National Security Study Memorandum 200: Implications of Worldwide Population Growth for U.S. Security and Overseas Interests (NSSM200) was completed on December 10, 1974 by the United States National Security Council under the direction of Henry Kissinger.
It was adopted as official US policy by US PresidentGerald Ford in November 1975. It was classified for a while but was obtained by researchers in the early 1990s.
Findings
The basic thesis of the memorandum was that population growth in the least developed countries (LDCs) is a concern to US national security, because it would tend to risk civil unrest
and political instability in countries that had a high potential for
economic development. The policy gives "paramount importance" to
population control measures and the promotion of contraception among 13
populous countries to control rapid population growth which the US deems
inimical to the socio-political and economic growth of these countries
and to the national interests of the United States since the "U.S.
economy will require large and increasing amounts of minerals from
abroad" and the countries can produce destabilizing opposition forces
against the US.
It recommends for US leadership to "influence national leaders"
and that "improved world-wide support for population-related efforts
should be sought through increased emphasis on mass media and other
population education and motivation programs by the UN, USIA, and
USAID."
It also raises the question of whether the US should consider
preferential allocation of surplus food supplies to states deemed
constructive in use of population control measures.
General oversight
The paper takes a look at worldwide demographic population trends as projected in 1974.
It is divided into two major sections: an analytical section and policy recommendations.
The analytical section discusses projected world demographic
trends and their influence on world food supply, minerals, and fuel. It
looks at the relation between economic development in the least
developed nations and investigates the implications of world population
pressures on US national security.
The policy recommendations is divided into two sections. A US
population strategy and action to create conditions for fertility
decline. A major concern reiterated in the paper concerns the effect of
population on starvation and famine.
"Growing populations will have a serious impact on the need for
food especially in the poorest, fastest growing LDCs.[least developed
countries] While under normal weather conditions and assuming food
production growth in line with recent trends, total world agricultural
production could expand faster than population, there will nevertheless
be serious problems in food distribution and financing, making
shortages, even at today's poor nutrition levels, probable in many of
the larger more populous LDC regions. Even today 10 to 20 million people
die each year due, directly or indirectly, to malnutrition. Even more
serious is the consequence of major crop failures which are likely to
occur from time to time.
"The most serious consequence for the short and middle term is
the possibility of massive famines in certain parts of the world,
especially the poorest regions. World needs for food rise by 2.5 percent
or more per year (making a modest allowance for improved diets and
nutrition) at a time when readily available fertilizer and well-watered
land is already largely being utilized. Therefore, additions to food
production must come mainly from higher yields.
"Countries with large population growth cannot afford constantly
growing imports, but for them to raise food output steadily by 2 to 4
percent over the next generation or two is a formidable challenge."
Key insights
"The
U.S. economy will require large and increasing amounts of minerals from
abroad, especially from less developed countries [see National
Commission on Materials Policy, Towards a National Materials Policy:
Basic Data and Issues, April 1972]. That fact gives the U.S. enhanced
interest in the political, economic, and social stability of the
supplying countries. Wherever a lessening of population pressures
through reduced birth rates can increase the prospects for such
stability, population policy becomes relevant to resource supplies and
to the economic interests of the United States.... The location of known
reserves of higher grade ores of most minerals favors increasing
dependence of all industrialized regions on imports from less developed
countries. The real problems of mineral supplies lie, not in basic
physical sufficiency, but in the politico-economic issues of access,
terms for exploration and exploitation, and division of the benefits
among producers, consumers, and host country governments" [Chapter III,
"Minerals and Fuel"].
"Whether through government action, labor conflicts, sabotage, or
civil disturbance, the smooth flow of needed materials will be
jeopardized. Although population pressure is obviously not the only
factor involved, these types of frustrations are much less likely under
conditions of slow or zero population growth" [Chapter III, "Minerals
and Fuel"].
"Populations with a high proportion of growth. The young people, who
are in much higher proportions in many LDCs, are likely to be more
volatile, unstable, prone to extremes, alienation and violence than an
older population. These young people can more readily be persuaded to
attack the legal institutions of the government or real property of the
'establishment,' 'imperialists,' multinational corporations, or other --
often foreign -- influences blamed for their troubles" [Chapter V,
"Implications of Population Pressures for National Security"].
"We must take care that our activities should not give the
appearance to the LDCs of an industrialized country policy directed
against the LDCs. Caution must be taken that in any approaches in this
field we support in the LDCs are ones we can support within this
country. "Third World" leaders should be in the forefront and obtain the
credit for successful programs. In this context it is important to
demonstrate to LDC leaders that such family planning programs have
worked and can work within a reasonable period of time." [Chapter I,
"World Demographic Trends"]
"In these sensitive relations, however, it is important in style as well as substance to avoid the appearance of coercion."
Abortion as a geopolitical strategy is mentioned several dozen times
in the report with suggestive implications: "No country has reduced its
population growth without resorting to abortion.... under developing
country conditions foresight methods not only are frequently unavailable
but often fail because of ignorance, lack of preparation, misuse and
non-use. Because of these latter conditions, increasing numbers of women
in the developing world have been resorting to abortion....
Demography (from prefix demo- from Ancient Greek δῆμος dēmos meaning "the people", and -graphy from γράφω graphō, ies "writing, description or measurement") is the statistical study of populations, especially human beings.
Demography encompasses the study of the size, structure, and
distribution of these populations, and spatial or temporal changes in
them in response to birth, migration, aging, and death.
As a very general science, it can analyze any kind of dynamic living
population, i.e., one that changes over time or space. Demographics are quantifiable characteristics of a given population.
Demographic analysis can cover whole societies or groups defined by criteria such as education, nationality, religion, and ethnicity. Educational institutions usually treat demography as a field of sociology, though there are a number of independent demography departments.
Based on the demographic research of the earth, earth's population up
to the year 2050 and 2100 can be estimated by demographers.
Formal demography limits its object of study to the measurement of population processes, while the broader field of social demography
or population studies also analyses the relationships between economic,
social, cultural, and biological processes influencing a population.
History
Demographic thoughts traced back to antiquity, and were present in many civilisations and cultures, like Ancient Greece, Ancient Rome, China and India. Demography is made up of two word Demos and Graphy . The term Demography refers to the overall study of population.
One of the earliest demographic studies in the modern period was Natural and Political Observations Made upon the Bills of Mortality (1662) by John Graunt, which contains a primitive form of life table.
Among the study's findings were that one third of the children in
London died before their sixteenth birthday. Mathematicians, such as Edmond Halley, developed the life table as the basis for life insurance mathematics. Richard Price was credited with the first textbook on life contingencies published in 1771, followed later by Augustus de Morgan, ‘On the Application of Probabilities to Life Contingencies’ (1838).
In 1855, a Belgian scholar Achille Guillard defined demography as
the natural and social history of human species or the mathematical
knowledge of populations, of their general changes, and of their
physical, civil, intellectual and moral condition.
The period 1860-1910 can be characterised as a period of
transition wherein demography emerged from statistics as a separate
field of interest. This period included a panoply of international
‘great demographers’ like Adolphe Quételet (1796–1874), William Farr (1807–1883), Louis-Adolphe Bertillon (1821–1883) and his son Jacques (1851–1922), Joseph Körösi (1844–1906), Anders Nicolas Kaier (1838–1919), Richard Böckh (1824–1907), Émile Durkheim (1858-1917), Wilhelm Lexis (1837–1914), and Luigi Bodio (1840–1920) contributed to the development of demography and to the toolkit of methods and techniques of demographic analysis.
Methods
There are two types of data collection—direct and indirect—with several different methods of each type.
Direct methods
Direct
data comes from vital statistics registries that track all births and
deaths as well as certain changes in legal status such as marriage,
divorce, and migration (registration of place of residence). In
developed countries with good registration systems (such as the United
States and much of Europe), registry statistics are the best method for
estimating the number of births and deaths.
A census
is the other common direct method of collecting demographic data. A
census is usually conducted by a national government and attempts to
enumerate every person in a country. In contrast to vital statistics
data, which are typically collected continuously and summarized on an
annual basis, censuses typically occur only every 10 years or so, and
thus are not usually the best source of data on births and deaths.
Analyses are conducted after a census to estimate how much over or
undercounting took place. These compare the sex ratios from the census data to those estimated from natural values and mortality data.
Censuses do more than just count people. They typically collect
information about families or households in addition to individual
characteristics such as age, sex, marital status, literacy/education,
employment status, and occupation, and geographical location. They may
also collect data on migration (or place of birth or of previous
residence), language, religion, nationality (or ethnicity or race), and
citizenship. In countries in which the vital registration system may be
incomplete, the censuses are also used as a direct source of
information about fertility and mortality; for example the censuses of
the People's Republic of China gather information on births and deaths that occurred in the 18 months immediately preceding the census.
Rate of human population growth showing projections for later this century
Indirect methods
Indirect
methods of collecting data are required in countries and periods where
full data are not available, such as is the case in much of the
developing world, and most of historical demography.
One of these techniques in contemporary demography is the sister
method, where survey researchers ask women how many of their sisters
have died or had children and at what age. With these surveys,
researchers can then indirectly estimate birth or death rates for the
entire population. Other indirect methods in contemporary demography
include asking people about siblings, parents, and children. Other
indirect methods are necessary in historical demography.
The United Kingdom has a series of four national birth cohort
studies, the first three spaced apart by 12 years: the 1946 National
Survey of Health and Development, the 1958 National Child Development Study, the 1970 British Cohort Study, and the Millennium Cohort Study,
begun much more recently in 2000. These have followed the lives of
samples of people (typically beginning with around 17,000 in each study)
for many years, and are still continuing. As the samples have been
drawn in a nationally representative way, inferences can be drawn from
these studies about the differences between four distinct generations of
British people in terms of their health, education, attitudes,
childbearing and employment patterns.
Common rates and ratios
The crude birth rate, the annual number of live births per 1,000 people.
The general fertility rate,
the annual number of live births per 1,000 women of childbearing age
(often taken to be from 15 to 49 years old, but sometimes from 15 to
44).
The age-specific fertility rates, the annual number of live births per 1,000 women in particular age groups (usually age 15–19, 20-24 etc.)
The crude death rate, the annual number of deaths per 1,000 people.
The infant mortality rate, the annual number of deaths of children less than 1 year old per 1,000 live births.
The expectation of life (or life expectancy), the number of years that an individual at a given age could expect to live at present mortality levels.
The total fertility rate,
the number of live births per woman completing her reproductive life,
if her childbearing at each age reflected current age-specific fertility
rates.
The replacement level fertility, the average number of
children women must have in order to replace the population for the next
generation. For example, the replacement level fertility in the US is
2.11.
The gross reproduction rate, the number of daughters who would be born to a woman completing her reproductive life at current age-specific fertility rates.
The net reproduction ratio is the expected number of
daughters, per newborn prospective mother, who may or may not survive to
and through the ages of childbearing.
A stable population, one that has had constant crude birth
and death rates for such a long period of time that the percentage of
people in every age class remains constant, or equivalently, the
population pyramid has an unchanging structure.
A stationary population, one that is both stable and unchanging in size (the difference between crude birth rate and crude death rate is zero).
A stable population does not necessarily remain fixed in size. It can be expanding or shrinking.
Note that the crude death rate as defined above and applied to a
whole population can give a misleading impression. For example, the
number of deaths per 1,000 people can be higher for developed nations
than in less-developed countries, despite standards of health being
better in developed countries. This is because developed countries have
proportionally more older people, who are more likely to die in a given
year, so that the overall mortality rate can be higher even if the
mortality rate at any given age is lower. A more complete picture of
mortality is given by a life table, which summarizes mortality separately at each age. A life table is necessary to give a good estimate of life expectancy.
Basic equation
Suppose that a country (or other entity) contains Populationt persons at time t.
What is the size of the population at time t + 1 ?
Natural increase from time t to t + 1:
Net migration from time t to t + 1:
This basic equation can also be applied to subpopulations. For
example, the population size of ethnic groups or nationalities within a
given society or country is subject to the same sources of change. When
dealing with ethnic groups, however, "net migration" might have to be
subdivided into physical migration and ethnic reidentification (assimilation).
Individuals who change their ethnic self-labels or whose ethnic
classification in government statistics changes over time may be thought
of as migrating or moving from one population subcategory to another.
More generally, while the basic demographic equation holds true
by definition, in practice the recording and counting of events (births,
deaths, immigration, emigration) and the enumeration of the total
population size are subject to error. So allowance needs to be made for
error in the underlying statistics when any accounting of population
size or change is made.
The figure in this section shows the latest (2004) UN projections
of world population out to the year 2150 (red = high, orange = medium,
green = low). The UN "medium" projection shows world population reaching
an approximate equilibrium at 9 billion by 2075. Working independently,
demographers at the International Institute for Applied Systems Analysis in Austria expect world population to peak at 9 billion by 2070. Throughout the 21st century, the average age of the population is likely to continue to rise.
Science of population
Populations
can change through three processes: fertility, mortality, and
migration. Fertility involves the number of children that women have
and is to be contrasted with fecundity (a woman's childbearing
potential).
Mortality is the study of the causes, consequences, and measurement of
processes affecting death to members of the population. Demographers
most commonly study mortality using the Life Table,
a statistical device that provides information about the mortality
conditions (most notably the life expectancy) in the population.
Migration refers to the movement of persons from a locality of
origin to a destination place across some predefined, political
boundary. Migration researchers do not designate movements 'migrations'
unless they are somewhat permanent. Thus demographers do not consider
tourists and travellers to be migrating. While demographers who study
migration typically do so through census data on place of residence,
indirect sources of data including tax forms and labour force surveys
are also important.
Demography is today w(?) Great Depression many universities across
the world, attracting students with initial training in social sciences,
statistics or health studies. Being at the crossroads of several
disciplines such as sociology, economics, epidemiology, geography, anthropology and history,
demography offers tools to approach a large range of population issues
by combining a more technical quantitative approach that represents the
core of the discipline with many other methods borrowed from social or
other sciences. Demographic research is conducted in universities, in
research institutes as well as in statistical departments and in several
international agencies. Population institutions are part of the Cicred
(International Committee for Coordination of Demographic Research)
network while most individual scientists engaged in demographic research
are members of the International Union for the Scientific Study of Population, or a national association such as the Population Association of America in the United States, or affiliates of the Federation of Canadian Demographers in Canada.
Global health is the health of populations in the global context;
it has been defined as "the area of study, research and practice that
places a priority on improving health and achieving equity in health for all people worldwide". Problems that transcend national borders or have a global political and economic impact are often emphasized.
Thus, global health is about worldwide health improvement (including
mental health), reduction of disparities, and protection against global
threats that disregard national borders. Global health is not to be confused with international health, which is defined as the branch of public health focusing on developing nations and foreign aid efforts by industrialized countries.
Global health can be measured as a function of various global diseases
and their prevalence in the world and threat to decrease life in the
present day.
The predominant agency associated with global health (and international health) is the World Health Organization (WHO). Other important agencies impacting global health include UNICEF and World Food Programme.
The United Nations system has also played a part with cross-sectoral
actions to address global health and its underlying socioeconomic
determinants with the declaration of the Millennium Development Goals and the more recent Sustainable Development Goals.
Definition
Global health employs several perspectives that focus on the determinants and distribution of health in international contexts:
Medicine describes the pathology of diseases and promotes prevention, diagnosis, and treatment.
Both individuals and organizations working in the domain of global health often face many questions regarding ethical and human rights.
Critical examination of the various causes and justifications of health
inequities is necessary for the success of proposed solutions. Such
issues are discussed at the bi-annual Global Summits of National Ethics/Bioethics Councils, next in March 2016 in Berlin, with experts from WHO and UNESCO, by invitation of the German Ethics Council.
History
Life expectancy by world region, from 1770 to 2018
The 19th century held major discoveries in medicine and public health. The Broad Street cholera outbreak of 1854 was central to the development of modern epidemiology. The microorganisms responsible for malaria and tuberculosis
were identified in 1880 and 1882, respectively. The 20th century saw
the development of preventive and curative treatments for many diseases,
including the BCG vaccine (for tuberculosis) and penicillin in the 1920s. The eradication of smallpox, with the last naturally occurring case recorded in 1977, raised hope that other diseases could be eradicated as well.
At a United Nations Summit in 2000, member nations declared eight Millennium Development Goals (MDGs), which reflected the major challenges facing human development globally, to be achieved by 2015.
The declaration was matched by unprecedented global investment by donor
and recipient countries. According to the UN, these MDGs provided an
important framework for development and significant progress has been
made in a number of areas.
However, progress has been uneven and some of the MDGs were not fully
realized including maternal, newborn and child health and reproductive
health. Building on the MDGs, a new Sustainable Development Agenda with 17 Sustainable Development Goals (SDGs) has been established for the years 2016–2030. The first goal being an ambitious and historic pledge to end poverty. On 25 September 2015, the 193 countries of the UN General Assembly adopted the 2030 Development Agenda titled Transforming our world: the 2030 Agenda for Sustainable Development.
In 2015 a book titled "To Save Humanity" was published, with nearly 100 essays regarding today's most pressing global health issues. The essays were authored by global figures in politics, science, and advocacy ranging from Bill Clinton to Peter Piot, and addressed a wide range of issues including vaccinations, antimicrobial resistance, health coverage, tobacco use, research methodology, climate change, equity, access to medicine, and media coverage of health research.
In 2015, the Lancet Commission on Global Surgery was released
describing the large burden of surgical disease impacting low- and
middle-income countries (LMICs).
The shortfall in access to surgical care worldwide is estimated to
affect approximately 5 billion people who do not have timely access to
life-saving surgical care.
The Commission outlines the need to improve infrastructure to
make the bellwether procedures – laparotomy, caesarean section, open
fracture care – more widely available in LMICs in order to prevent a
$12.3 trillion loss in economic productivity by 2030 as result of
surgically-related morbidity and mortality.
Disability-adjusted life years per 100,000 people in 2004.
No data
Less than 9,250
9,250–16,000
16,000–22,750
22,750–29,500
29,500–36,250
36,250–43,000
43,000–49,750
49,750–56,500
56,500–63,250
63,250–70,000
70,000–80,000
Over 80000
The DALY is a summary measure that combines the impact of illness, disability,
and mortality by measuring the time lived with disability and the time
lost due to premature mortality. One DALY can be thought of as one lost
year of "healthy" life. The DALY for a disease is the sum of the years
of life lost due to premature mortality and the years lost due to
disability for incident cases of the health condition.
Quality-adjusted life years
QALYs combine expected survival with expected quality of life into a
single number: if an additional year of healthy life is worth a value of
one (year), then a year of less healthy life is worth less than one
(year). QALY calculations are based on measurements of the value that
individuals place on expected years of survival. Measurements can be
made in several ways: by techniques that simulate gambles about
preferences for alternative states of health, with surveys or analyses
that infer willingness to pay for alternative states of health, or
through instruments that are based on trading off some or all likely
survival time that a medical intervention might provide in order to gain
less survival time of higher quality.
Infant and child mortality
Infant mortality and child mortality for children under age 5 are
more specific than DALYs or QALYs in representing the health in the
poorest sections of a population, and are thus especially useful when
focusing on health equity.
Morbidity
Morbidity measures include incidence rate, prevalence, and cumulative incidence,
with incidence rate referring to the risk of developing a new health
condition within a specified period of time. Although sometimes loosely
expressed simply as the number of new cases during a time period,
morbidity is better expressed as a proportion or a rate.
Health conditions
The diseases and health conditions targeted by global health initiatives are sometimes grouped under "diseases of poverty" versus "diseases of affluence", although the impact of globalization is increasingly blurring the lines between the two.
Respiratory infections
Infections of the respiratory tract and middle ear are major causes of morbidity and mortality worldwide. Some respiratory infections of global significance include tuberculosis, measles, influenza, and pneumonias caused by pneumococci and Haemophilus influenzae.
The spread of respiratory infections is exacerbated by crowded
conditions, and poverty is associated with more than a 20-fold increase
in the relative burden of lung infections.
Diarrheal diseases
Diarrhea is the second most common cause of child mortality worldwide, responsible for 17% of deaths of children under age 5. Poor sanitation
can increase transmission of bacteria and viruses through water, food,
utensils, hands, and flies. Dehydration due to diarrhea can be
effectively treated through oral rehydration therapy with dramatic reductions in mortality. Important nutritional measures include the promotion of breastfeeding and zinc supplementation. While hygienic measures alone may be insufficient for the prevention of rotavirus diarrhea, it can be prevented by a safe and potentially cost-effective vaccine.
Maternal health
Maternal health clinic in Afghanistan (source: Merlin)
Complications of pregnancy and childbirth are the leading causes of death among women of reproductive age in many developing countries: a woman dies from complications from childbirth approximately every minute. According to the World Health Organization's 2005 World Health Report, poor maternal conditions are the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal deaths and injuries can be prevented, and such deaths have been largely eradicated in the developed world. Targets for improving maternal health include increasing the number of deliveries accompanied by skilled birth attendants.
68 low-income countries tracked by the WHO- and UNICEF-led collaboration Countdown to 2015 are estimated to hold for 97% of worldwide maternal and child deaths.
HIV/AIDS
The HIV/AIDS epidemic has highlighted the global nature of human
health and welfare and globalisation has given rise to a trend toward
finding common solutions to global health challenges. Numerous
international funds have been set up in recent times to address global
health challenges such as HIV. Since
the beginning of the epidemic, more than 70 million people have been
infected with the HIV virus and about 35 million people have died of
HIV. Globally, 36.9 million [31.1–43.9 million] people were living with
HIV at the end of 2017. An estimated 0.8% [0.6–0.9%] of adults aged
15–49 years worldwide are living with HIV, although the burden of the
epidemic continues to vary considerably between countries and regions.
The WHO African region remains most severely affected, with nearly 1 in
every 25 adults (4.1%) living with HIV and accounting for nearly
two-thirds of the people living with HIV worldwide.
Human immunodeficiency virus (HIV) is transmitted through unprotected
sex, unclean needles, blood transfusions, and from mother to child
during birth or lactation. Globally, HIV is primarily spread through
sexual intercourse. The risk-per-exposure with vaginal sex in low-income
countries from female to male is 0.38% and male to female is 0.3%.The infection damages the immune system, leading to acquired immunodeficiency syndrome (AIDS) and eventually, death. Antiretroviral drugs prolong life and delay the onset of AIDS by minimizing the amount of HIV in the body.
Malaria
Malaria is a mosquito-borne infectious disease caused by the parasites of the genus Plasmodium.
Symptoms may include fever, headaches, chills, and nausea. Each year,
there are approximately 500 million cases of malaria worldwide, most
commonly among children and pregnant women in developing countries.
The WHO African Region carries a disproportionately high share of the
global malaria burden. In 2016, the region was home to 90% of malaria
cases and 91% of malaria deaths. The use of insecticide-treated bednets is a cost-effective way to reduce deaths from malaria, as is prompt artemisinin-based combination therapy, supported by intermittent preventive therapy in pregnancy. International travellers to endemic zones are advised chemoprophylaxis with antimalarial drugs like Atovaquone-proguanil, doxycycline, or mefloquine
Nutrition
In
2010, about 104 million children were underweight, and undernutrition
contributes to about one third of child deaths around the world. (Undernutrition is not to be confused with malnutrition, which refers to poor proportion of food intake and can thus refer to obesity.) Undernutrition impairs the immune system, increasing the frequency, severity, and duration of infections (including measles, pneumonia, and diarrhea). Infection can further contribute to malnutrition. Deficiencies of micronutrient, such as vitamin A, iron, iodine, and zinc, are common worldwide and can compromise intellectual potential, growth, development, and adult productivity.
Interventions to prevent malnutrition include micronutrient
supplementation, fortification of basic grocery foods, dietary
diversification, hygienic measures to reduce spread of infections, and
the promotion of breastfeeding.
Violence against women
Violence against women
has been defined as: "physical, sexual and psychological violence
occurring in the family and in the general community, including
battering, sexual abuse of children, dowry-related violence, rape, female genital mutilation
and other traditional practices harmful to women, non-spousal violence
and violence related to exploitation, sexual harassment and intimidation
at work, in educational institutions and elsewhere, trafficking in
women, forced prostitution and violence perpetrated or condoned by the
state."
In addition to causing injury, violence may increase "women’s long-term
risk of a number of other health problems, including chronic pain,
physical disability, drug and alcohol abuse, and depression".
The WHO Report on global and regional estimates on violence against
women found that partner abuse causes women to have 16% more chances of
suffering miscarriages,41% more occurrences of pre-term birth babies and
twice the likeliness of having abortions and acquiring HIV or other
STD’s.
Although statistics can be difficult to obtain as many cases go
unreported, it is estimated that one in every five women faces some form
of violence during her lifetime, in some cases leading to serious
injury or even death.
Risk factors for being a perpetrator include low education, past
exposure to child maltreatment or witnessing violence between parents,
harmful use of alcohol, attitudes accepting of violence and gender
inequality. Equality of women has been addressed in the Millennium development goals.
Preventing the violence against women needs to form an essential part
of the public health reforms in the form of advocation and evidence
gathering. Primary prevention in the form of raising women economic
empowerment facilities, microfinance and skills training social projects
related to gender equality should be conducted. Activities promoting
relationship and communication skills among couples, reducing alcohol
access and altering societal ideologies should be organized. Childhood
interventions, community and school- based education, raising
media-oriented awareness and other approaches should be carried out to
challenge social norms and stereotypical thought processes to promote
behavioral alterations among men and raise gender equality. Trained
health care providers would play a vital role in secondary and tertiary
prevention of abuse, by performing early identification of women
suffering from violence and contributing to the addressal of their
health and psychological needs. They could be highly important in
prevention of the recurrence of violence and the mitigation of its
effects on the health of the abused women and their children.
The Member States of the World Health Assembly endorsed a plan in 2016
for reinforcing the health system’s role in addressing the global
phenomenon of violence against women and girls and working towards their
health and protection.
Chronic disease
Approximately 80% of deaths linked to non-communicable diseases occur in developing countries. For
instance, urbanization and aging have led to increasing poor health
conditions related to non-communicable diseases in India. The
fastest-growing causes of disease burden over the last 26 years were
diabetes (rate increased by 80%) and ischemic heart disease (up 34%).
More than 60% of deaths, about 6.1 million, in 2016 were due to NCDs, up
from about 38% in 1990. Increases in refugee urbanization, has led to a growing number of people diagnosed with chronic noncommunicable diseases.
In September 2011, the United Nations is hosting its first
General Assembly Special Summit on the issue of non-communicable
diseases.
Noting that non-communicable diseases are the cause of some 35 million
deaths each year, the international community is being increasingly
called to take measures for the prevention and control of chronic
diseases and mitigate their impacts on the world population, especially
on women, who are usually the primary caregivers.
For example, the rate of type 2 diabetes, associated with obesity,
has been on the rise in countries previously plagued by hunger. In
low-income countries, the number of individuals with diabetes is
expected to increase from 84 million to 228 million by 2030. Obesity, a preventable condition, is associated with numerous chronic diseases, including cardiovascular conditions, stroke, certain cancers, and respiratory disease. About 16% of the global burden of disease, measured as DALYs, has been accounted for by obesity.
Neglected tropical diseases
More than one billion people were treated for at least one neglected tropical disease in 2015.
Neglected tropical diseases are a diverse group of infectious diseases
that are endemic in tropical and subtropical regions of 149 countries,
primarily effecting low and middle income populations in Africa, Asia,
and Latin America. They are variously caused by bacteria (Trachoma, Leprosy), viruses (Dengue, Rabies), protozoa (Human African trypanosomiasis, Chagas), and helminths (Schistosomiasis, Onchocerciasis, Soil transmitted helminths).
The Global Burden of Disease Study concluded that neglected tropical
diseases comprehensively contributed to approximately 26.06 million disability-adjusted life years in 2010, as well as significant deleterious economic effects.
In 2011, the World Health Organization launched a 2020 Roadmap for
neglected tropical diseases, aiming for the control or elimination of 10
common diseases. The 2012 London Declaration
builds on this initiative, and called on endemic countries and the
international community to improve access to clean water and basic
sanitation, improved living conditions, vector control, and health
education, to reach the 2020 goals. In 2017, a WHO report cited 'unprecedented progress' against neglected tropical diseases since 2007, especially due to mass drug administration of drugs donated by pharmaceutical companies.
Surgical Disease
Surgery remains grossly neglected in global health, famously described by Halfdan T. Mahler
as the 'neglected stepchild of global health'. This particularly
affects low-resource settings with weak surgical health systems. 'Global
surgery' is the term now adopted to describe the rapidly developing
field seeking to address this, and has been defined as 'the
multidisciplinary enterprise of providing improved and equitable
surgical care to the world's population, with its core tenets as the
issues of need, access and quality'.
Surgical diseases make up at least 11% of the global burden of
disease, with a mix of injuries, malignancies, congenital anomalies, and
complications of pregnancy.
Globally, 4.2 million people are estimated to die within 30 days of
surgery each year, with half of these occurring in low- and
middle-income countries.
There is significant variation in outcomes associated with the
development level of the country where surgery is taking place. A
prospective study of 10,745 adults undergoing emergency abdominal
surgery from 357 centres across 58 countries found that mortality is
three times higher in low- compared with high-human development index
(HDI) countries even when adjusted for prognostic factors.
The right to health care is a key component of the Universal
Declaration of Human Rights and has lacked the appropriate attention in
low-income countries in recent history.
Surgical diseases can result in considerable morbidity and mortality
for individuals whom are unable to access appropriate care, yet in
low-income countries, this category of disease has been deemed too
expensive to invest in.
In recent years, however, it has been recognized that surgical diseases
are a neglected health problem of great proportion and requires urgent
prioritization.
Surgical conditions such as appendicitis, complications of abdominal
hernias, and obstructed labour can be fatal if not treated by a surgical
team, and on a global scale, the financial consequences of citizens
dying from potentially treatable surgical conditions translates into
upwards of $12.3 trillion of lost economic productivity to LMICs between
2015–2030 if no action is taken to improve access to surgical care.
Health interventions
Global interventions for improved child health and survival include the promotion of breastfeeding, zinc supplementation, vitamin A fortification, salt iodization, hygiene interventions such as hand-washing, vaccinations, and treatments of severe acute malnutrition. The Global Health Council suggests a list of 32 treatments and health interventions that could potentially save several million lives each year.
Many populations face an "outcome gap", which refers to the gap
between members of a population who have access to medical treatment
versus those who do not. Countries facing outcome gaps lack sustainable
infrastructure. In Guatemala, a subset of the public sector, the Programa de Accessibilidad a los Medicamentos
("Program for Access to Medicines"), had the lowest average
availability (25%) compared to the private sector (35%). In the private
sector, highest- and lowest-priced medicines were 22.7 and 10.7 times
more expensive than international reference prices respectively.
Treatments were generally unaffordable, costing as much as 15 days wages
for a course of the antibiotic ceftriaxone. The public sector in Pakistan,
while having access to medicines at a lower price than international
reference prices, has a chronic shortage of and lack of access to basic
medicines.
Journalist Laurie Garrett
argues that the field of global health is not plagued by a lack of
funds, but that more funds do not always translate into positive
outcomes. The problem lies in the way these funds are allocated, as they
are often disproportionately allocated to alleviating a single disease.
In its 2006 World Health Report, the WHO estimated a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide, especially in sub-Saharan Africa.
Surgical Care
Data
from WHO and the World Bank indicate that scaling up infrastructure to
enable access to surgical care in regions which it is currently limited
or non-existent is, in fact, a low-cost measure relative to the
significant morbidity and mortality caused by lack of surgical treatment. For example, it is estimated that 90% of maternal deaths could be prevented with basic surgical care.
From a cost perspective, studies at district hospitals have
demonstrated that provision of basic surgical care can be on par with
vaccination programs, which counters a common perception of surgical
care as a financially prohibitive endeavor in LMICs.
Furthermore, the Lancet Commission on Global Surgery estimates $12.3
trillion in economic productivity will be lost in developing countries
by 2030 if access to surgical care is not improved.
.
Bellwether procedures are considered a minimum level of care that
first-level hospitals should be able to provide in order to capture the
most basic emergency surgical care. These include 3 main surgical
procedures; laparotomy (for abdominal emergencies), caesarean section,
and treatment of an open fracture.
This would require anaesthetists, obstetricians, surgeons, nurses, and
facilities with operating theatres and pre- and post-surgical care
capabilities.
Global Health Security Agenda
The
Global Health Security Agenda (GHSA) is "a multilateral, multi-sector
effort that includes 60 participating countries and numerous private and
public international organizations focused on building up worldwide
health security capabilities toward meeting such threats" as the spread
of infectious disease. On March 26–28, 2018, the GHSA held a high-level
meeting in Tbilisi, Georgia, on biosurveillance of infectious disease
threats, "which include such modern-day examples as HIV/AIDS, severe
acute respiratory syndrome (SARS), H1N1 influenza, multi-drug resistant
tuberculosis — any emerging or reemerging disease that threatens human
health and global economic stability."
This event brought together GHSA partner countries, contributing
countries of Real-Time Surveillance Action Package, and international
partner organizations supporting the strengthening of capacities to
detect infectious disease threats within the Real-Time Surveillance
Action Package and other cross-cutting packages. Georgia is the lead
country for the Real-Time Surveillance Action Package.
GHSA works through four main mechanisms of member action, action
packages, task forces and international cooperation. In 2015, the
Steering Group of the GHSA agreed upon the implementation of their
commitments through 11 Action Packages. Action Packages are a commitment
by member countries and their partners to work collaboratively towards
development and implementation of International Health Regulations
(IHR).
Action packages are based on GHSA’s aim to strengthen national and
international capacity to prevent, detect, and respond to infectious
disease threats. Each action package consists of five-year targets,
measures of progress, desired impacts, country commitments, and list of
baseline assessments.
The Joint External Evaluation (JEE) process, derived as part of the IHR
Monitoring and Evaluation Framework is an assessment of a country’s
capacity for responding to public health threats.
So far, G7 partners and EU have made a collective commitment to assist
76 countries whereas the US committed to helping 32 countries to achieve
GHSA targets for IHR implementation. In September 2014, a pilot tool
was developed to measure progress of the Action Packages and applied in
countries (Georgia, Peru, Uganda, Portugal, the United Kingdom, and
Ukraine) that volunteered to participate in an external assessment.
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. It is part of the U.N. Sustainable Development Group.
The WHO Constitution, which establishes the agency's governing
structure and principles, states its main objective as ensuring "the
attainment by all peoples of the highest possible level of health." It is headquartered in Geneva, Switzerland, with six semi-autonomous regional offices and 150 field offices worldwide.
The WHO was established in 7 April 1948, which is commemorated as World Health Day. The first meeting of the World Health Assembly (WHA), the agency's governing body, took place on 24 July 1948. The WHO incorporated the assets, personnel, and duties of the League of Nations' Health Organisation and the Office International d'Hygiène Publique, including the International Classification of Diseases. Its work began in earnest in 1951 following a significant infusion of financial and technical resources.
The WHO's broad mandate includes advocating for universal
healthcare, monitoring public health risks, coordinating responses to
health emergencies, and promoting human health and well being.
It provides technical assistance to countries, sets international
health standards and guidelines, and collects data on global health
issues through the World Health Survey. Its flagship publication, the World Health Report, provides expert assessments of global health topics and health statistics on all nations. The WHO also serves as a forum for summits and discussions on health issues.
The WHA, composed of representatives from all 194 member states,
serves as the agency's supreme decision-making body. It also elects and
advises an Executive Board made up of 34 health specialists. The WHA
convenes annually and is responsible for selecting the Director-General,
setting goals and priorities, and approving the WHO's budget and
activities. The current Director-General is Tedros Adhanom, former Health Minister and Foreign Minister of Ethiopia, who began his five-year term on 1 July 2017.
The WHO relies on assessed and voluntary contributions from
member states and private donors for funding. As of 2018, it has a
budget of over $4.2 billion, most of which comes from voluntary
contributions from member states.
History and development
Origins
The International Sanitary Conferences,
originally held on 23 June 1851, were the first predecessors of the
WHO. A series of 14 conferences that lasted from 1851 to 1938, the
International Sanitary Conferences worked to combat many diseases, chief
among them cholera, yellow fever, and the bubonic plague.
The conferences were largely ineffective until the seventh, in 1892;
when an International Sanitary Convention that dealt with cholera was
passed.
During the 1945 United Nations Conference on International Organization, Szeming Sze,
a delegate from the Republic of 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. 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 specialized 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 Štampar 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.
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.
1966: The WHO moved its headquarters from the Ariana wing at the Palace of Nations to a newly constructed HQ elsewhere in Geneva.
1967: The WHO 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.
1967: The WHO launched the Special Programme for Research and Training in Tropical Diseases
and the World Health Assembly voted to enact a resolution on Disability
Prevention and Rehabilitation, with a focus on community-driven care.
1986: The WHO began its global programme on HIV/AIDS. Two years later preventing discrimination against sufferers was attended to and in 1996 UNAIDS was formed.
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.
2006: The organization endorsed the world's first official
HIV/AIDS Toolkit for Zimbabwe, which formed the basis for global
prevention, treatment, and support the 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".
The WHO fulfills this objective through its functions as defined
in its Constitution: (a) To act as the directing and coordinating
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, the WHO has defined its role in public health as follows:
providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
shaping the research agenda and stimulating the generation, translation, and dissemination of valuable knowledge;
setting norms and standards and promoting and monitoring their implementation;
articulating ethical and evidence-based policy options;
providing technical support, catalysing change, and building sustainable institutional capacity; and
monitoring the health situation and assessing health trends.
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, the World Health Organization has worked within the UNAIDS network and strives 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%.
During 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, the 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 effect
of tuberculosis and stabilising the drug supply. It has also recognized
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), 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".
In 2017, a study was conducted where why Polio Vaccines may not be
enough to eradicate the Virus & conduct new technology. Polio is now
on the verge of extinction, thanks to a Global Vaccination Drive. the
World Health Organization (WHO) stated the eradication programme has
saved millions from deadly disease.
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".
The Division of Noncommunicable Diseases for Promoting Health through
the Life-course Sexual and Reproductive Health has published the
magazine, Entre Nous, across Europe since 1983.
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.
2018 (30 October – 1 November) : 1 WHO's first global conference on air pollution and health (Improving air quality, combatting climate change – saving lives) ;
organized in collaboration with UN Environment, World Meteorological
Organization (WMO) and the secretariat of the UN Framework Convention on
Climate Change (UNFCCC)
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".
In April 2019, the WHO released new recommendations stating that
children between the ages of two and five should spend no more than one
hour per day engaging in sedentary behavior in front of a screen and
that children under two should not be permitted any sedentary screen
time.
Surgery and trauma care
The World Health Organization promotes road safety as a means to reduce traffic-related injuries. It 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 was a world health emergency – outbreaks of the disease in Asia, Africa, and the Middle East were considered "extraordinary".
On 8 August 2014, WHO declared that the spread of Ebola
was a public health emergency; an outbreak which was believed to have
started in Guinea had spread to other nearby countries such as Liberia
and Sierra Leone. The situation in West Africa was considered very
serious.
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".
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. 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:
"to provide leadership, strengthen governance and foster
partnership and collaboration with countries, the United Nations system,
and other stakeholders in order to fulfill the mandate of WHO in
advancing the global health agenda"; and
"to develop and sustain WHO as a flexible, learning organization,
enabling it to carry out its mandate more efficiently and effectively".
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 co-operation into practice in the health sector.
WHO also aims to improve access to health research and literature in developing countries such as through the HINARI network.
WHO collaborates with the Global Fund to fight AIDS, Tuberculosis
and Malaria, UNITAID, and the United States President's Emergency Plan
for AIDS Relief to spearhead and fund the development of HIV programs.
WHO created the Civil Society Reference Group on HIV, which brings together other networks that are involved in policy making and the dissemination of guidelines.
WHO, a sector of the United Nations, partners with UNAIDS to contribute to the development of HIV responses in different areas of the world.
WHO facilitates technical partnerships through the Technical Advisory Committee on HIV, which they created to develop WHO guidelines and policies.
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).
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 affect 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 Aging 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 used 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.
In 2016, the World Health Organization drafted a global health
sector strategy on HIV. In the draft, the World Health Organization
outlines its commitment to ending the AIDS epidemic by the year 2030
with interim targets for the year 2020. To make achievements towards
these targets, the draft lists actions that countries and the WHO can
take, such as a commitment to universal health coverage, medical
accessibility, prevention and eradication of disease, and efforts to
educate the public. Some notable points made in the draft include
addressing gender inequity where females are nearly twice as likely as
men to get infected with HIV and tailoring resources to mobilized
regions where the health system may be compromised due to natural
disasters, etc. Among the points made, it seems clear that although the
prevalence of HIV transmission is declining, there is still a need for
resources, health education, and global efforts to end this epidemic.
Countries by World Health Organization membership status
As of 2016, the WHO has 194 member states: all of the member states of the United Nations except for Liechtenstein, plus 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" recognized 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.
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 website, "other countries
may be admitted as members when their application has been approved by a
simple majority vote of the World Health Assembly". The World Health Assembly is attended by delegations from all member states, and determines the policies of the organization.
The World Health Assembly
(WHA) 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. The current chairman of the executive board is Dr. Assad Hafeez.
Director-General
The head of the organization is the Director-General, elected by the World Health Assembly.
The term lasts for 5 years, and Directors-General are typically
appointed in May, when the Assembly meets. The current Director-General
is Dr. Tedros Adhanom Ghebreyesus, who was appointed on 1 July 2017.
Global institutions
Apart from regional, country and liaison offices, the World Health Assembly has also established other institutions for promoting and carrying on research.
The regional divisions of WHO were created between 1949 and 1952, and
are based on article 44 of the 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 full members. 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 director, who is elected by the
Regional Committee. The Board must approve such appointments, although
as of 2004, it had never over-ruled 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, and typically take their position on 1 February.
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 centres. 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.
AFRO includes most of Africa, with the exception of Egypt, Sudan,
Djibouti, Tunisia, Libya, Somalia and Morocco (all fall under EMRO). The Regional Director is Dr. Matshidiso Moeti, a Botswanan national. (Tenure: – present).
EURO includes all of Europe (except Liechtenstein) Israel, and all of the former USSR. The Regional Director is Dr. Zsuzsanna Jakab, a Hungarian national (Tenure: 2010 – present).
The Eastern Mediterranean Regional Office
serves the countries of Africa that are not included in AFRO, as well
as all countries in the Middle East except for Israel. Pakistan is
served by EMRO. The Regional Director is Dr. Ahmed Al-Mandhari, an Omani national (Tenure: 2018 – present).
WPRO covers all the Asian countries not served by SEARO and EMRO,
and all the countries in Oceania. South Korea is served by WPRO. The Regional Director is Dr. Shin Young-soo, a South Korean national (Tenure: 2009 – present).
The WHO employs 8,500 people in 147 countries to carry out its principles. 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 World Health Organization operates 150 country offices in six different 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 the 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. WHO Representatives in
the Region termed the Americas 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.
U.S. contributions to the WHO are funded through the U.S. State Department’s
account for Contributions to International Organizations (CIO). In the
budget requests for fiscal years 2020 and 2021, the Trump administration
asked to halve funding for the WHO.
In April 2020, President Donald Trump announced that his administration would be halting funding to the WHO. Funds previously earmarked for the WHO would be on hold for 60-90 days pending an investigation into WHO's handling of the COVID-19 pandemic, particularly in respect to the organization's purported relationship with China.
Controversies
IAEA – Agreement WHA 12–40
Alexey Yablokov (left) and Vassili Nesterenko (farthest right) protesting in front of the World Health Organization headquarters in Geneva, Switzerland in 2008.
In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency
(IAEA). Reading of this document (clause 3) can result in the
understanding that the IAEA is able to prevent the WHO from conducting
research or work on some areas. The agreement states that the WHO
recognizes the IAEA as having responsibility for peaceful nuclear energy
without prejudice to the roles of the WHO of promoting health. The following paragraph adds:
“
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 groups and activists including Women in Europe for a Common Future to claim 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.
IndependentWHO held a weekly vigil from 2007–2017 in front of WHO headquarters.
However, as pointed out by Foreman in clause 2 it states:
“
2. In
particular, and in accordance with the Constitution of the World Health
Organization and the Statute of the International Atomic Energy Agency
and its agreement with the United Nations together with the exchange of
letters related thereto, and taking into account the respective
co-ordinating responsibilities of both organizations, it is recognized
by the World Health Organization that the International Atomic Energy
Agency has the primary responsibility for encouraging, assisting and
co-ordinating research and development and practical application of
atomic energy for peaceful uses throughout the world without prejudice
to the right of the World Health Organization to concern itself with
promoting, developing, assisting and co-ordinating international health
work, including research, in all its aspects.
”
Ebola and HIV experimentation
It has been alleged that the WHO was aware of a Dr. Hilary Koprowski, a doctor allegedly performing research on AIDS and Ebola by deceiving and infecting Africans with a faux polio vaccine. It was estimated that over a million Africans were infected from 1954 to 1957. However, his work having been the cause of any disease has been refuted.
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, has condemned Pope Benedict's
opposition to contraception, saying he was trying to "create confusion"
and "impede" proven strategies in the battle against the disease.
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 free sugars 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
the following statement in the report: "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 free sugars levels by half and said
that free sugars 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 and health officials. A pandemic involving the H1N1 influenza virus was declared by the then Director-General Margaret Chan in April 2009. Margret Chan declared in 2010 that the H1N1 has moved into the post-pandemic period.
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 during
the last decade".
2013–2016 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 the 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
2013–2016 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 few mechanisms to help enforce compliance with the
FCTC.
However, there have 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
(e.g., 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".
IARC controversies
The World Health Organization sub-department, the International
Agency for Research on Cancer (IARC), has been criticized for the way it
analyses the tendency of certain substances and activities to cause
cancer and for having a politically motivated bias when it selects
studies for its analysis. Ed Yong, a British science journalist, has
criticized the agency and its "confusing" category system for misleading
the public. Marcel Kuntz, a French director of research at the French National Centre for Scientific Research,
criticized the agency for its classification of potentially
carcinogenic substances. He claimed that this classification did not
take into account the extent of exposure: for example, red meat is
qualified as probably carcinogenic, but the quantity of consumed red
meat at which it could become dangerous is not specified.
Controversies have erupted multiple times when the IARC has
classified many things as Class 2a (probable carcinogens) or 2b
(possible carcinogen), including cell phone signals, glyphosate, drinking hot beverages, and working as a barber.
Taiwanese membership and participation
Between 2009 and 2016 Taiwan was allowed to attend WHO meetings and
events as an observer but was forced to stop due to renewed pressure
from China.
Political pressure from China has led to Taiwan being barred from
membership of the WHO and other UN-affiliated organizations, and in
2017 to 2020 the WHO refused to allow Taiwanese delegates to attend the WHO annual assembly. On multiple occasions Taiwanese journalists have been denied access to report on the assembly.
In May 2018, the WHO denied access to its annual assembly by Taiwanese media reportedly due to demands from China. Later in May 172 members of the United States House of Representatives wrote to the Director-General of the World Health Organization to argue for Taiwan's inclusion as an observer at the WHA. The United States, Japan, Germany, and Australia all support Taiwan's inclusion in WHO.
Pressure to allow Taiwan to participate in WHO increased as a
result of the 2019–2020 coronavirus pandemic with Taiwan's exclusion
from emergency meetings concerning the outbreak bringing a rare united
front from Taiwan's diverse political parties. Taiwan's main opposition
party, the KMT,
expressed their anger at being excluded arguing that disease respects
neither politics nor geography. China once again dismissed concerns over
Taiwanese inclusion with the Foreign Minister claiming that no-one
cares more about the health and wellbeing of the Taiwanese people than
China's central government. During the outbreak Canadian Prime Minister Justin Trudeau voiced his support for Taiwan's participation in WHO, as did Japanese Prime Minister Shinzo Abe. In January 2020 the European Union,
a WHO observer, backed Taiwan's participation in WHO meetings related
to the coronavirus pandemic as well as their general participation.
In a 2020 interview, assistant director-general Bruce Aylward
appeared to dodge a question about Taiwan and when the question was
repeated, the connection was "cut off" blaming internet connection
issues.
When the video chat was restarted, he was asked another question about
Taiwan but he claimed to have already answered the question and formally
ended the interview.
Taiwan’s effective response to the coronavirus outbreak has
bolstered its case for WHO membership. Taiwan’s response to the outbreak
has been praised by a number of experts.
Travel expenses
According to The Associated Press, the WHO routinely spends about $200 million a year on travel expenses, more than it spends to tackle mental health problems, HIV/AIDS, Tuberculosis, and Malaria combined. In 2016, Margaret Chan, Director-General of WHO from November 2006 to June 2017, stayed in a $1000-per-night hotel room while visiting West Africa.
Robert Mugabe's role as a goodwill ambassador
On 21 October 2017, the Director-General Tedros Adhanom Ghebreyesus appointed former Zimbabwean president Robert Mugabe as a WHO Goodwill Ambassador
to help promote the fight against non-communicable diseases. The
appointment address praised Mugabe for his commitment to public health
in Zimbabwe.
The appointment attracted widespread condemnation and criticism
in WHO member states and international organizations due to Robert
Mugabe's poor record on human rights and presiding over a decline in
Zimbabwe's public health. Due to the outcry, the following day the appointment was revoked.
2019–20 COVID-19 pandemic
The WHO's handling of the epidemic has come under criticism amidst
what has been described as the agency's "diplomatic balancing act"
between "China and China's critics," including scrutiny of the
relationship between the agency and Chinese authorities.
Initial concerns included the observation that while WHO relies upon
data provided and filtered by member states, China has had a "historical
aversion to transparency and sensitivity to international criticism". While the WHO and some world leaders have praised the Chinese government's transparency in comparison to the 2003 SARS outbreak,
others including John Mackenzie of the WHO's emergency committee and
Anne Schuchat of the US' CDC have shown skepticism, suggesting that
China's official tally of cases and deaths may be an underestimation.
David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine,
said in response to skepticism on transparency that "China has been
very transparent and open in sharing its data … they’re sharing it very
well and they opened up all of their files with the WHO present."
In response to the criticisms, Director-General Tedros has stated
that China "doesn't need to be asked to be praised. China has done many
good things to slow down the virus. The whole world can judge. There is
no spinning here,"
and further stating that "I know there is a lot of pressure on WHO when
we appreciate what China is doing but because of pressure we should not
fail to tell the truth, we don't say anything to appease anyone. It's
because it's the truth." Amid the pandemic, African leaders expressed support for the WHO, with the African Union saying the organization had done "good work" and Nigerian President Muhammadu Buhari calling for "global solidarity".
Some observers have said the WHO is unable to risk antagonizing
the Chinese government, as otherwise the agency would not have been able
to stay informed on the domestic state of the outbreak and influence
response measures there, after which there would have "likely have been a
raft of articles criticizing the WHO for needlessly offending China at a
time of crisis and hamstringing its own ability to operate."
Through this, experts such as Dr. David Nabarro have defended this
strategy in order "to ensure Beijing's co-operation in mounting an
effective global response to the outbreak". Osman Dar, director of the One Health Project at the Chatham House
Centre on Global Health Security defended the WHO's conduct, stating
that the same pressure was one "that UN organisations have always had
from the advanced economies."
The inclusion of the "Taiwan region" in the WHO's daily situation
reports, which resulted in Taiwan receiving the same WHO "very high"
risk rating as the mainland despite only a having a relatively small
number of cases on the ROC-governed island has led to protests by Taiwan who says that the rating has led to it receiving travel bans as a result.
Further concerns regarding Taiwan's non-member status in the WHO has
been on the effect this has on increasing Taiwan's vulnerability in the
case of an outbreak in the region without proper channels to the WHO. In
response, the WHO has said that they "have Taiwanese experts involved
in all of our consultations ... so they're fully engaged and fully aware
of all of the developments in the expert networks."
The controversy was furthered when Canadian WHO epidemiologist Bruce Aylward, head of the WHO's 2019–20 COVID-19 response team, refused to answer questions from RTHK
reporter Yvonne Tong about Taiwan's response to the pandemic and
inclusion in the WHO, leading to accusations about China's political
influence over the international organization.
On 14 April 2020, United States President Donald Trump
announced that he would stop United States funding of the WHO while
reviewing its role in what he described as “severely mismanaging and
covering up the spread of the coronavirus.”
A week earlier, at a press briefing, Trump had criticized the WHO for
"missing the call" on the coronavirus pandemic and had threatened to
withhold U.S. funding to the organization; on the same day, he also
tweeted a complaint that China benefits disproportionately from the WHO,
saying that "the WHO really blew it."
The U.S. Congress had already allocated about $122 million to WHO for
2020, and Trump had previously proposed in the White House's 2021 budget
request to reduce WHO funding to $58 million.
Traditional medicine
WHO has been moving toward acceptance and integration of traditional medicine and traditional Chinese medicine (TCM). In 2022, the new International Statistical Classification of Diseases and Related Health Problems, ICD-11, will attempt to enable classifications from traditional medicine to be integrated with classifications from evidence-based medicine.
This and other support of WHO for such practices has been criticized by
the medical and scientific community, due to lack of evidence and the
risk of endangering wildlife hunted for traditional remedies. A WHO spokesman said that the inclusion was "not an endorsement of the
scientific validity of any Traditional Medicine practice or the efficacy
of any Traditional Medicine intervention."
World headquarters
The seat of the organization is in Geneva, Switzerland. It was designed by Swiss architect Jean Tschumi and inaugurated in 1966. In 2017, the organization launched an international competition to redesign and extend its headquarters.