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(WP/RC15/Min/4 Rev.l) ~
MINUTES OF' THE FOURTH MEEl'ING WHO Conference Hall Saturday, 19 Septer::tber J.964 at 9.00 a. m. CHAIRMAN: Dr L. W. Jayesuria CONTENTS
1.
Statement by the Representative of the M:!dical Women IS International Association and the International Paediatric Association •.•••...•..••....••••.••••••...•.••••.• Protection of the pre-school child .•...••...•...••••.•••••••. The public health aspects of protection against ionizing radiation .•.•.......••.•....•.•••..•...••.•.••...•.•
154 154 158 163
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2. 3.
4.
Dental epidemiology and national dental services ...•.•....••.
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152
REGIOOAL COI+D:'ITEE: FIFTEENTH SESSION <.
Fourth
~eting
Saturday, 19 September 1964 at 9.00 PRESENT
a.m.
I.
Rep:t\esente.tives of ~mber states
AUSTRALIA CAMBODIA
Dr H. E. Downes Dr C.J. Ross-Smith
His Highness Prince Norodom M:lnissara Dr T.C. Hsu ~decin
China FRANCE JAPAN
Commandant J.L. Rigaud
Dr Y. Ozaki
KOREA LAOS
Dr Sang Tae Han Dr Phouy Phouttasak
MALAYSIA
Dr L. W. Je.ye suria
Dr D. M. Cameron Dr R. Dickie Dr V. Theve.thasan PHILIPPINES
Dr A.H. Cruz Dr J.J. Dizon Dr V. Mauricio Dr A. San Juan
Dr A. Acosta PORl'UGAL UNITED KINGDOM
Dr N. C. de Andrade
Dr A.C. Guerra Dr P.H. Teng Dr J.D. MacGregor Dr D.W. Bookless Dr R.K.C. Lee Dr J. W. Sampson Dr Nghiem Xuan Tho
UNITED STATES OF AMERICA
VIET-HAM
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MINUTES OF THE FOURTH MEEI'ING
155
II.
Representatives of the Thlited Nations and, Specialized Agencies INTERNATIONAL LABOUR ORGANISATION Dr R. Goldsmith
III. Representatives of non-governmental organizations INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS INTERNATIONAL PAEDIATRIC ASSOCIATION INTERNATIONAL UNION FOR HEALTH EDUCATION MEDICAJ" WOMEN I S INTERNATIONAL ASSOCIATION IV.
Dr S.P. Lopez Mrs L.A. Alvarez Dr D. Valenzuela Dr Fe d,el Mun.do Dr F. M. Herrera Dr Fe del Mundo
WHO Secretariat REPRESENTATIVE OF THE DIRECTOR-GENERAL SECREI'ARY Dr P.M. Dorolle Deputy Director-General Dr I.C. Fang Regional Director
REnIONAL COMMITTEE: FIFTEENTH SESSION
1.
STATEMENT BY THE REPRESENTATIVE OF THE MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION AND THE INTERNATIONAL PAEDIATRIC ASSOCIATION (continued from the first meeting, section 13) Speaking at the invitation of the Chairman, Dr DEL MUNDO extended
greetings on behaJ.f' of the Medical Women t s International Association and the International Paediatric Association. The inclusion of the subject,
''The use of statistics in public health administration", as a topic for the Technical Discussions had been noted with interest. Statistics-
vital, health, medical or otherwise - constituted the basis for any action taken to raise the level of health. In this part of the world,
as everywhere, recognition of the illi>ortance of this phase of public health work had become a basic necessity. Statistics were useful. both
for gauging the effectivity of the 1I!i>1ementation of public health measures and in helping design what measures should be put up. Accurate
and adequate statistics could very well be the backbone of public health administration. The CHAIRMAN thanked Dr del Muldo for her statement. (For further statements presented, see minutes of the fifth meeting, section 1.)
2.
PRarECTION OF THE PRE-SCHOOL CHILD: (Document WP/RC15/8)
Item 15 of the Agenda
The REGIONAL DIRECTOR said that the purpose of document WP/RC15/8
was to draw attention to the need for inwroved health services for the pre-school child. Although there bad. been inwrovements in infant and
maternal mortality rates in most countries, the same situation did not exist in the case of the pre-school child. The document presented
MINUTES OF THE FOURTH MEEl'ING
155
.' outlined the various factors responsible for this situation and included proposals for expanded health services to cover this illlJ?ortant group. Dr DOWNES (Australia) stated that in his country infant or child welfare services had been developed either by the state governments or by the local health authority. had been born in 1963. In New South Wales, over 84 000 babies
There were 411 baby health centres with a total In Victoria (the second most populated The
attendance of over one million.
state), the total number of babies born in 1963 had been 65 641. total number of baby health centres was 658.
The total number of enro1-
ments during the year was 180 000 for the age group 0-5, and the total number of attendances over a million. concept had been ad.opted. In Western Australia, a new
A pre-school health plan had been sponsored
by a local organization which intended to collaborate with the general practitioners in the service. M;dical examination records of the pre-
schoolers would be kept at the infant health centres where they would be available for statistical study. M;dical examinations were being carried
out six to eight weeks after birth, at one year of age, and in the fifth year, by physicians, both in general and consultant paediatric practice. In Australia, it had been observed that it was not sufficient to
set up a specific pre-school child health service.
It was felt that
the best means for the care of pre-school children was the development of infant welfare centres and the extension of child care services up
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to the age of five • Dr CRUZ (Philippines) appreciated the magnitude and size of the problem connected with the protection of the pre-school child. It was
considered as one of those falling under the challenge of unfinished
156
". tasks. In the Philippines, the Government
was faced with the problem ot
insu:ff'icient birth registration~
If' all births had been registered the The figures
infant mortality rate vrould be lower than that reported. given in the document were tor 1960.
However, in 1962 the infant morts.l.ity
rate per 1000 births had been reduced by 2 per cent. and the morts.l.ity of children between one to four years per 1000 population had decreased to 8.3 per cent. Consideration was being given to the protection of pre-school
children in a programme geared to the economic potentiality of the country. His Government considered this an important problem and had
utilized, and put into ma.x1mum use, the technical knowledge not only of the staff of the Department of Health but also of specialists in social paediatrics. He acknowledged the assistance provided by WHO in
helping to solve this problem. Dr OZAKI (Japan) referred to some of the problems in his country in connection with the health protection of pre-school children. Although
there had been a steady decline in the death rates in children these 'Were considered higher than those in other advanced countries. The main
causes of the high death rate were attributed to acCidents, pneumonia and diarrhoeal enteritis. A survey conducted in 1960 had indicated
that remarkable progress had been made in the development of the physique of infants and children since 1950. This was greater in the urban areas
where the dietary sta.nd.a.rd of the people, including the children, was higher than that in the rural areas. Certain measures had been adopted -
by the Ministry of Health to protect the health of the pre-school child. In 1961 a health examination programme for three-year old children had
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been started and special clinics established in all the health centres. This programme was part of the routine health clinic activities tor
MINUTES OF THE FOURTH MEm'ING
157
infants.
Three-year old children had been selected because it was felt
that they were at a stage where they could acquire a minimum degree of physical function and self-formation. Mental retardation or physical
defects, such as speech and hearing ability, could be detected without much difficulty. The latest report had indicated that the percentage of children receiving a health examination was 70 per cent. of the total child population; of the children examined, 17 per cent. had been found to have physical defects and 5 per cent. to have mental defects such as nervousness, mental deficiency, emotional disturbance and abnormal habits which required psychological guidance. In 1964 systematic maternal and child
health control through registration had been started in a number of model towns or villages. children. Dr SAMPSON (United States of America) said that having just arrived
This covered pregnant mothers, infants and pre-school
in the Pacific area he found himself in an area of many small islands with under-developed types of health programmes, particularly from the standpoint of health education. Many of the health habits were developed In th~
during the first five or six years of one's life.
United States
the gap between the infant up to the age of one year and the time the child started going to school was becoming narrower because kindergarten and nursery schools had been developed. The third party inter-
vening in the life of the child certainly meant that it would receive further protection. He
endorsed the thought behind the paper and
hoped that something worthwhile would be developed from it. The
CHAIRMAN said that in Malaya it had been possible to reduce
the infant mortal.ity rate, although over the past few years it had
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not yet reached the point where it could favourably compare with that of the surrounding territories or the more highly developed countries. h~
He
however noticed that little progress had been made among pre-school He
children where the mortality and morbidity rates 'Were still high.
had been trying to extend the services for infants into the pre-school age, through the help of the rural health centres. hO'Wever J fully staffed. These 'Were not yet,
Health education was also being used to persuade
the woman's organizations to try and form committees at village level, to bring the mothers together and show them how to teach the infant, and the pre-school child, healthy habits. A medical officer was in
charge of all the maternal and child health activities and it was hoped that this officer would be able to make a contribution to the improvement of the health of the pre-school child. The CHAIRMAN said that in the absence of further comments, the importance of the paper would be noted and recorded in the minutes of the meeting. resolution. The Rapporteurs liere asked to prepare an appropriate (For consideration of draft resolution, see minutes of
the fifth meeting, section
8.3.)
THE PUBLIC HEALTH ASPECTS OF PROTECTION AGAINST IONIZING RADIATION: Item 16 of the Agenda (Document WP/RC15/9)
The REGIONAL DIRECTOR stated that document WP/RC15/9 had been presented to the Committee for information and discussion on an important aspect of health which deserved serious and urgent consideration. The increasing use of ionizing radiation and the rapid deve1op-
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ment of new sources of irradiation 'Were associated with growing health problems. The most important source of artificial irradiation was
MINUTES OF THE FOURTH MEEl'ING
159
medical, and health authorities would have to take appropriate action to ensure the adequate protection of both the population at risk and the professional workers themselves. The Organization strongly recommended
the establishment of national programmes of radiation protection within the framework of public health services and would be glad to provide any assistance required in tW.s important field. Dr DOWNES (Australia) said that it might be of interest to the
.
Committee to trace the history of the development of radiation control programmes in his country. In the early part of the century there had In 1926, ten grams of radium,
been fears of the danger of X-rays.
costing about half a million dollars, had been procured and distributed to hospitals in Australia and to authorized personnel. Thought had,
however, been given to the necessity to control this and to devise ways of protecting those who had. contact with radiation and radiation sources. In 1929 the Commonwealth Department of Health had. established its Commonwealth X-ray and Radium Laboratory, which included among its functions an advisory service on questions of ~adiological
protection,
laboratory facilities and services in the fleld.
E"rery person dealing
with radiation was well aware of the risl{, and par:rpbJ_ets on radiation protection .had been circulated at about the same time. In 1932 the
Government had prohibited the entry of radioactive elements, radiation and irradiating apparatus into the countr'J, subject to the control of the Commonwealth Director-General of Health. After the usual control
of nuclear radiation, and after information on its peaceful uses had become available in 1947 and 1948, radioisotopes had been imported. A radiation laboratory and national cOmmittees, composed of radiation experts, pathologists and. phYSicians, had been established.
160
REGIONAL COMMITTEE: FIFTEENTH SESSION ~.
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Wh1l.e this was being enforced by statutory requirements, there came
a.
demand from industries for the use of isotopes and a draft law had been prepared for enactment by the states. The National Heal.th and ~dical.
Research CounciJ. served as a
liaison unit on radiation control, and legislation covering this had been adopted in a.lJ. states of the Commonwealth. radiation reactor had been set up. Subsequent to this, a
The COImJlOnwealth had also seen fit
to set up national radiation committees to advise the Commonwealth Government on a.lJ. aspects of radiation. Extensive field service super-
vision was also conducted on radiation workers and on those engaged in the mining of radioactive ores. The paper presented was a val.uable one and the recommendations made
had been put into effect in his country.
Dr OZAKI (Japan) stated that in Japan, 90.3 per cent. of the hospitals, which numbered 6600, had medical doctors who were undertaking X-ray diagnosis and treatn:ent of patients as a routine procedure; 1670 X-ray machines were in use. In several hospit.a.ls B-tron or lini-a.ccelera:tors Radioactive isotopes were
.-.
were being used for the treatment of cancer.
being used in more than ll10 institutions for diagnosis and treatment and also in the medical research field. Although radiation ha.za.rd prevention 'W8.S
Japan had nine atomic rea.ct.orc. the administrative responsi-
bility of the Science and Technology Agency of the Prime Minister's Of':f'ice, the Ministry of Health and Welfare shared the responsibility :for :fixing the requirements of machines and buildings in which the ionizing radiation was installed. It also undertook routine inspections to ensure that the machines were being properly used and that the wrkers concerned were equipped with film badges or exposure metres
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MINUTES OF THE FOURl'H MEEl'ING
for hazard prevention.
Laws on the preventj.on of radiation hazard had
been enacted to COver the legislative aspects. Dr SAMPSON (United states of America) said that the United States had. been interested. in radiation protection ever since World War II. ~
In
states legislation had been enacted on the use of X-ray and radium.
After the Atonrl.c Energy Commission had been developed, this group preeIllPted, as it were, most of the prerogatives on the isotopes. last ~ew
In the
years, there had been active attempts on the part of both the
Atomic Energy Commission and the various states to establish an agreement, whereby the states exercising their sovereign rights in the field of health actually handled the health portion of rad.iation within the confines of their states. In order to use isotopes anywhere in the United
States, one must be licensed by the Atomic Energy Commission and the state in which one resided. Sometimes the over-use of newspaper
publicity made people apprehensive about X-rays for tuberculosis and other conditions, but this was a calculated risk and the mach:i.nes were normally used safely and well. The United States believed U..at the
principle behind this paper was an important one. The CHAIRMAN agreed with the previous speal{f!J;'s on the importance of the paper. In Malaya there was an increasing aw..reness of the dangers
of ionizing radiation and of the need to protect the population against these dangers. With that end in view, a radium substances act had been
drafted and was now in the hands of the Legal Iepartment for review. He hoped that it would soon be put into bill form and presented to Parliament for approval.
REGlrn.AL COMMl'1"I'EE: FIFTEENTH SESSION
Dr CRUZ (Philippines) stated that following the establishment o£
the Atomic Reactor in Quezon City, the Department o£ Health had £ully realized the importance o£ protection against ionizing radiation not only £or the general public but for the 'WOrkers themselves. Although
atomic energy belonged to the so-called Atomic Energy Commission, the health aspects were a matter of interest to the Department of Health which had created a special committee for this purpose. One of the
concerns of the Atomic Energy Commission and the Department of Health was the disposal of atomic wastes. Frequent meetings were, therefore, Comrn:!.ssion end th~
being held by the Philippine Atomi<:' Ene:rgy of Health to solve this problem. routinely surveyed.
Department
X-ray installations were also being
Dr DOWNES stated that his country was aware of the efforts made to
reach the ideals indicated in the paper.
Some difficulties had been
encountered at the time when this subject was being considered about 1950. The agency which had gathered the most information on protection
measures was the International Committee for Radiation Protection (ICRP). Legislation on radiation, including transport, had therefore been patterned after the ICRP. However, the International Air Transport
Association had prOduced its own requirements for international transmission o£ radioactive materials and this had made things a little di£ferent again. By this time, those who were concerned with the
protection of workers had come to the fore, and it was £ound that a higher level organization had come into being which gave a different labelling. With the inauguration of the International Atomic Energy In order
Association, slightly different standards were again set up.
to avoid confUSion, international agencies should set tosether and speak with one voice.
MINUTES OF THE FOURl'H MEEl'ING
The CHAIRMAN agreed that it was rather confusing to have so many in!Portant organizations with different sets 01' rules. There being no
further discussion, he asked the Rapporteurs to prepare a draft resolution f'or consideration of' the Committee. resol~tion,
(For consideration of draft
see minutes of' the fifth meeting, section 8.3.)
4.
DENTAL EPIDEMIOLOGY AND NATIONAL DENTAL SERVICES: Item 18 of the Agenda (Document WP/RCl5/12 Rev.l) Dr SCRAGG (Australia) stated that the paper had been prepared by
the Dental Services in New Guinea.
It did not clearly bring out the
amount of work already being undertaken by WHO as stated in the Regional Director's report, which had, however, been received after the preparation of this document. He thought that the recommendations ms.de had in The series of activities
a large part already been undertaken by WHO.
suggested and the establishment of information and reviewing centres in
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fact implied the appointment of a dental officer to the regional organization. The Government of' Australia was not fully a'T9.re of \tat work was
being done in connection with the promotional activities on the need for and the principles of dental epidemiology. This again related to the
first of' the series of activities which would possibly require a dental o1'ficer at regional level. In general, the paper had been preeented for
information purposes but there was a feeling among dentists that there should be greater emphasis given to dental health at the regional level. The REGIONAL DIRECTOR thanked the Australian delegation, and in
particular Dr Barmes of the Administration of Papua and New Guinea, for the timely presentation of an excellent paper stressing the importance of dental epidemiology in relation to the planning and operation of
164 national dental services. Dr Barmes and his staff should be congratulated
on having successfully undertaken a series of epidemiological surveys and studies in Papua and New Guinea which were of basic importance to the Administration in determining or amending its dental health policy. The
problems of dental health in the Western Pacific Region had been
discussed at two previous WHO seminars and during the Technical Discussions held in Wellington in 1961. As a result of these deliberations, an inter-
country project, consisting of five phases, had been initiated in 1962. The first phase had consisted of a questionnaire addressed to all Member governments. In phase II, a WHO dental consultant had visited a number
of countries and territories to explain the nature of the project and to gain some first-hand knowledge of the dental health conditions in each. Phase III consisted of training and a three~onth
course had been held
in Singapore from February to May 1964.
A similar course would be
organized in Suva, Fiji, from mid-February to mid-May 1965 for dental officers in the South Pacific. Following these two training courses, ~
it was expected that governments would be able to conduct their own surveys. These activities would constitute phase IV. WHO assistance
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would be given again in phase V, when a consultant would study the findings of the various surveys and discuss with each government, if so requested, the planning and strengthening of its dental health service. It was possible that another dental health seminar YIOuld be
held in 1967 to discuss the problems encountered by governments in their efforts to solve the dental problems uncovered by the survey. Dr Barmes had suggested in his paper the organization of a WIlO dental epidemiology team to undertake major dental surveys and to train. the staff officers of national dental services in dental
MINUTES OF THE FOURTH MEETnG
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epidemiology.
The training aspect of this suggestion had in fact already Experience had, how-
been undertaken and would be completed by May 1965.
ever, shown that it was far better to assist governments to develop t.heir own resources than for HHO teams to undertake operational. activities on their behalf. The information centre proposed was an excellent sugsestion
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and had already occupied the attention of WO Headquarters, which had also been concerned with the problem of comparability mentioned in the paper. Efforts had been made to develop a standardized international methodology for dental surveys and a WO scientific group on research in dental health would meet in Geneva next April to adviSe the Director-General on how to develop a global dental epidemiology programme. Dr DIZON (Philippines) stated that the Philippine Government was particularly pleased wIth the inclusion of this topic in the discussion. He wished to congratulate Dr Barrues for his very interesting paper.
The
Philippines had recently reorganized its dental services and WO had. provid~d,
fellowships for two dental officers who would represent a
nucleus of the dental epidemiological unit that would be attached to the Disease Intelligence Centre. He proposed to irnglement new activities
by starting to collect statistical data so that the problems of dental diseases in the Philippines might be defined, to undertake epidemi010gical. surveys so as to explain the occurrence of certain dental problems, and to evaluate some preventive techniques, specifically in fluoridation, which was being done at present. 'l'he CHAIRIv'A1'iJ' agreed that the paper was most important.
In Malaya
a dental health service was associated with the rural health services.
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Attendances had been very good and the dental health clinic was becoming quite a :popular feature.
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REGIONAL COMMITTEE: FIFTEENTH SESSION
The CHAIRMAN asked Dr Scragg to trausmit the thanks of the Committee to Dr Barmes for having presented the report. (For consideration of
.,
draft resolution, see minutes of the fifth meeting, section
8.4.)
The meeting adjourned at 10.05 a.m.
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