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of tropical and preventive medicine. The improvement in military 

 medical organization from the Civil War on, the ability of the services 

 to attract competent researchers and practitioners, and the mobility 

 of the Armed Forces, have made it possible for mihtary niedicine to 

 contribute to the remarkable progress of American medicine as a 

 whole and especially to the solution of global health problems. Ameri- 

 can military medicine has produced one of the best medical libraries 

 in the world, and among the medical disciplines it ranks high in the 

 fields of pathology and epidemiology. DOD supports a substantial 

 amount of research in foreign countries and maintains four overseas 

 offices in developed nations, mainly for research and development 

 liaison purposes. Experienced observers have noted that with the 

 end of colonial administrations and their health services in many of 

 the less-developed countries, U.S. military medicine has helped to fill 

 the gap, especially by providing a pattern for American industry to 

 follow. 



With the decline in teaching of tropical medicine in U.S. medical 

 schools a physician must look either to military service or to experience 

 in one of the international health programs to learn how to deal with 

 malaria and other endemic tropical diseases. 



Despite all this U.S. activity in the international health field, what 

 seems to stand out in overview is a reluctance to become any more 

 involved than is required by the tacit dictates of conscience, humani- 

 tarian impulse, and characteristic American pragmatism. Forthright 

 considerations of moral leadership, on the one hand, or of political 

 gains to be had in pressing U.S. technical and economic advantages, on 

 the other, do not appear to have been consequential factors. 



Role of Congress 



Early congressional actions with respect to WHO were not enthusias- 

 tic. Congress was slow to ratify the WHO constitution and then 

 arbitrarily set the annual U.S. contribution at $1.9 million, meanwhile 

 appropriating tens of millions for short-term bilateral health aid. In 

 general, extensive hearings records examined during the preparation 

 of this study showed a strong congressional preference for bilateral 

 programs. Three major studies of aid and development, available at 

 the time, were of little use in focusing the attention of Congress on the 

 extent to which poor health impedes the social and economic progress 

 of mankind, or in presenting a realistic and balanced picture of both 

 the problems facing international organizations like WHO and the 

 great potential of adequately supported health organizations for 

 providing cost-effective solutions to many of these problems. These 

 three studies were : 



One: The 400-page Pearson Keport of September 15, 1969 (report 

 of the Commission on International Development set up by World 

 Bank President Robert S. McNamara), which dismissed international 

 health problems in two pages but conveyed the impression of sweeping 

 advances and credited WHO with achievements that that Agency 

 would not itself claim — prompting the New England Journal oj Medi- 

 cine to comment: "The cursory and grossly inaccurate treatment 

 afforded health is representative of current economic thought." 



Two: The Jackson Report of September 30, 1969 ("A Study of the 

 Capacity of the United Nations Development System," published by 

 the United Nations), which appeared to deemphasize WHO in favor 

 of a reorganized U.N. development program as the focal point of 



