January 31, 2024

World health organisation and Global Public health

This article has been written by Ms. Zuha, a 4th year BA.LL.B student studying at the University of Kashmir, J&K.

 Abstract

Which international organisation declared the Covid 19 pandemic? Who declared quite a many Indian exported pharmaceutical drugs as unsafe for use by issuing public health warnings? When was smallpox declared as eradicated? When issues transcend territorial boundaries, it is the World Health Organisation which steps in. In this article, we will be delving into the journey of understanding the World Health Organisation as an international body and its formation, its structural organisation and its values. To develop a better understanding, few examples of its practical work around the world will be shared and explained to demonstrate its impact and success on improving and promoting global health. 

 What does the World Health Organisation do?

 The World Health Organisation (WHO) operates as a dedicated body of the United Nations which combines global expertise, science and cooperation for the ultimate object of promotion of the health of the people across the world. It was founded in 1948 and is an umbrella organisation encompassing medical experts, healthcare providers, scientists, epidemiologists and other working staff from across the global space.  As a specialised organ of the United Nations, it directs its resources on medical research, monitors and evaluates the healthcare systems around the world, issues public health related warnings, supervises the drug export and import, facilitates international cooperation in the field of medical science, enhances public awareness and so on and so forth. 

 Structure and funding

The global presence of the organisation stretches beyond its Geneva headquarters and is spread in as many as 150 offices across the divided six regions. In addition to that, there are other operational offices/stations/centres of the WHO which are special bodies focused on Epidemic intelligence, traditional medicine, IT centres etc. At present, the body is comprised of 194 Member nations who receive tailored attention by the WHO in prioritising the improvement of their healthcare systems, plans and policies.  They put across their concerns and frame global health goals and policies every year through World Health Assembly which is the main decision- making body. The body is led by Director General who is elected from amongst the representatives of the constituent member states. He in his role of supervision and leadership is assisted by the six regional directors. The main working body of the organisation is the Secretariat which amalgamates experts, researchers, field workers and managerial staff.  

In terms of funding, the organisation is financed by various sources to fulfil its mandate. The WHO budget mostly comprises of mandatory dues paid by member nations and other voluntary contributions, donations which can include core (flexible) funds or specific funds. The top contributors of the WHO include Germany, Japan, and USA, European commission and Bill and Melinda Gates foundation.

Historical Background

When the United Nations was formed in 1945, there was a consensus among the global leaders as to the formation of a dedicated body on global health. Since medical science was still evolving and we didn’t have many answers as we have now, the healthcare landscape was not very promising. Medical research, achievements, errors and understanding of the common health issues were scattered, a need was felt to consolidate and bring together countries in terms of raising the global health standards. A technical Preparatory Committee was formed on the basis of whose proposals; the constitution of the WHO was adopted by the International Health Conference held in New York City in the year 1946. However, the constitution only came into force in 1948 on the fulfilment of certain technical requirements. Initially, the body comprised of only 55 member states as against it total roll now. 

Constitution and values

 The WHO commits itself to promotion of global health and runs by these principles in its commitment of reaching excellence-

  • Health is inclusive; it is not just defined in terms of the absence of disease and infirmity. 
  • It recognises Right to Health as one of the fundamental rights which must be enjoyed by all. 
  • It necessitates global cooperation in promoting the global standards and links it to peace and security.
  • It acknowledges that progress in health in one country is progress in the other. 
  • It equates health disparities as common danger. 
  • Emphasises on global knowledge sharing 
  • It considers public opinion and participation is integral to better health

 

Global Health Initiatives

  • Polio Eradication– Polio is a highly infectious disabling disease which affects the respiratory muscles mostly in younger children. Although polio paralysis had been there since a long time, the rate of its transmission accelerated in the early 1900’s in the United States.  Despite the virus affecting thousands of children every year in the US and many more in other countries, the first inject able and effective vaccine was formed in the year 1955. Soon after in 1961, oral vaccine was also invented. However, the disease could not be effectively curbed at a global scale unless a planned global approach was put in place.  Global Polio Eradication Initiative was launched by the WHO by passing a resolution in the year 1988. This was followed up by kick-starting various wide reaching national campaigns to bring down the rates of polio cases. The WHO in collaboration with individual countries raised public awareness; enhanced capacity and production of the vaccine to meet the global needs and national immunization days were also coordinated, thus saving millions of children from this lifelong crippling disease.
  • Model List of Essential medicines – Started in 1977, the WHO publishes every two years a list of essential medicines in general and for children which a country must have at all times in prescribed qualities, dosages and affordable prices to cater to the needs of the local population respectively. These essential medicines are the basic medicines setting the minimum standard of availability of medicines which are crucial for addressing the healthcare needs. Compiled by taking into consideration the prevailing diseases, drug efficacy, cost, safety etc, this list ensures that even the poorest of countries have the minimum level of drugs and medicines available and accessible to its population. These lists act as guides to various countries in planning, procurement, circulation and avoiding possible shortages of the drugs. At present, there are 502 and 361 medications listed on the Model List of Essential medicines and Essential Medicines for Children. 
  • Diarrhoeal Disease Control Programme– For some context, it is pertinent to mention that diarrhoea is the leading cause of death among children aged below five. The official figures estimated around 4.6 million deaths in 1980 caused by diarrhoea. This is a serious problem even now if we consider those billions of children who lack access to safe drinking water and sanitation worldwide.  With the efforts of WHO in enabling countries make drinking water accessible and encouraging use of Oral Rehydration Salts, the numbers of diarrhoea related deaths have significantly dropped to 356000 in 2019. As part of its programme, the WHO issued some guidelines to countries which included encouraging people to wash their hands, eliminating open defecation, effective bio waste disposal, providing ORS and other zinc and vitamin A medication to improve body’s resistance. 
  • The Death of Smallpox– Smallpox, once a source of misery for billions is a thing of past and has been totally eradicated from the planet.  The eradication is credited to the WHO which envisioned a smallpox free world in its 1958 assembly session. In the year 1967 a worldwide intensified programme was launched by organising huge manpower in its plan of mass vaccination to actively containing the spread through field surveillance.  The mission would not have been possible had it not been for the thousands of field workers who significantly contained the disease by active surveillance, reporting, quarantining and vaccinating people in their local region even if meant reaching the remotest of areas. From gradually taking regions at a time to revolutionizing the vaccine model to ensuring that each and every person in the world vaccinates against smallpox, the WHO finally declared smallpox as dead in 1980. 
  • Women Reproductive health and rights– In face of growing population crisis and controversial abortion laws of various countries, the WHO has dedicated part of its work on focusing on issues and needs specific to women.  A conference was held wherein in a bid to broaden our understanding of reproductive health, a comprehensive definition was provided and certain rights were recognised.  The right to control pregnancy was furthered by the WHO by including contraceptive pills on the list of essential medicines.  Furthermore, improving maternal health is one of the key priorities of the organisation. It not only recommends and encourages but also strengthens midwifery education as it believes that midwifery intervention can reduce pregnancy related complications. It also started a breastfeeding initiative to increase the rates of breastfeeding as such practice is linked to maternal and child mortality. Member nations were directed to bring in financial as well as legal measures to provide a conducive environment for breastfeeding by regulating advertising practices of breast milk substitutes, counselling, breastfeeding breaks in employment, and paid maternity leaves. The issue around adolescent pregnancy and raising sexual education has also been one of the focus areas of the organisation. Special committees and reports have been put in place to formalise education about one’s sexual health and the associated risks and preventive measures.  
  • Combating HIV Aids– Remember that ad wherein a HIV patient was terminated from his job because of his diagnosis and how his colleagues stood against the employer and exhibited support and solidarity to bring him back?   In addressing this pressing medical issue, it is important for us to not just detect, report and treat patients with HIV Aids but also to end the stigma and shame associated with it. The approach of the WHO was simple yet elaborate, first to raise awareness about the virus and its potential causes , fast tracking testing and early detections, then making affected people access treatment and care options and to cut the shame around it. The goal of the WHO was to bring down the numbers of the HIV affected persons globally and also related deaths. This was done by launching programs like “3 by 5” which focused n accelerating HIV services including treatment to the affected. This was equally important to curb further transmission in newborns since treatment could drop the chance of transmission to just 1%. Furthermore, ending the stigma around it encouraged more people to come forward and seek timely medical intervention.  
  • Declaring health emergencies– In 2005, under the International Health regulations, WHO undertook the role to mitigate, prevent and monitor health emergencies. However, help from the WHO can come only when countries themselves seek so in case of national emergencies. But in case where such emergency acquires international character, the WHO holds the exclusive right to declare such emergency as well as take steps to combat it in terms of issuing guidance on response by the affected countries, tracking data and offering treatment guidelines. To quote a few examples; 2009 swine flu epidemic, Ebola outbreak in West Africa, Zika virus 2016, and global pandemic Covid-19. During the recent Covid pandemic, WHO coordinated international efforts by providing supplies, protective equipment and offering technical guidance to countries worldwide.  It also played an integral role in raising awareness about the issue, issuing public precautionary guidelines and clearing public doubts and queries by conducting expert seminars and podcasts.
  • Education– the WHO has tremendously improved public engagement by keeping them updated about the heath policies, plans and issues. The publicly accessible website of the organisation is a repository of educational resources ranging from online journals, research papers, publications, info graphics, documentaries etc. It also runs separate podcast series on various global health topics and online newsroom where the goal is to keep the public and the member nations informed of the changing scenarios around the world. It even offers various e-guides like labour care guide, midwifery educational kit, neglected tropical diseases, hand hygiene, waste management and so on. 
  • Mental Health Awareness– In May, 2013, the WHO adopted Comprehensive Mental Health Action Plan to promote inclusion and awareness on mental health. It was a significant achievement in the sense as it called for international coordinated response on dealing with people with mental disorders, providing care, ending stigmatisation and treating mental health at par with any other health issue. The 2013 plan was followed up and built on by other subsequent metal health action resolutions. The various resources like Mental Health Atlas (tracking policies and strategies), suicide data, MinDBank online database (offering educational resources on legal frameworks, rights, conventions etc), celebrating World Mental Health Day, bear testament to its commitment in promoting and valuing mental health.

 

Conclusion

WHO has taken a pioneering role in promoting global health by providing effective leadership on framing international policy matters.  The various initiatives as discussed above testify to the organisation’s commitment to realising public health goals. The current success can be credited to its approach towards health in covering all the possible aspects with curbing public health emergencies, spearheading vaccination programs to exploring mental and sexual health. Though it has received some criticism in terms of its functioning on its delayed response on Ebola outbreak and plummeting finance, new reforms like creating emergency funds, reserve force, moving staff on rotational basis etc hold a promising picture for its future endeavours.

References

 

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