Sept 28 (week 3, lecture 3)
-Eras of international health activity
1-meeting and greeting, 1851-1902: need to share info on outbreaks, enforce
quarantine during imperial era
2-institution building, 1902-1939: first international health agencies developed, treaties
signed, research/education, campaigns
3-bureaucratization and professionalization, 1946-1970: permanent health
organizations founded, large scale training, disease campaigns
4-contested success, 1970-1985: vertical campaign vs. horizontal health and social
5- evidence and evaluation, 1985-vWuµoµv^À]v_
interventions, technical and cost-effective disease control, stressing social justice,
infrastructure, human rights
-but a new, Cold War quickly takes center stage
-dominant powers, individually and collectively cultivated new arrangements with emerging
countries which preserved imbalances of power.
-biomedical approach: focus on disease eradication rather than holistic well-being and agenda-
setting by powerful became institutionalized.
World Health Organization (73-76)
-flagship international health organization, as an independent agency within the UN.
-directing and coordinating authority for international health
-strengthening of health services and emergency aid
-promote maternal, child health and welfare
-promote improvement of nutrition, housing, sanitation, recreation, working conditions, etc.
-study and report on public health and medical care; promote research and training
-eradicate epidemic, endemic and other diseases, injury prevention
-conventions, agreements, regulations; recommendations for health matters
-develop, establish and promote international standards for food, biological, pharmaceuticals .
-standardize diagnostic procedures
-central technical services: epidemiologic intelligence, international agreements, standardization of
vaccines/pharmaceuticals, spreading of knowledge through meetings and reports.
-193 member states (from 1948)
-Governing body: world health assembly each May- 34 member executive board. Director General
elected by WHA every 5 years.
-8000 staff (geneva and 6 regional offices)
-regular budgets: assessment of member states based on population size and GNP (net loss for poorest
countries? Because the fees they pay for being a member of WHO are very high)
-In 1960 extra budgetary funds (voluntary contributions) began to displace budget, giving greater voice
to big donorsX^}v}_Z}Á}u]vZ}ÁµP(µvds are allocated, led to instability and
insecurity, undemocratic policy making.
-2008-9- total budget approximately $4.2 billion a year
-WHO is constitutionally the fulcrum of all international health activity and has a democratic mandate,
yet this democratic set up has been displaced due to the budget crisis and extra budgetary situation.
-Malaria eradication campaign
DDT spraying was a massive Cold War campaign largely funded by the US. Africa, that had the
highest Malaria prevalence was left out because it was said that malaria would never be
eradicated there. DDT resistant mosquitos emerged. Campaign neglected basic health