TABLE 1-A.-Infectious disease problems, by continent-Continued The scientific outlook even though difficult problems must be solved. The Director General of the World Health Organization, Dr. Marcolino G. Candau, said in 1958: I am convinced that, if the great advances gained in science and technology are put at the service of all the people of the world, our children and their children will live in an age from which most of the diseases our grandparents and parents took for granted will be banished. It is in our power to narrow further the gap which exists between the few countries which have already reached a relatively high level of health and the many others which are still in the early stages of their health development. Through intensified and well-coordinated research we shall be able to find the means to cure or prevent the diseases which today prevail in the economically developed areas and which tomorrow may strike those regions which are in process of rapid development. Together with cardiovascular diseases, cancer, diabetes, arthritis, rheumatism, influenza, poliomyelitis, etc., the treatment and the prevention of emotional and mental disorders are the great medical problems of tomorrow. We shall also have to face the consequences which the expanding use of nuclear energy may have for the health of man, and in this opening phase of the launching of earth satellites it may no longer be utopian to envisage a new chapter in the history of medicine, linked to ways of traveling and of communication which have until now belonged to the realms of fantasy and fiction." World Health. May-June 1958, vol. XI, No. 3, p. 5. C. WORLD RESOURCES FOR HEALTH The world's resources for health, broadly speaking, include the world's capacity to produce food, clothing, and shelter, the educational systems of the world, and the human institutions through which goods and services are distributed. But, here attention will be centered on health resources more narrowly defined as the supply of physicians, nurses, dentists, technicians, and other specially trained people for health protection. The material resources for prevention and cure of disease, such as public health services, clinics, and hospitals, are also included. No country on earth has enough resources for health; every country is trying to expand its resources. This is the main fact. This explains why WHO, upon the urging of the member states, stresses (as shown in pt. III of this report) the training of manpower. The shortages of health resources in many parts of the world are appalling as indicated by figures for 1956, the last year for which data are available. For the whole of Africa, for example, there is only one physician for every 9,000 people as compared with one physician per 950 people in the United States. And, in many countries of Africa there are fewer than 1 physician for every 20,000 inhabitants. In Ethiopia, one doctor must serve 110,000 persons. In Indonesia, there is only 1 doctor for every 70,000 persons. The situation by continent is as follows: TABLE 1-B.-Number of physicians, by continent The same wide disparity exists among countries with respect to the size of the population groups that must be served by a single dentist or nurse. Differences in training Not only the supply of physicians, but the quality of training varies widely throughout the world. Medical and related education in many countries is deficient because of such factors, partly financial in origin, as inability to establish medical teaching as a full-time profession, the inadequacy of classrooms, laboratories, and equipment, undue reliance upon lectures, and failure to adjust curricula to local needs. Decades of work lie ahead in lifting the teaching standards of many nations in the fields of medicine, nursing, sanitary engineering, dentistry, and other related professions to the levels needed if people trained to protect health are to be available in adequate numbers. In many countries, new schools will have to be established. While national efforts will be most important, a substantial degree of international collaboration will be necessary to strengthen the world's structure of health manpower. Disparity in hospital availability As might be expected, the physical facilities available for health protection are also unequally distributed over the surface of the earth. The extreme variations, and particularly the virtual absence of health facilities in many densely populated areas of the globe, are seriously unfortunate. Curative medicine of an effective scientific type must rest on good hospital facilities as its basis. Preventive medicine must depend in large measure on outpatient services for the ambulant case and on centers for health promotion through individual instruction in the principles of personal hygiene. Accurate data on the latter point-outpatient and health-center services are difficult to obtain on an international scale. In the provision of hospitals, however, the same deplorable disparity between facilities in various areas which has been emphasized in previous paragraphs is encountered. New Zealand and the United States have shown for recent years a ratio of close to 100 hospital beds per 10,000 population. In some Pacific areas reasonably satisfactory ratios are reported (61 in Malaya). The figure falls to less than 10 per 10,000 for many other regions (9 for Indonesia and 7 for Burma). In India and Manchuria it is estimated that about 3 beds are available per 10,000 population; and in China proper the ratio has been assumed to be about 1 per 10,000. Vast populations, then, are served by from one-tenth to onehundredth of the proportion of hospital beds found in the most prosperous areas. Everywhere the deficiency in medical personnel and institutional facilities falls most heavily on the rural population. States (in the United States) with less than 30 percent rural population have reported for recent years about 1,000 days of hospital care per 1,000 population per year; while for States with 70 percent or more rural population, the ratio has been about 500 days of hospital care per 1,000 population. Even in the most prosperous areas, it has been maintained that hospital facilities are not fully adequate. Studies in the United States suggest that the country needs 245,000 more general hospital beds, 325,000 more mental hospital beds, and 260,000 more beds for chronic diseases, which would bring the ideal ratio up to about 150 per 10,000. There are other trends of thought, however, which point toward more moderate goals. In Scandinavia, beds in tuberculosis sanitaria are now being used for the care of the aged. In the Montefiore Hospital of New York City, a most promising program is in force under which patients are discharged from the hospital much earlier than has been the case in the past but are provided in their own homes with all necessary medical and nursing care under the general supervision of the hospital staff. The magnitude of the task of providing even the most rudimentary health services for large parts of the world is staggering. The differences in disease problems, in cultures, in material resources, and in social institutions are so vast that there is no single pattern or approach that will fit the world. This is why the World Health Organization, to whose activities this report now turns, stresses the prime importance of efforts to strengthen national health resources. This is a task that will endure for decades. An assessment of the first of these decades-the first 10 years of the World Health Organization-is in order. Part II EVOLUTION OF WHO ACTIVITIES As the health problems of the world are viewed in relation to the resources of the world for health, several facts have become clear; (1) The world does not now possess, for the world as a whole, the resources to conquer all of its most urgent disease problems. (2) Advances in the state of the health of the world over the past decades have been little short of astounding. Further advances have a high degree of likelihood. (3) The economic capacity, the educational and research. structures, and the scope and organization of health services vary in the widest degree among nations. (4) A more effective attack on the major diseases of mankind will rest to a large degree upon international efforts to strengthen the worldwide structure for health and to improve national health services. This part of the report is devoted to the role played by WHO as the primary agent of national governments in strengthening international health programs. The first phase of this part reviews the main characteristics of WHO programs and recounts some experience gained in their execution. The second phase gives a few examples of the work carried out in some of the main fields of public health. A. THE CONSTITUTIONAL BASE The principles, objectives, and functions of WHO have been clearly stated in the preamble and articles I and II of its constitution: CONSTITUTION OF THE WORLD HEALTH ORGANIZATION The States Parties to this Constitution declare, in conformity with the Charter of the United Nations, that the following principles are basic to the happiness, harmonious relations and security of all peoples: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. |