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International Friday, 27 November, 1998, 17:36 GMT
50 years of the WHO - its successes and failures
WHO logo
The WHO celebrates its 50th birthday with a new director general
The World Health Organisation is struggling to eradicate leprosy and several other diseases around the globe. The BBC's Health Correspondent, Richard Hannaford, reports from Geneva on its mixed record:

To millions around the globe the organisation is known for providing healthcare to impoverished people in developing nations.

But for many others the WHO has become a by-word for international politicking and financial mismanagement.

There are persistent criticisms that many appointments within the organisation owe less to ability than to political patronage. Most of the controversy, however, has focused on the post of the organisation's director general. At the 1993 election, there were allegations of vote buying.

Gro Harlem Brundtland new WHO chief
Gro Harlem Brundtland plans sweeping changes
This year Gro Harlem Brundtland was elected as the WHO's first female director general. Her arrival at the post is likely to bring many changes in the structure and staffing of the organisation. She has already promised sweeping changes to top management.

History

The idea of a World Health Organisation was first thought of as long ago as 1851, but it was not until after World War II when, flushed with idealism, a specially convened conference was held in New York in 1946 which drew up the organisation's constitution. The World Health Organisation was officially established on the 7th April 1948 when the United Nations formally ratified its constitution.

Objectives

Its primary objective is "the attainment by all peoples of the highest possible level of health". Health being not just the absence of illness or infirmity - but the complete physical, mental, and social well being of the individual.

Today, the WHO is the main directing and co-ordinating authority on international health work. It can provide governments with technical help to supply healthcare and deliver emergency aid in times of crisis.

But the organisation is perhaps best known for its work to prevent and control epidemics like Aids, tuberculosis, malaria and other diseases.

Successes

Perhaps the WHO's greatest triumph so far came in 1977 when it announced that it had achieved its aim of eradicating smallpox from the globe. It is also on course to eliminate poliomyelitis - possibly by 2010.

Tuberculosis doctor
Tuberculosis is highly infectious
Four other tropical diseases - leprosy, river blindness, chagas disease and filariasis are on its hit list. It believes that within 10 years all four can be removed as public health dangers - given a little additional investment.

Its encouragement of breast feeding and its campaign to immunise children in developing nations against six diseases of childhood - diphtheria, tetanus, whooping cough, poliomyelitis, measles and TB, also stand as proud achievements.

However, in recent years there have been major setbacks for TB containment and the WHO has launched a big campaign against the disease, which has now reached epidemic proportions.

Perhaps the WHO's biggest impact has been its influence on public health medicine. Its emphasis on community solutions rather than hospital based healthcare has led to a revolution in the design of health services not only in developing nations but also in industrialised ones.

It has also expanded its agenda to include social and environmental issues. Nowadays it is accepted that it has as much right to talk about water quality as it has to discuss medicines and to address the issues of bad housing and environmental pollution as well as infant mortality and Aids.

Failures

However there have been some notable failures. Despite initially declaring that malaria would be eradicated, the WHO has had to concede that the disease has proved more persistent and resistant to drugs than it originally realised.

Mosquito
Malaria is spread by mosquitoes
Earlier this year, the WHO and the World Bank set up a Malaria Network, a global electronic network for health workers and health ministers to spread information on how to reduce incidence of the disease.

There is also the depressing fact that cholera, diarrhoea and tuberculosis are still killing thousands of children and adults each year in the developing world despite cures being available.

In the case of TB, complacency over treatment of the disease in the last three decades has led to a big rise in the number of cases being reported. Around 2.9 million people died from the disease last year. A third of the cases in the last five years were due to HIV, which the WHO sees as the deadliest threat to world health. It killed 1.8 million people last year and the numbers are expected to rise.

One factor in the rise in TB deaths is that some strains have become resistant to antibiotics. A new TB programme has been set up to try to address the problem, but progress is proving slow.

Criticism

But many of these setbacks would have been accepted by the WHO's critics were it not for allegations that the organisation has become bureaucratic and hamstrung by internal politicking.

Gro Harlem Brundtland took over from Dr Hiroshi Nakajima, who was the Director General for the past 10 years and came in for fierce criticism both from inside and outside the organisation.

His critics accused him of being autocratic, bureaucratic, and lacking in communication skills. When he stood for a second five-year-term in 1993, there were allegations that funds had been used to buy votes.

Although a financial audit found no evidence of that, the report was critical in tone.

Such was the bad feeling surrounding the re-election that someone got into the ornamental pond at the WHO's Headquarters in Geneva and killed and gutted a Koi carp called D-G.

Financial constraints

As a result of the bad feeling engendered by his re-election and shrinking aid budgets world-wide, the WHO has found itself under increasing scrutiny by the major financial donors.

Controversy broke out again in 1995 when the WHO's external auditor told the Assembly that the Secretariat in Geneva had failed to cooperate with his inquiry into alleged fraud, waste, and financial impropriety.

While many of the projects run by the WHO found themselves under tight financial constraints, the budget to fight Aids continued to grow. But continued criticism about the way it was managed led to the United Nations transferring responsibility for Aids to a new UN programme.

Also during this time the WHO began to lose its role as the world's main health authority, as non-governmental organisations and even other UN agencies began to play an important role in shaping international health policy.

The Issues

The pattern of illness is changing. More and more heart disease and cancers are becoming not just the diseases of the affluent countries, but also of those aspiring to affluence.

Despite the criticism, it is agreed by all that some form of international organisation is needed to co-ordinate public health programmes across the world. In the age of inter-continental jet travel the belief that one country's epidemic threatens all is a reality.

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