730 



AID administei"S the bulk of United States bilateral technical 

 find economic assistance, inchidino- healtli and sanitation projects, 

 and makes voluntary contributions to multilateral organizations 

 like the United Nations Development Program. Although the U.S. 

 foreign aid program has luidergone many changes, is re-organizing 

 now and will doubtless reorganize again, the original objective 

 remains essentially intact. The concept as it applies to the health of 

 the less developed countries was described several years ago by 

 David E. Bell, administrator of AID at that time : 



— to help them act to meet their most immediate health problems — of 

 which the most conspicuous are malaria and the water-borne 

 diseases — and 



— to help them create the trained personnel and the functioning 

 institutions to enable them progressively to overcome their health 

 problems. The most urgent of these institutional changes are 

 generally taken to be those which are concerned with training 

 health personnel, those concerned with the provision of public 

 health services, and those concerned with the study of a nation's 

 health problems and with planning how to meet them." ^^^ 



In what may be considered a well-phrased political objective, the 

 health progi^ams supported by AID are : 



* * * Measures that bring better health to the whole popu- 

 lation, or a large segment of it, lay a basis for a bix>ader 

 distribution of political power, for where only the elite are 

 healthy and vigorous and most of the people are lethargic 

 from sickness, power tends to remain concentrated and demo- 

 cratic institutions are not likely to develop. 



140 



AID'S INTERNAmONAL HEALTH ACTIVITIES 



It is difficult to determine from AID's diverse activities in health 

 matters which ones should be regarded as clearly emergency or relief 

 as against longer term public health pi'ograms, or indeed which pro- 

 grams are bilateral and which multilateral. Tlie war on hunger, the 

 green revolution, population and family planning, nutrition and child 

 feeding, and food from the sea, as described in the Foreign Assistance 

 Program report for 1969,"^ are crucial to the health of all populations 

 and especially those where malnutrition and endemic disease work 

 together in the production of high morbidity and mortality. Also what 

 may appear to be a straight ward engineering operation may have a 

 most profound significance for public health. For example, one of the 

 largest health programs, in financial terms, which AID has supported 

 was that for community water supply development and sewerage and 

 waste disposal. The financial assistance (from about 1961 to 1965) 

 was nearly $400 million, but was largely in the form of loans from 

 international lending agencies. These funds, together with local ex- 

 penditures made by the developing countries involved, constituted an 

 $800 million improvement in water supply and sewage dis})osal sys- 

 tems."^ Tliis type of cooperative venture does not require a pliysician 



"9 Ibid., piige 69. 

 "" Ihid.. pnges 75-76. 



141 "The Foreign Assistance Program, Auniial Report to Congress for FY 1969" (Wash- 

 ington, U.S. Government Printing OflSce, 1970), pages 11-14. 



>" 'International Cooperation in Health and Sanitation Programs," op. clt., page 76. 



