The birth of WHO : interview [with] Dr Szeming Sze

The birth of WHO In an interview originally published in our sister periodical World Health Forum, Or Szeming Sze, who was a member of the Chinese delegation to the conference convened to draft the Charter of the United Nations in 1945, takes a look back to the days when WHO began. WHO: Or Sze, you are one of the "founding fathers" of the World Health Organization. Can you tell us something about what hap- pened during the United Nations Conference on International Organizations held in San Franci- sco in 1945, where the idea was born? Or Sze: Well, it came about quite accidentally. The San Francisco Conference was being held so that 50 countries could pledge them- selves to establish the United Nations, and nobody had any thought at the start of the Confer- ence of forming a health organi- zation. However. there were two medical men there besides myself: Or Karl Evang of Norway and Or Geraldo de Paula Souza of Brazil. As far as I know, there were no doctors in the French, Russian, United Kingdom, or United States delegations. So one day the three of us had what you might call a "medical lunch" together. WHO: What date was that? Or Sze: I am not sure exactly, but it must have been about 2 May 1945. Karl Evang, of course, was the most active of the three of us. He said. "Why don't we start a new health organization?" I was a little scep- tical because we had been asked to go to San Francisco to draw up the Charter for the United Nations, and I knew that there had been no thought beforehand of setting up a health organization. But Evang was so enthusiastic, as was his nature. that all three of us became keen to start something. Now, as you know, China was one of the four sponsors of the S!ln , Francisco Conference, along with UK, USA and USSR; so Or Evang and Or Souza thought the Chinese delegation should take the lead in making the proposal. Fortunately it was rather easy for me to help things along because I was there as the private secretary of the head of our delegation - not in any medical capacity, but because I could write his speeches in English. I merely 28 spoke to my boss and he said "Yes, go ahead" - just like that. So the first hurdle was easily surmounted; if I had not been working for him it would have taken weeks to have gone through all the different com- mittees and procedures that just our delegation alone would have required. Almost before I realised what was happening, I was landed with the job of presenting a propo- sal to the San Francisco Confer- ence that we should set up a single health organization. WHO: Why do you say a "single health organization"? Or Sze: Let us cast our minds back to 1945. At that time there were a number of pre-existing health organizations: the Office Interna- tional d'Hygiene Publique (OIHP), which had been set up by the International Sanitary Conventions and had been operating since 1907; the League of Nations Health Organization created after the First World War; and the Health Division of the United Nations Relief and Rehabilitation Admin - istration (UNRRA), which was dealing with health activities in the aftermath of the Second World War. In addition. there were regio- nal bodies like the Pan American Sanitary Bureau and the Egyptian Sanitary, Maritime and Quarantine The Interim Commission which met in 1946 served as midwife to the as yet unborn World Health Organization. Its chairman decided where its future headquarters would be. Board. So it became a matter of trying to tidy up the situation and of pulling all these disparate organizations into a single entity. That was our first aim. However, so as not to get tied up in practical politics we had to agree among ourselves how to present the proposal. lt was Or Souza who proposed that the word "health" be inserted into the United Nations Charter. We thought that if we got the word "health" in once, there would be an obligation to set up a health organization. I was all for playing · safe and getting a special confer- ence started, with the purpose of setting up the health organization. However, I saw no harm in letting the Brazilian delegation try to have the word inserted into the Charter. Rather to my surprise he succeeded. That's why you find "health" in the United Nations Charter, but it still did not give us the conference we wanted. A restriction had been announced on draft resolutions because there were too many of them. I was giving up hope of getting anything started when Fate took a hand: one evening at a dinner party I found myself sitting next to the Secretary-General of the Conference. Mr Alger Hiss. I asked him what we could do to provoke the attention of the Con- ference now that we could no longer present a resolution for its adoption. He immediately said, " Oh, it's very simple: don't present it as a resolution. call it a decla- ration." WHO: Did it work? Or Sze: Yes, very well. We pre- sented a recommendation for a general conference to be convened to establish an international health organization, as a joint declaration by the governments of Brazil and China, that is. the delegations of Or Souza and myself. We had to leave out Norway because Or Evang had been recalled following the liberation of Norway on 8 May 1945, and he had very important work to do at home as Director- General of Public Health. Our declaration was approved unani - mously by the Conference: that was the very beginning of the World Health Organization. Our proposal to convene a con- ference to set up a health organi - zation was approved by the Economic and Social Council in February 1946. Subsequently the International Health Conference was held in New York on 19 to 22 July 1946. WHO : That was when details were worked out about what the organi- zation should be called. how it should function. and so on? Dr Sze : Not entirely: much groundwork was done beforehand. Once things began to move. they went quickly. Before the confer- ence. a committee of experts called the Technical Preparatory Com- mittee was set up. and had its first meeting in Paris on 18 March. During the course of 22 such meetings we drew up the draft Constitution of WHO. which was signed at the New York Conference on 22 July 1946. WHO: How did the headquarters end up in Geneva? Dr Sze: That's another story. An Interim Commission had to be founded and it was understood that the place chosen for the Com- mission's meetings would probably be the headquarters of the future World Health Organization. We had a number of votes on the question - should it be held in Europe or in USA? USA won by a fairly large majority. However. it was left fairly flexible. and the choice of the exact location was left to the Chairman of the Interim Commission. Or Andrija Stampar of Yugoslavia. Most people thought that. in view of the vote. it would naturally be in the USA; however. as you said. we ended up in Geneva. and this was really Or Stampar's decision. Cer- tainly. it has been a very happy choice as far as I am concerned. WHO: Individual personalities were very much a determining factor in getting WHO started? Dr Sze: Well. I always said that my part in the foundation of WHO was 90 per cent diplomatic and only 1 0 per cent medical. lt was politics all the time. WHO: How did you arrive at a consensus on the definition of health? Dr Sze: A lot of people did not think that we should even define health in the Constitution of WHO. I only got into it because I found myself on the committee working on the preamble. I think there were WORLD HEALTH, May 1989 three of us - Or Brock Chisholm from Canada (who became the first Director-General of WHO). Or Gre- gorio Bermann from Argentina. and myself: it was a pleasant little group at which we had some interesting academic discussions. Chisholm. being a psychiatrist. wanted to mention mental health. and I thought we should put in some- thing that emphasised the impor- tance of the preventive side of health . That's how we came up with the wording in the Consti- tution that defines health as "a state of complete physical. mental and social well-being. and not merely the absence of disease or infirmity." WHO: What about the emblem of WHO? Dr Sze: We had a discussion on emblems and flags in the days of the Interim Commission . I remem- had to work out a compromise. We were able to come up with a formula that satisfied all concerned and left the door open for the integration of the Pan American Sanitary Bureau into WHO: this happened later. when Or Fred Soper took over from Or Cumming as PASB director. WHO Can you tell us something more about the people who were the instigators of WHO? What sort of a man was Karl Evang? Dr Sze: Oh. he was a delightful person. A little rigid. perhaps. because he had been very strictly brought up by his clergyman father. He always wore black. and I thought he was rather a severe man. but we played a lot of tennis together and became great friends. He was one of the outstanding personalities in those early days of WHO. He was a brilliant speaker in English and he had excellent ideas. He was always frank and honest and never held anything back. But it was his rigidity on certain ques- tions. particularly his advocacy of contraception. that lost him the support of the Latin-American countries. If he had had this support. he would have been a strong candidate for the Director- . Generalship of WHO. ~ WHO: What about the man who ~ actually became WHO's first _D_r_B_r_o_c_k_C_h-,-.s-h-o-lm-,- 0 -f _C_a_n_a-da_,_t_h_e D i rector- G en er a I . D r B rock first Director-General of the Chisholm? World Health Organization. Dr Sze: He was a very shy man. but with a good sense of humour. He ber one or two people thought that operated very quietly. He had sens- the proposed yellow flag with the ible ideas. and always expressed WHO logo on it was too much like them very quietly. but somehow the international shipping flag for they always came out on top in the quarantine. and they opposed it for end. it must be because he was a this reason. But it was nevertheless psychiatrist! adopted as a temporary emblem. WHO: We have been talking about WHO: The flag was yellow? some far-sighted young and not- Or Sze: Yes. Later. of course. it was so-young men some forty years changed to light blue. so as to have ago. Has their dream come true? a family resemblance to the United Dr Sze: In my opinion WHO has Nations flag. expanded and grown way beyond WHO: I understand that regional my dreams. I never imagined that arrangements provoked heated you could manipulate such a tre- debate. mendous budget as there is nowa- Dr Sze: Yes. that was one of the days and carry out so many few controversial questions we had programmes. WHO has grown to deal with in the Interim Commis- immeasurably beyond what I had sion. We had to take account of the hoped. strong regional health organization WHO: And now you have become that already existed in the Amer- interested in the history of WHO. do icas. The director of the Pan Amer- you think we can learn from it for ican Sanitary Bureau. Or Hugh S. the future? Cumming. wanted to be indepen- Dr Sze: Of course we can all learn dent of any single health organi- from history. We learn from the zation. Well. we all concentrated mistakes we made if not from the our efforts on him. I somehow successes: · learning the reasons found myself in the middle again. why certain things happened often because China was more or less saves us from making the same neutral in this discussion . . so we mistakes again. • 29