Accepting these principles, and for the purpose of co-operation among themselves and with others to promote and protect the health of all peoples, the Contracting Parties agree to the present Constitution and hereby establish the World Health Organization as a specialized agency within the terms of Article 57 of the Charter of the United Nations.

CHAPTER I. OBJECTIVE

ARTICLE 1

The objective of the World Health Organization (hereinafter called the Organization) shall be the attainment by all peoples of the highest possible level of health.

CHAPTER II. FUNCTIONS

ARTICLE 2

In order to achieve its objective, the functions of the Organization shall be: (a) to act as the directing and co-ordinating authority on international health work;

(b) to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations, professional groups and such other organizations as may be deemed appropriate; (c) to assist Governments, upon request, in strengthening health services; (d) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments;

(e) to provide or assist in providing, upon the request of the United Nations, health services and facilities to special groups such as the peoples of trust territories;

(f) to establish and maintain such administrative and technical services as may be required, including epidemiological and statistical services;

(g) to stimulate and advance work to eradicate epidemic, endemic and other diseases;

(h) to promote, in co-operation with other specialized agencies where necessary, the prevention of accidental injuries;

(i) to promote, in co-operation with other specialized agencies where necessary, the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene; (j) to promote co-operation among scientific and professional groups which contribute to the advancement of health;

(k) to propose conventions, agreements and regulations, and make recommendations with respect to international health matters and to perform such duties as may be assigned thereby to the Organization and are consistent with its objective;

(1) to promote maternal and child health and welfare and to foster the ability to live harmoniously in a changing total environment;

(m) to foster activities in the field of mental health, especially those affecting the harmony of human relations;

(n) to promote and conduct research in the field of health;

(o) to promote improved standards of teaching and training in the health, medical and related professions;

(p) to study and report on, in co-operation with other specialized agencies where necessary, administrative and social techniques affecting public health and medical care from preventive and curative points of view, including hospital services and social security;

(q) to provide information, counsel and assistance in the field of health; (r) to assist in developing an informed public opinion among all peoples on matters of health;

(s) to establish and revise as necessary international nomenclatures of diseases, of causes of death and of public health practices;

(t) to standardize diagnostic procedures as necessary;

(u) to develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products;

(v) generally to take all necessary action to attain the objective of the Organization."

Goals of WHO programs

To achieve the broad aims defined by the constitution, the World Health Assemblies approve, year by year, long range plans and settle the broad lines of advance over considerable periods. The annual programs provide for immediate needs and the more urgent tasks.

Within this framework the Organization has put into practice certain broad principles designed to further practical action in the field and to raise standards of health in all member countries.

The fundamental object of the programs of WHO is to strengthen the public health services of countries which seek its assistance. The actual work is carried out, as will be shown, by the governments themselves.

Three broad categories are now universally recognized; the prevention of disease by practical measures in the field and the laboratory; the promotion of mental, physical, and social well-being; and the care and rehabilitation of the sick.

Experience has shown that in assisting countries, two steps are indispensable; the training of national medical and paramedical personnel, and the strengthening of administrative machinery of health agencies at the national, provincial, and local levels. In order to make international assistance to health projects more effective, WHO maintains close collaboration with the United Nations and its specialized agencies (see pt. V). At the local level especially, there is a strong movement toward concerted programs of community development.

These general principles are put into effect through two complementary sets of activities. The first activity is designed to create a supranational health structure to meet those needs of governments which cannot be fulfilled by national efforts. The second activity is designed to strengthen the health work of national governments.

B. FIRST OBJECTIVE-CREATE A WORLD FRAMEWORK FOR HEALTH

The first function has been to create a permanent worldwide health organization in which all countries are partners. This has involved. a number of activities undertaken on a worldwide basis, and of interest to all nations:

(a) Establishment of epidemiological and statistical services on a world scale, from material obtained directly from every country.

(b) Establishment of international standards of nomenclature, and the classification of diseases, injuries, and causes of death. (c) Standardization of pharmaceutical products and biological preparations.

(d) Collection and extension of knowledge of the theory and practice of public health work with a view to its international application. This is achieved by keeping in constant touch with diverse activities bearing on health, and assisting in the application of new developments in health services throughout the world. (e) Stimulation, promotion and coordination of research, distributing widely its scientific discoveries and serving as a clearinghouse for problems between one country and another. This past point is most important and will be referred to in later pages in connection with development of WHO research.

Considered as a whole, these activities constitute a joint world health effort. The scale and degree of technical competence of the undertaking are unprecedented.

C. SECOND OBJECTIVE-STRENGTHEN NATIONAL HEALTH STRUCTURES

WHO's general philosophy is that countries should be helped to gain a position that will make them largely self-reliant so far as health protection programs are concerned.

If this objective is to be achieved, stress has to be placed on the establishment of strong, adaptable, well staffed, appropriately decentralized national health administrations. To build such a structure requires a substantial knowledge not only of medicine and public health but of modern administrative theory and practice.

Many nations do not at this time have the internal resources required to build an effective public health structure. Accordingly, WHO advises governments on ways to strengthen existing national health services. Special emphasis is laid on coordinating programs and teamwork in the field. These joint programs include prevention and control of the main communicable diseases and professional and technical education of national health personnel. This includes the provision of fellowships abroad on an extensive scale and plans for the training of auxiliary workers in the respective countries.

Assistance to governments is given only upon their request. It is put into effect in the form of projects under the government's own administrative control and within the scope of its resources. In fostering the self-reliance of individual countries, the Organization wisely seeks to insure the continuity of assisted programs after the period of international assistance has come to an end.

In most countries in the early stages of developing a public health structure, the training of manpower is a matter of highest priority. In fact, the training of manpower is a problem that is so significant to all WHO activities that discussion of this subject is reserved for subsequent pages.

D. EVOLUTION OF FUNCTIONS

The work of WHO during the past decade has gone through three distinct phases.

First, there was the inevitable period of extemporization, required by the very novelty of international assistance. Then came an intermediate phase of experiment and ad hoc assistance. During this period, trial and error led to a better understanding of the value and the limitations of this form of international service. The experience thus gained paved the way to a third phase in which comprehensive assistance through teamwork has been the most striking characteristic. Programs have not evolved in isolation. They have been fitted into the general trend of socioeconomic and technical progress of countries requiring assistance.

The existence of regional health organizations before WHO came into being has exerted a considerable influence on the structure and functions of the organization. As a result, regionalization is now a distinctive feature of the World Health Organization. Operations are highly decentralized to regions, and WHO's relationships with governments on operating programs are conducted primarily through regions. The Assembly has defined six regional areas.

Fortunately, over the years there has been a constructive unity of effort between the Executive Board and the Director General, on the one hand, and the regional committees and the regional directors, on the other. The coordination between the Director General and the regional directors has been so close that it has been possible to adapt programs to the needs and circumstances of assisted countries without unduly incurring the disadvantages which might be expected from a substantial degree of decentralization.

Sequence of planning

Plans of assistance to governments are preceded by systematic surveys. Detailed programs are made on the basis of these pilot studies. As time goes on, mobile campaigns become woven into more permanent services; simple projects become more comprehensive in scope and regional work is broadened to include intercountry projects that extend far beyond the regional boundaries.

In the same way, a single fellowship award of a few years ago grew into a system of fellowships deliberately planned to meet the needs of a country as a whole and to create a sound basis for teamwork. The experience gained in assisting the promotion of single subjects in the medical curricula of assisted teaching institutions expanded as time went on. It evolved into a planned reorientation of entire curricula to suit the academic and practical needs of the countries. concerned.

As an accompaniment to this broadening in the scope of the Organization's work, there has been an encouraging improvement in the international climate in which various programs have been carried out. During the past decade the government and people of many countries have been made more aware of the importance of reasonable health planning. It is evident from the records that there has been a growing acceptance by governments of their new responsibilities and obligations in the promotion of health and the prevention of sickness.

At first, all the concentration of thought and finance was on the immediate urgencies of treating the sick and the relief of individual suffering. Longer range needs of international health work is now being more fully understood. It is receiving year by year increasing and understanding support by government, nongovernmental organizations, and other institutions.

The emergence of the longer range view, as well as the emergence of acute problems in disease control programs, has led to an increasing emphasis upon the stimulation, support and coordination of research by WHO. The development of the research function of WHO is, as previously indicated, a matter of such significance that it is discussed in detail later (see pt. IV).

E. OPERATING PROGRAMS-COMMUNICABLE DISEASES

Carrying out the general functions of WHO involves the selection of priorities so that the resources of the WHO and the member nations may be directed to important, attainable objectives. In its efforts during the past decade to attack the great epidemic and communicable diseases, WHO has concentrated its forces on improving resistance,

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controlling the vectors, and reducing the animal and human reservoirs of infection.

With this end in view it has sought to encourage research directed toward improving methods of control. This demands both surveys and active work in the field and fundamental research in the laboratory. Progress in both is dependent upon the adequate training of personnel for both field and laboratory work. Training of auxiliary workers for research is particularly urgent. This in its turn demands that training courses should be organized for teachers. The training of instructors is probably best carried out by means of fellowships to established training institutions. However, the training courses for auxiliaries of all kinds must be carried out in the countries themselves.

Coordination of research covering both the laboratory work and field studies is now being extended to a wide range of epidemiological problems. Epidemiological studies and local surveys have been recognized as essential to the preparation of projects against practically all the communicable diseases.

One of the difficult questions now under consideration is how campaigns against specific diseases can be combined in a general outline of communicable disease control and how they can be made part of the regular community health services in rural areas. As has been indicated above, an essential preliminary to this advance is the training of auxiliary workers both in individual subjects and in cooperation as a team.

Malaria

Malaria is still the greatest single menace to the health of man and to his economic development. WHO has devoted more resources in terms of money and manpower to this than to any other disease. For this unprecedented worldwide attack on a single disease, the World Health Assembly has created a malaria eradication special account to which various nations, and notably the United States, have contributed very generously. Funds from the United Nations Children's Fund and the expanded program of technical assistance of the United Nations are also being extensively used to implement the program.

The eradication of malaria is indirectly but inescapably a matter of high significance to the United States. For this reason, the malaria program is described in some detail in the following part.

Tuberculosis control

The control of tuberculosis formerly required the building and maintenance of expensive institutions and the training of specialized staffs. Both these requirements have surpassed the resources of many countries. In an effort to help them, the WHO in cooperation with UNICEF put into effect a worldwide program of tuberculin testing and BCG vaccination through which about 200 million have been tested and over 80 million vaccinated.

A few countries have been assisted in setting up tuberculosis control training and demonstration centers. With antibiotics like streptomycin, and therapeutic drugs like isoniazid and PAS (paraamino-salicylic acid) it has been possible to secure effective home treatment of infectious patients and to attempt preventive treatment of recently infected contacts. As a result, health authorities in