International Health

International Health

Dr. D.R. Veda priyaAssistant ProfessorDept. of community MedicineAVMC&HPondicherry

2

“Nothing on earth is more international

than disease”

Paul Russel

International health

History• Disease in any part of the world Threat to other countries

• In order to prevent the spread Many attempts by individual ruler eg. Barriers

against infection by detection and isolation of travellers.

• 14th cent Quarantine( to protect against importation of plague for -

40 days) Europe

• Practiced in many countries Origin of International health work

• Opposition came from several quarters-- (40 days lead to inconvenience in

international trade and travel)

• International conference was set for discussion, agreement and cooperation on

matters of international health.

International health 3

History and Development…

First International Sanitary Conference (1851, Paris)

-Attended Austria, France, Great Britain, Italy, Greece, Portugal,

Russia, Spain

Objective: Introduce some order and uniformity into quarantine

measures which varied from country to country

-Prepared sanitary code 137 articles dealing with cholera,

plague, yellow fever(never came into force)

-Ended in failure


Pan American Sanitary Bureau (1902, Americas)

First international health agency

• Intended to coordinate quarantine procedure in American States

• Pan American Sanitary code Still in force between the states

• 1958 Pan American Health organization-grown as major

health agency –headquarters in Washigton,D.C.


Office International D’Hygiene Publique(OIHP)- 1907

To establish Permanent International Health Bureau(1903)

Office International D’Hygiene Publique, Paris Office (1907)

To disseminate information on communicable diseases and to supervise

international quarantine measure

OIHP AND PASB joined together

British India joined OIHP

Continued to exist until 1950 and taken over by WHO

6International health

The Health Organization of the League of Nations (1923)

• After first world war(1914-1918) league of nations established

better world

‘Health Organization’ (“take steps of international concern

for prevention and control of disease”)

• Not concerned only on quarantine

• HO branched into nutrition, housing, rural hygiene, training of

health workers

• Till second world war they were co-exisiting(OIHP,PASB and HO)

• Later HO only was existing.


The United Nations Relief and Rehabilitation Administration (1943)

• Purpose organize recovery from the effect of 2nd world war.

• Did outstanding work of preventing the spread of typhus and

other diseases

• Assistance to malaria control in Italy and Greece

• 1946-taken over by interim Commission on the WHO


Birth of WHO1945

The United Nations Conference in San Francisco, USA, unanimously approves the establishment of a new, autonomous international health organization.

1946The International Health Conference in New York approves the Constitution

of the World Health Organization in July.

1947The epidemiological information service is established. An automatic telex reply service, it tracks information on diseases subject to the International Sanitary Regulations (later renamed International Health Regulations) and other communicable diseases of international importance.

1948The World Health Organization Constitution comes into force on 7 April.

1948-1953Dr. Brock Chisholm from Canada is elected as the first Director-General

of the World Health Organization.

1950The World Health Assembly establishes World Health Day to take

place annually on 7 April.

World Health Day Themes(focus attention on specific aspect of public health)

• 2006 Working together for health

• 2005 Make every mother and child count

• 2004 Road safety

• 2003 Healthy environments for children

• 2002Move for health


2009

• Make hospitals safe in emergencies


Objective:

The attainment by all peoples of the highest level of health

(Its major task is to combat disease, especially key infectious

diseases, and to promote the general health of the people of the

world.)

Membership:

• Open to all countries.

• Each member state contributes yearly to the budget each is

entitled to the services and aid the organization can provide .

• Have right to vote


Regional offices and regions of the WHO:

Africa;HQ Brazzaville, Congo

Americas; HQ: Washington,D.C.,USA

Eastern Med.; HQ: Cairo, Egypt

Europe;HQ: Copenhagen,Denmark

South East Asia;HQ: NewDelhi, India

Western Pacific; HQ: Manila,Philippines

Work of WHO Constitutional Function: Act as the directing and coordinating

authority on all International health work

1. Prevention and Control of specific Diseases

2. Development of Comprehensive Health Services

3. Family Health

4. Environmental Health

5. Health Statistics

6. Bio-Medical Research

7. Health Literature and Information

8. Cooperation with Other Organization



Communicable diseases :

All are sometime the subject of WHO activities

eg. Global eradication of Small pox International health cooperation

• Important work Epidemiological surveillance of CD

• WHO collects information and send it to International Health

Regulations (IHR--to ensure the maximum security against the

international spread of diseases with a minimum interference with

world traffic)


• Non-Communicable Diseases:

Paid attention to NCD’s Cancer, DM, CVD, Genetic

disorders, mental disorders, drug addiction etc

• Vector biology and control, VCRC--Pondicherry

• immunology,

• quality control of drugs and biological products,

• drug evaluation and monitoring and

• health laboratory technology

(Relavent to control CD’s and NCD’s)

• Immunization against common diseases of childhood


1950Mass TB immunization gets under way as the bacille Calmette-Guerin (BCG)

vaccine is used to protect children from tuberculosis.

1953-1973Dr Marcolino Gomes Candau of Brazil is elected as the second Director-General of the World Health Organization.

1955The Malaria Eradication Programme is launched. Its objective was modified in 1969. Subsequently, most of the malaria eradication programmes were turned into national malaria control programmes.

1965The first report on diabetes mellitus is issued. By 2000, 171 million people worldwide carried the disease. The number is likely to increase to at least 366 million by 2030.

1965The International Agency for Research on Cancer is established to coordinate and conduct epidemiological and laboratory research into the causes of human cancer.

1966The new headquarters building of the World Health Organization in Geneva is inaugurated.

1973-1988Dr Halfdan T. Mahler of Denmark is elected as the third Director-General of the World Health Organization.

1974The onchocerciasis control programme is launched in collaboration with the World Bank, the United Nations Development Programme and the Food and Agriculture Organization.

1974The expanded programme on immunization is launched. Immunization currently averts between 2-3 million deaths every year.

1975The Special Programme for Research and Training in Tropical Diseases is established to help coordinate, support and influence global efforts to combat neglected infectious diseases that disproportionately affect poor and marginalized populations.

1976The World Health Assembly adopts a resolution on disability prevention and rehabilitation, calling for an integration of rehabilitation into primary health care programmes and community life.

1977The first essential medicines list is published. Today, the list contains 340 medicines that address most global priority conditions, including malaria, HIV/AIDS, tuberculosis, reproductive health and, increasingly, chronic diseases such as cancer and diabetes.

1978The International Conference on Primary Health Care in Alma-Ata (in the former Soviet Union) sets the historic goal of "Health for all".

1979A global commission certifies the worldwide eradication of smallpox.

1986The global programme on AIDS is created to develop and coordinate a global strategy to fight the disease.

1988-1998Dr Hiroshi Nakajima of Japan is elected as the fourth Director-General of the World Health Organization.

1988The World Health Assembly endorses a resolution on non-discrimination against people living with AIDS.

1988The Global Polio Eradication Initiative is established in collaboration with Rotary International, the US Centers for Disease Control and Prevention and UNICEF.

1995The International Commission for the Certification of Dracunculiasis Eradication is established. Dracunculiasis is also known as guinea-worm disease.

1996UNAIDS is created with six founding partner agencies.

1998-2003Dr Gro Harlem Brundtland of Norway is elected as the fifth Director-General of the World Health Organization.

2000The Stop TB Partnership, hosted by WHO, is launched. The partnership includes over 500 partners working to reach the MDG for TB by increasing access to treatment through DOTS programmes, and addressing challenges such as TB/HIV and drug-resistant TB.

2001The Measles Initiative is launched in partnership with the American Red Cross, UNICEF, the United Nations Foundation and the US Centers for Disease Control and Prevention. As of October 2007, overall global measles deaths have fallen by 68%.

2002The Global Fund to Fight AIDS, Tuberculosis and Malaria is created to substantially increase resources to fight three of the world's most devastating diseases.

2002The first World report on violence and health is launched. The report's findings and recommendations set a new agenda for the prevention of violence, and lead the way for communities, governments and international agencies to address interpersonal, self-directed and collective violence.

2003-2006Dr LEE Jong-wook of the Republic of Korea is elected as the sixth Director-General of the World Health Organization.

2003The 3x5 Initiative is launched with UNAIDS, aiming to get three million people on antiretroviral treatment by the end of 2005.

2003The World Health Assembly adopts the Framework Convention on Tobacco Control, now one of the most widely supported treaties in the history of the United Nations.

2003Severe Acute Respiratory Syndrome (SARS) is first recognized and then controlled. WHO coordinates the international investigation with the Global Outbreak Alert and Response Network and works closely with health authorities in the affected countries.

2005The World Health Assembly revises and adopts the International Health Regulations, a new legal framework adopted by most countries to contain the threats from diseases that may rapidly spread from one country to another. The regulations came into force in 2007.

2006Dr Margaret Chan of the People's Republic of China is elected as the seventh Director-General of the World Health Organization.

2009

• Make hospitals safe in emergencies

Birth of the WHO

• 7th April 1948

• World Health Day-7th April

• Specific theme each year focus attention on specific aspect of

public health

Objective:

The attainment by all peoples of the highest level of health


Work of WHO Constitutional Function: Act as the directing and coordinating

authority on all International health work


2. Development of Comprehensive Health Services

3. Family Health

4. Environmental Health

5. Health Statistics

6. Bio-Medical Research


8. Cooperation with Other Organization



Communicable diseases :

All are sometime the subject of WHO activities

eg. Global eradication of Small pox International health cooperation

• Important work Epidemiological surveillance of CD

• WHO collects information and send it to International Health

Regulations (IHR--to ensure the maximum security against the

international spread of diseases with a minimum interference with

world traffic)


• Non-Communicable Diseases:

Paid attention to NCD’s Cancer, DM, CVD, Genetic

disorders, mental disorders, drug addiction etc

• Vector biology and control,

• immunology,

• quality control of drugs and biological products,

• drug evaluation and monitoring and

• health laboratory technology

(Relavent to control CD’s and NCD’s)

• Immunization against common diseases of childhood


2. Development of Comprehensive health services

• Function is to promote and support National health policy

development

NHP2002 Eradicate Polio by 2005, Eliminate Leprosy 2005

• Development of comprehensive Nat. health prog.

• Organizing health system based on PHC

• Development of health manpower

• Building of long term national capability

eg. Health infrastructure development.


3. Family health

• Major programme activities of WHO since 1970

• Subdivided Maternal and child health care, human

reproduction, nutrition, and health education

• Chief concern improvement of the quality of life of

the family as a unit.


4. Environmental health:

Recent activities:

Protection of quality of air, water and food

Health conditions at work

Radiation protection and

Early detection of new hazards originating from

new technological developments

Prog. WHO Environmental Health Criteria Prog.

WHO Environmental Health Monitoring Prog.


5.Health statistics

Since 1947 morbidity and mortality statistics are published in

a. Weekly Epidemiological Records

b. World Health Statistics quarterly and Annual

Statistics from different countries should be comparable

hence WHO publishes International Classification of

Diseases

Updated every 10yrs eg. Neoplasm-(C00-D48)


6. Bio Medical Research• WHO Stimulates and coordinates research work

• World wide WHO collaborating centers

• For promoting researchAwards grants Researchers

and research institutions

• Two committee

1. Regional Advisory Committees define regional

health priorities

2. Global Advisory Committees deals with policy

issues


• Target of WHO special prog. For Research and Training

Six diseases malaria, schistosomiasis,

trypanosomiasis, filariasis,

leishmaniasis and leporsy

• To develop new tools, training workers strengthen

research institutions.



WHO library

Satelite centres of Medical Literature Analysis and

Retrieval System (MEDLARS)

Fully computerized indexing system covering the whole

of medicine on an international basis.


8. Cooperation with other Organizations

• Collaborates with UN and other specialized

agencies and

• Also with number of international government

organizations

Maintains working relationships.


Structure1. World Health Assembly “Health Parliament” of Nations and the supreme

governing body of the organization.

Meets annually at headquarters Geneva.

Functions:

To determine international health policy and programmes

To review the work of the past

To approve the budget for following year

To elect Member States to serve for 3 yrs on the Executive Board


The Executive Board

• 30-31 members designated as “Member State”. At least 3

persons from each WHO

regions

• Meets twice a year

• To give effect to the decision and policies of the Assembly

• Has power to take decision emergencies eg. Earthquakes,

floods etc.


The Secretariat

Headed by Director General (chief technical and administrative

officer of the organization)

Function:

To provide technical and managerial support for their national

health development prog.

WHO Secretariat comprised of

Division of communicable diseases, Division of environmental

health, Division of mental health, Division of budget and finance

etc. (14)


Regions• South East Asia-New Delhi

• Africa-Harare (Zimbabwe)

• The Americas-Washington D C (USA)

• Europe-Copenhagen (Denmark)

• Eastern Mediterranean-Alexandria (Egypt)

• Western Pacific-Manila (Philippines)

SEARO: (Bangladesh, Bhutan, India, Indonesia, Korea, Maldives,

Timor-Leste, Myanmar, Nepal, Srilanka, Thailand)


UNICEFUnited Nations International Children’s Emergency Fund

Specialized agency of United Nations

Established 1946

To deal with rehabilitation of children in war ravaged countries

United Nation’s Children’s Fund UNICEF

Head Quarters United Nations, New York.

Regional Office New Delhi

Works in collaboration with WHO, UNDP, FAO

Eg. Worked with WHO urgent problems Malaria, TB etc.


Greater attention “Whole child” concept

Assistance forwarded should not only to health and

nutrition (immediate benefit) but also to their long term

personnel development and to the development of

countries where they live.

This approach is called “Country Health

Programme”


Services provided:1. Child Health:

a. Provided aid for the production of Vaccines and sera

Supported India:

For BCG vaccintion prog. from its inception

For errection Pencillin plant in, Pune

Donated two plant for manufacture of triple

vaccine and iodized salt.


b. Assisted environmental sanitation prog.

For safe and sufficient water for drinking and

household work

c. Providing Primary Health Care:

Mother and Children

(immunization, infant and young child care, family

planning, safe water and adequate sanitation)


Child Nutrition• 1950’s Low cost protein rich foods

• Along with FAO began “applied nutrition”

eg. agriculture extension, help pop. to grow and eat

food for better nutrition.

• Supplied equipments for modern dairy plant.

• Provision of large dose of vit.A (xerophthalmia is

prevalent)

• Enrichment of salt with iodine,

• Provision of iron and folic acid to combat anemias


3. Family and child welfare

• Improve the care of children both within and outside

their homes by

eg. parent education, day care centers,

child welfare and youth agencies and women’s club


4.Education –formal and non formal

Assisting India in expansion and improvement of teaching

science in India

Science laboratories,

Work shop tools,

Library books,

Audio visual aids

made available to educational institutions


UNICEF’s GOBI — FFF Programs

The fact that just four relatively simple and inexpensive

methods could now enable parents themselves can save

the lives of up to 20,000 children each day.

In brief, those methods are:

1. Growth Monitoring:- which could help mothers to prevent

most child malnutrition before it begins.


2.Oral Rehydration:-

which could save more than 4 million young children

who now die each year from diarrhoeal dehydration.

3. Breast Feeding:

Which can ensure that infants have the best possible

food and a considerable degree of immunity from

common infections during the first six month of life.


4.Immunization:

Which can protect a child against measles, diphtheria,

whooping cough, tetanus, tuberculosis, and polio.

At present,

These diseases kill as estimated 5 million young

children a year,

Leave 5 million more disabled, and are a major

cause of child malnutrition.


In addition, recent research in the developing world has

highlighted three kinds of support for women.

1. FEMALE EDUCATION:

Even within low-income communities, a child born to a

mother with no education has been shown to be twice

as likely to die in infancy as a child born to a mother

with even four years of schooling.


2. FAMILY SPACING:

Infant and child deaths have been found to be, on average, twice

as high when the interval between births is less than two years.

3. FOOD SUPPLEMENTS:

A handful of extra food each day for at-risk pregnant women has

been shown to reduce the risk of low birth-weight - a risk which

carries with it a two or three times greater likelihood of death in

infancy.

GOBI — FFF


UNDP- (United Nations Development Programme)

To help poor nations develop their human and natural

resources.They cover economic and social sector

eg. Industry, education, agriculture etc.

FAO-(The Food and Agriculture Organization)

To improve nutrition of all countries

ILO (International Labour Organization)

To improve the working and living conditions of the

working population all over the world

.


International Red cross:

• Is an international humanitarian movement with approximately

97 million volunteers worldwide

• Which started to protect human life and health,

• To ensure respect for the human being, and

• To prevent and alleviate human suffering, without any

discrimination based on race, religion etc

Principles: Humanity, Impartiality, Neutrality, Independence,

Voluntary Service, Unity, Universality.



Founded by Henry Dunant


French postcard celebrating the role of Red Cross nurses during the First World War, 1915

The ICRC Headquarters in Geneva86

Slide I.1 - International Red Cross Red Crescent Movement

ICRC

• National Red Cross and Red Crescent Societies “National Societies”

International Federation of Red Cross and Red Crescent Societies “International Federation”

International Committee of the Red Cross "ICRC"

International Red Cross Red Crescent Movement

• Indian Red Cross Society ( IRCS ) was established in 1920

under the Indian Red Cross Society Act

• The IRCS has 35 State / Union Territories Branches with

their more than 700 districts and sub district branches.

• His Excellency The President of India is the President and

Hon'ble Union Health Minister is the Chairman of the

Society


Indian Red Cross

• Improvement of health

• Prevention of disease

• Mitigation of suffering


Programmes and activities

• Promoting humanitarian principles and values; Disaster

response;

• Disaster preparedness

aware of the risks they face,

how to reduce their vulnerability, and

how to cope when disaster strikes. and

• Health and Care in the Community

Too many people die as a result of no access to even the most basic

health services and elementary health education


Bilateral Agencies

• USAID

• SIDA

• DANIDAOther INGOs

• Rockefeller Foundation

• Ford Foundation

• CARE

• International Red Cross


World Health Day Themes

• 2006 Working together for health

• 2005 Make every mother and child count

• 2004 Road safety

• 2003 Healthy environments for children

• 2002Move for health



International Health

Health & Medicine

health international

international health

international health

failure international

general health

world health assembly

international conference

international trade