World Health Organization (WHO)

DEFINITION: The World Health Organization (WHO) is a specialized agency of the United Nations that fights illness and disease all over the globe.

Functions and Responsibilities

The World Health Organization (WHO) is a specialized agency of the United Nations. Founded in 1948 and headquartered in Geneva, Switzerland, the organization works to improve health conditions worldwide. It functions under the aegis of the United Nations Economic and Social Council. The governing body of WHO is the World Health Assembly, which is composed of delegations from all member states—194 in 2024. The assembly decides the policies, programs, and budget of the organization. Every three years, the assembly elects members of its thirty-four-member executive board, which oversees the programs and budget for the coming year. These plans are presented for approval by the director general, appointed every five years, who, with a staff of approximately two thousand, is responsible for conducting investigations and surveys.

WHO is divided into six regional subdivisions working in Europe, the Americas, Africa, the eastern Mediterranean, southeastern Asia, and the Western Pacific. These regional organizations have headquarters in Copenhagen, Denmark; Washington, DC; Brazzaville, Congo; Cairo, Egypt; New Delhi, India; and Manila, Philippines, respectively.

The regular budget is contributed directly to WHO by its member states. The United Nations also devotes many resources to funding for technical assistance to underdeveloped countries, of which a substantial part is for health work. Other financial sources are individual donations for promoting good health practices and eradicating malaria. Despite these incomes, there is a continual drain on funds because many underdeveloped countries cannot afford to pay for the drugs, vaccines, or technical medical assistance that they receive.

One of WHO’s enduring achievements has been to communicate to the world an understanding and acceptance of the idea of a common, basic list of drugs. The Model Lists of Essential Medicines—the editions of which are broken down into separate lists for adults and children, each separated into lists of core and complementary drugs—have been a powerful tool in providing scientific justification for the improvement of health standards and practices through publicity, workshops, and training in the developing world. The first list of essential drugs was published in 1977 and included 205 drugs; by 2023, the adult list included just over 500 medicines. The growing lists of drugs are included based on recommendations of expert committees from both developing and developed countries. The committees consist of clinical pharmacologists, health officials, and university professors. The drugs are chosen for efficacy, safety, quality, and stability. By emphasizing generic agents, the list aims to stimulate international competition among drug suppliers and has brought down prices—an important consideration since some countries spend 40 percent of their slim health budgets on drugs.

WHO concerns itself with the needs of those billions of people in the world who are still without regular access to the most basic drugs at the primary health-care level. It seeks to establish equitable access to essential drugs for people. The organization has helped more than 90 percent of its member nations to develop a partly or fully developed essential drugs policy. The Model Lists of Essential Medicines are a valuable resource for countries trying to develop their own national lists. Changes have been made in the lists for several reasons, including oversight or omission, accumulation of more conclusive evidence of the therapeutic advantages of various drugs, and changes in the perceived role of the overall list itself.

WHO attacks communicable diseases in every country through prevention, control, and treatment. The cornerstone of prevention and control is education. Public information is of crucial importance in controlling epidemics. Also vital to many populations is information on nutrition, breastfeeding, personal hygiene, cleanliness, and the use of safe water. Stress is placed on the public’s ability to play an important role in prevention and early detection. With full and accurate information, symptoms may be correctly interpreted and conditions correctly diagnosed, thus preventing the spread of disease.

Various WHO commissions have continued working on projects to improve health standards. Efforts have continued to increase the number of trained medical personnel in many countries. Systems for selecting, procuring, storing, and distributing drugs and supplies more efficiently have continually been refined. WHO remained cognizant of a global range of concerns, from promoting a healthy environment to revising guidelines for ethical conduct in research on an international level.

History

WHO has its roots in the International Sanitary Conferences that took place between 1851 and 1938 and brought together scientists and medical professionals from across the world to combat disease and improve public health. Though their effectiveness was limited by political squabbling, these conferences laid some groundwork for an international health agency. Such efforts were continued by various groups over the years, including the Paris-based International Office of Public Health, formed in 1907. The League of Nations, the precursor to the United Nations (UN), established its Health Organization in 1923.

In the tumultuous years following World War II, several members of the newly formed UN called for an international conference on health. A constitution for WHO was drafted and unanimously passed by the UN member nations in 1946. The organization was officially established on April 7, 1948, later celebrated as World Health Day. Its basic mission was to coordinate global health standards and otherwise develop advice and best practices for public health officials worldwide. It was not intended to focus on hands-on medical work itself, and it held no power to operate in a country without permission or even to require members to heed its recommendations.

At its inception, the priorities of WHO included generally improving public health and hygiene and combating specific diseases such as malaria, tuberculosis, and sexually transmitted infections (STIs). It quickly branched into many other efforts, from disease classification to vaccination campaigns. Many of its programs resulted in substantial progress, including drastic reductions of diseases including polio, cholera, and measles. Among the most notable successes was an intensive twelve-year campaign that led to the eradication of smallpox worldwide in 1979, showing the potential of cooperation between numerous nations and agencies.

Efforts around the World

WHO continued to monitor the spread or decline of disease all over the world. Many of its efforts have had a clear positive impact on public health on a global scale. Vaccine campaigns remained perhaps the most high-profile example, with several notable successes beyond the eradication of smallpox. For example, in 1988, WHO undertook a program to eradicate polio on a global scale, using the polio vaccine. The polio vaccine confers long-lasting immunity and is easy to administer. It remained routinely used to immunize children and adults against polio throughout the world. By the 2020s, WHO's highly successful program had eliminated polio in all but two countries worldwide—Afghanistan and Pakistan—down from more than 125 countries when the Global Polio Eradication Initiative was first launched.

Millions more children have also been immunized against diphtheria, pertussis (whooping cough), measles, and tetanus. Using advanced biotechnology, scientists have worked on keeping vaccines cool in transit to recipients in the tropics. Vaccinating newborns against the hepatitis B virus, a contagious infection of the liver, is another successful campaign by WHO. Immunizing impoverished children remained an ongoing, worldwide program.

Prenatal care and safe childbirth practices also continued to be global concerns of WHO, which has launched many efforts to reduce maternal mortality, especially in developing nations. Apart from such specific causes as excessive blood clots, difficult confinements, infections, and other complications, factors in maternal mortality include anemia, malnutrition, malaria, and simply overwork.

Heavy publicity efforts have been part of the multifaceted WHO campaign to cope with the global acquired immunodeficiency syndrome (AIDS) toll. Statistics have shown that human immunodeficiency virus (HIV) infection has spread rapidly among women and children in sub-Saharan Africa and in Asia. AIDS eroded many of the gains developing countries made in decreasing infant mortality rates during the 1980s and 1990s. Experts working in the field of AIDS have noted that one of the greatest obstacles to prevention is the general lack of basic health care in the developing world, as well as among people experiencing poverty in urban cities. A lack of resources and medicine has compounded the seriousness of AIDS in sub-Saharan African countries. At times, there is no money to buy medicine, even if the supply of medicine exists. Experts have also noted that women’s status and their frequent lack of control over their own sexuality have had dire consequences for the AIDS epidemic in developing countries.

While scientists worked further toward a cure for curing HIV/AIDS, WHO has recommended treating and suppressing the progression of HIV with a combination of at least three antiretroviral (ARV) drugs. Unfortunately, access to these medications has often been severely limited for people with the disease in Africa and Asia. WHO continued to promote better distribution and use of drugs in the developing world, and it also financed drug development studies for promising agents in these countries. In 2003, WHO announced its ambitious “3 by 5” program—getting three million people on critically important antiretroviral therapy (ART) by the end of 2005. Only 300,000 people globally had access to ART at the time, but experts estimated that five to six million people infected with HIV in the developing world needed it. The initiative ultimately fell short of its goal, but the number of people receiving ART did triple. Supplying the developing world with antiretroviral medications remained a key mission of WHO into the 2020s.

Campaigns against other infectious diseases have also been fought by WHO on various fronts. Oral rehydration tablets to cope with diarrhea among children, for example, have proven effective, reducing infant mortality in many countries by 50 percent. Early in the 1950s, Professor Samir Najjar of Lebanon produced a formula for oral rehydration that differed only slightly from the present oral rehydration formula. Then in 1962, a hospital training course in oral rehydration was organized in Alexandria, Egypt, another pioneering effort. Eventually, oral rehydration salts became the standard worldwide treatment of diarrhea in the 1970s.

On several occasions, WHO has been at the forefront of infectious disease outbreaks that make international headlines due to the threat of a global pandemic. It was credited with helping to halt the outbreak of severe acute respiratory syndrome (SARS) that began in 2003, and it also played a prominent role in the response to the H1N1 swine flu outbreak in 2009. In March 2014, an outbreak of Ebola, a severe communicable virus disease, started in Western Africa. WHO's response to the outbreak included monitoring and supportive services, such as community engagement, case management, contact tracing, and infection control, and training, all to help reduce transmission of the Ebola virus and contain the outbreak.

WHO took a similar approach during the coronavirus disease 2019 (COVID-19) pandemic. It declared the viral disease a public health emergency of international concern (PHEIC) on January 30, 2020, as the number of known cases outside of China began to grow. (Soon after, it assigned the official name COVID-19.) It declared COVID-19 a pandemic that March as cases continued to rise around the world. With the highly infectious virus affecting every country in the world, WHO's focus on international coordination was considered vital to the overall management effort. As more information emerged, WHO advised those in impacted locations to shut down non-essential businesses, wear masks when in public, and partake in social distancing.

In addition to focusing on and calling attention to the ongoing mpox outbreaks in African countries, including declaring this spread of the viral disease and its evolving strains a PHEIC, by the early 2020s WHO had continued working on establishing improved international knowledge of and coordinated response to infectious disease outbreaks. Citing weaknesses exposed by the COVID-19 pandemic, the organization oversaw negotiations among member states of a formal agreement meant to strengthen pandemic preparedness, response, and prevention. In 2024, WHO released a global framework for member states to use in investigations of the origins of both new and reemerging pathogens.

Beyond efforts to control infectious diseases, other endeavors by WHO have included “no tobacco” days, laws to facilitate the distribution of drugs and medical supplies, the reduction of prices charged by manufacturers, the provision of more x-ray machines, the elimination of iron deficiency among those who are destitute, and advanced research on amino acids. For example, in the area of nutrition, WHO helped publicize that requirements for each amino acid may be higher than previously recommended; with such knowledge, better protein nutrition can be achieved, and food aid programs can be improved. WHO has also examined and advocated about the health impacts of environmental issues such as ozone depletion, pollution, deforestation, and climate change.

Criticism

Despite its successes, WHO has been no stranger to controversy. In 1949 the Soviet Union and several affiliated nations announced their withdrawal from the organization, claiming it was too beholden to the United States. Though they eventually rejoined, it was clear that political tensions could easily strain the agency and its mission. Disagreements over the handling of specific issues also arose over the decades. WHO has been criticized for its cooperation with the International Atomic Energy Agency, which some suggest hampered research into the effects of radiation on human health. Some observers also considered the organization's response to the emergence of the HIV/AIDS epidemic in the 1980s too sluggish.

In the twenty-first century, WHO's response to the H1N1 swine flu outbreak in 2009 was criticized by many for causing panic and exaggerating the danger of the virus while struggling to coordinate vaccine distribution. Allegations of corruption also began to appear, as some questioned whether the organization had benefited from vaccines that proved to be drastically over-produced. WHO's response to the Ebola outbreak in West Africa in 2014 was even more widely criticized as ineffective. The organization downplayed the outbreak at first and subsequently struggled with the logistics of taking on the response.

Political tensions also continued to complicate WHO's image, perhaps most notably regarding Taiwan and China. Taiwan, which China viewed as a breakaway province, was allowed to observe WHO meetings between 2009 and 2016 but barred from membership due to pressure from China. Taiwan's delegates to WHO were then refused entry to the annual assembly meeting in 2017 as Chinese pressure increased. Some observers suggested that influence from powerful member states, particularly China, compromised the integrity and effectiveness of WHO. In the 2020s, the United States urged WHO to consider allowing Taiwan to attend meetings, if only as an observer.

These tensions were thrust into the spotlight during the COVID-19 pandemic. WHO initially suggested there was no evidence of human-to-human transmission of the virus and recommended against precautionary travel bans; after human-to-human transmission was eventually confirmed, some observers criticized the organization for being too trusting of China and not moving fast enough to warn of the true threat level. Criticism of WHO's response continued as the pandemic progressed, particularly from the administration of US president Donald Trump. In April 2020, Trump announced that the United States would halt its funding to the organization—the single largest contribution of any nation, at $400 to $500 million annually. He accused WHO officials of mismanagement and even covering up the spread of the disease, particularly by pandering to China. Yet supporters of WHO stood by its actions and pointed out that the organization was responsible to all its member states, including China, and did not have the authority to force any nation to comply with a specific timetable. In May 2020, Trump announced that the United States would withdraw from WHO completely, and his administration formally notified the United Nations of this intent that July. However, President Joe Biden, shortly after his ascent to the presidency in 2021, reversed these moves, keeping the US part of WHO.

Bibliography

"Advice for the Public: Coronavirus Disease (COVID-19)." World Health Organization, 18 Mar. 2023, www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Accessed 4 Sept. 2024.

Beigbeder, Yves. The World Health Organization. M. Nijhoff, 1998.

Blinken, Antony J. “Taiwan as an Observer in the World Health Assembly—United States Department of State.” State Department, 9 May 2023, www.state.gov/taiwan-as-an-observer-in-the-world-health-assembly-2. Accessed 5 Aug. 2023.

Burci, Gian Luca, and Claude-Henri Vignes. World Health Organization. Aspen, 2004.

Crowe, Jack. “How Coronavirus Has Challenged the World Health Organization.” National Review, 26 June 2020, www.nationalreview.com/2020/06/how-coronavirus-has-challenged-the-world-health-organization/. Accessed 25 Jan. 2022.

The Fourth Ten Years of the World Health Organization: 1978–1987. WHO, 2011.

Grahame, Deborah A. World Health Organization. Gareth Stevens, 2003.

“History of WHO.” World Health Organization, www.who.int/about/history. Accessed 4 Sept. 2024.

Huang, Pien. “Explainer: What Does the World Health Organization Do?” NPR, 19 May 2020, www.npr.org/sections/goatsandsoda/2020/04/28/847453237/what-is-who-and-what-does-it-do. Accessed 25 Jan. 2022.

Lee, Kelley, and Jennifer Fang. Historical Dictionary of the World Health Organization. 2nd ed., Scarecrow, 2013.

"Obesity Drugs Don't Make WHO's Essential List, but Ebola, MS Drugs Added." Reuters, 26 July 2023, www.reuters.com/business/healthcare-pharmaceuticals/obesity-drugs-dont-make-whos-essential-list-ebola-ms-drugs-added-2023-07-26/. Accessed 4 Sept. 2024.

"Pandemic Prevention, Preparedness and Response Accord." World Health Organization, 10 June 2024, www.who.int/news-room/questions-and-answers/item/pandemic-prevention--preparedness-and-response-accord. Accessed 4 Sept. 2024.

“Poliomyelitis (Polio).” World Health Organization (WHO), www.who.int/health-topics/poliomyelitis#tab=tab‗1. Accessed 4 Sept. 2024.

"WHO Director-General Declares Mpox Outbreak a Public Health Emergency of International Concern." World Health Organization, 14 Aug. 2024, www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern. Accessed 4 Sept. 2024.

"WHO Launches Global Framework for Understanding the Origins of New or Re-emerging Pathogens." World Health Organization, 4 Sept. 2024, www.who.int/news/item/04-09-2024-who-launches-global-framework-for-understanding-the-origins-of-new-or-re-emerging-pathogens. Accessed 4 Sept. 2024.