The World Health Organization

The History Of The World Health Organization

Today's WHO emerged from many other institutions and its development began about a hundred years ago: After adopting two conventions (against cholera and plague) in the late nineteenth century, the International Sanitary Bureau was finally set up in Washington, DC. Its constitution was revised in 1926 and from then on included provisions against smallpox and typhus.

By 1945, a demand for a new, autonomous, international health organization came up and made the United Nations Conference approve the constitution of the WHO, which comes into force on 7 April, 1948 (àWorld Health Day).

Everything worked until the year 1973: The à Executive Board concluded that radical changes were needed. In that year, the World Health Assembly (WHA) decided that the WHO should collaborate with its member states, and not only assist them. In 1998, the WHO celebrated the 50th Anniversary of its constitution.

- Health For All by the year 2000: This is what the 30th WHA set as target in 1977, all people should be able to lead a socially and economically productive live.

`Global Program on AIDS' or the global strategies for Health For All by the year 2000 were adopted unanimously in the 1980ies. Health For All doesn't mean a total end of all diseases or that doctors will care for everyone, but that resources for health are distributed and essential health care is accessible to everyone. Health begins at home, in schools and at workplaces, people should have better approaches for preventing or alleviating illness.

WHO has four main functions:
- to give worldwide guidance in the field of health · to set global standards for health
- to cooperate with governments in strengthening national health programs · to develop and transfer appropriate health technology, information and standards.

The Management Structure Of The WHO

The Executive Board (EB) consists of 32 members, which are appointed by the member states and produce reports on important global issues. These reports are presented at the WHA, which takes place each year in may, in Geneva. The WHA is held in two committees: One dealing with program and budget matters, the other dealing with administrative and legal matters.

The committees instruct the EB how to act on or investigate into the reported issues. The WHA
- elects countries that are entitled to appoint members of the EB, · appoints the Director-General (DG),
- appoints the Regional Directors in agreement with the regional committees.

The Budget Of The WHO

The regular budget is made up of contributions from Member States, but the WHO also receives voluntary contributions as well as from Member States as from other sources. Example: This can raise the budget from app. US$ 840 million to US$ 1.8 billion in the biennium 1998/1999.

In the constitution, the WHO is depicted as the directing and coordinating authority on the international health work, so the budget is usually used
- to assist governments, upon request, in improving health services · to provide information and assistance in the field of health
- to promote every aspect of environmental hygiene (nutrition, housing, sanitation, working conditions)
- to develop an informed public opinion among all peoples on matters of health. · to promote health services research
- to standardize diagnostic procedures and medical products
- to make recommendations about international nomenclature of diseases and causes of death.

Definitions

Control of disease, when applied to many communicable and some noncommunicable conditions, is defined as ongoing operations or programs aimed at reducing the incidence and/or prevalence, or eliminating such conditions.

Elimination of disease is defined as the reduction of case transmission to a predetermined very low level; e.g., elimination of tuberculosis as a public health problem was defined by WHO in 1991 as a reduction of prevalence to a level below one case per million population.

Eradication of disease is defined as achievement of a status whereby no further cases of a disease occur anywhere, and continued control measures are unnecessary.

Non-communicable disease

52 million people died in 1996 - almost half from diseases such as cancers and respiratory diseases. These chronic diseases affect both developed and developing countries. 40% of deaths in developing countries are now due to them.

WHO acts in an integrated, coordinated way to prevent, treat, rehabilitate and where possible, cure major noncommunicable diseases This involves the integration of disease-specific interventions, related to both physical and mental health into a comprehensive chronic disease control package. Global campaigns to encourage healthy lifestyles, healthy public policies and acceleration of research are also promoted. For those who cannot be cured, the alleviation of pain and reduction in suffering is a top priority.

Fighting diseases, old and new

All but one of the old diseases are still around. Some, which seemed to be in decline, have returned with new vigor. And new diseases are creating new problems. WHO is called upon to deal with all of them on a planetary scale.

For example, sexual transmitted diseases are a problem as old as humanity but they must be dealt with by each new generation. WHO estimates that at least 333 million new cases of sexually transmitted diseases (excluding HIV/AIDS) occurred in 1995. Tuberculosis once considered a disease of the past, has re-emerged to such an extent that it has been declared a global emergency by WHO.

New diseases are constantly emerging - at least 30 over the past twenty years. These include AIDS and viral diseases such as Ebola, the WHO must remain on alert.

Achievements And Challenges

The fight against infectious diseases is one of the WHO's priorities. Millions of children have been saved in part owing to global immunization programs; thus, child mortality decreases just like the infant mortality rate does.

The WHO eliminated or reduced cases of Yaws, Smallpox and Polio, it is now at the threshold of eradicating other major diseases in the next few years (e.g.: leprosy)

The World Health Day

...takes place every year on April 7 to celebrate the funding of the World Health Organization. Each year a particular topic is chosen (1998:Safe Motherhood).

World Health Day 2000 has been dedicated to the theme of Blood Safety, the Red Cross participated and took an active interest in the

objectives of this special project:
- to raise awareness of blood safety issues
- to promote donations from voluntary and non-remunerated blood donors.
The key messages of World Health Day 2000 were:
- There is a positive health impact from safe blood
- Blood safety is blood availability as well as transfusion safety and injection safety - There is a need for more safe blood donations
- People everywhere should care for their health and their blood; a blood donor must be aware that his blood could transmit a virus to the recipient.
- Donated blood must be used safely to ensure patient safety, and to demonstrate a respect for the donor

Some Facts: 20% of the global population in developed countries benefits from 60% of the units of blood donated each year in the world so that the remaining 80% of the population has access to only 40% of the blood.

5% of the HIV infections world-wide are transmitted through the transfusion of contaminated blood.

Since millions of lives can be saved through blood transfusion, availability and especially safety of blood must be guaranteed to all.

Blood And Blood Products: Blood can be used whole or can be separated into its individual components. These can be used for specific purposes so that each unit of donated blood can be used for more than one patient.

Red cells are used to replace blood loss (in childbirth, during surgery and in accidents).

Platelets are very small cells that are essential to blood clotting.

Plasma is the liquid in which blood cells are suspended.

There isn't any alternative to blood, but the need for transfusion can often be avoided by the prevention, early diagnosis and treatment of conditions that would lead to need for transfusion, if discovered in a late stadium.

But there will always be many patients whose lives depend on the availability of safe blood, such as accident victims or surgical patients.

Infections that can be transmitted by blood include:

- HIV, which leads to AIDS
- Hepatitis B or C
- Syphilis
- Malaria.

One should not give blood if his/her own health might suffer as a result. One should not give blood if it might cause harm to the recipient.

The safest blood donors are voluntary non-remunerated donors who give blood regularly.

Their primary motivation is to help other people and not to obtain any personal benefit, except the satisfaction of knowing they have helped to save someone's life.

'Family' donors give blood only when blood is required by a member of their own family. Their blood has been proven to be less safe than that of voluntary non-remunerated donors because they may be under pressure to donate when they are unsuitable to do so. People who give blood for payment are usually motivated by what they will receive for their blood rather than by the wish to help other people. They may harm their own health by donating blood more frequently than is recommended. (e.g.: drug addicts finance their drugs by donating blood, which is dangerous because of their other money source: prostitution) In most countries, the volume taken is 450 milliliters, less than 10% of one's total blood volume. There is no risk of acquiring any disease, such as HIV, hepatitis B or C, through donating blood if new, sterile and disposable equipment is used for each donation. You may receive chocolate or Cola after donating, so that you won't feel bad or week; and you'll get a free blood testing for HIV, Hepatitis and other diseases. In some countries, blood is still not yet tested for all infections that can be transmitted by transfusion, particularly outside the main urban centers. This is why it is so important to be truthful about any reasons why your blood might not be safe.

Expected Outcomes of the World Health Day 2000:

- An increased awareness among the public that blood donation is a safe process, and that the donation process is handled in confidence and professionally. · An increased awareness of the need for blood and therefore an increase in regular blood donations.
- The public will be more informed and able to make rational decisions on the need for blood transfusion.

To achieve these objectives, all key players - health professionals, public, policy-makers, politicians, young people, governmental agencies, nongovernmental organizations, international agencies, the private sector and others - are encouraged to organize various activities (e.g.: discussions on TV and/or radio, video spots with messages of thanks from recipients and donors' experiences).

To encourage people to donate blood, the WHO recommends actions like a national appeal to enroll as voluntary blood donor or publishing information messages related to World Health Day 2000 and blood safety on mass media.

Health Promotion - Health for all (HFA)

`The aim must be to make the healthier choice the easier choice'

Health promotion is the process of enabling people to increase control over, and to improve their quality of live, including their health. To reach a state of complete physical, mental and social well-being, one must be able to satisfy needs and to change or cope with the environment. Therefore, health is seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Thus, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.

Health Promotion encompasses the principles that underlie a series of strategies that seek to foster conditions that allow populations to be healthy and to make healthy choices. The range of strategies draws upon multiple fields of thought including sociology, psychology and other behavioral sciences, public health, political science, education and communication, to name a few, and their respective methodologies.

The fundamental conditions and resources for health are:

peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity.

Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioral and biological factors can all favor health or be harmful to it. For example, girls and women suffer from lower status in the household and workplace, economic dependence, illiteracy, violence and fewer opportunities for education, training, employment and inheritance rights, all of which increase their vulnerability to diseases. Promoting and protecting women's rights, empowering them and hence, improving their health, cuts across different WHO work areas, among them, reproductive health, HIV/AIDS and sexually transmitted diseases.

On the other hand, it has become evident that the capacity to develop is itself dependent on health. Health expenditures are a cost-effective investment in a nation's human capital, enhancing people's ability to contribute actively to overall economic and social development and enjoy a satisfactory quality of life.

The vastness of the field of health promotion, and the great number of actors involved in health promoting activities worldwide, necessitate that WHO continuously strives to focus its activities in the health promotion universe on those areas where it can achieve the greatest health impact. Such a focus must be found within the following suggested framework of areas:

Conditions, situations or problems

- that are critical to the health and development of WHO's Member States;
- that disproportionately affect the health of populations living in adverse circumstances due to poverty, gender, ethnicity, disability or age;
- that can be significantly avoided by targeting the social determinants of health.

Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men. Health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media. Education designed to improve health literacy is to improve knowledge and to develop life skills which are conducive to individual and community health.

To create supportive environments it's important to notice that our societies are complex and interrelated. Health cannot be separated from other goals. The links between people and their environment constitutes the basis for an appropriate approach to health. The conservation of natural resources throughout the world should be emphasized as a global responsibility. Changing patterns of life, work and leisure have a significant impact on health. Work and leisure should be a source of health for people. The way society organizes work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable.

Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health.

Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential and has to be facilitated (in school, at home, at work).

Caring, holism and ecology are essential issues in developing strategies for health promotion. Therefore, everyone should take as a guiding principle that, in each phase of health promotion activities, women and men should become equal partners.

It's essential to narrow the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of the different societies as well as acknowledging people as the main health resource and to support and enable them to keep themselves, their families and friends healthy.

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

Health in Prisons Project

Project description: The project's aims are to promote health in its broadest sense within the prison community. It is important both for the rights of the prisoner and for the public health of all countries that time in custody is used positively for the prevention of disease and the promotion of health, and that negative effects of custody on health are reduced to a minimum. The target audience is not only prisoners, but also staff, prisoners' families and local communities. Equally, health promotion and disease prevention are not just the responsibility of the clinical professionals in the prison, but can, and to be effective should, be built into every branch of prison management to create a whole climate for improving health. The work of the project will be to identify and foster good practices in prison health and health promotion, and to exchange information.

It will follow the concept of settings for Health Promotion, already developed successfully by the WHO in schools, hospitals and cities.

The project has been initiated and is directed by the Regional Office for Europe of the World Health organization (WHO), in collaboration with the Directorate of Health Care of the Prison Service for England and Wales (DHC). DHC was officially designated as the WHO's Collaborating Centre for the project in May 1996.

The idea for the network was launched at a meeting of pilot members of the project in London in October 1995. Representatives of the Council of Europe and the European Commission attended. At this meeting, three priority areas were identified for action by the project: mental health, drugs and communicable diseases (particularly AIDS, TB and hepatitis). The scope of the project however is not limited to these areas, and includes other areas of health promotion as well.

The network currently comprises 12 countries: eight of them invited to develop the project in the pilot phase - Finland, France, Poland, Portugal, Russian Federation, Switzerland, the Ukraine and the United Kingdom.

Why promote health in prisons?

The prison environment is not normally conducive to good health. Prisons can act as breeding grounds for communicable diseases, can introduce prisoners to new, unhealthy practices (e.g. drug use, unsafe sex) and can seriously worsen a prisoner's mental health. Prisoners have often lived in a less healthy lifestyle than the general population, have been more likely · to abuse alcohol, tobacco and illegal drugs,

- to suffer mental disorder and
- to contract communicable diseases.

Prison staff, too, may have unhealthy lifestyles which can be significantly improved by effective programs of Health Promotion, which also may improve their productivity and morale.

Illegal drugs are an increasing problem all over Europe, threatening the safety, order and health of communities and helping the spread of communicable diseases. Prisons hold many drug users - so their time in prison can offer an opportunity to change, creating the possibility that this will break the vicious circle of drug dependency which can lead to broader criminal activity to finance drug habits. Prisoners released in a reasonable state of mental well-being, and free from addictions, have a better chance of being rehabilitated into society. Prisoners are members of the general population: they come from and usually return to the community. So for prisoners infected with communicable diseases the relationship between prisoners' health, their families and the wider community is of acute concern. Both the prisoner and the wider community benefit of limiting the spread of these diseases in prison. Health promotion can also benefit the health of prisoners and staff by for example a reduction in smoking, a better diet, more exercise etc. reducing heart disease and some common cancers, so lessening the burdens on health systems in countries as a whole.

Examples of health promotion in prisons in Europe:

It is common to hear of prisons across Europe that they're struggling with problems of underfunding, overcrowding, poor provision, rising populations and in some cases, lack of the most basic amenities. This is not the case in all prisons, but whether it is or not, there is both the need and the possibility for simple interventions to limit the spread of disease and unhealthy practices.

The following are examples taken from prisons around Europe of what might be done:

- provision of advice, counselling or leaflets on reception to prison - to promote mental health, reduce substance abuse, prevent transmission of disease etc.; similar provision when the prisoner is released
- provision of hygiene packs, with advice and materials for personal and dental hygiene
- healthy eating - provision of low-fat high-fibre food, vegetarian food, and advice on healthy eating
- smoke-free areas (also for visitors) and cells, advice and encouragement to inmates and staff to give up smoking, provision of nicotine patches
- advice and services to screen for breast, cervical and testicular cancer and advice on how to avoid skin cancer and other cancers
- providing regular exercise and encouragement to exercise provision of staff health promotion.

Communicable diseases:

- needle exchange
- condom distribution for use in prison, or for conjugal visits, home leave and on release
- programs for the prevention and detection of diseases such as HIV/AIDS.

Illegal drugs:

- counseling, group therapy and therapeutic communities for drug users - drug-free prison wings
- occupational therapies
- support the recovered addict on release
- similar programs for abusers of legal drugs including alcohol

Mental health:

- 'listener' and 'befriending' schemes to help vulnerable prisoners - counseling and therapy
- psychiatric and psychological services
- monitoring of those considered at risk of suicide and self-harm, and schemes to reduce their vulnerability
- schemes to reduce bullying of vulnerable prisoners
- courses to improve prisoners' coping, social and parenting skills, including anger management therapy.

The Healthy Cities Project

The WHO Healthy Cities project (HCP) is a long-term international development project that seeks to put health on the agenda of decision-makers in the cities of Europe and to build a strong lobby for public health at the local level. The project is one of WHO's main vehicles for giving effect to the strategy for health for all (HFA). It has forged political, professional and technical alliances for health and provided a fertile ground for innovative action at local level, presenting the WHO's potential and ability to facilitate and bring about change.

Healthy cities are "field laboratories" where HFA initiatives are tested at a local level and give important feedback to WHO and Member States which can be used to update and improve the HFA strategy.

The first phase of implementation of the HCP (1987-1992) has been completed and a new phase of action started in 1993. Over the past few years, the project has become a major public health movement at local level involving networks of over 500 cities throughout Europe and another 300 cities in other parts of the world.

HCP helps change the ways in which individuals, communities, private and voluntary organizations and local governments throughout Europe think about, understand and make decisions about health.

The project applies, at local level, WHO's strategy for health for all.

A `healthy city' is not one that has achieved a particular level of health; it is one that is conscious of health and striving to improve it. Thus any city can be part of the healthy cities movement, regardless of its current health status; what is required is a commitment to health and a structure and process to achieve it.

The project's main operational elements are:

- the WHO project cities network, which is the network of cities that are involved in the project (including systematic monitoring and evaluation so that experience can be analysed and examples of good practices will be disseminated)
- multi-city action plans (MCAPs), implemented by subnetworks of cities working together on specific issues of common concern;
- special (model) projects in cities in central and eastern Europe, to help them carry out health care and environmental reforms.

Health Promotion And The Environment

WHO has initiated successful health promotion projects such as Healthy Cities and Villages, Healthy Islands and Health-Promoting Schools, Hospitals, and Work Sites. Some projects target vulnerable populations such as the elderly and women. Others focus on encouraging healthy lifestyles, sexual health and tobacco-free societies.

The impact of the environment on health is of high priority for WHO.

One example is access to safe drinking-water. WHO puts the highest priority on the development of community water supplies and sanitation facilities within the AFRICA 2000 initiative.

WHO is deeply concerned with prevention and control of ionizing radiation so dramatically highlighted by the Chernobyl nuclear accident. Other issues such as non-ionizing radiation, including the health effects of electro magnetic fields and the increasing depletion of the ozone layer, are of major concern.

The WHO- A Motor For Health Research

Working with its partners in health research, WHO collects current data on conditions and needs, particularly in developing countries. These range from the evaluation of school programs to epidemiological research in remote tropical forests, to monitoring the progress of genetic engineering in the laboratory.

In the field of health management, research includes studies into the cost effectiveness of health care. Research also helps to improve national and international epidemiological surveillance and to develop preventive strategies for new and emerging diseases.

Setting Standards For Health

Safe water to drink, cleaner air to breathe, antibiotics that can be guaranteed to work, are all areas where WHO sets the world standard:

WHO

- sets standards to ensure the highest quality of biological and pharmaceutical preparations. · brings together experts to establish standards that are practical and feasible. · makes sure that laboratories dealing with highly infectious material work under safe conditions
- helps developing countries establish a list of essential pharmaceuticals from those currently available on the market
- cooperates with the pharmaceutical industry to make medicines more available either free of charge or at low cost to poor communities.

Action that is scientific and ethical

Improved health is not achieved just with financial resources and high technology. It requires a social conscience and a commitment to share the advances of health science. Every field of health raises ethical questions concerning sex, birth, confidentiality and personal safety. WHO helps setting ethical standards by insisting, for example, that consensus must be reached on what is acceptable in cloning, that there is informed consent when carrying out experiments with humans, or estimating how much risk should be borne by volunteers testing the efficacy of drugs or vaccines. WHO brings together the world's experts to reach consensus on such key issues.

Working Together For Better Health

WHO works closely with other organizations in the United Nations system.

WHO's long-standing partnership with UNICEF has resulted in the launch of such initiatives as "Baby Friendly Hospitals" to promote breast-feeding. The Organization, together with UNICEF, UNESCO and the World Bank working together on a program coordinating the global effort to control the spread of HIV/AIDS.

WHO maintains close working relationships with bilateral agencies, intergovernmental and nongovernmental organizations. An example of this collaboration is WHO's work with Rotary International towards the global eradication of polio.

In addition, nearly 1,200 leading health-related institutions around the world are officially designated as WHO Collaborating Centers.

Challenges For The Future

Much of the world has benefited from better health in the fifty years since WHO was founded. But the need for the leader of the world alliance for health for all is greater than ever. Cholera and malaria were major health priorities in 1948 - unfortunately, after a period of decline, both are on the increase again and so remain a problem. There are other examples of so-called `re-emerging diseases' and, to make matters worse, some medicines and antibiotics are becoming less effective.

The next fifty years

Health For All - Towards the 21st century

HFA seeks to create the conditions where people have, as a fundamental human right, the opportunity to reach and maintain the highest attainable level of health. The vision of a renewed HFA policy builds on the WHO Constitution, the experience of the past and the needs of the future.

Fifty years may seem a long time to individuals, but it is a short spell in human history. For two centuries it was known that smallpox could be prevented, but only in the twentieth century was a coalition organized by WHO able to do something definitive about it. With political will, commitment and a willingness to work together there is no reason why this success cannot be continued.

Source: www.who.de and other websites.