43rd World Health Assembly: call for increased aid to developing countries for effective health development programmes.

43rd World Health Assembly

Additional support from developed countries was asked to reach the goal of health for all by the year 2000 through primary health care. The Assembly recommended providing this aid through bilateral and multilateral channels, including the World Health Organization (WHO).

The annual meeting was attended by some 1,000 delegates, representing 167 WHO member countries. Dr. Plutarco Naranjo Vargas, Ecuador's Minister of Health, presided. Namibia--formerly an associate member--became a full-fledged WHO member after its 21 March independence, accepting WHO's constitution on 23 April, the same day it became the UN's 160th Member State.

A trust- fund for the reconstruction and development of Namibia's health system is to be established. The Assembly also asked WHO to provide intensified technical cooperation and assistance for health programmes there.

The implementation of special technical assistance to improve the health conditions of Palestinians in the occupied territories was asked, as well as a study of Palestine's application for full WHO membership.

Also requested was a substantial expansion of WHO's programme of health, medical and relief assistance to Lebanon, which had "critical" health problems.

Diagnosis: 'Unacceptable

health conditions'

Dr. Hiroshi Nakajima, WHO Director-General, told the Assembly that "in spite of overal technological and economic progress, especially in the developed world, for the majority of the populatin in many developing countries, the basic conditions for health, socio-economic development and daily living remain unacceptable".

People in developing countries, he stated, "still carry the double burden of having to cope with infectious diseases, while facing many of the degenerative diseases previously associated with development".

He stressed that the health issues of the 1990s could not be dealt with in isolation. "They are inextricably related to issues of development and social equity. We must strive to close the poverty gap both between and within countries." He said that "only in this way can we realize our current hopes and prospects for peace and quality of life, in our time and for future generations".

Dr. Nakajima emphasized that primary health care was the most cost-effective approach to health care with an acceptable quality for all persons.

The Director-General also stressed that, despite gains in agriculture and health technology, there was still evidence in many countries of widespread malnutrition and improper nutritional practices. There was a need to "better confront the increasingly serious problem of malaria control".

Dr. Nakajima noted that "in the past, WHO has concentrated on developing concepts and theories and has striven to achieve symmetry and perfection in its activities". However, he warned, it was clear that "unless we now stress implementation, focusing on activities of the highest priority, a number of Member States will not achieve the goal of health for all by the year 2000".

Zimbabwe President Robert Mugabe and Guilio Andreotti, President of the Council of Ministers of Italy, addressed a special session of the Assembly.

Mr. Mugabe said existing gross inequalities in the health status of people in the world, particularly between developing and developed countries, as well as within countries, were politically destabilizing, socially immoral and economically counter-productive.

He stressed that economic development based on a new international economic order was of fundamental importance if the reduction of the gap in the health status of peoples between developing and developed countries was to be accomplished, and health for all attained.

He also stressed that "health interventions emphasizing the primary health care philosophy will not lead to significant health development if issues like the persistence of mass poverty and hunger, rampant population growth, environmental degradation and agricultural neglect are not simultaneously addressed".

Mr. Andreotti said the health of manking represented an absolute and inalienable right that must be defended "if we wish peace and development to progress jointly in order to realize social justice across the planet". He added: "We need a new civilization based on solidarity, a development process centered on man and his requirements." For that reason, it was necessary to promote all actions designed to improve the quality of life and, in some cases, even to onsure the very right to existence.

He stated that he had been struck by the results of a study showing that the objectives of world health could be effectively attained at the current levels of spending if available funds were used in a more rational and efficient way. That was why he advocated that the UN, WHO and the international community should prepare practical policies which would realize forcefully the principle of participation and the responsibility of local communities. They should not only benefit from assistance, but should also be the agent of their own health development.

Ten new members were elected to the 31-member WHO Executive Board. Designated by Governments, but serving in their individual capacity, the newly-elected members were nominated by China, France, Iraq, Myanmar, Rwanda, Sao tome and Principe, Senegal, Seychelles, the USSR and the United States.

Drugs, AIDS, smoking

WHO Member States were asked to implement measures in the 1990 UN Global Programme of Action against the scourge of drugs, adopted at a special session of the General Assembly held last February, and in the Political Declaration adopted at the World Ministerial Summit to Reduce Demand for Drugs and to Combat the Cocaine Threat, held in London in April.

WHO was also asked to increase its efforts to prevent spread of drug abuse in individuals, families, communities and countries, and to develop effective approaches to the treatment of drug dependence and associated diseases.

Noting that the theme of World AIDS Day on 1 December 1990 will be "Women and AIDS", the Assembly urged Member States to ensure that programmes for the control of the human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) were co-ordinated or integrated with other programmes for women, children and families. They were asked to recognize in the WHO Global Strategy for the prevention and control of AIDS and in their own national AIDS programmes the crucial role of women, and women's and non-governmental organizations in preventing HIV transmission and caring for people with AIDS-related diseases.

The Assembly expressed deep concern at the increasing evidence of the dangers to health posed by "passive smoking"--the result of smoke inhaled by non-smokers. Increased support was asked for the 1988-1995 WHO plan of action to reduce the use of tobacco products and the consequent risks to health.

WHO now estimates that, unless current smoking rates decrease, there will be 3 million tobacco-related deaths per year in the 1990s, rising to 10 million per year by 2020.

Infant nutrition,

hazardous wastes,

tropical diseases

Reiterating concern over the decreasing prevalence and duration of breast-feeding in many countries, the Assembly urged WHO Member States to protect and promote the practice as an essential component of overall food and nutrition policies and programmes on behalf of women and children. The goal should be that all women breast-feed their infants exclusively during the first four to six months of life, the Assembly said.

WHO Member States were also urged to strengthen programmes for environmentally sound management of hazardous wastes, in accordance with health-based standards and extend health surveillance systems to identify adverse effects of actual or potential exposure to hazardous substances.

The Assembly appealed to the pharmaceutical industry to increase research and development regarding tropical diseases and to intensify cooperation with the WHO-United Nations Development Programme (UNDP)-World Bank Special programme dealing with malaria, schistosomiasis, filariasis, onchocerciasis, African trypanosomiasis, Chagas disease, leshmaniasis and leprosy.

Other issues

The Assembly decided that WHO would aim at eliminating iodine deficiency disorders as a major public health problem in all countries by the year 2000. That decision was taken in view of the progress already achieved and the promising potential of current and planned national prevention and control programmes. The International Council for Control of Iodine Deficiency Disorders was commended on its efforts against conditions affecting some 1 billion people throughout the world.

WHO should continue to help the "front-line" States (Angola, Botswana, Mozambique, United Republic of Tanzania, Zambia, Zimbabwe), as well as Lesotho and Swaziland, to solve the acute health problems of South African and other refugees.

Noting the desire of Bolivia, Colombia, Ecuador, Peru and Venezuela--countries of the Andean sub-region of the Americas--to work closely together on selected priority health problems in a true spirit of technical co-operation, the Assembly urged support for the Andean Co-operation in Health Initiative.