such acceptance may become members by depositing instruments of ratification of the Constitution, following approval of their application by a simple majority vote of the Health Assembly.

The constitution provides that territories or groups of territories which are not responsible for the conduct of their international relations may be admitted as associate members by the Health Assembly upon application on behalf of such territories made by the member or other authority having responsibility for their international relations. No associate members have been admitted up to the present time.

As of September 15, 1949, the following 66 states are members of the Organization: Afghanistan, Albania, Argentina, Australia, Austria, Belgium, Brazil, Bulgaria, Burma, Byelorussian S.S.R., Canada, Ceylon, Chile, China, Costa Rica, Czechoslovakia, Denmark, Dominican Republic, Egypt, Ecuador, El Salvador, Ethiopia, Finland, France, Greece, Guatemala, Haiti, Honduras, Hungary, Iceland, India, Iran, Iraq, Ireland, Italy, Korea, Lebanon, Liberia, Luxembourg, Mexico, Monaco, Netherlands, New Zealand, Norway, Pakistan, Paraguay, Philippines, Poland, Portugal, Rumania, Saudi Arabia, Sweden, Switzerland, Syria, Thailand, Transjordan, Turkey, Ukrainian S.S.R., Union of South Africa, the United Kingdom, the United States, Union of Soviet Socialist Republics, Uruguay, Venezuela, and Yugoslavia.

the

Byelorussian Soviet Socialist Republic, the Ukrainian Soviet Socialist Republic and the Union of Soviet Socialist Republics notified the Director General of the WHO in February 1949 that they no longer considered themselves members of the WHо. Since the Constitution contains no provision for withdrawal, this question was placed before

the second Health Assembly meeting at Rome in June 1949. The Assembly adopted a resolution designed to obtain the reconsideration of the three countries.

PURPOSES, POWERS, AND FUNCTIONS

With the objective to raise the health level of all peoples, the WHO has been vested with powers which enable it to engage in activities more varied and of broader scope than those of the earlier organizations in this field. While recognizing the need of continuing the sanitary measures upon which states had relied for protection against the invasion of epidemic diseases, which were the principal concern of the older international organizations, world health authorities who set up the new Organization were of the opinion that such measures were not enough to insure adequate protection in the conditions resulting from the development of rapid transportation. Moreover health authorities are now better equipped to eradicate and control certain diseases at their source thus eliminating the danger of international epidemics. Hence the WHO has been assigned functions which represent a more positive approach to the health problem than that which was to a large extent based on the quarantine concept. One of the major aims of the WHO is to develop and improve national health administration and services. It provides advisory services to governments at their request and otherwise assists them in dealing with emergencies, as it did, for example, during the cholera epidemic in Egypt by obtaining and supplying vaccines to Egypt and the neighboring countries. The WHO grants fellowships, arranges for the exchange of professional personnel between countries, sends demonstration teams to countries in response to requests of governments and promotes research and the distribution of scientific knowledge.

Another important aspect of the WHO's work is the supervision of the execution of the international sanitary conventions designed to prevent the spread of epidemic diseases. In order to enable these measures to be kept more easily abreast of scientific knowledge the constitution invests the WHO with authority to adopt regulations which will replace these conventions. International conventions also entrust the WHO with the responsibility of determining whether particular drugs are habit-forming and thus prohibited from use or distribution except for medical or scientific purposes. The WHO has also been given the authority to develop regulations concerning standards with respect to the safety, purity, and potency of biological, pharmaceutical, and similar products, as well as concerning the advertising and labeling of such products, moving in international commerce.

Finally, as the recognized authoritative international organization in the field of health, the WHO provides pertinent advice and assistance

to the organs of the United Nations and other international organizations.

STRUCTURE

The basic constituent organ of the WHO is the Health Assembly which determines its policies. This body is composed of representatives of the members and meets annually. Each member is entitled to send three delegates who should be qualified by their technical competence in the field of health, together with alternates and advisers.

The constitution also provides for an Executive Board which has responsibility for giving effect to decisions and policies of the Health Assembly. This body is composed of 18 persons designated by as many members elected by the Assembly for this purpose and meets at least twice each year. The Board acts on behalf of the whole Assembly and hence its members do not sit as representatives of the governments which designate them.

The chief administrative officer of the Organization is the Director General, who is appointed by the Assembly on nomination of the Board for a period of five years, which term of office may be renewed. This post is now held by G. Brock Chisholm, who for two years had been head of the Interim Commission. The Director General is the ex officio Secretary of the Assembly and of the Executive Board. He is also the head of the secretariat, the staff of which is appointed by him in accordance with the regulations approved by the Health Assembly. There are two Assistant Directors.

Several advisory committees of experts have been appointed to assist the Director General and the Executive Board who share the responsibility for the execution of the program. Such committees have been established for the fields of malaria, tuberculosis, maternal and child health, venereal diseases, epidemiology and quarantine, biological standardization, unification of pharmacopoeias, habit-forming drugs, insecticides, and health statistics, nursing, mental health, leprosy, and environmental sanitation. In addition, joint committees have been established with other specialized agencies to advise the respective organizations on matters of common interest.

The Organization will carry on its activities to a large extent through regional offices in each of the six geographic areas which the first Health Assembly in 1948 defined for this purpose. At the present time three such offices are functioning: in New Delhi, the site of the regional office for Southeast Asia, in Washington where the Pan American Sanitary Bureau, which serves as the regional office in the Western Hemisphere, is situated, and in Alexandria, Egypt, where the regional office for the Mediterranean area was established on July 1, 1949.