In Memory of Dr. Taba, the Legendary WHO Regional Director

The article is a tribute to Dr. Abdul-Hossein Tabatabai-Naini, the former Regional Director of the Eastern Mediterranean Regional Office (EMRO), on the occasion of WHO's 75th anniversary. It reports on his achievements, personality, and philosophy of medicine.

Analysing malaria events from 1840 to 2020: the narrative told through postage stamps

The role played by postage stamps in the history of malaria control and eradication has largely gone unrecognized. Scientific investigators of malaria, especially Nobel laureates, were commemorated with special issues, but the work of the World Health Organization (WHO), which promoted an ambitious and global philatelic initiative in 1962 to support global eradication, is generally overlooked. This review examines the philatelic programme that helped to generate international commitment to the goal of malaria eradication in 1962 and established philatelic malaria icons that had worldwide recognition. Malaria-related postage stamps have continued to be issued since then, but the initial failure of malaria eradication and the changing goals of each new malaria programme, inevitably diluted their role. After the first Global Malaria Eradication Campaign was discontinued in 1969, few Nations released philatelic issues. Since the Spirit of Dakar Call for Action in 1996 a resurgence of postage stamp releases has occurred, largely tracking global malaria control initiatives introduced between 1996 and 2020. These releases were not co-ordinated by the WHO as before, were more commercialized and targeted stamp collectors, especially with attractive miniature sheets, often produced by photomontage. Having a different purpose, they demonstrated a much wider diversity in symbolism than the earlier stylized issues and at times, have been scientifically inaccurate. Nonetheless postage stamps greatly helped to communicate the importance of malaria control programmes to a wide audience and to some extent, have supported preventive health messages.

The World Health Organization's changing goals and expectations concerning malaria, 1948-2019

From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

Water and the death of ambition in global health, c.1970-1990

Economic development and good health depended on access to clean water and sanitation. Therefore, because economic development and good health depended on access to clean water and sanitation, beginning in the early 1970s the World Bank, the World Health Organization (WHO), and others began a period of sustained interest in developing both for the billions without either. During the 1980s, two massive and wildly ambitious projects showed what was possible. The International Drinking Water Supply and Sanitation Decade and the Blue Nile Health Project aimed for nothing less than the total overhaul of the way water was developed. This was, according to the WHO, "development in the spirit of social justice."

Between Donor Interest, Global Models and Local Conditions: Treatment and Decision-Making in the Somalia-Finland Tuberculosis Control Project, 1981-3

Despite numerous global health initiatives after World War II, tuberculosis still poses a major threat in sub-Saharan Africa. This article examines one attempt to tackle this problem: the Somalia-Finland Tuberculosis Control Project. Conducted in the 1980s as a bilateral development aid project between the two countries, it became the most extensive - and expensive - tuberculosis initiative in Somalia in that decade. An interesting feature of the project is that, despite a lack of previous experience in tuberculosis work in developing countries, the Finnish partner decided not to follow the WHO global guidelines designed to standardise tuberculosis activities across the developing world. Instead, Finns established their own treatment programme based on X-ray and short-course chemotherapy - otherwise rarely used in clinical practice in Africa. Through a close reading and comparison of the correspondence, project plans, memos and minutes, the article analyses the formation of this strategy. Focusing on ground-level decision-making, it argues that the decisions were based not only on a belief in the superior clinical effectiveness of these methods, but also on the fact that they better suited Finnish ambitions and project logic. Thus, the article supports the notion that donor perspectives on resources and project objectives determined what was seen as feasible treatment in a developing country. By shedding light on the debate between the supporters of short-course chemotherapy and the WHO standard treatment strategy, it also contributes to the early history of DOTS (directly observed treatment, short course).

Re-assessing the Foundations: Worldwide Smallpox Eradication, 1957-67

An expansive, worldwide smallpox eradication programme (SEP) was announced by the World Health Assembly in 1958, leading this decision-making body to instruct the World Health Organization Headquarters in Geneva to work with WHO regional offices to engage and draw in national governments to ensure success. Tabled by the Soviet Union's representative and passed by a majority vote by member states, the announcement was subject to intense diplomatic negotiations. This led to the formation, expansion and reshaping of an ambitious and complex campaign that cut across continents and countries. This article examines these inter-twining international, regional and national processes, and challenges long-standing historiographical assumptions about the fight against smallpox only gathering strength from the mid-1960s onwards, after the start of a US-supported programme in western Africa. The evidence presented here suggests a far more complex picture. It shows that although the SEP's structures grew slowly between 1958 and 1967, a worldwide eradication programme resulted from international negotiations made possible through gains during this period. Significant progress in limiting the incidence of smallpox sustained international collaboration, and justified the prolongation and expansion of activities. Indeed, all of this bore diplomatic and legal processes within the World Health Assembly and WHO that acted as the foundation of the so-called intensified phase of the SEP and the multi-faceted activities that led to the certification of smallpox eradication in 1980.

"Imagine All the People:" Andrija Štampar's Ideology in The Context of Contemporary Public Health Initiatives

Recently, the World Health Organization launched its Universal Health Coverage initiative with the aim to improve access to quality health care on a global level, without causing financial hardship to the patients. In this paper, we will identify and analyze the ideological similarities between this influential initiative and the work of one of the founders of the WHO-Andrija Štampar (1888-1958)-whose social medicine was built of various normative, sociological and philosophical elements. Our aim is to demonstrate the crucial role of carefully erected and thought-out ideology for the success of public health programs.

The historical roots and seminal research on health equity: a referenced publication year spectroscopy (RPYS) analysis

BACKGROUND

Health equity is a multidimensional concept that has been internationally considered as an essential element for health system development. However, our understanding about the root causes of health equity is limited. In this study, we investigated the historical roots and seminal works of research on health equity.

METHODS

Health equity-related publications were identified and downloaded from the Web of Science database (n = 67,739, up to 31 October 2018). Their cited references (n = 2,521,782) were analyzed through Reference Publication Year Spectroscopy (RPYS), which detected the historical roots and important works on health equity and quantified their impact in terms of referencing frequency.

RESULTS

A total of 17 pronounced peaks and 31 seminal works were identified. The first publication on health equity appeared in 1966. But the first cited reference can be traced back to 1801. Most seminal works were conducted by researchers from the US (19, 61.3%), the UK (7, 22.6%) and the Netherlands (3, 9.7%). Research on health equity experienced three important historical stages: origins (1800-1965), formative (1966-1991) and development and expansion (1991-2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899). The concept of health equity originated from the disciplines of public health, sociology and political economics and has been a major research area of social epidemiology since the early nineteenth century. Studies on health equity evolved from evidence gathering to the identification of cost-effective policies and governmental interventions.

CONCLUSION

The development of research on health equity is shaped by multiple disciplines, which has contributed to the emergence of a new stream of social epidemiology and political epidemiology. Past studies must be interpreted in light of their historical contexts. Further studies are needed to explore the causal pathways between the social determinants of health and health inequalities.

Vaccine Development and Collaborations: Lessons from the History of the Meningococcal A Vaccine (1969-73)

Based on a wide range of historical sources, including published scientific literature and archives (Institut Mérieux, WHO and IMTSSA), this article examines the history of the development of the meningococcal A vaccine between 1969 and 1973. It explores the social factors of vaccine development including various collaborations, informal discussions, the circulation of products and materials, formal meetings, trials and setbacks to highlight the complex reality of the development, production and use of the vaccine. Inscribed in a 'Golden Age' of vaccine development and production, this episode not only adds to the scholarship on the history of vaccines, which has tended to focus on a narrative of progress, but also considers the sharing of knowledge through collaborations, and the risks involved in the development of a vaccine. Finally, this perspective reveals the uncertainties and difficulties underlying the production of an effective vaccine.

Insulin Units and Conversion Factors: A Story of Truth, Boots, and Faster Half-Truths

Conventional insulin concentration units (IU/mL or just U/mL) are bioefficacy based, whereas the Système International (SI) units (pmol/L) are mass based. In converting between these two different approaches, there are at least 2 well-accepted conversion factors, where there should be only 1. The correct value is not the most-used or well-accepted using online calculators, some journal styles, laboratory reports, and published articles. In short, an incorrect insulin conversion factor is widely used which underreports insulin concentrations by ~15%, with potentially significant research and clinical implications. This short commentary describes the history of insulin IU definitions and conversion factors, and highlights the widespread nature of conversion factor misuse, to provoke deeper interest and thought regarding numbers we so often use without thinking.

Moving Away from the "Medical Model": The Development and Revision of the World Health Organization's Classification of Disability

Recently, there has been a prominent call in the history of medicine for greater engagement with disability perspectives. In this article, I suggest that critiques of the so-called medical model have been an important vehicle by which alternative narratives of disability entered the clinical arena. Historians of medicine have rarely engaged with the medical model beyond descriptive accounts of it. I argue that to more adequately address disability perspectives, historians of medicine must better historicize the medical model concept and critique, which has been drawn upon by physicians, activists, and others to advance particular perspectives on disability. My present contribution describes two distinct formulations of critique that originated in differing interest groups and characterized the medical model alternatively as insufficient and oppressive. I examine the World Health Organization's efforts to incorporate these distinctive medical model critiques during the development and revision of its International Classification of Impairments, Disabilities, and Handicaps.

[Technical assistance in crisis times: Brucelosis in the country programs for Spain of the world health organization (1951-1972)]

OBJECTIVE

Brucellosis was one of the most important health problems in post-Civil War Spain and in subsequent years. The objective of the study was to reconstruct the first programs that the WHO set up in this country, to address this problem, between 1951 and 1972 and their main outcomes.

METHODS

On the basis of primary sources of diverse origin, especially unpublished reports on Spain from foreign experts, from the WHO Historical Archive, the contents related to the disease were analyzed, contextualizing them within the framework of both the history of Spanish Public Health during the period studied and the international public health strategies for the prevention and control of brucellosis between 1951 and 1972.

RESULTS

Spain 0001 (E1), Spain 0012 (E12) programs were located. The first of them (E1), dedicated to the problem of endemoepidemic diseases (brucellosis, rabies and Q fever), developed between 1952 and 1956, offered assistance in the work of control of these diseases carried out by public health laboratories. The second was preceded by visits of experts between 1956-1958 and formally started in 1969 and ended in 1972. This program was specifically devoted to the fight against brucellosis and included the start-up of laboratory and epidemiological work, the training of specialists, vaccination experiences in goats and sheep and the initiation of studies on immunizations in humans.

CONCLUSIONS

The presence of consultants and experts from the WHO, from the highest scientific authority in the field of brucellosis such as Sandford Elberg or Martin Kaplan, was decisive in, at least, two aspects: first, to have an external view that would allow to know the reality of the Spanish health situation in the matter of the control of this zoonosis and, secondly, to start up and develop laboratory techniques and training of specialists with the aim of creating, at least, a center of reference for the preparation of vaccines, which the experts placed, ideally, in the National School of Health in Madrid.

Visualising Primary Health Care: World Health Organization Representations of Community Health Workers, 1970-89

For the World Health Organization (WHO), the 1978 Alma-Ata Declaration marked a move away from the disease-specific and technologically-focused programmes of the 1950s and 1960s towards a reimagined strategy to provide 'Health for All by the Year 2000'. This new approach was centred on primary health care, a vision based on acceptable methods and appropriate technologies, devised in collaboration with communities and dependent on their full participation. Since 1948, the WHO had used mass communications strategies to publicise its initiatives and shape public attitudes, and the policy shift in the 1970s required a new visual strategy. In this context, community health workers (CHWs) played a central role as key visual identifiers of Health for All. This article examines a period of picturing and public information work on the part of the WHO regarding CHWs. It sets out to understand how the visual politics of the WHO changed to accommodate PHC as a new priority programme from the 1970s onwards. The argument tracks attempts to define CHWs and examines the techniques employed by the WHO during the 1970s and early 1980s to promote the concept to different audiences around the world. It then moves to explore how the process was evaluated, as well as the difficulties in procuring fresh imagery. Finally, the article traces these representations through the 1980s, when community approaches came under sustained pressure from external and internal factors and imagery took on the supplementary role of defending the concept.

Health Planning in 1960s Africa: International Health Organisations and the Post-Colonial State

This article explores the programme of national health planning carried out in the 1960s in West and Central Africa by the World Health Organization (WHO), in collaboration with the United States Agency for International Development (USAID). Health plans were intended as integral aspects of economic development planning in five newly independent countries: Gabon, Liberia, Mali, Niger and Sierra Leone. We begin by showing that this episode is treated only superficially in the existing WHO historiography, then introduce some relevant critical literature on the history of development planning. Next we outline the context for health planning, noting: the opportunities which independence from colonial control offered to international development agencies; the WHO's limited capacity in Africa; and its preliminary efforts to avoid imposing Western values or partisan views of health system organisation. Our analysis of the plans themselves suggests they lacked the necessary administrative and statistical capacity properly to gauge local needs, while the absence of significant financial resources meant that they proposed little more than augmentation of existing structures. By the late 1960s optimism gave way to disappointment as it became apparent that implementation had been minimal. We describe the ensuing conflict within WHO over programme evaluation and ongoing expenditure, which exposed differences of opinion between African and American officials over approaches to international health aid. We conclude with a discussion of how the plans set in train longer processes of development planning, and, perhaps less desirably, gave bureaucratic shape to the post-colonial state.

A History of the International Commission on Non-Ionizing Radiation Protection

Concern about health risks from exposure to non-ionizing radiation (NIR) commenced in the 1950s after tracking radars were first introduced during the Second World War. Soon after, research on possible biological effects of microwave radiation in the former Soviet Union and the U.S. led to public and worker exposure limits being much lower in Eastern European than in Western countries, mainly because of different protection philosophies. As public concern increased, national authorities began introducing legislation to limit NIR exposures from domestic microwave ovens and workplace devices such as visual display units. The International Radiation Protection Association (IRPA) was formed in 1966 to represent national radiation protection societies. To address NIR protection issues, IRPA established a Working Group in 1974, then a Study Group in 1975, and finally the International NIR Committee (INIRC) in 1977. INIRC's publications quickly became accepted worldwide, and it was logical that it should become an independent commission. IRPA finally established the International Commission on Non-Ionizing Radiation Protection (ICNIRP), chartering its remit in 1992, and defining NIR as electromagnetic radiation (ultraviolet, visible, infrared), electromagnetic waves and fields, and infra- and ultrasound. ICNIRP's guidelines have been incorporated into legislation or adopted as standards in many countries. While ICNIRP has been subjected to criticism and close scrutiny by the public, media, and activists, it has continued to issue well-received, independent, science-based protection advice. This paper summarizes events leading to the formation of ICNIRP, its key activities up to 2017, ICNIRP's 25th anniversary year, and its future challenges.

At the Roots of The World Health Organization's Challenges: Politics and Regionalization

The World Health Organization's (WHO's) leadership challenges can be traced to its first decades of existence. Central to its governance and practice is regionalization: the division of its member countries into regions, each representing 1 geographical or cultural area. The particular composition of each region has varied over time-reflecting political divisions and especially decolonization. Currently, the 194 member countries belong to 6 regions: the Americas (35 countries), Europe (53 countries), the Eastern Mediterranean (21 countries), South-East Asia (11 countries), the Western Pacific (27 countries), and Africa (47 countries). The regions have considerable autonomy with their own leadership, budget, and priorities. This regional organization has been controversial since its beginnings in the first days of WHO, when representatives of the European countries believed that each country should have a direct relationship with the headquarters in Geneva, Switzerland, whereas others (especially the United States) argued in favor of the regionalization plan. Over time, regional directors have inevitably challenged the WHO directors-general over their degree of autonomy, responsibilities and duties, budgets, and national composition; similar tensions have occurred within regions. This article traces the historical roots of these challenges.

Policy Innovation and Policy Pathways: Tuberculosis Control in Sri Lanka, 1948-1990

This paper, based on World Health Organization and Sri Lankan sources, examines the attempts to control tuberculosis in Sri Lanka from independence in 1948. It focuses particularly on the attempt in 1966 to implement a World Health Organization model of community-orientated tuberculosis control that sought to establish a horizontally structured programme through the integration of control into the general health services. The objective was to create a cost- effective method of control that relied on a simple bacteriological test for case finding and for treatment at the nearest health facility that would take case detection and treatment to the rural periphery where specialist services were lacking. In the late 1940s and early 1950s, Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and social assistance for sufferers. This programme had both reduced mortality and enhanced awareness of the disease. This paper exposes the obstacles presented in trying to impose the World Health Organization's internationally devised model onto the existing structure of tuberculosis control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources but, equally important, was the existing medical culture that militated against its acceptance.

In memory of Giovanni Berlinguer. The Man, the Scientist, the Politician

On this occasion I am very grateful to the Academic Authorities for having asked me to illustrate the life of Giovanni Berlinguer as a Researcher, a Professor and a Doctor of Public Health. I will try to fulfill this duty, perhaps with some reservations, because I find it almost impossible to think of Giovanni as a researcher and a professor separately from his complex personality and his role as a politician and a brilliant and prolific writer. This is because Giovanni was an inextricable combination of all these roles, which cannot be described separately.

Local health policies under the microscope: consultants, experts, international missions and poliomyelitis in Spain, 1950-1975

One of the main focuses of analysis of this paper concerns the missions of international health agency experts to Spain to report on the situation, the activities in the fight against physical disabilities in children and on the actions taken to cope with the problem. The Spain-23 Plan was the instrument used by WHO and other agencies to start the process of change in a country undergoing a period of transformation under the enduring Franco dictatorship. As key sources, the paper uses unpublished reports of WHO experts on the subject, which resulted from visits to the country between 1950 and 1975. The methodological approach consists of an analysis of discourses from primary sources within the historiographical framework.

World citizenship and the emergence of the social psychiatry project of the World Health Organization, 1948-c.1965

This paper examines the relationship between 'world citizenship' and the new psychiatric research paradigm established by the World Health Organization in the early post-World War II period. Endorsing the humanitarian ideological concept of 'world citizenship', health professionals called for global rehabilitation initiatives to address the devastation after the war. The charm of world citizenship had not only provided theoretical grounds of international collaborative research into the psychopathology of psychiatric diseases, but also gave birth to the international psychiatric epidemiologic studies conducted by the World Health Organization. Themes explored in this paper include the global awareness of mental rehabilitation, the application of public health methods in psychiatry to improve mental health globally, the attempt by the WHO to conduct large-scale, cross-cultural studies relevant to mental health and the initial problems it faced.

Re-imagining the control of malaria in tropical Africa during the early years of the World Health Organization

This paper grew out of a meeting organized in September 2014 in London on 'Re-imagining malaria'. The focus of that meeting was on malaria today; only afterwards did the idea emerge that re-imagining the past might serve as a useful way for guiding present re-thinking. Sub-Saharan Africa is the logical place for such a re-examination for, as argued in this paper, the approaches that emerged following the collapse of the global eradication campaign were available to WHO in the 1950s, but these were not pursued as Africa was not encouraged to seek solutions outside those being advocated for eradication elsewhere.

Human population studies and the World Health Organization

This essay draws attention to the role of the WHO in shaping research agendas in the biomedical sciences in the postwar era. It considers in particular the genetic studies of human populations that were pursued under the aegis of the WHO from the late 1950s to 1970s. The study provides insights into how human and medical genetics entered the agenda of the WHO. At the same time, the population studies become a focus for tracking changing notions of international relations, cooperation, and development and their impact on research in biology and medicine in the post-World War I era. After a brief discussion of the early history of the WHO and its position in Cold War politics, the essay considers the WHO program in radiation protection and heredity and how the genetic study of "vanishing" human populations and a world-wide genetic study of newborns fitted this broader agenda. It then considers in more detail the kind of support offered by the WHO for these projects. The essay highlights the role of single individuals in taking advantage of WHO support for pushing their research agendas while establishing a trend towards cooperative international projects in biology.

Unfolding epidemiological stories: how the WHO made frozen blood into a flexible resource for the future

In the decades after World War II, the World Health Organization (WHO) played an important role in managing the process of stabilizing collections of variable blood samples as a fundamentally unstable, protean, and unfolding biomedical resource. In this system, known and as yet unknown constituents of blood were positioned as relevant to the work of multiple constituencies including human population geneticists, physical anthropologists, and immunologists. To facilitate serving these and other constituencies, it was crucial to standardize practices of collecting and preserving samples of blood from globally distributed human populations. The WHO achieved this by linking its administrative infrastructure-comprised of expert advisory groups and technical reports-to key laboratories, which served as sites for demonstrating and also for disseminating standards for working with variable blood samples. The practices that were articulated in making blood samples into a flexible resource contributes to emerging histories of global health that highlight the centrality of new institutions, like the WHO, new forms of expertise, like population genetics and serological epidemiology, and new kinds of research materials, like frozen blood.

The origins, development, effects, and future of the WHO Framework Convention on Tobacco Control: a personal perspective

Worldwide, more than 1 billion people use tobacco, resulting in about 6 million deaths per year. The tobacco industry's documented history of subverting control efforts required innovative approaches by WHO--led by Gro Harlem Brundtland--including invocation of its constitutional authority to develop treaties. In 2003, WHO member states adopted the WHO Framework Convention on Tobacco Control (WHO FCTC). In the decade since, 177 countries have ratified and started to implement its full provisions. Success has been tempered by new challenges. Tobacco use has fallen in countries that are members of the Organisation for Economic Co-operation and Development but increased in low-income and middle-income countries, a result in no small part of illicit trade and cheap products from China and other unregulated state monopolies. This review of 50 years of policy development aimed at reducing the burden of disease attributable to tobacco reviews the origins and strategies used in forging the WHO FCTC, from the perspective of one who was there.

[Joining WHO of Republic of Korea and the projects in the 1950s]

The Republic of Korea(ROK) and the World Health Organization(WHO) have done many projects successfully from 1949, in which the government of First Republic joined the WHO. However the relation between the ROK and the WHO have not been studied very much so far. The main purpose of this research, which could be done by the support of WHO, is connected with three questions. First research point would be "how could the ROK joined WHO in 1949 and what's the meaning of it? And the what's the difference in the process for the WHO between the ROK of 1949 and the DPRK(Democratic People's Republic of Korea) of 1973?" The first president of the ROK, Rhee Syngman, who had received his Ph. D.(about international politics) from Princeton University in 1910, was strongly interested in joining international institutes like UN, WHO. The ROK that could join WHO on 17 August 1949, with the approval of Assembly on 25 May 1949, was one of the founder members of the Western Pacific Region. By joining WHO, the ROK could get chance to increase the level of public health and its administration in 1950's. But the DPRK manage to became a member of WHO on 19 May 1973 and joined the South-East Asia Region. The joining of DPRK was influenced by the easing of the cold war after the Nixon Doctrine and the joining of the China(People's Republic of China). Second research point would be "What kind of roll did the WHO take in the First Republic?" Yet the public health administration of the First Republic that had been made in the period of US army military government was been strongly influenced by USA, the roll of WHO was also important in the 1950's. Last research point would be "What kind of the projects did the ROK and the WHO take part in during the period of he First Republic? How could evaluate the results?" The ROK and the WHO handled the projects including health services, communicable disease prevention and control, control of noncommunicable diseases, and protection of health. Specially for the efforts to prevent communicable disease, the WHO focused on leprosy, malaria, measles, smallpox, tuberculosis in 1950's. The First Republic could overcome the bad health condition after the Korea War successfully, supported by WHO.

The World Health Organization and Global Health Governance: post-1990

This article takes a historical perspective on the changing position of WHO in the global health architecture over the past two decades. From the early 1990s a number of weaknesses within the structure and governance of the World Health Organization were becoming apparent, as a rapidly changing post Cold War world placed more complex demands on the international organizations generally, but significantly so in the field of global health. Towards the end of that decade and during the first half of the next, WHO revitalized and played a crucial role in setting global health priorities. However, over the past decade, the organization has to some extent been bypassed for funding, and it lost some of its authority and its ability to set a global health agenda. The reasons for this decline are complex and multifaceted. Some of the main factors include WHO's inability to reform its core structure, the growing influence of non-governmental actors, a lack of coherence in the positions, priorities and funding decisions between the health ministries and the ministries overseeing development assistance in several donor member states, and the lack of strong leadership of the organization.

[The six final International Sanitary Conferences of 1892 to 1926, the basis of the World Health Organization]

The authors report the contributions of the last six sanitary conferences from 1886 to 1926. All of them, from 1851 to 1926, were the first roots of WHO.

Global health and development: conceptualizing health between economic growth and environmental sustainability

After World War II, health was firmly integrated into the discourse about national development. Transition theories portrayed health improvements as part of an overall development pattern based on economic growth as modeled by the recent history of industrialization in high-income countries. In the 1970s, an increasing awareness of the environmental degradation caused by industrialization challenged the conventional model of development. Gradually, it became clear that health improvements depended on poverty-reduction strategies including industrialization. Industrialization, in turn, risked aggravating environmental degradation with its negative effects on public health. Thus, public health in low-income countries threatened to suffer from lack of economic development as well as from the results of global economic development. Similarly, demands of developing countries risked being trapped between calls for global wealth redistribution, a political impossibility, and calls for unrestricted material development, which, in a world of finite land, water, air, energy, and resources, increasingly looked like a physical impossibility, too. Various international bodies, including the WHO, the Brundtland Commission, and the World Bank, tried to capture the problem and solution strategies in development theories. Broadly conceived, two models have emerged: a "localist model," which analyzes national health data and advocates growth policies with a strong focus on poverty reduction, and a "globalist" model, based on global health data, which calls for growth optimization, rather than maximization. Both models have focused on different types of health burdens and have received support from different institutions. In a nutshell, the health discourse epitomized a larger controversy regarding competing visions of development.

Destabilizing science from the right: the rhetoric of heterosexual victimhood in the World Health Organization's 2008 HIV/AIDS controversy

This article examines the 2008 World Health Organization/Joint United Nations Program on HIV/AIDS controversy through original reports and media coverage. Analysis reveals that discourse rhetorically exonerates heterosexuals from HIV/AIDS while reifying homophobic and morally righteous ideology about HIV/AIDS and homosexuality. Discourses of "fraudulent science," "heterosexual absence," and reverse victimization destabilize meaning of HIV/AIDS and heterosexuality. "AIDS," "heterosexuality," and even victimhood and minority status were destabilized and resignified in a rhetoric that benefited from its status as science even as it rendered past science suspect as ideological.

Road traffic injuries: social change and development

In the course of the twentieth century road traffic injuries (RTIs) became a major public health burden. RTI deaths first increased in high-income countries and declined after the 1970s, and they soared in low- and middle-income countries from the 1980s onwards. As motorisation took off in North America and then spread to Europe and to the rest of the world discussions on RTIs have reflected and influenced international interpretations of the costs and benefits of 'development', as conventionally understood. Using discourse analysis, this paper explores how RTIs have been constructed in ways that have served regional and global development agendas and how 'development' has been (re-)negotiated through the discourse of RTIs and vice versa. For this purpose, this paper analyses a selection of key publications of organisations in charge of international health or transport and places them in the context of (a) the surrounding scientific discussion of the period and (b) of relevant data regarding RTI mortality, development funding, and road and other transport infrastructure. Findings suggest that constructions of RTIs have shifted from being a necessary price to be paid for development to being a sign of development at an early stage or of an insufficiently coordinated development. In recent years, RTI discussions have raised questions about development being misdirected and in need of fundamental rethinking. At present, discussions are believed to be at a crossroads between different evaluations of developmental conceptualisations for the future.

World Health Organization discontinues its drinking-water guideline for manganese

BACKGROUND

The World Health Organization (WHO) released the fourth edition of Guidelines for Drinking-Water Quality in July 2011. In this edition, the 400-µg/L drinking-water guideline for manganese (Mn) was discontinued with the assertion that because "this health-based value is well above concentrations of manganese normally found in drinking water, it is not considered necessary to derive a formal guideline value."

OBJECTIVE

In this commentary, we review the WHO guideline for Mn in drinking water--from its introduction in 1958 through its discontinuation in 2011.

METHODS

For the primary references, we used the WHO publications that documented the Mn guidelines. We used peer-reviewed journal articles, government reports, published conference proceedings, and theses to identify countries with drinking water or potential drinking-water supplies exceeding 400 µg/L Mn and peer-reviewed journal articles to summarize the health effects of Mn.

DISCUSSION

Drinking water or potential drinking-water supplies with Mn concentrations > 400 µg/L are found in a substantial number of countries worldwide. The drinking water of many tens of millions of people has Mn concentrations > 400 µg/L. Recent research on the health effects of Mn suggests that the earlier WHO guideline of 400 µg/L may have been too high to adequately protect public health.

CONCLUSIONS

The toxic effects and geographic distribution of Mn in drinking-water supplies justify a reevaluation by the WHO of its decision to discontinue its drinking-water guideline for Mn.

Geography and global health

In the wake of the report of the World Health Organisation's Commission on the Social Determinants of Health, Closing the gap in a generation (Marmot 2008), this invited commentary considers the scope for geographical research on global health. We reflect on current work and note future possibilities, particularly those that take a critical perspective on the interplay of globalisation, security and health.

The politics of assessment: water and sanitation MDGs in the Middle East

The Middle East and North Africa (MENA) is generally considered to be making adequate progress towards meeting Target 10 of the Millennium Development Goals (MDGs), which calls for halving the proportion of the population with inadequate access to drinking water and sanitation. Progress towards achieving Target 10 is evaluated by the Joint Monitoring Programme (JMP), run by UNICEF and WHO. This article shows that the assessment methodologies employed by the JMP significantly overstate coverage rates in the drinking water and sanitation sectors, by overlooking and ‘not counting’ problems of access, affordability, quality of service and pollution. The authors show that states in MENA often fail to provide safe drinking water and adequate sanitation services, particularly in densely populated informal settlements, and that many centralized water and sanitation infrastructures contribute to water pollution and contamination. Despite the glaring gap between the MDG statistics and the evidence available from national and local reports, exclusionary political regimes in the region have had few incentives to adopt more accurate assessments and improve the quality of service. While international organizations have proposed some reforms, they too lack incentives to employ adequate measures that gauge access, quality and affordability of drinking water and sanitation services.

Setting a standard for a "silent" disease: defining osteoporosis in the 1980s and 1990s

Osteoporosis, a disease of bone loss associated with aging and estrogen loss, can be crippling but is 'silent' (symptomless) prior to bone fracture. Despite its disastrous health effects, high prevalence, and enormous associated health care costs, osteoporosis lacked a universally accepted definition until 1992. In the 1980s, the development of more accurate medical imaging technologies to measure bone density spurred the medical community's need and demand for a common definition. The medical community tried, and failed, to resolve these differing definitions several times at consensus conferences and through published articles. These experts finally accepted a standard definition at an international consensus conference convened by the World Health Organization in 1992. The construction of osteoporosis as a disease of quantifiable risk diagnosed by medical imaging machines reflects contemporary trends in medicine, including the quantification of disease, the risk factor model, medical disciplinary boundaries, and global standardization of medical knowledge.