3. Pharmaceutical preparations and biological standardization___ 4. Chronic diseases of major significance in the United States--- 9. The need for constant review of jurisdictional lines. 10. Cooperation on radiation problems.... D. Cooperation with international professional organizations. 1. Relationships with pharmaceutical organizations. 2. Relationships with the academic world.. 3. Relationship with foundations and associations.... F. Relationships with the U.S.S.R. and countries of Eastern Europe.. G. The proposed international public health and medical research year... LIST OF CHARTS 1-A Proportion of deaths from tuberculosis and other infectious diseases in total number of deaths: 1920 and 1956__. 1-B Notifications of cases of smallpox... 1-C Smallpox-Total of officially notified cases by continents.... 1-D Notifications of cases of cholera, 1948 and 1957.. 1-E Plague: Reported cases-1957--. 1-F Regression of typhus.. 1-G Expectation of life at birth......... 1-H Death rates-Infant death rates 1920 and 1956 3-A Progress of influenza epidemic from February 1957 to January 1958-3-B World influenza centers as at March 1958. 3-C Status of malaria eradication in the world at the end of 1957_ 4-A WHO polio centers as at April 1958 6-A Amounts authorized for use by WHO, 1953-59 6-B Revised estimates under regular budget for 1957 compared with approved 1958 and 1959 estimates.. 6-C Approved use of 1958 budget, by percentages.. 6-D Distribution of staff by work location__ Page 16 17 18 19 20 21 22 23 48 51 60 70 124 125 129 138 139 6-E Distribution of professional staff by nationality-- 1-A 1-B 5-A 5-B 5-C 6-A 6-B LIST OF TABLES Infectious disease problems, by continent. U.S. delegations to International Health Conferences and World Institutions and laboratories closely associated with WHO_ 6-C Contributions to the 1959 regular budget of WHO, by country- 6-E the special malaria fund, and funds obligated in the region of the Breakdown of obligations by major purposes, 1952-57, and estimated 6-F Obligations in respect of projects by specific fields of activity, 1952- 131 6-G Estimated government contribution to malaria eradication programs Summary by purpose-of-expenditure code, indicating percentages of 135 6-K World Health Organization-Geographical distribution of staff, 136 6-L U.S. and Soviet contributions to the World Health Organization.. 6-M Contributions to special projects of the World Health Organization by the United States and Soviet Union_.. 143 144 6-N United Nations expanded program of technical assistance funds obli- 144 INTRODUCTORY SECTION A. THE BACKGROUND OF SENATOR HUMPHREY'S 1958 TRIP TO EUROPE On August 18, 1958, the U.S. Senate unanimously approved Senate Resolution 347, 85th Congress. The Committee on Government Operations was directed thereby "to make a full and complete study of any and all matters pertaining to international health, research, rehabilitation, and assistance programs." By the decision of the chairman of the committee, the Honorable John L. McClellan, responsibility for the study was entrusted to the standing Subcommittee on Reorganization and International Organi zations. This subcommittee is responsible, among other duties, for— (a) Analysis of legislation and of administrative problems relating to the organization of the Federal Government. (b) Review of American relations with international organizations. In both of these respects, the international health study comes clearly within the purview of the subcommittee. By way of illustration (a) Health research engages the attention of over a half dozen agencies of the Federal Government. (b) Health activities fall, as well, within the scope of numerous intergovernmental organizations of which the United States is a member. Outstanding among such organizations is the World Health Organization. Related intergovernmental organizations in which the United States participates are the United Nations Children's Fund, the Food and Agriculture Organization, the International Labor Organization (the last named with particular reference to occupational health) and the United Nations Educational, Scientific, and Cultural Organization. To analyze both of these phases, a comprehensive work plan was prepared. Questionnaires were sent out, reports were requested, interviews and conferences held. Specific purposes in tour of European Health Centers Commencing November 17, 1958, the scene of the inquiry turned from the United States to relationships with foreign governments and with intergovernmental organizations in Europe itself. For several intensive weeks thereafter, I held formal and informal discussions with officials and private individuals in nine European countries: France, Switzerland, West Germany, Denmark, Sweden, Finland, the Soviet Union, Norway, and the United Kingdom, in that order. My purpose was to gain facts and insight on (a) Problems of world health. (b) The ways in which the U.S. Government itself is helping to meet these problems. (c) The ways in which intergovernmental organizations of which the United States is a member are meeting the problems. Or, expressed in another way, I sought understanding of (a) The health challenge; (b) The U.S. approach to the challenge-unilaterally (through our own independent efforts at home), bilaterally (through cooperation in each instance with another individual country); and (c) Multilaterally-through participation in a multination organization. The fact is that, increasingly, there is a blending of all three types of effort-unilateral, bilateral, and multilateral. The conduct of medical research, as such, provides perhaps, the best example of the fusing of these modi operandi. But medical assistance to the developing areas of the globe is likewise increasingly involved in the constructive interplay of bilateral and multilateral relationships. To help determine, then, how the American taxpayer's money is being spent for research purposes by U.S. Government health agencies at home, it is invaluable to know what we are doing in our research efforts abroad. The converse is true as well. Science, especially medical science, is international. This was the theme of the first committee print in the subcommittee's series of publications. Science, to be fully successful, requires genuine cooperaation among the nations. Key role of WHO in world health In country after country, as I traveled throughout Europe, I found that one means of cooperation-one organization-emerged in almost every conversation on the topic of health. That organization is, of course, the World Health Organization. Its three initials-WHO-have become virtually synonymous with efforts in world health. WHO has become the hub of the world health wheel, the center of motion for innumerable constructive forces. Wherever I went in Europe I found reference to its good works on the continent and disseminating throughout the world. Geneva, its world headquarters, was of course an ideal location to obtain the central view of its farflung work. But it is not the best place to see its works themselves, as WHO officials readily stated. WHO is a regionalized and decentralized organization, the crux of whose efforts may best be seen in the field, notably in the developing areas of the globe. Had time been available for my visiting the Middle East, as I had previously, or south Asia, Latin America, or Africa, I am certain that the powerful impact of WHO would have been felt even more keenly than I did feel it in Europe. In instance after instance, while commenting on themes of health cooperation with health officials in, say, Paris, Stockholm, or Moscow, I found that WHO entered almost inevitably into the discussion. Since so many of the conversations gravitated to the theme of WHO, I felt that this report to the committee and to the Congress might serve to best advantage if it concentrated on this remarkable organization. |