EB49/28 7 December 1971

REGIONAL СШМ1ТТЕЕ FOR THE AMERICAS Report on the Twenty-third Session

The Director-General has the honour to present to the Executive Board the report on the twenty-third session of the Regional Committee for the Americas/xx Meeting of the Directing Council of the Pan American Health Organization.1 This report is preceded by an introduction which summarizes the discussions and action taken at this meeting.

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTÉ

EXECUTIVE BOARD Forty-ninth Session

Provisional agenda item 5,2.

EB49/28

7 December 1971

I N D E X E D

Document CD20/39_

XX MEETING OF THE DIRECTING COUNCIL OF THE PAN AMEEIGM HEALTH ORGANIZATION

The XX Meeting of the Directing Council of the Pan American Health Organization, XXIII Meeting of

七

lie Regional Committee of the World Health Organization of the Americas, was held in Washington, D. G. from 27 September to 7 October 1971， in accordance with the convocation issued by the Director of the Pan American Sanitary Bureau, pursuant to the decision of the

Executive Committee at its

h Meeting.

The following governments were represented : Argentina, Barbados, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, France, Guatemala, Guyana, Haiti, Honduras, Jamaica, Kingdom of the Netherlands, Mexico, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, United

Kingdom, United States of America, Uruguay and Venezuela.

The Executive Committee of the Directing Council of the

Pan American Health Organization was represented by its

Chairman, Dr. Rogelio Valladares. Also present were the

Assistant Director General of the World Health

Organization, Dr. Lucien Bernard, as well as observers of the Organization of American States (OAS), the

Inter-American Development Bank (工 DB), the United

Nations Children^ Fund (UNICEF), the Food and Agriculture Organization of the United Nations (PAO)

and the United Nations

Programme (UNDP). Observers from 8 non-governmental organizations also attended the meeting.

The Meeting was opened by the Acting Chairman, Dr. Rogelio Valladares, Director General, Ministry of Health and Social Welfare of Venezuela, and Chairman of the 66th Meeting of the Executive Committee. The Council then elected its officers as follows : Chairman, Dr. Jesse L. Steinfeld (United States of America); Vice Presidents, Dr. Jose Maria Salazar BucheHi (Colombia) and Dr. Abelardo Saenz Sanguinetti (Uruguay)

Dr. Jose Luis Orlich (Costa Rica) served as rapporteur and Dr. Abraham Horwitz,

Director of the Pan American Sanitary Bureau,as Secretary

ex officio.

The Committee on Credentials was composed of the following members : Dr. Alberto Aguilar Rivas

(El Salvador), Chairman; Dr. A. V. Wells (Barbados), Rapporteur; Dr. Xavier Manrique (Ecuador), Member The General Committee was composed of the President, the Vice Presidents, and the Rapporteur of the Council and, in addition, the Representative of Argentina, Dr. Robinson E. Holmes D'Aiutolo

the Representative of Jamaica, Dr. E. J. Valentine, and the Representative of Mexico, Dr. Renaldo Guzman Orozco.

Four working groups were established : the first,

composed of the Representatives of Argentina, Trinidad and

Tobago,, and Venezuela, was responsible for studying the

application of Article G-B of the Constitution (suspension

of the voting privileges of any Government two years in

arrears in the payment of i

s quotas)

the second, com-

posed of the Representatives of Argentina, Brazil, Canada,

Cuba, Mexico

and the United States of America was established

to study a plan for a poliomyelitis control program; the

third, composed of the Representatives of Canada, Chile and

Guatemala, examined the topics suggested for the Technical Discussions to Ъе held during the next Meeting of the Directing Council; and the fourth, composed of the Representatives of Canada, Chile, Mexico, Trinidad and Tobago, and Venezuela, was re-

sponsible for studying an agenda item concerning the next Meeting of Ministers of Health of the Americas, in particular the date and place of

hat meeting The topic of the Technical Discussions of the Council at this meeting was "Environmental Pollution"- The

report on the Technical Discussions was presented at the Thirteenth Plenary Session of the Council which approved Resolution XXXV relating thereto.

The Directing Council held sixteen plenary- sessions and a closing session- The Committee on

Credentials held four sessions and the General Committee ten sessions. The Council considered 40 items, in

accordance v;ith the agenda adopted^and approved 55

résolu

ions in the course of the meeting.

Admission of Canada

0 Membership of the Pan American Health Organization

In May 1971 the Government of Canada submitted an application for membership of РАНО, and in July of the same year the Executive Commit

ее at its eeth Meeting recommended to the Directing Council that it accept the application.

Considering that the Government of Canada has de- clared its willingness

о assume all the obligations set forth in the Constitution of the Pan American Health

Organization and to comply with the provisions of the Pan American Sanitary Code, and bearing in mind that at the admission of Canada to membership of

he Pan American Health Organization is a valuable contribution fco the

common effort to improve the health and well-being of the Continent, the Directing Council approved with, satisfaction the request of Canada for admission to membership of

he Pan American Health Organization and instructed the

Director to transmit this decision to the other members of the Organization (Resolution II).

The resolution was approved following short state- ments Ъ,у the

of the Member Governments

who thereupon voted the admission of Canada by acclamation.

With the admission of Ganada^which is one of the founder

members of the World Health Organization, РАНО now has 29 members

all the countries of the Hemisphere are now members of both health organizations.

Annual Report of the Director of the Pan American Sanitary Bureau

After examining the Annual Report for 1970 of the Director of the Pan American Sanitary Bureau, Regional Office of the World Health Organization for the Americas (Official Document 109), the Direct i np;

Council adopted Resolution VIII approving it. It also commanded the üirf^ctor for the work done an<i e>-tf;nd<^d the commendation to all

lie staff at the Bureau.

The Report of the Director is divided into nine parts, namely: 1) health, protection^which includes

a) eradication and control of diseases and Ъ) engineering and environmental sciences; 2) health promotion^which comprises a) general services and Ъ) specific programs ; 3) development of. human resources;

health planning;

5) research development and coordination; scientific

and public communications; 7) external relations of the

Organiza

ion; 8) organization and administration; and

9) project activities.

In presenting his report the Director emphasized that preventive and curative services should not be a privilege but a right for all. He drew attention to certain problems common to all the countries, the first of which is the change in the patterns of mortality as reflected in the increase in life expectancy at birth and a greater prevalence of chronic diseases which, in turn, is related to a greater demand for services as a result of population growth. He underscored both the desirability of increasing direct and indirect

investments in the health field and the urgent need

to increase the output of the existing capacity of human

material^ and financial resources by means of planning, organization, systems analysis^and operations research.

After stressing the importance of community participation in all stages of the process, he stated that,, despite the progress made

vital and health statistics were still de-

ficient with the exception of those of Canada and the

United States of America. It was, therefore, necessary

to reorganize the teaching and learning process in respect

of the health sciences to cover the promotion,

protection^and restoration of health. In his opinion many of the serious health problems affecting rural

areas were related to the accelerated migration of rural dwellers to urban areas, a phenomenon which was not to be regarded as inevitable and which, the governments

should halt by aesigning it top priority. He related the low level of development with, higher prevalence of com- шип1саЪ1е diseases^ in particular those of children under

five years of age, and pointed out that the growth of urbanization and industrialization brought with it a

predominance of chronic diseases and other problems such as air, water, and soil pollution and an increase in noise and violence. Consequently, it was necessary to

streamline the administrative management of the governments as much as possible^since there was undoubtedly a close interdependence between planning, evaluation^ and in- formation in any health, system. In that connection lie pointed outj among other important points

that the

"budgets frequently have no direct relation to the

objectives of each project and that the equipment, materials

and personnel were not available to those carrying out each activity. He said that his remarks did not

constitute a criticism but

on the contrary； were

related to the undeniable health progress made in the last twenty years in the Continent. All these

problems were present in varying forms and

in the 629 projects in which. РАНО and WHO had assisted the countries and territories of the Americas in 1970.

The Director pointed out with considerable satis- faction that,since April 1971， there had not been a single recorded case of smallpox in the Continent, and drew attention to the work done Ъу Brazil^ which had

vaccinated more than 76 million persons in recent years.

In all the other cotintries

even though the immunity level of the population had been raised, it was still neces- sary to put epidemiological surveillance on a systematic and continuing basis. In support of his statement he referred to the reinfestations Ъу Aedes aegypti, a vector capable of transmitting not only yellow fever

and dengue but also Venezuelan equine encephalitis. The

cost of dealing with those reinfestations was much greater

than, would have been the cost of maintaining epidemio- logical surveillance. He mentioned the valuable

assistance provided by UNICEF and AID (Agency for International Development of the United States) for the total elimination of malaria and referred to the use of OMS-33 in areas in which anoiüxeline moe-

quitoes were resistant to chlorinated Insecticides.

There have been no changes in the frequency of bubonic plague and no case of cholera had been reported despite the heavy air traffic with Spain and Portugal where outbreaks of cholera had recently occurred. He

emphasized the important assistance received from the National Comnrunicable Disease Control Center in Atlanta

(U.S.A.) and from the Governments of Colombia and Brazil.

He pointed to the progress made in the field of

tuberculosis control in the last 10 years and stressed

the generous cooperation of the Government of Venezuela

which had sponsored annual training courses for epidemio-

logists and microbiologists in tuberculosis control. On

the other hand, there was a lack of reliable comparative

data on leprosy but the Bureau would make available to the Government a study prepared by a committee of

experts with a view to reducing the incidence of the disease which is static-

He expressed his satisfaction with the reduction in the питЪег of human cases of rabies, of bovine

brucellosis^ and tuberculosis

and of foot-and-mouth

disease, which had resulted in an increase in the amount of animal proteins available for consumption.

With respect to water supply and Aewerage systems in urban and rural areas, he said that considerable

national and international funds had been devoted to those projects. The total investment amounted to

US$384,740,000 of which US$121,930,000 had been provided Ъу international financial institutions, in particular, the 工

As a result, potable water

of

domiciliary connections would be available for

7,200,000 persons

this essential element will Ъе pro-

vided by means of public standpipes for 3^-5,000 persons

and an additional 7 million would receive improved water

supply services. As had been happening in the past decade

page

the total number of persons served in the year was greater than the population increase.

He referred to the important work of the Pan

American Center for Sanitary Engineering and Environmental Sciences (CEPIS) in Lima

the coordination of the Pan American Air Pollution

Sampling Network which, with the in-

stallation of seven stations during the year, already had 29 stations in 1$ countries. An analysis of

the data from these stations had already enabled the participating countries to establish differences with re- spect to powder in suspension, sedimentable powder, and sulphur anhydride. The governments had thus been pro- vided with, information enabling them to formulate their policy with regard to the installation of industries which may result in air pollution.

In I97O technical assistance was given to 17 countries on sewerage systems, water pollution,

and industrial wastes

to 16 on problems relating to water

quality; to 14 oô programs for the installation of latrines

in rural areas and to 10 on the utilization of oxidation

ponds for the treatment of sewage. In view of the growing concern of the national and municipal authori- ties about soil contaminationdue to the indiscriminate elimination of solid wastes in cities, the Organization gave technical assistance in 1970 to 12 countries on this problem, including financing and improvement of existing

services.

The Director stressed the assistance provided by PASB for the development of river basins, such as those of Santa Lucia in Uruguay, Huallaga in Peru, and Guayas in Ecuador. He next referred to the activities undertaken by the countries with, the assistance of the Organization to expand the coverage of

and improve

general health

services. At the beginning of the year,50 general health service projects were in operation

Ъу the end of the

year，57 were being conducted in 26 ^ ^ countries and 14 territories. During tlie year, 21 countries

undertook an overall analysis of the health situation which included the study of the factors conditioning，inter alia , the infrastructure of the sector with respect to resources

8 4 2 1

and their administration.

The XVIII Pan American Sanitary Conference recommended to the governments"that they initiate action that will lead to the prompt establishment of a nursing system in which areas of responsibility and quantity and category of personnel required are defined and which, is compatible with

be local health program objectives and the type and level of medical care to Ъе

о

provided. The Director emphasized that,in Middle

America and especially in South America, there were fewer nurses and even auxiliary nurses than physicians,whereas the reverse was so in Canada and the United States of America. Despite the interest expressed by nurses in all the countries in participating in the formulation of

health plans and in the programming of nursing activities, their lack of participation was obvious.

The Governments of Mexico, Cuba, Cblle, Peru,

Venezuela, and Guatemala have made important progress in

the production of biological products; the two first

mentioned have received funds for that purpose from the

Special Fund of the United Nations Development Program

(UNDP/SF) In Central America, the ne

work of laboratories

for the diagnosis of communicable diseases and of

products of interest to public health had been expanded.

Referring to the great importance assigned to drug control, the Director reported that

in the Latin

七he

American and/Caribbean countries, there were approximately 2,000 important drug manufacturing businesses whose

annual production amounted to US5l

2 3

million at factory prices. The amount of drugs imported into the Region

exceeded exports Ъу US$116 million annually, which increased the volume of annual consumption to US$1,350 million at

Government expenditures for drug control in Latin America

US$1.7 per $1,000 of drugs consumed,whereas government outlays for drug quality control in the United States of America and Canada amount to US$4.8 and US$5•9¡respectively, per US$1,000 of drugs consumed.

Until recent years there had been almost no

interest in hospital maintenance and engineering. The

Center for Hospital Maintenance and Engineering

continued to conduct training and service programs in Venezuela. The Maracay Hospital was selected as a pilot hospital for tlie center in order to establish

favorable conditions for conducting hospital maintenance programs.

Thanks to a grant from the W. K. Kellog Foundation

the Bureau had been able to assist six

university hospitals to strengthen intensive care uni

s wbich helped to raise the quality of the medical care patients should receive 24 hours a day.

Regarding the Inter-American Investigation of Mortality in Childhood, the Director reported that data on nutrition, sociological factors,and environmental con- ditions had been collected oil 35

000 families that had suffered the loss of a child under 5 years of age in the two-year period 1968 throu^i 1969; in this way efforts were being made to correlate each death with, biological

economic, and social factors. The influence of the rural

environment, malnutrition, illiteracy, infectious diseases

and unsatisfactory maternity care, was clear.

He related maternal and child health to family planning, and reaffirmed the policy followed in this respect Ъу VIHO and РАНО pointing out, however, that infant mortality rates were falling in families which space

he birth of their children. PASB was already

assisting 14 governments and was ready to assist any other government that wishied to establish, its own population policy.

The Organization had assigned high priority

о technical assistance to nutrition programs, including projects for the enrichment of salt with, iodine, maize with lysine and tryptophan, and sugar with Vitamin A, as a result of research carried out Ъу the Institute of Nutrition of Central America and Panama. It was also exploring the possibility of enriching food with iron in view of the

frequency of iron deficiency anemias. Of a total of 75 projects receiving aid from the World Food Program (VÎT) in Latin American and the Caribbean area, the primary objective

of 22 was health,

5 had health, as a secondary objective, and 8 were unrelated to it. The total value of the WFP

assistance to 67 projects amounted to 芨1 56,787,000 or 89.7%

of the total aid provided to the Americas. In view of the

proven need for the formulation of a food and nutrition

policy РАНО was working together with UNICEF and FAC•.

After referring to the fundamental importance of water fluoridation for dental health, the Director emphasized the urgent need for the training of auxiliary dental personnel. He stated that the Organization was providing training opportunities in an effort to solve the manpower shortage which was holding up the execution of health programs. In 1970

a total of 935 fellowships was awarded involving an investment Si,804,963-

the

He emphasized that the means of regulating/cellular functionwere complex, that the limits of adaptability to a given diet were not well understood, and that the necessary information would not Ъе obtained from the perpetuation of traditional experiments in human nutrition but rather from

those based on the nost recent concepts of molecular

biology and cellular regulation. It was such considerations as these that led to the Symposium on Metabolic Adaptation and Nutrition which took place during the Ninth Heetinp; of the РАНО Advisory Committee on Medical Hesearch. The intrinsic

chemical or molecular aspects of cells, organsjand the

hormonal system in each human being were examined with respect to various córrela

ions. The facts

accepted do not always make it possible to establish value judgments because adaptation is an individual process. More sensitive indicators are needed for identifying marginal states and they should Ъе de-

veloped from studies on cellular biology, biochemistry, genetics, and related areas. In that way, new ideas and methods for reducing the impact of malnutrition on physical and mental health would Ъе developed. In view of the exceedingly high incidence of malnutrition,

efforts to apply what was known should Ъе increased.

Finally, the Director stated his conviction that the Continent would soon be speaking less of mortality and morloidi

7 and more of health, and wellbeing, an authentic wellbeing deriving from a genuine social co-existence.

Budgets and Financing

At this meeting the Directing Council approved a

number of resolutions relating to the administrative and

financial management of the Organization, including the

following:

page 21

Financial Report of the Director and Report of the External Auditor for 1970

The Council examined and approved Resolution IX the Financial Report of the Director and the Report of the External Auditor for 1970 (Official Document 10o)

after noting

he improvement in the presentation of the informational annex on РАНО/WHO expenditures^ which

permits comparison of the funds assigned to and spent on each, program. It also again commended the Director for having consistently pursued long term financial policies enabling the Organization to achieve and maintain a sound

financial position, and thanked the External Auditor

for his report.

РАНО Appropriations (1972)

For the financial year 1972 the Council appro- priated US

0,388,314 (Resolution V) as follows:

3 6 3， 斗9 1

-Headquarters 4,082,167

-Pield and Other Programs 11,230,660

-Special Fund for Health Promotion 250,000

page 22

Increase to Assets 350,000

- P a n American Foot and Mouth

Disease Center

Effective Working Budget S 17

821， 855 -Staff assessment (transfer to

Tax Eaualization Fund) 2,5

^,759

Total S 20,388,^14

It also decided that the appropriation would be financed from: a) Assessments in respect of Member Governments and Participating Governments amounting to

$20,183,614- and b) Miscellaneous Income of US$205,000.

The amount of US$17.8 million for the РАНО effective working

budget for 1972 is almost 8% higher than the US$16.5 million figure for 1971.

Total Budget (PAHO/WHO) for 1972

The joint PAHO/WHO (Region of the Americas) budget for 1972 amounts to US$3^,^98,879 and comes from the

following sources :

1• РАНО regular

2. Other РАНО funds

$ 1 7， 8 2 1 ， 85 5

РАНО Special Malaria

РАНО Community

er Supply Grants and о七her contributions

о РАНО:

INCAP and related grants Other grants and contri-

butions 3. WHO regular "budge

4. Other WHO funds :

United Nations Development Fund：

Technical assistance Special Fund

Grants and other contributions Total $

200,000 199,835

1，1 6^,080

2,737M5 8,237,703

1,889,175

2,106,832

З^Л98,879

Under the 1972 approved program budget, IISS-7 • 3

million is assigned to communicable diseases such as

malaria, smallpox^and tuberculosis; US$3 •

о environmental sanitation; US$3 million to development of health education institutions； and US$2.6 million to

nutrition.

EB49/28

page 24

Provisional draft of the РАНО proposed program and

"budget; estimates for 197$

In Resolution VII, the Council took note of the provisional draft of the proposed program and budget estimates of the Pan American Health. Organization for 197

(Official Document 107)

and requested the Director

the

to use/provisional draft as a basis for the .prepara 七 ion of the proposed program and budget estima

es for 197 after further consulta

ion with the Governments to

determine their latest desires and requirements in relation to the health priorities of the countries.

Proposed program and budget estimates of the World Health Organization for the Region of the Americas for 1973

In accordance with

he recommendations made Ъу the eeth. Meeting of the Executive Committee and noting

with concern the trend, in

he level of the WHO budget assigned to the Region of the Americas, the Directing

Council approved the proposed program and budget estimates

of the World Heal

h Organization for the Americas for 1973

(Official Document 10?), and

page 25

to transmit them to ttie Director General of the Organization so that he may take them into account in preparir^ the WHO "budge

estimates for 1973* He also requested the Director General

those proposed budget estimates, to give favorable con- sideration

о increasing the proportion assigned to the Region of the Americas (Résolu

ion XI).

Proposed WHO program and budget estimates for the Region of the Americas for 197

Bearing in mind the need

о take into consideration the health requirements of the Continent in future years,

tie Directing Council recommended to the Director General of WHO that, witbin

lie amount he finds possible to allocate to the Americas, hie include^in the proposed program and

budget for 197

the proposal set out in Document CD20/23, giving due regard to the projects and priorities contained in Document CD20/21, Addendum 1. It also requested him to give favorable consideration to increasing the proportion assigned

о the Region of the Americas, recognizing that

this request; should not imply a recommendation for increasing

the total budget of WHO. (Resolution XVI).

Communicable diseases

Malaria. In Resolution XÏVI, the Directing Council viewed with concern the financial difficulties

hat; are hindering the progress of some national malaria eradication programs

noted that the agricultural use of insecticides may engender vector resistance and that DDT is still the most useful insecticide for most of the

the

malarious areas. After taking note of/XIX Report on

the Status of Malaria Eradication in the Americas (Document CD20/2)

it reiterated its wish that tbe Governments v?i

li eradication programs that have not yet been reexamined undertake that reexamination in accordance with Resolution WHA22.39). It also recommended to the Governments that,

through their minis

ries of health and agriculture’ they issue regulations governing

he use of acceptable insecti- cides for health campaigns and agricultural use, and re-

quested the countries producing DDT to continue manufacturing it for those activities.

Finally, the Council reaffirmed the importance of

strengthening basic health, services in originally malarious

areas and of strengthening coordination between national malaria eradication services and general health services

and thanked UNICEF, UNDP and the Governments of the United

States of America and of the Federal Republic of Germany for the assistance they have provided and requested

them to continue to provide assistance at a level that will enable the programs to be efficiently conducted.

Aedes aegypti eradication. Bearing in mind the danger represented by the infestation Ъу Aedes- ae^ypti of extensive areas of the Continent, and seriously con- cerned about the preven

ion and control of yellow fever

and dengue, the Directing Council in Resolution XIII endorsed

七

he recommendation contained in Resolution V of the S

>th Meeting of the Executive Committee that the studies and investigations being carried out should not entail any reduction in the efforts of the countries to eradicate

the vector from their territories or

when that is achieved^

to prevent their reinfestation. It also noted that the

Organiza 七 ion had signed a contract for cost—bene fit; studies

of programs for

he prevention of Aedes ae^ypti-borne

EB49/28

page 28

diseases which did not involve any increase in the "budge

and it requested the countries and territories s

ill infested to make every effort to eradicate Aedes aegypti as soon as possible and requested countries free of the vector to intensify surveillance activities in order to prevent reinfestations.

Poliomyelitis. When adopting Resolution XXII on this item, the Council took in

о account the report of the Director on poliomyelitis vaccination programs in

the countries of Hiddle America and South America(Document CD20/27 )， as well as the statement made by Dr. Albert B.

Sabin concerning the disease which affects almost all the countries of the Americas with, varying degrees of

morbidity, and which periodically occurs

here in epidemics of varying severity and extent. It noted that;, although poliomyelitis mortality rates were relatively low, the disease was one which was the cause of serious sequelae.•

However, the disease can Ъе controlled with live attentuated

poliomyelitis oral vaccine which is available and easy to

administer, and has been used successfully in several

page 29

countries of the Region to the point of virtually

eliminating in some of them the occurrence of clinical cases. In view of this and considering that it is the objective of the Member Governments that poliomyelitis cease to Ъе a health problem in th.e American Continent, the Council recommended to the Member Governments that they study their situation in order to organize, in-

tensify, expand or maintain whichever is applicable,their poliomyelitis control programs. It also requested the Director to coordinate the studies and conduct of polio- myelitis control programs in the Americas, and to provide the countries within available resources with technical and material assistance in planning, organizing, conducting and evaluating the corresponding epidemiological surveillance programs, especially in the event of the tbreat or the

occurrence of epidemics.

In order to expand the available assistance for poliomyelitis control programs in the Americas,

the Council authorized the Director to establish a Special

Fund, financed Ъу voluntary contributions, and invited

he

Member Governments to generously contribute funds, ma

erial and equipment for the establishment and

maintenance of this fund; and for that purpose requested the Director to approach UNICEF and other United Nations agencies as well as private and public institutions.

Finally, the Council took two other important decisions about poliomyelitis : 1) to establish, a suf- ficient reserve of live attentuated poliomyelitis oral vaccine, the cost of wliich is to Ъе borne by the Special Fund, to serve the needs for epidemic control and to be distributed to the countries in accordance with the needs of and progress made Ъу the respective programs

and 2) to request the Director to take

he necessary steps to promote the organization of a regional network of labora- tories for the isolation, diagnosis, and typing of polio- myelitis virus, which, could Ъе used also by countries that do not have such laboratories.

Smallpox eradication. After considering the report

of the Director on the status of the smallpox eradication

campaign in the Americas (CD20/6)

the Directing Council

page 31

approved Resolution XXIII recognizing the substantial progress made in

he campaign which, must be consolidated by improving case reporting, surveillance

and maintenance

services if eradication of the disease is to be achieved.

The Council reaffirmed that the eradication of smallpox con

inues to have high priority, thanked the Governments for the efforts they had made to eradicate the disease^

in particular the Government of Brazil for the activities it has been carrying out to achieve that objective^and urged them to continue to cooperate with, and aid countries

t h a t request assistance by supplying vaccine, laboratory

diagnosis facilities, and technical advisory services.

The résolu

ion also noted that the Government of tlie United States of America had recommended to the States within the U. S. A. that they suspend the compulsory small- pox vaccina

ion

a step ¿justified, by the existence of

excellent epidemiological surveillance services in that

country. The Council recommended

о

he other countries

of the Continent that

before adopting a similar measure,

they study the risks it involves and they maintain their

vaccination services and improve their epidemiological surveillances in order to proceed with the immediate investigation, of any suspect cases of smallpox and wi

li revaccinations^whenever necessary.

Cholera. In Resolution XXIV the Council noted that the appearance of cholera in certain European

countries represents a threa

о the Americas and

after examining Resolution V/HA24.2S of the 24th World Health Assembly on the cholera pandemic, reaffirmed the recom- mendation of the XVIII Pan American Sanitary Conference to the Governments that they intensify their surveillance efforts in order to provide the earliest possible warning incase the disease appears in the Americas. It also

strongly recommended to 七 lie Government s that'in applying the measures provided for in international health, regulations with, regard to international travelers, they not go beyond the scope of those regulations.

Heetinp; of Ministers of Heal

h and -place of the Meeting;

of the XXI Meeting of the Directing Council

Recognizing the need to define a health policy for the Americas for the decade 3.971-1980, consistent with

8 2 2 3

the anticipated socio-economic development in the decade, the Directing Council recommended Resolution XXVII that a Meeting of Ministers of Health of the Americas be held immediately before the XXI Meeting of the Directing

Council, XXIV Meeting of

he WHO Regional Committee in Santiago, Gtiile^in September or October 1972. In making this decision,

he Council took into account the kind invitation extended by the Government of Chile to hold the meeting in that city.

The Council proposed that the Meeting of Ministers deal with the following subjects :

a) regional analysis of the progress made in the health sector in attaining the goals of the decade 19^1-1970;

b) assessment of prevalen

health problems and their Continental implications in the light of the anticipated socioeconomic development in the decade 1971 - 1980;

c) establishment of goals for the period

including the setting of priorities;

d) establishment of the strategy for attaining these goals, including an examination of the financial implications.

I

also requested the Director to take the neces- sary steps to convoke and organize the Meeting of

Ministers and recommended to the Executive Committee ttiat

as soon as the Governments have examined the

working documents for the meeting, it draw up a proposed agenda and submit it to tlie countries for consideration at an early date.

IV Inter-American Meetdnp; at the Ministerial Level on the Control of Foot-and-Mouth Disease and other Zoonoses

The Council considered

and took note in Résolution XIV of the Final Report of the IV Inter-American Meeting

at the Ministerial Level on the Control of Foot-and-Mouth Disease and other Zoonoses (Document CE66/8)

and expressed its thanks to the Ministers of Agriculture for their efforts to control those diseases which seriously affect food

a

production and have/marked impact on human heal

Ь and well-

being. It also expressed its satisfaction with the

resolutions relating to programs for manpower development and for the planning and evaluation of animal health

programs and reaffirmed its support of the Pan American Foot-and-Mouth Disease Center and the Pan American Zoonoses Ceri

er and of the programs they are carrying out, and

approved the program and budget estima

es of those Centers fcr 1972 and the preliminary draft for 1973.

In reaffirming its support of the request of the Governments to the United Nations Development Program that

it provide

he Pan American Zoonoses Center with, financial assistance, it emphasized the need for the Organization to provide increased technical assistance for the study and conduct of programs for the control of diseases such as Venezuelan equine encephalitis

which are emerging as

serious health problems. Finally, it thanked the Governments of Argentina and of Brazil for the technical and financial assistance they have given to the Pan American Zoonoses Center and the Pan American Foot-and-Mou

h Disease Center respectively.

Man-environment relationships

The Directing Council examined the report on man-

environment relationships which included suggested goals for 1970-1980 (Document CD20/7)

submitted Ъу the Director whom it commended for its presentation.

When approving Resolution XXXI on this item, the Council noted, inter alia, the unprecedented advances in traditional sanitation achieved over the past decade Ъу Member Governments, especially in providing water supply and sewerage services; in

strengthening national institutions essential

о en- vironmental quality control

in establishing the Pan

American Center for Sanitary Engineering and Environmental Sciences; and in initiating continental networks for

monitoring and continuing education, research^and graduate study. This progress notwithstanding, the Council urged the Ministers of Health to expand and

strengthen their capabilities to cope with, health related

problems of the changing human environment and to continue

to emphasize the provision of basic sanitation services

to urban and rural populations with special attention to

community organization, self help concep

s,and revolving

fund mechanisms to support mass approach techniques.

The Council thanked the international lending agencies for their support to Governments in projects to improve sanitation and health and requested them to continue their collaboration. It suggested to the Director that he reassess the Organization's

resources for environmental health and that he arrange for liaison and collaboration with national and inter- national agencies to exchange information regarding

environmental changes. It also requested him to explore ways and means

establishing

Center

Human

and Health Sciences as a supplement for existing Centers to serve as a prototype in a global network for human ecology.

РАНО Research Policy and Program

After examining tlxe report on the РАНО Research Program 1962-1971 (Document CD20/13)

the Directing Council con-

gratulated the Director, in Resolution XXXIV, on the

progress of this program in the last decade. Recognizing that,in order to successfully carry out the research

program in the next decade, i

was necessary to strengthen

the Organization's research, and research training efforts, it instructed him to include in the regular budget increasing amounts for the program only with more emphasis in the areas of the administration and delivery of services, housing and environmental control, and chronic diseases. It also instructed the Director to renew his efforts with.

he Organization of American States to include the Pan American Health Organization as an active participant in

he Regional Scientific and Technological Development Program with access to the funds made available for implementing that program.

The resolution of the Council thanked tlie Govern- ments ,foundations, agencies and other groups which, has so far supported the program and specifically the Govern- ments of Chile, Trinidad and Tobago, and Uruguay for their contributions to the Special Fund for Research and urged all other Member Governments to contribute

о this Fund on a regular basis.

Traffic accidents

After examining

he report of the Director on

traffic accidents (Document CD20/10, Rev. 1 )， the Council expressed its satisfaction in Resolution XXVIII, with a presentation of the subject^seeing that^ as is shown by the data presented

it is a public health problem whose extent and epidemiology are not accurately known particularly in Latin America•

In view of the need to stimulate interest in this problem, the Council suggests to the Director that the Organization continue and intensify its col- laboration with organizations working in this field and promote coordination between them and that he furnish advice to the countries on the study of

tie epidemiology of the factors involved in the causation of traffic

accidents,

and on the establishment of uniform standards of accident classification, adoption of control measures and training of specialized personnel.

It also recommended to the Governments that they

give special attention to the epidemiological study of

accidents; that they encourage the conduct of programs

for accident prevention, medical care for victims, driver

instruction, improvement of procedures for the granting

of drivers' permits and the traffic safety education of

he public, in particular of school children

and drivers. Finally, it recommended "that; they review their legislation in this respect and appropriate the necessary funds to finance these activities.

The Council thanked and accepted the offer of the United States of America to finance an international seminar or working party of experts for the purpose of studying the factors of drinking alcohol that enter into play in traffic accidents and measures for their prevention and requested

he Director to take the necessary steps to plan and organize this seminar.

Technical discussions •

Having considered

lie Final Report of the Technical Discussions on "Environmental Pollution", which were held during the meeting, the Council expressed in Resolution XXXV its great concern with respect to adverse environmental

aspects, inter alia,and recommended to the Governments

that

hey pursue

he possibility of establishing programs

for controlling

he quality of the environment； promoting

the search for new concepts and approaches, fostering

he

creation of institutions for environmental protection, and training personnel for that purpose. It also urged the Member Governments to establish or reinforce

environmental health activities within the Ministries of Health, in particular the execution of housing programs and those for the provision of water supply, excreta disposal,and air pollution control. Finally, the Council expressed its satisfaction with

he conduct of the

Discussions and suggested to the

Director that he give the Final Report and background documents wide distribution.

For the Technical Discussions to Ъе held during the XXI Meeting of the Directing Council, XXIV Meeting of the WHO Regional Committee for the Americas, the

Directing Council selected the following topic : "Community health, services and community involvement" (Resolution XXIX).

* The Final Report and tbe background documents of the Technical Discussions will be published in the January

1972 issue of this Bole

in.

Other resolutions

Election of three Member Governments to the Executive Committee. The Directing Council elected the Governments of Barbados, Canada

and El Salvador to the Executive Committee for a period of three years, on the termination of the periods of office of

Argentina, Costa Rica,and Mexico (Resolution XVII).

Resolutions of the World Health Aseembl.y of

interest to the Regional Committee. In Resolution XV

the Council took note of the following resolutions con-

tained in Document CD20/3, which, were adopted by the

24th World Health. Assembly: WHA24.30 (Occupational

health programs), УНА24.31 (Development of the medical

use of ionizing radiation), V/HA2^. $6 (Disinsection of

aircraft), WHA24.45 (Smallpox eradication), WHA21

7

(Problems of the human environment), WHA24-49 (Strategy

for healtli during the Second United Nations Development

Decade), УНА24.55 (Community water supply: report on

the financial consequences of the program for WHO) and

WHÁ24.59 (Training of national personnel).

Drug; abuse. The Directing Council commended Resolution WHA24.57 on drug abuse and recommended to the Director of

he Pan American Sanitary Bureau that he continue his efforts to carry out an epidemiological

investigation to ascertain the extent of the

problem in the countries of the Americas. It also re- quested the Director General of WHO to approach, the United Nations Fund for Drug Atuse Control with a view

to obtaining the funds for carrying out this important program (Resolution XXV).

РАНО textbook propyam. The Directing Council took note of the report of the Director on the textbook program (Document CD20/5， Rev. 1)， and congratulated him on the way in which

he program had been conducted and on obtaining adequate long-term financing for it. It thanked the Inter-American Development Bank for approving the loan to finance this important program as well as the Pan American Health. Education Foundation for its co-

operation with РАНО in this activity (Resolution XVIII).

Expansion of occupational health services. The

Council urged the Governments

о establish national

occupational health programs or, if they already existed, to expand them with, government collaboration, since

these programs help to increase individual productivity and contribute to a country's economical development.

工七

requested the Director

within budgetary priorities, to broaden the Organization

s assis

anee to governments to strengthen these programs and urge the governments to encourage institutions that finance industrial development to provide funds for occupational health requirements in the projects they finance as well as for the treatment of industrial waste (Resolution XXXII).

Promoting; community participation in public health programs. The Council thanked the Government of Mexico for its interesting and stimulating report presented by the Representative of that country on the philosophical and pragmatic principles of programs designed to raise the level of living of the rural population. Noting that rural underdevelopment is a general characteristic of most of the Latin American countries, it recommended to the

Governments of the countries of the Continent whose rural

develop programs that will contribute to raising the level of

health living of rural populations (Resolution XXXIII).

directing council

PAN AMERICAN HEALTH

ORGANIZATION

regional committee

WORLD HEALTH ORGANIZATION

EB49/2 8 ANNEXE I

XX Meeting XX Reunion

Washington, D.C.

September-October 1971 Septiembre-Octubre 1971

XXIII Meeting XXIII Reunion

CD20/29, Rev. 4 18 October 1971 18 Octubre 1971 18 octobre 1971

LIST OF PARTICIPANTS LISTA DE PARTICIPANTES LISTE DES PARTICIPANTS

ARGENTINA ARGENTINE Representative - Representante 一 Représentant

Dr, Robinson Eugenio Holmes DfAiutolo Subsecretaría de Salud Publica

Ministerio de Bienestar Social

Alternate - Suplente - Suppléant Dr. Victorio V. Olguín

Jefe del Departamento de Relaciones Sanitarias Internacionales

Subsecretaría de Salud Publica Ministerio de Bienestar Social

BARBADOS BARBADE Representative - Representante - Représentant

Dr. A. V. Wells, O.B.E.

Chief Medical Officer

Ministry of Health and Social Welfare

Alternates - Suplentes — Suppléants Dr, James A. Williams

Hospital Director, Queen Elizabeth Hospital Minis try of Health and Social Welfare

Mr. A. F. Daniel

Senior Asst. Secretary

Ministry of Health and Social Welfare

BOLIVIA BOLIVIE Representative - Representante 一 Représentant

(Not represented) (No representado) (Pas de représentation)

BRAZIL BRASIL

"BRESIL Representative - Representante - Représentant

Dr, Hugo Victorino Alqueres^Batista Secretario de Assistencia Medica Ministerio da Saude

Alternate - Suplente - Suppléant Dr. Alfredo N. Bica

Secretario de Saude Publica Ministerio da Saude

Advisers 一 Asesores - Conseillers Dr. Olympio da Silva Cascaes

Sub-Chefe do Gabinete do Ministro da Saude Mr, Genaro Mucciolo-

Segundo Secretario

da Missao do Brasil junto a OEA

CANADA Representative - Representante - Représentant

The Hon, John Munro

Minister of National Health and Welfare

Department of National Health and Welfare

Alternates 一 Suplentes - Suppléants Dr, J. S. Maurice LeClair

Deputy Minis ter of National Health Department of National Health

and Welfare

Mr. К, B. Williamson Minister, Canadian Embassy- Washington, D.C.

Dr. B. D. B. Layton

Principal Medical Officer International Health

Department of National Health and Welfare

Advisers 一 Asesores - Conseillers Dr. Didier Dufour

Directeur, Institut National de la Recherche Scientifique-Santé Centre de Biomedecine

Université Laval Quëb ec

Dr. Ernest Mastromatteo Director

Environmental Health Services Branch Ontario Dept. of Health

Mr. L. S. Clark First Secretary Canadian Embassy Washington, D.C.

CHILE CHILI Representative - Representante - Représentant

Dr. Juan Carlos Concha Ministro de Salud Publica Ministerio de Salud Publica

Alternates 一 Suplentes - Suppléants D r� Bogoslav Juricic

Secretario del Consejo Consultivo del Ministerio de Salud Publica, y Jefe, Oficina Asuntos Internacionales

del Servicio Nacional de Salud Sr. Olegario Russi M.

Consejero de la Delegación de Chile ante la Organización de los Estados Americanos Washington, D. C.

Sra. Luz María Destefano de Leonard

Tercer Secretario de Delegación de Chile ante la Organización de los Estados Americanos Washington, D.C.

COLOMBIA COLOMBIE Representative 一 Representante 一 Représentant

Dr. José María Salazar Buchelli Ministro de Salud Publica

Ministerio de Salud Publica

Alternates - Suplentes - Suppléants Dr. Pablo Isaza Nieto

Jefe, Oficina de Planeacion Ministerio de Salud Publica Dr. Sofonías Yacup Revelo

Secretario General

Ministerio de Salud Publica

COSTA RICA

Representative 一 Representante - Représentant Dr. José Luis Orlich

Ministro de Salubridad Publica Ministerio de Salubridad Publica Adviser - Asesor 一 Conseiller

Dr. Edgar Mohs Villalta

Viceministro de Salubridad Publica Ministerio de Salubridad Publica

CUBA

Representative - Representante - Représentant Dr. Roberto Pereda Chávez

Director del Departamento de Relaciones Internacionales

Ministerio de Salud Publica

Alternates - Suplentes 一 S u p p l é a n t s Dr. Daniel Alonso Menéndez

Director de Iríves tigaciones Medicas Ministerio de Salud Publica

Dr. José Otero Molina

Director, Hospital Docente General Calixto García

Ministerio de Salud Publica Advisers - Asesores 一 Conseillers

Sr. Teofilo Acosta Rodríguez Primer Secretario de la Misión

Permanente ante las Naciones Unidas Sr. Jesus Zenen Buergo

Primer Secretario de la Misión

Permanente ante las Naciones Unidas

DOMINICAN REPUBLIC REPUBLICA DOMINICANA REPUBLIQUE DOMINICAINE

Representative - Representante 一 Représentant Dr, Francisco Manuel Tezanos

Secretario de Estado de Salud Publica y Asistencia Social

. ECUADOR EQUATEUR

Representative - Representante - Représentant Dr. Xavier Manrique

Subsecretario de Salud Publica Ministerio de Salud Publica

EL SALVADOR

Representative 一 Representante 一 Représentant Dr» Alberto Aguilar Rivas

Secretario del Departamento de Planificación y Coordinacion

Ministerio de Salud Pública y Asistencia Social

FRANCE FRANCIA Representative - Representante 一Représentant

M. Gerald Errera

2eme secretaire

Ambassade de France aux Etats Unis Washington, D.C,

Alternate - Suplente - Suppléant Dr. A, Chiarini

Médecin-Inspecteur Regional de la Santé Region Sanitaire Antilles-Guyane

Adviser - Asesor 一 Conseiller Dr. Dominique Sterin

Attache Scientifique

Ambassade de France aux Etats-Unis Washington, D.C,

GUATEMALA

Representative - Representante - Représentant Dr. José Trinidad Uclës

Ministro de Salud Publica y Asistencia Social Ministerio de Salud Publica y Asistencia Social

GUYANA GUYANE Representative - Representante 一 Représentant

Dr. Robert L. Baird Chief Medical Officer Ministry of Health

HAITI

Representative - Representante - Représentant Dr. Alix Thëard

Secrétaire dfEtat de la Santé Publique et de la Population

Alternate - Suplente - Suppléant Dr, Hubert Delva

Directeur du Service de Santé Domiciliaire Rurale

HONDURAS

Representative 一 Representante 一 Représentant Dr. Gilberto Osorio Contreras

Ministro de Salud Publica y Asistencia Social Ministerio de Salud Publica y Asistencia Social Alternate 一 Suplente 一 Suppléant

Dr. Carlos A. Pineda

Jefe del Departamento de Planificaci6n

JAMAICA JAMAÏQUE Representative - Representante 一 Représentant

Dr. Em J. Valentine

Principal Medical Officer

KINGDOM OF THE NETHERLANDS

"REINO DE LOS PAISES BAJOS PAYS-BAS

Rep res enta t ive 一 Representante - Représentant Dr. J. T. H. Gielen

Director-General of Public Health The Netherlands Antilles

Alternates 一 Suplentes 一 Suppléants Dr. W^# A. van Kan ten

Deputy Director of Health Surinam

Mr. H.E.Th.E. Mathon

First Secretary of the Embassy Washington, D.C,

Dr. A. E. Hart Pediatrician

Member, Board Medical Association

MEXICO MEXIQUE Representative 一 Representante 一 Représentant

Dr. Renaldo Guzman Orozсо Subsecretario de Salubridad

Secretaría de Salubridad y Asistencia

Alternates 一 Suplentes 一 Suppléants Dr. Héctor Acuña Monteverde

Director General de Asuntos Internacionales Secretaría de Salubridad y Asistencia

Dr. Jorge Vilchis Villaseñor

Director de Epidemiología y Campañas Sanitarias Secretaría de Salubridad y Asistencia

NICARAGUA

Representative - Representante 一 Représentant Dr. Carlos H. Canales

Director General de Salud Publica

Alternate一： Suplente - Suppléant Dr. Orontes Aviles

Director de Planificación de la Salud

GOBIERNOS GOUVERNEMENTS

PANAMA Representative - Representante - Représentant

Sr. Rogelio Novey Secretario

Embajada de Panamá

PARAGUAY Representative - Representante - Représentant

Dr. Roque J. Avila

Embajador del Paraguay ante la

Organización de los Estados Americanos Sr, Gilberto Cáñiza

Consejero, Embajada del Paraguay

PERU PEROU Representative - Representante 一 Représentant

Dr. Baltazar Caravedo Carranza Director Superior de Salud Ministerio de Salud

TRINIDAD AND TOBAGO TRINIDAD Y TABAGO

TRINI TE-ET-TOBAGO Representative - Representante 一 Représentant

Mr, John L. Nunez Permanent Secretary

Minis try of Health and Local Government Alternate - Suplente 一 Suppléant

Dr, Mervyn U, Henry Chief Medical Officer

Ministry of Health and Local Government

Adviser - Asesor 一 Conseiller Miss С. A. Baptiste

Alternate Representative of Trinidad and Tobago to the Organization of American States

Washington, D.C.

CD20/29, Rev Page 15 Pagina 15

UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND

~ R E I N O UNIDO DE GRAN BRETAÑA E IRLANDA DEL N O R T E ~ ROYAUME-UNI DE GRANDE-BRETAGNE ET D'IRLANDE DU NORD Representative 一 Representante - Représentant

Dr, James Malcolm Lis tori Chief Medical Adviser

Overseas Development Administration Foreign and Commonwealth Office Alternate - Suplente 一 Suppléant

Mr. Richard Thomas

First Secretary of the British Embassy Washington, D.C.

UNITED STATES OF AMERICA ESTADOS UNIDOS DE AMERÎCA

ETATS-UNIS D'AMERIQUE~

Representative 一 Representante - Représentant Dr. Jesse L, Steinfeld

Surgeon General

Public Health Service

Department of Health, Education, and Welfare

Alternates - Suplentes - Suppléants Dr. P. F. Robert de Caires

Associate Director for Planning and Evaluation

Office of International Health Department of Health, Education,

and Welfare

Dr. S. Paul Ehrlich, Jr.

Director, Office of International Health Department of Health, Education,

and Welfare

UNITED STATES OF AMERICA (cont.) ESTADOS UNIDOS DE AMERICA (cont.)

ETATS-UNIS D'AMERIQUE (suite) Advisers - Asesores - Conseillers

Mr, Lyndall G. Beamer Program Analys t

Office of International Health Department of Health, Education,

and Welfare Miss Rose Belmont

Chief, International Organizations Office of International Health Department of Health, Education,

and Welfare Mr. John L, Hagan

Foreign Affairs Officer Bureau of International Department of State

Organizations Affairs

Mr. Edward P, Noziglia Agency Director, Health Bureau of International Department of State

and Drug Control Organizations Affairs

Dr. Albert P. Talboys Chief Sanitary Engineer

Office of International Health Department of Health, Education,

and Welfare

Mr. Simon N. Wilson

Inter-American Organizations Adviser Bureau of Inter-American Affairs Department of State