International Health

International Health Dr. D.R. Veda priya Assistant Professor Dept. of community Medicine AVMC&H Pondicherry

“ 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.

14 th 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

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

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 2 nd 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 1945 The United Nations Conference in San Francisco, USA, unanimously approves the establishment of a new, autonomous international health organization .

1946 The International Health Conference in New York approves the Constitution of the World Health Organization in July.

1947 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 .

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

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

1950 The 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

2002  Move 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

International health 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

Prevention and Control of specific Diseases

Development of Comprehensive Health Services

Family Health

Environmental Health

Health Statistics

Bio-Medical Research

Health Literature and Information

Cooperation with Other Organization

1. Prevention and Control of specific Diseases

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

1950 Mass TB immunization gets under way as the bacille Calmette-Guerin (BCG) vaccine is used to protect children from tuberculosis .

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

1955 The 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 .

1965 The 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.

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

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

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

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

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

1975 The 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.

1976 The 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.

1977 The 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.

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

1979 A global commission certifies the worldwide eradication of smallpox.

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

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

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

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

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

1996 UNAIDS is created with six founding partner agencies.

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

2000 The 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.

2001 The 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%.

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

2002 The 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.

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

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

2003 The 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.

2003 Severe 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 .

2005 The 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.

2006 Dr 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

7 th April 1948

World Health Day-7 th 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

Prevention and Control of specific Diseases

Development of Comprehensive Health Services

Family Health

Environmental Health

Health Statistics

Bio-Medical Research

Health Literature and Information

Cooperation with Other Organization

1. Prevention and Control of specific Diseases

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 research  Awards 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.

7. Health Literature and Information

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.

Structure

1. 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)

UNICEF

U nited N ations I nternational C hildren’s E mergency F und

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 :

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 .