World Health Organization

Establishment

During the 1945 United Nations Conference on International Organization, Dr. Szeming Sze, a delegate from China, conferred with Norwegian and Brazilian delegates on creating an international health organization under the auspices of the new United Nations. After failing to get a resolution passed on the subject, Alger Hiss, the Secretary General of the conference, recommended using a declaration to establish such an organization. Dr. Sze and other delegates lobbied and a declaration passed calling for an international conference on health. The use of the word "world", rather than "international", emphasized the truly global nature of what the organization was seeking to achieve. The constitution of the World Health Organization was signed by all 51 countries of the United Nations, and by 10 other countries, on 22 July 1946. It thus became the first specialised agency of the United Nations to which every member subscribed. Its constitution formally came into force on the first World Health Day on 7 April 1948, when it was ratified by the 26th member state. The first meeting of the World Health Assembly finished on 24 July 1948, having secured a budget of US$5 million (then GB£1,250,000) for the 1949 year. Andrija Stampar was the Assembly's first president, and G. Brock Chisholm was appointed Director-General of WHO, having served as Executive Secretary during the planning stages. Its first priorities were to control the spread of malaria, tuberculosis and sexually transmitted infections, and to improve maternal and child health, nutrition and environmental hygiene. Its first legislative act was concerning the compilation of accurate statistics on the spread and morbidity of disease. The logo of the World Health Organization features the Rod of Asclepius as a symbol for healing.

Operational history

In 1947 the WHO established an epidemiological information service via telex , and by 1950 a mass tuberculosis inoculation drive using the BCG vaccine was under way. In 1955, the malaria eradication programme was launched, although it was later altered in objective. 1965 saw the first report on diabetes mellitus and the creation of the International Agency for Research on Cancer.

In 1958, Viktor Zhdanov, Deputy Minister of Health for the USSR, called on the World Health Assembly to undertake a global initiative to eradicate smallpox, resulting in Resolution WHA11.54. At this point, 2 million people were dying from smallpox every year.

In 1966, WHO moved into its headquarters building.

In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort and adopted a new disease surveillance method. The initial problem the WHO team faced was inadequate reporting of smallpox cases. WHO established a network of consultants who assisted countries in setting up surveillance and containment activities. The WHO also helped contain the last European outbreak in Yugoslavia in 1972. After over two decades of fighting smallpox, the WHO declared in 1979 that the disease had been eradicated – the first disease in history to be eliminated by human effort. In 1974, the Expanded Programme on Immunization and the control programme of onchocerciasis was started, an important partnership between the Food and Agriculture Organization (FAO), the United Nations Development Programme (UNDP), and World Bank. In 1967 the Special Programme for Research and Training in Tropical Diseases was also launched. In 1976, the World Health Assembly voted to enact a resolution on Disability Prevention and Rehabilitation, with a focus on community-driven care. In 1977, the first list of essential medicines was drawn up , and a year later the ambitious goal of "Health For All" was declared. In 1986, WHO started its global programme on HIV/AIDS. Two years later preventing discrimination against sufferers was attended to and in 1996 UNAIDS was formed. In 1988, the Global Polio Eradication Initiative was established. In 1998, WHO's Director General highlighted gains in child survival, reduced infant mortality, increased life expectancy and reduced rates of "scourges" such as smallpox and polio on the fiftieth anniversary of WHO's founding. He, did, however, accept that more had to be done to assist maternal health and that progress in this area had been slow.

In 2000, the Stop TB Partnership was created along with the UN's formulation of the Millennium Development Goals. In 2001 the measles initiative was formed , and credited with reducing global deaths from the disease by 68% by 2007. In 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria was drawn up to improve the resources available. In 2006, the organization endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed the basis for a global prevention, treatment and support plan to fight the AIDS pandemic.

Overall focus

The WHO's Constitution states that its objective "is the attainment by all people of the highest possible level of health".

WHO fulfills its objective through its functions as defined in its Constitution: (a) to act as the directing and co-ordinating authority on international health work (b) to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations, professional groups and such other organizations as may be deemed appropriate (c) to assist Governments, upon request, in strengthening health services (d) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments (e) to provide or assist in providing, upon the request of the United Nations, health services and facilities to special groups, such as the peoples of trust territories (f) to establish and maintain such administrative and technical services as may be required, including epidemiological and statistical services (g) to stimulate and advance work to eradicate epidemic, endemic and other diseases (h) to promote, in co-operation with other specialized agencies where necessary, the prevention of accidental injuries (i) to promote, in co-operation with other specialized agencies where necessary, the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene (j) to promote co-operation among scientific and professional groups which contribute to the advancement of health (k) to propose conventions, agreements and regulations, and make recommendations with respect to international health matters and to perform.

As of 2012 WHO has defined its role in public health as follows:

Communicable diseases

The 2012–2013 WHO budget identified 5 areas among which funding was distributed. Two of those five areas related to communicable diseases: the first, to reduce the "health, social and economic burden" of communicable diseases in general; the second to combat HIV/AIDS, malaria and tuberculosis in particular.

As of 2015 WHO has worked within the UNAIDS network and strived to involve sections of society other than health to help deal with the economic and social effects of HIV/AIDS. In line with UNAIDS, WHO has set itself the interim task between 2009 and 2015 of reducing the number of those aged 15–24 years who are infected by 50%; reducing new HIV infections in children by 90%; and reducing HIV-related deaths by 25%.

in the 1970s WHO had dropped its commitment to a global malaria eradication campaign as too ambitious, it retained a strong commitment to malaria control. WHO's Global Malaria Programme works to keep track of malaria cases, and future problems in malaria control schemes. As of 2012 WHO was to report,as to whether RTS,S/AS01, were a viable malaria vaccine. For the time being, insecticide-treated mosquito nets and insecticide sprays are used to prevent the spread of malaria, as are antimalarial drugs – particularly to vulnerable people such as pregnant women and young children.

between 1990 and 2010, WHO's help has contributed to a 40% decline in the number of deaths from tuberculosis, and since 2005, over 46 million people have been treated and an estimated 7 million lives saved through practices advocated by WHO. These include engaging national governments and their financing, early diagnosis, standardising treatment, monitoring of the spread and impact of tuberculosis and stabilising the drug supply. It has also recognised the vulnerability of victims of HIV/AIDS to tuberculosis.

In 1988,WHO launched the Global Polio Eradication Initiative to eradicate polio. It has also been successful in helping to reduce cases by 99% since which partnered WHO with Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF), and smaller organizations. As of 2011 it has been working to immunize young children and prevent the re-emergence of cases in countries declared "polio-free".

Non-communicable diseases

Another of the thirteen WHO priority areas is aimed at the prevention and reduction of "disease, disability and premature deaths from chronic noncommunicable diseases, mental disorders, violence and injuries, and visual impairment".

Environmental health

The WHO estimates that 12.6 million people died as a result of living or working in an unhealthy environment in 2012 – this accounts for nearly 1 in 4 of total global deaths. Environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change, and ultraviolet radiation, contribute to more than 100 diseases and injuries. This can result in a number of pollution-related diseases.

Life course and life style

WHO works to "reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy aging for all individuals".

It also tries to prevent or reduce risk factors for "health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets and physical inactivity and unsafe sex".

WHO works to improve nutrition, food safety and food security and to ensure this has a positive effect on public health and sustainable development.

Surgery and trauma care

The WHO promotes road safety as a means to reduce traffic-related injuries.

WHO has also worked on global initiatives in surgery, including emergency and essential surgical care, trauma care, and safe surgery. The WHO Surgical Safety Checklist is in current use worldwide in the effort to improve patient safety.

Emergency work

The World Health Organization's primary objective in natural and man-made emergencies is to coordinate with Member States and other stakeholders to "reduce avoidable loss of life and the burden of disease and disability."

On 5 May 2014, WHO announced that the spread of polio is a world health emergency – outbreaks of the disease in Asia, Africa and the Middle East are considered "extraordinary".

On 8 August 2014, WHO declared that the spread of Ebola is a public health emergency; an outbreak which is believed to have started in Guinea, has spread to other nearby countries such as Liberia and Sierra Leone. The situation in West Africa is considered very serious.

Health policy

WHO addresses government health policy with two aims: firstly, "to address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches" and secondly "to promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health".

The organization develops and promotes the use of evidence-based tools, norms and standards to support member states to inform health policy options. It oversees the implementation of the International Health Regulations, and publishes a series of medical classifications; of these, three are overreaching "reference classifications": the International Statistical Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Interventions (ICHI). Other international policy frameworks produced by WHO include the International Code of Marketing of Breast-milk Substitutes (adopted in 1981), Framework Convention on Tobacco Control (adopted in 2003) and the Global Code of Practice on the International Recruitment of Health Personnel (adopted in 2010).

In terms of health services, WHO looks to improve "governance, financing, staffing and management" and the availability and quality of evidence and research to guide policy making. It also strives to "ensure improved access, quality and use of medical products and technologies". WHO - working with donor agencies and national governments - can improve their use of and their reporting about their use of research evidence.

Governance and support

The remaining two of WHO's thirteen identified policy areas relate to the role of WHO itself:

Partnerships

The WHO along with the World Bank constitute the core team responsible for administering the International Health Partnership (IHP+). The IHP+ is a group of partner governments, development agencies, civil society and others committed to improving the health of citizens in developing countries. Partners work together to put international principles for aid effectiveness and development cooperation into practice in the health sector.

The organization relies on contributions from renowned scientists and professionals to inform its work, such as the WHO Expert Committee on Biological Standardization, the WHO Expert Committee on Leprosy, and the WHO Study Group on Interprofessional Education & Collaborative Practice.

WHO runs the Alliance for Health Policy and systems Research, targeted at improving health policy and systems.

WHO also aims to improve access to health research and literature in developing countries such as through the HINARI network.

Public health education and action

Each year, the organization marks World Health Day and other observances focusing on a specific health promotion topic. World Health Day falls on 7 April each year, timed to match the anniversary of WHO's founding. Recent themes have been vector-borne diseases (2014), healthy ageing (2012) and drug resistance (2011).

The other official global public health campaigns marked by WHO are World Tuberculosis Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Blood Donor Day, World Hepatitis Day, and World AIDS Day.

As part of the United Nations, the World Health Organization supports work towards the Millennium Development Goals. Of the eight Millennium Development Goals, three – reducing child mortality by two-thirds, to reduce maternal deaths by three-quarters, and to halt and begin to reduce the spread of HIV/AIDS – relate directly to WHO's scope; the other five inter-relate and have an impact on world health.

Data handling and publications

The World Health Organization works to provide the needed health and well-being evidence through a variety of data collection platforms, including the World Health Survey covering almost 400,000 respondents from 70 countries, and the Study on Global Ageing and Adult Health (SAGE) covering over 50,000 persons over 50 years old in 23 countries. The Country Health Intelligence Portal (CHIP), has also been developed to provide an access point to information about the health services that are available in different countries. The information gathered in this portal is utilized by the countries to set priorities for future strategies or plans, implement, monitor, and evaluate it.

The WHO has published various tools for measuring and monitoring the capacity of national health systems and health workforces. The Global health Observatory (GHO) has been the WHO's main portal which provides access to data and analyses for key health themes by monitoring health situations around the globe.

The WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the WHO Quality of Life Instrument (WHOQOL), and the Service Availability and Readiness Assessment (SARA) provide guidance for data collection. Collaborative efforts between WHO and other agencies, such as through the Health Metrics Network, also aim to provide sufficient high-quality information to assist governmental decision making. WHO promotes the development of capacities in member states to use and produce research that addresses their national needs, including through the Evidence-Informed Policy Network (EVIPNet). The Pan American Health Organization (PAHO/AMRO) became the first region to develop and pass a policy on research for health approved in September 2009.

On 10 December 2013, a new WHO database, known as MiNDbank, went online. The database was launched on Human Rights Day, and is part of WHO's QualityRights initiative, which aims to end human rights violations against people with mental health conditions. The new database presents a great deal of information about mental health, substance abuse, disability, human rights, and the different policies, strategies, laws, and service standards being implemented in different countries. It also contains important international documents and information. The database allows visitors to access the health information of WHO member states and other partners. Users can review policies, laws, and strategies and search for the best practices and success stories in the field of mental health.

The WHO regularly publishes a World Health Report, its leading publication, including an expert assessment of a specific global health topic. Other publications of WHO include the Bulletin of the World Health Organization, the Eastern Mediterranean Health Journal (overseen by EMRO), the Human Resources for Health (published in collaboration with BioMed Central), and the Pan American Journal of Public Health (overseen by PAHO/AMRO).

Structure

The World Health Organization is a member of the United Nations Development Group.

Membership

As of 2015, the WHO has 194 member states: all of them Member States of the United Nations except for the Cook Islands and Niue. (A state becomes a full member of WHO by ratifying the treaty known as the Constitution of the World Health Organization.) As of 2013, it also had two associate members, Puerto Rico and Tokelau. Several other countries have been granted observer status. Palestine is an observer as a "national liberation movement" recognised by the League of Arab States under United Nations Resolution 3118. The Holy See also attends as an observer, as does the Order of Malta. In 2010, Taiwan was invited under the name of "Chinese Taipei".

WHO Member States appoint delegations to the World Health Assembly, WHO's supreme decision-making body. All UN Member States are eligible for WHO membership, and, according to the WHO web site, "other countries may be admitted as members when their application has been approved by a simple majority vote of the World Health Assembly".

In addition, the UN observer organizations International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies have entered into "official relations" with WHO and are invited as observers. In the World Health Assembly they are seated alongside the other NGOs.

Assembly and Executive Board

The World Health Assembly is the legislative and supreme body of WHO. Based in Geneva, it typically meets yearly in May. It appoints the Director-General every five years, and votes on matters of policy and finance of WHO, including the proposed budget. It also reviews reports of the Executive Board and decides whether there are areas of work requiring further examination. The Assembly elects 34 members, technically qualified in the field of health, to the Executive Board for three-year terms. The main functions of the Board are to carry out the decisions and policies of the Assembly, to advise it and to facilitate its work.

Regional offices

The regional divisions of WHO were created between 1949 and 1952, and are based on article 44 of WHO's constitution, which allowed the WHO to "establish a [single] regional organization to meet the special needs of [each defined] area". Many decisions are made at regional level, including important discussions over WHO's budget, and in deciding the members of the next assembly, which are designated by the regions.

Each region has a Regional Committee, which generally meets once a year, normally in the autumn. Representatives attend from each member or associative member in each region, including those states that are not fully recognised. For example, Palestine attends meetings of the Eastern Mediterranean Regional office. Each region also has a regional office. Each Regional Office is headed by a Regional Director, who is elected by the Regional Committee. The Board must approve such appointments, although as of 2004, it had never overruled the preference of a regional committee. The exact role of the board in the process has been a subject of debate, but the practical effect has always been small. Since 1999, Regional Directors serve for a once-renewable five-year term.

Each Regional Committee of the WHO consists of all the Health Department heads, in all the governments of the countries that constitute the Region. Aside from electing the Regional Director, the Regional Committee is also in charge of setting the guidelines for the implementation, within the region, of the health and other policies adopted by the World Health Assembly. The Regional Committee also serves as a progress review board for the actions of WHO within the Region.

The Regional Director is effectively the head of WHO for his or her Region. The RD manages and/or supervises a staff of health and other experts at the regional offices and in specialized centers. The RD is also the direct supervising authority—concomitantly with the WHO Director-General—of all the heads of WHO country offices, known as WHO Representatives, within the Region.

People

The head of the organization is the Director-General, elected by the World Health Assembly. The current Director-General is Margaret Chan, who was first appointed on 9 November 2006 and confirmed for a second term until the end of June 2017.

WHO employs 8,500 people in 147 countries. In support of the principle of a tobacco-free work environment the WHO does not recruit cigarette smokers. The organization has previously instigated the Framework Convention on Tobacco Control in 2003.

The WHO operates "Goodwill Ambassadors", members of the arts, sport or other fields of public life aimed at drawing attention to WHO's initiatives and projects. There are currently five Goodwill Ambassadors (Jet Li, Nancy Brinker, Peng Liyuan, Yohei Sasakawa and the Vienna Philharmonic Orchestra) and a further ambassador associated with a partnership project (Craig David).

Country and liaison offices

The World Health Organization operates 147 country offices in all its regions. It also operates several liaison offices, including those with the European Union, United Nations and a single office covering the World Bank and International Monetary Fund. It also operates the International Agency for Research on Cancer in Lyon, France, and the WHO Centre for Health Development in Kobe, Japan. Additional offices include those in Pristina; the West Bank and Gaza; the US-Mexico Border Field Office in El Paso; the Office of the Caribbean Program Coordination in Barbados; and Northern Micronesia office. There will generally be one WHO country office in the capital, occasionally accompanied by satellite-offices in the provinces or sub-regions of the country in question.

The country office is headed by a WHO Representative (WR). As of 2010, the only WHO Representative outside Europe to be a national of that country was for the Libyan Arab Jamahiriya ("Libya"); all other staff were international. Those in the Region for the Americas, they are referred to as PAHO/WHO Representatives. In Europe, WHO Representatives also serve as Head of Country Office, and are nationals with the exception of Serbia; there are also Heads of Country Office in Albania, the Russian Federation, Tajikistan, Turkey, and Uzbekistan. The WR is member of the UN system country team which is coordinated by the UN System Resident Coordinator.

The country office consists of the WR, and several health and other experts, both foreign and local, as well as the necessary support staff. The main functions of WHO country offices include being the primary adviser of that country's government in matters of health and pharmaceutical policies.

Financing and partnerships

The WHO is financed by contributions from member states and outside donors. As of 2012, the largest annual assessed contributions from member states came from the United States ($110 million), Japan ($58 million), Germany ($37 million), United Kingdom ($31 million) and France ($31 million). The combined 2012–2013 budget has proposed a total expenditure of $3,959 million, of which $944 million (24%) will come from assessed contributions. This represented a significant fall in outlay compared to the previous 2009–2010 budget, adjusting to take account of previous underspends. Assessed contributions were kept the same. Voluntary contributions will account for $3,015 million (76%), of which $800 million is regarded as highly or moderately flexible funding, with the remainder tied to particular programmes or objectives.

In recent years, the WHO's work has involved increasing collaboration with external bodies. As of 2002, a total of 473 non-governmental organizations (NGO) had some form of partnership with WHO. There were 189 partnerships with international NGOs in formal "official relations" – the rest being considered informal in character. Partners include the Bill and Melinda Gates Foundation and the Rockefeller Foundation.

IAEA – Agreement WHA 12–40

In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency (IAEA). The agreement states that the WHO recognises the IAEA as having responsibility for peaceful nuclear energy without prejudice to the roles of the WHO of promoting health. However, the following paragraph adds that "whenever either organization proposes to initiate a programme or activity on a subject in which the other organization has or may have a substantial interest, the first party shall consult the other with a view to adjusting the matter by mutual agreement". The nature of this statement has led some pressure groups and activists (including Women in Europe for a Common Future) to believe that the WHO is restricted in its ability to investigate the effects on human health of radiation caused by the use of nuclear power and the continuing effects of nuclear disasters in Chernobyl and Fukushima. They believe WHO must regain what they see as "independence".

Roman Catholic Church and AIDS

In 2003, the WHO denounced the Roman Curia's health department's opposition to the use of condoms, saying: "These incorrect statements about condoms and HIV are dangerous when we are facing a global pandemic which has already killed more than 20 million people, and currently affects at least 42 million." As of 2009, the Catholic Church remains opposed to increasing the use of contraception to combat HIV/AIDS. At the time, the World Health Assembly President, Guyana's Health Minister Leslie Ramsammy, condemned Pope Benedict's opposition to contraception, saying he was trying to "create confusion" and "impede" proven strategies in the battle against the disease.

Intermittent preventive therapy

The aggressive support of the Bill & Melinda Gates Foundation for intermittent preventive therapy of malaria triggered a memo from the former WHO malaria chief Akira Kochi.

Diet and sugar intake

Some of the research undertaken or supported by WHO to determine how people's lifestyles and environments are influencing whether they live in better or worse health can be controversial, as illustrated by a 2003 joint WHO/FAO report on nutrition and the prevention of chronic non-communicable disease, which recommended that sugar should form no more than 10% of a healthy diet. The report led to lobbying by the sugar industry against the recommendation, to which the WHO/FAO responded by including in the report this statement: "The Consultation recognized that a population goal for free sugars of less than 10% of total energy is controversial". It also stood by its recommendation based upon its own analysis of scientific studies. In 2014, WHO reduced recommended sugar levels by half and said that sugar should make up no more than 5% of a healthy diet.

2009 swine flu pandemic

In 2007, the WHO organized work on pandemic influenza vaccine development through clinical trials in collaboration with many experts. A pandemic involving the H1N1 influenza virus was declared by Director-General Margaret Chan in April 2009.

By the post-pandemic period critics claimed the WHO had exaggerated the danger, spreading "fear and confusion" rather than "immediate information". Industry experts countered that the 2009 pandemic had led to "unprecedented collaboration between global health authorities, scientists and manufacturers, resulting in the most comprehensive pandemic response ever undertaken, with a number of vaccines approved for use three months after the pandemic declaration. This response was only possible because of the extensive preparations undertaken in during the last decade".

2013-16 Ebola outbreak and reform efforts

Following the 2014 Ebola outbreak in West Africa, the organization was heavily criticized for its bureaucracy, insufficient financing, regional structure, and staffing profile.

An internal WHO report on the Ebola response pointed to underfunding and lack of "core capacity" in health systems in developing countries as the primary weaknesses of the existing system. At the annual World Health Assembly in 2015, Director General Margaret Chan announced a $100 million Contingency Fund for rapid response to future emergencies, of which it had received $26.9 million by April 2016 (for 2017 disbursement). WHO has budgeted an additional $494 million for its Health Emergencies Programme in 2016-17, for which it had received $140 million by April 2016.

The program was aimed at rebuilding WHO capacity for direct action, which critics said had been lost due to budget cuts in the previous decade that had left the organization in an advisory role dependent on member states for on-the-ground activities. In comparison, billions of dollars have been spent by developed countries on the 2013-16 Ebola epidemic and 2015-16 Zika epidemic.

FCTC implementation database

The WHO has a Framework Convention on Tobacco implementation database which is one of the only mechanisms to help enforce compliance with the FCTC. However, there has been reports of numerous discrepancies between it and national implementation reports on which it was built. As researchers Hoffman and Rizvi report "As of July 4, 2012, 361 (32·7%) of 1104 countries' responses were misreported: 33 (3·0%) were clear errors (eg, database indicated “yes” when report indicated “no”), 270 (24·5%) were missing despite countries having submitted responses, and 58 (5·3%) were, in our opinion, misinterpreted by WHO staff".

World headquarters

The seat of the organization is in Geneva, Switzerland. It was dedicated and opened in 1966.