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Since its founding more than a century ago, the leadershipof the American Public Health Association has recognizedthe importance of understanding public health from aglobal perspective. This was not only to protect the healthof the public, but also for international humanitarianismand justice, so all people everywhere can achieve the high-est levels of health and quality of life.

Ironically, almost exactly one hundred years after its found-ing, the APHA established a special membership section forInternational Health. This became the focal point for all ofthe APHA members who have a professional interest inhow APHA can contribute toward the improvement ofpublic health in international or global settings.

The growth and development of the APHA InternationalHealth Section is outlined in detail in the following histori-cal document account. As you will discover, APHA itselfhas gone through many changes as it approached this agen-da. This historical review explains how APHA viewedInternational Health from a professional, scientific, politi-cal as well as a financial perspective. The lessons learnedfrom this historical review provide important insights bothto APHA leadership, the membership at large, and to thosewith whom APHA seeks to become partners.

APHA leadership, members, and International Health staffhave demonstrated a special ability to tie APHA’s publichealth interests, both domestic and international, into thestrategic priorities of the global health community.Through government and private initiatives, bi-lateral aswell as multi-lateral efforts, APHA has worked aggressivelyto promote and protect the health of all citizens of theworld. The unique linkage between APHA and the WorldFederation of Public Health Associations has been a criticalpartnership ally in this process.

Given all of the changes in our global community since theappearance of SARS, it is woefully apparent that

International Health cooperation must be a priority of thepublic health community. APHA has the opportunity,experience, and capacity to assume a key leadership role inthe changed world in which we all live.

As you read this history, I urge you to use these experiencesto better identify and support what next steps APHAshould take in helping to improve the public health of allof the world’s citizens. At the same time, you have theopportunity to decide how you and your skills can con-tribute to this future agenda. APHA has developed a solidbase, a talented and energized membership and staff. Weare now ready to move with confidence into our secondcentury of International Health leadership.

On behalf of the Executive Board of APHA I want to per-sonally thank everyone involved in the development of thisimportant documentation of APHA’s history. We especiallywant to thank the Rockefeller Foundation for their enlight-ened support some four decades ago in helping launch in1959 APHA’s international endeavors, and, now in 2003,for their support enabling us to undertake this timely histo-ry documentation.

Finally, a special word of thanks to Frank Lostumbo,APHA member who authored the history, and to theAdvisory Committee members—Ray Martin, RussellMorgan and Allen Jones—who assisted in the process.

Georges Benjamin, MD, FACPExecutive DirectorSeptember 30, 2003

PREFACE

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ForewordThe International Health Section (IHS) of the AmericanPublic Health Association (APHA) commissioned thepreparation of a history beginning with the Section’s incep-tion in 1976. However, to understand properly the evolu-tion of the IHS it is important to include the unfolding ofinternational health as seen from APHA’s perspective,including the establishment and growth of its global affili-ate the World Federation of Public Health Associations(WFPHA). The history is based on an analysis of availableIHS and APHA files, publications, and newsletters supple-mented by oral interviews with current and former mem-bers. The file information served as a guide and referencepoint for some 50 interviews, which provided in depthperspective on many key events. An advisory committeeguided the process and included Ray Martin, retiredUSAID/Chair IHS, Allen Jones, Director Education &Global Health Resources, APHA/Secretary GeneralWFPHA, and Russell Morgan Jr., President, SPRYFoundation and formerly senior international health staffat APHA 1970-1979.

IntroductionThe origin of the International Health Section wasbased on the need for an international health constituencywithin APHA and an international health forum thatwould encourage dialogue on the interdependence ofdomestic and international health issues. To understandthis evolution the review includes the early vision of APHAleaders during the formative period of APHA’s initial agen-da for international health. That interest began in the mid-50s with the emergence of APHA leaders wanting to beengaged internationally while the majority of the 13,000APHA members and many affiliates placed higher priorityon domestic public health issues at state, community, andlocal levels.

BackgroundThe APHA is a membership association with headquar-ters in Washington, DC. The organization currently has30,000 members, including 1,600 members from othercountries plus state affiliates. The membership is diverseand includes officials and workers from most health andhealth related professions/organizations across many levelsof government, academia, and private entities. The struc-ture of the organization is complex and encompasses thevolunteer Executive Board with numerous committees; aGoverning Council made up of councilors elected from thesections, special interest groups (SPIGS), and affiliates; 26autonomous sections each with their own volunteer leader-ship; and 65 APHA staff organized in functional unitsheaded by an Executive Director. The significance of themultidisciplinary make-up of APHA is reflected in eachelection cycle as new members ascend to the voluntaryleadership levels, bringing their own interests and prioritiesfor the organization. These shifting dynamics also influenceand shape communication and interaction among theAPHA board, the sections, and the staff. Adequate boardrepresentation and communications have been and arecontinuing issues shared by many sections and their lead-

ers. The International Health Section (IHS) is one of 26functional interest sections within APHA. It began with345 members in 1976 and rapidly grew to 1,500 by 1982.The number of section members has remained stable foralmost two decades and the overall APHA membership hasremained around 30,000 during that same period. Thereare 1,655 members of the International Health Section asof July 2003.

Early BeginningsStephen Smith founded APHA in 1872, and by 1884,his foresight on the importance of securing internationalcooperation in public health matters led the organizationto expand its membership beyond the United States byinviting professionals from Canada, Colombia, Cuba, andMexico to join. In 1891, the first non-US member electedpresident of APHA was a Canadian, FrederickMontizambert from Quebec.1 The ranks of the non-USmembers increased and international relations or interac-tions mostly centered on the problems of contagious dis-eases and the related issues of immigration and quarantine.

However, a broader interest beyond internationalmembership evolved in 1955, when a committee of theHealth Education Section composed of Ann WilsonHaynes, Donald Dukelow, Alfred Kessler, Mary LouSkinner, and Ruth Sumner proposed a resolution to APHArequesting that the section become a member of theInternational Union for Health Education of PublicHealth.2 The Executive Board denied the request on thebasis that such membership required a fee of $30 andwould set a precedent. In reality, APHA was already con-sidering membership in the International Federation ofPublic Health Associations and the Confederation ofPublic Health Associations in the Americas.

As a result of this request and of the growing interestfor international outreach by several sections, an interna-tional resolution was passed by APHA on November 16,1955.3 The resolution included the point that improve-ment of health throughout the world is a necessary part ofthe social and economic conditions required for lastingpeace. The resolution called for strengthened support andactive interest in international health work and recom-mended that the Public Health Service and the Departmentof State bring about a freer exchange of information andvisitors between countries. Several years passed before anyspecific international actions were taken within APHA.However, APHA did receive a three-year grant from theInternational Cooperation Agency (the predecessor ofUSAID) to cover costs of APHA membership and atten-dance at annual meetings for 3,568 ICA Fellows fromaround the world.

APHA took its first step in implementing the resolu-tion on international health in early 1959, when APHAPresident Leona Baumgartner obtained financial supportfrom the Rockefeller Foundation to facilitate having fourdistinguished professors from Ghana, India, Japan, and theSoviet Union attend and address the 87th AnnualMeeting.4 She believed that development of internationalrelationships was a responsibility of the APHA and was infavor of establishing an ad hoc committee with this goal.

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The Rockefeller support provided the impe-tus that led APHA into the broader arena ofinternational health. Baumgartner would laterplay a key role in strengthening health activi-ties at USAID and setting in motion theeventual evolution of international healthactivities of APHA.

At the February 20, 1959 ExecutiveBoard Meeting, Executive Director Berwyn

Mattison presented an initiative for APHA to establish anew Program Area Committee (PAC) on InternationalHealth5 to do the following:

• liaise with public health associations in othercountries

• aid in formulation of some kind of internationalunion of public health associations

• be a mechanism for exchanging public healthresearch information

• be a mechanism for relating APHA to the WorldHealth Organization (WHO).

The report of the meeting states that the proposal foranother PAC was met with some resistance because of con-flicting roles between sections and the various board PACs.A key issue was the fact that many sections were not repre-sented on the board making communication and presenta-tion of their interests difficult. The fact that PACs had staffsupport while sections did not was also an issue. JohnPorterfield, chair of the Executive Board, and MalcolmMerrill, APHA president, studied the issue along with aboard committee including Herman Hilleboe, AbrahamHorowitz, and Estelle Ford Warner. Their findings recom-mended the establishment of the PAC/IH, which wasapproved at the October 1959 meeting of the ExecutiveBoard. The leaders also believed it was important that thisProgram Area Committee on International Health bechaired by a person who was vested and experienced ininternational health activities. Fred Soper, director of thePan American Health Organization (PAHO), was selectedas Chair and committee members included GaylordAnderson, Jessie Berman, Herbert Bosch, Frank Boudreau,L.T. Coggesshall, Henry Van Zile Hyde, Estella FordWarner, and John Weir. While the issue of having an international effort was solved, the structural weakness ofinadequate representation and difficult communicationchannels for many APHA sections was not resolved andwould continue.

The Committee on InternationalHealth (as the PAC/IH came to be known)reported in 1960 that a potential internation-al partner for APHA was the Inter AmericanFederation of Public Health Associations(IAFPHA) established in 1925 with head-quarters in Mexico City, Mexico. As the IAF-PHA was meeting December 5-10, 1960, theBoard designated Philip Blackerby andEugene Campbell to attend as representatives

of APHA. Soper cautioned that to provide for an effectiveinternational network would require resources and an orga-nizational base that was currently absent. Thus this effort

was not an initiative that an APHA staff member couldcarry out. Soper’s observation may explain why no actionwas recorded regarding an official partnership.

Insight on the Links between APHA and USAIDBy 1963, Leona Baumgartner had been appointed USAIDassistant administrator for Technical Services where she ledUSAID in broadening international interaction in health.In November 1965, Malcolm Merrill joined USAID asdeputy assistant administrator for Health, Population andNutrition and Lee Howard served as deputy. These twopublic health officials listened to the concerns of manydeveloping country members of WHO as they cited their

urgent needs for ruralhealth systems. Inresponse Howarddeveloped anapproach called theDEIDS project(Development andEvaluation ofIntegrated DeliverySystems) that wasendorsed by Merrill.The work of these twopioneers during their

three years together at USAID would provide a uniquevision of rural health and also have significant impact forAPHA.

The World Federation of Public Health Associations,WFPHA

APHA continued its efforts through the Committee onInternational Health to establish and strengthen the vari-ous public health associations in other countries. In 1966,at its 94th Annual Meeting in San Francisco, APHA spon-sored an initial meeting of delegates from 13 different for-eign counterpart associations to discuss and plan for a newinternational entity.6 The Executive Board Meeting ofFebruary 1967, chaired by Myron Wegman, approved thenext step in the process. The first meeting would be inGeneva, Switzerland in May and provided for three dele-gates from each organization, plus an application fee formembership (just under $2,000). The board voted to sendBerwyn Mattison, Malcolm Merrill, and Carl Taylor asAPHA delegates. In May 1967, during the occasion of theWorld Health Assembly in Geneva, Switzerland, a group ofdelegates representing 32 national public health associa-tions convened and established the World Federation ofPublic Health Associations (WFPHA) with 16 core mem-ber associations. The efforts of Hugh Leavell and ErnestStebbins were instrumental in this formal establishment ofthe WFPHA. This new global organization culminated theinternational vision set in 1959 by Mattison andBaumgartner and APHA celebrated this achievement andacknowledged the efforts of the Committee onInternational Health at the 95th APHA Conference.

APHA contracted with the Council of InternationalOrganizations for Medical Sciences (CIOMS) based inGeneva, to provide temporary space for the new federa-

Leona Baumgartner

Berwyn Mattison

Lee Howard being sworn in at USAID as director ofMalaria Programs by Ed Lapham and witnessed byAssistant Administrator Leona Baumgartner in1964. Howard would become director of healthfrom 1967 to 1981.

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tion, and the Royal Society for Public Health of the UnitedKingdom provided funding support for the first year.WFPHA evolved, according to many APHA members, as apredominantly European organization. However, APHAassisted in the growth of WFPHA from the original 16core members to 67 member associations in 2003, and hasprovided unwavering support to WFPHA over its 36 yearlife span. This is also reflected in the numbers of APHAstaff who have served as Executive Secretary of WFPHAincluding Hugh Leavell (1969-1972), Thomas Hood(1972-1974), Russell Morgan Jr. (1974-1979), Susi Kessler(1979-1988), Diane Kuntz (1988-1998), and Allen Jones(1999-present). In November 2002, WFPHA President

Theo Abelin, when citing WFPHA accom-plishments as a scientific network, indicatedthat the organization was poised to expandbeyond networking, publications, and stan-dard setting and take on a more robust advo-cacy role to improve health policies nationallyand globally.

In 1968, APHA established the domes-tic focused Community Health ActionPlanning Service (CHAPS) and Malcolm

Merrill joined APHA staff as its director. Within a yearrequests for international assistance were received fromnumerous countries and APHA would begin internationalactivities the following year along with liaison activity insupport of the WFPHA.

New Vision for APHAIn April 1969, the two-year study of the APHAConference on Association Functions, Organizations and Relationships (CAFOR) culminated in the establishment of a new structure and vision for theAssociation. A sense of the global thinking at that time,particularly of the APHA leaders, is reflected in excerptsfrom Russell Train’s plenary address.7 He quoted fromcolumnist Russell Baker’s article on the moon landing say-ing “the reason we reach the moon with such efficiency,alacrity, and elan was precisely because the odds wereagainst it. The possible things like cleaning up our air,water, and slums are not challenging enough, such tasksbore us.” Train proposed a broader view of public health, arecognition that involves the total public and its habitat,not just a condition or disease. He considered the entireearth as man’s home and not just the little piece of turfwhere you hang your clothes and eat your meals. Thewinds of change were in the air, and in 1973, Train wouldbecome the second Administrator for the newEnvironmental Protection Agency (EPA) established inDecember 1970, when the federal government transferredenvironmental programs out of the Public Health Service.This was an historic point in public health history as itmarked the fork in the road where environment and publichealth took separate paths.

APHA was changing too as evidenced by the remarksof another key visionary, Lester Breslow, in his 1969 presi-dential address.8 Breslow spoke of the slow change in thepattern of health conditions during the 19th century but asthe rate of change sped up during the 20th century, a

whole new set of health problems emerged correspondingto the advances in industrial technology. He cited three elements in the origin of the health crisis at that time:

• Failure to comprehend the long-term adversehealth effects that result from the application ofcertain technological innovations;

• Continuing reliance on industry to find simpletechnological solutions to problems identified andthe danger of emphasis on production and profitsregardless of the cost in health;

• Lack of adequate social mechanisms for the con-trol of current health problems.

Breslow used the example of the roles of machineproduction and the attractive marketing of tobacco that ledto expansion of a highly profitable industry that took a tollon the health of millions of consumers. He emphasizedthat it took four decades to recognize the problem andthree decades to educate the public to reach the point oftaking action. It took another three decades for action ontobacco at a global scale when on May 20, 2003, theWorld Health Assembly invoked their treaty authority forthe first time and voted unanimously to support an inter-national treaty to combat tobacco use.9 The treaty, viewedas one of the more important international public healthinitiatives, is designed to make it more difficult for ciga-rette companies to promote and sell their products world-wide but especially in poor nations where smoking ratesare still relatively low. While implementation of the treatyin different countries will be a challenge, the decision isgratifying to APHA and the health community as it isbased on long-range public health impact.

Implementation of the VisionAPHA introduced a streamlined reorganization in 1970with a new agenda for social action based on the CAFORReport. This marked a culmination of the vision and long-term guidance under the leadership of Lester Breslow, PaulCornely, and Berwyn Mattison. APHA began a proactiveyear to educate the general public and elected officialsregarding air, water, and noise pollution, the relationshipbetween housing and health, and concerted action againstthe environmental crisis. APHA also raised the issue ofwidespread gun sales and the reduction of the hazards ofhomicide, suicide, and child violence.

APHA President P. Walter Purdom and President-Elect Myron Wegman led the effort of social activism andthe commitment to influence improved health policy at thenational level. The reorganization included a relocation ofAPHA headquarters from New York to Washington, DC.Executive Director Berwyn Mattison, a visionary leader forover 13 years, retired in early 1970. He was succeeded byJames R. Kimmey, who took on the daunting task of themove and implementing these structural changes and poli-cies for the new organization. A labor problem ensued as70% of the staff declined to relocate to Washington, D.C.This delayed the actual move, which eventually took placein the summer of 1971.

Kimmey described the move and implementation ofa new agenda as a “period of unfreezing of the organization

Malcolm Merrill

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in an effort to becomemore influential inhealth policy.” It wasalso a time of concen-tration on specificissues such as nationalhealth insurance andtobacco. APHA fol-lowed a model where-by providing good

technical information, APHA could drive a change in policy.Kimmey commented, “We learned in the long haul that itdidn’t! I was fortunate to have Malcolm Merrill andappointed him head of the Division of InternationalHealth Programs (DIHP) in 1970. As a past president ofAPHA (1959-1960) and former Sedgewick award winner,he brought great distinction to APHA’s health effortsabroad. At a critical time he became a venture capitalistwho brought in needed resources for APHA while buildinga successful field activity that also utilized over 500 APHAmembers as consultants and advisors.”

The move to Washington, D.C. turned out to bemore costly than originally projected and by 1972, APHAhad encountered a severe budgetary deficit. Dues incomehad dropped to around 50% of budgeted projections andaccounting problems revealed a shortfall in financialreserves. Facing a financial crisis, the board initiated afund-raising campaign to raise $300,000. At the same timeKimmey and Merrill developed a strategy to increase exter-nal funding by seeking support from government sources.An historical parallel here is the similar experience of theNational Council for International Health (NCIH) com-munity some two decades later. Periods of severe financialstress were problems common to many health organiza-tions and their successful resolution requires the coopera-tive effort of board and staff.

The Division of International Health Programs (DIHP)In 1968, Mattison hired Malcolm Merrill from USAIDand Hugh R. Leavell, also a former president of APHA andrecently retired from Harvard School of Public Health.APHA had received its first research grant in InternationalHealth in 1969 from the Milbank Memorial Fund to assess“The Role of National Voluntary Health Organizations inSupporting National Health Objectives.” It would becomea five-year research project co-sponsored by WFPHA andwas first located in the New York City headquarters ofAPHA. Leavell served as director of the project and RussellE. Morgan, Jr, was hired as the senior health specialist onthe project and represented the first full-time staff personhired by APHA exclusively for international health activi-ties. The Milbank project was designed to study and assessthe potential of non-governmental organizations, such astraditional voluntary health agencies, to help newly emerg-ing developing country ministries of health in developingand implementing national public health, nutrition andfamily planning programs. It had become clear in the earlydays of independence in many developing countries thatgovernment resources were extremely limited, particularlythose designated to improve “the health of the people” in

their broadest context. Community-based organizationsthat linked local people and resources to development wereseen as a complimentary approach to government healthservices that needed to be strengthened. An interestingnote here is that the Milbank Foundation credits this studyas helping to launch the broader non-governmental move-ment in health care delivery in developing countries. Thus

APHA played an important role as much for-eign assistance is channeled through NGOsin US to NGOs in developing countries.

However, on July 6, 1970, at therequest of the new APHA executive director,the office relocated to Washington, DC alongwith Malcolm Merrill and the staff of theCHAPS project. This began the establish-ment of the first Washington base for APHA,with the new Division of International

Health Programs (DIHP), the CHAPS program, andWFPHA. In the midst of this changing environment therewere protracted staff negotiations and loss of experiencedpeople as Kimmey and remaining staff did not depart fromNew York until the following year.

Merrill obtained a grant from the USAgency for International Development(USAID) to supplement the funding fromMilbank for the research project onVoluntary Health Organizations. Leavell andMorgan initiated the country studies in collaboration with the national voluntaryorganizations. Staff analyzed the role of vol-untary health organizations in 25 developingcountries and established two model demon-

stration projects in Costa Rica and the Philippines. Theproject also provided an opportunity for the WFPHA andAPHA to work collaboratively with the World HealthOrganization, and it was during the ensuing period thatthe WFPHA received “official relations designation” withWHO and several other UN agencies. This official desig-nation allowed the WFPHA to co-sponsor the project withWHO—Geneva and its regional offices. This was animportant step for the WFPHA, as it would lead to afuture leadership role with the non-governmental commu-nity and with the WHO.

Under Merrill’s guidance, the division received additional funding for projects in Africa, Asia, and LatinAmerica. The largest long-term contract received by theDivision of International Health was for the USAIDDevelopment and Evaluation of an Integrated HealthDelivery System (DEIDS) project in 1972. The large-scaleendorsement of low cost primary health programs byUSAID was based on project designs by the developingcountries themselves with technical guidance by publichealth consultants. Lee Howard and USAID looked toAPHA as the best vehicle to provide the technical guid-ance, as APHA was the only professional organization inthe US with comprehensive national representation. APHArepresented a unique asset that justified USAID doing solesource contracting with it. As a result of his experiencewithin and outside USAID, Merrill was aware of the strin-gent federal regulations regarding contracts and grants.

Russell Morgan

Hugh Leavell

James Kimmey and Myron Wegman — cutting ribbon for new quarters in DC

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USAID policy required a competitive re-examinationprocess prior to each renewal period for contracts/grants.As the funding increased, staff recruitment efforts increasedas well to handle such activities as health education pro-grams, promoting voluntary agencies, infectious diseasecontrol, population and family planning, maternal andchild health, nutrition, and environmental health studiesand assessments. APHA also organized numerous studytours for people interested in learning about public healthin countries such as Costa Rica, Guatemala, Panama,Japan, the Philippines, and Thailand.

In 1972, Kimmey assigned Thomas Hood, deputyexecutive director to the division to assist Merrill in theeffort to increase the level of external resources. Merrilladded Donald Rice, Dale C. Gibb, and Herbert Dalmat tothe DEIDS project. Rice would later be assigned to headthe CHAPS program. A major achievement, according toKimmey, was renegotiating the government overhead rateto 86% which eventually generated sufficient resources toease APHA out of its financial crisis. The USAID supportfor international activities increased significantly fromapproximately $500,000 in 1971 to $1.2 million by 1973.A 1972 proposed contract for APHA to evaluate the USAIDPopulation Programs was discussed and the board decidedagainst the project and instead established a subcommitteeto review APHA contractual obligations to USAID. Leavellretired in 1972 after three decades of service to APHA.

It is important to describe the pressures of the periodas APHA embarked on implementation of the new socialadvocacy policy that would move the organization into aconstructive, confrontational role with the governmentregarding improvements in health policies. Changes in thehealth hierarchy of the federal government attracted APHAattention in 1971. In an editorial by Kimmey10 on the sub-ject of the ouster of Roger Egeberg, assistant secretary forHealth and Scientific Affairs at the Department of HealthEducation and Welfare (DHEW), a key point was thatHEW policy formulation and decision-making in healthmatters passed from professional hands into those of “thegrey legion of business men” brought in to manage the fed-eral government’s health affairs. Kimmey’s editorial reflect-ed the growing concern of many public health profession-als that in the areas of environment and health, the federalgovernment was on a path that would weaken and eventu-ally displace trained public health leadership. Additionalobservations indicated that the American MedicalAssociation (AMA) was opposed to the national initiativeson Medicaid and Medicare spearheaded by DHEW andsupported by APHA. As many of the Public Health Service(PHS) leaders were professionally affiliated with the AMA,the differences over this issue created a tension between theDHEW and the PHS leadership. In 1967 HEW SecretaryJohn Gardner established a new position of AssistantSecretary for Health as an organizational layer above theSurgeon General of the PHS. This ultimately changed thedecision-making process in public health and was a majorconcern for APHA. This was the background for Kimmey’seditorial and APHA’s close monitoring and continuedadvocacy on the importance of trained public health lead-ers for these important posts affecting the nations health.

The history of that action reveals an evolution over threedecades that shifts the operational responsibility of thePublic Health Service from the Surgeon General to theSecretary of Health and Human Services.

The Founding of the National Council forInternational Health, NCIH

As in 1967 with the establishment of the WFPHA, the1970 World Health Assembly (WHA) was the setting forinformal discussions that were the precursor of anotherinteresting initiative. The US delegation included PaulEhrlich, DHEW, Lee Howard, State Department/AID andNorman W. Hoover, a representative of the AmericanMedical Association (AMA). Hoover, an orthopedic sur-geon from Chicago, had recently headed a two and onehalf year medical school project in Saigon, Vietnam. As anewcomer to the WHA, Hoover inquired about the inter-est of WHO and the US in sponsoring American doctorsfor short-term assignments overseas. The discussions dur-ing the WHA struck a sympathetic cord and convincedHoover that there was a far greater public health need inthe countries beyond the assignment of doctors. Hooversubsequently obtained approval from the AMA Board inMay 1970 to establish a Task Force on InternationalHealth to assess the problems of international health andto propose a mechanism by which common approachescould be defined, joint efforts undertaken and limitedresources used most effectively.

The twelve member Task Force was chaired by M.Alfred Haynes, Drew Medical School and included manyAPHA members such as Henry van Zile Hyde, Associationof American Medical Colleges; Dieter Koch-Weser,Harvard University; Carl Taylor, Johns Hopkins University;John Weir, Rockefeller Foundation; Leroy E. Burney,Milbank Memorial Fund; and ex-officio members S. PaulEhrlich and Lee M. Howard. The Task Force met fourtimes during an eight-month period and presented theirfindings at the Fifth AMA Conference on InternationalHealth held in Chicago, Illinois in September 1971. TheAMA Board approved the recommendation establishingthe National Council for International Health (NCIH)and a General Assembly of International Health Agenciesto provide a regular meeting place of all interested organi-zations and individuals. The latter became the NCIHAnnual Conference with its emphasis on achieving an openforum and finding a basis for consensus on internationalhealth issues. The AMA also approved funding and provid-ed secretarial support for a three-year period to allowNCIH to become viable. While NCIH was not NormanHoover’s idea, his leadership brought about AMA supportfor the study group that culminated in NCIH.

Ten organizations were invited to be founding mem-bers and to have permanent seats on the Board ofDirectors. Through the efforts of Carl Taylor and MalcolmMerrill, APHA was one of the ten founding members. Theoriginal board members were American Dental Association(ADA), Victor H. Frank; American Hospital Association(AHA), Robert M. Farrier; American Medical Association(AMA), Burt L. Davis; American Nurses Association(ANA), Hildegard E. Peplau; American Public Health

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Association (APHA), Malcolm H.Merrill; AmericanSociety of Tropical Medicine and Hygiene (ASTMH)Franklin A. Neva; Association of American MedicalColleges (AAMC), Henry van Zile Hyde; Association ofSchools of Public Health (ASPH), Carl E. Taylor; NationalCouncil of Churches(NCC), William L. Nute and theNational Medical Association (NMA), George Tolbert Ex-officio governmental agency members and representativesincluded Office of Assistant Secretary of Defense, Healthand Environment (DOD), Bedford H. Berrey; Office ofInternational Health (DHEW), S. Paul Ehrlich; Office ofHealth Technical Assistance Bureau, (Department of State),AID Lee M. Howard and Deputy Assistant Secretary ofState for Medical Services, George I. Mishtowt. Generalmembers, who also served on the board with the foundinggroup were: Leroy E. Burney, Milbank Memorial Fund;James P. Hughes, Kaiser Foundation International andWilfred Malenbaum, Wharton School, University ofPennsylvania. APHA sponsorship of NCIH was announcedin the August 1971 issue of The Nation’s Health.

Carl E.Taylor served as the first volunteer chair of theNCIH from 1972 to 1974 with Malcolm Merrill as ViceChair and Henry van Zile Hyde as Secretary Treasurer thusestablishing a strong early link between NCIH and APHA.Henry Feffer became volunteer chair in 1975 and obtainedfunding and partnership support for NCIH from theInstitute of Medicine (IOM), USAID and others. JoePerpich, IOM, provided administrative and secretarial sup-port to NCIH and Lee Howard, USAID, was instrumentalin obtaining longer term grant funding for the fledglingorganization. As a result of this early support, the NCIHwas able to begin work on the gathering of information onnon-governmental organizations in the US and to searchfor sources of funding to support the organization.

The organizational structure of NCIH was patternedafter the AMA House of Delegates and included a 21-member board with ten slots permanently reserved for thefounding organizations. Later the board would expand to atotal of 32. Most of the key individuals saw a need to max-imize the effectiveness of the many organizations workingin international health. The group particularly promotedactive communication, partnerships, and cooperation.Feffer and others recall that a few members of the coregroup still saw things in terms of the interests of their ownacademic or professional institutions rather than the biggerpicture. This point provides a key insight to differences inperspectives between boards and staffs that both APHAand NCIH encountered from time to time. The firstNCIH conference on “Health Care Systems and HumanValues” was held April 25-27, 1973 and was chaired byTaylor. Feffer, would serve as facilitator, host and keeper ofthe annual minutes until 1979 when NCIH became incor-porated and would appoint a salaried President. At thesame time the DIHP at APHA was in full swing and thecreation of a section on international health had not yetcrystallized.

APHA Leadership ShiftFrom 1972-73, Kimmey encountered resistance and policydifferences with board members over priority issues. The

State Affiliates were concerned with local domestic issuesand were not as interested in federal policy as were theleaders of APHA. Kimmey described this intensive periodas leaving little time for interaction with board members.He believed that the external backdrop of the Vietnam Warand the nation’s Watergate crisis served to undermine con-fidence in the federal government and its policies and thisinfluenced the thinking of some new board members.Kimmey observed that this growing concern with govern-ment policies and the organization’s acceptance of govern-ment funds would trouble some board members for decades.On February 1, 1973 James Kimmey would leave APHAfor a state government position in Wisconsin and he wouldalso assume the presidency of the WFPHA for 1973.11

On June 1, 1973, William McBeath became theexecutive director of APHA, a position he would hold untilNovember 1993. In the Executive Director’s report to theboard in the fall of 1973, McBeath reported that the

DIHP activities had grown rapidly under theimpetus of several contracts from USAID. Hefurther noted that while the contracts sup-ported a wide variety of DIHP activities, thefunding was mostly out of the AID popula-tion accounts. This revelation generated sig-nificant board discussion and interest regard-ing the USAID contracts. Some board mem-bers were concerned over the use of popula-tion funds for health activities and others

wanted an internal policy review process for prior approvalof contracts and grants. Despite the fact that these activi-ties had been developed under the aegis of the Committeefor International Health and provided needed overheadincome, members of the APHA Program DevelopmentBoard and its Population Council believed the reviewprocess within APHA for screening contract proposals wasinadequate. A decision was made that the ExecutiveCommittee serve as a review committee for all contractsundertaken by the association.12

In the meantime USAID officials were pleased withthe success of APHA activities under DEIDS and staffadditions included Alberta Brasfield, Jason Calhoun, EileenCrawford, and Robert Lennox. An observation by LeeHoward was that APHA / DEIDS activities were unique atthat time as no other international organizations, includingWHO, had proposed or funded such activities. For exam-ple, in 1974, APHA started a demonstration project in theLampang province of Thailand, which was an early modelof community participation later applied to all of Thailandand was used as a teaching model for WHO membercountries in South East Asia for sustainable development.A cadre of trained local health workers, with the support ofthe Thai government, were able to assume the delivery ofintegrated services in maternal and child health, familyplanning, and nutrition to a community of 650,000 peo-ple. Similarly many members of the APHA Medical CareSection were initially supportive of the division’s activitiesbecause of their interest in the way medical care was organ-ized in the countries and the different ways countries struc-tured and financed their health systems. However, theirinterest and support waned over time as the division

William McBeath

8

became more involved with primary care public healthprojects. There were fewer advocates for the public healthpractice activities of DIHP on the board who saw the valueof different approaches to specific medical interventions.The success of the APHA projects resulted in continuingincreases in government funds through USAID. Merrilland the DIHP staff increased efforts to diversify fundingfrom other sources for APHA.

This transition from Mattison to Kimmey toMcBeath marked a shift in the dynamics, relationships,and interests of the Executive Board with the APHA/DIHPstaff. Previous board members, supportive of the division’swork, rotated off the Executive Board and the Committeeon International Health (CIH). New voices on the boardraised concerns and more detailed interest in APHA proce-dures for screening and approval of the contract/grantapplication process for DIHP. This perspective may havereflected the competing pressures for dwindling resourcesamong the specialty professions within public health.However, from a management perspective such detailedinvolvement of board members, even in the best of circum-stances, can severely impede an organization’s ability toactually obtain a grant/contract. Over the next few years,the framing of debates at board level would change withboard rotation leaving fewer advocates for the division’sinternational field activities. By 1974, APHA membershipgrowth was low and dues represented 43% of income. TheMembership retention rate was down to 68%. This drop incore income magnified by the exceptional growth ofUSAID funding to the Division of International HealthPrograms drew board attention as these funds dwarfed theAPHA membership income by a factor of 3 to 1.

The External EnvironmentA July 1974 editorial by McBeath in The Nation’s Healthprovides insight to the external environment of this trou-bled period. The editorial cites a series of surveys conduct-ed by the Center for Political Studies from 1958 to 1974indicating that Americans’ trust in government has fallensharply with striking evidence of lost faith in the politicalsystem as well as an erosion of confidence in social institu-tions. Also an Opinion Research Corporation survey forthe American Society of Association Executives indicatedthat only 53% of association members polled indicatedfavorable attitude toward their associations. Large associa-tions such as APHA and others classified as professionalreceived the most member criticism. The prolonged effectsof the Vietnam War from 1961 to 1970, the Watergateincident in 1972, followed by the OPEC Oil Embargo inOctober 1973 and the resulting energy crisis were some ofthe external distractions that had a significant impact onthe country. The resignation of President Richard Nixon in1974 added to the prevailing mood of the nation thatwould deeply affect the health professionals and their viewstoward government. This would influence the introductionof political aspects to board debates and strong rhetoricregarding government policies.

The Executive BoardThe International Health Activities Report to the board

in November 197513 describes APHA efforts to develop aprogram for diversifying the sources of funds for interna-tional health. APHA had arranged a conference of repre-sentatives of US private sector organizations that includedcorporate executives. The subsequent report to the board in1976 included the exciting news that a private sector groupof CEOs from that previous conference in 1975, hadalready responded by coming together again to create aninter-organizational task force called the InternationalHealth Resources Consortium (IHRC). From an historicalperspective this was a momentous coming together of theprivate and corporate sectors with APHA and represented aseminal opportunity for a unique public health partner-ship. The group included: Ambassador True Davis; PaulEntmacher (Vice President Metropolitan Life InsuranceCompany); Virginia Gordon (Vice President, CelaneseCorporation); James Grant (Director, OverseasDevelopment Council); Howard Hiatt (Dean, Harvard);Morton Hilbert (President, APHA); Van Holden(President, Rockefeller University); Leon Marion(Executive Director, International Association of VoluntaryOrganizations, IAVC) Frank Pace (President, InternationalExecutive Service Corps, IESC); Frank Picker (Dean,Columbia University); Ormsby Robinson (Vice President,IBM); Frank Stanton (President, CBS); and convenersClarence Pearson and Russell Morgan.

APHA was invited by IHRC to become a memberand George Silver (CIH Chair) and Morton Hilbert wereasked to serve as co-chairs. The role of the IHRC was toeducate corporate leaders on the value of investing in thepublic health infrastructure for developing countries. Aninitial project was developed by APHA in cooperation withAlcoa in Jamaica. The IHRC was ready to move quickly tosolicit funds and had proposed that APHA be the officialrecipient of any monies received. This was a moment intime where APHA could have facilitated a different pathfor national and international cooperation and financingfor public health. The innovative approach had significantpotential for the future of international public health. Itpresented APHA with an opportunity to assume a promi-nent role in assisting struggling Health Ministries aroundthe globe with a mechanism for diversified resources andjust as importantly balanced partnerships in deliveringhealth services.

Russell Morgan presented a staff recommendationthat an APHA foundation be established for the purpose ofreceiving the IHRC funds. Some board members simplyrejected the idea of establishing corporate partnerships assuggested by the IHRC. One board member referred to theproposal as “cultural imperialism.” McBeath reminded theboard that APHA initiated this activity when they facilitat-ed the formation of the inter-organizational task force in1975. The task force was viewed as a mechanism to contin-ue joint activity among those interested and the formationof the IHRC was an unplanned result of bringing thesecorporate leaders together. Merrill assured the board thatthe IHRC was not intended to encourage provision ofmedical care by the voluntary sector in developing coun-tries. Rather it was developing cooperative mechanisms forsupporting people in general and voluntary groups to par-

9

ticipate more responsibly in public health program devel-opment. Although not formally rejected, the boarddeferred and requested that APHA restudy the proposaland clarify purposes and processes. Despite the support ofAPHA President Hilbert, this cool reception by variousvocal board members was a huge disappointment andmajor setback for the DIHP, WFPHA and ultimately inter-national health.

This was a lost opportunity for APHA to explore aglobal vision through a truly unique partnership withorganizations that could really help the Association’s mis-sion on a global scale. The board constraints in effect

placed a governor onthe creativity ofAPHA/DIHP inexploring private sec-tor partnerships andseriously limited fur-ther proactive effortsfor alternative fund-ing. Other boardmembers and staffrealized at this pointthat without a con-stituency to demon-strate the presence ofsignificant support

within APHA for international health, it was very possiblethat the international health programs operated by APHAwould be in serious jeopardy and possibly eliminated. Aninteresting point here is that within two decades the PublicHealth Service Centers for Disease Control (CDC) wouldutilize the same strategy of establishing a foundation as amechanism to accept funding from private and corporatesources.

USAID support for the work of the Division ofInternational Health Programs continued as the four maincontracts were for multi-year terms. DIHP activities andstaff continued to grow and Barry Karlin was added tohead the education and health promotion activities. InJanuary 1977, APHA published the results of a two-yearstudy on 180 primary health care projects in 54 countries,called “State of the Art Delivering Low Cost HealthServices in Developing Countries.” APHA staff assistingKarlin in this effort included Alberta Brasfield, ShelleyBuckwalter, Eileen Crawford, Cecelia Doak, Robert Emry,Kenneth Farr, Dale Gibb, Reginald Gibson, and CarolPewanick. Many of these staff members would move on tobecome key leaders in government and private sectororganizations. This led to the creation of a computerizeddatabase of some 500 projects in developing countries.Other activities of the division included a computerizedroster of professional resources, two popular newsletters,and a series of cutting edge monographs. The newslettersincluded Salubritas, focusing on sharing innovative countrysystems for delivering health services that had a distribu-tion of 10,000 copies per issue in English, Spanish, andFrench, and Mothers and Children, covering infant feedingand maternal nutrition. Topics in the monograph seriesproduced by the division, included health economics,

health auxiliaries, pharmaceuticals, water and sanitation. Acontract from the Peace Corps provided funds for publica-tion of a manual for starting Community HealthEducation Projects in Developing Countries. Consultantscontributing to the manual included Pam Straley, UyenNyoc Luong, Diane Hoffman, and Mary Jo Kraft. Theseinnovative publications were based on field projects andactivities of health workers in their own countries, a con-cept that was new. Previously universities active in thecountries published their research under their own banners.APHA published field-based activities highlighting localcountry nationals as a service important to people workingin the field. The DIHP practice arm of public health wasthus highly regarded by many countries and served as amodel for the international community. APHA developedan international based network and deployed an estimated750 consultants.

APHA’s external funding for international activitiescontinued to grow significantly from 1975-1977, com-pared to the relatively sluggish dues income. This causedsome angst and displeasure among representatives whoascended to the APHA Board. New voices on the boardwere more vocal in opposing USAID funding for APHAwhile others were simply opposed to APHA receiving anygovernment funding. Political issues entered the discussionsas board members raised concerns regarding US govern-ment international policies and others were conflicted bythe pressures of their own organizations competing forfunding.

These discussions introduced new debates at theboard level. Section leaders continually raised concernsover their lack of adequate representation on the board andthe difficulty of communications with the board over vari-ous section issues and priorities. The problem of externalfunds being out of equilibrium with core funds was a legit-imate management concern as was the importance toAPHA of the overhead income from the government fund-ing and the value of the activities. However, these factsappeared overshadowed in board discussions as voices thatopposed government funds lobbied that they compromisedthe independence of APHA and tainted the organization.

One member of the board, Vicente Navarro, raisedobjections to what he perceived as the close working rela-tionship between APHA division staff and staff at the StateDepartment (USAID) because it reflected poorly onAPHA. His position was that to be a leader in internation-al health APHA could not receive funds from the US gov-ernment. Navarro proposed closer supervision over thedivision by the Executive Board or the outright discontinu-ance of the division’s international activities.14 His interven-tions introduced a difficult and stressful period for APHAdecision makers. The increased numbers of members fromnew and evolving professional disciplines presented anarray of new and different ideas. The record also revealspart of this change included a significant loss of old mem-bers, particularly those who supported the internationalactivities of APHA, as retention rates were poor. The lingering debate, contained in fascinating accounts in theminutes of board meetings and committee reports from1975 through 1976, diverted board attention from a sub-

International Health Research ConsortiumMeeting in 1976. From left Frank Pace, IESC;Clarence Pearson, Metropolitan Life Insurance;Howard Hiatt, Harvard University; True Davis,Ambassador; Russ Morgan, APHA; VirginiaGordon, Celenese Corporation; Frank Picker,Columbia University; Van Holden, RockefellerUniversity; Leon Marion, IAVO.

10

stantive discussion of the innovative and seminal ideas proposed by the Division for International Public Health.Instead of supporting the international health leaders, theboard deferred and initiated several studies and evaluationsinvolving special committees examining the division’s activ-ities and reviewing the appropriateness of APHA relation-ships and independence from USAID. The outcome of allthese evaluations supported the work, the relationships andfunding sources for the division and concluded that theywere very valuable and that APHA should continue to sup-port them.

The Executive Board moved to continue support ofthe Division through the CIH.15 However, the aftereffects of this controversial experience would ultimatelyundermine the APHA’s international health activities andstaff for the future. The passage from APHA memberthrough the portal of APHA board official did not alwaysresult in a change to a broader orientation or perspectivefor APHA.

During this period there were legitimate externalstresses as APHA leaders were involved in an importantinternational human rights effort to free six health workerswho had been detained, jailed, and persecuted in Chile.Hugo Behm, APHA vice president for Latin America, wasreleased from prison in October 1975, due to APHA’sextensive advocacy efforts. A special board task forcechaired by Paul Cornely continued pressuring both theChilean and US governments regarding human rights ofthe remaining health workers. It was these differences andconcerns over US policy that led to questioning the appropriateness of APHA accepting any funding from government.16

Formation of the International Health Section (IHS)Merrill together with staff recognized this changing per-spective on the board and determined that a supportingconstituency was necessary for the future of the division.Merrill requested Morgan to form a working group todevelop such a constituency within APHA. The groupincluded Eugene Campbell, USAID; Mary Jo Kraft, HHS:Russell Morgan Jr., DIHP; and Clarence Pearson,Metropolitan Life Insurance Company. The group’s effortincluded a survey instrument for determining memberinterest and support for a new section. Met Life providedfunding to underwrite costs for printing and mailing thesurvey to several thousand APHA members. The resultantdatabase of over 700 potential members demonstrated sig-nificant interest in international health, providing a basis totake the necessary steps for creation of an internationalhealth section.

The effort was reinforced by a number of APHAmembers including Janet K.Anderson, Robert Bowers,Leslie Corsa, Paul Ehrlich, Elizabeth Hilborn, HelenMartikainen, Lee Howard, Clifford Pease, Hildrus A.Poindexter, and Virginia Worsley, and the board approvedan International Health Section in late 1976.17 Carl Taylor,who had chaired the Board Committee on InternationalHealth from 1967 to 1970, and who had served as the firstchair for NCIH in 1971, was elected as the first chair ofthe new section. IHS initiated their first newsletter in early

1977 and developed alogo for the section.The IHS initiated aneffort within APHA toinfluence an awarenessof the importance ofinternational health todomestic health andthis mission would bereflected in the pro-

gram of the 1977 Annual Meeting, the first in which IHSwould participate. One of the presentations by the IHSwas “What America Can Learn From Other CountriesAbout Shaping National Health Policies,” that wouldbecome a staple for many future international sessions andreflects the basis for an IHS.

At the same 1977 Annual Meeting, Peter Bourne,special assistant to President Carter, spoke to the newInternational Health Section members on “US GlobalHealth Strategies in an Age of Interdependence.” Bournestated that a national health policy for the United Stateswould not be fully effective unless coupled with develop-ment of a strong US international health policy. Hestressed the need to reorient government and multilateraldevelopment strategies to affect health needs, to dispel thewelfare image of international health assistance, and toreinforce and emphasize economic development. His com-ments were based on a draft White House Report that hisoffice was preparing that analyzed how the full potential ofdiverse programs and resources in biomedicine, food, pop-ulation, trade, and related foreign policy areas might bebrought to bear on improving the health status of US citi-zens and foreign nationals. At that time 22 agencies wereinvolved in international health and their efforts were onlymarginally related to one another. The comprehensive 350-page report was introduced in 1978, as the plan for inter-national health during the Carter Administration.18 Theplan was not fully implemented as a change of administra-tion occurred in 1981. While most IHS members presentat this kickoff session of the section were very much intune with the Bourne approach, they were a minority with-in APHA.

Initially, other section leaders were concerned thatthe new IHS would compete with their own global inter-ests as a number of sections had members who were activeinternational experts. Paul Ehrlich states that the interna-tional attention within the APHA membership continuedto be minimal and that the section worked diligently tourge the APHA members to look beyond domestic issuesand to develop a more international outlook. There weremany other sections in APHA that had members who wereinvolved in specific international activities such as commu-nicable diseases, population, medical care, maternal health,and nutrition. Initially the IHS leadership was able tointeract with these sections and gain their support but thisrequired a continuing effort that ebbed and flowed over theensuing years. Since then most other sections have devel-oped an international unit or competency on their own.From the proliferation of specialty areas in health amiddwindling resources a pattern of competition emerges

Photo Carl Taylor, APHA and James Grant, UNICEFduring a field visit in China in 1984.

11

rather than one of reinforcement of all the various compo-nents to the health system. None-the-less, the new sectionbegan with 345 members and would grow to over 600 thefollowing year.

Oversight Role for the Committee on InternationalHealth

At the time the Executive Board approved the creation ofIHS, it did not reassess the role of the Committee onInternational Health (CIH) but rather increased its powersby giving it broad oversight of the Division ofInternational Health Programs. This marked a more formalrelationship as the Board assumed a monitoring and opera-tional role over the DIHP staff. The division had grown toa 33 person staff and developed a strong image and reputa-tion that was reflected in the field programs. APHAreceived substantial overhead income as the divisionachieved a significant record of success under Merrill andUSAID funding grew to $3.8 million by 1977. This alsoprovided APHA’s public health practice activities a signifi-cant comparative advantage over other organizations ininternational development. Malcolm Merrill retired fromAPHA in July 1977 and was succeeded by Susi Kessler.Under the new arrangement, CIH Chair Milton Roemerworked closely with Susi Kessler over the next five yearsuntil he stepped down as chair.

WFPHAChange was occurring at the global level as well. Themultinational agencies were looking with renewed interestat the role of voluntary organizations in health. As a resultof the Milbank/USAID funded project for voluntary agen-cies it became clear that non-governmental organizationswere critical to the development process and needed to bestrengthened in developing countries. They were seen ascore elements of democracy and thus were an alternative toproviding support to national governments who were inconstant transition. This new development assistance direc-tion became accelerated in the family planning field and inthe areas of child health, nutrition, and environmentalhealth. The research work led to WFPHA and its mem-bers, particularly APHA and the Canadian Public HealthAssociation (CPHA), being recognized as leaders in thefield of NGOs in public health.

In May 1977, WHO and the United NationsInternational Childrens Fund (UNICEF) invited WFPHAto take the leadership in coordinating the views of the non-governmental community and develop a position paper onprimary health care for presentation at the UNInternational Conference on Primary Health Care in AlmaAta, Kazakh SSR, in September 1978. The Milbank/USAID project provided APHA/WFPHA a solid base forwriting the position paper. To develop this consensus theWFPHA organized its second triennial congress in Halifax,Nova Scotia in May 1978. The congress report, “Non-Governmental Organizations and Primary Health Care,”was finalized and printed in six languages (Arabic, Chinese,English, French, Russian, and Spanish). WFPHA PresidentGerry Dafoe was invited to make a formal presentation ofthe final paper to all of the government and non-govern-

ment delegates attending the Alma Ata Conference. Thiswas major recognition for both APHA and the WFPHAand it represented the first time that a non-governmentalorganization representative was permitted to make a formalpresentation to the WHO/UNICEF government delegates.Linda Vogel (HHS), commented that Alma Ata establishedAPHA as an important player in international health andthe APHA/WFPHA partnership changed the direction ofglobal health. It was also a testament to the dedication andeffort of the APHA staff of Merrill, Leavell, and Morgannine years earlier. Another outcome of the Milbank/USAID funded effort provided the WFPHA/APHA staffto establish new contacts and relationships that helpedstrengthen national public health associations in manycountries around the world.

NCIHIn 1978, the NCIH Board of Directors determined thatthey needed to hire a full time president in order to movefrom being a totally volunteer and networking group withan annual conference to a professional association. In April1979, Russell Morgan left APHA and became the first paidpresident of NCIH, serving for 14 years. The PanAmerican Health Organization (PAHO) initially providedoffice space for the organization and USAID provided agrant to help US private voluntary organizations (PVO)become more effective in primary health care. NCIH start-ed with a budget of $8,000 that would increase to over $1.5 million during Morgan’s tenure. Over the next tenyears, NCIH would play a unique role in internationaldevelopment building a base of 122 member organizationsinto an effective coalition. Lee Howard relates that theNCIH was effective in mobilizing and developing financ-ing mechanisms for the PVOs. The annual conferencewould become a premier event in international healthinvolving world and national leaders from congress, gov-ernments, and the PVO community. It would develop an“Action Agenda” around a specific health issue and gener-ate coalition action through education, advocacy, and fol-low up to improve policy and increase international fund-ing for child survival, communicable diseases population,environment, and women’s health.

NCIH, supported by funding from USAID, devel-oped an AIDS initiative that mobilized an informed globalnetwork of advocacy organizations that helped to raiseawareness and international funding for AIDS activities. Italso diversified its funding, which brought in base grantsfrom a number of private foundations. Taking the conceptof “Bringing International Health Back Home,” the NCIHnetwork with partners in the various regions of the USdocumented and incorporated many “Lessons WithoutBorders” in a publication entitled “Global Learning forHealth.” Clifford Pease and Jack Geiger introduced the“Lessons Without Borders” concept at an NCIH brownbag lunch in 1983. During this period many IHS membersalso joined NCIH as members and the relationships at thismembership level were excellent as evidenced by the IHSregularly scheduling sessions during the NCIHConference. The first international challenge faced by thefledgling NCIH was a result of the Cambodian crisis.

12

NCIH was asked to mobilize health volunteers to beassigned for short term stays in Cambodia. Graham Fralickmanaged the NCIH project for its duration.

A short time later, James Cobey, director of the vol-unteer organization Orthopedics Overseas (OO), contactedCurtis Swezy of the NCIH staff and an administrative con-tract was arranged to enhance the capacity of the voluntaryNGO in deploying teams of orthopedic physicians, whopaid their own way in providing six-week rotational servic-es to countries such as Peru, Bangladesh, and Vietnam.

Nancy Kelly was hiredas an intern to sup-port the project,allowing NCIH toexpand the programto other disciplines bydeveloping a databaseof physicians, nurses,laboratory staff, andvarious health practitioners for this

purpose. After several years of continuing growth andexpansion to other countries, this program became a separate country-oriented entity called “Health VolunteersOverseas.”

Challenge for DIHPKessler describes her Division of International HealthPrograms role with the Committee on International Healthand the International Health Section as an organizationalchallenge because the roles and functions of each werefuzzy. With the creative tension between the CIH and theIHS, she saw her role as a buffer among the three to facili-tate communication because there was no direct linkagebetween the board committee and section. She stated thather primary task beginning in 1979 was supportingWFPHA, as there was an APHA budget allocation for thatactivity. During her ten-year tenure she reported thatAPHA did not allocate an annual budget for the interna-tional projects or project development. Thus the activitiesof the division were severely limited to those activities sup-ported by the external grants and multi-year contracts.This left no funding available for project development. Sheindicated there was a real hesitancy by APHA leaders toinvest core resources in program development. Further, by1980, a number of key staff had departed from the divisionleaving experience voids in a number of key areas. In 1981,CIH Chair Roemer recommended that APHA add a badlyneeded position to the 1982 proposed budget to addressthe division’s lack of expertise in project development. Theboard deferred on adding a staff position and the resultcreated a gap that left the DIHP staff ill equipped to suc-cessfully compete for project grant funding. A final evalua-tion of the division in 1982 indicated dwindling staffmorale that eroded the division’s capacity to maintain itsmomentum and to cope with future changes. Some fund-ing was obtained from the Aga Khan Foundation andUNICEF provided for a series of issues papers in July 1983on Health Education and Training of Community HealthWorkers. A number of IHS stalwarts who provided con-

sultant services to the division included Julius Bud Prince,Dory Storms, and Curtis Swezy.

J. Henry Montes, a member of the board, describesthe years from 1976 through 1988 as a roller coaster periodfor APHA leaders as changes of government administra-tions brought about dramatic philosophical shifts. As anexample of the growing angst with government policies, hecited the fact that Eugene Babb and Steve Joseph, chairelect of the IHS, resigned their government positions atUSAID on principle in 1981. The issue was that the USgovernment cast the lone negative vote against the WHOCode on Marketing Infant Formula. APHA had actively sup-ported the code during its 1979 to 1981 involvement inthe committee review process with WHO. The last minuteturnabout by the Reagan administration created serious dis-satisfaction within the health community and furtheraffected relationships with the government. Montes, chairof the APHA Equal Health Opportunity Committee, wasparticularly concerned with the Reagan administration’sposition on affirmative action and dedicated his effortswithin the committee to improving the program in APHA.

Expressing concern about the significant drop in staffand resources in 1983, IHS Chair Dieter Koch-Weserraised the question of viability of the Division ofInternational Health Programs.16 Was it a viable entity orshould it be changed? The response by Kessler was that itwould be difficult to remain viable, as its largest AID con-tract, DEIDS, had been extended 15 months throughApril 1984, but with a substantially reduced budget. It wasnoted that the Association of Schools of Public Health(ASPH) was competing for the renewal of the same con-tract and there was concern that if APHA was awarded thecontract that they would be required to sub-contract withthe ASPH. Kessler reported that the Caribbean activities,Infant and Maternal Nutrition Newsletter, UNICEF activi-ties, and water sanitation projects in Swaziland had suffi-cient funding to be maintained. The IHS leaders expressedtheir concerns about the future of the division with APHAExecutive Director McBeath. The Chair and IHS teamwere reminded that the Committee (CIH) had a watchdogrole over the division activities while IHS did not. It waspointed out that while a member of a section may be onthe committee or board, sections are not responsible forthe activities of APHA. This response made it clear thatwithout IHS representation on the board, IHS views, par-ticularly those supportive of the DIHP, had little impact onAPHA leaders and their decisions. After working diligentlyto establish an international health constituency withinAPHA there was a sense of powerlessness among the IHSmembers.

Similar comments from various people in leadershippositions at that time indicate there was a desire to keepAPHA independent of the government. This, along withthe lack of representation of IHS at the board level, wasbelieved to have precluded a fair and open hearing on theimportance of the division and its extension of publichealth practice to the countries. Added to the stress andstrain of the time, the rules of the government grants hadchanged in 1982 from national categorical grants to blockgrants for states with reductions in available national allo-

Russell Morgan and Mother Theresa at an NCIHConference in 1989.

13

50’s

70’s

80’s

90’s

00’s

60’s

cations. The competitive process for winning grantsfavored aggressive coalitions and partnerships with experi-ence in writing project proposals and understanding therules and regulations of government grants and contracts.

At the November 1983 Annual Meeting in Dallas,Texas, APHA reported a dismal fiscal picture with a declinein book sales, decline in membership to 29,268, and adecline in attendance for the meeting. The ExecutiveDirector’s report stated that a joint bid by APHA andHarvard for a successor activity to the Accelerated DeliverySystems Support (ADSS) project was lost to ManagementSciences for Health (MSH) which was awarded the inter-national contract. IHS then turned to what it could con-trol by urging its members to contact their congressionalrepresentatives to advocate for increases in the budget allo-cations for USAID international development assistance.IHS promoted the concept of the interdependence of theUnited States and other countries in the practice of inter-national health. The IHS section during 1983 aggressivelyengaged in advocacy dialogue supporting increasing gov-ernment allocations in international assistance and collabo-rated with NCIH for their annual conference onTraditional Healing and Contemporary Medicine.

It was not surprising when McBeath reported a 55%reduction of USAID contract extensions. APHA could nolonger rely on its accomplishments and sole source

provider status quo with USAID. By 1983, the Division ofInternational Health Program’s support from USAID fellsharply to under $3 million and in July the ExecutiveBoard requested a review on the future of InternationalHealth Programs and a working group provided a plan ofaction.19

External funding support for the division was in freefall by 1984.20 An IHS report during the November 11-15,1984 Annual Meeting in Anaheim, California, indicatedthat $100,000 was allocated from core association funds toDIHP, however without project development expertiseAPHA was at a disadvantage. The rise of competing non-governmental and for-profit entities and the interest ofgovernment agencies to disperse their funds to differentorganizations simply raised the bar for APHA. AlthoughCIH, chaired by Diane Hedgecock, supported DIHP, theboard debate continued as some stated that the interna-tional health projects activity was atypical of APHAendeavors as it did not relate to the entire membership.Continued CIH support may have helped as the 1986Executive Board Minutes reveal an allocation from corefunds of $99,000 for the Division’s activities. However, thisallocation was rather late as the USAID funding to DIHPhad already trickled to less than $1M and extensions ofremaining contracts were through 1987. APHA reducedthe staff to one professional position and maintained sup-

History Timeline

1972–1974

Watergate Scandal

●

1973

OPEC Oil Embargo

Board Subcommittee reviews APHA-USAID

relationships and recom-mends development of international programs

●

1974

Energy crisis and resigna-tion of President Nixon

●

1975

APHA Board Membersvoice growing concern over

USAID government funding—CIH Program

Review recommends largerAPHA role in International

Health Policy—Boardinstructs Executive Boardconduct a thorough reviewof international activities

1976

Board defers InternationalHealth Resource

Consortium invitation forpartnership

Opportunity to establish anAPHA Foundation to receive

resources proposed—Minority recommendation

of special committee on IHrecommends abolishmentof DIHP—not accepted by

board but need for a supporting IH constituency

apparent.

International HealthSection (IHS) approved byAPHA Board to provide an

IH constituency

●

1978

WFPHA/APHA lead NGOparticipation at

UNICEF/WHO Alma Ata“Health for All” Conference

●

1979

NCIH hires full timePresident and receives

funding from USAID

1981

US veto at WHO on marketing code for infantformula criticized by APHA

●

1983–1987

USAID grants to DIHdecline precipitously during

period when DIHP lacksproject development

expertise

●

1988–1989

IHS redefined and developsactive advocacy and

strategic planning efforts

●

1997

APHA initiates fundraisingand partnerships with pri-

vate and corporate entities

●

2000

WFPHA—leads a reassessment of Alma Ata

and a Call to Action re-primary care strategy

●

2003

New opportunity for APHAto assume leadership role

in global health

1968

APHA establishesCommunity Health ActionPlanning Service (CHAPS)

Malcolm Merrill hired asDirector of CHAPS

Hugh Leavell becomesExecutive Secretary of

WFPHA

●

1969

Milbank Memorial Fundawards grant to APHA to

study the role of NonGovernmental

Organizations in health

●

1970

APHA reorganization-socialaction strategy adopted

Division of InternationalHealth Programs (DIHP)

created

First USAID contract awarded to DIHP

●

1971

National Council forInternational Health (NCIH)established with key roleplayed by APHA members

1955

APHA Health EducationCouncil requests approvalto join the International

Union of Health Educationfor Public Health-Board

Denies request.

First Resolution onInternational Health

passed by APHA

●

1959

Rockefeller Grant awardedto APHA

APHA Program ActionBoard establishes

Committee on InternationalHealth (CIH)

●

1961-1973

Vietnam War

●

1967

APHA provides impetus forestablishment of World

Federation of Public HealthAssociations (WFPHA)

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port to WFPHA. A number of APHA leaders reactedstrongly to the loss of USAID contracts, including theexecutive director who said that “never again will we acceptproject funds” from the federal government.

By contrast, one of the many non-profit organiza-tions that seized the opportunity was the Association ofSchools of Public Health (ASPH)). It was successful inwinning the competition for USAID funding and main-taining their independence. An insight offered by LeeHoward was that perhaps it was not easy for all boardmembers to appreciate the onerous federal and congres-sional regulations that USAID was required to followregarding contract rules and project approvals. Severalmembers remarked that since the APHA programs(DEIDS, immunization, and MCH) were so successful inthe countries, it appears as an historical puzzle that mem-bers of the Executive Board would focus on the magnitudeof USAID funding rather than the substantive contribu-tions of the APHA extension of public health practiceactivities globally.

Perhaps another perspective on the historical puzzlelies in the extreme specialization of health professions thathas evolved along with a strong protective zeal within eachspecialty and the competition for resources. As APHAfunding from USAID continued to increase, the angst ofsome board members may also have increased regardingthe competing needs of their own organizations. Whileresearching the IHS files, a fascinating historical chart wasdiscovered which helps to shed further light on the histori-cal puzzle. The updated 1985 chart was entitled“Milestones of Public Health in America” and was original-ly published by APHA in 1926. A remarkable aspect of thechart, which begins with the Colonial Birth and DeathRegistration Law in 1639 and ends with the discovery ofantitoxin for scarlet fever in 1926, is the subtle way inwhich nine different components of public health at thattime are depicted separately yet are linked together thusreinforcing an overall perspective of public health.

These separate components or specialties listed in thechart include: Laboratory, Tuberculosis, Organization,Sanitation, Vital Statistics, Communicable Diseases, Foodsand Drugs, Public Health Nursing and Prenatal Infant andChild Hygiene. Today it would be extremely difficult toprepare a similar chart due to the exponential growth inthe number of specialty areas and the difficulties in depict-ing the same types of linkages among various public healthspecialties. The unending stress of competing for diminish-ing resources by the many different health specialties overthe past few decades often has overshadowed and dimmedthe importance of the fact that all the specialties are inter-linked and very essential for an improved public health system.

Thus the task of IHS in advocating and educatingAPHA internally on the importance of international healthand on broad public health issues has been extremely diffi-cult. The experience with private sector foundation fund-ing in the US also reflects a primary interest in supportingvery specific endeavors or issues such as onchocerchiasis,trachoma, population, and AIDS. This also contributed tothe diminishing of general public health resources and tothe difficult transition of organizational or specialty repre-

sentatives elected to board status with concerns about thesecompetitive funding pressures for their specialty interestsand perhaps less so for APHA.

Activities and Contribution of IHS With the loss of government funding, the ExecutiveBoard set about to clarify APHA’s role in internationalhealth work. Susi Kessler left APHA for UNICEF andDiane Kuntz was hired in 1988 for the sole positionremaining in the International Health unit. A workinggroup consisting of John B. Walker, Ruth Roemer, andDiane Hedgecock developed a new mission statement forIHS that was adopted by the Executive Board inNovember 1988. An excerpt from the mission statementprovides some insight as to the tension of the time.

“The international health mission of theAmerican Public Health Association is firstand foremost to do everything in its powerto advance the health of all people in theworld, especially those in the developingcountries. Another international mission ofAPHA is to maintain friendly relationshipsand to exchange ideas with the health work-ers of all countries, so as to learn lessonsthat may improve the health of Americansand transmit knowledge that may help oth-ers. In order to carry out this double mis-sion, APHA must serve as an independentorganization, representing its members; it isnot an instrument of the U.S. Government.”

The last sentence perhaps best reflects the impact ofthe issues and the prevailing perspectives that affectedAPHA for several decades and depicts the stresses andstrains of the politics of public health.

APHA President Ruth Roemer expressed concernthat while the association was not discontinuing activitiesin the international area, it had discontinued dedicatingstaff for international health activities as reflected in the1988 proposed budget. APHA would continue theClearinghouse on Maternal Nutrition and its newsletter asthe only major AID funded activity in 1988. Roemer stat-ed that in addition to the importance of the activities andprograms to association members and to world popula-tions, the international activities uniquely apply to everysection of APHA. She described that significant shifting ofthe emphasis of international activities from projects to thevarious sections had been made under Kessler’s leadershipand that the emphasis needed to be continued. Perhapsthis insight explains the erosion of critical mass for theinternational health activities.

Redefining IHSDiane Hedgecock, former deputy director NCIH,became chair of the International Health Section for the1987-1988 period. Having served as chair of theCommittee on International Health from 1983-1984, shewas familiar with many of the issues faced by the IHS andhad knowledge of how the Executive Board worked and itsvarious complexities. This experience helped her to initiate

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several cooperative activities with other sections andencourage broader involvement by members. Her NCIHbackground provided a strong sense of partnership andcoalition building. She forged a partnership between IHSand the Alcohol and Drug Abuse Section. That partnershipresulted in winning a challenge grant from APHA for ananti-tobacco marketing campaign in developing countries.

This was also a period when APHA leaders showed anew interest in international public health concerns asreflected in the President’s column in January and Februaryarticles in The Nations Health. Section membership grew to1,433 and more members became active as APHA joined aconsortium that took on the US Government’s budget cutsand contribution deferrals to the World HealthOrganization. The section developed resolutions on the UScontribution to WHO, universal childhood immunizationand exportation of tobacco products. A new student com-mittee was formed and submitted plans for a studentaward in recognition of contributions to internationalhealth work at their meeting in New Orleans.

John Wyon established a Community Based Group(CBG) within the IHS that included Carl Taylor, Gretchenand Warren Berggren, and Joseph Valdez and the CBG hasgrown significantly since then. This new period ofincreased activity led to an exploration by the IHS mem-bership to redefine the role and responsibility of the sec-tion. In 1988, some forward thinking members of IHSestablished an AIDS Task Force headed by Ron Waldman.This initiative is an example of the section’s responsivenessto global health issues and would evolve over time into aSpecial Primary Interest group achieving section status in2001. IHS participated in the 40th AnniversaryCelebration of WHO by sponsoring a dinner during the116th APHA Annual Meeting in Boston honoringHalfdan Mahler former Director General. NCIH and theAmerican Association of World Health (AAWH) were co-sponsors along with IHS.

Ken Bart and Dory Storms drafted a position paperin 1989 on key health problems and issues of concern toAPHA’s international health constituency. The provocativedocument generated discussion within IHS resulting twoyears later in a policy paper on the Role and Opportunitiesof the American Public Health Association InternationalHealth Section. This was a defining moment for the sectionand much of it was due to Hedgecock’s leadership andcommitment in guiding the section and the initiative ofmembers, particularly Bart and Storms. IHS membershippeaked at 1589 for 1990 and then dropped to 1551 in1991. Over the next decade the section would miss theextensive support that had been provided by the DIHPand the useful lessons and country experiences that wereinvaluable to the advocacy efforts of the section. Perhapsthis partially explains the fact that the membership levelsremained fairly stable for the next decade. However, therecurring problem of difficulty in communication contin-ued between the section and various levels of leadership.

An interesting point here is that the term “interna-tional health” had been used for several decades and for themost part meant “over there” or defined countries otherthan the US. Around 1989, the change in nomenclature

from international to global began and provides a moreinclusive term that includes the US in the definition ofglobal public health. It remains to be seen if this achieves amore inclusive modus operandi for US interactions inglobal health. Hopes for achieving a global public healthperspective may be tempered by the impacts of global eco-nomics.

In 1991, the IHS continued its efforts by forming aTask Force on Child Survival headed by Dory Storms anda Task Force on Tobacco led by Reed Wulsin. In efforts towiden student participation, IHS added 1-2 student slotsfor all working committees and task forces. DeborahBender served as chair of the Student ParticipationCommittee. APHA’s 119th Annual Meeting in AtlantaGeorgia November 10-14, was marked by the concurrentscheduling of the WFPHA’s 6th International Congress.

During 1993-1994 Chair Samir Banoob reorganizedall the committees and task forces of IHS by adding co-chairs to strengthen communications. He also reintroducedthe annual Distinguished Service Award for the IHS, asthere had been no awards granted since 1986. Membershipin IHS peaked to 1611 during his tenure. A list of the vari-ous IHS awards and their recipients are attached.

John Bryant, chair IHS 1995-1996, although basedin Pakistan, initiated an effort to incorporate IHS globalthinking to the APHA Strategic Planning Process. An IHSposition paper on “Strengthening the Role of the UnitedStates in the Field of International Health” was submittedto the APHA. Its prophetic preamble warns of threats tohealth for the world including new and re-emerging dis-eases, increasing violence, threats of bio-warfare and bio-terrorism, and unconstrained movement across geographi-cal boundaries. Accompanying these are increasing healthproblems arising from individual behavior—smoking, drugabuse, vehicular injuries, inappropriate diet, and environ-mental degradation, increasing poverty, and population allof which weave their web of social decay and destruction.All of these contribute to diseases and hazards well beyondthe realm of health to endanger the very stability of soci-eties and global security. The message to APHA and thepublic was that the US was not immune and could not dis-tance itself from these problems without increasing its ownvulnerability. Bryant also attempted to re-establish coopera-tive relationships with NCIH, Institute of Medicine,National Academy of Sciences, and other entities. Aninsight to this period is shared in a 1996 memo sent byBryant to Diane Kuntz. Bryant writes, “The APHA and itsIHS is a curious mix. Instead of saying the work is neverdone, I would say that much of what we would like to dois never begun. The field is so vast and complex and inter-linked with national policy issues and international prob-lems that getting hold of the issues is difficult. We see anagenda that is hard to shape and actions that are hard totake. Nevertheless we are all in it because we sense itsimportance and we look for ways in which whatever wecan do might help a bit.” His perception perhaps best cap-tures the resiliency, perseverance, and intermittent frustra-tion of the international health community.

Henri Migala, chair of IHS from 1998-1999, provideda penetrating perspective of his term of office. He cited the

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nature and complexity of the APHA organizational struc-ture. When one first becomes the chair, one is faced withwhat appears to be a replication of duties between govern-ing board, nominating board, committees, and the compli-cations of how all that information flows. His experiencewas that it almost takes the full two-year period of office tofathom and understand how to guide the section. He rec-ommends the section develop a primer on how to interactwith the APHA political structure and how to make thingshappen internally. He also believes that in transitioning tonew officers, IHS needs to provide more opportunities foroverlapping with incumbent officers. Migala actually insti-tuted such a transition process. He also shared that mem-bers in the International Health Section travel frequently,are geographically dispersed, and as volunteers have otherresponsibilities making it difficult to hold productive fol-low-up meetings and posing challenges in getting thingsdone or providing continuity. The problem of schedulingan active group of practitioners for voluntary meetings maybe difficult, but does not appear to be insurmountable.

Other members also reaffirmed the key challenge forIHS involves the problem of successfully navigating thecomplex APHA organization to allow the section anopportunity to influence policy. They state that there is aneed to establish a system for documenting previous expe-riences as a tool for future chairs. Each chair starts a two-year term with a handicap because there is no primer orbody of lessons and guidelines to reduce the learning curveand allow a smooth transition. The cyclical repetition ofthe slow learning curve impacts on available time for allvolunteer section officers leaving them splitting timebetween focusing on the needs or expectations of the mem-bers while attempting to learn the complexities of theorganization. All members interviewed stressed that IHScould represent a strong political force if it could befocused and obtain APHA support. This cyclical dilemmaalso impacts effectiveness in determining how the sectioncan be more influential and which key issues to tackle.Alleviating some of these hurdles for the volunteer leader-ship positions could improve their effectiveness in deter-mining the most productive way to interact with APHAleadership

Ahmed Moen, former membership chair, JuliusPrince, consultant and mentor, Dory Storms, former IHSchair, and other members affirm that despite these prob-lems and difficulties the section has provided a gateway forwomen into the international arena and provided valuablementoring and guidance to many students and new entriesto the field while maintaining a continuous advocacy effortfor international health. The student sections have beencyclical in terms of activity that is related to the differencesin students and the extent of their involvement for eachsuccessive class.

Many former members recommend that IHS needsto better utilize the resolutions process to get APHA mem-bers supporting international health initiatives. Althoughthe process takes a year or more, other sections have suc-cessfully used the resolution mechanism to get things done.In reviewing all the IHS resolutions during those powerlessdays, the majority centered on various political reactions:

i.e., protests to ban bombing or in response to a refugeecrisis in Central America. In reality none of those resolu-tions were a prescription for working on programs and theIHS was thus seen as a moral conscience or prod but not aprogram builder. Some members tried to get IHS to thinkabout more substantive issues that would result in imple-menting good programs. However, to use the resolutionprocess successfully takes extensive planning rather thantrying to initiate an issue at the Annual Meeting with aflurry of effort at the last minute.

Members state that the section lost its links to keymentors such as Merrill, Ehrlich, Howard, and Leavell whowere interested in both public health practice and under-standing policy. This meant that people entering the fieldof international health lost the benefit of the mentoringand wisdom of the experienced international visionaries.Members interviewed believe this was an important transi-tion for newcomers into the field as the insights of theseformer leaders linked policy and public health practice andprovided an important understanding of global health forthe new members.

In the fall of 1996, APHA’s new Executive DirectorMohammad Akhter brought a strong global health focus tothe organization reminiscent of the 1970s. Akhter believedthere was a shift in how people looked at internationalhealth and public health. He saw an opportunity to utilizeglobal health as a platform to unify APHA within a broadarena in which all members could participate. He also pur-sued a strategy to create a revenue stream from otherorganizations and develop partnerships to help APHAcarry out its missions and goals. Primary revenue sourcesfor APHA were from three areas: publications 36%, mem-bership 33%, and conventions 26%. Akhter pledged toimprove three main areas for the organization:

1) Maintain the scientific base of the association.

2) Put forth an educational effort to provide practi-tioners with scientific based information toimprove the health of citizens of the US and theworld.

3) Promote grass roots advocacy.

Through the WFPHA, a study tour sponsored by APHAwas organized in December 1996 to learn about the healthsystem in Vietnam. This was reminiscent of the study toursconducted in the early ‘70s to involve more of the mem-bers in global interaction and to Nicaragua and Cuba inthe late 1980s and 1990s.

CHANGE FOR NCIH Advocacy1996 marked a milestone for the NCIH community. Ledby President Frank Lostumbo and Board Chair Barry H.Smith, NCIH completed a successful three-year advocacyeffort to prevent severe budget cuts to the foreign assistanceprogram. Describing the USAID Sustainable DevelopmentProgram as a “Fragile Shield” that helps to improve healththroughout the world including the US, the NCIH net-work, joined by a broad coalition of agencies, was success-ful in staving off elimination of the program by Congress.At the NCIH 23rd Annual Conference on June 12, 1996,Vice President Al Gore announced a major policy to safe-

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guard the world from the threat of new and re-emergingdiseases. This success was attributed to a number of keyNCIH officials, members, and supporters including SirGeorge Alleyne, Jose Barzelatto, James Hughes, AnthonyFauci, Rosalia Rodriguez-Garcia, Janet Gottschalk, TonyHall, Norbert Hirschorn, Gordon Perkin, Adel Mahmoud,Miriam Labbok, Joshua Lederberg, Elaine Murphy, DavidNewberry, Waafas Ofosu-Amah, James Sarn, DavidSatcher, Nils Daulaire, Linda Vogel, and Karl Western.

This achievement andthe announced retire-ment of Lostumbostimulated a strategicinitiative for develop-ing the future role ofthe NCIH. A specialconsultative groupheaded by C. EverettKoop recommended amore global focus andstreamlining of the

organization’s cumbersome board structure from 32 to 7.The re-structured successor, Global Health Council(GHC) was launched in early 1998, with Nils Daulaire,former USAID deputy director, as president.

In 1997, IHS Chair Dory Storms led networkingefforts resulting in three regional meetings of section mem-bers being established. Chicago area members convened atWheaton College and were organized by GretchenBerggren. Steven Schensul at the University of Connecticuthosted a Northeast meeting, and Mary Ann Mercer organ-ized the Northwest International Health Action Coalition,a Seattle area group based at the University of Washington.

Also in 1997, APHA conducted a feasibility studythat found corporations were interested in contributing toAPHA. APHA members who worked for corporationscommented that they saw opportunities to advance thecause of public health from within those settings. Thoseinterviewed were interested in contributing to APHA butnoted that the Association appeared to keep them at armslength. This was not surprising as a few voices continuedto believe such funds were tainted, while many boardmembers believed it was time to re-examine this issue. Theexecutive director believed that APHA was at a pivotaljuncture and needed to define partnerships that wouldadvance public health and healthy communities into the21st century. This time, a decision was made by the Boardto pursue a strategy that was reminiscent of the foresightand vision of the international staff and their innovativepartnership recommendations to the 1976 Board.

As a result of the feasibility study, the ExecutiveBoard in January 1998 endorsed the idea of fund raisingand a Development Campaign for APHA under the leader-ship of William Foege. While the stimulus for this was theconstruction of an APHA owned building, this opened thedoor to a more open policy regarding external funds forthe association. This led to the next major change asAPHA developed an internal policy in April 1998 for theassociation receiving corporate support or donations.APHA had come full circle after deferring to accept an

offer of partnership from the International HealthResource Consortium two decades earlier. This reachingout to government and non-government entities helpedAPHA build a new headquarters building in WashingtonD.C. and establish new cooperative relationships and part-nerships with other organizations to strengthen publichealth advocacy efforts.

It was also in 1997, that APHA’s Executive Boardreassessed the organization’s interest and commitment toglobal health. In reviewing the organization’s four goals,there was some discussion that a fifth goal be added onglobal health. However, after debate, the decision wasmade that instead of adding a new goal, it was more appro-priate to add language that included a global dimension toeach of the four existing goals, making global health animportant component of its overall vision and mission.

In 1998, APHA partnered with the American CancerSociety, the National Center for Tobacco-Free Kids, andUS Senators Richard Durbin, Ron Wyden, and SusanCollins to plan an international policy conference on chil-dren and tobacco for March 1999 in Washington, D.C.This conference brought together health ministers and keypolicymakers from around the world to fashion a legislativestrategy to curb the use of tobacco as it affects children.The WFPHA took the tobacco issue to its 8thInternational Congress in Arusha, Tanzania in October1997, and later adopted a policy paper on tobacco andestablished a Task Force on Tobacco at its annual meetingin May 1998. This effort assisted the process of globalrecognition of the tobacco issue. The Federation alsoadopted resolutions on global free trade and other leadingpublic health issues. The WFPHA’s trade resolution urgedthat trade agreements incorporate “social clauses” that pro-tect the environment, promote the rights of children, andadvance workers rights.

Akhter re-established working relationships with thefederal government and after an absence of several decadesAPHA was included as a member of US delegations to theWorld Health Assembly, from 1997 through 2001. TheAssociation invited members to participate in providinginput for the proposed strategic plan for 1999-2002, andstrategic priorities for 2000-2003. Henri Migala and RayMartin initiated a brainstorming and dialogue processwithin the IHS seeking to incorporate some recognition ofglobal health into APHA’s priorities. Pioneering APHA’s“broadcast email” facility, the section was able to solicitinput from 700 members for a June 18, 1999, memo toAPHA drafted by Bart Burkhalter, Ray Martin, and AllenJones. The IHS recommended that APHA’s goals expressexplicitly an interest in international and global health andurged that APHA expand its advocacy and research, espe-cially in priority areas, the top four of which were identi-fied as HIV/AIDS prevention and control, child survivaland children’s health in developing countries, public healthimpact of violence and war, and women’s health. Despitethe executive director’s invitation to the IH Section to helpthe association as a whole define its objectives, agenda, andpriorities in global and international health, none of thesection’s recommendations found their way into the finalstrategic plan and priorities eventually submitted by the

Left to right-Donna Shalala, Secretary HHS, VicePresident Al Gore and Frank Lostumbo at the NCIHConference in 1996.

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Executive Board to the Governing Council. This fact led tosome disillusionment in the IHS about how seriously theAPHA values section input. An observation by staff indi-cated that the IHS contribution would have receivedgreater attention and had more impact had IHS effortsbeen in closer sync with the APHA’s overall planningprocess. After two decades of frustration for the IHS, thesection did note some positive progress regarding sectionrepresentation on the board.

An interesting example of the growing relevance ofglobal health issues to the US public was an incident in1999 when officials from New York’s Health Departmentattended an IHS business meeting during the APHAAnnual Meeting in Chicago to request assistance from theInternational Health Section as a result of the outbreak ofWest Nile virus in Brooklyn. While section membersshared their experiences and views, there was no resourcecapability to provide assistance. Yet educating and convinc-ing the total APHA membership of the global aspects ofpublic health continues to be elusive and predicated on aspecific crisis.

WFPHA GrowthWFPHA’s role further evolved as a global NGO at its 9thInternational Congress, held in Beijing, China in earlySeptember 2000. The Federation organized a LeadershipForum in Beijing that included representation and partici-pation from such global public health figures as WHODirectors Halfdan Mahler and Gro Harlem Brundtland,PAHO Director Sir George Alleyne, US Surgeon GeneralDavid Satcher, and others. The Leadership Forum partici-pants reviewed the quarter century that had passed sincethe 1978 adoption of the Alma Ata Declaration that forgedan international commitment to primary health care.During this 25- year period, this commitment has ebbedand flowed and been uncertain at times, partly as a resultof competing global initiatives in such areas as humanrights, children’s health, food and nutrition, and the envi-ronment.

Based on the forum and congress proceedings, theFederation revisited the Alma Ata declaration and reaf-firmed its commitment to primary health care by issuing aCall to Action in Beijing. This Call appealed to publichealth leaders throughout the world to consolidate effortsaround the common cause of social justice and to advancethe goal of “Health for All” in the 21st century. The Callto Action renewed commitment to primary care and tookup the challenge to translate current knowledge and skillsinto specific actions for the better health of all the peopleof the world.

At the conclusion of the Beijing Congress, the Callwas sent to the UN Secretary General Kofi Annan, whowas meeting in New York with World leaders to discuss thechallenges for the new millennium and the targets andpledges necessary to meet those challenges. The Federationutilized this theme to plan its next congress. The 10thWFPHA International Congress: “Sustaining PublicHealth in a Changing World—Vision to Action” will meetin Brighton, England in April 2004.

Perhaps Executive Director Akhter’s global perspec-

tive stimulated a glimmer of interest within APHA of theimportance of global public health issues as well as recogni-tion of the increasing importance of these issues to the USpublic. This was reflected in the theme “One World,Global Health” for APHA’s 129th Annual Meeting inAtlanta, October 21-25, 2001. Another IHS regional unittook flight as Tom Hall organized a San FranciscoInternational Health Interest Group.

In 2002, APHA combined its education and interna-tional staffs in a new unit, Education and Global HealthResources. This was undertaken in part for budgetary con-siderations and resulted in some reduction of staff resources.However, this consolidation provides an opportunity tocreate an integrated and comprehensive platform foraddressing global needs in public health education andtraining. These issues are of key importance for countriesinvolved in health sector reform and such crises as theHIV/AIDS pandemic, which indicate a critical need foradequate numbers of trained public health manpower.

A new collaboration between APHA and theAmerican Medical Association may provide a benefit to theaims of the International Health Section. The collaborationaims to create a stronger link between medicine and publichealth. The effort is championed by APHA President JayGlasser with support from AMA Presidents Hank Cobleand Roy Schwarz and recognizes that the two professionshave in recent history acted more often in competitionwith one another rather than in collaboration or coopera-tion. As this weakness has also been observed withinAPHA, perhaps this initiative will help to bring about a

spirit of mutual rein-forcement among thespecialty areas of pub-lic health. Health carecosts have increaseddramatically whileresources have notkept pace. This sug-gests that a new com-mitment across theprofessional lines and

specialty areas to develop mutually reinforcing strategiesthat can strengthen public health in the US and globally.

History Presentation at 130th Annual Meeting“International Health Where are We? Where are WeGoing?” was the topic of a panel session at the APHAAnnual Meeting in Philadelphia, Pennsylvania, onNovember 11, 2002. Panelist Frank Lostumbo provided anoverview of the history based on his research and extensiveoral interviews. Panelist Russell Morgan, a member ofAPHA’s Division of International Health from 1969-1979,described his experiences working with Malcolm Merrill,Hugh Leavell, Dale Gibb, and others in DIHP when theyreceived the initial Milbank Foundation grant to jump-start the division. He also shared events from his term asWFPHA Executive Secretary and cooperative activitieswith then President of WFPHA Gerry Dafoe. A highlightfrom that period was presenting the position paper on theRole of NGOs at the Alma Ata Conference in 1978 at the

Mohammad Akhter, Georges Benjamin and AllenJones.

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request of WHO andUNICEF.

Panelist DoryStorms shared her rec-ollections from earlyyears as a student andnew member of theIHS to later becominga key leader and chairof the Section. She

pointed out that her experience during those years wasenriched by members of the section being outgoing andinclusive during meetings while presenting many diverseinterests and ideas. A valuable contribution of the sectionmembers was the fact that the IHS had served as a gatewayfor women to enter international health careers. In addi-tion the section provided many opportunities for studentsand new members. Other key points she made were thevalue of the mentoring role of the early leaders and theimportance of IHS inviting retired and former members toserve as volunteer mentors and recapturing the broadvision of the early leaders. She observed that IHS neededto increase and broaden efforts for new members.

Panelist Carl Taylor shared remembrances andinsights of his 26 years of IHS advocacy and his involve-ment with CIH, WFPHA, and NCIH. Carl closed hisremarks by stating that he believed it was time for everyonein international health to pause and review the basicassumptions of IHS and look at the changing environmentin which the global health arena is functioning. Whileevents in the world in 2002 are quite different, there aresimilar parallels with the challenges of 30 years ago.Reviewing the history of the IHS provides an opportunityto take a fresh and broader look at today’s challenges andto redefine the section. He asked that the group reassessthe reasons why there should be an International HealthSection and asked John Bryant to assist in posting fourquestions to the audience:

1) Does the start of the International Health Sectionin the Vietnam era give us any lessons to guide usin our concern for terrorism and the war pendingin Iraq?

2) What is the current justification for theInternational Health Section?

3) What kinds of functions have we been performingand need to perform for the next generation ofleaders?

4) Do we need a change in our approach toward recognizing the importance of a community-basedapproach?

These questions invoked a provocative discussion and pre-cipitated other questions and ideas from the audience.Although a Strategic Plan for IHS had been developed in1999, it was obvious from the discussion that it needsupdating and reorientation to the new and different globalchallenges before us. Some of the key points of the discus-sion include:

• Should the role of the APHA IH Section be tied

closely with current international political eventsimpacting the US? For example, should the publichealth impact of bio-terrorism be an importantniche for the IHS?

• Should IHS/APHA pursue a project for the devel-opment of mechanisms and support for trainingfuture leaders for global public health activities?

• Should IHS/APHA expand by creating a geo-graphic network of both student chapters andregional chapters of international health that couldprovide strong grass roots support that wouldaddress local priorities, national priorities andglobal issues. An IHS Chapter for the District ofColombia was actually in the planning stage andbeing organized by IHS members Curtis Swezyand Julie Hantman.

• The role of mentoring was a small endeavor donewell by IHS in previous eras, but which requiresstaff continuity and the coordination of a cadre ofvolunteer members. This is an activity that couldstrengthen all sections and provide additionalhuman resource support for APHA

Such initiatives require assessments of the level ofsupport available within APHA including budget priorities,

and availability ofleaders and active vol-unteer support fromthe members.

Ray Martin andAllen Jones incorpo-rated the essence ofthe panel discussion toreshape a series ofquestions to be circu-lated via e-mail to the

full IHS membership and to other Section Chairs. Theresults of that process will be included in the strategic plan-ning process and utilized for future initiatives.

Conclusions, Lessons and Insights from the History ofInternational Health

This history of International Health covers some fourdecades and provides an interesting lesson on leadershipthat can occur in many different ways and at many differ-ent levels. An obvious observation is that a few key leaderssuch as Leona Baumgartner, Hugh Leavell, BerwynMattison, and Malcolm Merrill had international perspec-tive and foresight. The strong international vision of a fewled a movement that made a significant difference andinfluenced the whole of APHA. This is also the story of asubsequent group of dedicated leaders and members whosteadfastly attempted to follow the global roadmap whilethe organization as a whole had difficulty envisioning theimportance of global links to their domestic interests.APHA exhibited moments of global foresight that resultedin seminal actions and decisions in the early years. Some ofthe key events and lessons are as follows:

• A Rockefeller Foundation grant in 1959 launchedAPHA’s initial involvement in international health

Russell Morgan, Gerry Dafoe and Jay Glasser

Allen Jones, Russell Morgan, Frank Lostumbo andRay Martin

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activities. The participation of four internationalhealth leaders (Ghana, India, Japan and the SovietUnion) began the process of global interaction asenvisioned by Baumgartner and Mattison

• A Milbank Memorial Foundation Grant in 1969to APHA provided the first program grant to studythe role of non-governmental organizations inhealth was important to APHA and internationalhealth. This five-year study helped launch thenon-government involvement in health servicesdelivery in developing countries. This seminal effortstimulated the channeling of US foreign assistancefunding through US based NGOs and to NGOsthroughout the world. It also served to increasethe validity of the non-governmental communityto WHO, UNICEF, UNFPA and other multina-tionals as envisioned by Merrill and Leavell.

• APHA’s unwavering investment in strengtheningnational non-governmental associations and sup-porting the establishment of WFPHA as an inde-pendent global entity continues to be a significantcontribution to public health.

• Leadership in international health was exhibitedby a relatively small corps of officials and dedicat-ed members whose foresight and steadfast com-mitment to international health led to the estab-lishment of:

World Federation of Public Health Associations(1967 to present)

Division of International Health Programs (1970 to 1988)

The International Health Section (1976 to present)

National Council for International Health (NCIH 1971 to 1997) / Global Health Council(1998 to present)

• The International Health Resource Consortium in1976 presented a unique opportunity for APHAto assume a leadership role in establishing partner-ships with private sector organizations. Unfortunately,this concept was too innovative for some APHAGoverning Board members who successfully achieveda no-decision position by the APHA Board. Thisconcept was partially implemented in early 1990when Public Health Service/Centers for DiseaseControl established a CDC Foundation allowing amechanism for a government agency to raise pri-vate sector funds and corporate donations. Effortsbetween the government and non-government sec-tors for partnerships in health are still evolving.

• The need for an international health constituencywithin APHA was the driving force for establish-ing the IHS. However, it would be a number ofyears before adequate IHS representation could beachieved on the APHA Board. Nonetheless, manyinternational health section members continued toprovide significant contributions to improving

health in poor and underserved areas of the world.

• Changes in external environments at both nationaland global levels significantly influenced APHAleaders as they struggled with how to address inter-national health issues. These forces included theVietnam War from 1961 to 1970, the Watergatescandal in 1972, and the polarizing trauma thatfollowed, and the OPEC Oil Embargo in late1973 that precipitated an energy crisis through1974, and generated mistrust in government poli-cies. In addition US foreign policy in Central andSouth America further frustrated the public healthcommunity and moved them to action in responseto the Human Rights Abuses in Chile in 1975 and1976. These events provided a chaotic backdrop ofpolarizing views that affected decisions by APHAofficials and framed their outlook regarding theimportance of the international activities.

• The lack of consistent follow-through by the boardon the early vision of the role of internationalhealth within APHA was described as an historicalpuzzle. Perhaps it has more to do with differencesin behavior and expectations of members regard-ing their perspectives and the role on the board.The board structure is complex. The increase ofpublic health specialties led to growth of many dif-ferent sections and special interest groups withinAPHA. As these representatives ascended frommember status and passed through the portal tobecome board members, a wider range of narrowerparadigms were introduced pulling APHA in dif-ferent directions. While some changed their focusto a broader APHA vision, others maintaineduncompromising views creating polarization thatshrouded the value of the association’s internation-al activities and obscured the global vision of thecharismatic early visionaries. Perhaps the boldorganizational transition experience of 1970 whena few APHA leaders were willing to take risks witha clear vision could provide some options formeeting the challenges of the future.

• The founding and evolution of WFPHA, NCIH/GHC, and IHS are reflected in the common linkbetween many of the early leaders whose interestsintersected and who believed in cooperative part-nerships as critical for improving health. The over-lap of many individuals being members to bothNCIH / GHC and IHS has continued to the pres-ent. GHC is an independent organization with astreamlined board that allows rapid response andthe ability to act quickly and mobilize coalitions ororganizational partnerships as needed. IHS is asection made up of individual members within anAPHA organizational structure that often inhibitscommunications and slows response capability.

• Recent consolidation of the education and interna-tional health functions within APHA provides aplatform for a leadership role in identifying andfacilitating the education and training skills neces-

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sary for health sector reform. Realistically, con-necting these two program components has signif-icant potential that is worthy of a re-evaluation ofresources and staff necessary to achieve an APHAprominence and leadership effort in these areas.

• The history reveals that irrespective of the cyclicalproblems of budget deficits and internal differ-ences, the IHS continually maintained a signifi-cant amount of energy, resources, and focus for aninternational program at each APHA AnnualMeeting and often influenced a global theme. TheAnnual Meeting provides excellent cutting-edgepresentations to attendees already active in thefield and has kept the IHS true to its educationand advocacy for the importance of global health.

• With APHA providing the Secretariat support, theWFPHA assumed a leadership role for the non-governmental community in global health withthe presentation of the Background Paper on theRole of Non-Governmental Organizations at the1978 WHO/UNICEF-sponsored Conference onPrimary Health Care at Alma Ata—A significantaction that helped to change the direction ofWHO and UNICEF regarding the role of non-governmental organizations in global health.

• APHA/DIHP in partnership with national andnon-governmental organizations working for thepoor successfully extended public health practiceto improve conditions in basic health and environ-mental services. It contributed to building com-munity-based public health innovations from1970 to 1987, and disseminated informationabout effective country experiences important forpublic health advocacy and education.

• The accomplishments of a few committed peoplewith global foresight provides a proud legacy forAPHA. Their dedication in promoting communi-cation and cooperation among key players ininternational health serves as a valuable lesson andguideline for the future, particularly the impor-tance of maintaining dialogue with all sectors irre-spective of policy differences. This concept needsto be re-affirmed to address communication andorganizational barriers among sections andbetween the sections and the governing board, tochange the emphasis from competition amongpublic health specialties to a mutually reinforcingpublic health coalition..

• The synergy created among the leaders of APHA,Rockefeller Foundation and the MilbankMemorial Fund launched major initiatives ininternational health, including the formation andstrengthening of WFPHA and creation ofNCIH/GHC, and should serve as a model toadvance further development of internationalhealth organizations.

Comment on Where We Have Been and Where We areGoing!

APHA, as a pre-eminent non-governmental organizationwith a mission dedicated to the public’s health, has apotentially crucial role in the future health of the nationand in the interconnected globe. The recent threats of WestNile virus and SARS have demonstrated clearly that publichealth cannot be confined to just local, state, or nationallevels, as it requires a global scope to be effective. Manydedicated APHA pioneers and workers in internationalhealth have continually advocated for this global context asan integral part of all APHA’s public health activities, oftenduring periods of inconsistent support from the APHAboard. This analysis of the history and evolution of theInternational Health Section is the story of where the sec-tion has been and the path that was taken. This retrospec-tive reflection was based on a review of available filesenhanced by oral interviews and has provided a uniquewindow to those visionary leaders who were able to lift theorganization’s efforts at various times. In addition the his-tory provides glimpses of other types of leadership andresolve demonstrated by the many individual members ofthe International Health Section.

NCIH/GHC & APHA/IHS share the common linkprovided by the international health perspective of a fewleaders and the value of board support providing politicalwill that allows the organization to accomplish much more.

Advocacy for public health takes time and requirescooperation, partnership and mutual reinforcement amongthe many different health professions. The challenge forAPHA and WFPHA is to focus the coalition of organiza-tions to improve the conditions of poverty so that advocacyefforts can influence improved public health policy andpractice in the countries.

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References1. Excerpts from Nancy R. Bernstein’s History of Public Health from

The Nations Health 1-12/72

2. June 1955 Executive Board Minutes

3. APHA Annual Meeting Kansas City, November 1955 ExecutiveBoard Minutes

4. June 1959 Executive Board Minutes

5. February 20, 1959 Executive Board Meeting

6. Argentina, Australia, Brazil, Chile, India, Israel, Japan, Mexico,Netherlands, Nigeria, Philippines, Venezuela and United Kingdom

7. “Prescription for a Planet” at the 9th Bronfman LectureNovember 13, 1969 Philadelphia published in AJPH Vol.60 NO. 3pg. 433.

8. The Urgency for Social Action for Health. 1970 Vol. 60, NO. 1AJPH.

9. 56th World Health Assembly Framework Convention for TobaccoControl (FCTC) May2003

10. Nations Health April 1971 page one

11. July 1971 Nations Health page three

12. Agenda Item 3.32 International Health program Report 1973

13. Minutes of the Executive Board November 15, 1975 Chicago,Illinois Agenda Item 12.07

14. Report of the International Activities Subcommittee to theExecutive Board A Dissenting View pages 233-234, September1976 Governing Council Minutes.

15. The Nations Health August 1976 page 5

16. Executive Board Report on International Agenda Item 6.3 pages22-25

17. Agenda Item 7.20 Establishment of International Health SectionOctober 1976 page 25, EB Minutes

18. White House Report New Directions in International HealthCooperation Spring 1978

19. Minutes of the Executive Meeting of the International HealthSection, APHA February 16, 1983 pages 4-6

20. Executive Board Minutes June 2-3, 1984, Washington, DCAgenda Item 6.00 International Health Program Review, pages130-136.

AttachmentsIndividuals interviewed for the history

Mohammad Akhter, Tim Baker, Samir N.Banoob, James E. Banta,Rose Belmont, Georges Benjamin, Peter Bourne, John Bryant, ElieseCutler, John C. Cutler, Rosemary Donley, Gerry Dafoe, S. Paul EhrlichJr., Caswell Evans, Henry Feffer, Jay Glasser, Janet Gottschalk, DianeHedgecock, Lee Howard, Allen Jones, Barry Karlin, Susi Kessler,James R. Kimmey, Lani Marquez, Ray Martin, William McBeath, JeroldMichael, Henri Migala, Ahmed A. Moen, J. Henry Montes, Roscoe M.Moore Jr., Russell Morgan Jr., Julius S. (Bud) Prince, Vicente Navarro,Clarence Pearson, Jean Pease, Lorraine Pease, Olive Roen, RoseSchneider, Josefa Ippolito-Shepherd, George Silver, Dory Storms,Curtis Swezy, Carl E. Taylor, Ann Tinker, Linda Vogel, Ronald Waldman,Ned Wallace, Myron E. Wegman, Charles L. Williams Jr., ChuckWoolery, Joe Wray, and John Wyon.

Awards and RecognitionRecipients of the International Health Section Lifetime AchievementAward for Excellence in International Health:Dr. Stanley O. Foster, 2002Dr. Joe Wray, 2001Dr. Jack Bryant, 2000Drs. Warren and Gretchen Berggren, 1999Ms. Veronica Elliott, 1998Dr. Milton Roemer and Dr. Moye Freymann*, 1997Dr. Julius “Bud” Prince and Dr. Jeanne Sumner Newman*, 1996Dr. John Wyon, 1995Dr. Timothy Baker, 1994Dr. Cicely Williams*, 1993Dr. Derrick Jelliffe*, 1992Dr. Carl Taylor, 1991

*Awarded posthumously

Recipients of the International Health Section Mid-Career Award:Dr. Adnan Hyder, 2001

(No Mid-Career award in 2000)Dr. Stephen Gloyd, 1999Dr. Luis Tam, 1998Dr. Marty Makinen, 1997Ms. Colleen Conroy, 1996Dr. Mary Ann Mercer, 1995Dr. Irwin Shorr, 1994Dr. Walter K. Patrick, 1993Dr. Dory Storms 1990

Recipients of the International Health Section Distinguished Service Award:Dr. Marty Makinen, 2002Ms. Lani Marquez, 2001Dr. Dory Storms, 2000Dr. Samir Banoob and Dr. Susi Kessler, 1997Dr. Henri Migala, 1996Dr. Ahmed Moen, 1995Dr. Olive Roen and Mr. H. Pennington Whiteside, 1994 (the award was

re-introduced)Dr. Raymond B.Isely*, 1986Dr. Diane Hedgecock 1985Dr. Kathleen A. Parker—initial award 1984

Other AwardsSpecial RecognitionDikembe Mutombo, 2002

International Health Section Chairs/Newsletter Editors1976.................Carl Taylor1977.................Malcolm Merrill ..................Janet Anderson1978.................Hildrus Poindexter ..............Naomi H. Chamberlain1979.................Jeanne Sumner Newman ....Jason Calhoun1980.................Jeanne Sumner Newman ....Harold Royaltey1981.................Carlos H. Daza ..................Charles L. Williams Jr.1982.................John Karefa-Smart .............Charles L. Williams Jr.1983–1984 .......Dieter Koch-Weser- .............Frank I. Gauldfeldt1985–1986 .......William A. Reinke ...............Harold H. Royaltey1987–1988 .......Diane Hedgecock ...............Marty Pipp /

Pennington Whiteside 1989–1990 .......Richard Cash .....................Cynthia MacCormac /

Olive Roen1991–1992 .......Susi Kessler ......................Olive Roen1993–1994 .......Samir N. Banoob ...............Olive Roen1995–1996 .......John H. Bryant ...................Vishnu-Priya Sneller1997–1998 .......Dory Storms ......................Vishnu-Priya Sneller1999–2000 .......Henry Migala .....................Josefa Ippolito-Shepherd2001–2002 .......Ronald Waldman ................Josefa Ippolito-Shepherd2003–2004 .......Ray Martin.........................Josefa Ippolito-Shepherd