World Health Organization

World Health Organization منظمة الصحة العالمية 世界卫生组织 Organization mondiale de la Santé Всемирная организация здравоохранения Organización Mundial de la Salud
Flag of the World Health Organization
Org type	Specialized agency of the United Nations
Acronyms	WHO OMS
Head	Margaret Chan
Status	Active
Established	7 April 1948
Headquarters	Geneva, Switzerland
Website	www.who.int
Parent org	United Nations Economic and Social Council (ECOSOC)

The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that is concerned with international public health. It was established on 7 April 1948, with headquarters in Geneva, Switzerland, and is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

The constitution of the World Health Organization had been signed by all 61 countries of the United Nations by 22 July 1946, with the first meeting of the World Health Assembly finishing on 24 July 1948. It incorporated the Office International d'Hygiène Publique and the League of Nations Health Organization. Since its creation, WHO has been responsible for playing a leading role in the eradication of smallpox. Its current priorities include communicable diseases, in particular, HIV/AIDS, malaria and tuberculosis; the mitigation of the effects of non-communicable diseases; sexual and reproductive health, development, and aging; nutrition, food security and healthy eating; occupational health; substance abuse; and drive the development of reporting, publications, and networking. WHO is responsible for the World Health Report, a leading international publication on health, the worldwide World Health Survey, and World Health Day (7th-April of every Year).

Its links with the International Atomic Energy Agency and distribution of contraception have both proved controversial, as have guidelines on healthy eating and the 2009 flu pandemic.

History

Establishment

The League of Nations Health Organization was established following the First World War inside the League of Nations framework. According to the League's Covenant, it was to "endeavour to take steps in matters of international concern for the prevention and control of disease, even in cases of dire human hardship". Its efforts were hampered by the Second World War, during which United Nations Relief and Rehabilitation Administration also played a role in international health initiatives. During the United Nations Conference on International Organization, references to health had been incorporated into the United Nations Charter and it passed a declaration that an international health body would be set up.

In February 1946, the Economic and Social Council of the United Nations helped draft the constitution of the new body. The use of the word "world", rather than "international", emphasised the truly global nature of what the organization was seeking to achieve. The constitution of the World Health Organization had been signed by all 61 countries of the United Nations by 22 July 1946. It thus became the first specialised agency of the United Nations to which every member subscribed. Its constitution formally came into force on the first World Health Day on 7 April 1948, when it was ratified by the 26th member state. The first meeting of the World Health Assembly finished on 24 July 1948, having secured a budget of US$5 million (then GBP£1,250,000) for the 1949 year. Andrija Stampar was the Assembly's first president, and G. Brock Chisholm was appointed Director-General of WHO, having served as Executive Secretary during the planning stages. Its first priorities were to control the spread of malaria, tuberculosis and sexually transmitted infections, and to improve maternal and child health, nutrition and environmental hygiene. Its first legislative act was concerning the compilation of accurate statistics on the spread and morbidity of disease. The logo of the World Health Organization features the Rod of Asclepius as a symbol for healing.

Operational history

WHO established an epidemiological information service via telex in 1947, and by 1950 a mass tuberculosis inoculation drive (using the BCG vaccine) was under way. In 1955, the malaria eradication programme was launched, although it was later altered in objective. 1965 saw the first report on diabetes mellitus and the creation of the International Agency for Research on Cancer. WHO moved into its headquarters building in 1966. The Expanded Programme on Immunization was started in 1974, as was the control programme into onchocerciasis – an important partnership between the Food and Agriculture Organization (FAO), the United Nations Development Programme (UNDP), and World Bank. In the following year, the Special Programme for Research and Training in Tropical Diseases was also launched. In 1976, the World Health Assembly voted to enact a resolution on Disability Prevention and Rehabilitation, with a focus on community-driven care. The first list of essential medicines was drawn up in 1977, and a year later the ambitious goal of "health for all" was declared. In 1986, WHO started it global programme on the growing problem of HIV/AIDS, followed two years later by additional attention on preventing discrimination against sufferers and UNAIDS was formed in 1996. The Global Polio Eradication Initiative was established in 1988.

In 1958, Viktor Zhdanov, Deputy Minister of Health for the USSR, called on the World Health Assembly to undertake a global initiative to eradicate smallpox, resulting in Resolution WHA11.54. At this point, 2 million people were dying from smallpox every year. In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort and adopted a new disease surveillance method. The initial problem the WHO team faced was inadequate reporting of smallpox cases. WHO established a network of consultants who assisted countries in setting up surveillance and containment activities. The WHO also helped contain the last European outbreak in Yugoslavia in 1972. After over two decades of fighting smallpox, the WHO declared in 1980 that the disease had been eradicated – the first disease in history to be eliminated by human effort.

In 1998, WHO's Director General highlighted gains in child survival, reduced infant mortality, raised life expectancy and reduced rates of "scourges" such as smallpox and polio on the fiftieth anniversary of WHO's founding. He, did, however, accept that more had to be done to assist maternal health and that progress in this area had been slow. Cholera and malaria have remained problems since WHO's founding, although in decline for a large part of that period. In the twenty-first century, the Stop TB Partnership was created in 2000, along with the UN's formulation of the Millennium Development Goals. The Measles initiative was formed in 2001, and credited with reducing global deaths from the disease by 68% by 2007. In 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria was drawn up to improve the resources available. In 2006, the organization endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed the basis for a global prevention, treatment and support plan to fight the AIDS pandemic.

Current projects

Overall focus

The WHO's constitution states that its objective "is the attainment by all people of the highest possible level of health".

WHO identifies its role as one of six main objectives:

• providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
• shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
• setting norms and standards and promoting and monitoring their implementation;
• articulating ethical and evidence-based policy options;
• providing technical support, catalyzing change, and building sustainable institutional capacity; and
• monitoring the health situation and assessing health trends.

The 2012–2013 budget further identified thirteen areas among which funding was distributed.

Communicable diseases

Two of those thirteen areas related to communicable diseases: the first, to reduce the "health, social and economic burden" of communicable diseases in general; the second to combat HIV/AIDS, malaria and tuberculosis in particular.

In terms of HIV/AIDS, WHO works within the UNAIDS network and considers it important that it works in alignment with UNAIDS objectives and strategies. It also strives to involve sections of society other than health to help deal with the economic and social effects of the disease. In line with UNAIDS, WHO has set itself the interim task between 2009 and 2015 of reducing the number of those aged 15–24 years who are infected by 50%; reducing new HIV infections in children by 90%; and reducing HIV-related deaths by 25%.

Although WHO dropped its commitment to a global malaria eradication campaign in the 1970s as too ambitious, it retains a strong commitment to malaria control. WHO's Global Malaria Programme works to keep track of malaria cases, and future problems in malaria control schemes. WHO is to report, likely in 2015, as to whether RTS,S/AS01, currently in research, is a viable malaria vaccine. For the time being, insecticide-treated mosquito nets and insecticide sprays are used to prevent the spread of malaria, as are antimalarial drugs – particularly to vulnerable people such as pregnant women and young children.

WHO's help has contributed to a 40% fall in the number of deaths from tuberculosis between 1990 and 2010, and since 2005, it claims that over 46 million people have been treated and an estimated 7 million lives saved through practices advocated by WHO. These include engaging national governments and their financing, early diagnosis, standardising treatment, monitoring of the spread and impact of tuberculosis and stabilising the drug supply. It has also recognised the vulnerability of victims of HIV/AIDS to tuberculosis.

WHO aims to eradicate polio. It has also been successful in helping to reduce cases by 99% since the Global Polio Eradication Initiative was launched in 1988, which partnered WHO with Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF), as well as smaller organizations. It works to immunize young children and prevent the re-emergence of cases in countries declared "polio-free".

Non-communicable diseases

Another of the thirteen areas is aimed at the prevention and reduction of "disease, disability and premature from chronic noncommunicable diseases, mental disorders, violence and injuries and visual impairment".

Life and lifestyle

WHO also works to "reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy aging for all individuals".

It also tries to prevent or reduce risk factors for"health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets and physical inactivity and unsafe sex".

WHO works to improve nutrition, food safety and food security and to ensure this has a positive effect on public health and sustainable development.

Emergency work

When any sort of disaster or emergency occurs, it is WHO's stated objective to reduce any consequences it may have on world health and its social and economic implications.

Health policy

WHO also addresses government health policy with two aims: firstly, "to address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, genderresponsive, and human rights-based approaches" and secondly "to promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health".

In terms of health services, WHO looks to improve "governance, financing, staffing and management" and the availability and quality of evidence and research to guide policy making. It also strives to "ensure improved access, quality and use of medical products and technologies".

Governance and support

The remaining two of WHO's thirteen identified policy areas relate to the role of WHO itself: firstly, "to provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfill the mandate of WHO in advancing the global health agenda" and secondly "to develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively".

Other work

The WHO and the World Bank constitute the core team responsible for administering the International Health Partnership (IHP+). The IHP+ is a group of partner governments, development agencies, civil society and others committed to improving the health of citizens in developing countries. Partners work together to put international principles for aid effectiveness and development cooperation into practice in the health sector.

In addition, the WHO has also promoted road safety. Each year, the organization marks World Health Day focusing on a specific health promotion topic, timed to match the anniversary of WHO's founding. Recent themes have been drug resistance (2011) and ageing (2012). As part of the United Nations, the World Health Organization supports work towards the Millennium Development Goals. Of the eight Millennium Development Goals, three – reducing child mortality by two-thirds, to reduce maternal deaths by three-quarters, and to halt and begin to reduce the spread of HIV/AIDS – relate directly to WHO's scope; the other five inter-relate and have an impact on world health.

Data handling and publications

The organization relies on contributions from renowned scientists and professionals to inform its work, such as the WHO Expert Committee on Biological Standardization, the WHO Expert Committee on Leprosy, and the WHO Study Group on Interprofessional Education & Collaborative Practice. WHO has also worked on global initiatives in surgery, including emergency and essential surgical care, trauma care, and safe surgery. The WHO Surgical Safety Checklist is in current use worldwide in the effort to improve patient safety.

WHO runs the Alliance for Health Policy and Systems Research, targeted at improving health policy and systems. WHO aims to improve access to health research and literature in developing countries such as through the HINARI network. The organization has published tools for monitoring the capacity of national health systems and health workforces. The Global Health Observatory(GHO) has been the WHO's main portal which provides access to data and analyses for key health themes by monitoring health situations around the globe. The World Health Organization works to provide the needed health and well-being evidence through a variety of data collection platforms, including the World Health Survey covering almost 400,000 respondents from 70 countries, and the Study on Global Ageing and Adult Health (SAGE) covering over 50,000 persons over 50 years old in 23 countries. The Country Health Intelligence Portal (CHIP), has also been developed to provide an access point to information about the health services that are available in different countries. The information gathered in this portal is utilized by the countries to set priorities for future strategies or plans, implement, monitor, and evaluate it. The WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the WHO Quality of Life Instrument (WHOQOL), and the Service Availability and Readiness Assessment (SARA) provide guidance for data collection. Collaborative efforts between WHO and other agencies, such as through the Health Metrics Network, also aim to provide sufficient high-quality information to assist governmental decision making. WHO promotes the development of capacities in member states to use and produce research that addresses their national needs, including through the Evidence-Informed Policy Network (EVIPNet). The Pan American Health Organization (PAHO/AMRO) became the first region to develop and pass a policy on research for health approved in September 2009.

The organization develops and promotes the use of evidence-based tools, norms and standards to support member states to inform health policy options. It oversees the implementation of the International Health Regulations, and publishes a series of medical classifications; of these, three are overreaching "reference classifications": the International Statistical Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Interventions (ICHI). Other international policy frameworks produced by WHO include the International Code of Marketing of Breast-milk Substitutes (adopted in 1981), Framework Convention on Tobacco Control (adopted in 2003) and the Global Code of Practice on the International Recruitment of Health Personnel (adopted in 2010). The WHO regularly publishes a World Health Report, its leading publication, including an expert assessment of a specific global health topic. Other publications of WHO include the Bulletin of the World Health Organization, the Eastern Mediterranean Health Journal (overseen by EMRO), the Human Resources for Health (published in collaboration with BioMed Central), and the Pan American Journal of Public Health (overseen by PAHO/AMRO).

Structure

The World Health Organization is a member of the United Nations Development Group.

Membership

As of 2012, the WHO has 194 member states, including all Member States of the United Nations (except Liechtenstein), the Cook Islands and Niue. As of 2009, it also had two associate members, Puerto Rico and Tokelau. Non-members of the WHO include besides Liechtenstein and other states with limited diplomatic recognition. Several other entities have been granted observer status. Palestine is an observer as a "national liberation movement" recognised by the League of Arab States under United Nations Resolution 3118. The Holy See also attends as an observer, as does the Order of Malta. In 2010, Taiwan was invited under the name of " Chinese Taipei".

WHO Member States appoint delegations to the World Health Assembly, WHO's supreme decision-making body. All UN Member States are eligible for WHO membership, and, according to the WHO web site, "other countries may be admitted as members when their application has been approved by a simple majority vote of the World Health Assembly".

In addition, the UN observer organizations International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies have entered into "official relations" with WHO and are invited as observers. In the World Health Assembly they are seated along the other NGOs.

Assembly and Executive Board

The World Health Assembly is the legislative and supreme body of WHO. Based in Geneva, it typically meets yearly in May. It appoints the Director-General every five years, and votes on matters of policy and finance of WHO, including the proposed budget. It also reviews reports of the Executive Board and decides whether there are areas of work requiring further examination. The Assembly elects 34 members, technically qualified in the field of health, to the Executive Board for three-year terms. The main functions of the Board are to carry out the decisions and policies of the Assembly, to advise it and to facilitate its work.

Regional offices

The regional divisions of WHO were created between 1949 and 1952, and are based on article 44 of WHO's constitution, which allowed the WHA to "establish a [single] regional organization to meet the special needs of [each defined] area". Many decisions are made at regional level, including importance discussions over WHO's budget, and in deciding the members of the next assembly, which are designated by the regions.

Each region has a Regional Committee, which generally meets once a year, normally in the autumn. Representatives attend from each member or associative member in each region, including those states that are not fully recognised. For example, Palestine attends meetings of the Eastern Mediterranean Regional office. Each region also has a regional office. Each Regional Office is headed by a Regional Director, who is elected by the Regional Committee. The Board must approve such appointments, although as of 2004, it had never overruled the preference of a regional committee. The exact role of the board in the process has been a subject of debate, but the practical effect has always been small. Since 1999, Regional Directors serve for a once-renewable five-year term.

Each Regional Committee of the WHO consists of all the Health Department heads, in all the governments of the countries that constitute the Region. Aside from electing the Regional Director, the Regional Committee is also in charge of setting the guidelines for the implementation, within the region, of the health and other policies adopted by the World Health Assembly. The Regional Committee also serves as a progress review board for the actions of WHO within the Region.

The Regional Director is effectively the head of WHO for his or her Region. The RD manages and/or supervises a staff of health and other experts at the regional offices and in specialized centers. The RD is also the direct supervising authority—concomitantly with the WHO Director-General—of all the heads of WHO country offices, known as WHO Representatives, within the Region.

Regional Offices of WHO

Region	Headquarters	Notes	Website
Africa	Brazzaville, Republic of Congo	AFRO includes most of Africa, with the exception of Egypt, Sudan, South Sudan, Tunisia, Libya, Somalia and Morocco (all fall under EMRO).	AFRO
Europe	Copenhagen, Denmark.	EURO includes most of Europe and Israel.	EURO
South-East Asia	New Delhi, India	North Korea is served by SEARO.	SEARO
Eastern Mediterranean	Cairo, Egypt	Eastern Mediterranean Regional office includes the countries of Africa that are not included in AFRO, as well as the countries of the Middle East, except for Israel. Pakistan is served by EMRO.	EMRO
Western Pacific	Manila, Philippines.	WPRO covers all the Asian countries not served by SEARO and EMRO, and all the countries in Oceania. South Korea is served by WPRO.	WPRO
The Americas	Washington D.C., USA.	Also known as the Pan American Health Organization (PAHO), and covers the Americas.	AMRO

People

Former Directors-General of WHO

Name	Years of tenure
Brock Chisholm	1948–1953
Marcolino Gomes Candau	1953–1973
Halfdan T. Mahler	1973–1988
Hiroshi Nakajima	1988–1998
Gro Harlem Brundtland	1998–2003
Lee Jong-wook	2003–2006
Anders Nordström*	2006
*Acting Director-General following the death of Lee Jong-wook while in office

The head of the organization is the Director-General, appointed by the World Health Assembly. The current Director-General is Margaret Chan, who was appointed on 9 November 2006. On 18 January 2012, Chan was nominated by the WHO's Executive Board for a second term. If confirmed by the World Health Assembly in May 2012, Dr Chan will remain Director-General until the end of June 2017.

WHO employs 8,500 people in 147 countries. In support of the principle of a tobacco-free work environment the WHO does not recruit cigarette smokers. The organization has previously instigated the Framework Convention on Tobacco Control in 2003.

The WHO operates " Goodwill Ambassadors", members of the arts, sport or other fields of public life aimed at drawing attention to WHO's initiatives and projects. There are currently five Goodwill Ambassadors ( Jet Li, Nancy Brinker, Peng Liyuan, Yohei Sasakawa and the Vienna Philharmonic Orchestra) and a further ambassador associated with a partnership project ( Craig David).

Country and liaison offices

The World Health Organization operates 147 country offices in all its regions. It also operates several liaison offices, including those with the European Union, United Nations and a single office covering the World Bank and International Monetary Fund. It also operates the International Agency for Research on Cancer in Lyon, France, and the WHO Centre for Health Development in Kobe, Japan. Additional offices include those in Pristina; the West Bank and Gaza; the US–Mexican Border Field Office in El Paso; the Office of the Caribbean Program Coordination in Barbados; and Northern Micronesia office. There will generally be one WHO country office in the capital, occasionally accompanied by satellite-offices in the provinces or sub-regions of the country in question.

The country office is headed by a WHO Representative (WR). As of 2010, the only WHO Representative outside Europe to be a national of that country was for the Libyan Arab Jamahiriya ("Libya"); all other staff were international. Those in the Region for the Americas, they are referred to as PAHO/WHO Representatives. In Europe, WHO Representatives also serve as Head of Country Office, and are nationals with the exception of Serbia; there are also Heads of Country Office in Albania, the Russian Federation, Tajikistan, Turkey, and Uzbekistan. The WR is member of the UN system country team which is coordinated by the UN System Resident Coordinator.

The country office consists of the WR, and several health and other experts, both foreign and local, as well as the necessary support staff. The main functions of WHO country offices include being the primary adviser of that country's government in matters of health and pharmaceutical policies.

Financing and partnerships

The WHO is financed by contributions from member states and outside donors. As of 2012, the largest annual assessed contributions from member states came from the United States ($110 million), Japan ($58 million), Germany ($37 million), United Kingdom ($31 million) and France ($31 million). The combined 2012–2013 budget has proposed a total expenditure of $3,959 million, of which $944 million (24%) will come from assessed contributions. This represented a significant fall in outlay compared to the previous 2009–2010 budget, adjusting to take account of previous underspends. Assessed contributions were kept the same. Voluntary contributions will account for $3,015 million (76%), of which $800 million is regarded as highly or moderately flexible funding, with the remainder tied to particular programmes or objectives.

In recent years, the WHO's work has involved increasing collaboration with external bodies. As of 2002, a total of 473 NGOs had some form of partnership with WHO. There were 189 partnerships with international non-governmental organization (NGO) in formal "official relations" – the rest being considered informal in character. Partners include the Bill and Melinda Gates Foundation and the Rockefeller Foundation.

Controversies

IAEA – Agreement WHA 12–40

In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency (IAEA). The agreement states that the WHO recognises the IAEA as having responsibility for peaceful nuclear energy without prejudice to the roles of the WHO of promoting health. However, the following paragraph adds: "whenever either organization proposes to initiate a programme or activity on a subject in which the other organization has or may have a substantial interest, the first party shall consult the other with a view to adjusting the matter by mutual agreement". The nature of this statement has led some pressure groups and activists (including Women in Europe for a Common Future) to believe that the WHO is restricted in its ability to investigate the effects on human health of radiation caused by the use of nuclear power and the continuing effects of nuclear disasters in Chernobyl and Fukushima. They believe WHO must regain what they see as "independence".

Roman Catholic Church and AIDS

In 2003, the WHO denounced the Roman Curia's health department's opposition to the use of condoms, saying: "These incorrect statements about condoms and HIV are dangerous when we are facing a global pandemic which has already killed more than 20 million people, and currently affects at least 42 million." As of 2009, the Catholic Church remains opposed to increasing the use of contraception to combat HIV/AIDS. At the time, the World Health Assembly President, Guyana's Health Minister Leslie Ramsammy, condemned Pope Benedict's call, saying he was trying to "create confusion" and "impede" proven strategies in the battle against the disease.

Intermittent preventive therapy

The aggressive support of the Bill & Melinda Gates Foundation for intermittent preventive therapy of malaria which included the commissioning of a report from the Institute of Medicine triggered a memo from the former WHO malaria chief Akira Kochi.

Diet and sugar intake

Some of the research undertaken or supported by WHO to determine how people's lifestyles and environments are influencing whether they live in better or worse health can be controversial, as illustrated by a 2003 joint WHO/FAO report on nutrition and the prevention of chronic non-communicable disease, which recommended that sugar should form no more than 10% of a healthy diet. This report led to lobbying by the sugar industry against the recommendation, to which the WHO/FAO responded by including in the report the statement "The Consultation recognized that a population goal for free sugars of less than 10% of total energy is controversial", but also stood by its recommendation based upon its own analysis of scientific studies.

2009 influenza pandemic

In 2007, the WHO organized work on pandemic influenza vaccine development through clinical trials in collaboration with many experts. A pandemic involving the H1N1 influenza virus was declared by Director-General Margaret Chan in April 2009.

By the post-pandemic period critics claimed the WHO had exaggerated the danger, spreading "fear and confusion" rather than "immediate information". Industry experts countered that the 2009 pandemic had led to "unprecedented collaboration between global health authorities, scientists and manufacturers, resulting in the most comprehensive pandemic response ever undertaken, with a number of vaccines approved for use three months after the pandemic declaration. This response was only possible because of the extensive preparations undertaken in during the last decade".