686 



Other questions emerge about present perspectives on the implica- 

 tions of global health : About the practical necessity of a healthy world 

 in order to safeguard health in the United States, and about the 

 possibility that health programs for the "world village" may be 

 o:rossly undercapitalized as compared with growing demands for 

 individual health care in the United States. Indeed, there are striking 

 differences between the emphasis of international health agencies on 

 highly cost-effective, preventive medical care and the curative emphasis 

 of U.S. medicine, which only an affluent society can afford — if even 

 such a society can. 



Another interpretatic^n available from the data and trends presented 

 in the study is that public health and preventive medicine may have 

 already played their major role in histoiy, and that the future solution 

 to health problems lies in the character of the curative-oriented Ameri- 

 can medical enterprise and its emulation by other countries around 

 the Avorld. It may be that the international health machinery for 

 which there were such high hopes twenty-five years ago has run its 

 course, that a technolog;\' with predictable but unexciting results has 

 failed to enlist world support, and that the apathy surrounding 

 international health activities in both political and medical circles will 

 reduce further the lonely concern with which only a relatively fcAv 

 com]>etent Ameriraji scientists and statesmen are now engaged. 



The study deals with an immensely complex subject. It is a piece- 

 meal attempt to provide an adequate picture of the situations and 

 changes in U.S. involvement in global health institutions. The ap- 

 proach is to select and deal in some depth with several elenionts crucial 

 to underetanding and policy, rather than to provide a cursory overall 

 treatment of the subject. The elements selected include: 



— The historical perspective of international health conventions; 



— The objective and functions of international health organizations; 



— The ability of international health institutions to function effec- 

 tively under cold war conditions ; 



— The cost of U.S. participation in international health organiza- 

 tions ; 



— The activities and trends of U.S. Federal agencies in overseas 

 biomedical work; and 



— The links and barriers between congressional committees and the 

 Federal agencies responsible for the administration of U.S. com- 

 mitments to international health organizations. 



In the effort, to concentrate research effort on activities of the highest 

 current concern, in which the decisions of the U.S. Congress could be 

 most decisive, many fields of global medicine were glossed over or 

 virtually ignored. The global network of industrial corporations and 

 international corporations dealing in drugs and medical supplies was 

 not considered. Little space was given to the health activities of the 

 Communist World, or to bilateral arrangements of the Soviet Union 

 with aided countries. The various programs of imperial countries to 

 extend health services to their colonies, or former colonies, and the 

 various "World War II health programs by the United States over 

 much of the world were not researched, although in particular areas 

 they may well have been of decisive importance. In short, the study 

 is largely future-oriented : being concerned with those kinds of inter- 

 national health activity judged of high cost/effectiveness, and with 



