SUMMARY RECORD OF THE THIRD MEETING

WHO Conference Hall, Manila Tuesday,. 7 September 1976 at 9.00a.liI.

CHAIRMAN: Mr J .S. Singh (Fiji)

CON'IENT.3

(WPRjRc27/SR/3 )

1 Consideration of draft resolutions .•..•..........•.•.•.•..•• 113

2 Address by incoming Chairman ••..•..•....••••••..••••••••..•• 113

3 WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research ••• 113

4 Alcoholism and other dependence problems ••.•.•.••••••••.•••• 118

5 Reconsideration of preparation of a fifth regional programme of work for a specific period (1978-1983 inclusive) ••....••• 121

6 '!he regional environmental health programme: regional centre for environmental health sciences •••.•.•.•••••.••••••••••••• 122

7 Frequency of meetings of the Regional COll1llli ttee ••.•.•.•••••.• 125

8 Annual reporting by the Regional Director •.•...••......••••• 127

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110 REGIONAL COMMITlEE: 'IWENTY-8EVENTH SESSION

'lhird Meeting

Tuesday. 7 September 1976 at 9.00 a.m.

PRESENT

I. Representatives of Member States

AUSTRALIA

CHINA

FIJI

FRANCE

JAPAN

LAO PEOPIE' S DEMOCRATIC REPUBLIC

MALAYSIA

NEW ZEALAND

PAPUA NEW GUINEA

PHILIPPINES

PORTUGAL

REPUBLIC OF KOREA

SINGAPORE

Dr C. Evans Mr K. Boreham

Dr Chen Hai-feng Dr Chin Hsiang-kuan Dr Huang Yu-hsiang Mr Tsao Yung-lin Mr Li Ching Hsiu

Mr J .S. Singh Dr J.B. Senilagaka1i

Dr P. Leproux

Dr A. Tanaka Dr H. Shinozaki Mr T. Yano

Dr Keo Phimphachanh

Tan Sri Datuk (Dr) Abdul Majid Ismail Dr Mehar Singh Gill Mr Onn bin Kayat

Dr B.W. Christmas

Mr E. Robin Safitoa Dr K. Wari

Dr J. Sumpaico Dr A.M. Angara

Dr Leone1 dos Remedios

Dr Kyong Shik Chang Mr Se Lin Huh Mr Moo Gaun Jeon

Dr Leong Kwok Wah

;.

SUMMARY RECORD OF THE THIRD MEETING

SOCIALIST REPUBLIC OF VIET NAM

UNI'lED KINGDOM

UNITED STA'lES OF AMERICA

WESTERN SAMOA

Dr Tran Ngoc Dang Dr Nguyen Van Trang Mr Nguyen Hong Quang

Dr J.A.B. Nicholson

Dr J .C. King

Dr Solia Tapeni Faaiuaso

II. Representatives of Other Intergovernmental Organizations

SOUTH PACIFIC COMMISSION Dr E. Macu Salato

III. Representatives of Non-governmental Organizations

WORlD FEDERATION OF THE Mrs E.S. Carlos DEAF

INTERNATIONAL DENTAL Dr R.C. Navia FEDERATION

INTERNATIONAL UNION FOR Dr F. Herrera HEALTH EDUCATION

WORID FEDERATION FOR Dr J. Cuyegkeng MEDICAL EDUCATION

MEDICAL WOMEN'S Dr E.I. Cuyegkeng INTERNATIONAL ASSOCIATION

INTERNATIONAL COMMITTEE Mrs M.R. Ordonez OF CATHOLIC NURSES

INTERNATIONAL COUNCIL Mrs F.M. Valdez OF NURSES

WORID FEDERATION OF Miss C. Tablan-Santos OCCUPATIONAL THERAPISTS

INTERNATIONAL PLANNED Dr J.B. Catindig PARENTHOOD FEDERATION

INTERNATIONAL SOCIETY OF Mr N.A. Palomo RADIOGRAPHERS AND RADIOLOGICAL 'lECHNICIANS

INTERNATIONAL SOCIETY Dr H. Zialci ta OF RADIOLOGY

LEAGUE OF RED CROSS Brigadier General P.R. Sotto (Ret.) SOCIETIES

111

112 REGIONAL COMMITlEE: 'lWEN'lY-SEVENTH SESSION

REHABILITATION Mrs C. Floro INTERNATIONAL

INTERNATIONAL LEAGUE Dr T.P. Torralba AGAINST RHEUMATISM

IN'IERNATIONAL COUNCIL Brigadier General P.R. Sotto (Ret. ) , -

ON SOCIAL WELFARE

WORID VE'IERANS FEDERATION Brigadier General P.R. Sotto (Ret.)

WORID FEDERATION OF Dr N.M. Santiago UNI'IED NATIONS ASSOCIATION

IV. WHO Secretariat

SECRETARY Dr Francisco J. Dy ,;:

SUMMARY RECORD OF THE THIRD MEETING 113

1 CONSIDERATION OF DRAFT RESOLUTIONS

The Committee considered the following resolutions:

1.1 Annual Report of the Regional Di rector (Document WPR!RC27 iWP /1)

Decision: The draft resolution was adopted without comment (see resolution WPRjRc27.R2).

1.2 SpeCial assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Republic of Viet Nam (Document WPR/RC27;WP/2)

The REGIONAL DIRECTOR announced that the Government of Canada would contribute US$ 250 000 for assistance to the Lao People's Democratic Republic. The Committee might wish to amend the fourth line of operative paragraph 3 of the draft resolution to read: " • • • • • •• Governments of Australia and Canada ••••• "

Decision: The draft resolution was adopted as amended (see resolution WPR/RC27.R3).

1.3 Resolutions of regional interest adopted by the Twenty-ninth World Health Assembly and the Executive Board at its fifty­seventh and fifty-eighth sessions (Document WPR!RC27 iWP /3)

Decision: The draft resolution was adopted without comment (see resolution WPR/RC27.R4).

2 ADDRESS BY INCOMIW CHAIRMAN: Item 5 of the Agenda

The CHAIRMAN addressed the meeting. His statement appears in Annex 1.

3 WHO'S ROLE IN THE DEVELOPMmr AND COORDINATION OF BIOMEDICAL RESEARCH: GREATER INVOLVEMENT OF THE REGIONS IN RESEARCH: Item 13 of the Agenda (Document WPR!RC27(7)

The REGIONAL DIRECTOR said that three maj or steps had been taken in implementation of resolution wpR/RC26.RlO adopted by the Committee at its twenty-sixth session: (1) a post of adviser in biomedical research had been established in the Regional Office and a suitable candidate was being sought; (2) a group composed of the Chairman of the Headquarters Advisory Committee on Medical Research, Dr Scrimshaw, a Headquarters staff member who was an authority on parasitic and tropical diseases, Dr Buck, and Dr Reyes from the Regional Office, had travelled in the Region to study the feasibility of designating a WHO regional centre for research and training in tropical diseases; and (3) the first meeting of the Regional Advisory Committee on Medical Research (RACMR) had taken place in Manila:

Document wpR/RC2717 and its annexes presented summaries of the recommendations arising from both the feasibility study and the meeting of the Regional Advisory Committee on Medical Research. The enthusiasm and support encountered for establishing priority areas for regional

114 REGIONAL COMMI T1EE : 'IWENTY-SEVENTH SESSION

research had been very encouraging. With the approval of the Committee and provided the necessary extrabudgetary funds could be found, it was hoped soon to establish the three recommended task forces: on health services research; on parasitic and other communicable diseases; and on cardiovascular diseases, in order to develop comprehensive proposals for research programmes.

The Committee would wish to consider whether the recommendations arising from the feasibility study and the RACMR were acceptable.

Dr KING (United States of America) said that the Government of the United States of America supported the Regional Director's efforts to strengthen the role of medical research in the Region and commended the rapid establishment of a post of adviser in biomedical research and anRACMR.

In particular, the Government: (1) supported the RACMR recommenda­tion that the Regional Director establish task forces to develop regional plans for research in the areas of health services, parasitic and other communicable diseases, and cardiovascular diseases; supported the recommendation that experts in parasitology and enteric infections be included as members of the RACMR; (2) agreed to the proposal that the Regional Director seek funds for start-up costs, which should nevertheless be kept to a minimum; each task force should develop an estimated budget on future research and administrative overheads, to be reviewed by the RACMR and presented to the Committee at its twenty-eighth session; (3) supported the proposal to designate the Institute for Medical Research, Kuala Lumpur, Malaysia, as a WHO regional research centre, while noting that the United States was already assisting the Institute through the University of California; (4) supported the recommendation to establish close collaboration with the Korea Health Development Institute and recommended that the task force on health services research develop a roster of other institutions in the Region involved in operational health research; (5) recommended that the Committee await submission of the task force plans for research before agreeing to fund research on the control of S. japonicum in the Philippines and urban tropical health in Singapore.

Dr King asked whether the Regional Director sought to fund the biomedical research programme from extrabudgetary sources only or also from the Regular Budget.

Dr TANAKA (Japan) agreed that it was very important to strengthen coordination and collaboration of research in the Region. The Delegation of Japan supported the proposals in principle but felt that every effort should be made to obtain the necessary funds for setting up the three task forces from the Regular Budget.

Dr SUMPAICO (Philippines) strongly supported the RACMR recommendations and welcomed the opportunity to site schistosomiasis

SUl4>1ARY RECORD OF THE THrRD MEETING 115

research in the Philippines, .nere the disease had long been a problem. It was hoped that contributions would be available for the purpose. Greater involvement of the regions in research was most welcome. Previously aotivities had been oarried out in collaboration with WHO Headquarters whereas now the Regional Office was participating fuily and coordination was thus facilitated.

Dr MAJID (Malaysia) said that the Government of Malaysia supported the RACMR recommendations. It was honoured that the Institute for Medical Research, Kuala Lumpur had been recommended for designation as a WHO regional centre, following an offer made at the twenty-sixth session of the Committee.

The Institute was reported to be competent in fields such as parasitology, filariasiS, scrub typhus, medical ecology, medical entomology, arbovirus research and bacteriology, human genetiCS, nutritional biochemistry and community health research. There were deficiences in other areas, as noted by the visiting team, and they would certainly be investigated.

The recommendation that detailed plans should be drawn up for establishment of the regional research centre was welcomed. The Government of Malaysia would do all it could to ensure that it became a centre of excellence for basiC medical research on tropical infectious diseases in the Region.

Dr SENILAGAKAIJ: (FiJi) endorsed the remarks and recommendations made. The Government of Fiji welcomed the designation of a research centre to serve the Region in Kuala Lumpur, which was an excellent site for the purpose. Training of medical personnel to work in the Region should best be undertaken in local institutions.

Mr SAFITOA (papua New Guinea) expressed his appreciation of the steps taken. Such research was very important in determining the basis of any health service to enable it to deal with problems encountered. The establishment of the RACMR and its work so far were to be commended. As a new member of WHO, Papua New Guinea would endeavour to support the project in every way possible.

Dr FAAIUASO (Western Samoa) wondered, without any bias being intended, .nether a similar programme of training and research might be carried out at an institute in the South Paoific as well as at Kuala Lumpur.

Dr LEPROUX (France) said that the Government of France fully endorsed the recommendatiOns of the RACMR. French Polynesia had a Medical Research Institute which had recently been granted scientific recognition by the Institut Pasteur, Paris, with which it was linked by convention. This Institute, which ha4 acquired an appreciable competence in fish food poisoning (ichthyosarcotoxism) and filariasis,

116 REGIONAL COMMITIEE: 'MNTY-SEVENTH SESSION

had already collaborated with the Organization, and this cooperation with WHO and countries in the Region could usefully expand. Furthermore, French Polynesia, where imports alone accounted for a daily consumption of 5000 calories per person, offered an ideal field for the study of plethoric diseases such as diabetes, hypertension and obesity.

Dr CHEN HAI-FENG (China) said that the key issue was who medical research should serve and how. He wished to describe briefly the "open door" research carried out in China. "Open door" hospitals, education and scientific research were innovations arising from the Great Proletarian Cultural Revolution. Now millions of workers, peasants, barefoot doctors and basic-level health workers were participating in the research and excellent progress was being made. China had broken with the old ways and was taking its own road in vigorously developing science and technology.

Stress was firmly placed on the rural areas. Every effort was made to prevent, control and eliminate common infectious diseases at the basic level.

Many research workers had gone from their laboratories to the countryside, factories and mines; to areas afflicted by diseases and rich in herbal medicines. They gave emphasis to prevention, integration of traditional and western medicine, and the destruction of pests. Front­line scientific research bases had been created with a three-in-one combination of worker-peasant-soldier masses, professional personnel and cadres. The research was undertaken together with local barefoot doctors, red doctors, practitioners of traditional medicine and herbal farmers. Some institutes had established links with factories, mines or rural health units in order to conduct studies and training among the people. The research took many forms and the results were promptly disseminated.

The "open door" approach had been successfully applied in the development of laser techniques, the fight against cancer and tumours, and the prevention and treatment of schistosomiasis.

Research was no longer divorced from politics and the broad masses. --" had been firmly reorientated in serving the workers, peasants and soldiers and joining forces with productive labour. The old situation of institute­and theory-centred research monopolized by a handful of intellectuals had been changed. Research was now carried out on a mass movement basis, with better, speedier and more economical results.

Theoretical research was also done in an "open door" manner, laboratory work being combined with vast experimentation among the broad masses, in both long- and short-term studies.

"Open door" research was regarded as an important achievement of the socialist revolution.

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SUMMARY RECORD OF THE THIRD MEETING 117

Dr TRAN NGOC DANG (Socialist Republic of Viet Nam) expressed the full support of the Delegation of the Socialist Republic of Viet Nam for the recommendations of the RACr.m. WHO had been assisting in building in Viet Nam an Institute of Hygiene for medical study and research, as well as for the training of health workers from the Region. This Institute, established in Ho Chi Minh Ville. had been found undamaged when the present authorities entered the City. Thanks to assistance supplied by Denmark. the Netherlands and New Zealand construction would be completed shortly.

Dr KYONG SHIK CHANG (Republic of Korea) said that the Delegation of the Republic of Korea supported the RACMR recommendations and commended the efforts made.

The establishment of close collaboration with the Korea Health Development Institute, as proposed, would be a significant step. Through that Institute it was planned to develop a low-cost health care delivery system adapted to the social and cultural background of the country.

Technical cooperation by WHO and other United Nations and international agencies would be welcome. At the same time the Government of the Republic of Korea was willing to exchange information on progress made in research at the Institute with other establishments in Member States.

Dr DOS REMEDIOS (Portugal) said that although there were no diseases like schistosomiasis in his Territory, the RACr.m recommendation was fully supported.

Dr NICHOLSON (United Kingdom) said that the Government of the United Kingdom supported the recommendations in principle, noting that research was needed on specific hazards in terms of their priorities. He wondered whether the funds involved would come only from extrabudgetary sources or also from the Regular Budget.

The REGIONAL DIRECTOR, replying to the questions raised, pointed out, with regard to the site of the research and training centre, mentioned by the Representative of Western Samoa, that he had visited the Institute for Medical Research in Kuala Lumpur and had been impressed. He could endorse the recommendation of the feasibility team. However, not all activities would be centred there since the disease conditions for some research were not present in Malaysia; it would therefore have to be conducted elsewhere. A filariasis research programme was to be launched in Western Samoa, which would also benefit other countries and areas having the same health problem. Moreover all research activities had a training aspect. Apart from the training available in connexion with the research in Western Samoa, investigators would be able to train at the centre of excellence in Malaysia and elsewhere.

With regard to the major question of the source of funds for the programme in the Region, raised by the Representatives of the United Kingdom and the United states, provision was made in the Regular Budget only for the posts of adviser and his secretary and for the members of the RACMR to attend its sessions. It was also hoped to finance the

118 REGIONAL COMMITTEE: TWENTY-SEVENTH SESSION

preliminary meetings of the task forces, which should if possible prepare for presentation to the RACMR and the Regional Committee detailed plans and corresponding budgets, for which extrabudgetary resources would be needed. It was hoped that Member States from within, and even from outside, the Region would contribute extrabudgetary funds, without which the research programme would proceed very slowly. It did not seem justifiable for WHO to divert funds from direct technical collaboration with developing countries for the purpose of expanding research activities, which could be very costly.

There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution see the fourth meeting, section 1.1, and the fifth meeting, section 2.1).

4 AlCOHOLISM AND OTHER DEPENDENCE PROBIEMS: Item 14 of the Agenda (Document WPR/RC27!8 and Corr.l)

'!he REGIONAL DIREC'roR reminded the Committee that at its twenty­sixth session a number of representatives had expressed the view that, while problems resulting from drug dependence and from alcoholism were similar, they were nevertheless distinct and should be considered separately. Indeed in many parts of the Region alcoholism was considered to be the greater problem.

With the appointment of an adviser under an intercountry project the regional programme in prevention and control of drug abuse was already being intensified. Resolution WPR/RC26/Rll had requested the Regional Director to include the subject of alcoholism as a separate item on the Agenda of the Committee's twenty-seventh session.

Document WPR/RC27/8 therefore contained a review of the present situation in the Region carried out through circulation of a questionnaire. The information obtained was interesting. For example, traffic accidents, though they were not a result of alcohol dependence per se, were considered to be one of the major consequences of ex~sive drinking. The Regional Director mentioned that the WHO programme on health aspects of traffic accidents, for which the Regional Office for Europe was responsible, would include a study of the interaction of alcohol and drugs with road traffic accidents.

Dr EVANS (Australia), commenting on the effect of alcoholism on public health, said that it was a major problem in Australia. It was noted with regret, from the figures given in document WPR/RC27/8, that the consumption of alcohol per person was greater in Australia than anywhere else in the Region. Very little attention had been given in the document to physical control measures, in spite of the fact that the Finnish Foundation for Alcohol Studies, the. WHO Regional Office for Europe, and the Addiction Research Foundation of Ontario, Canada had already produced a publication which demonstrated the major importance of physical measures in controlling alcohol consumption. l

1 Alcohol Control Policies in Public Health Perspective, The Finnish

Foundation for Alcohol Studies, 25, Forssa, 1975.

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SUMMARY RECORD OF THE THIRD MEETING 119

The Delegation of Australia endorsed reoommendation (a) for fUture action but felt that emphasis should be placed on developing means for collecting, processing and publishing available data, and for regular and ad hoc colleotion of statistics. This could be done at less cost, and Of~to greater benefit, than by introducing new procedures and new colleotions of statistics and material. The Government of Australia. had been so concerned with the alcohol problem that the Senate Standing Committee on Social Welfare had requested the Department of Health to produce a position paper.

The development of training programmes was a central issue in the control of alcoholism. The skillful use of control measures offered the greatest hope of quick containment of health problems related to alcohol and drugs. It was suggested therefore that encouragement be given to further studies and research, with built-in means of evaluation, to produce meaningfUl results.

Dr TANAKA (Japan) stated that the Delegation of Japan supported the planned future action described in document WPR/RC27/B. He said that as a result of urbanization and industrialization, alcoholism had become an important social problem in Japan. It had spread among the younger generation, the socially high-ranking, and even among women. Ten years ago most patients had been treated in closed mental hospitals but recently open-care treatment had been proved effective. In addition to the care given i'n hospitals, there were voluntary "stop-drinking" organizations throughout the country consisting of cured alooholics. The Ministry of Health and Welfare had given priority in the field of mental health to alcoholism and was planning to undertake intensified research, prevention campaigns, training of health personnel and to assist in the development of voluntary organizations at the oommunity level.

Dr CHRISTMAS (New Zealand) stated that the Government of New Zealand shared the concern of the Governments of Australia and Japan, particularly that expressed by the Representative of Japan regarding consumption of alcohol by young people, the results of which were already being reflected in the increased traffic accident rate affecting this age group. There was also evidence that the drinking pattern was increasing among married women. In an effort to deal with the problem, the Government of New Zealand proposed to set up an alcohol advisory council. Intensified health education was directed towards problems associated with drinking and driving. Hospital boards were being encouraged to establish clinics to serve as detoxification centres. In addition to preventive action, the effective development of supportive services merited special attention. The Government of New Zealand relied very much on voluntary organizations. Undoubtedly, trained workers experienced in handling the long-term psychosocial problems of the alcoholic were needed in the Region.

Dr MAJID (Malaysia) spoke of the problem of alcoholism in the developed countries of the Western Pacific Region. The ambivalent attitude of a permissive society which. knowing it had been proved a hazard to health, still considered the drinking of alcohol as adding to

120 REGIONAL COMMITlEE: 'lWENTY-8EVENTH SESSION

social status, contributed to the problem. In developing nations such as Malaysia, the problem was to some extent contained, because of social

\sanctions; it was mostly confined to a small section of the adult \popu1ation. The problem of dependence on dangerous narcotic drugs was of prior concern. This did not mean that there was a complacent attitude to the problem of alcoholism. Prevention programmes were still experimental and needed support. Success depended very much on the strength of religious beliefs, the vitality of tradition and culture and the will to exercise social and legal sanctions. The Government of Malaysia, with the cooperation of WHO, intended to implement th~e recommendations for future action that were applicable to the country. InfPrmation on production, distribution, consumption and ill effects attributed to alcohol; absenteeism from work; economic loss incurred; and the occurrence of traffic accidents leading to incapacity, invalidism and death, Were useful guides in the study of the nature and extent of the problem.

Dr SENILAGAKALI (Fiji) suggested that the thirteen countries or areas in the Region that had not replied to the questionnaire be urged to do so, since the information obtained would be of benefit to all Member States in the Region. A Royal Commission appointed to assess the crime situation in Fiji had found that alcoholism was increasing, especially among young people. The Government would be reviewing the report of the Commission and it was hoped that drastic decisions would be taken to prevent an increase in the problem. A survey conducted in 1975 revealed that 30% of children suffering from malnutrition in urban areas had parents who drank liquor excessively. Religious organizations were very active in teaching their congregations temperance. The problem of alcoholism in Fiji and possibly also in the other Pacific island territories, was intensified by the tendency for people to get drunk on home-made alcohol. In Fiji, laws had been formulated against this and against consumption of other intoxicating substances.

Dr WARI (Papua New Guinea) said it was appropriate that this subject was being discussed separately. While developed countries had expressed concern, developing countries such as Papua New Guinea could not be excluded, because the problem was increasing; mainly as a result of urbanization and migration from rural areas to the towns. The Government of Papua New Guinea supported the idea of planned future action. Certain measures had already been taken, such as restricting drinking hours. On important days liquor was not sold at all and on pay days the hours during which liquor could be sold were limited. Organizations, such as women's groups, were active in combating alcoholism.

Dr SUMPAICO (Philippines) said that the problem of alcoholism in the Philippines, at present moderate, was increasing. It was interesting to note the figures given for the Philippines in the table of annual per capita consumption. The Delegation of the Philippines would support any action the Committee might recommend for the future.

There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.2.)

SUMMARY RECORD OF THE THIRD faTING

5 RECONSIDERATION OF PREPARATION OF A FIFTH REGIONAL PROGRAMME OF WORK FOR A SPECIFIC PERIOD (1978-1983 INCLUSIVE):l Item 16 of the Agenda (Documents WPR/RC27/10 and WPR/RC27/Working Paper/1)

121

The CHAIRMAN introduced the working paper, which set out the proposed terms of reference for the Working Group set up to examine regional action in connexion with the WHO Sixth General Programme of Work.

Dr KING (United States of America) expressed agreement with the principles of the terms of reference, but felt there was some ambiguity between sections (i) and (ii). The mechanism set up in section (i) seemed to be ignored in section (ii).

Dr SUMPAICO (Philippines) asked whether the "highest priority" in section (ii) referred to one programme or several programmes.

Dr EVANS (Australia), replying to questions at the suggestion of the REGIONAL DIREC'lDR, explained that section (i) referred to a regular, ongoing process of annual review. Section (ii) referred to specific programmes to be suggested to the Executive Board for study at its next session.

Dr CHRISTMAS (New Zealand) supported the proposals as explained by the Representative of Australia.

The REGIONAL DlREC'lDR suggested that the reference to the World Health Assembly be removed from section (ii) and that the words "at its next session" be inserted at the end of that section. He also proposed that section (iii) be deleted: the proposal to suggest a definition of "technical cooperation" to the Executive Board was a helpful initiative, but the matter could more appropriately be discussed during the discussion on the programme budget. Enlargement of the Working Group by one or two members might also be considered.

Dr MAJID (Malaysia) supported the proposals of the Regional Director.

Mr BOREHAM (Australia) said the Delegation of Australia had no objections to the amendments proposed by the Regional Director, provided that the definition of "technical cooperation" were discussed at a later meeting.

The CHAIRMAN invited Dr Senilagakali (Fiji) and Dr Sumpaico (Philippines) to join the Working Group.

It was so agreed.

The REGIONAL DIRECTOR suggested that the Working Group might wish to meet during the morning of Wednesday, 8 September. The Secretariat would provide all possible assistance. (For consideration of the report of the Working Group, see the fifth meeting, section 3.)

1 . See also WPR/RC27/SR/2, Section 2.

122 REGIONAL COMMI'I'IEE: 'lWENTY-SEVENTH SESSION

6 THE REGIONAL ENVIRONMENTAL HEALTH PROGRAMME: REGIONAL CENTRE FOR ENVIRONMENTAL HEALTH SCIENCES: Item 15 of the Agenda (Document WPR/RC27/9)

The REGIONAL DIRECTOR informed the Committee that document WPR/RC27/9 provided the Justification for a proposal that a regional centre for environmental health sciences, similar to the one in Lima, Peru, be established in the western Pacific Region.

Lacking in the Region were: facilities for intensive training courses on different aspects of environmental health for professionals and technicians; basic data and data on progress in the field of environmental health; criteria and standardized methods applicable to the Region; applied research activities aimed at developing autochthonous technology where only limited resources were available; and a regional forum where scientists could exchange experience.

It was proposed, if the Committee agreed, to carry out a study early in 1977 on the feasibility of establishing such a centre. He invited the Committee to indicate whether it supported the proposals in principle.

Mr BOREHAM (Australia) stated that the Government of Australia was not opposed to the proposed feasibility study, but wished to raise a number of pOints for discussion before the proposal was accepted.

The proposed terms of reference for the consultant appeared to presuppose the need for such a centre; however. the Government believed that the provision of adequate water supplies and basic sanitation in areas of the Region that lacked them should be given priority over a centre for environmental health sciences.

The main reasons advanced in the document for establishing such a centre were to carry out applied research; to collect and disseminate information; and to conduct training courses. With regard to the first two activities, there was already verY adequate published research material for dealing with the technical problems related to water supplies, sanitation, food hygiene. and air pollution. As regards training, courses for village health workers were the most urgent need and were best conducted in the trainee I s own countrY, while senior staff could be trained more economically in existing establishments in the Region.

Moreover, the Director~General had been asked by the World Health Assembly to ensure that by 1980 at least 60% of the regular programme budget would be spent on IItechnical cooperation". Before taking any decision it was advisable to clarify whether the proposed centre would come under the heading of IItechnical cooperation", a term that had not yet been defined.

To sum up, the Government of Australia was not opposed to the feasibility study, but doubted whether the proposed centre could achieve anything that could not be done equally well by existing mechanisms.

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SUMMARY RECORD OF THE TllRD MEETING

Dr KING (United States of America) said that the Government of the United States of America supported the proposal to conduct a feasibility study, but emphasized the need to await the results of

123

the study before making any assumptions as to whether a regional centre for environmental health sciences should be established. The study should define the needs that the centre might meet; indicate alternative methods of meeting those needs, including the use of existing facilities; and present a comprehensive analysis of the cost of each alternative. The study should also include a review of experience at the Lima Centre. The period of the study should be extended to four months to give sufficient time for analysis.

Finally, the Committee should guard against too ready an acceptance of the need to construct a separate building for the proposed centre.

Dr TANAKA (Japan) stated that the Government of Japan supported the proposal to set up a regional centre for environmental health sciences. However, several consultants might be needed to study the technical and financial feasibility of the proposal, and his Government would readily provide the services of its own experts. The centre need not necessarily be located in a developing country, but should be set up in the most suitable location as recommended by the consultants.

Dr MAJID (Malaysia) said he felt there was a good case for setting up a regional centre, as there were many enVironmental health problems peculiar to the Region which required more scientific study. There was a need to collect baseline data more systematically, analyse them thoroughly and present them meaningfully. A core of specialist inter­disciplinary scientific personnel needed to be trained, while bacterio­logists, entomologists, engineers and food technologists should be taught to appreciate the public health aspects of their work. The Delegation of Malaysia therefore supported the proposal to conduct a feasibility study.

Dr SUMPAICO (Philippines) supported the proposal that a feasibility study should be setup. The Philippines stood at the threshold of industrial development, which was vital for the country. Therefore, if the feasibility study pointed to the necessity for such a centre, his delegation would support its establishment.

Dr LEPROUX (France) informed the Committee that the Government of France, while taking a deep interest in environmental health, was not in favour of establishing the proposed Centre. It had pledged an annual contribution of US$ 1 500 000 for a period of five years to the United Nations Environmental Programme and considered that an optimal use of the data received in Geneva from the eXisting Centres in the Region would provide all the information required.

Speaking at the request of the CHAIRMAN, the REGIONAL DIRECTOR thanked the members of the Committee for their pertinent comments, which had provided valuable guidance.

124 REGIONAL COMMITmE: 'IWENTY-SEVENTH SESSION

Mr GO (Regional Adviser in Environmental Health) said that many of the issues raised by the Representative of Australia would be fully explored in the feasibility study. His concern that a white elephant might be created was understood. He personally was somewhat biased towards problems of the human environment and could not agree that, although the prOVision of rural water supplies was the first priority, one could ignore the many other environmental problems facing developing countries. It was noteworthy that. simultaneously with the current session of the Regional Committee, the Government of the Philippines was holding a conference on "Science and Human Survival" - thus showing the emphasis that it placed on such problems. Moreover, in 1977. among the major health concerns that were emerging in the developing countries, that of the quality of the environment was to be treated as a priority programme area by WHO.

As regards the concept of establishing the Centre, he stressed the desirability of promoting collaboration among countries. The proposed Centre would be a forum where nationals of countries or areas in the Region could work together on environmental problems indigenous to the Region. In reply to the comment made by the Representative of Australia that the activities of such a Centre might not be fully appropriate in view of the emphasis that had been placed on technical cooperation in resolution WHA29.48, he said that, in fact, the Centre would encourage technical cooperation. There were many activities, particularly in the field of training, that could be carried out more effectively with the facilities that would be provided by the Centre and that were not currently available. It was unlikely that any country of the Region, apart from the more advanced countries, would be able to set up a national institute dealing with environmental sciences. As had been pointed out by the Representative of Malaysia and other representatives, one of the problems faced by many countries was the lack of data on which policies could be based. The projected centre could fulfil that need more economically than separate national entities. If no immediate action were taken to facilitate the establish­ment of the Centre, the process might take 20 years.

Dr CHRISTMAS (New Zealand) doubted the advisability of bringing so many disciplines together in the same institute, since such a large collection of physiCists, chemists, engineers, and microbiologists might embrace a very large organization. The problems of occupational health and air pollution might be dealt with more effectively at one institute and those of food technology in relation to public health at another. Such institutes could then work in collaboration with each other.

Mr GO (Regi onal Adviser in Environmental Health) thought that it would be inadvisable to set up different centres to deal with various aspects, for reasons of economy, and because of the benefits to be derived from having persons from different disciplines working together. Many environmental policy issues could not be dealt with by a unisectoral approach. For instance, air pollution involved not only the ministry of health but also economic and social factors such as gain and adverse effects.

SUMMARY RECORD OF THE THIRD MEETING

The REGIONAL DIRECTOR pOinted out that the question raised by the Representative of New Zealand might be one of the topics to be explored in the feasibility study by one or more consultants.

Mr BOREHAM (Australia) said that his delegation welcomed the assurance given by the Regional Adviser in Environmental Health that the points raised would be fully discussed in the feasibility study.

125

The REGIONAL DIRECTOR expressed his appreciation of the offer made by the Delegation of Japan, to contribute the services of an environmental health consultant. He presumed that the Committee accepted the offer, without cost to the Organization.

It was so agreed.

There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.3.)

7 FREQUENCY OF MEETINGS OF THE REGIONAL COMMIT'IEE: Item 17.1 of the Agenda (Document WPR/RC27/11 Rev.l)

The REGIONAL DIRECTOR referred to document WPR/RC27 III Rev.l, which contained a report on the implications of changing the sessions of the Regional Committee to a biennial sequence.

Representatives would have noted the arguments for and against the proposal, including the fact that amendments to Articles 34 and 55 of the WHO Constitution had not yet entered into force and therefore the World Health Assembly still had to consider the budgetary and financial aspects of the biennial programme budget annually. The Committee might therefore feel that it also should review, in the year following its consideration of the proposed biennial programme budget, revisions to the budget proposals for the second year of the biennium.

It was up to the Committee to decide whether it wished to change the frequency with which it met immediately, or wait until the matter was considered throughout the Organization, probably when the amendments to Articles 34 and 55 entered into force.

The Regional Director went on to say that he had just received a message from WHO Headquarters regarding the proposed amendments to Articles 34 and 55 of the Constitution: by 26 August 1976. 75 Member States had accepted the amendments; 23 more acceptances were still required.

Dr FAAIUASO (Western samoa) suggested, in the light of the Committee's observations and points 3.5 and 3.6 of document WPR/Rc27/ll Rev.l, that further discussion of the subject be postponed until the amendments to the Constitution had entered into force.

126 REGIONAL COMMI'I'IEE: 'J.\oIENTY-SEVENTH SESSION

Dr EVANS (Australia) remarked that the matter had been raised by his delegation in 1975. Although the reasons advanced at that time in support of biennial sessions still held good, the Regional Director had mentioned certain practical difficulties in his report and in his statement. It might be advisable, therefore, to discuss the possible implementation of such biennial sessions at a later stage. The problems appeared to be that the Regional Committee needed to meet in even-numbered years in order to approve the programme budget; the Government of Japan had offered to act as host to the 1977 session and it would not be reasonable to suspend that session. By 1981, the World Health Assembly would probably have adopted biennial budgeting. His delegation therefore agreed with the suggestion of the Representative of Western Samoa, that discussion of the item should be postponed.

Dr MAJID (Malaysia) thought that, for a number of reasons, the current annual sequence of sessions should be. maintained. There was no obvious advantage to countries in changing the existing practice. The financial savings would be largely offset by the need for longer sessions. Most countries planned their national budgets annually and hence their programming activities also were on an annual basis. If the proposed change were accepted, it might upset financial procedures for the allocation of funds to various ministries. It might not be possible for countries to send senior officers to the sessions if they lasted longer. The annual seSSions, besides reviewing regional activities, also provided an opportunity for senior health officials to exchange their views on important technical developments, and promoted goodwill and understanding. In the absence of adequate justifications for the new practice, he urged that the proposal to change the frequency not be accepted and that a session of the Regional Committee continue to be held annually.

Dr SENILAGAKALr (Fiji) supported the view expressed by the Representative of Malaysia. The Government of Fiji had an annual budget and he foresaw difficulties in providing money for visits of senior officers to the Regional Committee if the meetings were held every second year and lasted longer. 'Ibe. theoretical savings did not justify the prolonged absence of such senior staff from their countries.

Dr SUMPAICO (Philippines) proposed that the status quo be preserved until more justifications for holding biennial sessions were forthcoming.

Dr DOS REMEDIOS (Portugal) said that his delegation was satisfied with the existing arrangement.

Dr mONG (Singapore) endorsed the comments made by the Representative of Malaysia. From the point of view of the Government of Singapore, fiscal arrangements would be much easier if meetings continued to be held annually.

Dr FAAIUASO (Western Samoa) asked what the position of the Regional Committee would be if the World Health Assembly changed the Constitution as had been proposed.

... -SUMMARY RECORD OF THE THIRD MEETING 127

Miss NEWTON (Chief, Administration and Finance) explained that, under the Rules of Procedure of the Regional Committee for the Western Pacific, which the Committee had adopted in accordance with the constitutional provisions, it could meet as often as it considered necessary. It had been the practice for the Committee to hold annual sessions but it was free to change the frequency of its meetings if it so desired.

There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.4).

8 ANNUAL REPORTING BY THE REGIONAL DIREC'roR: Item 17.2 of the Agenda (Document WPR/RC27/12 and Corr.l)

The REGIONAL DIREC'roR stated that, in 1977, the Director-General would present to the World Health Assembly, as background material for its consideration of the proposed programme budget for 1978 and 1979, a short report covering significant matters and developments in 1976. In 1978, he would publish and present to the Health Assembly a comprehensive report on the work of WHO in 1976 and 1977 - that is, the years covered by the present biennial programme budget. He would also discontinue publishing a report on individual projects. The decision to adopt that new cycle had been taken in order to relate reporting by the Director­General to biennial programme budgeting and to the new concept of programming by objectives and budgeting by programmes.

Document WPR/RC27/12 described the background to the Health Assembly's decision in detail. Representatives were requested to comment on whether the report of the Regional Director to the Regional Committee should follow a similar cycle; remembering that the proposed biennial programme budget was considered by the Committee in the year before it was considered by the Health Assembly and that the cycle of reporting to the Regional Committee would therefore have to be: a comprehensive report in odd­numbered years and a short report in even-numbered years.

Mr BOREHAM (Australia) congratulated the Regional Director on the clarity of the language in the documents before the Committee. The Delegation of Australia supported the proposal that the Regional Director should implement similar changes in the presentation of his report to the Regional Committee as those adopted for the Director­General's reports to the World Health Assembly. Thus a comprehensive report would be issued in odd-numbered years and, since in its consideration of the programme budget, the Regional Committee should be able to take a broader view instead of discussing minutiae, a shorter report in even-numbered years. Publication of a report on individual projects should also be discontinued.

128 REGIONAL COMMI'PIEE: 'lWENTY-SEVENTH SESSION

Dr MAJID (Malaysia) said that his delegation agreed with the views expressed by the Representative of Australia and had supported resolution WHA28.29. If the Committee decided to hold a session annually, then Malaysia would agree that the Regional Director should publish a comprehensive report every other year and a short report in the intervening year. The Delegation of Malaysia also agreed to the discontinuation of the report on individual projects.

There being no further comment, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.5.)

The meeting rose at 12 noon

I

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'''''' SUMMARY RECORD OF THE THIRD MEETING

ADDRESS BY THE INCOMING CHAIRMAN

Respected Regional Director, Distinguished Representatives, Representatives of the United Nations, and related

organizations and non-governmental organizations, Ladies and Gentlemen,

129

ANNEX 1

Yesterday when this meeting elected me to this Chair, I stated that I would give a brief address this morning.

First of all, let me say how very grateful I am for the great honour you all have bestowed on rrry country, Fiji, and on me personally, as one of the representatives to this meeting. I do thank you all for your confidence in me.

Having come from a tiny country; from the remotest part of the Pacific to these large and beautiful islands, and amidst such distinguished and experienced representatives, I find myself unworthy to be so honoured.

As this is the first occasion that Fiji is chairing this meeting, I do plead for your close cooperation and assistance in carrying out my duties. You already indicated your willingness to cooperate in no small means yesterday. If there are any shortcomings, you will no doubt bear with me, in the same spirit as elder and more experienced members of a family treat the smaller individuals in the household.

May I also take this opportunity to thank most sincerely the fellow Member countries of this Region that successfully supported my country's candidature for the Executive Board of the World Health Organization, at the last World Health Assembly in Geneva.

May I also warmly congratulate the Vice-Chairman and the distinguished Rapporteurs on their election. I feel certain of their fullest cooperation.

Distinguished Representatives, whilst we meet here to deliberate on matters affecting the health and welfare of people generally, we are not unmindful of the sad and tragic calamities that have recently befallen parts of this very country, where we all have gathered together for this important meeting.

130 REGIONAL COMMITmE: 'IWENTY-SEVENTH SESSION

On behalf of my Government - I am sure all other distinguished representatives share my sentiments - I wish to convey my heartfelt sympathies and condolences to the Government and the people of the Republic of the Philippines on this major disaster causing loss of thousands of innocent lives and property. We all mourn for the victims of this disaster and do wish the stricken areas a speedy recovery.

Finally, distinguished representatives, I pray for God's guidance in our deliberations and with this meeting every success. Thank you.