International health

International Health
Dr Dharmendra Gahwai
MD (Community Medicine)
Asstt. Professor
Deptt. Of Community Medicine
CIMS, Bilaspur (C.G.)

‘Nothing is more international than
a disease.’
- Paul Russel

INTERNATIONAL HEALTH
• Also called ‘Geographic medicine’ or ‘Global
health’.
• It is a field of health care, usually with emphasis
towards public health dealing with health across
regional and/or international boundaries.

BACKGROUND
• Health and diseases has no political boundaries.
• Disease in any part of the world is a threat to other
countries.
• History replete with spread of disease (exm – Plague and
Cholera) along trade routes.

• In order to protect spread of disease , attempts had
been made by rulers/States to place barriers against
infection by detection and isolation of travelers.
• In 14th Century a procedure Quarantine was
introduced in Europe to protect importation of
disease.

• 40 days quarantine programme in Europe  plague .
• Quarantine soon became an established practice.
• Different countries adopted different quarantine
procedures.
• This was ORIGIN of international health work.

• But, later opposition came from several quarters 
40 days  long period and caused inconvenience for
international trade and travelers.
• Quarantine failed in its objective because lack of
scientific knowledge.

• It became necessary for international agreement
and cooperation on QUARANTINE matters to
control communicable disease.
• Thus, International Conferences were held and
organizations were set up to discussions,
agreement and cooperation on matters of
international health.

Early Health Organizations YEAR
1. First International Sanitary Conference 1851
2. Pan American Sanitary Bureau 1902
3. Office International D’Hyegiene Publique 1907
4. The Health Organizations of League of Nations 1923
5.
The United Nations Relief and Rehabilitation
Administration
1943
6. Birth of WHO 1948

FIRST INTERNATIONAL SANITARY CONFERENCE
(PARIS - 1851)
• Convened in Paris.
• Attended mainly by Europian countries: Austria, France,
Great Britain, Greece, Portugal, Russia, Spain and four
Sovereign States (Sardinia, the two Sicilies and Tuscany) &
Turkey.
• Objective: To bring some order and uniformity in the
quarantine measures.

• Prepared an International Sanitary Code containing
137 articles dealing with cholera, plague and yellow
fever  but never came into existence.
• Further, 10 other conferences were held between
1851 – 1902 for the same purpose but were equally
unsuccessful.

PAN AMERCIAN SAITARY BUREAU (PASB)
(AMERICA – 1902)
• First International Health Agency.
• Intended to coordinate quarantine procedure in American
States.
• Pan American Sanitary Code signed in 1924  Still in
force between the states.

• 1947 Bureau was reorganized and called the
‘Pan American Sanitary Organization.’ (PASO)
• 1958  renamed 
Pan American Health Organization
• since then PAHO has grown as major health
agency  headquarters in Washington, D.C.

OFFICE INTERNATIONAL D’HYGIENE PUBLIQUE
(OIHP) (PARIS – 1907)
• International Sanitary conference lead to the
establishment of a Permanent International Health
Bureau (1903).
• OIHP also k/as “Paris Office” started to disseminate
information on communicable diseases and
supervised international quarantine measures.

• OIHP and PASB joined together.
• British India and 60+ countries joined OIHP.
• Continued to exist until the 1950 and was taken over
by the WHO.

THE HEALTH ORGANIZATIONS OF THE LEAGUE OF
NATIONS (1923)
• After first World War - I (1914 - 1918) 
the League of Nations was established to build a better world.
• League of Nations include –
‘Health Organization’ which took steps in matters of international
concern for prevention and control of disease.

• Not concerned only with quarantine.
• But, branched out into various fields of nutrition,
housing, rural hygiene, training of health workers etc.
• League analyzed epidemiological information and
started the series of periodical epidemiological
reports now issued by WHO.

• Till second world war the three co-existed (OIHP,
PASB and HO.)
• In 1939, League of Nations dissolved, but its Health
Organization in Geneva continued to publish Weekly
Epidemiological Reports.

THE UNITED NATIONS RELIEF AND
REHABILITATION ADMINISTRATION (UNRRA) (1943)
• Purpose  organize recovery from the effect of World
War- II.
• Had a health division to care of health to the millions
displaced, to restore and help services and to revive
machinery to aid the exchange of information on
epidemic diseases.

• 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 of
the WHO.

BIRTH OF THE WHO
• In April 1945  Conference at San Francisco  United
Nation was formed.
• 7th April 1948 – WHO was born.
• World Health Day - 7th April

WORLD HEALTH ORGANIZATION
(WHO)

• WHO is a specialized, non-political health
agency of United Nations.
• Its constitution came in to force on 7th April
1948 . (Rene Sand - Chairmen)
• Which is celebrated as “World Health Day.”

WORLD HEALTH ORGANIZATION (WHO)
• Headquarters – Geneva, Switzerland.
• It’s a part of UN, not subordinate to it.

• It is unique among the UN specialized agencies that it
has own constitution, governing bodies, members and
budget.
• Each member contributes to the budget and is thus
entitled to its services and also has a right to vote.

OBJECTIVE
• “Attainment by all people’s of the highest level of
health.”
• Current objective –
“Attainment by the all people of the world a level of
health that will permit them to lead a socially and
economically productive life.”

Preamble of the Constitution
• “Health is a state of complete physical, mental and
social well-being and not merely absence of disease
or infirmity.”
• “The enjoyment of highest attainable standard of
health is one of the fundamental rights of every
human being without distinction of race, religion,
political belief, economic and social conditions.”

Membership
• Open to all countries.
• Most nations are members of UN and WHO. (except-
Switzerland – member of WHO only)
• In 1948, the WHO had 56 members.
• Now has 194 members states and two associate
members.

Functions of WHO
• First Constitutional Function is to act as the directing and
coordinating authority in 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. Biomedical Research.
7. Health Literature and Information.
8. Cooperation with other organizations.

1. Prevention and control of specific diseases
• Epidemiological surveillance of communicable disease.
• Collect and disseminate information on diseases subject to
IHR.
• ATRS – AutomaticTelex Reply System.
• WER - Weekly Epidemiological Record.
• The aim of IHR is to ensure maximum security against spread
of disease.
• Non-communicable disease – Cancer, CVS, DM, mental
disorders, drug addiction.

2. Development of Comprehensive Health Services.
• Function is to promote and support development of National
health policy and National Health Programs.
• Organizing health system based on Primary health Care.
• Development of health manpower and building of long term
national capabilities.
• Appropriate Technology for Health (ATH) is a new programme to
encourage self sufficiency in Primary health Care.

3. Family Health
• Major programme activities of WHO since 1970.
• Subdivided into  Maternal and child health care
(MCH), 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 govts – Sanitary services.
• Protection of quality of air, water and food.
• Health conditions at work.
• Radiation protection.
• Detection of new hazards from new technological
developments.
• WHO Environmental Health Criteria Programme.
• WHO Environmental Health Monitoring Programme.

5. Health Statistics
1. Since 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. 10th revision- 1993 )
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
• Two committees:
1. Regional Advisory Committees  define regional health priorities.
2. Global Advisory Committees  deals with policy issues.
• Target of WHO special programs for research and training:
Six diseases  malaria, schistosomiasis, trypanosomiasis, filariasis,
leishmaniasis and leprosy.
• To develop new tools, train workers and strengthen 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.

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
development programs.
WHO staff –
In 1948 – 250 in 2010 - 8000

WHO Secretariat comprises of 14 different divisions
1. Division of epidemiological surveillance and health
situation and trend assessment.
2. Division of communicable diseases.
3. Division of vector biology and control.
4. Division of environmental health.
5. Division of public information and education for health.
6. Division of mental health.
7. Division of budget and finance etc.

8. Division of strengthening of health services.
9. Division of family health.
10. Division of non-communicable diseases.
11. Division of health manpower and development.
12. Division of information system support.
13. Division of personal and general services.
14. Division of budget and finance.

WHO Regional Organizations
SN Region Headquarters
1. South East Asia Region New Delhi
2. Africa Brazzaville Congo
3. The Americas Washington D.C. (U.S.A.)
4. Europe Copenhagen (Denmark)
5. Eastern mediterrianean Alexandria (Egypt)
6. Western pacific Manila (Phillipines)

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.

United Nations International Children’s Emergency Fund
Specialized agency of United Nations
Established  1946
To deal with rehabilitation of children in war ravaged countries.
30 nations executive board.

• Now, United Nation’s Children’s Fund  UNICEF
Head Quarters  New York.
Works in collaboration with WHO, UNDP, FAO.
Early years, worked with WHO  urgent problems
Malaria, TB etc.
Country Health Program  focuses on “whole child.”

SERVICES PROVIDED
i. Provides aid for the production of vaccines and sera.
ii. Assisted environmental sanitation programs for safe and sufficient water
for drinking and household work.
iii. Providing Primary Health Care: Mother and Children
(immunization, infant and young child care, family planning, safe water and
adequate sanitation)
iv. Local community participation  planning personnel and material support.
Child Health
Child Nutrition
 Family and Child Welfare
Education (Formal & Non-
Formal)
1. CHILD HEALTH:

2. CHILD NUTRITION
• 1950’s  Low cost protein rich foods
• Along with FAO  began “applied nutrition.”
E.g. agriculture extension, helped population to grow and eat food
for better nutrition.
• Supplied equipment's for modern dairy plant to various countries.
• Provision of large dose of Vitamin A ( xerophthalmia is prevalent)
• Enrichment of salt with iodine in regions with endemic goiter.
• Provision of iron and folic acid to combat anaemias

3. FAMILY AND CHILD WELFARE
Improve the care of children both within and
outside their homes by giving parent
education, opening day care centers, child
welfare and youth agencies and women’s
club for training.

4. EDUCATION – FORMAL AND NON - FORMAL
 Works in collaboration with UNESCO.
 Currently, GOBI campaign is being promoted to encourage the following 4
strategies for “Child Health Revolution.”
UNICEF’S G.O.B.I. — FFF PROGRAMS
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 diarrheal 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 months of
life.
4. Immunization: Which can protect a child against measles, diphtheria, whooping cough,
tetanus, tuberculosis, and polio.

OTHER AGENCIES
 UNDP (1966) – Main source of funds for technical assistance. Helps poorer nations develop their
human and natural resources.
 UN FUNDS FOR POPULATIONS ACTIVITIES – Funds national level schemes, area projects
for development of health, infrastructure, family welfare 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.
 ILO (1919) – 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.

BILATERAL AGENCIES
• USAID (US Agency for International Development)
• SIDA (Swedish International Development Agency)
• DANIDA
OTHER NGO’s
• Rockefeller Foundation
• Ford Foundation
• CARE (Co-operative for Assistance and Relief Everywhere)
• International Red Cross

WORLD HEALTH DAY THEMES
 2014  Vector-borne Diseases
 2013  Healthy Blood Pressure
 2012  Ageing and Health
 2011  Anti-microbial resistance
 2010  Urbanization and Health
 2009  Save Lives. Make Hospitals Safe in Emergencies.
 2008  Protecting Health from the Adverse Effects of Climate Change
 2007  Invest in Health, Build a Safer Future
 2006 Working together for health
 2005 Make every mother and child count
 2004 Road safety
 2003 Healthy environments for children
 2002Move for health

International health

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