FIFTH REPORT - World Health Organization

4 FIFTH REPORT ON THE WORLD HEALTH SITUATION
The Third Report devoted a new chapter to expenditure
on health services. This initiative reflects the
concern of economists and health authorities in the
face of the increasing cost of health activities, not only
in absolute terms but also -which is more serious -
as a proportion of the gross national product. The
1969 report of the Canadian Task Force on Costs of
Health Services illustrated it for Canada (see Part II).
This concern was generally predominant in the Fourth
Report, where the study was extended to include the
problems of social and economic development that
influence the financing of health activities. The Report
also stressed the important decisions concerning health
legislation and the organization of health services that
were taken during the period 1965 -1968.
These last two aspects -on the one hand, economic
and social development and its consequences for the
development of health care, and, on the other hand,
legislation and administration on health, social security,
and welfare services -constitute important problems
in the period 1969 -1972, which is covered by this
Fifth Report. It is not that the traditional problems
of public health, communicable disease control
and environmental sanitation, have been solved -far
from it. But techniques and organizational principles
have now a rational basis in experience gained over
about 20 years. If the health services in some countries
have not succeeded as quickly as was hoped in eradicating
malaria and smallpox and in reducing the incidence
of tuberculosis, this is not always because they
were uncertain about the techniques to be used, but
basically because they encountered two major obstacles:
financial constraints and the weakness of their
administrative structure. For example, WHO received
very few requests for emergency assistance in 1972
from countries affected by cholera, since these countries
have acquired the necessary knowledge and confidence
to organize the control of that disease. Setbacks
are attributable not so much to errors in method
as to impediments in financing and manpower. If replies
from a number of developed countries to the questionnaire
for this Report indicate a spectacular reduction
in communicable diseases, which have fallen far behind
some of the chronic degenerative diseases, it is because
their financial resources and their improved legislative
and administrative apparatus have enabled those
countries to apply specific techniques.
Moreover, there are several examples to show that
the relations between economic development and the
social sector are more complex than was imagined
10 years ago. The strengthening of the public health
services is not an automatic consequence of economic
growth. In the absence of social legislation there is a
risk that rapid industrial and commercial development
will accentuate the disparities in living and health
standards that exist between different population
groups. The aim of such legislation is to facilitate
the fair redistribution of national income by complex
mechanisms, the most effective of which are: some
system of balancing ministerial budgets; wage and
salary adjustments; price control; rates of income tax
and other taxes; and social security organizations.
The improvement of the standard of health of the
population as a whole requires the construction of a
legislative framework, with financial components, to
cover the entire social sector of which public health is
an important part.
On account of these considerations, which have
emerged clearly during the last decade and have been
the subject of statements by experts on political economy
and committees convened by the United Nations
and the specialized agencies, it seems justifiable in this
Fifth Report to give more weight to financial problems
and to legislative and administrative structure by
defining the place of-health among social programmes.
This does not mean that the traditional and concrete
problems confronting national health administrators
are neglected. They are dealt with in the usual way,
and, so as not to confuse the reader, the order of presentation
of the various chapters and sections in the
Fifth Report conforms in broad outline to that in the
four earlier reports.