Dr. Inoue gave us a talk on proper behavior and attitude of participating in an international meeting. Detailed report available in Japanese text only.

　

　

Dr. Nesbit gave us a lecture on the structure/functions of WHO. The key points from the lecture are:

　

[What is WHO?]

United Nations specialized agency for health

Established on 7 April 1948

191 member states

[Structure]

WHO performs through three principal bodies:

◇World Health Assembly

-composed of representatives from WHO's Member States Secretariat

-held in May, in Geneva

-to approve programs and budgets for the following biennium and to decide major policy questions

◇Executive Board

◇secretariat

-headed by Director-General (Dr. Gro Harlem Brundtland)

WHO has its headquarters, six regional offices and country offices:

◇Headquarters -Geneva, Switzerland

◇Regional Offices

◇Country Representative Offices

[Collaboration]

WHO works closely with other Organizations in the UN System and collaborates with

[Core functions]

[Strategic directions]

　

Dr. Nesbit also explained to us the structure and the issues of WPRO.

　

[About WPRO]

27 member states within 37 countries

Covers a population of 1.6 billion people

＜Regional Committee＞

･Held in September

･Formulate policies governing matters of a regional nature

･Supervise activities of the regional office

＜Issues＞

･Health sector reform-insurance, decentralization issue

･Epidemiological transition-communicable→ non-communicable

･Demographical transition

･Inequity, Poverty

　

　

We had a lecture about Expanded Program on Immunization, especially on eradication of Polio. Detailed report available in Japanese text only.

　

　

Dr. Stanton started with a pop quiz. The questions were as below.

　

Then he gave us a lecture on o control with a passionate message, that reducing o consumption would be the most effective measure to prevent premature deaths.

　

Today, about 1.1 billion people smoke worldwide. By 2025, the number is expected to rise to more than 1.6 billion. Reducing o consumption can prevent millions of premature deaths and much disability. While o consumption is declining in men in developed countries, smoking is sharply increasing among men in low and middle-income countries. o use in women is also increasing in most countries. Smoking causes fatal and disabling disease, and compared to other risky behaviors, the risk of premature deaths is extremely high. Half of regular smokers will eventually be killed by o, half of them in middle age.

　

However, policymakers are reluctant from taking action to control smoking because they are worried about economic consequences of o control. For example,

･o tax increases would reduce revenue

･o control would lead to permanent job loss

　

However, even countries heavily dependent on o farming would not see permanent job loss because the decline of jobs would be gradual and the economy would have time to adjust.

　

There are several approaches to o control:

･Rising o taxes

･Bans on o advertising and promotion

･Counter-advertising campaigns

･Prominent health warning labels on cigarette packs

･Restrictions in public and work places

　

Japan has big problems in o control, especially with flourishing advertisement and promotion, and not labeling prominent health warning on cigarette packs. Also, there are too many vending machines.Japan is very behind other developed countries in o control.

　

Smoking also has affects on nonsmokers. Infants born to smoking mothers are in great risks. They face a greater risk of respiratory diseases such as asthma, and risk of dying from sudden infant syndrome. Smokers rapidly become addicted to nicotine and many of them do not understand the danger of nicotine addiction. Therefore, the o dependent treatment plays an important role in o control.

Treatment + Prevention = maximal public health benefit.

So widening access to NRT (Nicotine Replacement Therapy) is very important.

　

Dr. Stanton concluded his lecture by emphasizing again the importance of taking action to reduce smoking because it saves a lot of lives.

　

　

Dr. Omi spared 3 hours for us. He answered kindly to our many questions and told us about his background and his dream. Detailed report available in Japanese text only.

　

　

Because Dr. Omi gave us an exciting 3 hour lecture, which was originally scheduled for 30 minutes, some lectures were canceled and the next class started immediately with no break in between.

　

Dr. Palmer started his lecture with an explanation of the idea of the title, Roll Back Malaria. Malaria had been greatly reduced in the 1990s, but the disease still causes about 20,000 deaths per year in the Western Pacific Region. There is a need to recognize that malaria is not a former disease but a major public health issue we still have to face with.

　

He showed us an epidemiological map of the Philippines. The incidence and mortality rates are high in the northern Luzon, Mindanao, and the Palawan Islands. Those are the relatively poor areas in this county. Through the statistics, we could see that the number of confirmed cases and the incidence rate of malaria are being steadily reduced after 1990's, but the number of malaria death has not changed. In the background of this fact, we can say that there are problems such as drug shortage, drug-resistant malaria, as well as use of self-diagnosis and self-medication including traditional herbal remedies.

　

As a top priority, we need to tackle poverty. At the same time, we have to promote health education to rural residents, ensure high coverage and good targeting of insecticide-treated nets and other locally appropriate vector control methods, train health workers for correct and prompt diagnosis (dipstick examination or microscopy) and appropriate medical treatment, and supply enough drugs to every health station, as well as make a referral system for severe malaria cases.

　

In order to carry out these strategies, there must be close partnership among NGOs, Ministry of Health, Ministry of Education, Ministry of Agriculture, police and military forces, female organizations, as well as international organizations like UNICEF and UNDP.

　

I understood from this lecture that each strategy is very reasonable, but malaria seems to take a long time to be conquered because the project has to be considered from many aspects. Someone with strong leadership must play a role of an organizer. I felt that it is the role of WHO to show stronger leadership.

　

　

The impact hazards have on an area greatly differs depending on its vulnerability or readiness. Damage by a hazard can be lessened by readiness. Therefore, WHO enforces and assists programs for emergency preparedness, disaster mitigation and emergency response. Detailed report available in Japanese text only.

　

　

Many problems have emerged in relation to urbanization of an area. The Health City Project aims for the improvement of health and quality of life of people under all kinds of situations. Detailed report available in Japanese text only.

　

　

The first cases of human immunodeficiency virus (HIV) infection started to be reported in the Region in the midl980's. By the end of 1999, the Regional Office estimated that more than 900000 individuals in the Region were infected with HIV. By the end of 2000, it was projected that this number will exceed 1 million. Currently high and increasing HIV incidence through primarily heterosexual transmission is seen in Cambodia and in certain areas of Papua New Guinea. High HIV incidence among injecting drug users and increasing HIV heterosexual transmission is found in China and Vietnam. However, there is the potential for increased HIV transmission in many countries, given the high incidence and prevalence of sexually transmitted infections (STIs) in the Region.

It is essential that HIV prevention measures be continued and intensified. The transmission of AIDS is strongly associated with that of other STIs. Achieving reductions in STI transmission is an effective way of reducing the transmission of HIV. The Regional Office estimates that more than 35 million new cases of curable STIs occur in the region annually STI rates in the sexually active population generally vary from 2% to 5%, and in female sex workers from 20% to 40%. This emphasizes the need to target sex workers and their clients as priority groups for STI prevention and treatment.

　

HIV Rate

　

WPRO efforts in HIV/AIDS

･Condom programs for high risk individuals

･Development of STI service

･Development of harm reduction for IDU (injection drug use)

･HIV/AIDS care and support

･Epidemiological surveillance

･Development of national blood services