History Through Pictures
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1 The World Health Organization and the Transition from History Through Pictures International to Global Health Elizabeth Fee History of Medicine Division National Library of Medicine
2 Global and Globalization are everywhere Yale: Division of Global Health Harvard: Center for Health and the Global Environment London SHTM: Center on Global Change and Health
3 Table 1 PubMed Entries; Keyword Search done: January s 1960s 1970s 1980s 1990s * * NB 60 months only International ,333 8,506 17,651 51,778 44,479* Global ,138 7,193 27,925 33,702*
4 International across national boundaries Intergovernmental relationships between governments of sovereign nations Global health health needs of people across the planet
5 A new paradigm? Is this shift in terminology trendy, trivial, or trenchant?
6 Bunyavanitch and Walkup interview with 29 international health leaders in 1999: half thought the new vocabulary was meaningless jargon; half thought a major shift was underway but seemed unable to clearly articulate what it was AJPH 2001:
7 Yach and Bettcher: The globalization of public health is both promising and threatening. Upside: Diffusion of useful technologies Diffusion of ideas and values - human rights
8 Downside: Diminished social safety nets Facilitated marketing of tobacco, alcohol Easier worldwide spread of infectious diseases Pollution and global warming AJPH 1998:
9 The World Health Organization would provide the solutions: Global intersectoral action through transnational partnerships Global vigilance, research, and monitoring Linking disease surveillance systems across countries Global early warning systems
10 George Silver: The WHO s leadership role has passed to the far wealthier and more influential World Bank, and the WHO s mission has been dispersed among other UN agencies. The UN and its agencies are in disarray, hamstrung by financial constraints and internal incompetencies, frustrated by turf wars and cross-national policies. AJPH, 1998: 728.
11 1902 International Sanitary Office (Pan American Health Organization) 1907 Office Internationale d Hygiène Publique 1920 League of Nations Health Organization 1948 Ratification of WHO Constitution by World Health Assembly
12 WHO Early beginnings of WHO involved prominent advocates of social medicine: Stampar, Sand, Parran, Chisholm Then soon, in Cold War context, Soviet Union and other Communist countries walked out of UN, and UN agencies shifted closer to US interests
13 1950s DDT and the Global Program of Malaria Eradication: a vertical disease eradication program, centered on a promised technological solution to a major disease problem Winning hearts and minds Failure of malaria eradication
14 1960s-1970s Emergence of decolonized independent African nations Spread of nationalist and left movements Non-aligned movement United Nations Conference on Trade and Development New International Economic Order
15 China s reentry into UN in 1973 Within WHO, great interest in the barefoot doctors Emergence of Primary Health Care movement Halfdan Mahler becomes Director-General of WHO, Alma Ata, 1978 Health for All by the Year 2000
16 Bellagio conference, 1979 World Bank Rockefeller Foundation Ford Foundation USAID UNICEF
17 Selective Primary Health Care Low cost technical interventions Limited in scope Easy to monitor and evaluate Pragmatism, as opposed to WHO s idealism
18 1980s US withholds its contribution to WHO s regular budget in protest against WHO s Essential Drug Program WHO s budget is frozen Hiroshi Nakajima replaces Mahler, 1988
19 Growth of extra-budgetary funding By 1991, extra-budgetary funds were 54% of WHO s total World Health Assembly only controls regular budget Wealthy donor nations control extrabudgetary funds
20 World Bank takes leadership in the new context of neo-liberal policies in economics, trade, and politics World Bank relatively isolated from populations of developing countries; sensitive to the concerns of Wall Street
21 Private sector has to be involved in service delivery Management reforms decentralization Cost-effectiveness calculations decide services Structural adjustment policies to cut public spending
22 Bank loans for health projects surpass WHO total budget, : $13.5 billion
23 WHO embraces global health ; elects Gro Harlem Brundtland, former Prime Minister of Norway Chair of U.N. World Commission on Environment and Development
24 A department of consequence Commission on Macroeconomics and Health Organized global partnerships and global funds : strengthening finances Roll Back Malaria GAVI Stop TB
25 Bill and Melinda Gates Foundation, $1.7 billion, Drugs and vaccines Priority diseases
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