1620 



POSSIBLE REASONS FOR EARLY U.S. DELAY IN SUPPORTING W.H.O. 



For example, the 2-year delay of the United States in ratifying the 

 constitution of WHO seems to have been motivated by both medical- 

 political and national-poHtical considerations, including fears that 

 WHO would become involved in such questions as health insurance 

 and socialized medicine in an international context rather than the 

 problems of preventive medicine on an international scale. Another 

 factor making for confusion of goals at the outset may have been 

 that the American leaders involved in the planning of WHO were 

 more likely to have been specialists in preventive medicine or public 

 health than experts in curative medicine with individual patient 

 orientation. They were supported by diplomats whose thinking was 

 conditioned by the past dominance of pubhc health (preventive medi- 

 cine) over private health (curative medicine) philosophies in most of 

 the countries of the world. It is the curative medicine school of thought 

 that has dominated the power structure of American medical practice, 

 and that is the more vocal and organized in exerting pressures on the 

 decisonmaking processes of the U.S. Government. Another pervasive 

 factor has been the U.S. preference for bilateral programs, over which 

 it could exercise more direct control, as against multilateral activities, 

 which many U.S. leaders have tended to regard as inefficient if not 

 misdirected. 



Since World War II the United States has conducted a wide range 

 of bilateral programs in the international health field, some with 

 further multilateral ties and some independent. The major U.S. 

 Government departments supporting programs of research, technical 

 assistance, or economic aid in health and related subjects overseas 

 have been the Departments of State, HEW, and Defense. 



U.S. GOVERNMENT ORGANIZATION FOR INTERNATIONAL HEALTH AFFAIRS 

 It 



The two principal organizations in the Department of State with 

 responsibilities for international health affairs are the Bureau of 

 International Organization Aifairs (10) and the Agency for Interna- 

 tional Development (AID). The former administers the U.S. con- 

 tributions to international and Inter-American organizations — mainly 

 WHO and PAHO — and to certain special programs; they are dis- 

 cussed further below under Role of Congress. AID administers the 

 bulk of U.S. bilateral technical and economic assistance, including 

 health and sanitation projects, and makes voluntary contributions to 

 multilateral organizations like the United Nations Development 

 Program. One of the largest health programs supported by AID has 

 involved community water supply development and management of 

 sewerage and waste disposal systems to lessen the danger of diseases 

 caused by pollution. By 1971 AID had established unique guidelines 

 and machinery for both operations and research in international 

 health work, such as the control and eradication of epidemic and 

 endemic diseases. Although funds available for such operations had 

 been decreasing year by year, there was a turnabout in 1972; by 1975 



