RESUMO
The tension between managing episodic, acute, and deadly pandemics and the arduous path to ameliorating the chronic maladies and social conditions that kill many more people, but in far less dramatic ways, has always shaped the agenda and work of the World Health Organization. Yet the historical record amply demonstrates how international efforts to control infectious disease, beginning in the mid-nineteenth century and extending to the present, have dominated global health policies, regulations, agendas and budgets: often at the expense of addressing more chronic health and environmental concerns. How these challenges have affected present circumstances and created demands for an entirely new conception and execution of 21st century global health efforts is the focus of this paper.