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nized, and the environment and character of life of rural popula-
tions call for a special approach”. It was also noted that such an
approach had been developed by the LNHO for Europe in 1931
and for the Far Eastern countries in 1937. Sanitary engineering
was cited as being of importance to “all public health activities”
[18:11]. It is difficult to judge which IC members were aware
of LNHO’s approach as the only other reference to it is to be
found in a background paper prepared by Andrija
Stampar.An-
other person who likely knew of the LNHO’s history is Hyde,
who in 1975 read to a group discussing community medicine “a
document and asked them how they liked that; if that seemed to
cover what they had in mind.They all agreed it did, and at least
one of them thought this was something I’d just written and was
testing on them” [19:74]; it was an excerpt from the Bandoeng
report, a policy direction that Hyde pursued when he was with
the USPHS.
Environmental sanitation joins
list of priorities
When the 1
st
WHA took place, Martha Eliot, US delegate,
took the occasion to suggest “adding to the four priority items
the major category of environmental hygiene, to include the
diseases borne by water, food and insects, such as typhoid fe-
ver, cholera and dysentery”, adding that such diseases
“could
be effectively and promptly controlled and their elimination
was fundamental to any progress in health” [20:116]. Another
member of the US delegation, Dr Halverson, “pressed for the
inclusion of environmental hygiene in the first priority items,
as many diseases arose from unsafe water, faulty sewage-dis-
posal, poor food-protection and failure to eliminate flies.The
related subjects of rural hygiene and tropical hygiene “could
be amalgamated with environmental hygiene” [20:165].
The new priority granted to environmental sanitation was
generally welcomed by the delegates to the 2
nd
WHA.When
Dr MacCormack, the delegate from Ireland, suggested that
“environmental sanitation be coordinated with work for the
extermination of endemic diseases and should form a neces-
sary part of the follow-up programme in any such scheme,
Hyde, who was chairing the committee, indicated that Mac-
Cormack had “expressed very clearly what was, in fact, the
view of the Director-General” [21:169].
As outlined by the first WHO Expert Committee responsi-
ble for Environmental Sanitation that took place in September
1949, environmental sanitation referred to the control of a
long list of items, including methods for the disposal of ex-
creta, sewage, and community wastes to ensure they are ad-
equate and safe; water-supplies, to ensure that they are pure
and wholesome; housing, to ensure that it is of a character
likely to provide as few opportunities as possible for the di-
rect transmission of disease, especially respiratory infections,
and encourage healthful habits in the occupants; arthropod,
rodent, mollusk, or other alternative hosts of human disease;
and infections commonly acquired or transmitted by the ali-
mentary route, especially the enteric group; infections com-
monly acquired by the respiratory route; infections common-
ly acquired by surface contamination, which included yaws,
leprosy and hookworm disease; and infections transmitted
through the agency of an alternative host, which included ma-
laria, yellow fever, leishmaniasis, bilharziasis, plague and epi-
demic typhus.
The Committee thought it evident that the sanitation of the
environment is “literally the foundation upon which a sound
public health structure must be built”. Without it the super-
structure “will be costly, weak, and insubstantial.” If all of its
constituents
are not firmly designed, the “structure will still
totter” [22:5-6]. One is tempted to add ‘amen’.
The committee met again in 1951, when it was asked
Chisholm to “devote its attention … to the specific problem
of education, training, and utilization of personnel for envi-
ronmental sanitation [23: 3]. It remained at pains to provide
specific guidance for “underdeveloped or emergent countries”
due to “the wide variety and complexity of the systems pres-
ently in use”, and to the “many different ways” in which the
systems of local and central government exercise their con-
trol of the environment [23: 5]. However, it did identify the
categories of personnel involved which ranged from sanitary
engineers “to serve as true professionals at the various levels of
responsibility relating to the environment in public health and
associated organizations”, to sanitarians who were grouped
under the titles health inspector, health assistant, and health
aid [23:9]. Health inspectors were “the backbone of the sani-
tary service” and were expected to have sufficient education to
matriculate at a university. Also included were voluntary lead-
ers for the mobilization of self-help, who it was hoped would
include local leaders, village school-masters and “young men
with enthusiasm who work or own property in the village…”
[23:12].
The 3rd session of this Committee, which met in 1953, ad-
dressed the sanitation problems of small communities in
under-developed countries and methods of solving these
problems. Dr Marcolino Candau, WHO’s Director-General
(1953-1973), in his opening comments, stressed two points:
a program of rural sanitation cannot be successful without the
active participation of the local community, and it is neces-
sary for all health workers at every level to participate in well-
designed programs of health education of the rural population
[24: 3].
The Committee stressed the fact that “sanitation was funda-
mental and basic to individual and community existence” [24:
4]. Furthermore, “it should be considered axiomatic that en-
vironmental sanitation programmes in underdeveloped areas
should be integrated with general community development,
and particularly with agricultural progress” [24: 5].
The administrative structure should provide the “simplest pos-
sible mechanism for the local health worker to obtain tech-
nical guidance from and consultation with staff at the next