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26 August 2011

World Health Organization (WHO)

The World Health Organization (WHO) is a specialized agency within the United Nations (UN) organization. The UN is an international organization that serves as a leader on many issues, including political conflicts, education, agriculture, and the environment.

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BACKGROUND

The World Health Organization (WHO) is a specialized agency within the United Nations (UN) organization. The UN is an international organization that serves as a leader on many issues, including political conflicts, education, agriculture, and the environment.

The WHO is an international public health agency that coordinates and responds to global public health threats. It supports and conducts health-related research and works toward improving the health of the global community.

The WHO comprises 193 member countries. Members join the WHO in one of two ways: by signing the WHO's constitution or by being voted into the WHO by a majority of delegates. This body elects the Director-General (the head of the WHO) and the Executive Board, and also votes on pertinent issues, such as the WHO's budget and policies.

The WHO has six regional offices, in Washington, Manila, New Delhi, Cairo, Brazzaville, and Copenhagen; 147 country offices; and a headquarters in Geneva. More than 8,000 people work for the WHO. These professionals include scientists, doctors, public health officials, and administrators.

The WHO partners with other international agencies, governments, nongovernmental organizations, companies, UN agencies, and individuals to meet its goals. Partners include the U.S. Agency for International Development (USAID), the Bill and Melinda Gates Foundation, the UN Children's Fund (UNICEF), the U.S. Centers for Disease Control and Prevention (CDC), and the World Bank.

In July 1946, the newly formed United Nations held an International Health Conference that was attended by delegates from 61 countries. The WHO's delegates ratified and enacted the WHO Constitution in 1948. The constitution established the WHO's role as an international public health agency and defined its objectives and mission. In 1977, 1994, and 2005, the World Health Assemblies (the governing body of the WHO) adopted amendments to the original constitution.

The first World Health Assemblies focused on several issues that greatly affected global health. These included diseases such as malaria and tuberculosis. Malnutrition, clean water, and the health of women and children were also priorities.

In 1948, in one of its first official duties, the WHO took over the International Classification of Disease, a catalogue of all known diseases that serves as the criteria for the identification of disease by medical and epidemiological experts.

In 1975, the WHO developed a list of essential medicines necessary for good health. In 1977, the Essential Medicines List was first published. It contained 208 medications that addressed priority public issues, including acetylsalicylic acid (a mild pain reliever), activated charcoal (an antidote for poisoning), and dextran 70 (which increases the volume of blood plasma). Every two years, a team of experts reviews the list and updates the medication information. The list contains more than 300 medications.

Since it was established in 1946, the WHO has met several goals for eradicating or reducing the incidence of certain diseases. In 1965, after a 13-year-long program, the incidence of yaws was decreased by 95% after treating millions of people worldwide with penicillin. The Onchocerciasis (also called river blindness) Control Program in West Africa greatly reduced the risk of infection and opened up 25 million hectares of river land to agriculture. In 1979, a 12-year-long control program culminated in the eradication of smallpox. A similar program to eliminate polio has cut infections by 99% after the immunization of two billion children. In 2003, the WHO discovered Severe Acute Respiratory Syndrome (SARS). The WHO spearheaded the global surveillance of and response to the SARS pandemic with its Global Alert and Response (GAR) network, a coordinated effort to prepare for, monitor, and respond to epidemics.

The WHO has established several programs to address specific health issues, such as tobacco use and physical fitness. In 2003, the World Health Assembly voted to enact a treaty to decrease the incidence of disease and ill health brought on by tobacco use. In 2004, the WHO established the Global Strategy on Diet, Physical Activity, and Health.

The WHO responds to health crises brought on by political conflict and environmental disasters. The WHO's Health Action in Crises are teams of experts that work with WHO member countries to respond to these crisis situations. The WHO responded to the outbreak of SARS, H1N1 influenza, the South Asian tsunami, and various conflicts.

The WHO's International Health Regulations (IHR) standardizes member countries' responses to disease outbreaks. The WHO monitors and investigates member countries' actions, although no mechanism for the enforcement of the IHR is currently in place.

TECHNIQUE

General: The World Health Organization (WHO) is a part of the United Nations (UN) system and is an international authority on public health. The WHO is involved with health research, public health policy, and helping countries achieve international and national public health goals.

Constitution: The WHO Constitution defines the organization's role, objectives, and mission. The Constitution defines health and its role in the lives of human beings. According to the Constitution, a person's state of health is physical, social, and mental well-being. The attainment of a healthy state of being is one of the basic human rights afforded to every person, regardless of his or her background. The Constitution also establishes the importance of understanding human health and disseminating that knowledge to all people. The Constitution established it as a specialized agency of the United Nations.

Functions: The functions of the WHO, as set out by the Constitution, are to act as an international authority on public health and health issues, to collaborate with other relevant groups and agencies, to support countries in attaining health goals, to promote research into health issues, and to encourage health training. Some of the health issues of interest to the WHO are the treatment and eradication of disease, the prevention of injury, and the improvement of environmental and occupational conditions. Other interests include improved maternal, child, and mental health.

Participants: The Constitution also establishes how countries may participate in WHO activities. Membership in the WHO is open to all countries that are also member states of the United Nations. To become a member state in the WHO, delegates of the member state sign the WHO Constitution, agreeing to uphold its objectives and mission, or are voted into membership by a majority of delegates from the World Health Assembly. The Constitution also defines associate memberships in the WHO.

Structure: The Constitution establishes how the WHO is governed and by whom. It also outlines how frequently these bodies will meet and what they should aim to accomplish at these sessions. It establishes the duties and obligations of the WHO staff, the locations of headquarters and regional offices, and the process of proposing and executing budgets and financing. The Constitution also requires that a General Program of Work that outlines the WHO's objectives for a specific period of time be submitted to the governing body for approval.

Governance: The WHO's policies are set by a delegation made up of representatives from 193 member states (countries). Territories that are not yet members of the United Nations may also join the WHO as Associate Members.. This governing body, called the World Health Assembly, meets annually in Geneva, Switzerland. Member states are allowed to assign no more than three delegates to the Assembly. These delegates are required to have health expertise. The Assembly chooses the head of the WHO (the Director-General) every five years and assesses the budget and other financial matters. It also directs the Executive Board as to what issues should be its focus.

Executive Board: The Executive Board is made up of 34 health experts, which may include public health researchers, doctors, nurses, and health administrators. These experts are appointed to the position by member states that are elected by the World Health Assembly to a three-year term.

The Board is divided into committees that address different policy issues, including program development, administration, budget, finance, and audit. The Board creates a General Program of Work that is submitted to the Assembly for approval. The Board sets the agenda for the World Health Assembly and nominates the Director-General. It also supports the WHO staff in acting on the agenda and policies set by the Assembly. The WHO staff (also called the Secretariat) consists of 8,000 health professionals and administrators who work at international, regional, or national levels in more than 150 countries.

Structure: The Secretariat of the WHO is divided among its headquarters in Geneva, Switzerland; six regional offices located in Brazzaville, Congo (African region); Washington, D.C. (region of the Americas); New Delhi, India (South-East Asian region); Copenhagen, Denmark (European region); Cairo, Egypt (Eastern Mediterranean region); Manila, Philippines (Western Pacific region); and additional national offices (147 country offices) and local offices. The Secretariat includes doctors, researchers, and experts in public health, epidemiology, economics, and statistics. There are also information, technology, communication, financial, and administrative staff.

Headquarters: The tasks of the international WHO offices (headquarters) are split among 10 divisions. The office of the Director-General houses the Director-General (who is the chief executive of the WHO), the Executive Director, advisers, communications personnel, legal counsel, and the staff of the Framework Convention on Tobacco Control (a smoking abatement program). The General Management handles administrative tasks such as finance, human resources, information technology, and operational support. The Office of Information, Evidence, and Research deals with research policy and management of research data. Additional divisions focus on specific programs at the international level such as Family and Community Health; Health Action in Crises (Emergency Preparedness); HIV/AIDS, TB, Malaria, and Neglected Tropical Diseases; Health Security and Environment; Health Systems and Services; Noncommunicable Diseases and Mental Health; and Partnerships and United Nations Reform.

Implementation: Local and national offices often serve as first points of contact on various health issues and also implement policies at the grassroots level set out by the World Health Assembly. They act as advisors to health officials and support healthcare systems in providing services that are in line with the WHO's policies. In collaboration with other groups and communities, the national offices implement certain programs. They may also fundraise or advocate for particular issues, such as encouraging physical fitness or reducing tobacco-related diseases. The six regional offices focus on health issues that affect their region and provide support to country-based WHO staff. The WHO staff at headquarters also provide support to regional and country staff. They set policy, publicize programs, and mobilize support at an international level.

Core functions: The WHO has six core functions that are priorities guiding the Secretariat in implementing programs and policies. These priorities are: (1) to function as an international leader on health issues and to develop partnerships with relevant groups; (2) to encourage and disseminate health research that furthers knowledge on specific health topics; (3) to create and implement health standards; (4) to promote different policy options that are based on sound research; (5) to create sustainable healthcare systems; and (6) to monitor health trends.

Budget: Voluntary contributions from various groups and nations, and fees paid by members of the World Health Assembly, fund the WHO. In 2006-2007, 72% of the WHO's budget came from voluntary contributions by agencies and other groups, and the remaining 28% came from Assembly member fees.

Voluntary contributions for 2004 came mostly from member states of the World Health Assembly, making up 67% of funding. Seventeen percent was given by the United States and intergovernmental organizations, six percent from foundations, four percent from nongovernmental organizations, two percent from supply services funds, two percent from interest income, one percent from local governments and towns, and one percent from the private sector.

Location: The WHO's budget for 2006-2007 was about $3.3 billion. These funds were divided among the WHO's six regional offices and headquarters. The headquarters received 25% of funding, the Africa region received 30.7%, the Eastern Mediterranean region received 12.3%, the South-East Asian region received 11.6%, the Western Pacific region received 7.5%, the European region received 6.5%, and the Americas region received 6.3%.

Priority areas: The WHO's expenditures for 2006-2007 fell into four categories that were approved by the World Health Assembly. Fifty-three percent of expenses went to essential health interventions, which include immunizations, mental health, malaria, reproductive health, child and adolescent health, tuberculosis, and HIV/AIDS. Twenty-one percent of expenses were used to support members of the World Health Assembly, including planning, infrastructure, and human resources. Thirteen percent of expenses went to health systems and policies, including health technologies, medicines, and health financing. Eleven percent of expenses were used for the factors that influence health, such as nutrition, tobacco, violence, the environment, and food safety.

THEORY/EVIDENCE

General: The World Health Organization (WHO), an international public health agency that is part of the United Nations (UN) system, was created to meet the needs of an increasingly global community, wherein the health issues of one nation can affect another. The WHO works toward the achievement of the highest level of health for the global community, regardless of economic status, gender, ethnicity, or other factors.

Goals: The WHO's public health goals and how they are reached are outlined in its General Program of Work, a report created by the World Health Assembly's Executive Board. The WHO's Eleventh General Program of Work (GPW) focuses on the period between 2006 and 2015. It sets the WHO's core functions during this time: serving as an international leader on health issues, developing partnerships, disseminating health research, creating and implementing health standards, promoting policy options, creating sustainable healthcare systems, and monitoring trends in health.

Current state of health: According to the WHO, increased global life expectancy (six or seven years longer) in the past three decades was spurred by overall cleaner water, better sanitation, improved healthcare, and economic growth. Disparities in health exist, depending on gender, ethnicity, and economic status. Those living in the poorest countries may experience decreased life expectancies due to HIV/AIDS or other factors. For instance, the HIV/AIDS epidemic in sub-Saharan Africa has contributed to declining conditions and health systems, as has increased population in the African region. In contrast, disease prevalence in developed countries has shifted to chronic illnesses, which now make up 60% of diseases globally. These include mental health and tobacco-related diseases. This is due in part to poor diet, inactivity, and alcohol and tobacco abuse.

Current challenges: The most recent GPW acknowledges that in spite of technological developments in the fields of medicine and public health, many global health problems remain. The GPW assesses current challenges and determines how all concerned parties, including the WHO, should address these problems. One of the greatest challenges for this period is collaborating productively with other relevant agencies and groups to achieve public health goals. The WHO's global partnerships have increased in the last decade, which brings new resources to the WHO and affects how the organization addresses public health issues.

Gaps in response: The WHO identifies several areas that hinder the delivery and implementation of public health initiatives. According to the WHO, gaps in the equitable treatment of certain ethnic groups and other communities lead to discrimination, which may negatively impact health. Sexism and racism, for example, in health programs may lead to inadequate care. Differences in life expectancies between the wealthy and poor are another example of how discrimination may impact health. Also, lack of a structured approached to healthcare implementation among the WHO and its partners may affect treatment of medical conditions. Battling drug-resistant bacteria, for example, requires coordination among various sectors, including medical research, finance, and international law. The WHO's resources may not reach all communities due to gaps in the implementation of healthcare programs. Focus may be placed on smaller projects that test new strategies instead of known solutions. Inappropriately focused research may also cause gaps in understanding.

The WHO established a global health agenda for its members and other communities to meet the Millennium Development Goals set out by the United Nations: reducing poverty, addressing health security, encouraging universal and equal healthcare coverage, understanding health determinants, improving healthcare systems and governance, and utilizing scientific research and technology. The members of the United Nations established the Millennium Development Goals in 2000 as a means to improve the lives of people worldwide by the year 2015by addressing poverty, poor health and living conditions, and social injustice.

Specific issues: The WHO focuses its efforts in two specific areas: women's health and healthcare in African nations. Women are often affected by violence, malaria, sexually transmitted diseases, and pulmonary diseases. Death during pregnancy or childbirth may be common in developing nations, although overall women's life expectancies may be longer than men's. Other health issues disproportionately affecting women include tobacco use, HIV infection, and eye diseases.

Sub-Saharan African nations are also disproportionately affected by disease. The WHO created the African Regional Health Report to provide a complete examination of health issues in the WHO's African region. The WHO considers the state of health in Africa as a benchmark for its overall performance.

Publications: The WHO produces numerous publications to achieve its goal of disseminating well-researched, evidence-based health information. The organization as a whole, as well as individual regions, publishes reports summarizing public health data collected and analyzed by the WHO. The WHO also publishes several peer-reviewed, public health journals containing studies submitted by health professions from members of the World Health Assembly.

Reference materials: The World Health Report is an evidence-based assessment of global health produced annually. Every year, the report focuses on one issue or topic and provides health statistics for different countries or regions. The purpose of the report is to inform the public about the health of different countries and raise awareness about health policy decisions.

International Travel and Health is a WHO report that identifies health risks for travelers and outlines vaccinations required by different countries.

The International Classification of Diseases (ICD) classifies and assesses the prevalence of different diseases by groups of people and countries. The data found in this report allow members of the World Health Assembly to compile mortality statistics.

International Pharmacopoeia is a reference resource outlining medicines and other substances (and their dosages) that are used by health professionals for health management.

International Health Regulations are a set of global health policies to encourage health security in WHO member states.

Journals: The WHO publishes journals that feature research on public health policies and promote information sharing. For instance, the Bulletin of the World Health Organization is a monthly, global public health journal that focuses on developing countries. The Eastern Mediterranean Health Journal focuses on health issues in the Eastern Mediterranean region. The Pan American Journal of Public Health is published by and includes studies from the American region office of the WHO. Weekly Epidemiological Record is a weekly report of disease incidence, facilitating fast sharing of public health data. The WHO Drug Information journal is a quarterly publication that focuses on drug development and policies.

HEALTH IMPACT/SAFETY

Millennium development goals: World Health Statistics 2009 includes health information for the 193 countries that are members of the World Health Organization (WHO) and records the progress they are making toward the United Nation's Millennium Development Goals. According to the report, countries greatly affected by economic and political strife and HIV/AIDS are struggling to meet these goals.

Access to medications: The WHO has partnered with pharmaceutical companies to deliver affordable medications to developing countries. According to World Health Statistics 2009, only 35% of public health institutions and 63% of private health institutions in 30 developing countries have access to essential medications, which may lead some people to buy drugs with their own money or not at all.

Malaria: The WHO distributes mosquito nets treated with insecticide to regions where malaria (spread by mosquitoes) is endemic. Malaria incidence dropped by as much as 50% from 1990 to 2006 in 27 countries. In Tanzania, the WHO, the U.S. Agency for International Development (USAID), Technoserve, and BetterWorld Together Foundation supported the planting of Artemisia annua, a plant that produces artemisinin, an antimalarial drug. One hundred thirty-two metric tons of the plant was collected in Tanzania in 2005, although it may be too soon to tell what effect this has had on malaria rates.

Maternal health: Although some Caribbean, Latin American, and Asian countries have reported a drop in the number of deaths during pregnancy or childbirth, overall the maternal mortality rate has not changed since 1990. In 2005, 400 deaths per 100,000 live births were reported, primarily in sub-Saharan Africa.

Hunger: Malnourishment in children younger than five years of age has declined seven percent between 1990 and 2005, although some developing nations are still disproportionately affected by hunger. Studies demonstrate the decline in infant mortality from malnutrition when hospitals follow the WHO protocols for treating severe malnutrition.

Child mortality: Deaths of children younger than five years of age has dropped by 27% from 1990 to 2007 due to several WHO interventions, including the distribution of mosquito netting and insecticides, improved availability of vaccines and clean water, and the treatment of diarrhea with oral rehydration, although diarrhea and pneumonia are still responsible for 3.7 million child deaths.

Clean water: Clean water and adequate sanitation may help reduce deaths due to infectious diseases. Overall, access to clean water and sanitation has increased since 1990, but 900 million people still use water that may be contaminated with pathogens, and 2.5 billion people have inadequate sanitation. WHO data on cholera suggest a higher incidence of the disease in poorer countries with less access to clean water.

HIV/AIDS: According to World Health Statistics 2009, about one-third of people with HIV/AIDS in developing nations received treatment in 2007, and globally the fraction of adults with HIV has remained the same. Deaths from HIV/AIDS continued to rise in Africa, and 2.7 million people were reportedly infected with HIV in 2007.

In Kenya, the WHO, Indiana University, and Moi University have developed an electronic record-keeping system at HIV clinics in rural areas to coordinate testing and treatment for 40,000 patients. Studies indicate that these electronic systems have been successful in raising the level of care received in these areas. The WHO has also recommended that member countries track the development of drug-resistant HIV and support research in the area.

Tuberculosis: Several strains of tuberculosis are resistant to available treatments, making treatment difficult in countries such as Russia. Overall, though, the Millennium Development Goal of decreasing the incidence of tuberculosis was reached in 2004 with the adoption of early detection and treatment strategies. Studies indicate that the average incidence rate of tuberculosis decreased in 93 countries. Good sanitation coupled with a low infant mortality rate may further help reduce the rate of tuberculosis.

Global Alert and Response (GAR): Through the Global Alert and Response (GAR) Network, a coordinated international effort to control epidemics, the WHO leads the global community in fighting outbreaks of disease. The WHO provides verification of disease outbreaks, distributes relevant information, and works with its partners to offer technical assistance and resources during an epidemic. The WHO manages patients and dangerous pathogens, and it provides assistance within 24 hours of the outbreak. GAR establishes a standardized response to disease outbreaks and provides training to member countries for these practices. These diseases include Severe Acute Respiratory Syndrome (SARS), plague, yellow fever, smallpox, influenza, H1N1, anthrax, avian influenza, tularemia, Rift Valley fever, Lassa fever, hepatitis, dengue hemorrhagic fever, Crimean-Congo hemorrhagic fever, Ebola hemorrhagic fever, Hendra virus infection, Marburg hemorrhagic fever, Nipah virus infection, and meningococcal disease.

FUTURE RESEARCH OR APPLICATIONS

Future opportunities: The World Health Organization (WHO) Eleventh General Program of Work (GPW) outlines the objectives and goals of the WHO from 2006 to 2015. According to the GPW, the WHO's future goals include responding rapidly to health crises, acting as a health equity leader (with special consideration to gender equality), boosting national health resources and health systems, and collaborating more with industry and the public.

Medium-Term Strategic Plan: The WHO's Medium-Term Strategic Plan 2008-2013 sets the objectives for the WHO during this period. These objectives include promoting effective universal healthcare systems, improving health security, decreasing factors that undermine health, boosting the capacity of health agencies, and fortifying the WHO's role as a global and regional health leader that assists national and local governments with health issues. These goals are implemented through the guidance of the Medium-Term Strategic Plan 2008-2013 and program budgets that are proposed every two years. According to the Plan, reaching the Millennium Development Goals of 2015 (eight goals set out by United Nations member states, including addressing poverty) will be a challenge unless certain issues are addressed. Disparities exist among nations in terms of health knowledge, putting health agendas into practice, health equity, and responsibility.

Future scenarios: The WHO's Eleventh GPW developed four future public health scenarios based on what is currently understood about global health and predicting what may happen in the future. The first scenario states that the world will likely change steadily, with health following its present course. Although health is expected to improve globally, the WHO predicts that inequalities in health will continue between wealthy and poor nations.

The second scenario presupposes that the world becomes divided by economic recession and political conflicts that lead to violence and shortages of food and water. If this scenario holds true, it is expected to lead to a decline in health conditions.

The third scenario predicts an improvement in economic systems leading to better health conditions, technologies, policies, systems, and health security.

The fourth scenario also predicts improved health that may be attributed to increased cooperation among nations. The WHO predicts that this scenario may lead to successful health prevention, universal health care, and social equity.

AUTHOR INFORMATION

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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Copyright © 2011 Natural Standard (www.naturalstandard.com)
 
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