EB43/22
13 J a n u a r y 1 9 6 9
E X E C U T I V E B O A R D
P r o v i s i o n a l a g e n d a i t e m 2 . 2 F o r t y - t h i r d S e s s i o n
R E P O R T O N E X P E R T C O M M I T T E E M E E T I N G S R e p o r t of t h e D i r e c t o r - G e n e r a l
INDEXED
I N T R O D U C T I O N
In c o m p l i a n c e w i t h p a r a g r a p h 1 0 . 6 of t h e R e g u l a t i o n s for E x p e r t A d v i s o r y P a n e l s a n d C o m m i t t e e s , 1 t h e D i r e c t o r - G e n e r a l r e p o r t s h e r e o n t h e t e n m e e t i n g s o f e x p e r t c o m m i t t e e s
о
l i s t e d b e l o w , t h e r e p o r t s of w h i c h h a v e b e e n p r e p a r e d in b o t h w o r k i n g l a n g u a g e s s i n c e t h e f o r t y - s e c o n d s e s s i o n of t h e E x e c u t i v e B o a r d .
T h e E x e c u t i v e B o a r d , at its f o r t y - f i r s t s e s s i o n , a d o p t e d r e s o l u t i o n E B 4 1 . R 1 2 in w h i c h it r e q u e s t e d the D i r e c t o r - G e n e r a l to i n c l u d e in h i s r e p o r t to the E x e c u t i v e B o a r d o n e x p e r t c o m m i t t e e m e e t i n g s , i n f o r m a t i o n s h o w i n g t h e r e s u l t s o b t a i n e d in h i s c o n t i n u i n g e v a l u a t i o n o f t h e T e c h n i c a l R e p o r t S e r i e s w i t h a v i e w to i m p r o v i n g t h e i r q u a l i t y s t i l l f u r t h e r a n d g i v i n g t h e m a w i d e r a n d m o r e r a p i d d i s t r i b u t i o n . In t h i s c o n n e x i o n , t h e D i r e c t o r - G e n e r a l h a s t a k e n s t e p s to a f f e c t a m o r e r a p i d d i s t r i b u t i o n of t h e s e r e p o r t s . F u r t h e r m o r e , f o l l o w i n g
r e s o l u t i o n E B 4 2 . R 1 2 t h e m a t t e r w a s r e f e r r e d for c o n s i d e r a t i o n to t h e R e g i o n a l C o m m i t t e e s , s e v e r a l of w h i c h h a v e t a k e n n o t e of t h e e v a l u a t i o n m a d e b y t h e E x e c u t i v e B o a r d。 T h e D i r e c t i n g C o u n c i l of t h e P a n A m e r i c a n H e a l t h O r g a n i z a t i o n / R e g i o n a l C o m m i t t e e for t h e W o r l d H e a l t h O r g a n i z a t i o n , at its m e e t i n g in O c t o b e r 1 9 6 8 in B u e n o s A i r e s , A r g e n t i n a , d i s c u s s e d the m a t t e r a n d r e f e r r e d in p a r t i c u l a r to t h e n e e d for a n a n n o t a t e d i n d e x b y s u b j e c t o f t h e T e c h n i c a l R e p o r t S e r i e s .
T h e ten m e e t i n g s a r e r e v i e w e d h e r e u n d e r i n the f o l l o w i n g o r d e r :
1• E x p e r t C o m m i t t e e o n P l a n n i n g a n d E v a l u a t i o n of H e a l t h E d u c a t i o n S e r v i c e s 2 . E x p e r t C o m m i t t e e o n M i c r o b i o l o g i c a l A s p e c t s of F o o d H y g i e n e ( w i t h t h e
p a r t i c i p a t i o n of F A O )
3 . J o i n t M e e t i n g of t h e FAO W o r k i n g P a r t y of E x p e r t s o n P e s t i c i d e R e s i d u e s a n d t h e W H O E x p e r t C o m m i t t e e o n P e s t i c i d e R e s i d u e s
4 . E x p e r t C o m m i t t e e o n W a t e r P o l l u t i o n C o n t r o l in D e v e l o p i n g C o u n t r i e s
5 . E x p e r t C o m m i t t e e o n N o n - P r o p r i e t a r y N a m e s for P h a r m a c e u t i c a l P r e p a r a t i o n s , E i g h t e e n t h R e p o r t
6 . E x p e r t C o m m i t t e e o n U r b a n A i r P o l l u t i o n w i t h P a r t i c u l a r R e f e r e n c e to M o t o r V e h i c l e s 7 . E x p e r t C o m m i t t e e o n B i o l o g i c a l S t a n d a r d i z a t i o n , T w e n t y - f i r s t R e p o r t
8 . E x p e r t C o m m i t t e e o n D r u g D e p e n d e n c e , S i x t e e n t h R e p o r t
9 . J o i n t I L 0 / W H 0 C o m m i t t e e o n O c c u p a t i o n a l H e a l t h , S i x t h R e p o r t 1 0 . E x p e r t C o m m i t t e e o n G e n e t i c C o u n s e l l i n g
1 B a s i c D o c u m e n t s , 1 9 t h e d ” p . 9 2 .
2
C o p i e s of t h e s e r e p o r t s a r e a n n e x e d to t h i s d o c u m e n t (for M e m b e r s of t h e E x e c u t i v e B o a r d o n l y ) •EB43/22 page 2
1 • E x p e r t C o m m i t t e e o n P l a n n i n g a n d E v a l u a t i o n o f H e a l t h E d u c a t i o n S e r v i c e s ^ 1 • 1 B a c k g r o u n d i n f o r m a t i o n
T h e p r e v i o u s W H O e x p e r t c o m m i t t e e s d e a l i n g w i t h h e a l t h e d u c a t i o n h a v e b e e n c o n c e r n e d r e s p e c t i v e l y w i t h : ( a ) t h e m a i n p r o b l e m s , o b j e c t i v e s , a n d t h e r o l e o f h e a l t h e d u c a t i o n in e n l i s t i n g t h e p a r t i c i p a t i o n o f p e o p l e i n h e a l t h s e r v i c e s a n d in r e l a t e d p r o g r a m m e s o f a c o m m u n i t y d e v e l o p m e n t n a t u r e ; ^ ( b ) n e e d s a n d g u i d i n g p r i n c i p l e s for t h e t r a i n i n g o f h e a l t h p e r s o n n e l i n h e a l t h e d u c a t i o n ; ^ a n d ( c ) o b j e c t i v e s a n d s u g g e s t i o n s for t h e p r e p a r a t i o n i n h e a l t h e d u c a t i o n o f e l e m e n t a r y a n d s e c o n d a r y s c h o o l t e a c h e r s . T h i s w a s c o n v e n e d j o i n t l y b y W H O w i t h U N E S C O •4
T h e f i r s t E x p e r t C o m m i t t e e h a d c o n s i d e r e d b r i e f l y t h e m a i n p r o b l e m s a n d p r i n c i p l e s o f p l a n n i n g h e a l t h e d u c a t i o n i n p r i o r i t y h e a l t h p r o g r a m m e s . H o w e v e r , t o m e e t t h e n e e d s o f
p r o g r a m m e d e v e l o p m e n t i n s e v e r a l M e m b e r S t a t e s d u r i n g t h e p a s t f i f t e e n y e a r s a n d t h e i r e x p r e s s e d i n t e r e s t , a n e x p e r t m e e t i n g o f h e a l t h a d m i n i s t r a t o r s a n d d i r e c t o r s o f h e a l t h e d u c a t i o n s e r v i c e s w a s c o n v e n e d t o c o n s i d e r t h e o b j e c t i v e s , t e c h n i c a l s t a n d a r d s , and g u i d i n g p r i n c i p l e s for t h e p l a n n i n g a n d e v a l u a t i o n o f h e a l t h e d u c a t i o n s e r v i c e s w i t h i n t h e f r a m e w o r k o f p r i o r i t y h e a l t h p r o g r a m m e s a n d s e r v i c e s a t v a r i o u s a d m i n i s t r a t i v e l e v e l s .
1 . 2 T h e r e p o r t
T h e C o m m i t t e e c o n s i d e r e d t h a t h e a l t h e d u c a t i o n s e r v i c e s , w h e n p r o p e r l y p l a n n e d , o r g a n i z e d , a n d i m p l e m e n t e d w i t h i n t h e o r g a n i z a t i o n a l f r a m e w o r k o f n a t i o n a l h e a l t h p r o g r a m m e s , c a n b e o f i m p o r t a n t c o n s e q u e n c e i n e n l i s t i n g t h e a c t i v e p a r t i c i p a t i o n o f t h e p e o p l e , a n d i n i m p r o v i n g t h e u s e o f a v a i l a b l e h e a l t h s e r v i c e s a n d r e l a t e d r e s o u r c e s .
W h i l e n o t i n g a t r e n d t o w a r d m o r e w i d e s p r e a d u n d e r s t a n d i n g o f t h e v a l u e o f e f f e c t i v e h e a l t h e d u c a t i o n , t h e C o m m i t t e e s t r e s s e d t h e n e e d for a m u c h m o r e s y s t e m a t i c a n d s u b s t a n t i a l c o n s i d e - r a t i o n o f t h e p l a n n i n g , o r g a n i z a t i o n , a n d e v a l u a t i o n o f t h e h e a l t h e d u c a t i o n a s p e c t s o f h e a l t h p l a n s a n d p r o g r a m m e s . R e a l i s t i c p l a n n i n g a n d e v a l u a t i o n o f h e a l t h e d u c a t i o n a t v a r i o u s
a d m i n i s t r a t i v e l e v e l s w o u l d n e e d t o v a r y i n a c c o r d a n c e w i t h： (a) a v a i l a b l e h e a l t h m a n p o w e r a n d h e a l t h s e r v i c e s , a n d ( b ) a v a r i e t y o f c u l t u r a l , e d u c a t i o n a l , s o c i o - e c o n o m i c a n d r e l a t e d
c i r c u m s t a n c e s a n d r e s o u r c e s .
T h e d e g r e e t o w h i c h t h e p l a n n i n g o f h e a l t h e d u c a t i o n c o m p o n e n t s o f p r i o r i t y h e a l t h
p r o g r a m m e s i s e f f e c t i v e i n p r a c t i c e is i n f l u e n c e d b y t h e d e t a i l e d c o n s i d e r a t i o n g i v e n t o v a r i o u s i n t e r r e l a t e d f a c t o r s i n c l u d i n g： ( i ) t h e a c c e s s i b i l i t y o f h e a l t h a d v i c e a n d h e a l t h s e r v i c e s i n w h i c h t h e i n d i v i d u a l s h a v e c o n f i d e n c e ; ( i i ) t h e e c o n o m i c f e a s i b i l i t y o f t h e p e o p l e c o n c e r n e d
t o p u t i n t o p r a c t i c e t h e h e a l t h m e a s u r e s b e i n g a d v o c a t e d ; a n d ( i i i ) t h e a c c e p t a b i l i t y o f t h e p r o p o s e d h e a l t h p r a c t i c e i n t e r m s o f t h e a s p i r a t i o n s , b e l i e f s , a n d b e h a v i o u r a l p a t t e r n s o f d a i l y l i v i n g o f t h e p e o p l e c o n c e r n e de
T h e p r o f e s s i o n a l p e r s o n n e l r e s p o n s i b l e for t h e p l a n n i n g a n d e v a l u a t i o n o f h e a l t h e d u c a t i o n s e r v i c e s i n h e a l t h d e p a r t m e n t s o r m i n i s t r i e s
t e c h n i c a l f u n c t i o n s o f t h e i r s e r v i c e s t o t h e : p r o g r a m m e s a n d r e s o u r c e s o f t h e i r r e s p e c t i v e
m u s t b e a l e r t t o t h e c o n t i n u i n g n e e d t o a d j u s t t h e (i) p r i o r i t y o b j e c t i v e s , p o l i c i e s , p l a n s ,
h e a l t h a u t h o r i t i e s ; ( i i ) hea'lth e d u c a t i o n W l d H l t h O r g . t e c h n . R e p . S e r ” 1 9 6 9 , 4 0 9 .
2 W l d H l t h O r g . t e c h n . R e p . S e r ” 1 9 5 4 , 8 9 . 3 W l d H l t h O r g . t e c h n . R e p . S e r ” 1 9 5 8 , 1 5 6 . 4 W l d H l t h O r g . t e c h n . R e p . S e r ” 1 9 6 0 , 1 9 3 .
EB43/22 page 3 i m p l i c a t i o n s o f p r o g r a m m e s , o f o t h e r l e a d i n g m i n i s t r i e s , ( e d u c a t i o n , a g r i c u l t u r e , a n d o t h e r s ) w i t h w h i c h t h e i r r e s p e c t i v e h e a l t h a u t h o r i t i e s m a y c o - o p e r a t e； a n d ( i i i ) h e a l t h e d u c a t i o n a s p e c t s o f m e d i c a l a n d p u b l i c h e a l t h a c t i v i t i e s o f p r o f e s s i o n a l a s s o c i a t i o n s , n o n - g o v e r n m e n t a l h e a l t h o r g a n i z a t i o n s , i n d u s t r i a l e s t a b l i s h m e n t s , a n d o t h e r v o l u n t a r y a g e n c i e s a n d g r o u p s . 1 . 3 T h e r e c o m m e n d a t i o n s
T h e C o m m i t t e e r e c o m m e n d e d that :
(a) p l a n n i n g for h e a l t h e d u c a t i o n b e c o m e s a s p e c i f i c , s y s t e m a t i c , a n d i n t e g r a l p a r t o f a l l h e a l t h p l a n n i n g i n o r d e r t o s t r e n g t h e n i t s r o l e i n e n l i s t i n g t h e d e s i r e d a c t i o n a n d s u p p o r t o f p e o p l e i n p r i o r i t y h e a l t h s e r v i c e s a n d r e l a t e d p r o g r a m m e s；
(b) s t u d i e s a n d r e s e a r c h b e e n c o u r a g e d t o h e l p i m p r o v e t h e b a s i s o n w h i c h h e a l t h e d u c a t i o n a s p e c t s o f v a r i o u s h e a l t h p r o g r a m m e s a r e p l a n n e d i n v a r y i n g g e o g r a p h i c a l , t e c h n o l o g i c a l , e c o n o m i c , c u l t u r a l , a n d a d m i n i s t r a t i v e s e t t i n g s .
1.4 I m p l i c a t i o n s for t h e O r g a n i z a t i o n ' s p r o g r a m m e
T h e g u i d i n g p r i n c i p l e s a n d p r o p o s a l s m a d e b y t h e E x p e r t C o m m i t t e e w i l l b e t a k e n i n t o a c c o u n t in t h e f u r t h e r c o - o p e r a t i o n o f W H O w i t h p r o g r a m m e s o f M e m b e r S t a t e s c o n c e r n e d w i t h t h e p l a n n i n g a n d e v a l u a t i o n o f h e a l t h e d u c a t i o n s e r v i c e s w i t h i n t h e o r g a n i z a t i o n a l f r a m e w o r k o f v a r i o u s h e a l t h p r o g r a m m e s .
2 . E x p e r t C o m m i t t e e o n M i c r o b i o l o g i c a l A s p e c t s o f F o o d H y g i e n e ( w i t h t h e p a r t i c i p a t i o n o f F A 0 ) 1
2•1 B a c k g r o u n d i n f o r m a t i o n
T h i s r e p o r t w a s p r e p a r e d b y t h e C o m m i t t e e a t i t s f i r s t s e s s i o n h e l d i n G e n e v a i n O c t o b e r 1 9 6 7 . T h e p u r p o s e o f t h e m e e t i n g w a s t o d e a l w i t h t h e o v e r - a l l p r o b l e m s o f t h e t r a n s m i s s i o n o f m i c r o - o r g a n i s m s t h r o u g h f o o d , t h e i r d e t e c t i o n a n d p r e v e n t i o n . T h e C o m m i t t e e w a s a l s o c o n c e r n e d w i t h a s s e s s i n g t h e r o l e o f t h e m i c r o b i o l o g i c a l l a b o r a t o r y w i t h i n t h e o v e r - a l l p r o g r a m m e for t h e p r o m o t i o n a n d c o n t r o l o f f o o d h y g i e n e a n d a l s o d e a l t w i t h p r i n c i p l e s a n d d i f f i c u l t i e s o f s e t t i n g u p m i c r o b i o l o g i c a l s t a n d a r d s .
2 . 2 T h e r e p o r t
T h e g e n e r a l s e c t i o n o f t h e r e p o r t d e a l s w i t h r e p o r t i n g a n d s u r v e i l l a n c e i n t h e p r e v e n t i o n and c o n t r o l o f f o o d - b o r n e d i s e a s e s . It a l s o r e v i e w s t h e f a c t o r s w h i c h h a v e c o n t r i b u t e d o v e r the p a s t f e w y e a r s to t h e i n c r e a s i n g n e c e s s i t y for p r e v e n t i n g a n d d e a l i n g w i t h o u t b r e a k s o f f o o d - b o r n e d i s e a s e ; t h e c h a n g i n g e p i d e m i o l o g i c a l f a c t o r s , s u c h as r a p i d u r b a n i z a t i o n , t e c h n o - l o g i c a l a d v a n c e s , i n t e r n a t i o n a l s h i p m e n t o f f o o d s , c e n t r a l i z a t i o n o f food p r o c e s s i n g , l o n g c h a i n s o f f o o d d i s t r i b u t i o n , a n d c h a n g i n g f o o d h a b i t s . H e n c e t h e n e e d for m o d i f y i n g t h e c o n v e n t i o n a l a p p r o a c h e s to t h e e p i d e m i o l o g y o f f o o d - b o r n e d i s e a s e .
S p e c i a l s e c t i o n s a r e d e v o t e d to t h e m o r e i m p o r t a n t p a t h o g e n s , w h i c h m a y c a u s e f o o d - b o r n e d i s e a s e s i n c l u d i n g b a c t e r i a , v i r u s e s , r i c k e t t s i a s , f u n g i a n d t h e i r t o x i n s , f o o d - b o r n e a n i m a l p a r a s i t e s a n d p r o t o z o a a r e a l s o b r i e f l y m e n t i o n e d . S o u r c e s a n d v e h i c l e s o f p a t h o g e n s , i n f l u e n c e s o f v a r i o u s k i n d s o f food p r o c e s s i n g o n t h e i r d e s t r u c t i o n o r p e r s i s t e n c e , m e a n s o f l a b o r a t o r y e x a m i n a t i o n a n d e v a l u a t i o n o f f i n d i n g s a r e d e s c r i b e d . O n e o f t h e m o s t i m p o r t a n t c h a p t e r s is t h a t d e a l i n g w i t h t h e r o l e o f t h e l a b o r a t o r y i n food, h y g i e n e p r o g r a m m e s a n d m i c r o - b i o l o g i c a l s t a n d a r d i z a t i o n o f food p r o d u c t s .
1 Wld Hlth Org, techn. Rep. S e r ” 1968, 399.
EB43/22 page 4
N i n e a n n e x e s c o n t a i n u s e f u l a d d i t i o n a l i n f o r m a t i o n o n r e p o r t i n g o f f o o d - b o r n e d i s e a s e o u t b r e a k s , p r o c e d u r e s f o r c o l l e c t i n g a n d s u b m i t t i n g food s a m p l e s for l a b o r a t o r y e x a m i n a t i o n , a n d t h e i d e n t i f i c a t i o n o f s o m e p a t h o g e n s i n f o o d s a m p l e se
2 . 3 T h e r e c o m m e n d a t i o n s
T h e C o m m i t t e e m a d e s e v e r a l r e c o m m e n d a t i o n s c o n c e r n i n g r e s e a r c h o n t h e m i c r o b i o l o g i c a l a s p e c t s o f f o o d h y g i e n e a n d a l s o e n d o r s e d t h e r e c o m m e n d a t i o n s f o r r e s e a r c h m a d e b y t h e I n t e r n a t i o n a l C o m m i t t e e o n M i c r o b i o l o g i c a l S p e c i f i c a t i o n s for F o o d s , w h i c h h a s r e c e i v e d W H O g r a n t s f o r t h e w o r k i n t h i s f i e l d . T h e r e c o m m e n d a t i o n s p a r t i c u l a r l y d e a l w i t h p r o b l e m s o f d e v e l o p m e n t o f i m p r o v e d m e t h o d s o f m i c r o b i o l o g i c a l f o o d e x a m i n a t i o n , c l a r i f i c a t i o n o f t h e r o l e o f s o m e m i c r o - o r g a n i s m s s u c h a s f o o d - p o i s o n i n g a g e n t s , s t a t i s t i c a l s t u d i e s , e t c .
2#4 I m p l i c a t i o n s for t h e O r g a n i z a t i o n ' s p r o g r a m m e
W H O w i l l u s e t h e f i n d i n g s and. r e c o m m e n d a t i o n s o f t h e C o m m i t t e e t o a s s i s t a n d a d v i s e g o v e r n m e n t s i n d e a l i n g w i t h f o o d h y g i e n e p r o b l e m s a n d w i l l u s e t h e r e p o r t i n f o r m u l a t i n g p r o g r a m m e s i n t h i s f i e l d .
T h e f i n d i n g s o f t h i s C o m m i t t e e w i l l f o r m a n i m p o r t a n t b a s i s for t h e w o r k i n t h e J o i n t F A O / W H O F o o d S t a n d a r d s P r o g r a m m e ( C o d e x A l i m e n t a r i u s ) p a r t i c u l a r l y i n t h e C o d e x A l i m e n t a r i u s
C o m m i t t e e o n F o o d H y g i e n e .
T h e r e c o m m e n d a t i o n s f o r r e s e a r c h w i l l s e r v e a s a n i m p o r t a n t b a s i s f o r s t u d i e s i n m i c r o - b i o l o g i c a l a s p e c t s o f f o o d h y g i e n e d u r i n g t h e n e x t f e w y e a r s .
3 • J o i n t M e e t i n g o f t h e F A O W o r k i n g P a r t y o f E x p e r t s o n P e s t i c i d e R e s i d u e s a n d t h e W H O E x p e r t C o m m i t t e e o n P e s t i c i d e Residues-1-
3 • 1 B a c k g r o u n d i n f o r m â t i o n
A t a J o i n t M e e t i n g o f t h e F A O P a n e l o f E x p e r t s o n t h e U s e o f P e s t i c i d e s in A g r i c u l t u r e a n d t h e W H O E x p e r t C o m m i t t e e o n P e s t i c i d e R e s i d u e s i n 1 9 6 1 ^ it w a s r e c o m m e n d e d t h a t s t u d i e s b e u n d e r t a k e n t o e v a l u a t e t h e c o n s u m e r h a z a r d a r i s i n g f r o m t h e u s e o f p e s t i c i d e s . S u b s e q u e n t l y t h e F A O C o m m i t t e e o n P e s t i c i d e s i n A g r i c u l t u r e a n d t h e W H O E x p e r t C o m m i t t e e o n P e s t i c i d e
R e s i d u e s h e l d t w o j o i n t m e e t i n g s ( i n 1 9 6 3 ^ a n d 1 9 6 54) d e a l i n g w i t h a n u m b e r o f p e s t i c i d e s a n d s u g g e s t i n g , o n t h e b a s i s o f r e l e v a n t d a t a , a c c e p t a b l e d a i l y i n t a k e s for s o m e o f t h e m . T h e s e t o x i c o l o g i c a l e v a l u a t i o n s w e r e u s e d b y t h e F A O W o r k i n g P a r t y o n P e s t i c i d e R e s i d u e s a s o n e o f t h e b a s e s f o r r e c o m m e n d i n g t o l e r a n c e for p e s t i c i d e r e s i d u e s in c e r t a i n f o o d s。
I n o r d e r t o f a c i l i t a t e t h e p r o g r e s s o f w o r k i n t h i s f i e l d a f i r s t J o i n t M e e t i n g o f t h e F A O W o r k i n g P a r t y o n P e s t i c i d e R e s i d u e s a n d t h e W H O E x p e r t C o m m i t t e e o n P e s t i c i d e R e s i d u e s w a s c o n v e n e d i n 1 9 6 6 t o p r o v i d e b o t h t o x i c o l o g i c a l e v a l u a t i o n s a n d r e c o m m e n d a t i o n s o f t o l e r a n c e s •
к
T h e s e c o n d J o i n t M e e t i n g , n o w r e p o r t e d o n , t o o k p l a c e i n R o m e f r o m 4 - 1 1 D e c e m b e r 1 9 6 7 .1 W l d H l t h O r g , t e c h n . R e p . S e r ” 1 9 6 8 , 391 • 2 W l d H l t h O r g , t e c h n . R e p , S e r , , 1 9 6 2 , 2 4 0 . 3 D o c u m e n t W H O / F o o d A d d / 2 3 ( 1 9 6 4 ) .
4 D o c u m e n t W H O / F o o d A d d / 2 6 . 6 5e
5 Wld Hlth Org, techn. Rep. Ser., 1967, 370.
EB43/22 page 5 3 . 2 T h e r e p o r t
A t this J o i n t M e e t i n g , 17 p e s t i c i d e s , r e c o m m e n d e d for c o n s i d e r a t i o n b y t h e C o d e x C o m m i t t e e o n P e s t i c i d e R e s i d u e s , w e r e r e - e v a l u a t e d i n t h e l i g h t o f a d d i t i o n a l d a t a a n d o f t h e n e w c r i t e r i a , r e c o m m e n d e d b y a W H O S c i e n t i f i c G r o u p , for t h e i n t e r p r e t a t i o n o f t o x i c o l o g i c a l a n d r e l a t e d d a t a . T o l e r a n c e s , or ’,practical r e s i d u e l i m i t s " , w e r e a l s o r e c o m m e n d e d for s i x c o m p o u n d s • 、
A n u m b e r o f o t h e r p e s t i c i d e s w e r e a l s o r e - e v a l u a t e d . T h i s w a s d o n e b e c a u s e n e w d a t a h a d c o m e t o h a n d w h i c h c a s t d o u b t o n their s a f e t y for u s e .
T h e s i g n i f i c a n c e o f i n t e r a c t i o n b e t w e e n d i f f e r e n t p e s t i c i d e s a n d b e t w e e n p e s t i c i d e s a n d o t h e r c h e m i c a l s w a s r e v i e w e d . It w a s a g r e e d t h a t w i t h t h e p r e s e n t l e v e l s o f c o n s u m p t i o n t h e r e is n o n e e d for c o n c e r n a b o u t t h e p o s s i b l e a d d i t i v e or p o t e n t i a t i v e e f f e c t s o f i n t a k e o f m o r e t h a n o n e p e s t i c i d e o f t h e s a m e g r o u p or o f d i f f e r e n t g r o u p s .
3 . 3 T h e r e c o m m e n d a t i o n s
In t h e i n t e r e s t s o f p u b l i c h e a l t h a n d a g r i c u l t u r e , f u r t h e r j o i n t m e e t i n g s s h o u l d b e h e l d a n n u a l l y。
W H O s h o u l d p r o m o t e t h e d e v e l o p m e n t o f s t u d i e s o n t h e o r g a n o c h l o r i n e i n s e c t i c i d e s w i t h t h e o b j e c t o f c l a r i f y i n g t h e t o x i c o l o g i c a l s i g n i f i c a n c e o f s t i m u l a t i o n o f t h e a c t i v i t y o f l i v e r e n z y m e s a n d t h e a s s o c i a t e d m o r p h o l o g i c a l c h a n g e s .
W H O s h o u l d p r o m o t e a c t i o n a i m e d a t e v a l u a t i n g t h e s i g n i f i c a n c e o f t h e o b s e r v a t i o n o f
h e p a t o m a s i n l a b o r a t o r y a n i m a l s t r e a t e d w i t h s o m e o r g a n o c h l o r i n e i n s e c t i c i d e s , n o t a b l y d i e l d r i n . W H O s h o u l d i n v i t e t h e a p p r o p r i a t e i n t e r n a t i o n a l a g e n c y t o r e - e v a l u a t e t h e r e c e n t w o r k o n the c h r o n i c t o x i c i t y o f D D T i n m i c e , a n d if f u r t h e r e x p e r i m e n t s a r e c o n s i d e r e d n e c e s s a r y t h e s e s h o u l d b e g i v e n a h i g h p r i o r i t y .
3 . 4 I m p l i c a t i o n s for t h e O r g a n i z a t i o n ' s p r o g r a m m e
A J o i n t M e e t i n g o n P e s t i c i d e R e s i d u e s w a s h e l d i n 1 9 6 8 a n d a f u r t h e r o n © i n 1 9 6 9 .
P r o v i s i o n h a s b e e n m a d e f o r a r e s e a r c h p r o j e c t t o b e i n i t i a t e d in 1 9 6 9 u n d e r t h e S p e c i a l A c c o u n t for M e d i c a l R e s e a r c h .
P r e l i m i n a r y s t e p s h a v e b e e n t a k e n , i n c o l l a b o r a t i o n w i t h t h e I n t e r n a t i o n a l A g e n c y for R e s e a r c h o n C a n c e r , to i m p l e m e n t t h e r e c o m m e n d a t i o n o n h e p a t o m a s i n l a b o r a t o r y a n i m a l s , w h i l e r e c e n t w o r k o n D D T h a s b e e n r e - e v a l u a t e d a n d f u r t h e r e x p e r i m e n t s o n this c o m p o u n d a r e b e i n g c o n d u c t e d .
4 • E x p e r t C o m m i t t e e o n W a t e r P o l l u t i o n C o n t r o l i n D e v e l o p i n g C o u n t r i e s1
4 . 1 B a c k g r o u n d i n f o r m a t i o n
W a t e r p o l l u t i o n w a s t h e s u b j e c t o f a n E x p e r t C o m m i t t e e c o n v e n e d i n G e n e v a i n A p r i l 1 9 6 5 T h e r e p o r t r e c e i v e d w i d e p u b l i c i t y in t h e t e c h n i c a l p r e s s . T h a t C o m m i t t e e h a d t a k e n s t o c k o f t h e w o r l d w a t e r p o l l u t i o n p r o b l e m , i n t e m p e r a t e a n d t r o p i c a l z o n e s , a d v a n c e d a n d d e v e l o p i n g c o u n t r i e s , a n d i t s r e c o m m e n d a t i o n s w e r e o f u n i v e r s a l a p p l i c a t i o n .
1 W l d H l t h O r g , t e c h n . R e p . S e r . , 1 9 6 8 , 4 0 4 .
2 Wld Hlth Org, techn. Rep. Ser.’ 1966, 318.
E B 4 3 / 2 2 p a g e 6
The effects of water pollutiony however, are now becoming acute in the developing countries, often as a serious unwanted complication of development programmes. An Inter-Regional Seminar on Water Pollution Control, with particular reference to the developing countries, took place at New Delhi in November 1967• It was attended by fifteen participants from developing
countries. The material collected for that Seminar, and now being compiled into a report, was made available to the members of the Expert Committee as background information for their
deliberations.
4.2 The report
This Expert Committee reviewed the most important water pollution problems in the developing countries, most of which are situated in tropical or semi-arid regions, so that climatic
conditions and hence water resources have a vital bearing on pollution problems and their resolution. At the same time these countries have high rates of population growth, urbani- zation and industrialization.
The Committee considered the inter-relationship of water resources and water pollution, evaluated the health aspects of the problem and discussed remedies ranging from the planning of water use and pollution control at national or regional level, to general principles for the prevention of water pollution, training of personnel engaged in the management of water resources and pollution control. It also pointed to areas for research.
4.3 The recommendations
The Committee made 20 recommendations. In summary they bear on good planning of water resources, at national or regional level, both for public health and economic and social development; they stress the need, for conservation and re-use of water, the necessity for public health interests to be represented in national and regional water management and
sewerage authorities, and the importance of technical training at all levels for the personnel involved in the day-to-day operation of water pollution control facilities and in the enforce- ment of regulations.
Several of the recommendations made by the Committee are of special value to countries envisaging water pollution control programmes, with or without the assistance of WHO.
4.4 Implications for the Organization's programme
The Organization has taken account of these recommendations. Consultant services have been provided to a number of countries to assist the governments in conducting water pollution surveys or in drafting legislation for water pollution control, while considerable research into the special water pollution problems of the developing countries is being conducted in some countries, where UNDP/SF assisted projects, for which WHO is the Executing Agency, have been established.
The Organization is already assisting Member countries by training personnel, while other training facilities are now being planned.
5. Expert Committee on Non-Proprietary Names for Pharmaceutical Preparations, Eighteenth Report1
5.1 Background information
The main purpose of the meeting was the selection of international non-proprietary names for requests received from national authorities or directly from manufacturers. Up to now, 2198 names have been published in 19 lists of proposed international non-proprietary names.
These names are widely used throughout the world for regulatory, labelling, scientific and other purposes• -
1 Document WHO/Pharm/68.447.
E B 4 3 / 2 2 p a g e 7
5.2 The report
The Expert Committee examined 104 new requests for non-proprietary names and eight requests held over from previous meetings; 92 names were selected and are to be issued in a twentieth list of proposed international non-proprietary names.
The Expert Committee reviewed the General Principles for Guidance in Devising International Non-proprietary Names for Pharmaceutical Preparations and recommended a few changes to be
incorporated in the present texte
The Committee noted that List 19, containing 56 names selected by correspondence by the members of the Expert Advisory Panel on the International Pharmacopoeia and Pharmaceutical Preparations designated to deal with the selection of non-proprietary names, had been issued in March 1968. The Committee recommended that the selection of names by correspondence should be continued and that another list of international non-proprietary names could thus be prepared later on in the year. This selection and publication of names between meetings enables them to be provided more rapidly.
The Committee noted that a second cumulative list of international non-proprietary names had been published in English and French. This list includes 2027 names which have been proposed in the 17 lists published since the inception of the WHO programme on non-proprietary names in 1952 until February 1967. The Committee noted that six years had elapsed between the publications of the first two cumulative lists, and recommended that cumulative lists be issued at shorter intervals. It also recommended the inclusion of graphic formulae and of an index of molecular formulae in future cumulative lists.
The Committee recommended that the term "pharmaceutical preparations" in the titles of the 1 2 Committee and of the lists of names, and in the "Procedure for the Selection of Recommended
’�3
International Non-proprietary Names for Pharmaceutical Preparations should be replaced by the term "pharmaceutical substances • The Committee also recommended that the hyphen should be omitted from the word "non-proprietary".
5.3 The recommendations
The Expert Committee recommended that:
(a) In accordance with the "Procedure for the Selection of Recommended International Non-proprietary Names for Pharmaceutical Preparations'1»^ the names selected at the Meeting should be sent to Member States with a letter asking that the names should be examined for possible conflict with proprietary rights and also requesting protection for these names.
(b) These names should afterwards be published in the WHO Chronicle.
(c) The selection of names by correspondence and their publication between meetings should be continued.
(d) Cumulative lists should be published at shorter intervals.
Expert Committee on Non-proprietary Names for Pharmaceutical Preparations.
2 International Non-proprietary Names for Pharmaceutical Preparations, 3 Resolution EB15.R7, Off, Rec, Wld Hlth O r g ” 1955, 60, Annex 3.
E B 4 3 / 2 2 p a g e 8
(e) The term "international non-proprietary names for pharmaceutical preparations"
should be replaced by "international non-proprietary names for pharmaceutical substances in the context of the WHO programme on international non-proprietary names.
5• 4 Implications for the Organization's programme The above recommendations are under study.
6. Expert Committee on Urban Air Pollution with Particular Reference to Motor Vehicles.工 6• 1 Background information
Air pollution was first discussed at an Expert Committee in 1957 when a global review of о the problem was made. It was the subject of another Expert Committee convened in Geneva in October 1963. The report of that Committee reviewed air pollution problems of international interest and the progress made in control measures, in standardization of nomenclature, units and methods guides for air quality and made a number of recommendations for further action.^
Since 1963 the Organization has convened several scientific groups which dealt, among other things, with air pollution, and has sponsored, numerous studies on the health effects of air pollution, on the measurement and analysis of air pollutants, and on control technology•
6.2 The report
Air pollution being generally more evident in urban than in rural areas, this Committee's terms of reference were specifically: "to advise on problems of pollution created by motor vehicles, review data on the different types and concentrations of pollutants and on their possible health effects, and recommend air quality criteria, guides and control procedures to deal with the problem. The Committee will consider the significance for public health of the increasing pollution from motor vehicle exhausts superimposed on the existing pollution from power stations, domestic and industrial heating and various industrial processes. “
Air pollution by smoke is declining in some of the advanced countries as a result of
increased efficiency in combustion, and the substitution of oil or natural gas for coal, whereas pollution caused by motor vehicles is increasing. For example, according to recent data
published by the United States Public Health Service, motor vehicles contribute 60,6 per cent.
to the total air pollution load in United States cities (or 86 thousand tons per year of carbon monoxide, oxides of nitrogen, hydrocarbons, sulfur oxide, lead compounds and particular matter), and this amount is expected to increase considerably because of the anticipated trends in motor traffic development. Similar trends have also been observed in other countries.
Thus, though the Committee considered current general trends in urban air pollution, its deliberations tended to centre largely on the contribution of the motor vehicle to urban air pollution, on methods of measurement of the major pollutants 一 carbon monoxide, oxides of nitrogen, hydrocarbons, lead compounds, and oxidants formed by photo-chemical reactions 一 control and possible air quality criteria, guides and standards.
Wld Hlth Org. techn. Rep. Ser., 1969, 410.
2 Wld Hlth Org. techn. Rep. Ser., 1958, 157, 3 Wld Hlth Org. techn. Rep. Ser., 1964, 271.
4 Wld Hlth Org. techn. Rep. Ser., 1968, 406.
E B 4 3 / 2 2 p a g e 9
6.3 The recommendations
The Committee recognized the need for more data on carboxyhaemoglobin levels and other biochemical indices in persons exposed to pollution by traffic exhaust. Although there are some serious gaps, the data now available permit an initial appraisal to be made on guides to air quality for a few pollutants. Since much recently published work is of great technical complexity, the Committee recommended that information on individual pollutants be periodically appraised. Work on carbon monoxide, lead, hydrocarbons and nitrogen oxides and other oxidants requires such critical appraisal. Research on the sampling and analysis of pollutants should be continued, and simplified methods for the analysis of motor vehicle exhaust gases should be developed. Collaborative test projects between laboratories in different countries should be encouraged. Since technological feasibility and economic implications are necessarily involved in air pollution control, information on these matters should be gathered in order to assist countries in developing balanced programmes #
6.4 Implications for the Organization's programme
To a large extent, the Committee's recommendations endorse the programme already carried out by the Organization. For example, a study on the control of emissions from diesel engines, particularly by legislation and inspection, was issued in 1967; the WHO International Reference Centre on Air Pollution, set up at the end of 1967, is already reviewing studies commissioned by the Organization on methods for measuring the more common air pollutants, while an Inter- Regional Seminar held in the USSR in 1967 afforded training in modern air pollution control technology for high-level personnel from 11 countries from all six WHO regions. In 1969
consultants will be engaged to follow up the recommendations of this Committee and to assist in preparation for the Symposium on Air Quality Criteria and Guides planned for 1970. The Organization will, as far as possible, continue its assistance to research and to collect information on air pollution and its health effects in various countries through the Inter- national Reference Centre and the Regional Reference Centres, but it will be difficult to implement some of the other recommendations made by this Committee unless the WHO air pollution control programme is conôiderably expanded.
7• Expert Committee on Biological Standard ization, Twenty-first Report1
7.1 Background information
This meeting continued the work supervised by the twenty previous expert committees which have met since 1947. This Committee considered international biological standards and
reference preparations for a number of biological substances and certain international require- ments for biological substances which had been prepared by experts in collaboration with the WHO Secretariat• The Committee also considered a number of substances intended to be estab- lished as international biological reference reagents for the identification of micro-organisms.
7.2 The report
The present meeting included in its report the following:
Hormones 一 General
A number of problems of general nature in relation to the standardization and assay of protein and peptide hormones of human and animal origin, especially when techniques of immuno- assay are used, were discussed. A number of important and far-reaching decisions were made•
1
Document BS/68.10E B 4 3 / 2 2 p a g e 1 0
(a) Because of the species specificity of hormones the Committee decided to rename the existing international standard and reference preparations of hormones so as to indicate the species of origin of the preparations and the use for which they are
intended (bio-assay or immuno-assay), and to follow this principle when new preparations are established.
(b) Since immuno-assay methods of hormones are important in many areas of clinical medicine and public health, international standards should be established as early as possible when suitable materials could be obtained. Because the international colla- borative assays necessary for the establishment of international standards usually take considerable time, in some cases, the establishment of international reference prepara- tions would be useful if suitable preparations for this purpose are available.
(c) Such preparations established as international reference preparations should, however, fui fil certain minimum criteria of suitability to serve their purpose.
(d) For specifying potency as determined by immuno-assay it was agreed not to depart from the practice of using international units. The unit for an international standard for immuno-assay would be defined in the same way as the unit for an international
standard for bio-assay, but equated as accurately as possible with any existing inter- national unit for bio-assay.
(e) The results of immuno-assays should be expressed so as to distinguish them from the results obtained by bio-assays. This could be done by adding the word "immuno-assay,’
after the results stated in international units. In order to identify the units,
however, it was essential that the international standard relevant to the unit should also be stated.
(f) These suggestions regarding the use of international standards and reference preparations should be disseminated as widely as possible.
(g) The techniques of immuno-assays of hormones are valuable not only in diagnosis and research, but these techniques have also implications relating to the national control of hormone preparations used in therapy. At present bio-assay is the only accepted method of determining biological activity of such preparations• National control authorities should determine the extent to which immuno-assays should be used for the control of hormone preparations.
Pharmacological substances
International Standards for Rolitetracycline and for Colistin and International Reference Preparations of Gentamycin, Lymecyclin and Colistin Methane Sulfonate were established,
A number of other pharmacological substances, mainly antibiotics, were considered for possible establishment as international standards and reference preparations or replacements, including neomycin B, viomycin, chlortetracycline, polymyxin B, methacycline, the heptaene and other antifungal antibiotics (candicidin, trichomyCin, hamycin, levorin, pecilocin) and nicin, an antibiotic used in the food industry.
The International Standards for Penicillin (benzylpenicillin) and for Phenoxymethyl- penicillin have been discontinued, as they were no longer needed.
Immunological substances
The second International Standard for Anti-Brucella abortus Serum, as well as the International Reference Preparation of Newcastle Disease Vaccine (Live), were established.
E B 4 3 / 2 2 p a g e 11 Studies were reported on the International Standard for Anti-Toxoplasma Serum and on the International Reference Preparations of Typhoid Vaccines, Influenza Virus Haemagglutinin (Type A), Anti-Newcastle-Disease Serum and Rheumatoid Arthritis Serum as well as on the long- term stability of the International Reference Preparation of Rabies Vaccine.
Progress of work of a number of other immunological substances was reported, including anthrax vaccines, rubella haemagglutinin, anti-Mycoplasma gallisepticum serum, and certain additional blood-typing sera.
Studies were also reported to be in progress on various auto-immune antibody preparations (chiefly of research and diagnostic interest) and on interference.
The replacement of the International Reference Preparations for Cholera Vaccines (Inaba and Ogawa) by monovalent vaccine preparations, was planned, but studies were requested on the possible use of a divalent vaccine as a reference vaccine.
The Committee decided to discontinue the International Reference Preparations of Cholera Antigen (Ogawa) and. of Cholera Antigen (Inaba) as they were no longer needed, but the materials should continue to be distributed until stocks were exhausted.
Reference reagents
Further problems in connexion with the provision of reference materials intended to serve for diagnosis and identification of micro-organisms were considered. International Reference Reagents were established of Anti-Trichinella (Human) Serum, of Respiratory Virus Antisera and of Mycoplasma pneumoniae Antiserum.
Further substances considered for this category included a number of anti-Leptospira sera.
Requirements for biological substances
The Committee considered sets of Requirements for Immune Sera of Animal Origin and of revised Requirements for Cholera Vaccine. These requirements were adopted and included in the report, and they were considered useful for the production and control of these biological substances, in different countries.
7 • 3 The recommerldations
The Committee made a number of recommendations on technical aspects of the various
substances already mentioned, noted the progress of work in accordance with the recommendations of previous Committees and, where necessary, made further recommendations. The Committee was informed of the progress of work on proposed other requirements e.g. certain veterinary vaccines.
The need for requirements for rabies vaccine was suggested. The Committee also made a proposal for the formulation of recommendations for the development of National Control Laboratories for Biological Products as well as for guidance in techniques of assay and methods of control； such recommendations would contribute to the more effective use of international biological standards and requirements for biological substances throughout the world, particularly in developing countries•
7.4 Implications for the Organization's programme
The implications of the present report in the WHO programme of biological standardization will be considered by the Secretariat in conjunction with the International Laboratories for Biological Standards at Copenhagen, London and Weybridge. Details of the action to be taken in conformity with the recommendations have to be worked out. Collaborative studies of materials for the establishment of international standards and reference preparations will be
E B 4 3 / 2 2 p a g e 1 2
continued. Other substances intended to serve as international reference reagents will also be studied. In addition, the formulation of sets of requirements for various biological substances, further to those already published, will be arranged in accordance with the recom- mendations of the Committee.
The recommendations regarding the use of international standards and reference preparations for immuno-assay of hormones of importance in medicine, as well as regarding the methods of expressing results of immuno-assays will be disseminated as widely as possible to relevant areas of interest, including the major scientific journals dealing with endocrinology.
8• Expert Committee on Drug Dependence, Sixteenth Report-*- 8.1 Background information
The present report is the sixteenth of a series of reports of expert committees that assist the Organization in the formulation of decisions on the need for and degree of international control for certain types of drugs, as stipulated in various international treaties on narcotics control. In addition, these committees give technical advice to governments and health
organizations, as well as the narcotic control organs of the United Nations, on the prevention of drug dependence and abuse and on the treatment of drug dependent persons.
8.2 The report
The Committee first considered criteria by which the degree of hazard and the need for control of drugs or abuse might be evaluated. Noting that risk to public health is the prime determining factor in deciding for or against control of a particular drug, the Committee out- lined ways in which such risk could bé evaluated in respect of drugs already in use and of those being developed. In the situation where a drug is already in use, both national and inter- national controls may be required depending on (i) the seriousness of observed adverse effects,
(ii) the number and geographical distribution of persons involved, (iii) the degree of communi- cability, and (iv) the extent of illicit traffic. In the situation where a drug is being readied for medical use, both national and international controls may be required, depending on
(i) the type of formulation and intended medical use, (ii) how the drug will be marketed and the attendant risk of illicit diversion or traffic, (iii) pharmacological studies including a comparison with a known drug having similar properties, and (iv) the capacity of the drug to produce physical or psychic dependence.
The work of other bodies concerned with the international control of dependence-producing drugs was reviewed.
In respect of the control of certain dependence-producing drugs not now under international control, the Committee outlined three principles to be considered in the formulation of any national or international controls deemed necessary： (i) the degree of control should take account of the degree of risk to public health and the usefulness of the drug in medical therapy, (ii) the provisions should be sufficiently flexible to allow for appropriate control of a drug as new knowledge becomes available, and (iii) even the most dangerous drugs should be available for necessary scientific research. It was also concluded that groups of drugs requiring
different levels of control could be defined on the basis of these principles.
The Committee reiterated the opinion expressed in previous reports that cannabis is a drug of dependence producing public health and social problems and that its control should be
continued.
Because of claims that there was abuse of certain drugs considered by previous expert committees, the data now available on the use and abuse of these drugs was reviewed. It was concluded that the prevalence and extent of their abuse was so low as not now to constitute a public health problem.
1 W l d H l t h O r g , t e c h n . R e p . S e r ” 1969, 4 0 7 .
E B 4 3 / 2 2 p a g e 13 In reviewing various approaches in the treatment of drug dependent persons, the Committee expressed the opinion that the use of methadone maintenance for those with dependence of the morphine-type remains experimental and that it is not suitable for utilization by individual physicians.
8•3 The recommendations
The Committee formulated a decision regarding one substance, under the 1931 Protocol, and a recommendation on its control under the Single Convention on Narcotic Drugs, 1961. The Committee also stressed the need to improve the completeness and quality of information available on existing and potential drug dependence and related abuse.
8.4 Implications for the Organization's programme
The report will serve as a basis for recommendations and advice by the Organization in connexion with the prevention of drug dependence and related abuse, the treatment of persons dependent on drugs and the national and international control of dependence-producing drugs.
The latter calls for decisions and recommendations by the Organization within the framework of international narcotics control treaties.
9. Joint ILO/WHO Committee on Occupational Health, Sixth Report1
9•1 Background information
Previous Joint ILO/WHO Committees on Occupational Health have discussed the organization of comprehensive health service programmes in large and small industries and in agricultural enter- prises : methods of co-operation between public health and industrial services; implementation of existing industrial health legislation and standards; training of physicians in the field of occupational health; scope and organization of occupational health institutes; criteria for the recording of medical causes of absenteeism by occupational health services in developing countries.
The permissible levels of occupational exposure to airborne toxic substances was discussed at the sixth session because of a marked discrepancy between different countries in the maximum allowable concentrations of toxic substances in working environments and international agreement on these values would lead to better health protection of workers which is all the more indicated in view of the very marked increase in the industrial and agricultural use of potentially
hazardous chemicals.
9.2 The report
The criteria and procedures for assessing occupational exposure to toxic substances were discussed and present approaches to permissible limits of such substances in the working environment were reviewed by the Joint ILO/WHO Committee.
It noted that removal of the hazard at source 一 a control method commonly used - is not always possible, and that accordingly, where exposure to toxic substances is unavoidable, there has been increasing reliance on the concept of "permissible limits". It drew up categories of biological response in respect of occupational exposure to airborne substances. Such a
classification should stimulate further scientific and epidemiological research, and the collec- tion of data will help to make possible the establishment of internationally acceptable guide- lines for levels of emergency exposure. A survey of existing national legislation and practice concerning permissible limits revealed a significant measure of international agreement regarding twenty-four industrial and agricultural chemicals, and the Committee considered that safe
1 Document OH/69.1
E B 4 3 / 2 2 p a g e 14
concentration zones of these chemicals could be recommended. The lack of uniformity in permissible limits as between one country and another was discussed by the Committee, which stressed the need for investigation in order to acquire further information on the reasons for such differences.
9.3 The recommendations
The report recommends a four-level classification of biological effects. It is believed that this classification will, to a considerable extent, stimulate scientific and epidemio- logical research and assist in reaching greater understanding of the over-all problem. The report also contains, for international adoption, a list of safe concentration zones for some 24 substances.
9•4 Implications for the Organization's programme
The recommendations made at the meeting will require the attention of ILO and WHO, In December 1968, an informal meeting of Temporary Advisers (two from ILO, two from WHO), was convened to produce a standard form for the recording of the data on which national permissible limits are based. In 1969, this form will be tried out by some of the Temporary Advisers at the meeting. Later on the form will be circulated to appropriate members of the Expert Committee on Occupational Health for comment. When the various comments have been received they will be collated for further consideration.
10. Expert Committee on Genetic Counselling^- lO.l Background information
The purpose of the meeting was to review the role of genetic counselling in a medical care programme and to consider its integration into the public health service.
The second meeting of the Expert Committee on Human Genetics had concluded that ''genetic counselling is the most immediate and practical service that genetics can render in medicine
p
and surgery".
Many public health authorities have become increasingly aware of their responsibilities in matters of genetic counselling and have recently sought the advice of WHO. The problems
encountered vary widely in different parts of the world: in some areas, advice is primarily sought in connexion with congenital mal format ions or psychiatric disorders, in others in
relation to inbreeding whereas in countries with a high frequency of sickle-cell or thalassaemia genes, the provision of diagnostic and counselling services is receiving increasing attention.
10.2 The report
The Committee estimated that probably in all countries four per cent, of persons suffer from some genetic or partly genetic condition in regard to which genetic counsel is needed.
In some parts of the world the proportion is much higher (e.g. where, for instance, the gene for sickle-cell anaemia is carried by one quarter or more of the population) #
The Committee reviewed recent technical advances in human cytogenetics and biochemical genetics that have greatly increased the number of diagnostic tools available to the genetic counsellor. It described the types of cases requiring genetic counsel and the risk estimates that could be given. The main section of its report then dealt with the aims and functions of genetic counselling, the organization of counselling services, and the role of general practi- tioners and the importance of education of the public.
1 Document HG/69.1.
2 W l d H l t h O r g , t e c h n . R e p . Ser,, 1964, 2 8 2 .
E B 4 3 / 2 2 p a g e 15 The Committee considered the short and long-term consequences of genetic counselling.
It described the forms that should be taken by genetic counselling centres and the specialized medical and laboratory services they require and stressed that, as an integral part of medical care, they should be covered by health and social insurance schemes. It emphasized that genetic counselling was a medical service, in which therefore the doctor-patient relationship prevailed. It was primarily directed at the welfare of the patient or family seeking advice;
the counsellor should not seek to promote any genetic programme designed to alleviate the load of future generations if this in any way conflicted with the immediate interest of the person seeking advice.
It outlines the training needed for the personnel involved in genetic counselling and recommended the provision of specialized training and refresher courses in medical genetics.
Pamphlets, dealing with genetic problems of special importance in a particular country, should be made available to general practitioners or, in certain instances, to the public.
10.3 The recommendations
The Committee recommended the provision of adequate counselling services as well as the development of suitable medical facilities for the care of afflicted individuals.
Ministries of health should provide their health personnel with a descriptive list of the staff and facilities available for genetic counselling. In order to encourage consultation between centres and facilitate referral for highly specialized advice, the Committee recommended that WHO consider compiling this information in the form of an international directory of genetic counselling services. It also urged that all pedigree data and documentation on cases dealt with in genetic counselling centres be preserved and. filed for easy access for research
purposes•
This applied in particular to cytogenetic analyses, and the Committee recommended in this context the establishment of an international register of human chromosome anomalies to facili- tate the comparison of data.
10.4 Implications for the Organization's programme
(a) Adequate diffusion of the Committee's report to public health authorities, medical faculties and organizations concerned with human genetics.
(b) Assistance for training in human genetics by grants and courses.
(c) Consultant assistance to Member States in setting up counselling services.
(d) Setting up of an international directory of counselling services and of an inter- national register of human chromosome anomalies.
