ADDRESS
By
C, Everett Koop. M.D., Sc.D,
SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

#O>

PRESENTED AT THE 4OTH ANNIVERSARY OF THE WorRLD HEALTH ORGANIZATION
UnitTeD Nations, New York
OcToBer 27, 1988
1
MR. PRESIDENT, DIRECTOR-GENERAL NAKAJIMA, EXCELLENCIES,

DISTINGUISHED DELEGATES, LADIES AND GENTLEMEN:

AS SURGEON GENERAL, I REGARD IT BOTH AS A PRIVILEGE AND A
~ GREAT PERSONAL PLEASURE TO REPRESENT MY COUNTRY AT TODAY'S
EVENTS HONORING THE WORLD HEALTH ORGANIZATION,

FOR MOST OF MY CAREER, I HAVE BEEN INVOLVED IN
INTERNATIONAL HEALTH WORK, BUT IT HAS ONLY BEEN IN THE
PAST EIGHT YEARS, DURING MY TENURE AS SURGEON GENERAL OF THE U.S,
PUBLIC HEALTH SERVICE, THAT I HAVE HAD THE OPPORTUNITY TO
WORK CLOSELY WITH THE LEADERSHIP AND STAFF OF THE
WORLD HEALTH ORGANIZATION,
2
THE EXPERIENCE HAS REINFORCED MANY TIMES OVER MY BELIEF THAT

WeH.O. TS NOT ONLY AN AGENCY WHOSE EXISTENCE IS ESSENTIAL TO
WORLD HEALTH, BUT IS ALSO AN ORGANIZATION WHOSE ACCOMPLISHMENTS
OVER THE PAST 40 YEARS HAVE EVEN EXCEEDED THE GREAT HOPES THAT
ATTENDED ITS BIRTH,

W.H.O. WAS FOUNDED IN THE AFTERMATH OF WORLD WAR IT, IN A
TIME OF GREAT ECONOMIC AND SOCIAL UPHEAVAL:

* THE HEALTH SYSTEMS OF MANY NATIONS WERE DEVASTATED OR
NON-EXISTENT.
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* COMMUNICABLE DISEASES TOOK HEAVY TOLLS. SMALLPOX,

TUBERCULOSIS, MALARIA AND OTHER DISEASES WERE SO PREVALENT
THAT FEW COUNTRIES WERE SPARED,

* MANY MILLIONS OF INFANTS AND CHILDREN DIED EACH YEAR
BEFORE THE AGE OF FIVE,

THE NEED FOR AN INTERNATIONAL HEALTH ORGANIZATION WAS
APPALLINGLY EVIDENT,
4
AND, WE NOW KNOW THAT THE ORGANIZATION THAT EMERGED DURING

THAT PERIOD HAS SURPASSED OUR GREATEST EXPECTATIONS. AND IT HAD
A POWERFUL CONCEPT ... “THAT HEALTH, GOOD OR ILL, COULD NEVER
AGAIN BE PURELY A NATIONAL PHENOMENON.” THAT CONCEPT HAS
STIMULATED AND GUIDED THE WORLD HEALTH ORGANIZATION,

THE HEALTH STATUS OF ALL THE PEOPLE OF THE WORLD -- WHETHER
THEY LIVE IN DEVELOPED OR DEVELOPING COUNTRIES -- AFFECTS ALL
OTHERS. IT WAS THEREFORE IN THE INTEREST OF ALL NATIONS TO WORK
TOGETHER TO ADDRESS THE TOTALITY OF WORLD HEALTH PROBLEMS,
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NO VEHICLE WAS BETTER SUITED TO THE TASK THAN W.H.O,

AS WE LOOK AT OUR WORLD TODAY, WE SEE THAT ENORMOUS PROGRESS
HAS BEEN MADE IN THE FOUR DECADES DURING WHICH W.H.O. EVOLVED
FROM A TECHNICAL ASSISTANCE AGENCY, PRIMARILY CONCERNED WITH
COMMUNICABLE DISEASES CONTROL, TO A PARTNER OF ALL NATIONS IN
THE SUPPORT OF NATIONAL GOALS FOR HEALTH FOR ALL.

o WE HAVE IMPROVED OUR HEALTH CARE SYSTEMS AND MADE HEALTH
SERVICES AVAILABLE TO A DEGREE UNKNOWN 40 YEARS AGO.
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WE HAVE MADE GREAT STRIDES IN DEALING WITH COMMUNICABLE

DISEASES, ESPECIALLY MALARIA, DIARRHEAL DISEASES, AND
DISEASES THAT CAN BE PREVENTED BY VACCINATION.

LIFE EXPECTANCY HAS RISEN FROM A WORLDWIDE AVERAGE OF 41
YEARS IN 1950 TO 61 YEARS TODAY.

AND, WHILE FAR TOO MANY CHILDREN STILL DIE BEFORE THE AGE OF
FIVE, THE WORLD IS CERTAINLY A SAFER PLACE FOR CHILDREN,

THE NUMBER OF INFANTS AND CHILDREN WHO DIE BEFORE THE AGE OF
FIVE IS MANY MILLIONS LESS TODAY THAN THE NUMBER WHO DIED
DURING THE 1950'S, EVEN THOUGH THE TOTAL CHILD POPULATION

IN THE WORLD HAS SUBSTANTIALLY INCREASED.
/
WHILE THIS PROGRESS COULD NOT HAVE BEEN MADE WITHOUT A

GENUINE COMMITMENT ON THE PART OF NATIONAL GOVERNMENTS, THE
LEADERSHIP, THE GUIDANCE, THE ASSISTANCE, AND THE INSPIRATION
PROVIDED BY W.H.O. WERE ESSENTIAL INGREDIENTS IN OUR COLLECTIVE
SUCCESS.

TODAY, THANKS TO A VERY ACTIVE AND SUCCESSFUL W.H.0,
EXPANDED PROGRAM ON IMMUNIZATION, THERE IS EXCELLENT VACCINATION
COVERAGE AGAINST POLIOMYELITIS, DIPHTHERIA, TETANUS, WHOOPING
COUGH, MEASLES, ANID TUBERCULOSIS,
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AND, AT THE REQUEST OF MEMBER NATIONS, W.H.O. HAS NOW

LAUNCHED A SPECIAL EFFORT TO ELIMINATE POLIO EVERYWHERE. POLIO
MAY WELL BECOME THE SECOND DISEASE TO BE ERADICATED THROUGH THE
EFFORTS OF MANKIND,

THE SUCCESS STORY OF THAT FIRST ERADICATION EFFORT, AGAINST
SMALLPOX, HAS BEEN RECOUNTED MANY TIMES. AND, WHY NOT! THE
HUMAN RACE HAD NEVER BEFORE BEEN ABLE TO ACHIEVE SUCH A MEDICAL
MIRACLE AS THE ELIMINATION OF A SPECIFIC DISEASE FROM OUR
PLANET.
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THE ERADICATION OF SMALLPOX UNDER W.H.O. LEADERSHIP WILL

FOREVER REMAIN AS TESTIMONY TO THE KIND OF ACHIEVEMENTS THAT CAN
BE REALIZED WHEN THE NATIONS OF THE WORLD WORK TOGETHER TOWARD A
COMMON GOAL.

ORAL REHYDRATION THERAPY IS WELL ON ITS WAY TO BECOMING
ANOTHER SUCCESS STORY. IT IS BECOMING SO EFFECTIVE THAT THE
LIVES OF COUNTLESS INFANTS AND CHILDREN ARE BEING SPARED, THE
THERAPY, OF COURSE, IS BASED ON A SIMPLE SOLUTION OF WATER,
SUGAR, AND SALTS ... A FORMULA DEVISED BY W.H.0. SCIENTISTS,
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THE WORK ON MALARIA ALSO CONTINUES TO HOLD PROMISE THAT THIS

DISEASE, T00, WILL ONE DAY BE CONQUERED. FROM ITS CREATION,
W.H.O. HAS TARGETED THIS DISEASE. AND DESPITE THE DIFFICULTIES
OF MALARTA CONTROL, WE CAN REMAIN OPTIMISTIC ABOUT THE FUTURE.

W.H.O.°S SPECIAL PROGRAM FOR RESEARCH AND TRAINING IN
TROPICAL DISEASES HAS ALREADY SHOWN THAT CONCERTED SCIENTIFIC
EFFORTS CAN PRODUCE REMARKABLE ACHIEVEMENTS IN DEVELOPING METHODS

AND TOOLS FOR REDUCING OR ELIMINATING COMMUNICABLE DISEASES,
INCLUDING MALARIA,
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THE TROPICAL DISEASES RESEARCH PROGRAM UNIQUELY EXEMPLIFIES

THE ACHIEVEMENTS THAT CAN COME ABOUT WHEN DIFFERENT GROUPS, EVEN
THOSE WITH DIVERSE PHILOSOPHIES, JOIN HANDS AND WORK TOGETHER,

WITH URGING AND GUIDANCE FROM W.H.O., WE HAVE ALSO SEEN
DRAMATIC CHANGES IN HEALTH MANPOWER UTILIZATION AND A COURAGEOUS
REORIENTATION OF MEDICAL EDUCATION TOWARD PRIMARY HEALTH CARE,
TO PROVIDE A MORE REALISTIC APPROACH TO THE HEALTH NEEDS OF
LARGE POPULATIONS.
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THESE SUCCESS STORIES ARE IMPRESSIVE. BUT IF ANYTHING, THEY

SHOULD SERVE AS A STIMULUS TO US TO DO BETTER. THEY MUST NOT BE
AN EXCUSE FOR COMPLACENCY,

WE KNOW ALL TOO WELL THAT VICTORY OVER DISEASE IS OFTEN
COUNTER-BALANCED BY THE APPEARANCE OF NEW THREATS AND NEW
DISEASES,

WE ARE NOW EXPERIENCING THIS WITH AIDS.
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AIDS THREATENS EVERY NATION AND PRESENTS AN UNPRECEDENTED

CHALLENGE TO INTERNATIONAL PUBLIC HEALTH. EACH COUNTRY AFFECTED
THAT CONFRONTS THIS NEW HEALTH PROBLEM MAY DISCOVER IT MAY NEED
TO RESPOND WITH RESOURCES OF SO GREAT A MAGNITUDE THAT IT CAN
DEVASTATE THE VERY HEALTH SYSTEM IT IS TRYING TO STRENGTHEN,

THIS THREAT EXISTS FOR DEVELOPED AND DEVELOPING NATIONS
ALIKE. BUT, AS I STATED A YEAR AGO AT THIS SAME PODIUM, AIDS IS
POTENTIALLY MORE DESTRUCTIVE TO DEVELOPING NATIONS THAN TO THE
DEVELOPED OR INDUSTRIALIZED WORLD.
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AIDS TENDS TO IMPACT MOST OFTEN ON THE MOST PRODUCTIVE

MEMBERS OF SOCIETY: THE BREADWINNERS IN THE PRIME OF THEIR LIVES
HENCE, DEVELOPING NATIONS HIT BY AIDS COULD LOSE AN IRREPLACEABLE
GENERATION OF ENGINEERS, HEALTH WORKERS, TEACHERS, AND GOVERNMENT
OFFICIALS, AS WELL AS WORKERS IN AGRICULTURE, INDUSTRY, AND
TRADE.

AIDS HAS THE POTENTIAL TO DEVASTATE A COUNTRY’S PLANS FOR
DEVELOPMENT,
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A YEAR AGO, IN MY REMARKS HERE, I CALLED UPON W.H.O. AND THE

NATIONS OF THE WORLD TO GIVE A HIGH PRIORITY TO MAKING THE
WORLD'S BLOOD SUPPLY SAFE FOR TRANSFUSION. I EXPRESSED THE HOPE
THAT BY WORKING TOGETHER WE MIGHT DO THIS BY 1991,

A SAFE BLOOD SUPPLY IS IMPORTANT EVERYWHERE. THAT GOES
WITHOUT SAYING. BUT IN THE DEVELOPING WORLD IT HAS PARTICULAR
SIGNIFICANCE FOR TOURISM, BUSINESS, AND FOREIGN INVESTMENT,

OVER THE PAST YEAR, HIV SCREENING OF BLOOD DONORS HAS BEEN
INITIATED IN MANY COUNTRIES. IN SOME COUNTRIES IT IS NOW
MANDATORY. AND I UNDERSTAND THAT ALL AFRICAN COUNTRIES MAY BE
ABLE TO DO COMPLETE HIV SCREENING OF BLOOD DONORS BY THE END OF
THIS YEAR.
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APPROPRIATE POLICIES TO INSURE SAFE BLOOD DONORS HAVE BEEN

IMPLEMENTED IN MOST COUNTRIES, AND THE NEED TO LIMIT TRANSFUSIONS
TO THE NUMBER ABSOLUTELY NECESSARY IS ANOTHER STRATEGY BEING

PURSUED.

W.H.O. IS COORDINATING A GLOBAL BLOOD SUPPLY INITIATIVE
SUPPORTED BY SEVERAL ORGANIZATIONS, INCLUDING W.H.0.'S
GLOBAL PROGRAM ON AIDS AND THE W.H.O. LABORATORY TESTING UNIT,
THE LEAGUE OF RED CROSS AND RED CRESCENT SOCIETIES, THE
INTERNATIONAL SOCIETY FOR BLOOD TRANSFUSION, AND THE UNITED
NATIONS DEVELOPMENT PROGRAM,
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THESE BEGINNINGS MUST BE SUSTAINED AND SUPPORTED BY ALL

MEMBER NATIONS.

BECAUSE THE UNITED STATES HAS THE LARGEST EXPERIENCE WITH
AIDS, WE ARE ABLE TO SHARE OUR NATIONAL EXPERIENCE FOR THE
BENEFIT OF OTHER NATIONS,

AIDS IS A RISK TO ALL SOCIETY AND NOT JUST TO ONE OR MORE
NARROW GROUPS. AIDS IS STILL SPREADING IN THE UNITED STATES,
BOTH GEOGRAPHICALLY AND NUMERICALLY AND WE MUST STILL CONSIDER
IT A RISK TO ALL OF SOCIETY.
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HENCE, IN 1987 THE UNITED STATES MOUNTED THE LARGEST MOST

COMPREHENSIVE EDUCATIONAL CAMPAIGN IN THE HISTORY OF PUBLIC
HEALTH TO TELL THE PUBLIC THE FACTS ABOUT AIDS. IT IS DIFFICULT
TO MEASURE THE BEHAVIORAL CHANGES THAT TAKE PLACE AFTER
EDUCATION.

THE HOMOSEXUAL POPULATION HAS INDEED HEARD US, AND THE FACT
THAT THEY HAVE CHANGED THEIR BEHAVIOR IS EVIDENCE BY THE DECLINE
NOT ONLY IN OTHER SEXUALLY TRANSMITTED DISEASES AMONG HOMOSEXUAL
MEN BUT IN THE ACTUAL DROP IN THE INCIDENCE OF NEW CASES OF AIDS
AMONG THIS GROUP,
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BUT WE ARE CONCERNED THAT ALL OF OUR YOUNG PEOPLE RECEIVE

AND UNDERSTAND THAT EDUCATIONAL MESSAGE AND THE CHALLENGE FOR US
IS TO FIND INNOVATIVE AND CREATIVE WAYS OF GETTING THE MESSAGE
ACROSS SO THAT THESE YOUNG PEOPLE DO NOT EXPERIENCE A DECADE OF
SELF-DESTRUCTION,

THE GLOBAL FIGHT AGAINST AIDS WILL TAKE MANY YEARS, AND IT
WILL REQUIRE POLITICAL AND HEALTH LEADERS ALIKE TO HAVE THE
STRENGTH OF COMMITMENT NECESSARY TO MAKE DIFFICULT DECISIONS, TO
STAND FIRM AGAINST UNREASONABLE FEAR, AND TO MAINTAIN THE
CONSISTENCY AND UNITY OF ACTION THAT ARE ABSOLUTELY VITAL FOR A
GLOBAL FIGHT AGAINST THIS GLOBAL THREAT.
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NO COUNTRY CAN FIGHT AIDS ON ITS OWN. THE LEADERSHIP

NECESSARY TO COORDINATE OUR EFFORTS CAN ONLY COME FROM THE WORLD
HEALTH ORGANIZATION. W.H,.O. IS THE LINCHPIN HOLDING TOGETHER OUR
INDIVIDUAL EFFORTS AND GUIDING THEM INTO A GENUINELY UNIFIED
GLOBAL ATTACK ON AIDS.

T COMMEND W.H.0. FOR ITS EFFORTS AGAINST AIDS THUS FAR. I
AM CONFIDENT THAT UNDER ITS NEW DIRECTOR GENERAL, DR. HIROSHI
NAKAJIMA, W.H.O. WILL CONTINUE TO PROVIDE US WITH THE LEADERSHIP
AND GUIDANCE THAT WILL SOME DAY BRING US VICTORY.
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AFTER ALL, ONLY UNITED ACTION BY ALL COUNTRIES CAN BRING

ABOUT REAL AND LASTING IMPROVEMENTS IN THE HEALTH OF ALL THE
WORLD'S PEOPLE. AND THAT INCLUDES UNITED ACTION AGAINST AIDS,
THE GREATEST POTENTIAL CATASTROPHE ON TODAY’S HORIZON OF HEALTH,

THANK YOU.
HHH HF