The World Health Organization in historical perspective.

Abstract

THE WORLD HEALTH ORGANIZATION IN HISTORICAL PERSPECTIVE NORMAN HOWARD-JONES* The constitution of the World Health Organization came into force on April 7, 1948, when the twenty-sixth of the 51 member states of the United Nations that had signed it at the International Health Conference of 1946 in New York deposited a formal instrument of acceptance with the UN secretary-general. While WHO is one of the specialized agencies in relationship with the United Nations, it is an entirely autonomous organization with its own budget and governing bodies— the World Health Assembly and the Executive Board—and a membership that is almost identical with that of the United Nations. While WHO is generally well regarded both by the public and by the health professions , such regard is based more on sentiment than on an understanding of how and why this body came into being and what it represents . The purpose of this essay is to provide some insights into the origins of WHO and to certain of its characteristics. The World Health Organization's remote origins can be traced to the first formal intergovernmental meeting concerned with the prevention of epidemic diseases—the International Sanitary Conference of 18511852 , which was held in Paris and lasted for no less than 6 months. Eleven European states and the Ottoman Empire participated in this conference, the object of which was to agree on uniform international quarantine regulations against epidemic diseases (initially plague, cholera , and yellow fever), with a view of abolishing excessive precautions that were a serious hindrance to international commerce. Further International Sanitary Conferences took place in 1859 (Paris), 1866 (Constantinople), 1874 (Vienna), 1881 (Washington), and 1885 (Rome), all for the purpose of agreeing on international maritime quarantine regulations. But contradictory views on the etiology of *Chief medical editor, Interim Commission of WHO, January-August 1948; director, Division of Editorial and Reference Services, WHO, September 1948-January 1970. Present address: 28 Chemin Colladon, 1209 Geneva, Switzerland.© 1981 by The University of Chicago. 0031-5982/81/2403-0227$01.00 Perspectives inBiohgy and Medicine ¦ Spring 1981 | 467 epidemie diseases, particularly cholera, made such agreement impossible . The seventh conference, held in Venice in 1892, was a landmark in that all participants were in sufficient agreement on the etiology and mode of spread ofcholera to enable them to adopt the first international quarantine convention in respect of this disease. This convention was supplemented by further conventions adopted by conferences in 1893 (Dresden) and 1894 (Paris), all of them concerned exclusively with cholera . The next conference, held in Venice in 1897, resulted in a convention for the international control of plague, the mode of transmission of which was by then partially understood. At the eleventh conference, in Paris in 1903, a further landmark was established in that the conventions elaborated by the previous four conferences were amended and consolidated into a single instrument, and it was also agreed that a permanent international health office should be established in Paris. In December 1907, a special conference was convened in Rome to agree on the statutes of this organization, which was constituted as the Office international d'hygiène publique (OIHP). Twelve governments, including those of Brazil and the United States, signed the treaty—known as the Arrangement de Rome—that created this body, which consisted of Permanent Committee meeting twice a year and a small staff responsible for administering the international sanitary conventions and acting as the secretariat of the International Sanitary Conferences, of which the twelfth was held in Paris in 191 1-12. By 1920, the number of signatories of the Arrangement was 39. As with all the International Sanitary Conferences, except for that in Washington in 1881, the only language used at OIHP meetings and in its publications was French. The Interinar Years During the 1914-1918 war the activities of the OIHP were virtually limited to the publication of its monthly bulletin, the form of which had been laid down in the Arrangement de Rome. After the war, the birth of the League of Nations was to result in a broadening of the concept of "international health cooperation" far beyond the narrow confines of defensive quarantine measures. Article 23(f) of the...