1749 



into a total program. It would reduce unequal geographical preferences in aid' 

 distribution. It would stimulate regional integration among developing countries. 

 It would pave the way for international centers of documentation, advice, and 

 guidance, (pp. 213-214)389 



In the study itself, the question was left open as to whether bilateral 

 or multilateral aid was preferable. The discussion was concluded with 

 the following passage : 



The issue of multilateral versus bilateral aid is complicated by a practical 

 political consideration. Some of the objectives ascribed to the early Truman pro- 

 gram, still persuasive for some groups, are largely incompatible with the patterns 

 of cooperation essential in a multilateral program. A multinational program of 

 assistance is likely to find few friends and fewer sponsors. It may be easier to win 

 political support for foreign assistance, no matter how strongly supported by theo- 

 retical or policy considerations, if the U.S. electorate can identify directly the 

 relationship with the recipient. 



And finally, the problem remains unsolved of how to assess the impacts of pres- 

 ent and future technology at all these different levels, in relation to the various 

 sets of national and international objectives. The United States is only beginning 

 to appreciate the difficulty of assessing technology domestically. The task is 

 recognized as one of transcendent difficulty. The power of technology to alter the 

 human condition, so evident in the United States, can be equally potent on the 

 world scene. EflFects of technology can be favorable or adverse. Combinations of 

 technological effects can operate synergistically toward good or bad results. The 

 many nations of the world differ widely in their sophistication, their grasp of these 

 considerations. How far the United States should go in exercising leadership, 

 globally, in the international transfer of technology, and in the effort to separate 

 good from bad technology, in view of all the other elements of this great catscradle 

 must remain an open question.'^** 



ISSUE two: the politics of global health 



The essence of the findings of this study is that all nations share 

 an interest in the health of their peoples, and that this shared interest 

 strongly motivates a multilateral approach to advance the health of 

 all. Nevertheless an incredible multiplicity of programs and institu- 

 tions, public and private, national and international, bilateral and 

 multilateral, are engaged in efforts to improve the health of mankind. 

 Along with real accomphshments, these have resulted in confusion, 

 cross-purposes, and large areas of serious neglect. 



The study called particular attention to the utility of the World 

 Health Organization, a United Nations agency, as the focal center of 

 global health efforts. Said the author, Dr. Quimby: "Recent trends- 

 reflect the deliberate movement of international health activities from 

 bilateral programs to multilateral ones such as the United Nations 

 Development Program and the World Health Organization." ^^^ He 

 cited President Nixon's 1970 message to Congress and the Peterson 

 Report and noted that "The move [toward multilateral programs] has 

 already started, beginning with the multilateralization of the malaria 



389 Ibid. 



3»o Ibid., pp. 674-675. The reference to the "early Truman program" includes a passage that reveals the 

 mixed motives with which the program was undertaken. The passage reads: 



One difficulty with the program was that its objectives were seen differently by the various groups 

 Involved; various of its supporters looked for different outcomes. Was It a humanitarian program to raise 

 living standards in poor countries? Was it intend°d to effect political stabilization of those regions to halt the 

 spread of communism, under the containment doctrine of the period? Was it to render the political soil less 

 fertile for subversion? Was it to strengthen with gratitude U.S. relations with less-favored nations? Was 

 It to provide assured future sources of essential materials for U.S. industry or possible wartime military re- 

 quirements? All of these were offered at one time or another during the two years in which the Point IV 

 Program was debated In Congress. 



The point is that irrespective of whether a program is bilateral or multilateral it can hardly succeed if its: 

 motives and goals are so convoluted and contradictory. 



3»i Quimby, The Politics of Global Health, vol. 11, p. 759. 



