“Control, eradication, control, eradication. The experts repeat themselves, but they have to repeat themselves for this is a fight against time…‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.’ No, not merely the absence. Here, as elsewhere, we cannot afford to be negative. We cannot go back to the old days.”
That’s the British actor Michael Redgrave at the microphone in 1958, highlighting the core philosophy on which the World Health Organization (WHO) was founded and to which it still aspires today.
I’m Omar Musni, and welcome to another classic podcast from the vaults of our unique audiovisual archive here at UN Headquarters in New York.
Everyone everywhere has a right to benefit from health services they need without sacrificing other life necessities. And everyone can play a part on the path to universal health care.
Dr. Tedros Adhanom Ghebreyesus addressed the issue immediately upon his election as WHO Director-General.
“At present, only about half of the world’s people have access to health care without impoverishment. This needs to improve dramatically.”
Indeed, on the occasion of World Health Day, the WHO data make it clear — billions around the world are still missing out on basic services, while 100 million are being pushed into extreme poverty due to crippling health-care costs.
But as we’re about to hear in this UN Radio, WHO and BBC collaboration, enormous progress had already been made in the health watchdog’s first 10 years, and continue 60 years later.
Listen now as “Ten Steps Forward” takes us backwards in time to when disease ran rampant in the streets of even the most advanced societies on Earth.
“Bring out your dead! Bring out your dead! Bring out your dead!” Death carts in the streets, red crosses of warning on the doors, corpses tumbled naked into the plague pits — that was London in 1665. “Bring out your dead! Bring out your dead!”
“Epidemiological bulletin of the World Health Organization STOP Section 1…” This is today on the World Health Organization, created just 10 years ago to keep watch on the health of the world and to deal among many other things with such epidemics as that in 1947.
“Send off the following telegram to the Pasteur Institute in Paris, the Lister Institute in London, the Haffkine Institute in Bombay…”
“Seen this cable about cholera vaccine? Well, we’ve just three questions to answer: How much vaccine have we in hand? And how much more can we produce in a week? How soon can we get it to Cairo? Well, that’s, uh… that’s quite an order.”
Motorcycle escorts to La Guardia Airport in New York, but not, this time, escorting a very important person, just a very important vaccine. For that was October 1947 and in Egypt there were 33,000 cases of cholera. But in a few months…
“Geneva February 18th 1948, Egypt now declares whole country free from cholera.”
A victory for the international guardians of health. WHO did not yet officially exist, but it was already functioning. And two months later, on the 7th of April 1948, its constitution came into force at a time when, in the words of its first Director-General, Dr. Brock Chisholm: “We had just come out of a catastrophic world war, which had reminded people that ours was a small planet. Until quite recently, man’s environment had been his locality — only his village or town or, at the most, his own country. He had learned to live more or less at peace with his own emotions and had contrived to get along with his immediate neighbours. Now that situation had changed entirely. The environment of every person was the whole world and it was essential to the health of every individual that he develop beyond the capacity to live with his own kind of people only and be able to live with all the kinds of people all over the world. This and the concept of health was not just the absence of sickness or of infirmity, but a positive aim, was a new sort of idea. That was why we chose the name World Health Organization.”
A new sort of idea on a small planet, a planet which is still divided by frontiers. But those frontiers as ever can be crossed by the carriers of disease — by rat and bat, by insect and virus. They can also be crossed by an idea, especially by this new sort of idea.
In your different countries, you have different problems.
“We have roughly 1,500 patients and we are terribly understaffed. Roughly 8-10 male nurses and about 10 or 12 female nurses. Most of the work is done by untrained staff who attend to the general needs of the patient.” That is a mental hospital in Singapore.
“The local society for the welfare of crippled children in Lebanon was formed chiefly through the good offices of a Dr. Harfoush. She was rather appalled by the large number of undernourished and crippled children in the Lebanon and, indeed, throughout the whole of the Middle East.”
While further east still in the Punjab in India: “It was a little difficult. At first, we had to get cooperation of the village dai, or local midwife, and we tried to get her to realize that she needed a certain amount of training.” Training is nearly everywhere a problem. Training of midwives, training of nurses. “It’s very difficult to get suitable girls of a good standard of education to be nurses,” so says one of the few women doctors in Iraq.
“There’s a constant argument that goes on as to what kind of food a child ought to be given at any stage. Also, there’s a constant difference of opinion as to the proper kinds of food for mothers after they’ve been delivered.” That is in Formosa, an island where in fact: “In fact, in some areas there were no roads at all, and the midwife had to rush along on a bicycle between the rice patties either side, along a path that was scarcely 18 inches wide. And she wobbled along here until she reached a river. And when she reached the river, off she had to come off her bicycle, fling the bicycle over her shoulder, and go across the river as best she could.”
Yes, different problems in different countries. But the end is everywhere the same. ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,’ so runs the first clause in our constitution. And every year at the World Health Assembly, East meets West to discuss that aim.
We talk of privileged countries and underdeveloped countries, but in health, there is no one-way traffic. A two-way… a many-way traffic. And we are now controlling it better with signposts and lights and rules of the road. WHO holds a watching brief, watching and checking and double-checking and warning…
“Section 1, week ending 20th July. Cholera: Pakistan: Chittagong-1; India: Calcutta-36 STOP Small pox: Sierra Leone: Freetown-5; Sudan: Port Sudan-2; Pakistan: Karachi-2, Lahore-3…”
A constant eye for infectious diseases. In these last 10 years, such diseases have rapidly decreased. Look at the historic scourges like cholera, typhus, small pox, plague, relapsing fever, yellow fever. But WHO is not only concerned with epidemics, it’s concerned with your whole life from the cradle and, indeed, from before it.
Schlafe, mein Prinzchen, schlaf ein,
es ruhn Schäfchen und Vögelein…
This cradle song used to be attributed to Mozart. We now know that it was composed by an amateur musician, a doctor of medicine in Berlin towards the end of the 18th century, when conditions in Berlin, and all through Europe, were as bad as they are now in the underdeveloped countries. Mothers continually dying in childbirth. Children dying at birth or in infancy. Dr. Bernhard Flies’s lullaby is still sung: ‘Sleep, my little prince, go to sleep.’ But now, he is more likely to sleep sound.
‘Sleep, come to the eyes of my child. Your uncle, the moon, will enrich your dreams…’ so Indian mothers sing in Hindi. But they and their children are still surrounded by perils. It is those perils that WHO is combatting. The welfare of mother and child is one of its chief concerns. And already in many countries this work is bearing fruit. The child is more likely to sleep sound, the music less likely to break off.
After the danger of birth comes the danger of weaning. There is a disease of small children, which often leads to death before the child’s third birthday. It is well known to Dr. Omandi one of the few African doctors in Kenya. “In Kenya, there is a great deal of malnutrition, particularly of children who have previously been weaned and have been put to a diet which is deficient in proteins. And since they cannot get that protein, their growth is deficient. And these children are liable to a lot of infections such as bronchopneumonia and chronic malaria and worms. So, malnutrition is a real problem in Kenya which is being faced and which I hope will be under control in some time to come.”
Undernourished children and crippled children. There are many of the latter in Lebanon. Dr. Kraft went out there from Britain a few years ago to start up the first Lebanese centre for crippled children. “A number of the children were not only located around Beirut, but distances from the city. Now, Lebanon as anybody will know, is a country rather more mountainous than Switzerland. Traveling is extremely difficult. Distances not so much, but it’s the traveling. To get anybody to the centre at 6 o’clock in the morning meant leaving at midnight the night before. So, we had to make a very large dormitory. This proved wonderfully successful.”
So it goes on. Watching the mother before and during and after the birth of her child and watching that child in turn through the years of its growing up. And as it grows up, some menaces fall away, but new ones will take their place. It’s the same with countries. As a country becomes more developed, certain diseases decrease, but others acquire a new prominence. For instance, poliomyelitis — that disease which can cripple you for life.
Dr. A.M. Payne from Geneva has followed and taken part in the campaign against polio since the Second World War. “During and after the Second World War, there had been an alarming increase in poliomyelitis in some countries. And this was very disturbing because, at that time, there was no prospect of being able to do anything about it. But the real breakthrough came in 1949, when Enders and his colleagues discovered that the virus could be grown in tissue culture. This completely altered the prospects of controlling the disease because it opened the possibility of being able to manufacture a vaccine against the disease.”
Such a vaccine was manufactured — what is known as an inactivated vaccine. But hopes are now being placed on something more active, more sweeping: a live virus vaccine which will strike at the roots of this disease.
“Trials of the live virus vaccine are now going on in the United States, the USSR, the Netherlands, Mexico, South Africa. And they’re also being planned in a number of other countries. But meanwhile, of course, considerable success has been recorded in the United States in recent years in reducing the incidence of polio through the use of the Salk vaccine.”
But there are other diseases: malaria — the disease which may have killed Alexander the Great and later destroyed the Roman Empire. A disease which is carried by mosquitos and it can spread like wildfire. In the words of Dr. P.F. Russell, a WHO consultant: “So it goes, on and on: mosquito to man, to mosquito, to man, until almost everyone in a community has the disease. Probably 200 million persons were infected with malaria in this way in 1955. Those who have malaria naturally become anaemic. They lack vitality and ambition, can’t farm or work properly, can’t provide for their families, get into debt, and maybe die prematurely. Without doubt, malaria is bad for an individual, bad for a community, and bad for a nation.
In the middle 1930s in Ceylon, the malaria death roll was enormous. Ten years later, they took to DDT. And within three years, the death rate was down by 82.5 per cent. Ceylon was rightly proud of this achievement. The mosquito, it was thought, was defeated.
But in regard to malaria the word ‘control’ is already out of date. On October the 7th 1954, a report was received at WHO headquarters. It came from a Greek doctor, Peter Isaris, leader of the malaria team in Indonesia. “On the north coast of Java, DDT resistance has appeared in Anopheles sundaicus.” Which meant… which meant that everyone had to think again.
Anopheles sundaicus is a malarial mosquito and according to this report — to this bombshell — it was breeding itself immune to insecticides. And this meant… this meant that within a few years this new breed of resistant mosquitos would have multiplied to the point where it would menace mankind. So, the World Health Assembly of 1955 made a very bold resolution. They resolved to eradicate malaria and WHO now has a division of malaria eradication. Its director is Dr. Pampana of Italy.
“Well, I think that now you can say that the present policy of WHO is no longer control but eradication. And as Serokot Modalia said in 1957 at the World Health Assembly: ‘We in India are particularly interested in this programme because for many years we have been fighting the scourge of malaria and I am glad to note from the Director-General’s report that more and more countries are now coming to believe that the proper way of controlling malaria is not by control but by eradication.’”
Control, eradication, control, eradication. The experts repeat themselves, but they have to repeat themselves for this is a fight against time.
And there are other things, too, in this strange new world of ours, which involve a fight against time. Did you expect a clock? No, those are Geiger counters, which represent a new kind of energy and involve a new attitude to time. This, people say, this is the atomic age and, for better or worse, they are right. And WHO, on behalf of one and all of you, is trying to bring this all-important question into the sphere of the knowable and controllable. Dr. I.S. Yves, who is now in the Director-General’s office of WHO at Geneva, was previous medical officer at Windscale. It was a logical transfer: his subject is radiation protection.
“One of the most important things we think we can do in this subject of protection is training. We are anxious that knowledge of protection measures should spread across the Earth as rapidly as the spread of atomic energy itself. Sir Henry Cohen, Chief Medical Officer of the Department of Health of Scotland, has made a very interesting statement at the last World Health Assembly.”
“The future of the population of the world is indissolubly linked with the development of sources of nuclear energy. Exploitation of new sources of energy, which will flow and develop from the first halting steps in the use of fission processes, can bestow ineffable benefits on mankind. The evolution of these processes can be left to the nuclear physicist. But the hazards are the concern of the biophysicist and the health worker.”
The hazards are the concern of all of us.
There they go again: the clock of the atomic age, the life pulse of one and all of you. And to some of you, this pulse seems feverish. The thought of it adds to your nervous strain. But your nervous strain, your mental health, is also the concern of WHO. You remember that first clause, first challenge, first statement of faith? ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ No, not merely the absence. Here, as elsewhere, we cannot afford to be negative. We cannot go back to the old days.
“Bring out your dead!!!”
No, your living! Take off that tolling bell. We must bring out our living: living in every sense — physically, mentally, socially. This small planet is big with the future. And that future will live in our children and that future itself is like a child. It has many possibilities. Some of them we have mentioned today but there are many others which are on the agenda: the agenda of World Health Organization.
That was an edited version of “Ten Steps Forward”, narrated by British stage and screen actor Michael Redgrave to mark the tenth anniversary of WHO in 1958. As he said, the WHO agenda includes many topics and has since expanded to address such issues as substance abuse, road safety and clean energy, among others.
That’s it for this edition of our Podcast Classics series. You can find a wealth of other audio, film and video by going to www.unmultimedia.org/avlibrary/.
This unique collection of material goes back to the 1940s and the founding of the United Nations.
I’m Omar Musni, and thanks for listening.
“Gravity” by Borrtex.
“Naive” by Sergey Cheremisinov.