These visiting teams have not only produced remarkable results with a small outlay of money, but have set a sound precedent for extension of the WHO research program. The nature of research is such that communication is of paramount importance. The patterns adopted for medical education can apparently be adapted easily to research, which is intertwined with graduate teaching.

8. COLLECT, ANALYZE, AND DISTRIBUTE INFORMATION

Another general objective of WHO has been to make information on training institutions and methods for the health professions more widely known throughout the world. To attain this objective, studies, surveys, and analyses of two kinds have been done: first, those concerned with the personnel needs, resources and facilities of individual countries or groups of countries in order to assist them in planning training programs; second, those dealing with information and education problems of international interest, for the use of the world at large. In the first category, a number of nationwide surveys and studies on medical education have already been mentioned. Some of them were made by individual experts, others were based on reports made by visiting teams of medical scientists and were therefore the composite views of groups of senior academic teachers. In the southeast Asia region, for instance, surveys of one kind or the other have been made in all but one of the member states. Enough material has been collected for an analytical study of medical education in the region.

In the second category, a summary worldwide survey of medical education has been made in connection with the publication of the second edition of the "World Directory of Medical Schools." It contains tabular information on approximately 650 medical schools of all countries. It is preceded by a narrative describing all the important features of undergraduate medical training in 83 countries. This sort of background information is not only an essential tool for WHO's operating programs, but a new way of assessing the resources of the world for health protection.

Part IV

DEVELOPMENT OF WHO'S MEDICAL RESEARCH

The world is poised to enter a new era of medical research. Answers to the major health problems of the world cannot be found by research confined within national boundaries. A vast international medical research effort is required to supplement national efforts. Studies not merely on national but on a world basis are required to deal with questions such as these:

1. Why does cancer attack certain parts of the body many times more frequently in some parts of the world than in others? Is there such a thing as inherited susceptibility to cancer? Or are there environmental influences such as food, or irritants, or climate that affect susceptibility?

If the answers to these questions were known, long steps would have been taken toward solving the riddle of cancer. 2. Do such diseases as epilepsy and rheumatism differ in nature and incidence throughout the world?

The answer to this question is not known, and information must be available if a worldwide attack on such diseases is to be mounted.

3. What effects do events shortly before, during, and after birth have upon health-upon, for example, the chances of a child being born deformed?

A worldwide investigation, carefully planned to shed light on the most important questions by comparative studies involving geographic, racial, economic, and health differences among mothers, would go far toward providing

answers.

4. How can the virus diseases be brought under the same control as most of the bacterial diseases?

The field of virus research, including problems as diverse as the relationship of viruses to cancer and to heredity, the worldwide transmission of certain viruses by migration of birds, and the common cold, is expanding with explosive force. Nothing less than a worldwide effort involving the best scientists of the globe is adequate to make full use of the discoveries that are pouring from the world's laboratories faster than they can be assimilated into the body of scientific knowledge.

The very collection of different types of viruses from different parts of the world, with different climates and other factors, is a matter of greatest importance.

So far as the United States is concerned, full cooperation in all such studies provides an opportunity to join other nations in a common effort to defeat disease, and to increase the efficiency of its own national medical research effort.

The World Health Organization is the natural instrument for the planning and coordination that will be required if the nations of the

world are to seize the opportunity before them. For this reason, this part of the report recounts some highlights of WHO's research experience over the past 10 years.

A. CONSTITUTIONAL BASE

WHO's constitution provides not only that a function of the organization is

to promote and conduct research in the field of health (art. 2, sec. (n)), but also that a function of the Health Assembly is to promote and conduct research in the field of health by the personnel of the Organization, by the establishment of its own institutions or by cooperation with official or nonofficial institutions of any member with the consent of its government (art. 18, sec. (R)).

Within this broad charter, the continuing policy problem for the Organization has been not whether health research should be supported, but rather what kind and how much research should be promoted and conducted, and the means of promoting research.

It should be borne in mind when reading this section that WHO's training and educational programs (pt. 3) have contributed substantially to research throughout the world.

B. EARLY PROGRAM PRIORITIES

In the early days of the organization, the consensus was that much more was already known about health protection against important diseases than was being applied. For this reason, the development of research was not considered a matter of top priority when the program objectives were first set.

This 1949 resolution of the Second World Health Assembly was an important policy guide:

Whereas the development of planned programs requires continuous application of research and investigation on many problems, the solution of which may be found essential for the diagnosis, treatment and prevention of disease, and for the promotion of positive health;

Whereas research includes field investigations as well as those conducted in laboratories,

The Second World Health Assembly

Resolves, That the following guiding principles should be applied in the organization of research under the auspices of the World Health Organization:

(1) research and coordination of research are essential functions of the World Health Organization;

(2) first priority should be given to research directly relating to the programs of the World Health Organization;

(3) research should be supported in existing institutions and should form part of the duties of field teams supported by the World Health Organization; (4) all locally supported research should be so directed as to encourage assumption of responsibility for its continuance by local agencies where indicated;

(5) the World Health Organization should not consider at the present time the establishment, under its own auspices, of international research institutions.

Priorities in 1948

Early program priorities of the organization set by the First World Assembly in 1948 were as follows:

Priority group I

Venereal diseases, tuberculosis, malaria, maternal and child health, nutrition, and environmental sanitation.

Priority group II

Public health administration, including hospitals and clinics, medical care, medical rehabilitation, medical social work, nursing, health education, industrial hygiene, and the hygiene of seafarers. Priority group III

Ankylostomiasis, filariasis, leschnaniasis, schistosomiasis, and trypanosomiasis.

Priority group IV

Virus diseases, including poliomyelitis, trachoma, influenza, and rabies.

Priority group V

Mental health.

Priority group VI

Brucellosis, technical education, and procurement of medical supplies.

The major lines of early WHO research were set as a general, albeit not rigid, guide by these program priorities, plus the policy that research relating to them should take precedence over other research.

As the organization matured, increasing attention was paid to research on the chronic diseases, such as cancer and heart disease. This tendency was, as explained hereafter, markedly acclerated as a result of a farsighted gift in 1958 of $300,000 to WHO from the United States for planning of WHO's role in the international stimulation and coordination of research.

C. THE RESEARCH CENTER APPROACH

Research needs quickly developed as disease control programs expanded. In the preceding part, the need for influenza centers was spelled out. The concept of these centers was adapted to other disease agents: Poliomyelitis (chart 4-A) treponematosis, leptospirosis, brucellosis, shigella infections, salmonella, and escherichia infections.

Each set of centers cooperates in the study of specific problems and compares and classifies organisms isolated in various parts of the world. for the purposes of epidemiological study under standard comparable methods.

As an example, 15 WHO/FAO brucellosis centers are currently investigating epidemiological and control problems of brucellosis. As another example, with the uncovering of extensive leptospirosis infection among domestic animals the epidemiology of the disease takes on new interest. Six WHO/FAÒ Leptospirosis Reference Laboratories have been concerned in promoting greater uniformity of diagnosis, particularly with regard to classification and typing procedures.

The research centers are stressed at this point as a technique for stimulating and coordinating research because, as will be seen later, this device may well have broad applicability to a further expansion of WHO's research activities.