G. FUTURE FINANCIAL NEEDS AND PROGRAMS

The United States, like other powers, with relatively strong financial capacity, must determine how far and how fast it is prepared to go to bolster WHO's efforts by enabling the organization to enter significantly into new or enlarged fields of activity.

The number of relatively new areas of possible substantive action is considerable. Proposed eradication of smallpox is one such area; a massive assault for improved water systems and against gastroenteric (diarrheal) disease is another.

Water systems

The latter offers excellent illustrative possibilities as to the challenge and the financial dilemma.

At the World Health Assembly in Minneapolis in May 1958 the nations resolved in favor of increased emphasis on worldwide community water supply efforts. Clean water is obviously a key to a better, healthier life throughout the globe.

It should be noted that the broad array of preventable gastrointestinal (enteric) diseases includes those transmitted by water (typhoid, cholera, etc.), the diarrheal diseases and other diseases contact-transmitted through inadequate personal hygiene. It is estimated that the latter group annually amounts to some 500 million disabling illnesses and 5 million infant deaths worldwide.

Broad-scale improvement in environmental sanitation is essential for this and other purposes.

In the proposed U.S. budget for the 1960 fiscal year it is recommended that our Government strengthen international efforts in the field of water supply and sewerage.

Stronger bilateral efforts by the International Cooperation Administration and support of multilateral aid through WHO and PAHO are contemplated.

These specific proposals are, in my judgment, sound fields for expanded U.S. effort.

Yet it is manifest that overall decisions on them cannot be predicated on (a) 1 year or 2 years of future planning, or (b) by the United States alone. If we are to enter into bold, long-range effortsas I, for one, believe we should and must-we and others must open our eyes wide to the hard financial facts of long-range need.

For example, to train indispensable sanitary engineers in the developing nations is one thing; to secure massive funds to enable the engineers actually to construct, install, and maintain new water and sewerage systems some years hence is quite another.

The Congress should, therefore, make its decisions and time its actions accordingly, as should comparable decisionmaking bodies in those other nations which have the financial ability to join with us. Specifically, consideration must be given to exactly which sources are prepared to advance sums of money for capital construction of water and sewerage projects, with appropriate terms of interest and repayment.

Problem of sources of funds

Meanwhile, the sources of WHO finances represent problems which should have the attention of all those interested in the organization. Some of these problems consist of:

(a) The uncertainty of allocations based on varying distributions from United Nations expanded technical assistance funds, supplementing the regular budget.

(6) The trend toward separation from the regular budget of special and separate accounts for the purpose of meeting specific problems such as malaria eradication or expanded research.

(c) A current fact of overreliance upon the United States as the source for contributions to these special and separate accounts. The question of the varying future levels of the UNETAP distributions goes to the heart of the problem affecting emerging areas of the world, generally. It involves considerations of policy such as what, at each stage, (a) the industrialized powers are prepared to contribute and (b) what should be the highest specific priorities in assisting these emerging countries. The latters' needs remain so diversified and so pressing as to merit the best thinking of all nations. Problems of health and standards of living are inevitably intertwined with problems of food productivity, industrialization, and overall population, together with a host of other factors.

These enter, too, in weighing the ultimate impact of such special purposes of WHO as malaria eradication.

Meanwhile, the separation of special accounts poses fiscal dilemmas of its own. In considering the separate accounts, we note that the various nations tend to varying degrees, and with varying resources, to be interested along certain lines. No nation has had broader interest than the United States. We ourselves have, however, designated special sums for special purposes which we felt to be in the best interest of mankind.

U.S. contributions

The disparity is clear between the respective percentages of U.S. funds in relation to the world totals in these categories:

(a) The U.S. assessed contribution to WHO's regular budget (under 33 percent);

(b) U.S. voluntary contributions to the United Nations Expanded Technical Assistance Program (now 40 percent) and

(c) U.S. voluntary contributions to WHO's special accounts (where we are carrying 95 percent of the burden in the case of malaria).

I found WHO officials keenly concerned about these problems, especially about the almost total reliance on U.S. funds for the malaria eradication special account. Every effort, I was assured, has been made to encourage other nations' financial support.

It is understood that some consideration has been given toward proposing the joining of the separate special accounts into an overall voluntary account. In that way, for example, a country which would allocate funds or materials in kind for one special purpose could clearly receive appropriate "credit" in relation to sums or donations in kind from another country for a different specialized purpose.

Whatever the fiscal mechanism, which ultimately is worked out, the important goal is that as many countries as possible share in the task of meeting WHO's growing needs. WHO has always recognized the value of a large number of countries however limited their resources making available sums proportionate to their capacity, even though the total of such sums may not aggregate very large in the overall finances of the organization. It should be noted that the increase in the number of small nation contributions for these special purposes is to be commended. It is hoped the list will continue to grow with the years.

The task is not easy.

Many emerging countries are already under considerable strain to to fulfill present assessments. Despite this fact, the very modest amounts of arrears is a testament to these nations and to WHO.

Inflation, however, continues to raise havoc with national and international budgets and programs. It is essential, therefore, that feasible ways be devised for a breakthrough despite obstacles to higher financial ground.

U.S. leadership in WHO and PAHO

So far as what the U.S. attitude at the present time should be, it appears that in this circumstance, what is needed fiscally is not a rigid slide rule approach by the United States, in determining the level of its future financial support to these special programs. Any such impatience and inflexibility on our part would prove contraproductive to our goals.

Leadership by the United States has always entailed a generous willingness not only to be first and preeminent in meeting a need, but to remain first for a reasonable time in sustaining the response to the need. Problems of standards of living with which we and others are coping have been centuries in the making; they will be long in resolving. In its contributions to the Pan-American Health Organization, the United States has wisely not hesitated to provide what appears at first glance to be a very high percentage of the contributions in order to meet the heavy needs of this emerging area. While the relative percentages may seem high, the absolute amounts for PAHO and WHO are modest indeed in comparison to other U.S. budgetary commitments.

Here in the Western Hemisphere, PAHO has written a record of achievement which should be a source of deep pride to every inhabitant of the New World. On a global basis, WHO, often emulating past PAHO pioneering or otherwise writing bold new chapters of its own has amply repaid America's and the world's investment in it. Possibility of novel approaches

It should be noted that from time to time, WHO has considered various proposals of ways and means of raising special funds to augment the regular income of the organization. Several imaginative approaches have been reviewed and at least one (for voluntary purchase of World Health Seals) was tested for several years before discontinuation. Past unsatisfactory results should not however deter the nations from seeking to come to grips with the financial problem in a new resourceful way.

Other countries' contributions

In any event, the United States is entitled to ask that other nations with relatively strong financial capacity face up to their own voluntary obligations toward the world's growing health needs.

WHO officials take pride and rightly so in the community of genuine participation among the respective nations. Participation is evidenced in many ways, for example, in each country's contributions of its nationals to the staff, to consultants, to finances and accommodations, its donations in kind, and by other means. Even fuller and more universal participation should be continually encouraged. United States and U.S.S.R. contributions

It is not inappropriate at this point to return to reference to the financial roles of the U.S.S.R., and of the two still "inactive" nonpaying states, Byelorussia and the Ukraine.

By way of further background to the significance of the respective countries present and possible contributions, the following tables 6-L-M-N might be considered.

Comparison should be noted in the percentages of the United States as compared with the three Soviet states' contributions(a) on assessment;

(b) to special projects;

(c) to United Nations expanded technical assistance funds obligated by WHO.

The facts speak for themselves on the disproportionately heavier contributions made by the United States.

TABLE 6-L.-U.S. and Soviet contributions to the World Health Organization

1 Includes $650,354 working capital fund advance. * Includes $103,389 working capital fund advance. * Includes $3,532 working capital fund advance. • Includes $13,722 working capital fund advance. Working capital fund advances not included. Full years of inactive membership. Countries resuming active status must pay 5 percent of their assessment during full years of inactive membership, and 100 percent during partial years of inactive membership, over a period of 10 years. The U.S.S.R., Ukraine, and Byelorussia became inactive members during 1949. In 1956, the Soviet Union resumed active membership. The other two, so far, have not.