1626 



actual costs and the direct and indirect benefits of international 

 health programs. Examples are at hand of some successful surveys 

 in specific connections: e.g., the control of poliomyelitis in the 

 U.S.S.R., and the reduction of infant mortality in Yugoslavia. Such 

 a survey should take account not only of past and present experience 

 but also of potential benefits in relation to costs. For example, arrange- 

 ments for global medical surveillance and early warning of the danger- 

 ous spread of disease, together with reliable health statistics, have 

 hardly scratched the surface. The United States would benefit from 

 a WHO evaluation of the various systems of health care now in opera- 

 tion around the world; from a set of WHO standards on electronic 

 medical diagnostic equipment, water and air pollution, and methods 

 in the treatment of alcohohcs and heroin addicts; and from such 

 other internationally established standards as WHO-FAO (Food 

 and Agriculture Organization) criteria governing the permissible 

 amounts of heavy metals in foods. Other types of studies for which 

 the United States does not have sufficient affected population samples, 

 but from which much of value to U.S. medical research and the 

 American people could be learned, include studies of the effect of 

 severe malnutrition on early development and learning and perhaps 

 of certain types of cancer and heart disease. 



REASONS FOR POSSIBLE SHIFT OF BUDGET DEFENSE ROLE FROM STATE 



TO DHEW 



It might also be appropriate to consider shifting the main burden 

 of budgetary justification for WHO, PAHO, and other international 

 health activities from the Department of State to DHEW. With 

 appropriate State Department coordination but without present 

 constraints on the presentation of substantive accomplishments and 

 needs resulting from the simultaneous consideration of funding for all 

 international organization activities in all fields, DHEW might be 

 expected to serve as a more effective focal point for the technical 

 documentation, planning, review, and analysis of issues in connection 

 with U.S. participation in WHO, PAHO, and certain bilateral bio- 

 medical programs. Underlying this proposal is the reasoning that the 

 expansion of national public health interests to global dimensions 

 requires not only conventional diplomacy: It calls also for worldwide 

 experience with science, medicine, and public health as political 

 systems themselves and for experts in the subject matter. To the 

 increasing extent that a worldwide approach is taken to the problems 

 of human health, it will be necessary for knowledge to be shared and 

 exchanged by those who through training and practice are equipped 

 to work with it. 



The problems and potential of the State Department for managing 

 U.S. relationships with international activities in general are examined 

 later, in Issue Six. It has been a thesis of the present study that it would 

 be beneficial for the Department of Health, Education, and Welfare 

 to be brought more into the forefront of policy formulation and 

 review, and budget presentation, with respect to U.S. support of 

 international health programs. (See, however, the author's postscript 

 to this comment, immediately following.) 



