Risking the World’s Health

The World Health Assembly now under way in Geneva is an embarrassment for the United States as the United Nations World Health Organization struggles to implement its campaign of “Health for All by the Year 2000.” The campaign enjoys widespread support and virtually unanimous praise. But it remains handicapped by the continued failure of Americans to pay their share.

This particular assembly has much to celebrate, including the 40th anniversary of the founding of WHO. The organization has earned a reputation for efficiency and effectiveness, praised in almost every capital of the world. That has not spared it, however, from budget slashing in Washington, with the United States, the richest of the members, the only nation in substantial violation of its treaty obligation to pay its assessments.

There was, in the opening week of the assembly, an announcement by an American representative that the United States was finally going to pay up what it owed for 1987--a total of $20 million. But that left unpaid an additional $18 million owed from previous years, and it included not a penny toward the $74 million owed for this year. So the gesture did more to expose the meanness of the American position than to demonstrate generosity.

Fortunately, the U.S. contribution to the AIDS program at WHO is funded from discretionary foreign-aid funds. Voluntary contributions from member nations are being used to meet the extraordinary costs of the AIDS program, with a separate budget of $66 million this year. The U.S. Agency for International Development has promised full American support.

The conspicuous failure to meet obligations to the World Health Organization and other elements of the U.N. system is the result of three factors:the Reagan Administration’s lack of interest in multilateral diplomacy, the current federal budget deficit and a campaign--led by Sen. Nancy Landon Kassebaum (R-Kan.)--to bludgeon the international organizations into more frugal operations by withholding U.S. support, even though that support is a treaty obligation. So much for the efforts to piece together a global rule of law.

Other nations are not impressed with the apologies from Washington, for most of them also have budget-balancing problems but generally have met their obligations to the international organizations. The arrears to WHO is particularly unseemly, for that body is one against which there have been no charges of extravagance or poor management.

The American share of 25% is reasonableactually less than a fair proportion, based on gross national products of member nations. Until recent years the United States has provided that support enthusiastically, and with it strong leadership for WHO. That was not an entirely charitable decision. Clearly it is in the national self-interest to support a vigorous global public-health program, for, as the AIDS pandemic has shown most recently, no nation can isolate itself from the health problems of all nations.

Dr. Halfdan Mahler, the distinguished Danish physician, is stepping down in July as the director general of WHO. The election of Dr. Hiroshi Nakajima of Japan as his successor has been confirmed. Ahead lie programs of urgency--including renewed vaccination programs targeted at childhood diseases and polio, and the effort to extend basic health care to every corner of the world by the end of the century.

Congress and the Reagan Administration are placing at risk the promise of health benefits tobe shared by every nation. Washington cannot afford to meet its treaty obligations, we are told.If not, who can?