El proceso de creación de la Organización Mundial de la Salud y la Guerra Fría / The process of creation of the World Health Organization and the Cold War

Este artículo estudia el proceso médico y político de surgimiento de la Organización Mundial de la Salud (OMS), la principal agencia multilateral de salud, formalmente fundada en 1948 y ligada a la recientemente creada Organización de las Naciones Unidas. Este proceso se inició hacia el final de la Segunda Guerra Mundial, en 1945, cuando Estados Unidos y la Unión Soviética colaboraron para vencer a los nazis, y culminó poco después del inicio de la Guerra Fría en 1947, es decir, de la rivalidad entre las superpotencias soviética y norteamericana. La OMS pudo legitimarse en este cambiante contexto y dejar un legado que hasta ahora es importante en la salud pública.

Divorce between theory and practice: the system of public health training in the United States.

Many analysts have complained about the severe disconnect between public health as it is taught in schools of public health and public health as it is practiced in health departments. At least in the United States, few faculty members teaching in schools of public health have ever worked in public health departments. By the same token, few of those working in public health departments have degrees from schools of public health; most receive on-the-job training. This history traces the roots of this disconnect or "divorce between theory and practice." It finds that the 1930s were the prime years of community-based public health education, when the pressure of the Depression and the funding newly made available from the federal government by New Deal legislation encouraged practical training programs linked to local communities and health departments. The "divorce" began in the post-war period as an unintended consequence of the system for funding medical education and research at a time of general unpopularity of public health during the McCarthy era. Schools of public health were generally ignored in the 1950s and they began to adapt the strategy that continues today, of using research grants, primarily from the National Institutes of Health, to grow their faculty and facilities.

Divórcio entre teoria e prática: o sistema de treinamento em saúde pública nos Estados Unidos / Divorce between theory and practice: the system of public health training in the United States

Muitos analistas têm criticado a profunda separação entre saúde pública como é ensinada nas escolas de saúde pública e a praticada nos órgãos governamentais. Nos Estados Unidos, muitos membros do corpo docente de escolas de saúde pública jamais trabalharam em órgãos de saúde pública, poucos dos que trabalham em órgãos públicos têm certificados de escolas de saúde pública e a maioria recebe treinamento no local de trabalho. Este artigo busca identificar as raízes desta separação ou "divórcio entre teoria e prática". Mostra que a década de 1930 foi o principal período da educação em saúde pública voltada à comunidade, quando o peso da Grande Depressão e a verba disponibilizada pelo governo federal através da legislação do New Deal incentivaram programas de treinamento prático vinculados a comunidades locais e órgãos públicos. O "divórcio" teve início no período do pós-guerra como uma conseqüência não intencional do sistema de alocação de verbas para a educação médica e a pesquisa, em um momento de impopularidade generalizada da saúde pública durante a era McCarthy. As escolas de saúde pública eram, de modo geral, ignoradas na década de 1950 e começaram a adaptar a estratégia ainda vigente de usar verbas federais de pesquisa para ampliar seu corpo docente e instalações.

Many analysts have complained about the severe disconnect between public health as it is taught in schools of public health and public health as it is practiced in health departments. At least in the United States, few faculty members teaching in schools of public health have ever worked in public health departments. By the same token, few of those working in public health departments have degrees from schools of public health; most receive on-the-job training. This history traces the roots of this disconnect or "divorce between theory and practice." It finds that the 1930s were the prime years of community-based public health education, when the pressure of the Depression and the funding newly made available from the federal government by New Deal legislation encouraged practical training programs linked to local communities and health departments. The "divorce" began in the post-war period as an unintended consequence of the system for funding medical education and research at a time of general unpopularity of public health during the McCarthy era. Schools of public health were generally ignored in the 1950s and they began to adapt the strategy that continues today, of using research grants, primarily from the National Institutes of Health, to grow their faculty and facilities.

[The transition from 'international' to 'global' public health and the World Health Organization]. / A transição de saúde pública 'internacional' para 'global' e a Organização Mundial de Saúde.

Within the context of international public health, 'global health' seems to be emerging as a recognized term of preference. This article presents a critical analysis of the meaning and importance of 'global health' and situates its growing popularity within a historical context. A specific focus of this work is the role of the World Health Organization - WHO in both 'international' and 'global' health, and as na agent of transition from one to the other. Between 1948 and 1998, the WHO went through a period of hardship as it came up against an organizational crisis, budget cuts and a diminished status, especially when confronted with the growing influence of new, power players like the World Bank. We suggest that the WHO has responded to this changing international context by inititating its own process of restructuring and repositioning as an agent for coordinating, strategically planning and leading 'global health' initiatives.

A transição de saúde pública internacional para global e a Organização Mundial da Saúde / The transition from international to global public health and the World Health Organization

No contexto da saúde pública internacional, 'saúde global' parece estar emergindo como um termo de reconhecida preferência. Este artigo apresenta uma análise crítica do significado e importância de 'saúde global', e situa sua crescente popularidade no contexto histórico. Um foco específico deste estudo é o papel da Organização Mundial da Saúde - OMS, tanto na saúde 'internacional' quanto na 'global', e como um agente na transição de uma para outra. Entre 1948 e 1998 a OMS enfrentou dificuldades, ao deparar com uma crise organizacional, cortes orçamentários e status diminuído, especialmente em face da crescente influência de novos e poderosos atores, como o Banco Mundial. Sugerimos que a OMS começou a remodelar-se e a reposicionar-se nos papéis de coordenação, planejamento estratégico e liderança de iniciativas de 'saúde global', em resposta a esse contexto internacional em transformação.

Within the context of international public health, 'global health' seems to be emerging as a recognized term of preference. This article presents a critical analysis of the meaning and importance of 'global health' and situates its growing popularity within a historical context. A specific focus of this work is the role of the World Health Organization - WHO in both 'international' and 'global' health, and as an agent of transition from one to the other. Between 1948 and 1998, the WHO went through a period of hardship as it came up against an organizational crisis, budget cuts and a diminished status, especially when confronted with the growing influence of new, powerful players like the World Bank. We suggest that the WHO has responded to this changing international context by initiating its own process of restructuring and repositioning as an agent for coordinating, strategically planning and leading 'global health' initiatives.