## Post-war politics and international health cooperation [[WHO is pulled between health ideologies they should promote, between social medicine advocated by UK and Belgium versus United States' focus on individual risk factors]] Within international health, rising tensions between the United States and the Soviet Union brought into relief fundamental philosophical and ideological perspectives about the determinants of health and disease. This brought into greater relief the schism between those who envisioned an organization that embraced the values and goals of social medicine, and those who sought to circumscribe its mandate to, for example, disease surveillance and control. Social medicine was viewed suspiciously by a US government already preoccupied with the perceived geopolitical threat of the Soviet Union, dampening enthusiasm for a strong institution with a wide-ranging mandate. [[The United States was also fiercely protective of the independent status of Pan American Health Organization]] (PAHO, see below), and did not favor its subordination to another institution. [[Pan American Health Organisation (PAHO)]] The WHO Constitution came into force on 7 April 1948 (celebrated every year since as World Health Day) and the WHO came into formal existence in September 1948 as the UN specialized agency for health. Canadian Brock Chisholm, who served as one of 16 international experts consulted in drafting the agency’s first Constitution, was elected as the WHO’s first Director-General. > [!NOTE] Box 1.1 Brock Chisholm as the first WHO Director-General > George Brock Chisholm (1896–1971) became WHO’s first Director-General in 1948. Born in Canada, Chisholm served in the First World War before returning home to earn his medical degree from the University of Toronto in 1924. He then interned in England where he specialized in psychiatry. After six years in general practice in Ontario, he attended Yale University where he specialized in the mental health of children. At the outbreak of the Second World War, Chisholm rapidly rose within the Canadian military and government. He joined the war effort as a psychiatrist dealing with psychological aspects of soldier training before rising to the rank of DirectorGeneral of the Medical Services, the highest position within the medical ranks of the Canadian Army. He was the first psychiatrist to head the medical ranks of any army in the world. In 1944, the Canadian Government created the position of Deputy Minister of Health. Chisholm was the first person to occupy the post and held it until 1946. The same year Chisholm also became the Executive Secretary of the Interim Commission of WHO. He served as one of 16 international experts consulted in drafting the agency’s Constitution. As a committed internationalist, he was strongly committed to fostering collective health action across countries. This was demonstrated by the Egyptian cholera epidemic of 1947–48 during which he successfully facilitated efforts between Egypt and its neighbors to prevent the spread of the disease, including quarantine precautions. International aid to supply vaccines was also effectively mobilized. In 1948 Chisholm was elected as WHO’s first Director-General on a 46–2 vote. ==His own beliefs, that ill health was attributable to the shortcomings of human beings rather than biomedical factors, strongly influenced his tenure==. He famously stated, “The world was sick, and the ills from which it was suffering were mainly due to the perversion of man, his inability to live at peace with himself. The microbe was no longer the main enemy; science was sufficiently advanced to be able to cope with it admirably. If it were not for such barriers as superstition, ignorance, religious intolerance, misery and poverty.” He was especially moved by reports of the health consequences resulting from the atomic bombs dropped on Nagasaki and Hiroshima. In addition, Chisholm stressed the need to give attention to the importance of both physical and mental health. This belief is reflected in the broad definition of health within WHO’s Constitution. Refusing re-election, Chisholm remained Director-General until 1953 when he was succeeded by Marcolino Candau. Source: Compiled from Allan Irving, Brock Chisholm, Doctor to the World (Markham: Fitzhenry and Whiteside, 1998) ## Defining the mandate of the WHO WHO embodied the aspirations and principles of social medicine with its broad and inclusive vision of health development and cooperation. > This vision of the WHO’s mandate was viewed with some suspicion by those who equated the goal of social equity with the spread of postwar Communism. While this perceived association was erroneously simplistic, advocates of social medicine were clearly located on a different point in the political spectrum to those advocating a restricted role for government in the health sector. One important task for the WHO during its early years was the revision and conslidation of the International Sanitary Regulations, which were deemed to be "largely ineffective... [and] hampered inter alia by a lack of consistency and uniformity in their implementation." > In May 1951, the International Sanitary Regulations, renamed the International Health Regulations (IHR) in 1956, were adopted by the WHA. The IHR (1951) was a revision and conslidation of the recommendations of the proceeding 13 International Sanitary Conventions. WHO does not implement its own recommended policies but rather enables other organizations to do so. The current debate focuses on the identification of “core functions” of the WHO compared with those of other global health initiatives. These might include: 1. providing leadership on matters critical to health and engaging in partnerships where joint action is needed;  2. shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3. setting norms and standards and promoting and monitoring their implementation; 4. ==articulating ethical and evidence-based policy options==;  5. providing technical support, catalyzing change, and building sustainable institutional capacity; and  6. monitoring the health situation and assessing health trends. ## Who's in and who's out: human rights versus power politics Something about US, China, Taiwan, and the other geopolitics matter. Israel and Palestine was also mentioned here. ## Conclusion The conception, birth and formative years of the WHO were shaped by two strong and, at times, opposing influences. The first were the public health experts of the Technical Preparatory Committee who envisioned an organization of universal membership, acting to address the world’s physical and mental health needs through a broad range of collaborative activities. The organization was to be guided by the values of social equity and internationalism, serving humanitarian rather than selfinterested goals. The WHO’s Constitution, emphasizing health as a human right, has been the most lasting legacy of this perspective. The second influence came from those who located the WHO firmly within the geopolitics of the Cold War. In this context, the organization was expected to enhance international health cooperation, but within a confined range of activities. Health needs were largely defined in terms of diseases, notably epidemic infectious diseases, and the organization was expected to focus its efforts on controlling disease agents and supporting the delivery of scientific and technical interventions. The WHO remained subordinate to the UN as a whole, and efforts to place health goals above power politics were pointedly rejected. As shown in subsequent chapters, these two visions of the WHO would be an ongoing source of tension.