This Fri­day, April 7, the World Health Or­ga­ni­za­tion (WHO) marks its 75th an­niver­sary with the theme #Health­forall. The cel­e­bra­tion is billed as “an op­por­tu­ni­ty to look back at pub­lic health suc­cess­es that have im­proved qual­i­ty of life dur­ing the last sev­en decades.”

It is good and right that we ac­knowl­edge there is much to cel­e­brate glob­al­ly due to this 1948 com­mit­ment by coun­tries world­wide.

The his­to­ry of that day cred­its rep­re­sen­ta­tives of Brazil and Chi­na for propos­ing that the world need­ed an em­brac­ing or­gan­i­sa­tion to deal with health at the in­ter­na­tion­al lev­el.

So, in San Fran­cis­co, Cal­i­for­nia, USA, in 1945, while the con­fer­ence was be­ing held to set up the Unit­ed Na­tions, an­oth­er con­fer­ence was pro­posed for es­tab­lish­ing what we now know as the WHO. (https://www.who.int/about/his­to­ry)

The his­tor­i­cal re­count­ing says this all hap­pened 100 years af­ter in­ter­na­tion­al pub­lic health was birthed at the Paris In­ter­na­tion­al San­i­tary Con­fer­ence in 1851, an event prompt­ed by the pre­cip­i­tat­ed spread of cholera over a pri­or 20-year pe­ri­od.

In 1948, the goal of the WHO was stat­ed as “to pro­mote health, keep the world safe and serve the vul­ner­a­ble—so every­one, every­where can at­tain the high­est lev­el of health and well-be­ing,” Health eq­ui­ty, which we strug­gle to at­tain, is foun­da­tion­al to the thrust! 

Suc­cess­es and ben­e­fits in things we take for grant­ed, which keep our world health­i­er and safer, such as erad­i­ca­tion of in­fec­tious dis­eases like po­lio and small­pox, im­mu­ni­sa­tion, an­tibi­otics, as ex­am­ples, and the whole re­shap­ing of health­care de­liv­ery in­to the “health for all” mo­tif, set­ting the stage for uni­ver­sal health cov­er­age, and more, came through the or­gan­i­sa­tion of health un­der the WHO.

In 1978, at Al­ma Ata, in Kaza­khstan, the goal of health (for all) that “all peo­ple every­where have the right to achieve the high­est at­tain­able lev­el of health” re­shaped the de­liv­ery of care, mak­ing this the un­der­ly­ing prin­ci­ple of pri­ma­ry health care.

Pri­ma­ry health­care was re­fo­cused as the peo­ple-cen­tred de­liv­ery of ser­vices to meet peo­ple’s needs through­out their lives while re­spect­ing their choic­es.

As a pub­lic health prac­ti­tion­er, look­ing back at the his­to­ry of the WHO, read­ing its 10-year ac­counts for the past sev­en decades, and brows­ing the time­line of achieve­ments, give me hope for health, equal­i­ty in health, and health eq­ui­ty. My more pre­cise in­ter­est, of course, was to look at the his­tor­i­cal per­spec­tives on men­tal health. In the on­line doc­u­ment ac­count­ing for the WHO’s first ten years though, the sub­ject of men­tal health is list­ed on page 324, but the doc­u­ment ends at page 282, omit­ting many oth­er sub­ject ar­eas of in­ter­est such as nu­tri­tion, ad­dic­tion, ma­ter­nal and child health, and more. The next ac­count, 1958-1967, the sec­ond ten-year pe­ri­od, gave in­sight in­to how the progress and fu­ture of men­tal health was per­ceived.

It reads in part: “The mod­ern trend is away from cus­to­di­al care in an in­sti­tu­tion and to­wards ac­tive treat­ment, with the aim of re­turn­ing the pa­tient as soon as pos­si­ble to the high­est achiev­able de­gree of nor­mal life in the com­mu­ni­ty.”

My re­flec­tion here is that this “mod­ern trend” of the late 1950s and 1960s is still not trend­ing suf­fi­cient­ly in 2023. Back then, the WHO record­ed the ap­proach of psy­chi­a­try as “chang­ing, with em­pha­sis on so­cial psy­chi­a­try and com­mu­ni­ty care, through ex­pan­sion of out­pa­tient ser­vices, day care hos­pi­tals, domi­cil­iary care and fol­low-up ser­vices.”

WHO’s work in this field, it stat­ed, “has been in­creas­ing­ly con­cerned with the de­vel­op­ment of men­tal health ser­vices as part of the pub­lic health struc­ture, in­clud­ing the in­te­gra­tion of men­tal health care pro­grammes in the lo­cal health ser­vices.”

These as­pi­ra­tions in­clud­ed such things as un­der­grad­u­ate teach­ing of psy­chi­a­try and men­tal health pro­mo­tion in all med­ical cur­ric­u­la (1960), rec­om­men­da­tions for “the in­clu­sion of men­tal health in the cur­ric­u­la of all pub­lic health train­ing cen­tres and in post-grad­u­ate train­ing for gen­er­al prac­ti­tion­ers” (1961).

With a record­ed birth date of 1962, as I con­tin­ue to pe­ruse these doc­u­ments on health from 1948 and specif­i­cal­ly for men­tal health, I have mixed emo­tions.

Main­ly, about how the con­tin­ued lev­els of stig­ma and so­cial ex­clu­sion born out of mis­un­der­stand­ing and cru­el judg­ment, and em­bed­ded in sys­temic mal­func­tions, con­tin­ue to prop­a­gate dis­crim­i­na­tion in the en­tire are­na/field of men­tal health.

All of the good in­ten­tions are record­ed, but some­how the in­vest­ment and in­vesti­ture in the health of the mind re­mains im­bal­anced against what we see as the con­tin­ued progress and evo­lu­tion of the myr­i­ad is­sues of “phys­i­cal” and oc­cu­pa­tion­al/en­vi­ron­men­tal health.

Stig­ma against men­tal ill­ness­es by so­ci­ety (pub­lic stig­ma), at the in­sti­tu­tion­al lev­els (glob­al, na­tion­al), pro­fes­sion­al, and in­di­vid­ual lev­els con­tin­ue to re­tard the rate of progress that the world needs and de­serves.

That de­clared, to­day I con­grat­u­late the WHO for its 75 years of lead­ing and im­prov­ing pub­lic health. The COVID-19 pan­dem­ic may have brought the most at­ten­tion glob­al­ly in re­cent times to the in­ten­tion­al good and com­mend­able work of this or­gan­i­sa­tion.

For the his­to­ry of the WHO by decades: https://www.who.int/pub­li­ca­tions/i/item/9789241560146