International health

GLOBAL HEALTH

Dr. Subraham Pany

Department of Community Medicine.

‘Nothing is more

international than a

disease.’- Paul Russel.

REFERENCE: HTTP://WWW.WHO.INT/EN/

WHAT IS GLOBAL HEALTH? SYN:

- Geographic medicine - International health Health problems, issues, & concerns that go above national boundaries, which may be influenced by circumstances or experiences in other countries, & which are best addressed by cooperative actions and solutions.

HISTORY14th Century - EUROPE

Quarantine (In outlook to importation of PLAGUE)

Failure of quarantine (Due to opposition)

International conference was set for discussion, agreement and co-operation on matters of international

health.

This led to the origin of International Health work

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 agencyIntended to coordinate quarantine procedure in American 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 then taken over by WHO

The Health Organization of the League of Nations (1923)

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

established for a better world.

‘Health Organization’ was not concerned only on quarantine

rather it branched into nutrition, housing, rural hygiene & training

of health workers.

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

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 WHO – APRIL 1945The 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.

* The 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.

1947

1948THE WORLD HEALTH ORGANIZATION CONSTITUTION

COMES INTO FORCE ON 7 APRIL.

BIRTH OF THE WHO * 7th April 1948

* World Health Day - 7th April

* Specific theme each year focus attention on specific aspect of public health.

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.

WHO The world health organisation is a specialised, non – political health agency of the United Nations, with head quarters at Geneva.

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 member is entitled to the services and aid the organization can provide.Have right to vote.

 Africa; HQ Brazzaville, Congo     

Americas; HQ: Washington D.C.,

USA     

Eastern Med.; HQ: Cairo, Egypt     

Europe; HQ: Copenhagen, Denmark 

South East Asia; HQ: New Delhi, India  

 Western Pacific; HQ: Manila,

Philippines

REGIONAL OFFICES AND REGIONS OF THE WHO:

WORK OF WHO Constitutional Function: Act as the directing and

coordinating authority on all International health work:

1. Prevention and Control of specific Diseases2. Development of Comprehensive Health Services3. Family Health4. Environmental Health5. Health Statistics6. Bio-Medical Research7. Health Literature and Information 8. Cooperation with Other Organization

1. PREVENTION AND CONTROL OF SPECIFIC DISEASESCommunicable diseases : * Almost all communicable disease are at some point of time the subject of WHO activities

* e.g.. Global eradication of Small pox International health cooperation.

* Important work Epidemiological surveillance of CD

Non-Communicable Diseases: Paid attention to NCD’s like Cancer, DM, CVD, Genetic disorders, mental disorders, drug addiction etc.

Vector biology and control, immunology,

Immunization against common diseases of childhood

2. DEVELOPMENT OF COMPREHENSIVE HEALTH SERVICES

* Function is to promote & support Nat. health policy development

* NHP 2002 Eradicate Polio by 2005, Eliminate Leprosy 2005

* Development of comprehensive Nat. health Programme

* Organizing health system based on PHC

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 *Advisory to Govt.’s – Sanitary services. *Protection of quality of air, water and food. *Health conditions at work. *Radiation protection. *Detection of new hazards from new technological developments. *PROGRAMMES: WHO Environmental Health Criteria Programme. WHO Environmental Health Monitoring Programme.

5. HEALTH STATISTICSSince 1947, morbidity and mortality statistics are published in

a. Weekly Epidemiological Records.

b. World Health Statistics Quarterly.

c. World Health Statistics Annual.

2. Statistics from different countries should be comparable hence, WHO publishes-

International Classification of Diseases. (Updated in every 10 years. 12h revision- 2013 )

3. Assistance is provided to countries to improve their medical records and help in planning

and operation of National Health Information Systems.

6. BIO-MEDICAL RESEARCH WHO Stimulates and coordinates research work.

Worldwide network of WHO collaborating centers.

For promoting research WHO awards grants to

researchers and research institutions

7. HEALTH LITERATURE AND INFORMATION

* WHO LIBRARY Satellite center of

* Medical Literature Analysis and Retrieval System (MEDLARS).

* Only fully computerized indexing system covering the whole of medicine on an international basis.

* Public information services are found both at

headquarters and six regional offices.

8. COOPERATION WITH OTHER ORGANIZATIONS.

Collaborates with UN and other specialized agencies.

WHO maintains working relationships with a number of International

Government Organizations.

STRUCTURE OF WHO

THREE PRINCIPAL ORGANS

1. The World Health Assembly.

2. The Executive board.

3. The Secretariat.

“Health Parliament” of Nations and the supreme governing body of the organization.

Meets annually at headquarters in Geneva, Switzerland.

Health Assembly appoints “Director general” on the nomination of Executive board.

Functions:1. To determine international health policy and programs.

2. To review the work of the past.

3. To approve the budget for following year.

4. To elect Member States to serve for 3 years on the Executive Board.

WORLD HEALTH ASSEMBLY

THE EXECUTIVE BOARD Board now has 34 members each designated by a

“Member State”.

Should have at least 3 persons from each WHO region.

Meets twice a year.

To give effect to the decisions and policies of the Assembly.

Has power to take decisions Emergencies. E.g. Earthquakes, epidemics,

floods etc.

THE SECRETARIAT Headed by Director General - chief technical and administrative officer of the organization.

Assisted by 5 Assistant Director Generals at the headquarters.

Function:

To provide technical and managerial support for their national health programs.

WHO staff –

In 1948 – 250 --- in 2010 - 8000

THE SOUTH EAST ASIA REGION Head quarter in New Delhi – k/as World Health House, Indraprastha Estate. Region has 11 members – India, Bangladesh, Bhutan, Indonesia, Korea, Maldives, Myanmaar, Nepal,Srilanka, Thailand, Timor-leste. Major activities – Malaria eradication, TB control, control of other communicable disease, health statistics, public health administrations, environment health and water supply, nutrition, mental health, quality control and medical education.

1950MASS TB IMMUNIZATION GETS UNDER WAY AS THE BACILLE CALMETTE - GUERIN (BCG) VACCINE WAS

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 & 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 WHO.

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 WHO.

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 CENTRES 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 WHO.

2001THE MEASLES INITIATIVE IS LAUNCHED IN PARTNERSHIP WITH THE AMERICAN RED CROSS, UNICEF, THE U.N. FOUNDATION

AND THE US CENTERS FOR DISEASE CONTROL & 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.IT WAS 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 JONGWOOK OF THE REPUBLIC OF KOREA IS ELECTED AS THE SIXTH DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANIZATION.

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.

UNICEFUnited Nations International Children’s Emergency FundSpecialized agency of United NationsEstablished 1946To deal with rehabilitation of children in war ravaged countries Head Quarters United Nations, New York.Regional Office New DelhiWorks in collaboration with WHO, UNDP, FAO E.g.. Worked with WHO urgent problems Malaria, TB etc.

SERVICES PROVIDED BY UNICEF1. Child Health2. Child Nutrition3. Family And Child Welfare4. Formal And Non – Formal Education

UNICEF’s GOBI — FFF ProgramsGrowth monitoringOral rehydration Breast feedingImmunization

Female EducationFamily planningFood supplements

UNDP- (UNITED NATIONS DEVELOPMENT PROGRAMME)

To help poor nations develop their human and natural resources.

They cover economic and social sector

e.g.. Industry, education, agriculture etc.

FAO (1945) Chief aims are to raise the living standards; improve nutrition; increase efficiency of farming, forestry, fisheries; and to better the living conditions of rural people, thus widening the opportunity for all to indulge in productive work.

1960 FFHC (Freedom from Hunger Campaign) – To combat malnutrition and to spread awareness.

As an affiliate to the League of Nations to improve the living and working conditions of the working class.

Its purpose was to establish peace, improve international action, labour conditions, and the living standards; to promote economic and social stability.

WORLD BANK Governed by ‘Board of Directors’.Funds projects concerned with electric power, roads, railways, health, agriculture, family planning etc.

INTERNATIONAL RED CROSS:An international humanitarian movement

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.

Henry Dunant

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

ACTIVITIES OF USAIDThe US government is assisting in a number of projects designed to improve the health of Indian people.

1)Malaria eradication2)Medical education 3)Nursing education4)Health education5)Water supply and sanitation6)Control of communicable diseases7)Nutrition 8)Family planning

“Co-operative for assistance and relief everywhere” founded in North America in the wake of the second world war in the year 1945.Activities:CARE-India focused it’s food support in the ICDS programme and in developments of programmes in areas of health and income supplementation.Integrated nutrition and health projects, anaemia control project, improving women’s health projects, improved health care for adolescent's girls projects, child survival projects, Improving women’s reproductive health and family spacing project.

The United Nations Population Fund, is the lead UN agency.

UNFPA supports healthy families by:• Training health workers to deliver quality family planning services• Supplying contraceptives• Ensuring youth-friendly reproductive health care• Providing counselling and choices to women who want to avoid or delay pregnancy• Educating men on the benefits of birth spacing

Danish International Development Agency (DANIDA), provides humanitarian aid and development assistance to other countries, with focus on developing countries. Four main priority areas:*Human rights and democracy*Green growth*Social progress*Stability and protection

The United Nations Educational, Scientific and Cultural Organization is a specialized agency of the United Nations (UN).

UNESCO pursues its objectives through five major programs: education, natural sciences, social and human sciences, culture, and communication and information.

SIDA * Swedish International Development Cooperation (SIDA) Agency

is providing assistance since 1979 in form of X- ray Units,

microscope and anti- TB drugs. It also supported the pilot study of

Short Term Chemotherapy during 1983-1984.

* Being terminated in 2013.

ROCKEFELLER FOUNDATION

Concern with medical education, public health, social science and agricultural

sciences.

Help in Establishment of AIIPH Calcutta, AIIMS Delhi, KGMC Lucknow.

CMC Vellore,National Institute of Virology Pune.

Sponsor educational visits for advance training of health professional, sponsor

visit of specialist from USA.

Grant in Aid for research activities

Also giving support for improvement of agriculture, family planning and rural

development.

Bill and Millinda Gates foundation :

It delivers proven tools—including vaccines, drugs, and diagnostics—as well as discover pathbreaking new solutions that are affordable and reliable. They invest heavily in vaccines to prevent infectious diseases—including HIV, polio, and malaria—and support the development of integrated health solutions for family planning, nutrition, and maternal and child health.

OTHer Non Governmental Organisations

American Association for the Advancement of Science (AAAS)American Society of Tropical Medicine and Hygiene (ASTMH) Consortium of Universities for Global Health (CUGH)Center for Strategic and International Studies (CSIS) Global Health Policy CenterGlobal Alliance for Chronic Diseases (GACD)Accordia Global Health FoundationFoundation for NIH (FNIH)Wellcome TrustInstitute for Health Metrics and Evaluation (IHME)