Define International Health. Structures and functions of WHO. International Health Regulations 2005 and amendments done later on. Give answer from Park's Textbook of Preventive and Social Medicine

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International Health, WHO Structure & Functions, and IHR 2005

From Park's Textbook of Preventive and Social Medicine

INTERNATIONAL HEALTH - Definition and Origin

"Nothing on earth is more international than disease," said Paul Russel. Health and disease have no political or geographical boundaries. Disease in any part of the world is a constant threat to other parts.

International health refers to the body of knowledge, skills, and activities directed towards improving the health of all peoples of all nations, with particular emphasis on health conditions in the developing world and on the health consequences of international transactions.

The origin of international health work lies in quarantine. In the 14th century, a procedure known as "quarantine" was introduced in Europe to protect against the importation of plague - ships, crews, travellers and cargoes suspected of harbouring infection were detained for a 40-day period. Different countries adopted different quarantine procedures, causing serious inconveniences to international trade and travel. This necessitated international agreement and cooperation - giving birth to organised international health work.

HISTORICAL EVOLUTION OF INTERNATIONAL HEALTH ORGANIZATIONS

1. First International Sanitary Conference (1851)

The origin of international health cooperation dates back to 1851, when an international sanitary conference - the first of its kind - was convened in Paris. It was attended by European countries (Austria, France, Great Britain, Greece, Portugal, Russia, Spain) plus Turkey and Italian sovereign states. Its objective was to introduce order and uniformity into quarantine measures. An international sanitary code of 137 articles dealing with cholera, plague and yellow fever was prepared, but never came into force (ratified by only 3 countries). Between 1851 and 1902, no fewer than 10 conferences took place, equally unable to reach agreement.

2. Pan American Sanitary Bureau (1902)

Established in 1902 in the Americas to coordinate quarantine procedures. In 1924, "The Pan American Sanitary Code" was signed. In 1947 reorganized as the Pan American Sanitary Organization (PASO), which in 1949 became the WHO Regional Office for the Americas, and in 1958 renamed the Pan American Health Organization (PAHO) - the World's first international health agency, headquartered in Washington, D.C.

3. Office International D'Hygiene Publique (1907)

At the 1903 International Sanitary Conference, it was decided to establish a permanent International Health Bureau. This led to the creation of the Office International d'Hygiene Publique (OIHP) in 1907.

4. Birth of WHO

The WHO has its origin in April 1945, during the San Francisco Conference to set up the United Nations. Brazil and China proposed that an international health organization be established. The constitution was drawn up at an International Health Conference in New York in 1946. The same conference set up an "Interim Commission." Ratifications were secured by 7th April 1948, when WHO formally came into existence as a specialized agency of the United Nations.

WORLD HEALTH ORGANIZATION (WHO)

The World Health Organization is a specialized, non-political, health agency of the United Nations, with headquarters at Geneva. The constitution came into force on 7th April 1948 - celebrated every year as "World Health Day."

The WHO is unique among UN Specialized Agencies in that it has its own constitution, own governing bodies, own membership and own budget. It is part of, but not subordinate to, the United Nations.

Objective

The objective of WHO is "the attainment by all peoples of the highest level of health" - set out in the preamble of the Constitution. The preamble also includes the celebrated definition:

"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

It further states that:

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic and social condition.
The health of all peoples is fundamental to the attainment of peace and security.
Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.
Governments have a responsibility for the health of their peoples.

Membership

Membership in WHO is open to all countries. As of the time of writing, WHO has 194 member states and two associate members. Territories not responsible for their own international relations may be admitted as associate members (who participate without vote). Each member state contributes yearly to the budget.

STRUCTURE OF WHO

The WHO consists of three principal organs:

(a) The World Health Assembly (WHA)

This is the "Health Parliament of Nations" and the supreme governing body of WHO. It meets annually, usually in May, generally at headquarters in Geneva.

Composed of delegates representing Member States, each with one vote
Main functions:
1. To determine international health policy and programmes
2. To review the work of the past year
3. To approve the budget for the following year
4. To elect Member States to designate persons to serve on the Executive Board
5. To appoint the Director General on the nomination of the Executive Board
On the occasion of each Health Assembly, "technical discussions" on subjects of world interest are organized.

(b) The Executive Board

Currently has 34 members, each designated by a Member State
Members must be "technically qualified in the field of health" - they are designated by, but do not represent, their governments
One-third of the membership is renewed every year
Meets at least twice a year - generally in January and shortly after the WHA in May
Main work: to give effect to the decisions and policies of the Assembly
Also has power to take emergency action (epidemics, earthquakes, floods) where immediate action is needed

(c) The Secretariat

Headed by the Director General, who is the chief technical and administrative officer
Primary function: to provide Member States with technical and managerial support for national health development programmes
By 2010, staffed by about 8,000 health and other experts and support staff
At WHO headquarters in Geneva, there are 5 Assistant Director Generals

Secretariat Divisions (as listed):

Division of epidemiological surveillance and health situation and trend assessment
Division of communicable diseases
Division of vector biology and control
Division of environmental health
Division of public information and education for health
Division of mental health
Division of diagnostic, therapeutic and rehabilitative technology
Division of strengthening of health services
Division of family health
Division of non-communicable diseases
Division of health manpower development
Division of information systems support
Division of personnel and general services
Division of budget and finance

WHO REGIONAL ORGANIZATIONS

In order to meet the special health needs of different areas, WHO has established six regional organizations:

Region	Headquarters
1. South East Asia (SEARO)	New Delhi, India
2. Europe (EURO)	Copenhagen, Denmark
3. Eastern Mediterranean (EMRO)	Cairo, Egypt
4. The Americas (PAHO/AMRO)	Washington D.C., USA
5. Africa (AFRO)	Brazzaville, Congo
6. Western Pacific (WPRO)	Manila, Philippines

SEARO covers: Bangladesh, Bhutan, India, Indonesia, Korea (DPR), Maldives Islands, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste (11 members). Its activities cover malaria eradication, TB control, communicable diseases, health laboratory services, vaccines, public health administration, maternal and child health, nursing, environmental health, nutrition, mental health, dental health, and medical rehabilitation.

WORK (FUNCTIONS) OF WHO

WHO's first Constitutional function is to act as the directing and coordinating authority on all international health work. The eight major areas of work:

1. Prevention and Control of Specific Diseases

Communicable diseases form the core of WHO activities. The global eradication of smallpox is an outstanding example of international health cooperation.
WHO now directs the global battle against poliomyelitis.
Epidemiological surveillance of communicable diseases through the Weekly Epidemiological Record (WER) and the Automatic Telex Reply Service (ATRS).
Non-communicable diseases: cancer, cardiovascular diseases, genetic disorders, diabetes, blindness, mental disorders, drug addiction and dental diseases.
Vector biology and control, immunology, drug quality control, Expanded Programme on Immunization (EPI) as a priority programme.

2. Development of Comprehensive Health Services

Promotes and supports national health policy development and comprehensive national health programmes.
Activities include organizing health systems based on primary health care, development of health manpower, building of long-term national capability.
Appropriate Technology for Health (ATH): a programme encouraging self-sufficiency in solving health problems.

3. Family Health

A major programme activity since 1970.
Broadly subdivided into maternal and child health care, human reproduction, nutrition and health education.
Chief concern is improvement of the quality of life of the family as a unit.

4. Environmental Health

WHO advises governments on basic sanitary services.
Activities directed to protection of quality of air, water and food; health conditions of work; radiation protection; early identification of new hazards.
WHO Environmental Health Criteria Programme; WHO Environmental Health Monitoring Programme.

5. Health Statistics

WHO has been concerned with dissemination of morbidity and mortality statistics since 1947.
Data published in: (a) Weekly Epidemiological Record (b) World Health Statistics Quarterly (c) World Health Statistics Annual.
Publishes the International Classification of Diseases (ICD), updated every 10th year. The Tenth Revision (ICD-10) came into effect from 1st January 1993.
Provides assistance to countries in improvement of medical records and planning national health information systems.

6. Biomedical Research

WHO does not itself do research, but stimulates and coordinates research work.
Has established a worldwide network of WHO Collaborating Centres.
Established Regional Advisory Committees on health research, plus a Global Advisory Committee.
Six tropical diseases targeted by the WHO Special Programme for Research and Training in Tropical Diseases: malaria, schistosomiasis, trypanosomiasis, filariasis, leishmaniasis and leprosy.

7. Health Literature and Information

WHO acts as a clearing house for information on health problems.
Publications comprise hundreds of titles on health subjects.
WHO library is one of the satellite centres of the Medical Literature Analysis and Retrieval System (MEDLARS) of the U.S. National Library of Medicine.
MEDLARS is a fully computerised indexing system covering medicine on an international basis.
A public information service is maintained at both headquarters and each of the six regional offices.

8. Cooperation with Other Organizations

WHO collaborates with the UN and other specialized agencies, and maintains working relationships with various international governmental organizations (UNICEF, FAO, World Bank, ILO, etc.).

INTERNATIONAL HEALTH REGULATIONS (IHR) 2005

Background and Historical Context

Under the earlier International Health Regulations (IHR 1969, Third Annotated Edition 1983), certain prescribed diseases were notifiable to WHO. These were categorized as:

(a) Diseases subject to IHR (1969): cholera, plague and yellow fever
(b) Diseases under WHO surveillance: louse-borne typhus fever, relapsing fever, paralytic polio, malaria, viral influenza-A, SARS, smallpox, etc.

Health administrations are required to notify WHO Geneva of any communicable diseases under international surveillance and the IHR.

IHR 2005

The International Health Regulations 2005 represent a major revision of the 1969 IHR. They entered into force on 15 June 2007. The IHR (2005) cover a broader scope than the previous regulations, extending beyond specific disease lists to include any Public Health Emergency of International Concern (PHEIC).

Key features include:

Obligatory notification by Member States to WHO of events that may constitute a PHEIC
Requirement for core public health capacities at national and local levels
The use of a decision instrument (algorithm) to assess whether an event constitutes a PHEIC
Measures applicable to travellers, ports of entry, conveyances, and goods

Diseases Subject to IHR (2005)

Member States are required to notify WHO immediately of any confirmed case of:

Smallpox
Poliomyelitis (due to wild-type poliovirus)
Human influenza caused by a new subtype
SARS (Severe Acute Respiratory Syndrome)

(These four diseases always require notification under IHR 2005 regardless of context.)

Other events notifiable when they may constitute a PHEIC include: cholera, pneumonic plague, yellow fever, viral haemorrhagic fevers, West Nile fever, and any event of potential international public health concern.

Note: Since 2005, cholera notification is no longer mandatory internationally as it was under the old IHR.

Amendment to IHR 2005 - Yellow Fever Vaccination (2014/2016)

In May 2014, the World Health Assembly adopted an amendment of IHR (2005) concerning yellow fever vaccination:

"The period of protection afforded by yellow fever vaccination, and the term of validity of the certificate will change from 10 years to the duration of the life of the person vaccinated."

On 11th July 2016, this amendment entered into force and is legally binding upon all IHR states.
Lifetime validity applies automatically to all existing and new certificates, beginning 10 days after the date of vaccination.
As of 11th July 2016, revaccination or a booster dose of yellow fever vaccine is not required for international travellers as a condition of entry into a State Party, regardless of when the original certificate was issued.
In India, the lifetime validity of yellow fever vaccination applies automatically.

International Certificate of Vaccination

India and most other countries require a valid certificate of vaccination against yellow fever from travellers coming from infected areas.
A few countries (including India) require this even if the traveller has only been in transit.
India requires vaccination of infants (≥ 9 months of age) coming from endemic areas.

IHR Implementation - India's Approach

Measures to restrict spread of yellow fever (a receptive area for yellow fever) under IHR are implemented through stringent aerial and maritime traffic regulations covering:

Travellers: Valid international certificate of vaccination against yellow fever required before entry into receptive areas. Without certificate, quarantine in a mosquito-proof ward for 6 days.
Mosquitoes: Aircraft and ships from endemic areas subjected to aerosol spraying with prescribed insecticides; airports and seaports kept free from breeding of insect vectors over an area extending at least 400 metres; Aedes aegypti index kept below 1%.

Source: Park's Textbook of Preventive and Social Medicine (ISBN: 9789382219163), Chapter 25 (International Health and WHO), pp. 1020-1025; and relevant sections from chapters on Communicable Diseases and Yellow Fever.

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