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REGIONAL COMMITTEE FOR THE EASTERri PILD I TERRANEAN

ORIGINAL: ENGLISH

HEALTH AND THE NEW INTERNATIONAL ECONOMIC ORDER

The Executive Board of t h e World H e a l t h Organization,

a t i t s

Sixty-second Session, decided t h a t t h e s u b j e c t kor t h e Technical Discussions S e s s i o n a t t h e T h i r t y - t h i r d World Health Assembly t o b e h e l d i n May 1980 should be "Contribu- t i o n of Health t o t h e New I n t e r n a t i o n a l Economic Order".

I n o r d e r t o provide an o p p o r t u n i t y t o the Member S t a t e s t o c o n s i d e r t h e v a r i o u s a s p e c t s of t h e s u b j e c t by r e l a t i n g t h e s e t o t h e i r n a t i o n a l c o n t e x t , and t o extend t h e i r involvement i n f o r m u l a t i n g

WHO'S

p o l i c i e s , t h e paper f o r t h e Technical D i s c u s s i o n s i s being submitted t o t h e Regional C o n n i t t e e p r i o r t o i t s d i s c u s s i o n a t t h e World Health Assembly.

The views of t h e Member S t a t e s w i l l be of g r e a t a s s i s t a n c e i n f o r m u l a t i n g t h e p o s i t i o n papers f o r the Technical Discussions a t t h e World Health Assembly i n 1980.

It should be r e c a l l e d t h a t t h e S i x t h S p e c i a l S e s s i o n (1974) of t h e UN General Assembly adopted two r e s o l u t i o n s e n t i t l e d " D e c l a r a t i o n o n t h e E s t a b l i s h - ment of a New I n t e r n a t i o n a l Economic Order" (3201 S-VI) and "Programme of A c t i o n on t h e Establishment of a New I n t e r n a t i o n a l Economic 0rderU(3202 S-VI). The o b j e c t i v e s o u t l i n e d i n t h e s e r e s o l u t i o n s were e l a b o r a t e d l a t e r i n t h e year i n

the "Charter of Economic R i g h t s and D u t i e s of S t a t e s " , and f u r t h e r c o n s o l i d a t e d i n a r e s o l u t i o n on "Development and I n t e r n a t i o n a l Economic Co-operation" adopted i n 1975 by t h e Seventh S p e c i a l Session. With t h e a d o p t i o n of t h e s e r e s o l u t i o n s , t h e developing c o u n t r i e s had succeeded i n making development - t h e e s t a b l i s h m e n t of t h e New I n t e r n a t i o n a l Economic Order - t h e p r i o r i t y item on t h e i n t e r n a t i o n a l agenda. These r e s o l u t i o n s a r e t h e c u l m i n a t i o n of a s e r i e s of e f f o r t s made by t h e developing c o u n t r i e s t o improve t h e i r l o t .

The Seventh S p e c i a l S e s s i o n of t h e UN General Assembly i n September 1975, i n t h e i r r e s o l u t i o n e n t i t l e d "Development and I n t e r n a t i o n a l Economic co-operation"

(3362 S-VII), s t a t e d :

DETERMINED t o e l i m i n a t e i n j u s t i c e and i n e q u a l i t y which a f f l i c t v a s t s e c t i o n s of humanity and t o a c c e l e r a t e t h e development of developing c o u n t r i e s ,

BELIEVING

t h a t t h e o v e r a l l o b j e c t i v e

o f

t h e new i n t e r n a t i o n a l economic o r d e r

i s t o i n c r e a s e t h e c a p a c i t y of developing c o u n t r i e s , i n d i v i d u a l l y and c o l l e c t i v e l y ,

t o

pursue

t h e i r development;

DECIDES, t o t h i s end and i n t h e c o n t e x t of t h e foregoing. t o s e t i n motion

t h e following measures a s t h e b a s i s and framework f o r t h e work of t h e competent bodies and o r g a n i z a t i o n s of t h e United Nations system.

--

.

^{. . *}

I n S e c t i o n 111, paragraph 9, of t h e same r e s o l u t i o n , i t i s s t a t e d t h a t :

"The World Health O r g a n i z a t i o n and t h e competent organs of t h e United Nations system, i n p a r t i c u l a r the United Nations C h i l d r e n ' s Fund, should i n t e n s i f y t h e i n t e r n a t i o n a l e f f o r t aimed a t improving h e a l t h c o n d i t i o n s i n developing c o u n t r i e s by g i v i n g p r i o r i t y t o p r e v e n t i o n of d i s e a s e and m a l n u t r i t i o n and by p r o v i d i n g p r i - mary h e a l t h s e r v i c e s t o t h e comnunities, i n c l u d i n g maternal and c h i l d h e a l t h and family welfare".

Two a r e a s which a r e of d i r e c t i n t e r e s t f o r t h e h e a l t h s e c t o r a r e :

a . Development of i n s t i t u t i o n a l and p h y s i c a l i n f r a s t r u c t u r e i n t h e v a r i o u s socio-economic s e c t o r s i n t h e developing c o u n t r i e s , such as

:

food production;

e d u c a t i o n ; p o p u l a t i o n ; i n d u s t r y ; environment ( i n c l u d i n g housing, water sup- p l i e s , waste d i s p o s a l and p o l l u t i o n ) ; a g r i c u l t u r e ; i r r i g a t i o n and v e c t o r c o n t r o l which have i m p l i c a t i o n s f o r human h e a l t h and w e l f a r e ; and i n h e a l t h . b. Promotion of t h e t r a n s f e r of technology i n developing c o u n t r i e s , manpower t r a i n i n g . biomedical and h e a l t h o e r v i c e s r e s e a r c h , inter a l i a t h e development of indigenous c a p a c i t y i n the f i e l d of s c i e n c e and technology.

The a t t a c h e d d i s c u s s i o n paper h i g h l i g h t s some of t h e q u e s t i o n s ,

^answers

to which would h e l p i n developing a consensus i n f o r m u l a t i n g i n t e r n a t i o n a l and na-

t i o n a l p o l i c i e s f o r promoting h e a l t h

and

well-being of a l l people. This d i s c u s -

s i o n would a l s o c o n t r i b u t e i n developing a s t r a t e g y t o provide h e a l t h f o r a l l by

t h e Year

2000.

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

HEALTH AND THE NEW INTERNATIONAL ECONOMIC ORDER

A DISCUSSION PAPER

CONTENTS

Page

. . .

I n t r o d u c t i o n

2

P a r t I. A WHO o u t l o o k on t h e New I n t e r n a t i o n a l

Economic o r d e r

. . . ⁴ . . .

P a r t 11. H e a l t h development 9

P a r t 111. The c o n t r i b u t i o n of h e a l t h

t o

t h e

New I n t e r n a t i o n a l Economic Order

. . .

¹⁵

Annex 1 . Text

of

United N a t i o n s General Assembly r e s o l u t i o n s 3201 S-VI and 3202 S-VI Annex

2 .

The D e c l a r a t i o n o f Alma-Ata

Annex 3 . Drug p o l i c i e s and essential d r u g s : a c a s e s t u d y

1. The E x e c u t i v e Board o f WHO a t i t s s i x t y second s e s s i o n d e c i d e d t h a t t h e s u b j e c t f o r t h e T e c h n i c a l D i s c u s s i o n s a t t h e T h i r t y - t h i r d World H e a l t h Assembly t o be h e l d i n May 1980 s h o u l d b e "The c o n t r i b u t i o n o f h e a l t h t o t h e New I n t e r n a t i o n a l Economic Ordert'. T h i s paper i s a f i r s t s t e p t o p r o v i d e t h e background f o r t h e s e d i s c u s s i o n s .

2 . The New I n t e r n a t i o n a l Economic Order (NIEO) i s a s t a t e of i n t e r n a t i o n a l l y j u s t r e d r e s s of t h e p r e s e n t imbalances between t h e d e v e l o p i n g and t h e affluent countries. This is to be achieved by means of a s e r i e s of r e f o r m s aimed a t improving t h e l o t o f t h e d e v e l o p i n g c o u n t r i e s . Thus, measures a r e t o be t a k e n t o i n c r e a s e g r e a t l y t h e s h a r e of t h e s e c o u n t r i e s i n world p r o d u c t i o n . These measures i n c l u d e i n c r e a s i n g s u b s t a n t i a l l y food and a g r i c u l t u r a l p r o d u c t i o n i n t h e d e v e l o p i n g c o u n t r i e s , promoting i n d u s t r i a l i z a t i o n w i t h i n t h e s e c o u n t r i e s , p r o v i d i n g f o r a d d i t i o n a l employment w i t h i n them, and e n s u r i n g a c c e s s of t h e i r e x p o r t s t o i n t e r n a t i o n a l m a r k e t s on a more s t a b l e b a s i s and a t f a i r p r i c e s t h r o u g h improving t h e t e r m s of i n t e r n a t i o n a l t r a d e . A d d i t i o n a l measures includc thc strengthening of institutional and p h y s i c a l i n f r a s t r u c t u r e s i n t h e d e v e l o p i n g c o u n t r i e s , promoting t h e t r a n s f e r of t e c h n o l o g y t o them and t h e development of i n d i g e n o u s technology w i t h i n them, and s u b s t a n t i a l l y i n c r e a s i n g t h e flow of r e s o u r c e s t o them.

The N I E O i s framed i n economic terms. However, t h e r e i s an i m p l i c i t s o c i a l dimension, which i s made e x p l i c i t i n t h e I n t e r n a t i o n a l Development S t r a t e g y , which i s t h e

i n t e r n a t i o n a l communities' p r e s c r i p t i o n f o r advance towards t h e New International Economic Urder.

3 . H e a l t h

i s

an o u t p u t and an i n p u t i n t h e development p r o c e s s , and i s e s s e n t i a l t o a man-centred development, b e i n g t h e main and f i r s t i n g r e d i e n t of t h e q u a l i t y of l i f e .

4.

T h i s paper p o i n t s t o t h e i n t e r r e l a t i o n s h i p s of h e a l t h

and t h e New I n t e r n a t i o n a l Economic Order, and p o s e s some b a s i c q u e s t i o n s on how t o r a i s e t h e n e c e s s a r y p o l i t i c a l commitment a t n a t i o n a l and i n t e r n a t i o n a l l e v e l t h a t i s e s s e n t i a l i f p r o g r e s s i s co be made, k e e p i n g i n mind t h e

TDS/NIEO/~ 9.1 wider determinants of health in

a

society which go

far

Page

3

beyond the traditional responsibilities of a ministry of health.

5. The aim is to increase the awareness and ability of all politicians, planners and other decision-makers

in

the planning process, both at national and international level, recognizing their prime importance for effective action so as to facilitate the social goal of health for all by the year 2000 which was set by the Thirty-first World Health Assembly .

6.

The paper consists of three parts: Part I provides the

background to the formulation of the New International

Economic Order itself and the associated International

Development Strategy; Part I1 deals with the health aspect

of the issues involved; and Part I11 highlights the inter-

relationships of the two, leading to some fundamental

questions which, it is hoped, will stimulate discussion at

the Regional Committee Meetings in Autumn 1979. A collation

of the views thereon expressed will help amend this paper to

serve purposes: as a base paper for the Technical Discussions

at the Thirty-third World Health Assembly in May 1980; and

as a WHO input

to

the

Special Session

of

the General Assembly

which will review progress towards the New International

Economic Order, also in 1980.

PART

I. A WIIO OUTLOOIC ON TIIE NEW INTERNATIONAL ECONOMIC ORDER

7. As early as 1961, the United Nations General Assembly launched a United Nations Development Decade: a programme for international economic cooperation. This came directly after the achievement of independence for most of the

developing countries in the late 1950s and early 1960s.

_By

the mid-1960s it was clear to the majority of States, Members of the United Nations and other organizations and institutions of the United Nations system that the objectives set out

under the progransne of cooperation were not being attained.

It also became clear that the existing international economic system and irs related structures were organized along lines to benefit only a few countries, primarily those

i n the northern hemisphere.

8. To facilitate the dialogue between the developing countries and the industrialized countries, a new inter- national body was established in 1964 to serve as a central

forum for n c g o t i n t i o n s on e s s e n t i a l trade i s s u e s . That

body, the United Nations Conference on Trade and Development

(UNCTAD),

has over the years given rise to a large number of

resolutions and recommendations aimed at providing more

favourable terms of trade for developing countries. A joint declaration of developing countries was adopted at the first session of UNCTAD (1964) and the signatories of that

declaration became known as the Group of 77.

9. In the light of the failure to realize most of the goals of the United Nations Development Decade, additional measures were taken toward economic and social development. One of

these

was

the proclamation of the Declaration on Social Progress and Development made by the United Nations General Assembly in 1969. In 1970, the General Assembly launched a Second United Nations Development Decade and, at the same time, adopted aE lnternational Development Strategy for the Decade.

10. Whereas the First United Nations Development Decade was

formulated in rather broad terms emphasizing self-sustaining

growth of the economy of the individual nations and their

social advancemcznt, the Strategy for the Second Development

TDs/~1~0/7 9.1

page

5

Decade was considerably more specific regarding the economic and social goals and objectives to be attained during the 1970s. The Declaration on Social Progress and Development, on the other hand, was devoted essentially to social develop- merit issues. The oil crises of 1973, however, helped to underscore the interdependence of the countries of the world with respect to

at

least certain natural resources. Also,

as with the First Development Decade, it was becoming obvious that very slow progress was being achieved in implementing the measure's foreseen in the Strategy for the Second Development Decade. So, in 1974 a special session of the United Nations General Assembly was convened on the subject of raw materials and development. Two major resolutions were adopted by that session: a Declaration on the Establish- ment of a New International Economic Order (3201 S-VI) and a P r o g r a m of Action on the Establishment of a New International Economic Order (3202 S-VI). The framework provided by these two resolutions (see Annex 1) oIIered the international connnunity, for the first time, a comprehensive package of all the reforms that would

have

to be undertaken to change the existing economic order to a new international economic order.

11- It is apparent from the texts of resolutions 3201 S-VI and 3202

S-VI that the steps to

be taken to redress the

economic imbalances which persist between North and South are devoid of a social dimension except by implication.

In other words, social development is taken for granted to the extent that should all the measures foreseen within the P r o g r m e of Action be taken, thus leading to more af fluent societies in the developing countries, there will automati- cally be a higher quality of life. As such, it is assumed that international justice, to be realized through the establishment of the New International Economic Order, will lead to intranational justice, implying a more equitable distribution of national resources

in

all sectors, including social sectors such as health.

12. All development sectors are involved in the implementa-

tion of the New International Economic Order. This is not

because of the hard-core economic issues involved, buL

because a new order implies newness in every aspect of the

~ ~ s / ~ 1 ~ 0 / 7 9 . 1 page 6

development process, not the least of which is

a new

health order as part of the new social order. Since it would seem that the Programme of Action does not leave much space for the direct involvement of, for instance, health in its implementation, the architects of the Programme have provided opportunities for specialized agencies such as WHO to play an important role in the struggle for international justice by building bridges for that purpose. The first of these was the adoption of resolution 3362 S-VII by the Seventh Special Session of the United Nations General Assembly

(September 1975). That resolution contains seven sections, of which number

111,

paragraph

9,

states:

The World Health Organization and the competent organs of the United Nations system, in particular

the

United Nations Children' s Fund, should intensify the international effort aimed at improving health conditions in developing countries by giving priority

to

prevention of disease and malnutrition and by providing primary health services to the communities, including maternal and child health and family welfare.

13. The most important development to date has been the decision of the United Nations General Assembly

to

formulate a new International Development Strategy. This does not run parallel to the implementation of the NIEO; rather, it is seen that it will occur within the framework' of the NIEO, with a view to assisting in the attainment of the New

International Economic Order itself. There are eight major objectives1 to which the Strategy should address itself:

- bringing about, in the spirit of mutual benefit, far- reaching changes in the structure of world production, with a view to expand and diversify the production

of,

and provide for additional employment in, the developing countries;

- increasing substantially food and agriculture produc- tion in the developing countries and facilitating effectively the access of their agricultural exports

to

i~lternativnal markets on a stable and more

predictable basis and at fair remunerative prices;

- developing institutional and physical infrastructures in the various development sectors in the developing countries;

United Nations General Assembly resolution 33/193.

TDS/NIEO/~~. 1 page 7

- promoting industrialization in the developing countries and, to that end, ensuring inter alia speedy and tangible progress towards the fulfilment of the target of increasing

to

the maximum possible extent and, as far as possible, the share of

developing countries in total world industrial production to at least 25% by the year

2000;

- improving the terms of trade of developing

countries; ensuring a substantial increase of their share in world exports, especially through the

expansion and diversification of their production and trade; and extending to them special and preferential treatment, where feasible and appropriate, in the context of the general effort to liberalize world trade particularly in their favour, as steps towards promoting equity in trade relations between the developing and developed countries;

- increasing substantially

the

flow

of

resnurces in real terms to the developing countries on a predictable, continuous and increasingly assured basis;

- enhancing the responsiveness of the international monetary system to the needs and interest of the developing countries in the context of further reform of the system for the benefit of the inter- national community;

- promoting the transfer of technology to developing countries by securing the removal to the fullest extent possible of obstacles to, and

taking

positive measures for, such transfer; as well as the develop- ment of indigenous capacity in the field of science

and technology in these countries and formulation of national and international policies to avoid the reverse transfer of technology and the outflow of skilled personnel.

14. Two areas which seem to have a direct interest for the health sector are: (a) the development of institutional and physical infrastructure in the various development sectors in the developing countries; and (b) the promotion of the transfer of technology to developing countries, including, inter alia, the development of indigenous capacity in the field of science and technology.

15. In addition to the aforementioned objectives the Strategy should reflect the need for:

L

* United Nations General Assembly resolution 33/93.

adequate policies for the promotion of social develop- ment, to be defined by each country within the

framework of its development plans and priorities and in accordance with its cocioeconomic structure and stage of development, taking into account that the final aim of development must be the constant increase of the wellbeing of the entire population on

the

basis of its full participation in the process of development and a fair distribution of the benefits therefrom;

- full mobilization of national resources, both human and material, of developing countries;

- the mobilization and integration of women and youth in development;

- the protection of the environment and taking environ- mental considerations into account, in accordance with the development plans and priorities

of

developing countries.

16. The new International Development Strategy will be

formulated by a Preparatory Committee open to all States, with the assistance of the United Nations and other inter- national organizations and institutions of the United Nations

system. In principle the Strategy will be approved and launched by the United Nations General Assembly at its thirty-fifth session in 1980.

17. This chapter would be incomplete without a critical distinction between the New International Economic Order and the new International Development Strategy. The NIEO is the long-term, ultimate answer as presently seen for achieving economic equity between countries in the southern hemisphere and those in the northern hemisphere. It does not ensure intranational justice in terms

of

meeting people's needs

and

aspirations, although it implies that greater wealth through a better deal is a prerequisite for meeting needs and

aspirations at the national level. The assumption is made that the greater wealth to be acquired through the NIEO will be shared by all peoples and will not remain in the hands of only a few countries and individuals. The new International Development Strategy, on the other hand, is at present

considered as a shorter-term (most likely a decade) reply by

the international conrmunity by which it can forward inter-

national economic & international social development along

the road which ends at the NIEO and thus in conformity with

and interdependent world of peace, equality and justice.

PART 11: HEALTH DEVELOPMENT

18. At present, four-fifths of the world's population, living mainly in rural areas and urban slums, have no access to any organized form of health care. Nearly one thousand million people suffer from a combination of long-standing malnutrition and parasitic diseases, which greatly reduces

their work capacity and social development. The gap between the affluent and the developing countries is widening as far

as investments

in health are concerned. This gap is also apparent within countries, whatever their level of develop- ment. Moreover,

in most countries health

sysLems function outside the mainstream of social and economic development.

13.

Analysis v f

trends In death rates over the past 150 years shows a direct relationship between an improvement in socio~conomic

status and a reduction in d e a l h

rates. The difference is particularly striking in the case of infant mortality rate, which in the countries

with a per capita

GNP of less than US$ 520, covering over 70% of the population of the developing countries that do not export oil, averages more than six times the rate for the developed countries.

Thus, the curve of infant mortality rises as income levels fall. The industrialized countries with an average per capita GNP of US$ 5950, for instance, have an infant mortality rate of 15 per 1000 live births; in the developing world, the rate, starting at 25 per 1000 live births in the high-income countries, goes on rising (with falling incomes) to 35, 48, 88, and reaches 129 in the lowest income countries

with a GNP of US$ 151 per

capita.

20. Maternal mortality rates reflect the same situation.

While

in counrries with well-developed health care systems maternal mortality has been brought down to 0.5-3.0 per

1 0 000 births, there are still

countries where the death rate among young mothers is as high as 177 per 10

000

births.

At such levels maternal

mortality becomes a leading

cause

of

death among women. In areas with the highest rates - ^mostly

in Africa and west, south and east Asia - ^about

^{half a}

million women die from maternal causes every year, leaving

behind at least a million motherless children.

TDS/NIEO/~~. 1 page 10

21. Of

the 122 million infants to be born in 1979, roughly 10% will die before reaching their first birthday, and another 4% bcforc their fifth birthday. While the risk of dying before reaching adolescence is about 1 in 40 in developed countries, it is

1

in 4 in Africa as a whole, and even 1 in 2 in some countries. The probability of dying is at its peak at the time of birth, including the period immediately before birth. Perinatal mortality (death in the period between the 28th week of gestation and seventh day of life) is also closely associated with low birth weight, which is defined as a birth weight below 2500 g.

For every fatal outcome, there are many episodes of disease and ill-health. Many common childhood diseases do not normally kill their victims, but may cause serious or chronic damage. Some of this is already apparent in childhood (as blirrdrress or paralysis), while ulrer damage will becvu~e manifest only in later life (as chronic heart disease or mental retardation). Malnutrition is numerically the most

important condition affecting the health of children in all parts of the world, particularly in the developing countries.

Some 100 million children under the age of five years are suffering from protein-calorie malnutrition, more than 10 million of them from the severe form which is normally fatal if untreated. Research in the 1970s has made it clear that events in early life affect the health of the adult, and rany conditions can be prevented by early action.

22. The last decade has witnessed a serious rethinking of the basic principles and practice underlying health develop- ment. The pursuit of social justice and equity in health has been initiated with debates as to what is meant by

"health for all", recognizing that each country ultimately has the responsibility not only for answering this question but also for seeing that the necessary health actions are undertaken for its achievement. In this process, many have come to realize that the indicators of good health are also indicators of development - a healthy peoplebeing recognized as the most essential cause and effect of development.

Health development, as such, is now being seen as a viable

strategy for development planners to pursue as part of their

efforts to improve the quality of life of all the people.

TD~/NIEO/~ 9.1 page 11

23. The

International Conference on Primary Health Care,

meeting in Alma-Ata in September 1978, adopted the Declaration of Alma-Ata which

recognizes

primary health care (PHC) as the KEY to achieving the target of health for all (see sections VI and VII of the Declaration, reproduced in Annex 2).

2 4 . The

adoption of the strategy of health

for

all by

the

year 2000, with primary health care as its key, has evolved during the last five years.

While,

techni.cally speaking, primary health care is not a "new" concept, its reappearance reflects three important aspects of the present situation:

the growing acceptance that health servlces alone cannot bring health; the failure of existing health services

systems to meet the priority needs of the people most urgently requiring care; and the growing concern with international and intranational inequities, as reflected by the great

disparities in the measured health status of different popula- tion groups around the world.

25.

The Declaration of Alma-Ata calls upon all governments to "formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors". At the same time, the Executive Board of WHO has

drawl

up guiding principles and essential issues for formulating strategies for achieving health for all by

the

year

2000. These,

in addition to thc deliberations of Alma-Ata, form the basis for action to be undertaken at the national level. While the implications of such action

may

be very profound, they may not be realizable if corresponding international actions are not also undertaken simultaneously.

26. Some of the essential national and international impli- cations are outlined below in the form of a "before" and

"after" portrayal of the situation. Such a simple listing

cannot do justice to the complex interrelationships that

exist between each feature listed. Furthermore, such a

portrayal tends to exaggerate the wide difference between

the present reality (the left-hand column) and the desired

future (the right-hand column). Nevertheless, few would

argue with the statement that most countries, including the

developed countries, are far from realizing the promise of

TDs/~1~0/79.1 page 13 llBef orert

Concentration of resource in urban centres and offering of services meeting specialized needs of few.

Use of health technologies which promote "conunerciali-

zation" of health sector with heavy influence of extra- national interests.

Evaluation confined to measuring "inputs", i . ^{e . ,}

availability of resources, associated costs, etc.

"Af ter"

Equitable distribution of resources to social

periphery, concentrating on priority needs of majority.

Identification and promotion of technologies appropriate for local development, use and control.

Evaluation concerned with impact on health status of individuals and communities, especially underserved, high- risk groups.

28. International implications

~ultilateral/bilateral Assistance provided for assistance in health, con- health infrastructure centrating on capital development using tech- intensive projects, e.g., nologies well suited for building construction. individual country situa-

tion, including promotion of local production of technologies.

Overall assistance for health All development assistance small in comparison with evaluated from point of view assistance provided to other of impact on quality of sectors, and this latter life, especially of rural assistance often promotive of poor; measures taken to re- poor health, especially of design projects accordingly.

rural a g r i c u l t u r a l co~rnnuniLies

in the developing world.

No control over transnational Adoption of "code of ethicst'

food and drug companies for industry; monitoring of

gaining coriLrul over l o c a l

practices to uncover chose

national markets. with undesirable effects.

TDS/NIEO/~~. 1 page 14

"Before" "Af ter"

National media dominated by Adoption of "code of ethics"

international media which covering advertisements and directly or indirectly pro- feature stories related to mote health practices inappro- health; generation of news priate to national needs. material supportive of

"health for all" strategy.

Some food aid inconsistent Redesign of food aid with promotion of needed policies and practices in national nutrition policies support of increased and practices. national self-reliance,

e.g., greater use of foods and products that can be ingredients in national

cummercial supple111e11Lary

foods .

Belief that primary health Recognition that health care strategy of use only for systems of industrialized

Third World countries. countries in greaL rieed of

reorientation and that under-

lying philosophy of primary

health care is equally applicable to these systems.

2 9 .

The above illustrates that health development requires

mutually si.tpportive national and international actions whose

aims are to protect those in greatest need. It also illustrates that health development is a crucial aspect of

"social development and the international development

strategy" and could be used as the fundamental starting

point by all sectors for such development - nationally and

internationally. Many of the implications of this strategy

are of direct relevance to the NIEO as explored in the next

section.

TDS/NIEO/~

9.1

page 15 PART 111. HEALTH AND

THE

NEW INTERNATIONAL ECONOMIC ORDER

Economic growth or ecuriumic

development

30. The purpose of the New International Economic Order

( N l E U )

is development. According to the International Development Strategy,

'I.

. .

^the

ulLimate objective of development must be to bring about sustained improvement in the well-being of the individual and bestow benefits on all. If undue

privileges, extremes of wcalth and social injustice

persist, then development fails in its essential purpose. It is essential to bring about a more equitable distribution of income and

wealth for

promoting both social justice and efficiency of produc- tion, to raise substantially the level of employment, to achieve a greater degree of income security, to expand and improve facilities for education, health, nutrition, housing and social welfare, and to safeguard the environment. Thus, qualitative and structural

changes

in the society must go hand in hand with rapid economic growth, and existing disparities - regional, sectoral and social - should be substantially reduced.

These objectives are both determining factors and

end results of development; they should therefore be viewed as integrated parts of the same dynamic process and would require a unified approach."

In short, development implies continuing improvement in the living conditions and quality of life of people, including improvement in housing, the environment, food and health, all of which are fundamental to the quality of life.

31. When development is being advocated, its purpose must always be made explicit in human terms. Development cannot be equated with economic growth alone. Economic growth has to be regarded as one of the means for attaining the broader goal of socioeconomic development.

32. The NIEO is concerned mainly with economic matters that

do not refer to its social purpose. The social issues are

treated as separate entities. The main purpose of the NIEO

is the promotion of economic growth without specifying how

this will lead to social improvement. For example, if the

NIEO deals with the transfer of resources to countries, it

does not mention how these resources will ensure improvement

in the

living conditions and quality of life of the people

of these countries, particularly the underprivileged. It is

possible that a n e w national economic order

in some countries

is a prerequisite to the realization by them of the full

TDS/NIEO/~~. 1 page 16

benefits of a new international economic order. The question therefore needs

to

be asked how best an increase in the

transfer ot resources and an improvement in opportunities for trade, as required by the NIEO, can ensure better development for

the

masses. The infant mortality rate is a useful indicator not only of health status, but also of socio- economic dcvclopment in general. A marginal decline in this rate may be achieved by improving the lot of the elite but a substantial decline can only result from improving the lot

of

the total population. On the other hand, a rise in the

GNP

of a country may result from a

very

substantial improvement

in the economic status of the elite of that country. Simply raising the

GNP

is not enough. There is a great difference between economic growth and economic development, and

GNP

is a poor index of the latter.

3 3 .

The NIEO implies a new way of organizing the inter-

national economic system through improved terms of trade between richer and poorer countries, more control by developing countries over the economic cycles that pass through them, and increased and improved trade among the poorer countries. As indicated in Part 11, there appears to be a conflict between this strategy, which is inter- nationally oriented, and certain other national approaches which start from the primary needs of communities and individuals, seeking to provide basic consumer goods, basic services (including health services) , productive employment, an appropriate infrastructure, and mass participation in decision-taking and the implementation of projects.

Health development as a bridge between national and international approaches

34.

The conflict of approaches mentioned above is more

apparent than real. Non-material needs are also essential

for human development and the quality of life. Health,

although in one sense non-material, provides material

benefirs; health development can therefore be a bridge

between the international efforts of the NIEO and the

national efforts

for

social aid economic development.

T D S / N I E O / ~ ~ . 1 page 17

3 5 . Human energy i s the g r e a t e s t s o u r c e of economic

e n d e a v o u r , s o c i a l a w a r e n e s s , and a b i l i t y t o a b s o r b and a p p l y

?<nowledge. The a v a i l a b i l i t y of p r o d u c t i v e m n p o w e r , i n

t h e r i g h t numbers and , w i t h p r o p e r q u a l i f i c a t i o n i s a b a s i c p r e r e q u i s i t e f o r economic development. T h i s work f o r c e must e n j o y a l e v e l of h e a l t h , s u p p o r t e d by a d e q u a t e n u t r i t i o n , which e n a b l e s i t t o c o n t r i b u t e e f f i c i e n t l y t o t h e development of t h e c o u n t r y , and t h e r e f o r e t o i t s own s o c i a l development and t o t h e s o c i a l development of t h o s e who depend on i t .

36.

The i n f l u e n c e of h e a l t h on economic development through t h e s t i m u l a t i o n of i n d i v i d u a l human energy can be demon- s t r a t e d

by

c o n t r a s t i n g t h e downward s p i r a l of d i s e a s e , p o v e r t y and m a l n u t r i t i o n w i t h t h e upward s p i r a l of improved h e a l t h and a d e q u a t e n u t r i t i o n l e a d i n g t o b e t t e r p r o d u c t i v i t y and i n c r e a s e d economic and s o c i a l w e l l b e i n g . The c u m u l a t i v e e f f e c t s of h e a l t h and n u t r i t i o n can g i v e p o t e n t i a l t o i n d i - v i d u a l s for more r e g u l a r employment w i t h o u t e x h a u s t i o n and c o n s e q u e n t l y more o p p o r t u n i t y f o r work. A r e g u l a r income a s a n oiitcome of b e t t e r i n d i v i d u a l work c a p a c i t y call encourage any member of t h e p o p u l a t i o n i n most c o u n t r i e s and i n c r e a s e and m a i n t a i n a r e g u l a r l e v e l of consumption.

T h i s i n c r e a s e of p u r c h a s i n g power can i n i t s e l f be t h e s t a r t of a c u m u l a t i v e p r o c e s s of economic development, and t h e growth o f consumption by i n d i v i d u a l s w i l l encompass h e a l t h consumption, t h e r e b y a c c e l e r a t i n g t h e i n t e r a c t i n g p r o c e s s of economic growth s u s t a i n e d by h e a l t h and h e a l t h r e i n f o r c e d by economic growth.

37.

S i n c e human energy i s t h e b a s i s of development, t o d e t e r m i n e on t h e b a s i s of economic growth terms a l o n e t h a t p o r t i o n of t h e n a t i o n a l r e s o u r c e s t h a t i s t o b e d e v o t e d t o t h e s o c i a l s e c t o r , i n c l u d i n g i t s h e a l t h component, c a r r i e s t h e r i s k of p r o v i d i n g j u s t enough human energy f o r economic p r o d u c t i o n . I n f a c t , t h i s l e v e l of i n p u t

w i l l

n o t g e n e r a t e t h e human energy n e c e s s a r y t o improve s u f f i c i e n t l y t h e q u a l i t y of l i f e , and t h i s i s t h e u l t i m a t e m o t i v a t i o n f o r i n d i v i d u a l and c o l l e c t i v e e f f o r t s t o r a i s e p r o d u c t i o n and t o b r e a k o u t of t h e p o v e r t y e q u i l i b r i u m . H e a l t h i s

e s s e n t i a l f o r t h e g e n e r a t i o n o f t h i s c r i t i c a l inass ^{u 1} human energy. It i s t h u s n o t o n l y a fundamental human r i g h t , a s

TDS/NIEO/~

9.1 page 18

scated in the Constitution of the World Health Organization;

it is also a prerequisite to human development. Improve- ment in the level of health is a good indicator of improve- ment in the living standards of the mass of the population.

38. Health development could thus help the NIEO to lead to a genuine socioeconomic Development Order. Such health developmeilt, lluwever, must not be confused with conventional approaches to the provision of health care. The kind of health development referred to here is that which was accepted by the International Conference on Primary Health Care. The Declaration of Alma-Ata (see Annex

2)

and the recornendations of the Conference outline the main concepts

involved. Of these, it is worth mentioning in particular the mutual contribution to development of actions in the health and relevant socioeconomic sectors, an equitable distribution of health resources, and the involvement of the community in shaping its own health and socioeconomic future. As stated in t h c Alma-Ata DeclaraLiun, primary health care forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community.

3 9 . The world health situation depicted in Part I1 above on Health Development dramatically illustrates the

relationship between health and socioeconomic development which are inextricably interwoven. As stated above, development implies continuing improvements in the living conditions and quality of life of people, and the quality of lice depends directly upon the level of health. Health development is therefore essential for social and economic development, and the means for attaining them are clvsely linked. Measures aimed at genuine socioeconomic develop- ment, as distinct from mere economic growth, are likely to

contrfbute to health development; and genuine measures to improve health are likely to contribute to general socio- economic development. Actions to improve the health and the socioeconomic situation therefore have to be regarded as mutually supportive rather than competitive.

40. It has often been contended that improvements in health, and in particular its effect in reducing infant rnurtality, will add to the problem of over-population with all its

TDS/NIEO/~ 9.1 page 19 economic consequences. However, t h e a v a i l a b l e e v i d e n c e

shows t h a t h i g h l e v e l s of i n f a n t m o r t a l i t y a r e l i k e l y t o l e a d t o a n i n c r e a s e r a t h e r t h a n a d e c r e a s e i n t h e r a t e of p o p u l a t i o n growth. People have i n t h e p a s t t e n d e d t o have a l a r g e number of c h i l d r e n i n t h e hope t h a t some, and i n p a r t i c u l a r b o y s , w i l l remain a l i v e t o work and s u p p o r t t h e i r p a r e n t s i n t h e i r o l d age. Where c h i l d r e n a r e l e s s l i a b l e t o d i e young, t h i s r e q u i r e m e n t d i s a p p e a r s , and a d e c l i n e i n t h e b i r t h r a t e g e n e r a l l y f o l l o w s a d e c l i n e i n t h e i n f a n t m o r t a l i t y r a t e . Improvements i n h e a l t h , p a r t i c u l a r l y of

c h i l d r e n , can t h u s i n f a c t c o n t r i b u t e t o stemming p o p u l a t i o n growth. Whatever t h e c a u s e - e f f e c t r e l a t i o n s h i p , more and more e v i d e n c e i s a c c u m u l a t i n g t h a t p o i n t s t o t h e p o s i t i v e impact on s o c i a l and economic p r o d u c t i v i t x , i n c l u d i n g f a m i l y h e a l t h , whenever development t a k e s p l a c e i n a c l i m a t e o f e q u i t y .

41.

It h a s a l s o been contended t h a t b e t t e r h e a l t h w i l l n o t

l e a d t o h i g h e r n a t i o n a l o u t p u t i n a c o u n t r y where t h e r e i s widespread unemployment and underemployment. Even i f

h e a l t h y workers a r e more p r o d u c t i v e and have a l o n g e r working l i f e t h a n s i c k w o r k e r s , i t i s a r g u e d , when h e a l t h y workers become s i c k o t h e r s ^may e a s i l y b e found t o r e p l a c e them.

T h i s argument, however, i s concerned o n l y w i t h i n d i v i d u a l s , and does n o t t a k e i n t o a c c o u n t t h e d r a g on development when whole conanunities a r e a f f l i c t e d by d i s e a s e . I n a d d i t i o n , t h e c o n t r o l of a major d i s e a s e such a s m a l a r i a o r r i v e r b l i n d n e s s c a n o p e 9 up new a r e a s f o r a g r i c u l t u r e and c a n make a c c e p t a b l e more s u i t a b l e methods o f c u l t i v a t i o n . 4 2 . Economic growth a c t i v i t i e s t h e m s e l v e s o f t e n l e a d t o a

d e t e r i o r a t i o n i n t h e h e a l t h s i t u a t i o n . F o r example, a r t i f i c i a l l a k e s , dams, and c e r t a i n methods of i r r i g a t i o n can f a c i l i t a t e t h e s p r e a d of such d i s e a s e s a s m a l a r i a , s c h i s t o s o m i a s i s and c h o l e r a . I n d u s t r i a l development

and urban c o n c e n t r a t i o n g i v e r i s e t o r i s k s from overcrowding (e.g. i n c r e a s e d i n c i d e n c e of t u b e r c u l o s i s o r m e n t a l ill h e a l t h ) and from p o l l u t i o n . A l s o , t h e f e a r of d i s e a s e s

such a s c h o l e r a may h i n d e r i n t e r n a t i o n a l t r a d e and damage t o u r i s t p r o s p e c t s . A p p r o p r i a t e h e a l t h a c t i o n i s t h e r e f o r e n e c e s s a r y t o accompany such economic growth a c t i v i t i e s i n o r d e r t o a v o i d m i s t a k e s i n p l a n n i n g , t o a v o i d t h e w a s t e o f r e s o u r c e s used t o c o r r e c t t h o s e m i s t a k e s , and t o e n s u r e

T D S / N I E O / ~ ~ . 1 page 20

t h a t maximum b e n e f i t i s d e r i v e d from economic growth a c t i v i t i e s i n t e r n s of g e n u i n e human development.

4 3 . I n s h o r t , development can be a c h i e v e d a s a r e s u l t o f human m o t i v a t i o n , t h e a p p l i c a t i o n of t h e r i g h t knowledge, and t h e i n v e s t m e n t of t h e a p p r o p r i a t e r e s o u r c e s . P e o p l e ' s m o t i v a t i o n i s s t r o n g l y i n f l u e n c e d by improvement i n t h e i r h e a l t h , which i n d u c e s i n them g r e a t e r c o n f i d e n c e i n t h e i r f u t u r e . Moreover, t h e p h y s i c a l and m e n t a l energy engendered by good h e a l t h i s n o t o n l y i m p o r t a n t i n i t s e l f f o r t h e q u a l i t y o f l i f e , i t i s a l s o e s s e n t i a l t o a b s o r b t h e knowledge r e q u i r e d f o r development and t o t r a n s l a t e t h i s knowledge i n t o s o c i a l and economic p r o d u c t i v i t y .

H e a l t h f o r

a l l

by t h e y e a r 2000

4 4 . The r e c o g n i t i o n of t h e c l o s e r e l a t i o n s h i p between h e a l t h and development, and t h e r e a l i z a t i o n t h a t human energy i s t h e key t o development, l e d t h e T h i r t i e t h World H e a l t h Assembly t o d e c i d e i n May 1977 t h a t t h e main s o c i a l t a r g e t of govern- ments and WHO i n t h e coming d e c a d e s s h o u l d be t h e a t t a i n m e n t by a l l t h e c i t i z e n s of t h e world by t h e y e a r 2000 of a l e v e l o f h e a l t h t h a t p e r m i t s them t o l e a d a s o c i a l l y and economi- c a l l y p r o d u c t i v e l i f e . To a t t a i n t h i s t a r g e t a complete r e a p p r a i s a l of c o n v e n t i o n a l h e a l t h systems h a s t a k e n p l a c e . These a r e now c o n s i d e r e d t o r e a c h f a r beyond t h e c o n f i n e s of m e d i c a l c a r e . It i s r e c o g n i z e d t h a t improvements i n h e a l t h s t a t u s of p e o p l e can b e r e a c h e d o n l y a s a r e s u l t of n a t i o n a l and i n t e r n a t i o n a l p o l i t i c a l w i l l , and t h e c o o r d i n a - t e d e f f o r t s of t h e h e a l t h s e c t o r and r e l e v a n t a c t i v i t i e s of o t h e r s o c i a l and economic development s e c t o r s . S i n c e h e a l t h development b o t h c o n t r i b u t e s t o and r e s u l t s from s o c i a l and economic development, h e a l t h p o l i c i e s have t o form a p a r t of o v e r a l l development p o l i c i e s , t h u s r e f l e c t i n g t h e s o c i a l a n d economic g o a l s of governments and people. I t i s now u n d e r s t o o d t h a t h e a l t h programmes have t o be d e v i s e d t o g i v e e f f e c t t o t h e s e p o l i c i e s and a t t a i n t h e s e g o a l s , r a t h e r t h a n b e i n g mere e x t e n s i o n s of e x i s t i n g m e d i c a l c a r e s e r v i c e s . H e a l t h s e r v i c e s , i n t u r n , have t o be o r g a n i z e d i n such

a

way a s t o d e l i v e r t h e s e programmes.

45. The d i s t r i b u t i o n of r e s o u r c e s f o r h e a l t h h a s a l s o come u n d e r c l o s e s c r u t i n y . The need f o r a more e q u i t a b l e d i s t r i - b u t i o n of h e a l t h r e s o u r c e s w i t h i n and among c o u n t r i e s i s now w i d e l y a c c e p t e d , i n c l u d i n g t h e i r p r e f e r e n t i a l a l l o c a t i o n t o t h o s e i n g r e a t e s t s o c i a l need s o t h a t t h e h e a l t h system

T D S / N I E O / ~ . I page 21 adequately covers a l l t h e poplllation. I n c r e a s i n g emphasis

i s

being l a i d on p r e v e n t i v e measures w e l l i n t e g r a t e d with c u r a t i v e , r e h a b i l i t a t i v e a n d environmental measures. A l l t h e above h a s l e d t o s t r e n g t h e n i n g t h e concept of basing h e a l t h systems on what i s known a s primary h e a l t h care.

46. The D e c l a r a t i o n i s s u e d by t h e I n t e r n a t i o n a l Conference on Primary Health Care h e l d i n Alma-Ata, USSR, i n September 1978 (see Annex 2) irlcorporates t h e p r i n c i p l e s mentioned above, and w i l l have f a r - reaching consequences f o r h e a l t h development over t h e next t w o decades. It s t a t e s t h a t primary h e a l t h c a r e i s t h e key t o a t t a i n i n g an a c c e p t a b l e

l e v e l of h e a l t h f o r a l l by t h e y e a r 2000 and d e s c r i b e s primary h e a l t h c a r e a s e s s e n t i a l h e a l t h c a r e based on p r a c t i c a l , s c i e n t i f i c a l l y sound and s o c i a l l y a c c e p t a b l e methods and technology, made u n i v e r s a l l y a c c e s s i b l e t o

i n d i v i d u a l s and f a m i l i e s i n t h e c m u n i t y through t h e i r f u l l p a r t i c i p a t i o n and a t a c o s t t h a t t h e c o m u n i t y and t h e country can a f f o r d t o maintain a t every s t a g e of t h e i r development, i n t h e s p i r i t of s e l f - r e l i a n c e and s e l f - determination.

47. The D e c l a r a t i o n of A l m a - A t a urgcs a l l govermue11t.s t o formulate n a t i o n a l p o l i c i e s , s t r a t e g i e s and p l a n s of a c t i o n t o launch and s u s t a i n primary h e a l t h c a r e a s p a r t of a comprehensive n a t i o n a l h e a l t h system and i n c o o r d i n a t i o n w i t h o t h e r s e c t o r s . It a l s o c a l l s f o r urgent and e f f e c t i v e n a t i o n a l and i n t e r n a t i o n a l a c t i o n t o develop and implement primary h e a l t h c a r e throughout t h e world, and p a r t i c u l a r l y i n developing c o u n t r i e s , i n a s p i r i t of t e c h n i c a l cooperation and i n keeping with a New I n t e r n a t i o n a l Economic Order.

The Alma-Ata Conference a l s o recognized t h a t i n t e r n a t i o n a l h e a l t h support f o r developing c o u n t r i e s should r e s p e c t f u l l y t h e c o o r d i n a t i o n of t h e s e r e s o u r c e s by t h e developing

c o u n t r i e s themselves, making most use of l o c a l l y a v a i l a b l e r e s o u r c e s . The Conference urged c o u n t r i e s t o cooperate with one a n o t h e r , recognizing t h a t a l l c o u n t r i e s can l e a r n from one another i n m a t t e r s of h e a l t h and development.

48. The World Health Organization and i t s Member S t a t e s a r e now engaged i n preparing n a t i o n a l , r e g i o n a l and g l o b a l s t r a t e g i e s f o r a t t a i n i n g an a c c e p t a b l e l e v e l of h e a l t h f o r a l l based on primary h e a l t h care. These s t r a t e g i e s w i l l c o n s t i t ~ ~ t e t h e h e a l t h s e c t o r ' s c o n t r i b u t i o ~ l t o t h e New

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22

International Development Strategy, and will thus alsu contribute to the NIEO.

49. It can be seen that the philosophy, policy, principles and practices recently adopted in the world health sector correspond fully with the aims of the NIEO and with the means for achieving them.

Health activities implement NIEO objectives

50. The objectives of the NIEO are not in question: the transfer of resources, to ensure their more equitable distribution and to provide poorer countries with better opportunities to participate in world trade; and the transfer to those countries of appropriate technologies, with the accent on self-reliance. The adoption of these features has been initiated in the health field, which therefore provides an example of the application and practice of the principles involved in the NIEO.

51. The characteristics inherent in the strategy of health for all by the year 2000, based on primary health care, as described earlier, are precisely those demanded by the NIEO.

Examples are: multisectoral coordination, with the mutual contribution to development of actions in the health and relevant socioeconomic sectors; the transfer of tcchnology

(as in the policy of appropriate technology for health);

redistribution of resources on a more equitable basis, leading to universal accessibility of primary health care and its supporting services; increased self-reliance (as in the policy of technical cooperation among developing countries); and mass participation, ensuring involvement of the community in shaping its own health and socioeconomic future.

52. The transfer of appropriate technology for health to developing countries is an activity in which WHO is fully involved. The aim is to prornotc thc dcvelopment within countries

of

simple but scientifically sound health technologies, adapted to local needs, acceptable to those who apply them and to those for whom they are used, and able

to be maintained by the people themselves, in keeping with the principle of self-reliance, with resources that the community and the country can afford. The transfer of inappropriate technology can be viewed as a form of foreign occupation or of technological neo-colonialism. In the

TD~/NIEO/?~.

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23

ileal tll field, the transfer of appropriate technology to developing countries or between developing countries has been the subject of many conferences and specific

programes. Emphasis is laid on the development of the right kind of health technologies by Third World countries themselves, and this could act as an important principle in other sectors than health. By diminishing the influence of the socially irrelevant health technologies oi the atfluent countries and their high import costs for developing countries this type of programme could be one of the bases of a NIEO.

53.

Also fully consonant with the NIEO is the redistribu- tion of resources in the health sector, as exemplified by trends in WHO'S budget policy. For instance, as a result of a series of consultations held in November 1978 with major contributors of funds, representatives of developing countries and of the United Nations system, an International Health Funding Group has been formed. The broad mandate of the Group is to provide guidance to the Director-General on effective mobilization of international funding for health in terms of

WHO

priority programmes, but one of its most important functions is to advise on the alignment, harmoni- zation and coordination of bilateral flows in the context of strategies set by the Health Assembly, including the promotion of TCDC. The Group will facilitate cooperation among contributors themselves and with developing countries in health and allied fields. In addition, it will examine the primary health care requirements of individual

countries. The overall effect of the Group's activities is to ensure that funds and resources are properly channelled and exert their cffcct in a complcmcntary fashion.

54.

Another WHO policy aimed at stimulating national and regional self-reliance and promoting the redistribution of resources is technical cooperation among developing

countries (TCDC)

.

As mentioned previously, health develop- ment for the Third World implies technical cooperation among developing countries and economic cooperation among

developing countries. TCDC is of particular importance in health, where appropriate technologies found suitable in some

developing countries should be transferred to other

developing countries. Mechanisms for ensuring timely and

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24

appropriate exchanges of information on health matters are already being set up among interested countries. Within the framework of country strategies for achieving health for all by the year 2000, national centres for health development will be created and will support cooperation at the regional and international levels. TCDC has been recognized by the World Health Assembly as an important instrument for the

technical liberation of developing countries, particularly in the fields of research, development and training, and exchange of experience and information on health care.

Mechanisms for stimulating TCDC are being set up in WHO Regional Offices, and networks of regional and subregional centres concerned with various health activities are being estab1ished.l In this way, WHO'S Member States are making strenuous efforts to cooperate with each other in the

context of TCDC principles, with the Organization's coopera- tion. These activities are in addition to the many more instances of TCDC operating in the health field on a bilateral basis, without the direct involvement of WHO.

55.

The health sector stresses multisectoral coordination, and this attitude could easily spread to other sectors. It has been shown in the health sector that countries can sink

their differences in the intcrcsts of international health solidarity, with the objective of improving the health of the masses in the less favoured communities. In the health sector, world strategies are being constructed on the basis of national strategies. If this happened in other sectors too, a powerful force would be built up that would exert pressure to change the world order. This mass effect would be exerted from below rather than at the global Level. An important area in which multisectoral coordination is particularly noteworthy is the provision of an adequate supply of safe drinking water and basic sanitation, one of the essential components of primary health care. The target date for safe water supply and sanitation for all has been set for 1990, as decided by the United Nations Water Conference. To help reach this target an international mechanism has been created consisting of the United Nations,

'

For details see WHO document ~32/23 (Collaboration with the United Nations system: technical cooperation among

developing countries).

TDS/NIEO/~

9.1 page 25 the United Nations Children's Fund, the United Nations

Development Programme and the International Labour Office, the Food and Agriculture Organization, the World Bank and

WHO.

At country level, coordination between these bodies

is ensured by the Resident Representative of the United Nations Development Programme; at the global level, by a

steering committee of which

WHO

acts as servicing agency.

Massive bilateral support is also being active sought.

56.

Another area in which multisectoral coordination is essential but unfortunately has not yet been adequately achieved at the international level is that of food supplies. Promotion of food supply and proper nutrition is another essential component of primary health care. A world international food programme forms part of the NIEO.

57. In the development of any world international food programme an international nutrition policy is essential to complement the development effect of the production of food and to ensure that the right kinds of food are produced and consumed in the developing countries and that balance is reached between food crops and cash crops. These

nutrition programmes should be closely linked to the development of national and international food programmes.

The health industry as an economic entity

58. In purely economic terms, very heavy investments are

being made in the so-called health industry, which is in reality a sickness industry. There is also

a

large volume of interna- tional trade associated with this industry. The amount of economic activity involved means that the industry forms a sizeable part of world economy, and if the principles of the

NIEO

were applied in this industry alone, the results would be formidable. Trade objectives call for a specific trade policy related to the health system. For the moment, widely varying import policies relating to health supplies prevail in the developing countries. The international industrial health market is already very large, with an output in 1976 of US$ 50 000 million ior pharmaceuclcal production alone. In 1975 a handful of North American and European countries accounted for 71% of free-market

developed country drug exports. The access to the health market of those individuals who do not yet have access to it

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1 page 26

will also increase tremendously the international exchange between developed and developing countries, and also between developing countries, especially if combined with the

transfer of appropriate technology and industrialization programmes. The setting up of national drug policies and the appearance of a United Nations policy on drugs and the Third World should be an integral part of any programme relared to general trade. A case study on drug policies and essential drugs is presented in Annex

3.

59. At the national level, health as an economic sector in itself, in all countries, absorbs a large part of the national budget, to which private funds and private health consumption have to be added. Health, with its invest- ments, production and salaries, is an integral part of any economic system. When countries have overcome poverty, a growing percentage of the national revenue will be reinvested in other services, creating at the national level an

accelerating process comparable with that at the individual level. The economic implications of the health sector at the national level in the struggle to attain an acceptable level of health for all are complementary to those at the international level in ensuring that the NIEO becomes a genuine socioeconomic Development Order.

Health as a lever for development and peace

60. Exceptional efforts are being made in the health sector to promote health in a totally different way from accepted medical practice. These efforts aim at reducing health

inequalities. They have succeeded in setting in motion a process of international transfer of appropriate health technology, and have led to cooperation rather than confrontation between developed and developing countries.

This kind of health development is an integral part of socioeconomic development, and can act as a powerful lever for that development.

61. There is a strong advantage in using health as a common subject on which countries can agree to work together, both for the sake of improving health and the quality of life and for the sake of development in general, since health

aspirations are less controversial'politically than most