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

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

The World Health Organizations changing goals and expectations concerning malaria, 1948-2019 / As mudanças nos objetivos e expectativas da Organização Mundial da Saúde com relação à malária, 1948-2019

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

Resumo Desde sua origem, em 1948, a Organização Mundial da Saúde priorizou o controle da malária. Os primeiros êxitos induziram à crença na viabilidade da erradicação, apesar de sérias dúvidas quanto ao continente africano. À medida que se somavam comprovações de que a erradicação da malária não seria simples, o projeto com essa finalidade foi rebaixado a uma unidade em 1980. O reavivamento do interesse na malária ocorreu após a iniciativa Roll Back Malaria, criada em 1998. Este artigo apresenta um panorama histórico das mudanças nas ideias, em âmbito global, ligadas ao controle e à eliminação da doença e defende a tese de que a atenção dada ao fortalecimento dos serviços de saúde e a recursos humanos especializados foi insuficiente.

On the World Health Organization's Neglect of the Role of Medical Doctors in Its Conception and Practice of Primary Health Care.

Primary health care (PHC) emerged in the early 1970s as WHO's response to the failure of its basic health services approach. The Soviet Union succeeded in getting WHO's governing bodies to agree to hold an international conference on PHC, a conference that was held in Alma-Ata, the capital of the Soviet Republic of Kazakhstan, in September 1978. In 1975, Dr. Halfdan Mahler, WHO's charismatic director-general, introduced the goal of "health for all" (HFA) by the year 2000. Alma-Ata declared PHC as the key for achieving HFA. Although WHO had promoted the involvement of medical schools in community health, Mahler's antimedical establishment rhetoric contributed to WHO ignoring the potential role that medical doctors could play in PHC and HFA.

Cora Du Bois' Brief Stint With the World Health Organization (1950-1951): Right Time, Wrong Place.

Brock Chisholm, director-general of the World Health Organization (WHO) in the early 1950s, was heard to say that "one cultural anthropologist [Cora Du Bois] was worth one hundred malaria teams." Paul Russell, the leading malariologist at the time, responded (privately in his diary) that Chisholm's remark was the sort that "one might expect from a psychiatrist planning a world health program." George Foster reported that Du Bois "was completely disgusted with" her stay at WHO. "They never asked her to do anything. She never followed up." Chisholm was not the only one who appreciated her contribution to the work of WHO; other WHO programs and offices would have welcomed her contribution. However, by operating out of WHO's South-East Asia Regional Office (SEARO), she found herself isolated with little chance of her work being reviewed favorably, i.e., the "wrong place."

Marston Bates, Visionary Environmentalist.

Marston Bates (1906-1974) raised questions concerning man's relationship to nature, questions that are of much greater importance today than they were during his lifetime. He began his career with the Rockefeller Foundation as a mosquito expert, and by 1955 he had established himself as one of the key players in the field of human ecology through a series of publications that brought together in a clear and readable style the complexities involved in understanding human ecology. This article traces Bates's development and discusses how the Foundation failed to engage the subject of human ecology, even at a time when it recognized its critical importance to humankind.

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

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

Revisiting the schism.

The schism between medicine and public health has deep historical roots. The Rockefeller Foundation's Clinical Epidemiology program, initiated in the late 1970s, was seen by Kerr White, its director, as the means to heal the schism. This article revisits the role that the Foundation played in creating that schism before reviewing post-World War II efforts on the part of both the Foundation and the World Health Organization to incorporate the teaching of preventive medicine in medical education curricula. White labeled these efforts as failures, but a closer look at the history raises questions concerning what evidence he used to make this judgment and whether clinical epidemiology has not instead widened the gap between cure and prevention.

John Black Grant: a 20th-century public health giant.

John Black Grant (1890-1962) was instrumental in getting China, India, and Puerto Rico to develop health systems that integrated preventive and curative care and oriented medical education to be supportive of such systems. As these remain priority goals for all countries today, knowledge of his achievements remains of relevance. This article brings his accomplishments to the attention of the contemporary medical public.

Selskar Gunn and China: The Rockefeller Foundation's "other" approach to public health.

The Rockefeller Foundation's program for rural development in China was developed by Selskar Gunn during the period 1932-34 and was initiated in 1935. It was multidisciplinary in nature, and its aim was to raise the educational, social, and economic standards of rural China. It was recognized by some at the time as an alternative to the International Health Division's approach to public health. This paper describes the program, what led Gunn to develop it in China, and the internal tensions that it created. Also addressed is the question of why this program had such limited impact on subsequent developments in the field of international health.

The Christian Medical Commission and the development of the World Health Organization's primary health care approach.

The primary health care approach was introduced to the World Health Organization (WHO) Executive Board in January 1975. In this article, I describe the changes that occurred within WHO leading up to the executive board meeting that made it possible for such a radical approach to health services to emerge when it did. I also describe the lesser-known developments that were taking place in the Christian Medical Commission at the same time, developments that greatly enhanced the case for primary health care within WHO and its subsequent support by nongovernmental organizations concerned with community health.

Charles Dickens and the movement for sanitary reform.

Charles Dickens's adult life parallels the period when the movement for sanitary reform took root in England. Although he was not one of its leaders, he became in time one of its most outspoken advocates. This essay describes Dickens's growing involvement in the sanitary movement and looks at one of the most important ways he supported it--articles published in his weekly journal Household Words

The long and difficult road to Alma-Ata: a personal reflection.

This account of the events leading up to the Alma-Ata Conference in September 1978 (covering the years 1970 to 1978) is based on the author's recollections and his recent research of World Health Organization documents. The author builds his story around four themes: why the Soviets, in particular, wanted the conference; why the new WHO director-general did not; the time and energy lost by holding the conference; and what might have happened if it had not been held. The story involves not only people and their political and health ideologies but also reflections on the continuing question of how best to improve the health of commuunities. The account reveals how Alna-Ata constrained attempts by the new leadership of WHO to transform the way in which the organization fulfilled its international health responsibilities.