81 507 April 30, 1986 FOR THE WORLD HEALTH ORGANIZATION THE MOMENT OF TRUTH INTRODUCTION The World Healt h Organization was established decades ago to fight disease and make the world a healthier planet. It by and large has tried to do so and rightfully can claim many successes. In recent years, however, politics seems to be replacing medicine and health on t he WHO agenda. This regrettably seems to be the script for the key WHO two-week meeting which convenes May 5 in Geneva. There the 166 states belonging to WHO will gather as the World Health Assembly WHA the policy making body for the World Health Organiza t ion. It is expected that, as in the past few years, many of the WHA resolutions and actions will ignore health and instead will attack the free world especially the U.S. and Israel, will ridicule free market approaches to health care, will welcome the Pal estine Liberation Organization will promote one-sided disarmament, and will call for technology transfer to the Third World and the Soviet bloc.

At the 1985'WHA meeting, U.S. delegate Neil Boyer of the State Department condemned this politicization of WHO, warning If the Assembly can adopt [resolutions] with no concern for the divisive political attacks made in the debate then we see little hope for the future of WHO WHO Director-General Halfdan Mahler also warned at that meeting against spending precious t ime of the Assembly on extraneous political issues In view of the explicit warnings, this May's meeting is the World Health Organization's moment of truth. The Assembly will have to decide whether the WHO will return to the admirable and laudable vision o f its founders and of its early decades, or whether it will slide down the sorry slope to irrelevance and waste along with so many other United Nations agencies.

Health Organization from politicization. The U.S. delegates must attempt to prevent WHO from becoming still another propaganda forum.

In particular, the U.S. should 1) oppose any extension of the Infant Formula Code to apply to the advertising of other foods consumed by children 2) oppose any further attempts to regulate advertising and promotion of pharmaceuticals 3) oppose attempts to ban tobacco advertising 4) insist on a stronger role for free enterprise approaches to health care delivery 5) submit documents outlining the flaws of WHO studies on nuclear war and disarmament; 6) vote against dou b le standard resolutions aimed at undermining Western defense in the name of "health and development 7) demand that Israel be allowed to participate in WHO'S Eastern Mediterranean region activities; and 8) continue to oppose inflammatory anti-Israel resolu t ions In Geneva next month, the U.S. should try to rescue the World If the Assembly fails at its moment of truth-as other U.N organizations such as UNESCO have failed--then the U.S. must consi withdrawing from the World Health Organization. It should urge 0 th nations to do so also if they truly are concerned about improving planet's health. They and the U.S. could take the money they now spend on WHO and transfer it to other international health organizations more serious about fighting for health than scor i ng political points I GLOBAL STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000 der ler the The 1978 Alma-Ata WHO meeting, entitled International Conference on Primary Health Care, adopted the so-called "Strategy for Health for All by the Year 2000.11 This is e s sentially a blueprint which tilts, far against successful private sector health care systems in favor of state-run systems which, experience painfully teaches, fail to deliver medicines or care. The lvstrategyll states that basic health services must be I t a network of institutions ruf by the government as part of the country's administrative system.Il WHO has used this blueprint to push beyond its strict mandate, seeking worldwide redistribution of wealth and a vigorous anti-West disarmament program Washin g ton's response to this campaign so far has been weak. Not only has the U.S. failed to repudiate the goals of the Global Strategy which, ironically, was inspired in part by some Americans it has supported it. Example A 1985 report to WHO from the U.S., ent i tled 1. Glossnrv of Terms Uscd in the "Health for All" Scrics No. 1-8, World Hcalth Organization, 1984, P. 11 2Evaluatina the Stratesies for Health for All bv the Year 2000 states that "there are no overt obstacles that have impeded the development of nat ional health strategies in line with the strategies for Health for Allf1 (page 5 Nowhere does WHO note the plethora of evidence regarding the pitfalls of national planning in health cfre brought this material to WHO'S attention.

And the U.S. has not THE PA LESTINIAN ISSUE The U.S. delegation has warned WHO that its involvement in the U.N.Is campaign against Israel will undermine the organization's credibility. Since 1976 WHO repeatedly has adopted resolutions condemning Israel for its occupation of "Arab te rritoriestt and for Itits illegal exploitation of the natural wealth and resources of the Arab inhabitants.Il These are hardly health issues. Indeed, a U.N.

Special Committee generally has confirmed Israeli claims that the Arab populption in the territories occupied by Israel have adequate health care WHO ignores those findings and instead passes anti-Israeli resolutions.

This year Israel anticipates more attacks than in previous years. And if not for the U.S. law requiring that the U.S. withdraw from any organization that expels Israel or denies it participation, Israel might be denied participation in WHO on baseless charges regarding health conditions in Israeli occupied territories. Attempts to do so occurred in 1979 and 19

83. Israel already has been denied participation in WHO'S Eastern Mediterranean 2. For example, the study by Henry Aron and William Schwartz The Painful PrescriDtion Rationing Health Care (Washington, D.C.: The Brookings Institution, 1984), documents the advantages of the free marke t. See also Matthew J. Lynch and Stanley S. Raphael, cds.

Medicine and the State (Oakbrook, Illinois: Association of American Physicians and Surgeons, 1973 a comprehensive critique of state-run health care delivery systcms 3. To be sure, the report does co nclude with the obligatory promise that "whatever observations the Committee has made concerning the health conditions in the occupied territories, the problems of the population's health in thc sense of the WHO definition can be resolved only as a result of political action, for there can bc no health without peace, liberty, and justice A/38/10, April 15, 1985, p. 9 4. P.L. 99-83, Sec. 142 3-prevention The effect of such a report is, of course, completely one-sided, since health professionals in Soviet bl oc states'cannot get I region because the Arab sgates refused to allow Israel to be invited to the regional meetings allowed Israel to join the European region so that Israel can benefit from at least some WHO activities.

The PLO, which has had observer st atus in WHO since 1974, directs the campaign against Israel. Dr F. Arafat, brother of PLO boss Yassir Arafat, heads the PLO delegation to the WHO and urges the Assembly to support Palestinian national rights at the expense of Israel. And the majority inva riably votes in favor of the PLO-inspired anti-Israel resolutions Last year WHO Director-General Mahler I The WHO resolutions are then used by the PLO in its broader campaign against Israel throfghout the U.N. system.

Nations' Palestine Committee advertises those resolutions in its Bulletin and disseminates it worldwide through the U.N.Is Department of Public Information The United DISARMAMENT The WHA is required to distribute the report widely, its impact i thus reach i ng far beyond the meetings of WHO bodies. The U.S. only 5. Israel's exclusion from regional U.N. bodies violates Articlc 1, Paragraph 3, of the U.N. Charter, which calls for international cooperation in economic, social, cultural, and humanitarian matters "without distinction as to rncc SCX, language, or rcligion as well as Article 2, Paragraph 1, which states that the U.N is based on thc principle of the sovereign equality of all its members 6. Full title: Committee on the Exercise of the Inalienable Righ t s of the Palestinian People, Established in November 1975, this is a pro-PLO body. See Juliana Germ Pilon The PLO's Valuable Ally: The United Nations Heritage Foundation Backprounder No. 473 December 17, 1985 7. "Effects of Nuclear War on Health and Healt h Services A36/12, March 24, 1983, p. 7 4mildly has protested the inappropriateness of discussing disarmament in WHO, but never actually has attacked the report on the effects of nuclear war on health. Rose Belmont, Associate Director of Multilateral Progr a ms at the U.S. Health and Human Services Department and principal speech writer for the U.S. delegation to WHA, apparently does not understand the resolution's usefulness to the Soviet Union and the danger it poses to the U.S. nor does she seem to appreci ate how much such WHA activities divert attention and resources from the battle against disease in the world that the report is a fine llscientific document."

In 1985, the International Physicians for the Prevention of Nuclear War was officially admitted a s a nongovernmental organization NGO) affiliated with WHO. This group, strongly supported by a Soviet front group, The World Peace Council, was established in 19

80. The IPPNW has already become an influential participant in WHO, pressing for further WHO involvement in promoting disarmament She told The Heritage Foundation In a 1981 resolution, the WHO has specifically called for 'Ithe In an attempt to provide some reduction of military expenditures justification for WHO to address this issue, the resolut i on called for the allocation of the resources thus released to socioeconomic development and also to public health, especially in developing countries A similar resolution is expected to pass in 1986 TRADE EMBARGOES At the 1985 WHA meeting, Nicaragua intr o duced a resolution condemning the U.S. for its trade embargo against Nicaragua. The specific references to the U.S. and Nicaragua were deleted from the resolution eventually passed by the WHO, which condemned lldevelopedll countries that ''apply economic measures that have the purpose of exerting political coercion on the sovereign decisions of developing nations Its slap at the U.S. nevertheless was unmistakable. This language in fact was adopted directly from U.N. General Assembly resolution 39/2

10. The WHA resolution, WHA38.17, added a request that WHO member states increase collaboration with those developing countries. This resolution was adopted even though it has nothing to do with health issues.

The U.S. anticipates a similar resolution to be introduced at May's meeting.

NATIONAL LIBERATION MOVEMENTS At the 1985 WHA meeting, a resolution was passed supporting the liberation struggle in Southern Africa. It requested WHO 5-i Director-General Mahler to help the countries Ilnegatively affected" by Sou th Africa and named Angola, Botswana, Lesotho, Mozambique Swaziland, Tanzania, Zambia, and Zimbabwe. It also requested assistance to national liberation movements.

The report of the WHA by Director-General Mahler indicates, for example, that during 1984-1 985, $22,600 from the WHO regular budget has been used for the African National Congress and the Pan African Congress of Azania. The multinational training center in Tanzania for national liberation movements is funded through 21,000 from WHO'S regular bu dget and $512,028 from llextrabudgetary sources.1t $547,500 was proyided from WHO'S regular budget to Namibians in Angola and Zambia. The U.S. contributes 25 percent of the outlays.

INFANT FOOD REGULATION One of the best known WHO activities in the past de cade is the infant formula controversy infant feeding will be on the agenda of the upcoming World Health Assembly meeting And the issue of worldwide regulation of At a December 1985 meeting of WHO in cooperation with the U.N.

Children's Fund (UNICEF a document was produced entitled IIGuidelines for Determining Circumstances Requiring Breast Milk Substitutes.Il This is expected to be the focus of the Assembly's discussion in Geneva.

These llguidelinesll strongly favor breast feeding to the exclusion of everything else. Several radical leftist groups are expected to raise the issue of infant formula regulation at the WHA meeting in Geneva.

Among them: Health Action International, the; Interfaith Center for Corporate Responsibility, the International Baby Code Negotiating Council (the former Nestle Boycott Committee), and the International Organization of Consumer Unions.

The 1981 WHO resolution urging governments to adopt the Infant Formula Code has become a perennial WHO issue. The longirange aim of WHO, a ccording to an industry spokesman, is to curb the activities of the free market in the area of infant health. He estimates that WHO activists intend to take two approaches: 1) to make the guidelines more binding than they are now, and 2) to expand the gui d elines to include not only standard infant formulas but also formulas which contain cereals. According to the W.N. Report" of March 31, 1986 published by the U.S. Council for International Business, the Code might also be extended to regulate advertising o f foods intended for consumption by children governments to examine the promotion and use of foods unsuitable for In 1984, the WHA adopted a resolution asking 8. A38/15, April 15, 1985, p. 3 6foods unsuitable for infant and young child feeding and calling for a report to its 1986 session. The report has not yet been circulated.

TOBACCO INDUSTRY REGULATION WHO'S bias against multinational corporations also affects the tobacco industry on the advertisement of cigarettes and other tobacco products WHO has bee n conducting an anti-smoking campaign since the early 1970s under the topic I!Tobacco or Health." At its 1986 session, the WHO Executive Board adopted a resolution which Ildeplores all direct and indirect practices the aim of which is to promote the use o f tobacco,Il calling on governments to adopt strong anti-tobacco measures.

According to the U.S. Council for International Business Director-General Mahler is expected to submit a program of action to implement this resolution available The Assembly meeting is expected to consider a ban Details of the program are not yet REGULAT ION OF THE PHARMACEUTICAL INDUSTRY Item 24 on the Assembly agenda for next month is the !!Rational Use of Drugs This indicates that the Assembly may be moving toward a code on !!ethical criteria for drug promotion," a concept adopted by the WHA in 19

68. I n his February 10, 1986, report on WHO!s Revised Drug Strategy Director-General Mahler commends countries that "have national lists of essential drugs The Itessential drugs listn1 concept as promoted by the WHO is designed to prevent drugs, not on the lis t , from being sold on the market. This is a direct attack on the private drugs production and sales industry. Such an attack is particularly dangerous for developing countries. There the only effective provision of pharmaceuticals has been by private compa nies.

Ernst Lauridsen, who heads WHOIS Essential Drugs Program, and some members of his staff, reportedly have been advising governments to introduce Ilmedical needs" clauses in their national legislation.

Such laws would keep new medicines off the market unless it could be proved that they are !I$herapeutically superior or cheaper than other available medications. The "needs clause involves the requirement that a new medicinal product must be shown to be superior to existing treatments before that produc t is allowed to be marketed It may also require that a new product be cheaper than other existing treatment 9. For a thorough discussion of the "medical needs" concept see Roger A. Brooks Saving the WHO From a Poison Pill," Heritage Foundation Backgrounder No. 471, November 19 1985 7- An amendment to P.L. 99-190, drafted by Representative Bill I Lowery (R-CA) last year and passed by Congress and signed by.Ronald Reagan empowers the President to eliminate U.S. .contributions to those U.N. programs conducted i n communist countries. This affects a number of WHO programs, including Country Prosrams Cuba Korea Mongolia Albania Bulgaria Czechoslovakia GDR Hungary Poland Romania USSR Yugoslavia China 1984-85 Contributions from the Resular WHO Budset 777 200 1,327,4 00 $1,491,100 33 100 92 400 24 800 30,400 36,000 45,600 $45,600 60 700 37,200 4,242,800 8- Vietnam $3,751,400 Total 11,995,700 10 Source: WHO publication PB/84-85.

Of this nearly 12 million spent by WHO in communist countries the U.S. contributes $3 millio n. Under the terms of the Lowery Amendment, Reagan can hold back this amount from the U.S. contribution to WHO WHO publications advance Soviet bloc propaganda. Many of WHOIS publications depict the West in the least favorable light. Typical of this is the index of the WHO quarterly World Health Forum Vol. 3 of 19

82. Under the rubric W.S.A.,I1 only one entry is listed, on Istreptococcal infections in American Indians," and under ''United Kingdom1! only one on Itinequalities in health care In contrast to th ese negative references to the U.S. and Britain, the index lists five entries for the USSR, all positive, ranging from preventive medicine, public health, and medical education. Similarly, for a 1983 WHO study entitled 'IDepressive Disorders in Different Cultures,Il the populations studied were in Basle, Switzerland, in Montreal, Canada in Teheran, Iran (under the late Shah), and in both Nagasaki and Tokyo in Japan. No 'ldepressive disordersll were studied in the Soviet bloc.

The USSR reportedly is. using WHO officials in Afghanistan to provide intelligence for the Soviet troops which invaded that country. Soviet doctors in Afghanistan ostensibly on WHO business include Georgi Kovacsov in the WHO section on "Malaria Control,I1 Vadim Kodorov in !'Drug Polic ies and Management and Anatoly Gaygin in IIMother and Child Health Care/Family Planning1! section.

Within the WHO Secretariat, the Soviets are a powerful force despite their numerical underrepresentation and their considerably smaller contribution to WHO'S budget. While the U.S. gives WHO about 61 million or 25 percent of the organization's budget, the USSR gives only about $31 million, or 14.5 percent. According to Dr. Aubrey Outschoorn, the former Chief Medical Officer of Biological Standardization who s e rved at WHO from 1962 to 1975, the Soviets Wirtually dictate their nationals who are appointed in the professional posts at WHO.Il A former high-level employee recalls that expert committees in which he has participated invariably had a Soviet 10. These f i gures do not include inter-country programs 66,694,400 for the relevant regions, nor expenditures through WHO for these countries with monies from sourccs other than the regular WHO budget. When those other sources are included, the total is 14,204,900 9 c or Soviet bloc representative "to insure Soviet influencell at the meetings BUDGETARY IMPACT OF U.S. LEGISLATION ON WHO The Gram-Rudman-Hollings budget legislation will affect the 61.146 million budgeted by the U.S. for the total WHO regular budget for F Y 19

86. That sum, according to the State Department, is to be reduced by 4.3 percent. On October 1, the Kassebaum Amendment--section 143 of P.L. 99-93-will go into effect. That provision requires that unless WHO adopts a voting procedure that reflects to some extent the level of a country's contribution to WHO the U.S. assessed contribution to WHO will fall from 25 to 20 percent of WHO'S budget.

CONCLUSION At Geneva's May 1986 meeting of the World Health Assembly, the U.S. should vigorously oppose the pol iticization of WHO. It should o Oppose the provisions of the IIGlobal Strategy for Health for All by the Year 2O0Oi1 that involve national, state-controlled, rather than private sector approaches to health care. The U.S. should disseminate information reg a rding the pitfalls of socialized medicine and explain the success of the.private sector o Oppose the illegal isolation of Israel at WHO, and continue to condemn politically motivated resolutions condemning Israel. The U.S should demand that Israel be allo w ed to participate in activities of WHO'S Eastern Mediterranean Region o Expose the bias and the faulty premises of the WHO-published report on "Effects of Nuclear War on Health and Health Services.Il The U.S. should argue against the left's simplistic lin king of the economic plight of the Third World to the West's arms expenditures.

The U.S. should explain the reasons for Western defense and point out that this issue does not belong on a WHO agenda o Vote against any resolution condemning the U.S., whether explicitly or implicitly, for its use of economic sanctions. Instead the U.S. should sponsor a resolution banning the introduction of such politicized items on the WHA agenda o Protest any Ilassistancell to national liberation movements through WHO, and w arn that U.S. funds that are used to benefit such movements will be withheld 10 -o Oppose any attempts to extend the Infant Formula Code to other foods, and oppose any attempts to make the Code more binding o Protest overzealous, inappropriate activism by WHO employees.

The WHO Constitution requires them to be international civil servants who carry out WHO policies and not lobby member states companies WHO by the U.S. proportion of funds that is used for the benefit of communist countries o Oppose any atte mpts by WHO to regulate advertising by private o'Apply the Lowery Amendment and reduce the U.S. contribution to o Apply the Sundquist Amendment (sec. 151 of P.L. 99-93) reducing the amount of U.S. contribution to WHO by the amount which is the U.S proport i onate share of the salaries of Soviet employees which is used as lIkickbackst1 to their government. o Insist on a discussion of the Director-General's report on the I1Political Dimensionll of the Global Strategy and emphasize that WHO cannot and should no t Ifinterfere in the foreign policy of governments o Implement fully the legislatively mandated budgetary cuts to force WHO to spend its reduced funds on health rather than politics.

In Geneva, the World'Health organization faces its moment of truth. It ca n veer away from its increasing politicization and rediscover its commitment to improve the worldls health or it can continue on its present course. If it continues to become politicized, however, it must know that the U.S. will reconsider its membership in WHO. It is WHO'S choice.

Juliana Geran Pilon, Ph.D.

Senior Policy Analyst 11