Part I WORLD HEALTH-STATUS AND RESOURCES A. THE CHALLENGE The World Health Organization defines health as "a state of complete physical and mental well-being and not merely the absence of disease or infirmity" (preamble of WHO Constitution). Furthermore, "the objective of WHO shall be the attainment by all peoples of the highest possible level of health" (article 1 of the constitution). Four tools are used to attain these goals: promotion of health, prevention of disease, medical care, and rehabilitation. The types of human disease are so diversified, however, and incidence so widespread and often so relatively uncharted, that to attain a rapid picture of the world's health problem at the outset is not easy. Some general aspects soon emerge, however, on how far mankind has come and how far it still has to go to lift the mantle of sickness from human beings. Situation in emerging areas Inevitably, discussion of worldwide problems turns from the needs of highly industrialized nations to the plight of peoples in the developing areas of the globe. Two out of every three of the 2.7 billion people in the world live in the emerging or underdeveloped areas. Available statistical studies. confirm the low median age, the short span of life and the increasing increments of birth over deaths as characteristics of these population groups. With few exceptions the basic economy is agriculture and produces less than one-third of the world's income. This economic poverty is an artificial rather than a natural phenomenon, since these areas contain both the natural resources and the manpower necessary for creating wealth. Side by side with economic poverty are widespread illiteracy and human illness. First to suffer are the growing minds and bodies of children. Hunger stalks them from birth onward. Of the estimated 750 million children in underdeveloped areas, 60 percent live in countries where the national income per head is less than $100 a year; 17 percent live where it is from $100 to $200; and 23 percent where it is over $200. Into this scene of widespread wants and illness among young and old, come sounds and sights of today's age of high-speed transportation and communication. Space and time are shrunken by technology. Jet plane travel now makes a diseased, helpless indigent of a swarming ancient city of the East, virtually the next-door neighbor of Americans in newly built middle-income suburbia. Disease knows no frontiers, nor does compassion for the afflicted nor enlightened self-interest. Disease today is, therefore, a matter of concern for all mankind. Toll of a cholera epidemic A symbolic episode from recent history may be recalled. At El Korein, in Egypt, on September 22, 1947, 3 laborers, among some 6,000 workmen engaged in construction, contracted dreaded cholera. Nearby, from all the Egyptian provinces merchants had gathered for the annual date fair at this center on the eastern edge of the Nile Delta. With the dreaded news of the outbreak of cholera, came panic and flight from El Korein. Within days, dispersion of merchants and workmen brought sudden death to new cities. By October, the whole of Egypt was involved and a specter literally confronted the world. Fortunately, international action was promptly forthcoming. The WHO did not then even officially exist; it was still an interim commission. But lightning-fast action by the Section of International Quarantine, long a major element of the old League of Nations, coordinated the worldwide counterattack against the scourge. A cholera airlift of vaccine made medical history. From all over the world came supplies and specialists. By February 18, 1948, the signal went out from Geneva, "Egypt now declares whole country free from cholera." The death roll had been 20,472, but Egypt and the world had been saved infinitely worse heartbreak. In September, at the time of the outbreak, only 19 countries had ratified their membership in WHO. It could not formally exist until 26 nations did so. Before the "all clear" was sounded, however, 10 more had ratified and the stage was set for the first World Health Assembly to meet on June 24, 1948. On April 7, 1948, the WHO Constitution had come in force-an historic instrument born of necessity and of man's humanity to man. B. THE RESPONSE PAST SUCCESSES The world today is a healthier place in which to live than ever before in the recorded history of man. This is the great overriding conclusion apparent from the network of world disease and vital statistics, as established by the World Health Organization. Indeed, the first words of the world's standard statistical series on these matters, the United Nations Demographic Handbook (1957) were as follows: The reduction achieved in mortality during the last several decades is by now a well-known phenomenon *. The dramatic declines in the death rate which some of the underdeveloped areas have experienced have no precedent in the history of mortality among the countries of the world which now enjoy the lowest rates. The population of the world has increased (as of mid-1957) since mid-1955 by about 47 million inhabitants ***. This rate of population growth has been brought about almost entirely by a decline in the death rate, rather than by an increase in the birth rate. The resources devoted to health outlined hereinafter, scanty as they are in some parts of the world, have produced remarkable results. These resources, apart from those directly devoted to health, include education, technology, transportation and the other aids to physical well-being. In toto they tend to lift levels of health. For all practical purposes the environment of man has been controlled and improved beyond measure by the development of mechanical devices. The range of the habitable world is being extended year by year by developments in central heating and air conditioning and protection through modern insulation against excessive heat and cold. New methods of land irrigation devised by man's ingenuity and perseverance have greatly enlarged the scope and range of food production. Water has been harnessed for the production of electricity, and for land irrigation in zones which would otherwise be arid. The sea itself has been swept out to provide more fertile land; it has been explored for many of its treasures of food and is now being brought into subjection for the production of heat and power. To these powerful forces have been added modern health services and modern preventive and treatment measures. Decline of infectious diseases The elevation of levels of health has been worldwide, and not confined to industrialized countries. The striking contribution which, for example, the countries of the Middle East have made during the past decade to the health of their own peoples has been in the conquest of major epidemic diseases. There have been notable victories over cholera. But the most sustained progress has been made against malaria, a subject discussed in part III. The challenge is still great. Village and small-town populations are still gravely hampered by debilitating endemic diseases which can be cast out only by improved water and sewerage supplies, a marked improvement in housing and other environmental conditions, and by the widespread impact of health education. There is an urgent need to train and employ far more, medical, nursing, and auxiliary personnel. The developing areas of the world are characterized by such widespread variations in culture and tradition, in land and climate, that it is hard to generalize. Some clear general gains are, however, evident: Malaria is being defeated. Tuberculosis (chart 1-A) and smallpox (charts 1-B and 1-C) are declining. Cholera is on the way out, as indicated by sharp declines over the past decade (chart 1-D). Similarly, plague, the "Black Death" of the Middle Ages is being defeated (chart 1-E). Finally, there has been a steady decline in typhus all over the world (chart 1-F). Particular attention should be devoted to the latter scale which shows not only sharp declines but the rate at which the declines occur. Effects of rising health levels One general effect of rising health levels has been a prolongation of life in both industrialized and unindustrialized areas of the earth (chart 1-G). In India, for example, the average male born in the decade 1921-30 lived only 27 years from birth. But males born over the decade 1941-50 will live an average of 33 years after birth. Even the much longer average life span in countries with high per capita incomes has been growing longer. Another general effect of rising general health levels has been a general decline in infant death rates. Even in countries where infant death rates have been low for decades, the declines continue (chart 1-H). Infant mortality is in all probability declining throughout the world. For example, infant mortality rates during the past 10 years in Mexico City, Sao Paulo, and a number of other crowded areas in Latin America have fallen for the first time below 100 per 1,000 live births. However, the current state of vital statistics throughout the world. is such that birth and death records in many parts of the world are inadequate. Indeed, as was pointed out in the committee print, "The Status of World Health" and as will be pointed out later herein, one of the tasks of the World Health Organization is to help countries improve their records so that a clearer picture of the health of the world will be available. The ravages of infectious disease The earlier committee print confirmed, however, that the world health situation offers no cause for smugness. The rates for some infectious diseases shown above are vastly higher in many countries with low per capita income and unfavorable climates than in northern Europe and the United States. As will be shown in detail in later sections, the infectious and communicable diseases remain the major health problem over large portions of the globe. CHART 1-A PROPORTION OF DEATHS FROM TUBERCULOSIS AND OTHER INFECTIOUS DISEASES (Excluding accidents and violence) % 13 12 11 10 9 8 7 6 5 4 3 2 1 |