COMMITTEE ON INTERNATIONAL RELATIONS Science, Technology, and American Diplomacy An extended study of the interactions of science and technology with United States foreign policy Volume II COMMITTEE PRINT U.S. House of Representatives COMMITTEE ON INTERNATIONAL RELATIONS Science, Technology, and American Diplomacy An extended study of the interactions of science and technology with United States foreign policy U.S. House of Eepresentatrt:s U.S. Government Printing Office Washington: 1977 For sale by the Superintendent of Documents. U.S. Government Printing Office Washington, D.C. 20402 (3-Part Set; Sold in Sets Only) Stock Xo. 052-070-04350-4 COMMITTEE ON INTERNATIONAL RELATIONS ZABLOCKI, Wisconsin, Chairman WILLIAM S. BROOMFIELD, Micliigan EDWARD J. DERWIXSKI, Illinois PAUL FINDLEY, Illinois JOHN H. BUCHAXAN, Jr., Alabama J. HERBERT BURKE, Florida CHARLES W. WHALEN, Jr., Ohio LARRY WIXN, Jr., Kansas BEXJA:VIIN a. oilman, Xew York TEXXYSON GUYER, Oliio ROBERT J. LAGOMARSIXO, California WILLIAM P. GOODLING, Pennsylvania SHIRLEY N. PETTIS, California CLEMENT J. L. H. FOUXTAIN, North Carolina DAXTE B. FASCELL, Florida CHARLES C. DIGGS, Jr., Michigan ROBERT N. C. XIX, Pennsylvania DOXALD M. ERASER, Minnesota BENJAMIN S. ROSENTHAL, New York LEE H. HAMILTON, Indiana LESTER L. WOLFF, New York JONATHAN B. BINGHAM, New York GUS YATRON, Pennsylvania MICHAEL HARRINGTON, Massachusetts LEO J. RYAN, California CARDISS COLLINS, Illinois STEPHEN J. SOLARZ, New York HELEN S. MEYNER, New Jersey DON BONKER, Washington GERRY B. STUDDS," Massachusetts ANDY IRELAND, Florida DONALD J. PEASE, Ohio ANTHONY C. BEILENSOX, California WYCHE FO^^^:,ER, Jr., Georgia E (KIKA) DE LA GARZA, Texas GEORGE E. DANIELSON, California JOHN J. CAVANAUGH, Nebraska John J. Brady, Jr., Chief of Staff George R. Berdes, Staff Consultant Subcommittee on International Security and Scientific Affairs CLEMENT J. ZABLOCKI, Wisconsin, Chairman L. H. FOUNTAIN, North Carolina WILLIAM S. BROOMFIELD, Michigan JONATHAN B. BINGHAM, New York LARRY WINN, Jr., Kansas GERRY E. STUDDS, Massachusetts ANTHONY C. BEILENSON, California Ivo J. Spalatin, Subcommittee Staff Director William H. Fite, Minority Staff Consultant Forrest R. Frank, Suhcommittee Staff Associate La Verne Still, Staff Assistant (H) Contents — Volume II Page Organization of the Study V Part 2 — Six Issues: Chapter 9 — The Evohition of International Technology . 607 Chapter 10— The Politics of Global Health 681 Chapter 11 — Beyond Malthus: The Food/People Equa- tion 765 Chapter 12 — United States Scientists Abroad : An Exam- ination o.f Major Programs for Nongovernmental Scien- tific Exchange 865 Chapter 13 — Brain Drain: A Study of the Persistent Issue of International Scientific Mobility 1037 Chapter 11 — ^Science and Technology in the Department of State : Bringing Technical Content into Diplomatic Policy and Operations 1319 (in) ORGANIZATION OF THE STUDY ^■ n » Volume I Introduction to the Study as a Whole Toward a Neic Diplomacy hi a Scientific Age The Global Context of Science, Technology, and Diplomacy Part 1 — Six Cases The Bariich Plan Commercial Nuclear Power in Europe The Political Legacy of the International Geophysical Year The Mekong Project Exploiting the Resources of the Seabed United States-Soviet Commercial Pelations Volume II Part 2 — Six Issues The Evolution of International Technology The Politics of Global Health Beyond Malthus U.S. Scientists Abroad Brain Drain Science and Technology in the Department of State Volume III Introduction to the Analysis and Findings Recapitulation of Purpose, Scope, and Methodology of the Study Part 3 — Analysis of the Cases and Issues Analysis of the Cases Analysis of the Issues Part 4 — Principal Policy Implications About the Essays to Follow Initiative Versus Reactive Foreign Policy Bilateral Versus Multilateral Diplomatic Relationships High-Technology Diplo)nacy Versus Low-Technology Diplomacy Roles and Interactions of Public and Private Institutions in International Technology Independence Versus Interdependence Long-Range and Short-Range Planning Concluding Observations Bibliography (V) PART 2— SIX ISSUES C>K9 Chapter 9 — The Evolution Of International Technology CONTENTS Page I. Introduction 611 Technology as the Underpinning of Diplomacy 611 Contemporary Importance of Technology 612 Pace 613 Size — 613 Complexity 614 Variety or Scope 615 Range and Pervasiveness of Impacts 615 National Infrastructures of Technological Growth 616 Interactions of Technology With Diplomacy 617 Institutional Matters 618 Substantive Technological Matters 618 Diplomatic Need for a Coherent Policy Toward Technological Change 619 II. Historical Influence of Technology on Diplomacy 619 The Industrial Revolution as a Global Process 620 British and German Technological Supremacy 620 Technological Support for Germany's Struggle for Power 621 U.S. Rise to Technological Maturity 622 Trends in Industrial Research and Scientific Management 623 Maturing of the American Technological Posture 623 Diplomatic Implications of U.S. Technological Maturity 624 Frustration of U.S. Efforts to "Wield Technological Power 626 III. Trends in Contemporarv Technologv 627 ._ 628 ._ 629 ._ 631 ._ 632 Achievement of Overwhelming Nuclear Force The Problem of Stabilizing Deterrence Paramountcy of Offense A Dissenting View of Deterrent Stability The Diplomatic Significance of Space Technology 633 The Space Race With the Soviet Union 634 Measures of Progress in Space Technology 635 Diplomatic Aspects of the Space Race 635 -_ 637 ._ 637 ._ 638 -_ 639 ._ 640 Communications Satellites Feasible Functions of Surveillance Satellites Weather Forecasting by Satellite Earth Resources Satellite Surveys Growing Importance of Space-Diplomacy The Interaction of Agricultural Technology With Diplomacy 640 Modern Contrast With Jeffersonian Ideal 641 Political and Economic Trends 642 Some Diplomatic Consequences of Agricultural Change 643 Supporting Elements of National Technological Change 645 Different Views of "Infrastructure" 645 Education and Training 646 Health 647 Power 648 Transportation 648 Communications 649 International A.spects of Infrastructure 650 Recapitulation : Diplomatic Consequences of Technology 651 IV. The Internationalization of Technology 652 Assessment of National and International Technology 652 International Aspects of Technology Assessment 654 (609) 610 IV. The Internationalization of Technology — Continued Assessment of National and International Technology — Continued Page Suggestions for International Institutions 655 The Assessment Role of International Law 657 The Internationalization of Military Technology 658 Factors of Sub-Nuclear Technology 659 The Increasing Scope of Global Technology 661 Hazards of Economies of Scale 661 The Internationalization of Commercial Technologies 662 American High-Technology Bias 663 The Spread of Multinational Businesses — 664 National Control of International Corporations 665 Commercial Transfers of Technology 665 Technological Obstacles to U.S. Export Trade — 666 Regional Organizations for Technology 667 International Transfer of Technology 667 President Nixon's Foreign Policy 668 Review of U.S. Technical Aid Program 670 U.N. Study of Technical Assistance 672 Presidential Policy for Future Technical Aid 673 Some Future Problems in Technical Assistance 674 V. The Emerging Policy Issues of International Technology 675 The Issue of National Strategy in Technological Innovation 675 The Issues of Global Strategy in Technological Innovation 678 The Ultimate Issue : Reconciling National and Global Technologi- cal Advance 680 TABLES 1. Gross Domestic Product, Private Farm and Nonfarm Sectors, Selected Years 643 2. Suggested Required Levels of School Enrollment 646 3. How Trade Follows Research and Development 663 CHAPTER 9— THE EVOLUTION OF INTERNATIONAL TECHNOLOGY I. IxTRODUCTIOjST The focus of this chapter is on technology : it is intended to delineate the iini)ortant ways in which technology influences diplomacy ; to show technological change as a process producing effects tliat diplomats must deal Avith; and to raise questions as to whether and how govern- ments can make j^urposeful, constructive use of these processes to fur- ther diplomatic objectives. A survey of the history of tcclmology observes that the Industrial Kevolutiou — which might also be called the "Technological Eevolu- tion'* — was and continues to he a revolution of power, but not only in the power of the mnclnne. "It revolutionized the power of the middle- class em])loyer and the power of labour, the economic power of nations and the power of armaments. But power in itself is neither good nor evil : in the last analysis, its uses are subject to man's good sense or his stui)idity. If this is a truism, it is one tliat man, in tlie age of nuclear energy, can scarcely afford to ignore."* ^ Similarly, Professor Warner Schilling of Columbia University, who has written extensively in the field of international politics, observes that the industrial revolution changed all the elements of the "inter- ]iarional i)olitical process" including the structures of states, their policies, and their purposes, expectations, and means. Consider the chauges in * * * the number, location, and relative power [of states in the world coiiinumity of nations]. As the industrial revolution trans- formed the bases of military power and increased its mobility, international rela- tions became global, rather than regional, in scope, and the relations among the members of this global system became continuous, rather than episodic.^ Teclinology as the TJndcrpmnhig of Diplomacy The profound influence that technological change has had in the past, and promises to have for the, future, implies the need for a strong cori)S of diplomats trained to anticipate and prepare for the direct and indirect impacts of technology on diplomatic concerns. As William P. liogers, the Secretary of State, observed to the scientific ] numbers o f his diplomatic service, January 29, 1970: "Science and ' Charles Sinffpr, E. ,T. Holmyard, A. R, Hall, and Trevor I. Williams, eds. "A History of Technology." Vol. V : The Late Nineteenth Century, 1S50 to 1900 (New York, Oxford University Press, 19.'>S), page S40. - Warner R. Schillins;. "Teehnolosy and International Relations." International Encyclo- pedia of the Social Sciences. Edited by David L. Sills, (New York, , The Macmillan Company and the Free Press. Volume 15), 19GS, page 590. Note : This chapter was prepared in 1970 by Franklin P. Huddle. (611) 612 technology today have a telling impact on policy decisions in both national and international affairs * * *. We do not have to look far to find examples * * *." It would be foolhardy in this day and age [the Secretary went on] to set political objectives without an accounting of the technical realities — or to approach technological problems without regard to their political and social implications. Indeed, the assessment of what science and technology holds for us in the years ahead must be an integral part of today's policy and decision-making machinery. The conduct of our foreign affairs — the formulation of our policies and goals — must reflect the sometimes complex, sometimes subtle, but persistent influence and interaction of science and technology on the affairs of man. So it is obvious that in forging the capability of the State Department to deal with the problems of the 70s, the professional corps of the Foreign Service and the Department must develop the capacity to keep abreas't of these develop- ments and the skills necessary to cope with them. Diplomacy deals with problems between sovereign nations and with the common concerns of members of the world commmiity of nations. The objective of diplomacy is to reconcile or resolve issues and establish agreement^ to advance the national interest in a constantly changing world. Changes within the jurisdiction of each member of the world community alter its relations with others. No source of change is more potent than an alteration in a nation's technological condition. It produces changes of many kinds at many levels of impacts and interactions: military, commercial, cultural, political, and scientific; these changes involve many agencies of government, the academic world, private business, and the public at large. Familiarity with tecluiolog}' , and with the nature of its impacts, is thus an indispensable tool of the diplomat. Moreover, the skill with which a nation manages and advances its own technology contributes to the status of its diplomats, and to the options with which they can negotiate. In both senses, national technology confers diplomatic power. Moreover, it is more than a hypothesis that developments in U.S. teclinology have bearing on the achievement of such national and international objectives as peace, lessened tension, mutual trade, and easement of the plight of the less developed nations of the world. Accordingly, the Department of State has a cause for concern with the health and vigor of U.S. technology, both generally and with specific reference to technological fields that can be identified as con- tributing most directly to diplomatic objectives of the United States. The future direction of U.S. technological advances, no less than the Nation's general level of technological competence, has far-reaching consequences beyond its borders. Of great importance also are the uses made of this burgeoning technology, and the organizational arrange- ments — domestic and international — for overseeing these uses. In these senses, technology is an important basis for national power. Contemporary Importance of Technology Technology is a general term covering a wide variety of scientific and technical activities and products. In its simplest usage, it merely signifies "tools." At the other extreme, it conveys the broad meaning of "how man works" ^ and indeed "denotes the broad area of purposeful 3 Peter P. Drucker. "Technology, Management, and Society : Essays by Peter F. Drucker. (New York, Harper and Row, Publishers, 1958, reprinted 1970), page vil. 613 application of the contents of the physical, life, and behavioral sciences." ^ In Part I of this study, technology was described as "the cutting edge of science." It is the point in the system of scientific inquiry and application at which tangible and material impacts occur upon human affairs, and the point at which economic and political decisions are required. Expressed another way, technology is the rational use of knowledge about man's universe, while science is the process of discov- ering additional pieces of that knowledge. Notable changes have taken place, over the past several decades, in the role of technology in the United States. Tlie years 1950-1970 might perhaps be described as a "Golden Age of Technology" in this country. The changes can be described along five general headings of pace^ sise, coTJiplexity, variety or scope, and range and pei'vasive- ness of iTTipacts.^ PACE Speaking as Special Assistant to the President for Science and Tech- nology, in 1960, George B. Kistiakowsky declared: "What is new today is the rapidity with which the developments of science are alter- ing the human condition, the rapidity with wliich policy, particularly foreign policy, must adjust to the changes being wrought by the pace of scientific advance. Not only adjust — policy must prepare for, must predict, the impact of scientific discovery and must also in some sense attempt to guide it." ® The rate at which technological innovations have been introduced into the American culture has been a factor of the large postwar in- creases in the public investment in scientific research. It has also re- sulted from large public expenditures in related, areas (defense, space, and atomic energy) and supporting fields (communications and in- formation processing). Acceptance of such innovations is a factor, also, of the extensive public education in scientific subjects. The increased pace of change increases the rate at which interna- tional issues, problems, and opportunities arise. It confronts the diplo- mat with an ever-lengthening agenda, the need for a deeper under- standing of the processes of change, and the requirement for a great increase in the orderly flow of exact information concerning its ingredients. SIZE Although historical achievements in technology have sometimes approached heroic proportions (the Pyramids, Eoman roads, the Great Wall of China, and the Panama Canal, for example) , the size and cost of some of the modem technological systems is quite unprec- edented. Most notable are those in the field of military hardware, * Erich Jantsch. "Technological Forecasting in Perspective : A framework for tech- nological forecasting, its techniques and organisation ; a description of activities and an- notated bibliography by Erich Jantsch, consultant to the OECD. (Paris, Organisation for Economic Co-operation and Development, 1967), page 15. 5 This enlarges somewhat on a statement by Herman Pollack, (then) Acting Director, International Scientific and Technological Affairs, Department of State, at a Colloquium on Science and Human Affairs, University of Illinois, May 17, 1967. He said, in part : "We are in the midst of a technological revolution without precedent In its combination of scale, pace, and impace on the offices of men. The crucial element in that combination is pace. . . ." « Address to American Physical Society and American Association of Physics Teachers, reprinted In "Department of State Bulletin," (February 22, 1960), page 276. 614 such as the Miniiteman complexes, the DEW Line, air defense sys- tems, the Polaris system, and nuclear test detection systems. Othere include spacecraft like the Apollo series, global communications net- works, air traffic control systems, a global weather forecasting net- work, the Interstate Highway System, electric power grids, and the complexes of multipurpose dams on the Tennessee and other major rivers. The willingness and albility of American society to concentrate re- sources on miajor technological systems like these has been a striking phenomenon of recent years. Moreover, each of these large endeavors produces in its wake an array of lesser innovations useful elsewhere, and a technological "multiplier" effect analogous to the Keynesian eco- nomic multiplier seems to result, raising the general level of the Na- tion's technological culture to new orders of capability. Large technological projecte of an inlierently international char- acter impose burdens on the diplomat. Problems and benefits must be shared equitably by many nations. Acceptance of roles of participa- tion must be negotiated. New meclianisms of diplomacy are required. COMPLEXrrY The historical evolution of teclinology appears to have followed a series of cycles. An initial stage was the development and use by man of simple manual tools. Then the effectiveness of the tools was multi- plied by the use of energy sources — horses, wind, waterpower, steam, and electricity. Progressively, tools became more highly specialized and explicit in purpose. Then, tools of different functional purpose were integrated into large systems—such as the assembly line, rail- road and telephone systems, and petroleum pipelines and refineries. The most recent step has been the introduction of computers into these large systems, to automate the making of routine decisions in their management. These systems have now become so complicated in design and function that even to build them has come to require elaborate systems of planning and control, and these have also required the assistance of computers. Particularly in the fields of military weaponry and space explora- tion have systems of extreme complexity emerged. A typical air de- fense system might extend over a thousand miles, with hundreds of persons in each of dozens of stations, served by electronic sensors, tele- phone lines, computers to convert signals into readable forms, cathode ray tubes to display information visually, and computers to translate information into instructions for actions to be taken by interceptors, ground-to-air missiles, and other tracking stations. Equally complex is the arrangement of a manned space flight. Taken together, the com- puter and electronic communications have greatly enlarged man's ability to design and operate complex and far-flung systems. The evolution of the systems concept imposes burdens and offers opportunity to the diplomat. On the one hand, complexities of systems design present formidable obstacles to quick understanding of these large enterprises. On the other hand, it has been suggested that the disciplines and orderly methodologies they require can make a direct contribution to the processes of diplomatic analysis and problem solving. 615 VARIETY OR SCOPE The variety of technological innovations to which the individual citizen is today exposed seems to have increased by orders of magni- tude in the past quarter-century. This increase seems to be attributable, again, to the heavy and rising public investment in basic and applied physical science, to hea^^ developmental outlays in the high technology of military and space programs, to the initiative of entrepreneurs in effecting lateral transfers of new hardware to consumer markets, and to the receptivity of a teclmically literate and affluent consumer mar- ket. The imiovative trend is indicated by the automation and pro- ductivity of agriculture and industry; the great variety of consumer goods m the home ; the elaboration of hardware for recreational pur- poses ; the introduction of computers into banks, brokerage houses, ticket officers, the management of credit cards, and other services ; the elaborate expansion of hardware and technological systems into group medical practice and hospitals, school systems, and law enforcement administrations ; and the great range of different vehicles in service in the air, on the highways, and in shops, airports, heavy constmction projects, and urban areas. While the scope of diplomacy has not excluded attention to all these topics, there is a tendency for teclmology to make them more salient. Assigning priorities among a growing array of salient developments becomes increasingly difficult as a problem of formulating and imple- menting foreign policy. RANGE AND PERVASIVENESS OF IMPACTS The effects of an onrushing technology on the United States and in its relations with other countries are virtually without limit. His- torical concepts of war, and of the military base for diplomacy, have been unseated by atomic weapons and their long-range delivery systems. Industrial productivity, supported by technological innovations, has risen so impressively in relation to hours of work that a "post-indus- trial" condition can be foreseen in which standards of livmg will no longer be limited by the length of the work week. Consumption of industrial materials continues to rise, to support present high levels of industrial output, so that the future adequacy of minerals and fuels is increasingly in question. Consumption of electrical energy to run all the appliances and durable goods in the household, and for all manner of industrial appli- cations, has been doubling every decade in the United States, and seems destined to continue to double at this rate, at least through 1990. Impacts of power generation on environmental quality are a source of growing pul3lic and professional anxiety. Imperfections in technology are coming increasingly under attack : in terms of pollution of the air and surface waters ; in terms of noise, radiation, and thermal effects ; and in terms of massive quantities of waste products to be disposed of, and minute additions of toxic mate- rials that progressively accumulate in the environment. Agricultural technology has enabled the highest rate of per- worker productivity in all histoi-y, but at a cost of heavy uses of chemicals, some of which re- 616 main indefinitely in tlie environment. A further cost or hazard results from agricultural simplification — ^the reduced variety of crops — such that any attacking blight or pest that technology cannot control might wipe out a large fraction of the Nation's food supply. Technology of health and medical practice has imposed increasing burdens of knowledge on medical practitioners and increased costs on those treated, as well as on society at large. The same problem of infor- mation overload confronts technologists in most other fields ; indeed, the public at large is exposed to more choices, more solicitation and appeals for attention, and more stimuli, than ever before. As standards of material well-being in such affluent countries as the United States, Japan, the Scandinavian countries, and those of West- ern Europe, continue to rise, their condition becomes the source of envy and the target of the aspirations of less developed countries of the world. Defects perceived by the developed countries in their own technologies tend to be discounted by those less developed. Continued growth of technology and productivity, with their con- current imperfections and environmental effects, cannot reasonably be expected to go on indefinitely. In countries with less advanced tech- nologies and production systems, the United States is today a much- admired model for emulation. Global growth in the uses and defects of technology is in prospect, strongly supported by positive programs for the export of U.S. technology and by the efforts of the less-developed countries to increase their own technological sophistication through schools, universities, and institutes. The impacts of this growth on a finite world are sobering; to the extent that adverse effects of technol- ogy are attributed to the United States as the foremost technological nation, the consequences of this technological leadership seem to pose awkward problems for future diplomacy. However, for the present, the main theme is one of enthusiastic emulation. National Infrastructures of Technological Growth The rate at which a nation's technology grows, intensifies, integrates, and comes to dominate its culture, depends in large measure on a com- bination of foundational elements or "infrastructure." Marked differ- ences are evident among nations as to the completeness with which this infrastructure is developed, and accordingly as to their relative prospects for rapid teclinological advance. The extent of attention given to this infrastructure, historically, seems to have been more acci- dental than consciously directed. However, since about 1955, there has been a growing appreciation of the importance of the infrastructure for the evolution and strengthening of a nation's technology. Infrastructure encompasses many elements. A nation must be able to feed itself, for example, but unless the productivity of its agri- culture is such that one family can feed several by its efforts, there will be no food available for those who leave the farm for the urban factory or to sell abroad to buy machinery with. In the United States, a single farm worker — statistically — feeds something like 30 to 40 persons. To increase agricultural productivity requires mechanizatioia, agricultural science, and capital; this set of requirements in turn suggests the need for credit institutions, agricultural training pro- grams, research institutes (to provide information pertinent to the crops produced in the country concerned), an agricultural marketing system, and so on. Other elements of infrastructure are arrangements 617 for broad public education, a strong national health program, training in entrepreneurial and managerial skills, sophistication in the han- dling of industrial machinery, a national standards laboratory, and many other basic institutions. Rail and highway networks are of great importance to miify a national market and to open up the hinterland to the global network of ocean freight. Of course, as a practical matter, the infrastructure contains a host of other ingredients, such as the abundance of teclinological artifacts for youth to experiment with, the level of technology in the home with reference to such features as the American "do-it-yourself^ craze, the wide availability of popular science literature, the American consciousness of the importance of the worker-manager and worker- company relationship, the speed with which technology finds its way into toys and recreational hardware, the institution of the "science fair," and many more. There are many ways in which diplomacy and technological mf ra- structure are related : in the formulation of plans with or for develop- ing countries for aiding them to build their own infrastructure, in dealing with developed coimtries on issues of comparative excellence and competition in infrastructure-building, in exchange of informa- tion on measurement of aspects of infrastructure, and in resolving conflicts in foreign trade resulting from differential costs based on different levels of infrastructure, and so on. Interactions of Technology with Diplomacy The uses of teclinology have involved or affected relations between nations m many ways. The essence of technolog}^ is power : to increase the production of some manufactured good, to contrive some military weapon of surpassing potency or effectiveness, to perform some so- cially necessary or desired function, to demonstrate some demanding feat of skill, to secure resources and convert them into artifacts that modify the human environment in purposeful ways. The relations between nation states constitute an endless bargaining process in which the currency is power. A nation that consciously and dynamically lays the gromidwork for technological advance, encourages teclinological skills, rewards innovation, and systematically increases the variety, depth, sophistication, and universality of its tcchnolog;^', is in a stronger bargaining position than a nation that does not. Technology' increases the range of options open to a nation in its internal affairs and in its alternatives abroad. Selection and negotiation of courses to support foreign policy, which is the task of diplomacy, is broadened, strength- ened, and often made more flexible, by the achievements of tecluiology. On the other hand, not all the outcomes of technology are equally felicitous. A nation achieving a relatively high level of teclinological power may have the effect of encouraging other nations to combine forces to reduce its bargaining power. A nation generous with its tech- nological innovations (for example), the British in 1825-1850 or so, with their export of railroad locomotives and rolling stock) may com- bme benefits in one industry with injury to another. (In the British case, the effect was to stimulate tomiage impoits of agricultural products from the United States to the disadvantage of British farm- ers). Even if a nation bends every effort to achieve technological superiority, its lead over competitor nations will be only marginal at best because other nations will quickly duplicate its successes without 97-400 O - 77 - 2 618 involving themselves in the costs of its failures. Moreover, technological leadership, though gained at great cost, can be quickly lost if a nation relaxes from the effort even momentarily. For example, the United States pioneered the metallurgical technology in titanium, only to see Japanese metallurgists winnow the best information available and proceed to improve on it — efficiently and at low additional cost. Semi- conductor technology followed a similar course. The whole history of textiles has been a succession of international transfers of teclinology, with improvements occurring after almost every transfer. Qualitative differences in the directions taken by a nation's tech- nology can have important differences in the effect on quantity and intensity of diplomatic interactions. The relative power resulting from the British steel industry and the Chinese ceramics industry is ob- vious. Nations emphasizing maritime technologies increase the fre- quency of international contacts. Mass production of low cost items results in a need to export and often in an accompanying need for ever- increasing external sources of raw materials. From the literature of science and technology, and of diplomatic discussion, it is possible to delineate a long list of technological-diplo- matic problems, issues, and concerns, of which the following are illustrative : INSTITUTIONAL MATTERS Technological institutions to aid the less developed nations and to further U.S. technological relations with comitries phasing out of the AID program; Opportmiities for creative technological relationships and the evolu- tion of suitable, mutually-supported institutions with nations on the geographical and ideological periphery of the Soviet Union; Coordmation of the midtifarious teclinological programs, interests, and institutions of the United Nations, and also the many regional treaty organizations, European Community and Western Hemisphere organizations, and the like ; Resolution of j)olicy issues associated with the development of high-teclinology-oriented, multinational corporations. SUBSTANTIVE TECHNOLOGICAL MATTERS Development of plans for international cooperation to exploit satellites for coinmunications, meteorological research and forecast- ing, earth resources surveys, geographic mapping, navigation, pollu- tion detection, early warning of plant and forest diseases and insect infestation, and other purposes ; Teclinological and environmental problems of the Arctic regions ; Development of quick-response arrangements on an international basis to combat the spread of epidemics (whether afflicting man, animals, or plants), to disseminate curative and preventive teclinolo- gies, (to assure global availability of curative agents and instruments, to enable rapid mobilization of medical teams for emergencies, and to eliminate sources of endemic diseases ; Formulation of policies for the international exchange and use of government-owned patents, the protection of privately owned patents, and the exchange of trade secrets and other "intellectual property," especially where international consortia or multinational corporations are involved; 619 The bearing of the rate of teclinological advance in the United States, both absolutely and relative to particular countries and groups of countries, on U.S. diplomacy and diplomatic objectives; The importance for U.S. objectives of the fact that U.S. teclinologi- cal achievement is not imif orm across all of industry, but ranges from the high extremes of computers and control instruments to the rela- tively lower level of achievement in the steel industry and textiles. Diplomatic Need for a Coherent Policy Toward Technological Change The question to be explored in this chapter pertains to the inter- national role, past and prospective, of technology itself as an aspect of the national culture and power. 'What does it mean for the future role of the United States in relation to the community of nations ? ^^^lat could it mean ? In what ways can and should technology be exploited for diplomatic purposes ? What are the costs of this exploitation, and are they tolerable ? Technology is a concept in which every citizen is involved. It is capable of being influenced by Government action. It is a source of national strength and wealth. It requires elaborate institutional ar- rangements, and the more sophisticated it becomes the more complex and far-flung are the arrangements needed to manage it. Technology has been shown capable of advancing U.S. foreign policy objectives, but it is neither infallible nor invariably beneficial. The question, then, is how to determine what the Federal policy should be with respect to technology, for purposes of U.S. diplomacy. It is certain, in any event, that technology will continue to advance. Once set in motion, it has a momentum of its own. The question is whether and how the dynamics of this changing feature of the Amer- ican culture can be guided and directed to serve the objectives of U.S. international relations. Implicit in this question is the further issue of whether such diplomatic gains should be pursued or aban- doned when they are found to conflict with domestic or regional pro- grams. What sacrifices are necessary ? Are they tolerable ? AVlio should decide ? "Who should determine the rules of the game — the criteria and values on which the choice is made? What organizational resources are available to make these decisions ? Are they adequate for the pur- pose ? T\Tiat else needs to be done ? The hypothesis of this chapter is that technology is a primary source of national power and diplomatic influence. The section to fol- low will discuss briefly some of the liistorical effects of technology on the world scene and on the emergence of the United States as a world power. Section III, Trends in Contemporary Technology, selects for more extended treatment several important technologies or aspects of technology. Its purpose is to show that as each teclinology evolved it became internationalized, its substance became the subject of inter- national conversations, its effects extended beyond natiional .bound- aries, and an ultimate outcome to be foreseen would be the evolution of a global system mcorporating or resolvmg the teclinology. II. Historical. Ixfluence of Techxology on Diplomacy Technology today is at once the substance, an instrument, and a com- plicating factor of foreign policy. It involves every citizen ; it can be influenced by government action; it imposes on society the need for 620 more and more elaborate institutions for its use and control. On the world scene, technology is a source of national strength and wealth; it can advance a nation's foreign policy objectives ; but it is often un- predictable and sometimes injurious in its effects. The purpose of this section is to trace briefly the emergence of technology in the Western World, and chiefly in the United States, to provide an overview of the national and international role of teclmology as an aspect of na- tional culture and power. In general, it may be said that technology has contributed both divisive and cohesive factors to the spectrum of international politics. The development of military weaponry has increased the power in- ventory of nations; yet, vigorous development of military hardware by leading protagonists has merely tended to stabilize the balance of power between them. The application and pui^uit of technology expands national frontiers, but the quest for resources abroad has tended to stimulate closer economic relations with remote territories. Uneven growth of teclmology in developing countries has raised living standards, but has also generated tensions as hmnan expectations have outrun rewards. The Industrial Revolution as a Glohal Process Early in the industrial revolution, a race began for both overseas markets for manufactured goods and supplies of needed raw materials. In this race the process was one of commercial penetration, followed by military enforcement of commercial rights. It is described as follows : Ckmscious of their unassailable position, merchants demanded commercial privileges, and disputes over them often led to wars. From military victories followed the necessity to assume administrative and political authority. Thus, granted the immense European naval and military superiority, European control of the Far East was an almost inevitable consequence of Europe's commercial intrusion in the fifteenth century. Conquest, like missionary effort, was an aspect of the boundless energy of the west. It was the western ascendancy in warlike affairs, ship-building, and naviga- tion that first impinged upon the East [Products of artistic quality and crafts- manship did not emerge from the application of western technology.] . . . The huge, basic steps in technological progress seem to be linked with the satisfaction of the most elementary and insatiable human needs. Water- and wind-power were first applied to the grinding of corn, then to fulling cloth, then to mining and metallurgy. Steam-power went first to the mines, then to the mills. Mass- production methods appear first in ship-building yards, then in armament factories. Modern chemical industry begins with the 'heavy' chemicals, and so on. . . . The superiority of the West lay in its greater use of power and machinery, in its chemical industry, and, in a few respects, in its applications of natural science. These advantages enabled Europe to produce more goods more cheaply, and so gradually to raise its standard of living to an unprecented level, while dominating the commerce of the world and drawing to itself every necessary raw material.^ British and German Technological Supremacy From the close of the Napoleonic Wars to about 188.5, England remained dominant technologically and industrially over the other nations of Europe, and indeed the rest of the world. Factors behind this leadership included : the proximity of coal and iron at the outset of the age of steam ; superior flexibility in the availability of acciunu- lated capital for investment ; and early developments in machine tools ■^ Charles Singer, E. J. Holmyard, A. R. Hall and Trevor I. Williams, eds. "A History of Technology." Vol. Ill : From the Renaissance to the Industrial Revolution, 1500 — 1750. (New York, Oxford University Press, 1957), pages 709-711. 621 and precision metal-working. However, between 1870 and 1895, Ger- many passed the British and assumed world technological leadership. In Germany the advent of the railway age resulted in the iron-ore deposits becoming, for the first time, economically linked with coal in that country. The era of 'blood and iron' was dawning. By 1866 Prussia had replaced Austria as leader of the German-speaMng peoples. Four years later, a pretest had been found for war against EYance, and Bismarck's concept of a unified Germany had materialized. In achieving military victories the Prussian armies were consider- ably aided by their technological advantage in small arms. . . . Emergence of a united Germany and its acquisition by conquest of the low-grade phosphoric iron ores of Lorraine had a dominating significance in world events for the next three-quarters of a century. The Gilchrist and Thomas process, invented in England in 1879, permitted the first use of the iron ores of Lorraine and Luxem- burg in the manufacture of steel. The new powerful and energetic Germany was not long in rivalling Britain's early lead in steel production. By 1895 the British output was surpassed by the German.* German emphasis in education was on technological skills q,nd in- novation. '"The United Kingdom, on the other hand, was by then lagging technologically, especially in the newer fields of electrical engi- neering, organic chemical manufacture (particularly of dyestuffs) , and the motor-car industry. . . . Politically, at that time, German progress in arms manufacture — ^typified by the mighty Krupp works and great naval yards — seemed the most serious consequence of her industrial expansion." ^ Technological Support for Germany'' s Struggle for Power On the eve of World War I, Germany's energy showed itself in many ways : in ambitious plans for a railroad line to the Middle East, con- struction of a modern war fleet, development of African colonies, and the prospect of a technological hegemony over the European Con- tinent. ^^Hien the war broke out, Germany's superior technology very nearly enabled her to overmatch the combination of England, France, Italy, and Russia. In World War I, German submarines threatened England's command of the sea. German chemistry enabled her to produce synthetic nitrate fertilizer and synthetic nitrate explosives to frustrate the British blockade. German metallurgical skills enabled her to substitute available metals for those deemed indispensable. At this time. Imperial Germany led the world in most branches of the physical and biological sciences, and many fields of technology. Her collapse in 1918 was only partial, but the two decades that fol- lowed were marred by social upheavals, runaway inflation, political instability, and finally a dictatorship too erratic in its concepts to exploit systematically the undoubted talents of its people in science and technology. By the close of World War I, moreover, the industrial technology of the United States — in quantity if not quality — had overtaken Ger- many's. From then on, the United States assumed world technological leadership and provided the standard of achievement toward which the developed and developing nations of the world came to aspire. Yet, even in the period of decay, after 1939, the technological gains of Germany disturbed the world by the disclosure of the V-2 ballistic rockets, one of the major achievements in World War II. 8 "A History of Technology," Vol. V : The Late Nineteenth Century, 1850 to 1900, op. cit., pages 820-21. » Ibid., pages 821-822. 622 U.S. Rise to Technological Maturity Many factors, some geographic or historical and some sociological or economic, contributed to the emergence of the United States as the most dynamic technological nation of the world. An unpeopled con- tinent with rich natural resources and temperate cliinate was settled by immigrants who tended to be self-selected for initiative, education, independence, and political sophistication. A chronic labor shortage automatically placed value on labor-saving devices and machinery. These combined to sustain rapid progress in technological innovation toward high manpower productivity and swift economic growth. Foremost among the new Nation's needs were roads, canals, and a postal system, all of which the early Government undertook to pro- vide. Later, the railroad and telegraph were eagerly seized upon to link up throughout all parts of the Nation the flow of goods and information. The American Civil War had a profound effect on technology. For the first time, ". . . the technological resources of a whole nation were ultimately mobilized to overwhelm an opponent. There was mass- production of weapons and ammunition, of uniforms and boots; canned food was supplied to armies transported for the first time by rail."" The revolutionary nature of "mass production" made it the "great- est contribution of America to the development of technology." Eli Whitney, inventor of the cotton gin,^^ is also credited with the key technological developments that paved the way for modern mass pro- duction. There were four steps in this process : interchangeability of parts, specialization of production function, the conveyor belt, and mechanical instrumentation. The first two of these were demonstrated at AMiitney's arms plant in Connecticut, and the third came much later in the Dearborn plant of Henry Ford. The fourth step, which is still evolving, consists of instrumented controls, computers, computer software, and mechanical slaves, all to replace human operators. Rostow describes functionally the passage of the United States through the stages of economic growth : Steel launched this great expansion, and railway steel remained an important category of use ; but in these decades, mass-produced lighter engineering products came into their own : agricultural equipment, the typewriter, and those two almost universal harbingers of the age of durable consumers goods — the sewing- machine and the bicycle. Above all, with the railways mainly laid by the 1880s, the nation became a unified Continental market with powerful incentives within it to organize production and distribution in vast centralized bureaucratized units. Much in this industrial surge was based on radical improvements in the metal- working machine tool, which comes as close to being a correct symbol for the second phase of industrial growth as the railway is for the first. And, by the 1890s, electricity, chemical, and automobile industries, which were to play an extremely important role in the third phase, were commercially in being, the first two rooted in new and expanding fields of science and technology." i« Ibid, page 819. " Of this 1793 invention, the History observes that it had "led to a great increase in the size of cotton plantations, [and had] affected directly the lives of every man and woman, black and white, in the Southern States, and ultimately, through the slavery ques- tion and the Civil War, the whole of the North as well." (Ibid., page 818.) "Walt W. Rostow. "The United States in the World Arena: An Essay in Recent History." (New York, Harper and Row, Publishers, 1960), page 7. 623 Trends in Industrial Research and Scientific Management With the opening of the Twentieth Century, two important new trends heightened the intensity of U.S. exploitation of industrial technology. One was the appearance of the large industrial laboratory and the other was the rapid spread of the doctrine of "scientific man- agement" by the Taylor Societies. The first development, epitomized by the Bell Telephone Laboratory at Murray Hill, N.J., and the Gen- eral Electric Company laboratory at Schenectady, N.Y., proposed to shorten the time sequence between basic scientific discoveries and their commercial application. For the first time the tools and methods of science were employed by industry to "invent to order." Operating in another direction, the concept of scientific manage- ment involved the application of the quantitative scientific method to the actions and behavior of production-line workers as well as to the flow of materials and parts through industrial processes. It focused attention on "time and motion studies" to discover ways to reduce in- put costs and increase output of product. An important supplement to this program of industrial efficiency was the campaign by Herbert Hoover, as Secretary of Commerce in the early 1920s, to encourage the reduction of waste in industry and the adoption of industrial stand- ards and standardized methods of all kinds. The great industrial lab- oratories made products better and scientific management made them lower in cost. Maturing of the American Technological Posture World War II dramatized the importance of science for military power, but as a practical matter it was technology that proved itself of importance. Trained American scientists, with an impressive sup- plement of refugee and British scientists, were able to turn themselves into technologists to serve a great national and international purpose. In 1945, when the scientists called attention to the opportunities of the "endless frontier" of science, and urged its public support, they based their claim on the proposition that investment in research and education in the sciences would automatically reward society — would stimulate innovation, and develop opportunities for an expanding economy — in addition to its having military implications. When their appeal was heeded, beginning about 1950, a veritable explosion, scien- tific and technological, took place. Pursuing this course, and combining a high consumption economy with a heavy emphasis on scientific innovation, the United States, by 1970, had built a teclinological structure that included the following principal elements: A large number of very large, efficient, highly productive, geo- graphically extended busmess enterprises with families of satellite suppliers of materials, components, and specialized services, com- prising complex, interconnected, production-distribution-service enterprises; Separation of business ownership from business management; A great increase in policy, planning, and administrative staff in the management of enterprises of all kinds. The commercially-oriented part of this technological structure achieves higli levels of mass production at low cost, based on high levels of productivity of its labor. There is also a "high technology" 624 part of this structure (specifically, the aerospace and military systems industry) which is characterized by low production of items of high quality and j)erf ormance ; workers in this industry include a high pro- portion of scientific and technological professionals, skilled in solving complex and difficult problems. The outbreak of the Korean War was the signal for a great increase in military research and development. Demonstration of the feasibility £)f the hydrogen bomb accelerated efforts to exploit its high potency in an array of sophisticated attack systems, and at the same time to devise <3ountermeasures against these same systems in the hands of an ad- versary. With the exhibition of advances by the Soviet Union in rocketry and spacecraft, the efforts of the United States were redou- bled. To recapture the lead in space technology, the United States in- vested some $60 billion in the Apollo and other large programs of re- search, technological development, design, and system-building. Otlier programs of science and technology were concurrently ex- panding, such as the support of basic science by the National Science Fomidation, basic research installations in high-energy physics spon- sored by the Atomic Energy Commission, medical research in the Na- tional Institutes of Health, interdisciplinary research in the basic sci- ences and programs to create new scientific ''centers of excellence" with supix>rt by the Advanced Research Projects Agency of the Department of Defense, research in meteorology h\ the Environmental Science Services Administration, water desalting studies in the Department of the Interior, and so on. Servan-Schreiber sums up the consequences of this ferment in these words : During the past ten years, from the end of the cold war and the launching of the first Sputnik, American power has made an unprecedented leap forward. It has undergone a violent and productive internal revolution. Technological innova- tion has now become the basic objective of economic policy. In America today the government ofl5cial, the industrial manager, the economics professor, the engineer, and the scientist have joined forces to develop coordinated techniques for inte- grating factors of production. These techniques have stimulated what amounts to a permanent industrial revolution." Diplomatic hnpUcaticms of U.S. Technological Maturity At the beginning of the present century, when the United States was at the threshold of technological niaturity, the nation was con- fronted by three options : * * * To expand its power on the world scene ; to soften the harshnesses of industrialization through the devices of the welfare state; to elevate the stand- ard of mass consumption." This author concludes that the United Staites "opted*' rather whole- heartedly for the third course.^^ There were several diplomatic consequences of the U.S. decision to opt for a high-consumption economy: (1) As raw material resources at home were quickly consumed, American industry looked increasing- ly abroad for sources to make good a growing list of deficiencies. Heavy U.S. investments were made to develop overseas sources of chrome, manganese, bauxite, tungsten, and other metals needed by American i*.T.-J. Servan-Schrelber. "The American Challenge." Translated from the French by Ronald Steel. (New York, Atheneum, 1968), page 27. 1^ Rostow : "The United States in the World Arena : An Essay in Recent History," op. clt.. page 7. 15 Ibid., page 8. 625 industry. (2) Production of industrial goods in increasing volume exceeded the domestic capacity to consume, and led to progressive penetration of foreign markets. (3) Lagging sectors of the U.S. econ- omy sought protective tariffs and agricultural producers relied in- creasingly upon Government subsidies and assistance to maintain "parity" with the industrial sector of the economy. These developments brought the United States into the tangled maze of international monetary relations, currency exchange prob- lems, tariff negotiations, and questions of trade regulation. The need grew for commercial representation in foreign ports, for commercial and technological intelligence about agricultural production and min- eral discoveries abroad, and for information about export and import regulations and trade practices. World War II marked a revolutionary phase in the growth of U.S. diplomacy. Before the war, the style of the Nation's diplomats was that of an "observant wary minor power, with no bargaining instil- ments to bring to bear. . . ." But, "With the fall of France in 1940 and the British demonstration of military viability in the autumn, the United States turned to the task of bringing its assets to bear in relation to its interests on a worldwide basis ; and thus was launched the third and truly revolutionary phase of the American diplomatic tradition." ^® The primary basis for American diplomatic resources was the com- bination of industrial productivity and military potency displayed in that war. Characteristic of the war was the emphasis on science and technology. The experience of the Second World War was distinctive in three respects. First, military technology became linked to one area of science virtually at the level of fundamental science — atomic physics. Second, military technology became linked to several ai^eas of rapidly developing technology . . . notably electronics, rockets, and jet turbines. In all of these areas major new engineer- ing (rather than fundamental scientific) breakthroughs were in the process of developing in the intervrar years; and military technology . . . accelerated their unfolding practical possibilities. . . . The third characteristic . . . was simply that the scale on which first- rate minds were mobilized exceeded anything in past experience ; and this yielded a flow of technological developments derived from all levels of sci- ence and technology and applied over the full range of military activity on a unique scale. Like modern industry, modern warmaking came to build into its institutional structure the process of purposeful invention and innovation; and thus in quite new ways and on a quite new scale, a partnership was launched between the professional military men and the men of science and engineering." Following the close of the war, the shapers of American foreign policy found themselves confronted with an amazing array of un- resolved problems and alternatives. Collapse of the German Reich had left a power vacuum in war-torn Central Europe, and the United States accepted the obligation to aid the belligerent Powers to repair the destruction of their technological structures and infrastructures. An initial diplomatic effort to achieve multinational cooperation through' the United Nations failed with the withdrawal of the So- viet Union from the wartime alliance, the collapse of Nationalist " Ibid., pages 34-5. " Ibid., pages 59-60. 626 China, the rejection of tlie U.S. proposal to transfer an atomic mo- nopoly to international control, and the rise to power of an inward- looking Labour Government in the United Kingdom. The first manifestation of U.S. technological diplomacy after the war was the highly successful Marshall Plan to restore European industry. Early in this program, the United States scored a tech- nological coup by the Berl'in Airlift, which demonstrated the capa- bility of preserving a large city's viability by air shipments alone. However, elsewhere U.S. employment of technology as an instrument of foreign policy enjoyed only limited success. Frustration of U.S. Efforts to Wield Technological Power The outbreak of the Korean War in June 1950 was the signal for an intensification of military research and development, and vigorous expansion in industrial capacity. However, this war (like the Viet- namese conflict later on) was to demonstrate the serious, painful, and frustrating limitations of technology in waging a limited war against a highly organized and resourceful, if teclmologically unsophisticated, adversary. The Soviet Union had quickly caught up with the United States in the development of fission weapons, and was nearly even also in fusion (hydrogen) bombs. But in the United States, progress in nu- clear development had not been matched by progress in the develop- ment of delivery systems. "Thus, at a decisive period, when Russian science was organized in an all-out effort to close the gap between Soviet and American strength, there was a substantial deterioration in the efficacy with which the pool of American science and technology was applied to military problems." ^^ This trend was to change abruptly, with the evidence of Russian advances in nuclear delivery capability. There is no clear analogy in American history to the crisis triggered by the launching of the Soviet earth satellite on October 4, 1957. This intrinsically harmless act of science and engineering was also, of course, both a demonstration of foreseeable Soviet capability to launch an ICBM and a powerful act of psy- chological warfare. It immediately set in motion forces in American political life which radically reversed the Nation's ruling conception of its military problem, of the appropriate level of the budget, and of the role of science in its affairs. The reaction reached even deeper, opening a fundamental recon- sideration not only of the organization of the Department of Defense but also of the values and content of the American educational system and of the balance of values and objectives in contemporary American society as a whole.^® The most direct response, in the United States, was an expansion in outlays for space activities. These virtually doubled in each fiscal year after Sputnik, until 1961; they peaked at $7,688.5 million in 1966. Military R«S:D similarly rose : peaking in the Korean War period (fiscal year 1953) at a little more than $1 billion, rising again to $3 billion in the fiscal year 1957, to $5 billion in 1959, and continuing to rise thereafter to a peak of $8 billion in 1967.^*^ World admiration for U.S. achievements in manned lunar missions was tempered by reservations over U.S. inability to solve such domes- is Ibid., page 248 w Ibid., page 366. 2" U.S. National Science Foundation. "Federal Funds for Research, Development, and Other Scientific Activities, Fiscal Years 1968, 1969 and 1970." Vol. XVIII. (Washington, U.S. Government Printing Office, 1969), pages 248-9, (NSF 69-31.) 627 tic problems as pollution, racial tension, crime, and highway accidents ; the limitations of technology for the waging of limited war were also to be noted. The application of U.S. technology in support of world health seemed to offer great opportunities, accompanied by awkward side effects. For example, the insecticide DDT played an important role in malarial control and resultant population increase, but raised its own questions as to its ecological consequences. Various nations, developed and developing, became seriously con- cerned over the net emigration to the United States of technologically skilled persons. The territorial sovereignty concept in international law came in- creasingly in question with the evolution of high flying aircraft, ob- servation satellites, satellite communications, the Aiitarctic Treaty ^^ (in which, as in the later agreement for lunar exploration, a condi- tion of universal extraterritoriality was to prevail) , and the issue of the ownership of the ocean floor. Related to the sovereignty question also was the rise of the multina- tional corporation, resulting mainly from the opportunity seized by American entrepreneurs to exploit U.S. computer and electronic tech- nologies in European markets. Relieving and also complicating the emerging problem of world population control was the "Green Revolution" — by which the evolu- tion of new kinds of seeds significantly increased the farm labor productivity of developing countries. This innovative development seemed to offer at least a breathing space in which to search for solu- tions of the great future problem of balancing food and population. Thus, by the close of 1970, it was e\adent that U.S. technology had not been an unqualified success in furthering either U.S. foreign policy objectives or the aspirations of tlie world at large. The undoubted promise of technology had not achieved fulfillment. It was not clear why. Was it because technologists were unable to produce unflawed innovations? Were the diplomats unable to specify the performance of technologies for global effects ? Was there an insufficient coupling of technologists with diplomats to achieve proper teamwork toward a successful product ? WTiere did — and do — ^the weaknesses lie ? III. Trends in Contemporary Technology This section considers the evolution of atomic weapons and de- livery systems, space developments, agriculture, and the technological infrastructure. These elements, chosen more or less arbitrarilv. illus- trate a wide range of national and international issues of technology evident in the world today. Four trends are to be observed: (1) the important ways in which evolving technologies add to the problems and issues confronting the diplomat, (2) the ways in which technology te^ds to draw nations together in international enterprises, (3) the emergence of many posi- tive values and serious dangers of technology that are of concern to many nations, and (4) the need generated by technology for explicit governmental plans and programs to ensure that its consequences over the globe are compatible with U.S. foreign policy. 21 Antarctic Treaty. Signed at Washington, December 1, 1959. 628 A chievement of Overwhelming Nuclear Force Probably the most salient and far-reaching tecluiological achieve- ment of the present century is the atomic bomb. Traditionally, mili- tary power supplied the principal support of the diplomat at the bargaming table. But the undeniable force of nuclear weapons has been of uncertain \'^lue in this role. These weapons are so destructive that even the threat of their use has doubtful credibility. Accordingly, the capability of a nation to produce a bomb, while it accords the achieving nation technological distinction as a member of the "Nuclear Club", does not automatically confer significant advantages of negotia- tion in diplomacy. Nor does diplomatic advantage flow from the fur- ther capability of delivering a large number of atomic bombs ac- curately on remote targets by intercontinental guided ballistic missiles. The ability of the United States and the Soviet Union to wreak de- struction on any nation has not, for example, enabled resolution of conflicts in Vietnam or the Middle East, persuaded a settlement of the Kashmir issue, quieted dissonance in Cuba, or made a viable in- strument of peacekeeping out of the United Nations. Many aspects of atomic technology present intractable problems of contemporary diploipacy. The enormously destructive force of a hydrogen bomb explosion has made general war unthinkable as a rational course. Possession of a monopoly of nuclear weaponry from August 1945 to October 1949 seemingly gave little advantage to Amer- ican diplomats and generated many problems. One can only surmise what might have happened without them, but their conjectural bene- fits were accompanied by unmistakable diplomatic costs. During the monopoly period, the first issue was the possibility of international control and ownership of atomic technology ; a move by the United States to bring this about was abortive. The next issue was the desirability of sharing atomic teclinology with allies of the United States; the outcome of this issue was not only unfruitful but even disadvantageous : When President Truman's proposal of July 14, 1949, to continue joint under- takings with the United Kingdom was rejected in a meeting of leading oflBcials at the White House, the decision was "resented by the British Government as a repudiation of the close relationship that had existed during the war. . . ." ^ Rejection of the French request for assistance in atomic weapons and energy programs ". . . affected the entire range of our diplomatic relations with the central nation of the Common Market and of NATO and the NATO military forces." ^ According to a French military analyst — From 1945 to 1953 or 1954, a period characterized by the American atomic monopoly, Soviet expansion in Europe was limited only by United States negotia- tion and, later, by the North Atlantic treaty. Hitherto everything had occurred as though Moscow deliberately ignored American military possibilities, while Washington took no further account of the decisive nature of the means the West then possessed to oblige the Communist menace to withdraw. Each side had been the dupe of the atom : the Soviets, in their ignorance, not fearing it ; and the Americans not realizing the advantage their monopoly might have given them.** ^ David E. Lilienthal. "Change, Hope, and The Bomb." (Princeton, New Jersey, Prince- ton University Press, 1963), page 121. 23 Ibid., pages 122-3. 2* Pierre Gallols. "The Balance of Terror : Strategy for the Nuclear Age." (With a fore- word by Raymond Aron, Translated from the French by Richard Howard.) (Boston, Houghton Mifflin Company, 1961), page 23. 629 When the Soviet Union broke the atomic monopoly, late in 1949, the response of the United States was to proceed with the development of fusion weapons, weapons for limited nuclear warfare, and studies of air defense.25 Diplomatically, the Soviet Union exploited its possession of atomic weapons as an advantage : Each visible stage of the increase of Soviet power has provoked and justified new pressures. After the first Russian atomic explosion of 1^9, it appeared pos- sible to shift from the cold war in Europe to the warm war in Asia. After Sputnik I and the Soviet ballistic missiles came the Berlin ultimatum, the cam- paign of visits, the demonstrations of the inanity of the atomic armament . . . and then the offer of a disarmament plan which would permit the numerically superior side to impose its own laws.^ Nevertheless, the withdrawal by the U.S.S.R. of nuclear aid and tech- nicians from China seems to have been a factor in precipitating what has proved to be a persistent disaffection toward the U.S-S.R. The outcome of this tremendous technological effort by the two rival forces is now that neither can exploit the force of the weapon, or even threaten seriously to do so. THE PROBLEM OF STABILIZING DETERRENCE The mutual threat of nuclear attack seems to have had a stabilizing effect on United States-U.S.S.R. relations since 1955, or thereabouts, and the development of intercontinental and submarine-launched missiles has apparently strengthened this effect. This technological impasse was described in 1957 by Henry Kissinger. The essence of the nuclear stalemate is that it keeps the two superpowers from launching an all-out war because each can force the other to pay an exorbitant price for victory.^ [Accordingly] The destructiveness of modern weapons deprives victory in an all-out war of its historical meaning. Even the side which inflicts a greater devastation than its opponent may not retain suflScient resources to impose its will.^ The existence of atomic weapons and delivery systems apparently means that under conditions of general conflict, there can be no "total victory" and that only limited conflicts for limited gains are feasible. This kind of conflict, limited war, involvmg the renunciation of total victory, is repugnant to our military thought with its emphasis on breaking the enemy's will to resist and its reliance on the decisive role of industrial potential." ^^ The various alternatives that have been advanced for the U.S. posture include nuclear superiority, nuclear sufficiency, nuclear parity, and perhaps a fourth category involving an assured and adequate *'post-attack" striking capability — consisting of weapons of low vul- nerability and high probability of penetration of an adversary's territory. Maintenance of the deterrent posture can apparently take any of these forms. There appears to have been a tendency for both the United States and the Soviet Union to reject the fourth category. ^ Rostow, "The United States in the World Arena : An Essay in Recent History," op. cit., pages 248-9. =» Gallols, op. cit., page 231. ^ Henry A. Kissinger. "Nuclear Weapons and Foreign Policy." New York. (Published for the Council on Foreign Relations by Harper and Brothers, 1957), page 125. » Ibid., p. -90. *» Ibid., pages 86-7. 630 and to strive for a more commanding position in arms, although the policy of the Nixon administration has been explicitly to seek "suffi- ciency rather than . . . the meaningless 'will of the wisp' of nuclear superiority." ^° As President Nixon told his press conference, Janu- ary 27, 1969 : Our objective in this administration ... is to be sure that the United States has sufficient military power to defend our interests and to maintain the commit- ments which this administration determines are in the interest of the United States around the world. I think "sufficiency" is a better term, actually, than either "superiority" or "parity." ^ In announcing his decision on the antiballistic missile system, in his press conference March 14, 1969, the President disclaimed any thought that it was aggressive in concept. It would be merely a "safeguard of our deterrent system which is increasingly vulnerable due to the advances that have been made by the Soviet Union since the year 1967 when the Sentinel program was first laid out." 32 The President's concept of "sufficiency" required a good under- standing of the adversary's diplomatic motivations and purposes and a reliable set of offensive weapons to make it certain — (a) that the consequences of their use would be unmistakably disastrous to an adversary ; (b) that the known diplomatic objectives of the adversary would not justify any serious risk of invoking this retaliatory mechanism. Whether because or in spite of the vigorous programs of military technological development of the United States and the Soviet Union, both of the Great Powers have maintained their respective nuclear capabilities in some sort of balance. There is some assurance that the stability of the mutual deterrent is unlikely to be upset by further innovations. Jerome B. Wiesner, who had been science adviser to President Kennedy, expressed the opinion in early 1969 that "In my judgment there is no immediate danger of this stability being upset . . ." 33 On the same occasion, George B. Kistiakowsky, who had earlier been President Eisenhower's science adviser, declared : Mutual strategic deterrence provides whatever stability there is to nuclear peace. Beyond this necessary but st^itic role, nuclear weapons have almost ceased to be a useful instrument of national policy ; their possession provides few additional foreign policy options.*' In the Department of Defense, Harold Brown, as Secretary of the Air Force, declared May 14, 1968 : "There can be no successful ag- gression by means of strategic war today." And in the Department of State, U. Alexis Johnson, Under Secretary for Political Affairs, said 3" Herbert Scoville. Jr. "The Polities of the ABM Debate : The View From the Arms Con- trol and Disarmament Agency." Prepared for The American Political Science Association [Convention's] Panel on the Politics of the ABM Debate. (Mimeo, September 1970), page 7. 31 "The President's News Conference of .January 27, 1969." Weekly Compilation of Presi- dential Documents, (February 3, 1969, Volume 5, Number 5), page 178. 32 "Deployment of the Antiballistic Missile System." In "The President's News Confer- ence of March 14, 1969." Weekly Compilation of Presidential Documents, (March 17, 1969, Volume 5, Number 11), pages 401-2. 33 U.S. Congress. House. Committee on Foreign Affairs. "Strategy and Science : Toward a National Security Policy for the 1970's." Hearings before the Subcommittee on National Security Policy "and Scientific Developments of the . . . 91st Congress, first session. March 11, 13, 18, 19, 24, and 26, 1969. (Washington, U.S. Government Printing Office, 1969), page 9. »* Ibid., page 40. 631 March 26, 1968: ". . . There seems little likelihood that either side can break out of this situation of mutual deterrence and achieve a marked strategic advantage." PARAMOUNTCY OF OFFENSE Throughout the history of atomic weaponry one consistent theme has been the superiority of offense over defense. As a practical matter, the stability of the mutual nuclear deterrent rests on the assured ability of an attacked nuclear power to retaliate. Dr. Herbert York in testify- ing for the Test Ban Treaty took the position that ". . . it is simply easier to build devices that will penetrate a ballistic missile [i.e. assure that the missile warhead reaches its target] than it is to build an anti- missile which can cope with it." ^^ Similar confidence in the offense was expressed by Dr. Harold Brown, as Secretary of the Air Force, He declared, May 14, 1968, that "The Soviets could develop and deploy means to penetrate our defense at substantially lower cost than we could build it." He did, however, hold out hope that eventually "lesser levels of ABM defense, located around our missile fields, could serve to make an attack on our retaliatory force more difficult," ^^ The vulnerability of the United States to ballistic missile attack was also confirmed by Dr. John. Foster, the present Director of Defense Research and Enginering : The likelihood of large and sophisticated attacks with the deployment of significant U.S. defenses increases the technical uncertainty of the defensive sysitem. Even vv'ith an ABM deployment we would have to expect that in an all- out exchange, dozens of their warheads would likely exijlode in our cities.*^ Earlier, Secretary McNamara had stated that "none of the [ABM] systems at the present or f oi-eseeable state of the art would provide an impenetrable shield over the United States." ^* An analysis of future weapons and space systems by Harold A. Linstone, Associate Director of Development Planning-Systems Analysis, Lockheed Aircraft Corp., March 13, 1969, came to a similar conclusion. He described ten technological options at the disposal of the designers of offensive weapons, and concluded : "This diverse menu of options to maintain a second strike capability in the face of tech- nological changes also shows the difficulty of i)roviding an airtight defense against the offensive arsenal of a teclniologically alert and capable opponent, i.e., the Soviet Union." ^^ ^•■^ Dr. York's qualifications included : his position at that time as Chancellor of the University of California (San Diego), and his previous service as the first director of the Lawrence Radiation Laboratory at Liverniore, and as the first Director of Defense Research and Engineering, during the Eisenhower administration. (U.S. Congress. Senate. Committee on Foreign Relations. "Nuclear Test Ban Treaty." Hearings before the . . . SSth Congress, first session on Executive M. SSth Congress, 1st session, The treaty banning nuclear weapon tests in the atmosphere, in outer space, and underwater, signed at Moscow on August 5, 1963, on behalf of the United States of America, the United Kingdom of Great Britain and Northern Ireland, and the Union of Soviet Socialist Republics. August 12, 13, 14. 15. 19, 20, 21. 22, 23, 26, and 27, 1963. (Washington, U.S. Government Printing Ofiice, 1963) page 763.) ^ Quoted in "U.S. Strategic Forces." In "Secretary Brown On U.S. Strategic Forces." Extension of remarks of the Hon. Charles H. Wilson. Congressional Record, (May 20, 1968). page E4377. Dr. Brown had succeeded Dr. York as Director of Defense Research and Engineering. 3" Quoted in "The Proposed ABM System." Discussion on the floor of the Senate. Con- gressional Record, (June 13, 196S), page S7227. 38 Statement by Secretary of Defense Robert S. MoNamara. In Ibid., pages S7235-6. 39 Harold A. Linstone. "Future Weapons and Space Systems — Comments on Technological Forecasts for the Late 1970's and Beyond." In House "Strategy and Science : Toward a National Security Policy for the 1970's." Hearings, op. cit., page 46. 632 President Nixon, after an examination of the ABM issue, declared March 14, 1969 : Although every instinct motivates me to provide the American people with complete protection against a major nuclear attack, it is not now within our power to do so. The heaviest defense system we considered, one designed to protect our major cities, still could not prevent a catastrophic level of U.S. fatalities from a deliberate all-out Soviet attack. And it might look to an op- ponent like the prelude to an offensive strategy threatening the Soviet de- terrent.^" A DISSEXTIKG VIEW OF DETERRENT STARILITY The durability of the deterrent and the effect of technology on arms cx)ntrol negotiations (currently, tlie so-called SALT or ' Strategic Arms Limitations Talks'") between the two super-powers were both called into question by Dr. York in a recent article in Science. He noted that there had been evidence, beginning around 1960. of a "major Soviet effort in the ABM field" which had precipitated a ''technologi- cal contest between missile defense and missiie offense . . .*" The prin- cipal technological outcome of the contest was the "multiple warhead idea-' or "MIRV". The Soviet Union had deployed about 70 ABM interceptors, he said, and the response of the United States was to deploy MIRVs, which would mean a net increase of around 5000 in the number of warheads aimed at Russia, The Soviet response to this response was a multiple warhead development of their own, based on large SS-9 missiles, said to contain three separate warheads of five megatons each. The U.S. response to the SS-9 development was to deploy the Safeguard ABM system to defend the Minuteman force. He concluded: ABM and MIRV are thus inseparable; each one requires and inspires the other. Separately or in combination, they create imcertainty in each of the nuclear powers about the capability and even the intentions of the other. These uncer- tainties eventually lead in turn to fear, overreaction. and further increases in the number and types of all kinds of weapons, defensive as well as offensive. Moreover, Dr. York went on, the "ABM is a low-confidence system." Its use would require a quick response or "launch-on-waming" doc- trine. He declared : "The decision will have to be made on the basis of electronic signals electronically analyzed, in accordance with a plan worked out long before by apolitical analysts in an antiseptic and unreal atmosphere. In effect, not even the President, let alone the Congress, would really be a party to the ultimate decision to end civilization." Even if the U.S. technology was equal to the task of designing fail- safe electronic responses to control the ABlSf and the other elements of tlie defense system. Dr. York questioned whether the Soviet Union would be sufficiently competent. "Do they have the nece.ssary level of sophistication to solve the contradiction inherent in the need for a 'hair trigger' (so that their system will respond in time) and a 'stiff trigger' (so that they will not fire accidentally?) How good are their computers at recognizing false alarms? How good is the command and control system for the Polaris-type submarine fleet they are now ""T^.S. President (Richard M. Nixon). "Ballistic Missile Defense System. Statement by the President Announcing His Decision on Deployment of the System. March 14, 1969." In Weekly Compilation of Presidential Documents (Vol. 5, No. 11, March 17, 1969), page 406. 633 Tapidly^ if belatedly, building? Will it be 'fail-safe' r The point was that "unfavorable answers to these (questions about tJieir capability "will mean diminished national security for ws." ^^ . A more hopeful view of the arms race was voiced by Herbert ScoTille, Jr., of the Carnegie Endowment for International Peace, in September,*^ He suggested that "The resumption of new 'construct ion on Soviet SS-9 missile sites * * * may well have been occasioned by a Soviet decision under pressure from the military to emulate the stated US policy of pressing forward with all programs until agree- ments had been reached at SALT." Soviet awareness of the hazards of the present situation was shown in a statement attributed to For- eign Minister Gromyko (quoted in Dr. York's article in Science) to tlie effect that : The command and control systems for arms are becoming increasingly autono^ mous . . . from the people who create them. Human capacity to hear and see are incapable of reacting to modern speeds. The human brain is no longer capable of assessing at suflBeient speed the results of the multitude of instruments. 1 he decisions made by man depend in the last analysis on the conclusions provided by computers. Governments must do everything possible to be able to determine the development of events and not to find themselves in the role of captive of events. There appear to be at least six principal diplomatic effects of nu- clear arms technology: (1) Unlimited general war is an impractical and irrational enterprise and is not regarded as a realistic alternative to diplomatic agreement as was pre-atomic warfare; (2) possession of nuclear arms and delivery systems is essential to preservation of the mutual deterrent posture of the two superpowers and pursuit of nu- clear technology is essential in maintaining the balance of terror, a form of stability; (3) deployment of new weapons is a competitive activity in which both sides lose, which inhibits beneficial diplomatic processes, and which obstructs efforts toward agreement in the control of arms; (4) technological developments by either party are of in- tense interest to the other; (.5) the dangers in this relationship are so evident that formal means of direct communication have been judged necessary to reduce the possibility of a triggering misunderstanding of intentions; and (6) the condition of world peace, once only a pre- ferable alternative, has become a paramount and imperative goal of diplomacy. The Diplomatic Significance of Space Technology When the Soviet Union launched Sputnik I, the first manmade Earth satellite, October 4, 1957, and followed this with a second suc- cessful launch of Sputnik II, November 8, the Russian achievements "caused a great deal of turmoil in the United States." It was a "real jolt to the complacency of the American people." In true American tradition, a great clamor went up as to why the Soviet Union was ahead of the United States, who was to blame for the situation, and what was to be done about it.** « Herbert F. York. "ABM, MIRV. and the Arms Race." Science, (July 17, 1970, Volume 169), pages 2.57-60. *2 iJr. Scoville is currently with the Carnegie Endowment for International Peace. Earlier he was Assistant Director for Science and Technology, U.S. Arms Control and Disarmament Agency. His views were expressed in a paper delivered in September before a panel of the American Political Science Association in Los Angeles. " U.S. National Aeronautics and Space Administration. Scientific and Technical Infor- mation Division. Office of Technology Utilization. "Venture Into Space: Early Years of Goddard Space Flight Center." Prepared by Alfred Rosenthal. (Washington, U.S. Govern- ment Printing Office, 1968), pages 21, 23. (NASA Sp-4301). 97-400 O - 77 - 3 634 The Soviet achievement carried the implication that the Soviet Union had mastered the primary technology required for an intercon- tinental ballistic missile. At one stroke, this achievement erased the issue of the "Bomber Gap," created a "Missile Gap," rendered obsolete the elaborate early warning system of the United States against bomb- er attack, reduced the warning time of an attack from hours to min- utes, and raised the issue as to whether manned strategic bombers would not soon be obsolete. It gave a practical demonstration of the possibility and advantages of technological surprise. And, finally, it raised the prestige of the Soviet Union as a technological power of the foremost rank. The U.S. response was enactment of Public Law 85-568, the N'a- tional Aeronautics and Space Act, approved July 29, 1958. From this point on, the American space program was launched on an arduous and costly technological course for more than a decade of competition with the Soviet Union ; it was to embrace a tremendous range of scien- tific investigations, technological concepts, and practical applications. Most importantly, for the purposes of this study, it was a form of activity of inherent importance in international relations : its achieve- ments were prestigious and enabled the United States to recover and even raise its diplomatic stature ; its operations were obviously global in nature and required the cooperation of many nations; and the ex- ploitation of its technological capabilities offered attractive rewards to many nations, developed and undeveloped alike. While space was later to be formally abjured as a military combat regime, satellites obviously offered great advantages for surveillance (which would contribute to the stability of the mutual deterrence evolving between the United States and the Soviet Union). Surveil- lance from space also offered a way out of the awkward impasse presented by Soviet reluctance to admit any form of external inspec- tion as an adjunct of arms control agreements. THE SPACE RACE WITH THE SOVIET UNION There are many descriptions of the space race that began in 1957 and reached a dramatic climax with the first manned lunar landing, in July 1969. Comparison of U.S. and Soviet achievements in this race are difficult because the goals of the two programs are somewhat divergent. Among the Soviet goals have been the development of FOBS (a "fractional orbital bombardment satellite"), the achievement of a completely mechanized and unmanned vehicle to obtain geological specimens and return with them from the Moon to the Earth, a heavy emphasis on manned Earth-orbiting satellites to conduct experiments in the near-space environment, and various surveillance and weather satellites as well as some not yet explained. By contrast, one set of U.S. goals has included a series of progres- sions all directed toward the climax of landing a man on the Moon and returning him safely to Earth. Another set of objectives has been aimed at making practical use of space technology in the form of satellites to enable global electronic communications, survey the Earth, facilitate navigation, study the weather, and perform various other useful functions. 635 Both countries have made extensive use of satellites for purposes of military surveillance, planetary exploration, probes of deep space, and scientific observations from the space environment. MEASUEES OF PROGRESS IX SPACE TECHNOLOGY One measure of success is the comparative national effort invested in it. In rough terms, it appears that the total effort in both the United States and the Soviet Union is about even.*^ Another measure is the recognition, worldwide, of space achievements. Although the Soviets scored first, and remained well in the lead for 7 or 8 years thereafter, the U.S. moon landing reversed the relationship decisively. Moreover, U.S. practice in announcing nonmilitary launches in advance and admitting to failures has added credibility to U.S. announcements of successes. Advance announcements are also important in enabling the \vorld — in effect — to participate as an observer of each maj^r U.S. endeavor. As to numbers of satellites carrying out a mission successfully, the Soviet practice of not annoimcing failures makes comparison diffi- cult. Numbers of known launches and numbers of satellites actually orbited or dispatched on missions are roughly comparable. With respect to the utility of the space program — the commercial or economically beneficial uses of satellites — it would appear that the United States has a lead. The Syncom series of synchronous orbiting communications satellites, developed first by the United States, has provided the technological basis for global telephone and television systems that have now become an important and expanding commercial activity. Similarly, the world has been invited to share the benefits of the U.S. series of Tiros weather observation satellites. However, the Soviets have entered vigorously into both of these fields and apparently intend to match U.S. efforts in the forthcoming program of Earth resources satellite surveys. DIPLOMATIC ASPECTS OF THE SPACE RACE The National Aeronautics and Space Act of 1958, in its declaration of policy (Sec. 102-a) stated: "The Congress hereby declares that it is the policy of the United States that activities in space should be devoted to peaceful purposes for the benefit of all mankind." Such activities, moreover, should be conducted so as to contribute to ". . . co- operation by the United States with other nations and groups of na- tions ..." in the work and the enjoyment of its benefits. (Sec. 102-C-7) To this end : Sec. 205. The Administration, under the foreign policy guidance of the Presi- dent, may engage in a program of international cooperation in work done pur- suant to this Act, and in the peaceful application of the results thereof, pursuant to agreements made by the President with the advice and consent of the Senate. By 1970, the United States had entered into 250 international project agreements with some 74 nations under the space program. ** U.S. Congress. House. Committee on Science and Astronautics. "Review of the Soviet Space Program : With Comparative United States Data." Report of the ... . Prepared by the Science Policy Research Division, Legislative Reference Service, Library of Congress. 90th Congress, first session. (Washington, U.S. Government Printing Office, 1967), pages 83-4. [Committee Print.] 636 The non-militarj^ part of the U.S. space program is operated on a virtually open basis with "international exchange of personnel, visits,, combined experiments, shared tracking, and many other joint activi- ties." By contrast, the Soviet Union's combined military-civilian pro- gram has lacked any convenient way of arranging for international cooperation. It has been only in the last year [1966] that it has held a meeting of bloc countries to consider joint scientific experiments, and has negotiated with France a plan to put up a payload in about 1972. Most earlier Soviet coopera- tion consisted of a one-way flow of optical tracking reports from many bloc and associated countries to Moscow in support of Soviet studies/" Nevertheless, the inherently international nature of space activities offers encouragement for the evolution of cooperative programs ; in- formal understandings and the exploitation of practical applications seem to be on the increase, and may pave the way for more forma] arrangements. For example : ... In scientific circles, the Russians have appeared at meetings in the "vVest including the United States, and have permitted Americans to go to meetings in Russia at which technical papers have been given on each side. Through GOSPAR (the Committee on Space Research of the International Coun- cil of Scientific Unions) both countries and others have met to exchange flight data on a routine basis. On the political level, both have also filed flight data at the United Nations, and it was through the U.N. that the recent space treaty was negotiated. . . . Agreements have been negotiated which call for an ex- change of space-gathered weather data, with data passed over the so-called "cold line" between Moscow and Suitland, Md. This same agreement has called for exchange of geo-magnetic data, and also the joint preparation of a book on space medicine. . . . About the only other international activity of the Russians has been their exchange of television between Moscow and Paris. They have suggested to the Japanese they may also wish to exchange programs. For a long time they opposed the international consortium plan for communications satellites as un^- necessarily dominated by the United States." From time to time, both the United States and the Soviet Union have made overtures toward cooperation in their space programs. The USSR delegate Kuznetsov to the U.N. General Assembly announced,, October 6, 1959, that his country would propose : The calling of an international conference of scientists under U.N. auspices^ on the question of exchange of experience in the study of outer space." " The most positive suggestion, however, was that offered by Presi- dent Kennedy in September, 1963. This was an evident move to main- tain the momentum toward detente that had begun with his speech at The American University, June 10, and seemed likely to be fur- thered by anticipated favorable Senate action on the Test Ban Treaty.*^ Accordingly, on September 20, 1963, the President went be- fore the United Nations General Assembly to propose a global pro- gram in space, rather than a competition between the two leading contenders : Why . . . should man's first flight to the moon be a matter of national com- petition? Why should the United States and the Soviet Union, in preparing for such expeditions, become involved in immense duplications of research, con- struction, and expenditure? Surely we should explore whether the scientists and « Ibid., page 82. " Idem. *" Eugene B. Skolnikoff. "Science, Technology, and American Foreign Policy." (Cam.. bridge, The M.I.T. Press, 1967), pages 29-30. *8 Senate approval of the Treaty came on Sept. 24. 637 astronauts of our two countries — indeed, of all the world — cannot work together in the conquest of space, sending some day in this decade to the moon not the representatives of a single nation but the representatives of all of our countries."* Nothing came of this dramatic attempt to exploit space technology for diplomatic gain. COMMUXICATIOXS SATELLITES Many proposals have been advanced for ways to use Earth satel- lites for practical purposes, as distinguished from research. These proposals fall generally into three categories of satellite use : as point sources or relay ])oints for global comnumications systems; as stations to exploit the properties of the space environment ; and to perform surveys from a truly global vantage point. One of the earliest and most significant practical uses of satellites was for global communications. The commercial practicality of satel- lites for this purpose was accelerated by the development of syn- chronous satellites, which moved through space at the precise rate required for them to remain fixed above a pre-selected point on Earth's Equator. From this position, a satellite had many advantages for global communications : to relay voice communications from point to point, to distribute television programs from one continent to another, to broadcast programs directlj^, and to provide information for air traffic control. Other satellite functions — not necessarily requiring syn- chronous satellites — include the providing of position data and com- munications for aerial navigation, air transport separation standard management, position determination, collision avoidance, and search and rescue information. A legislative action to provide an administrative instrument for the management of commercial space communications was the Com- munications Satellite Act of 1962, approved August 31, 1962, Public Law 87-624 (76 Stat. 419) . Subsequently, an agreement was entered into, August 20, 1964, for international cooperation of the parties in the design, development, construction, establishment, maintenance and operation of the space segment of a global commercial communications satellite system, which had as its objective the achievement of basic global coverage in the latter part of 1967. The concept was that this agreement would be an interim arrangement and that recommendations would be forthcom- ing after the system became operational, for either (a) continuance of the interim program on a permanent basis or (b) a permanent in- ternational organization supported by an international administra- tive and technical staff. FEASIBLE FUNCTIONS OF SURVEILLANCE SATELLITES A\nii]e synchronous satellites appear to be the principal foundation element of global communications technology, satellites in uniform circular orbit closer to Earth seem most useful for many possible sur- veillance functions. Apart from their obvious advantages in arms in- spections and military operations, surveillance satellites are already useful for many commercial services and give promise of still greater *9U.S. Arms Control and Disarmament Agency. "Documents on Disarmament, 1963." (Washington, U.S. Government Printing Office, 1964), page 529. 638 future benefits over a wide range of applications. A NASA study in 1967 listed some of these as follows : hydrology (river forecasting and flood warning) tracking of migratory fish, animals, and birds iceberg reconnaissance mapping of land areas and ocean bottoms tsunami warning earthquake prediction air pollution monitoring and forecasting weather forecasting support for weather modification (precipitation enhancement, hail and lightning suppression, fog dispersal, atid storm modifica- tion) earth resources surveys (agricultural and mineral). WEATHER FORECASTING BY SATELLITE A measure of the possible economic advantages of weather forecast- ing was deA^eloped by a panel of the National Academy of Sciences, in 1965, which suggested that upwards of $2 billion "could be saved by farmers, fuel producers, public utilities, builders, and water managers if they were equipped with better forecasting tools." ^° International cooperation in this field has been quick to develop. For example, in a letter to Chairman Khrushchev, March 7, 1962, President Kennedy suggested "the joint establishment of an early operational weather satellite system"' to provide global weather data for use by any nation. To initiate this service, [the President continued! I propose that the United States and the Soviet Union each launch a satellite to photograph cloud cover and provide other agreed meteorological services for all nations. . . . This im- mensely valuable data vrould then be disseminated through normal international meteorological channels and would make a significant contribution to the research and service programs now under study by the World Meteorological Organiza- tion in response to Resolution 1721 (XVI) adopted by the United Nations General Assembly on December 20, 1961.^ Khrushchev agreed. In his reply, March 20, 1962, he said: Precise and timely weather prediction would be still another important step on the path to man's subjugation of the forces of nature ; it would permit him to combat more successfully the calamities of the elements and would give new prospects for advancing the well-being of mankind. Let us also cooperate in this field. °- Good progress appears to have been made in this subject. By April, 1967', the National Aeronautics and Space Administration was to report : One of the political benefits of weather satellites has been in fostering coopera- tion with other nations, particularly between the United States and the Soviet Union. An example of this is the 1962 agreement with the United States and the U.S.S.R. The agreement stated in part : "In the field of meteorology, it is im- portant that the two satellite launching nations contribute their capabilities 60 National Research Council. Committee on Oceanography. "Economic Benefits from Oceanographic Research, A Special Report." (Washington, D.C., National Academy of Sciences-National Research Council, 1964), page 37. (Publ. 1228.) SI Department of State Bulletin, (April 2, 1962), pages 536-7. s-U.S. Congress, Senate, Committee on Aeronautical and Space Sciences. "Documents on, International Aspects of the Exploration and Use of Outer Space, 1954-62." Staff report prepared for the use of the .... (Washington, U.S. Government Printing Office, May 9, 1963), page 250. 639 toward the establishment of a global weather system for the benefit of other nations." The first major activity in this area was the installation of the "cold line" between Moscow and Washington for the exchange of meteorological data. For many months only conventional data flowed across the line. However, in August 1966 the Russians began to exchange satellite cloud pictures and infrared data over the coldline from information provided by Cosmos 122. This exchange terminated after a few months presumably due to failure of Cosmos 122, and was resumed in March 1967, immediately after the launching of Cosmos 144 : This two way exchange is still in progress.^ The cooperative international program known as "World Weather Watch," under the aegis of the World Meteorological Organization (WMO) also relies extensively on satellites. It envisions a cooperative effort among the nations of the world to develop a global system for complete surveillance of the atmosphere and for the rapid dissemina- tion of weather information on a world wide basis. To support the program of TVTVIO, President Johnson, by letter of October 23, 1964, instructed Secretary Luther Hodges of the Department of Commerce, to "take such action as you may deem necessary to bring the interested Federal departments and agencies into closer consultation and coor- dination with regard to international activities in meteorology and the formulation of U.S. international meteorological policies and pro- grams to insure that the United States will continue to make a signifi- cant contribution, . ." ^* EARTH RESOURCES SATELLITE SURVEYS Of possibly great significance is the use of satellites for surveys of global resources of agricultural and mineral wealth, and for the management of these resources. On this subject, a NASA report has spelled out the advantages of gathering information about Earth resources. Accurate, timely, and broad-scale surveys of agricultural and forestry resources on a periodic basis by Earth-orbital remote sensing will become increasingly im- portant in future years. These techniques combined with automatic pattern recognition methods will yield information necessary to allow improved produc- tivity, development, and utilization of agricultural resources on a worldwide basis.^ These, said the report, should yield information useful with respect to soil classification, land use capability and changes, natural vegeta- tion, range surveys, crop identification, crop disease and insect inva- sion detection, flood control survey, watershed and hydrologic studies, recreation site evaluation, wildlife habitat studies, forest species iden- tification, forest fire detection, forest disease and insect invasion detec- tion, soil conservation programs, irrigation development, agricultural development projects, and crop acreage control programs. With respect to geology and mineral resources, the report suggested a number of possible applications of satellite data, such as : geologic mapping, mineral resource investigations, thermal activitj^ in connec- tion with volcanic eruptions, observations of magnetic and gravity ^ U.S. National Aeronautics and Space Administration. Space Applications Programs Office, Office of Space Science and Applications. Office of Technology Utilization. "A Survey of Space Applications . . . for the benefit of all mankind." (Washington, U.S. Government Printing Office, April 1967), pages 90-91. (NASA SP-142.) s* Department of State Bulletin (November 30, 1964), pages 792-4. ^ National Aeronautics and Space Administration. "A Survey of Space Applications '. . . for the benefit of all'mankind.' " Op. cit, page 5. 640 fields on a global basis, tectonic analysis of earthquake belts, data use- ful in planning and site selection for large engineering works, and continuous mapping of "subaqueous deposition, channel filling and excavation, effects of floods and other natural changes" in large coastal deltas. President Nixon has given support to the Earth resources satellite program. Addressing the United Nations General Assembly, Septem- ber 18, 1969, he announced that ". . . we are now developmg [such] satellites with the first experimental satellite to be launched sometime early in the decade of the seventies." These would be capable of yield- ing such data as the location of schools of fish in the oceans, the location of mineral deposits on land, and the health of agricultural crops.^^ Subsequently, the U.N. was notified (a) that a detailed descrip- tion of the U.S. program had been presented to the U.N. Secretary- General for dissemination to all U.N. members, (b) that an interna- tional workshop would be convened on Earth -resources-survey systems in the spring of 1971, (c) that various opportunities for education and training in the technologies involved would be made available by the United States to nationals of U.N. members, and (d) that the United States proposed to ". . . invite potential international users to work with us as we explore, from the standpoint of their needs and problems, the best ways of approaching such technically difficult matters as data processmg, interpretation, and dissemination." Although warning that there were many constraints and obstacles to be overcome in this pro- gram, one study concludes that "the 1970's could become a decade of international space cooperation." ^^ GROWING IMPORTANCE OF SPACE-DIPLOMACY Manifestly, the new technology of space has many implic'ations for diplomacy. It afforded a new and relatively non-controversial area of opportunity for joint US-USSK action. It was inherently global. It offered economic advantages and opportunities to all coun- tries. It demonstrated U.S. leadership in practical application of a dramatic new^ teclinology. As a communications link it brought the entire world closer together. It offered promise of solving such grave global problems as arms inspections, pollution detection, and resource inventory. At the same time, it raised a host of legal and diplomatic questions as to sovereignty of near space, content of global television programs, the equities of developing countries in an activity beyond their limited means, and the rights of nations and individuals to use information secured by satellite. The Inte7'action of AgHcuUural Technology loith Diplomacy The ideal state for Thomas Jefferson was a community of small, independent land -holders, deriving their income and subsistence from the soil. Something of this philosophy persisted in the United States 56 '"phe President's Address to the 24th Session of the General Assembly. September 18, 1969." Weekly Compilation of Presidential Documents, (September 22, 1969, Volume 5, Number 38) , page 1281. ^■^ John Hanessian, Jr. and John M. Logsdon. "Earth Resources Technology Satellite : Securing International Participation." Astronautics and Aeronautics. (August 1970, Vol- ume 8), pages 56, 60. 641 long after the reality had waned. Jefferson sa^Y agriculture as the most virtuous of employments: "When we get piled upon one another in large cities, ag in Europe, we shall become corrupt as in Europe, and go to eating one another as they do there." ^^ It was better, he said, "to carry provisions and materials to workmen there, than bring them to the provisions and materials, and with them their manners and principles." ^^ On the other hand, Alexander Hamilton, while granting the pre- eminence of agriculture, nevertheless considered industry important for "augmentation of the Produce and Revenue of the Society." In- herently, he said, division of labor made for a more productive and prosperous society ; mechanization increased productivity and employ- ment opportunities ; immigration would be encouraged ; and a market would be provided for surplus agricultural products.^ Application of the scientific method to agriculture was generally favored in the early Republic. Jeffersonians saw in it a means by which the individual could improve his lot ; Hamiltonians considered it a means to a prosperous and expanding economy. MODERN CONTRAST WITH JEFFERSONIAN IDEAL The application of technology to agriculture — scientific farming — has had precisely the opposite effect from that Jefferson sought. The subsistence farmer has been replaced by the large farm as the primary source of food and natural fiber. The small farmer is waging a des- perate rearguard action, finding it increasingly difficult to compete. Farming as a way of life is reserved for an ever-dwindling percentage of the population in the United States. Those remaining on the farms— who are still able to succeed — are doing so by specialization. The fact is that the farmer today is a part of a larger industrial sys- tem of mutual interdependence. He does not eat his own wheat; he does not grow his own truck; he relies heavily on the Government to supplement his own uncertain income. All these characteristics are in stark contrast with the Jeffersonian ideal. Initially, the application of technology to farming in a new, un- peopled continent where land was abundant meant that the skillful farm manager could expand his acreage and his production per acre. Additional acreage was made available for cultivation by impounding streams in arid regions and irrigating the land. Higher agricultural productivity was achieved by supplemental irrigation. Farms around urban areas, to provide milk and truck garden products, grew along Avith the urbanization of the country. Production of large volume com- modities — wheat, corn, cotton, rice, and the like — was increasingly con- centrated on very large farms. These were able to make heavy use of specialized farm machinery (powered first with animals, then with 58 "Letter to James Madison, December 20, 1787." In "The Complete Jefferson : Containing his Major Writings, Published and Unpublished, except His Letters." Assembled and ar- ranged bv Saul K. Padover. (New York, Tudor Publishing Company, 1943), page 123. ^ In Padover, Ibid., pages 678-9. «<• Alexander Hamilton. "Report on Manufacturers." In "The Reports of Alexander Hamil- ton." Edited by Jacob E. Cooke. (New York, Harper Torchbooks, Harper and Row, Pub- lishers, 1964), pages 118. 128. 642 steam and later with internal combustion engines) , chemical fertilizers and pesticides, aircraft to sow seed and spread chemicals, and mechani- cal contrivances to convert many different crops into standardized marketable units. Among the most important of technologies were the discoveries in plant and animal genetics. As a consequence of technology, agriculture in the United States became increasingly divided into two distinct categories : one was an industrial business and the other a precarious way of life, yielding barely enough product with Government assistance to maintain the capital and the soil. At first, the numbers of farms increased as land was opened to pur- chase, homesteading, and subdivision of unmanageable land grants. This process continued up to around 1935, when the number of farms peaked at 6.8 million. Thereafter the number started to decline to 3.7 million in 1962, with 1 million forecast by 1980. Significantly, the num- ber of farms of 1000 acres or larger rose from 29,000 in 1880, to 81,000 in 1930, and to 131,000 in 1954." "By 1959 these big units, which were only 3.7 percent of all farms had acquired 49 percent of all the land and their average size had reached 4,048 acres — more than six square miles apiece." They averaged annual sales of $94,000, had an average value of $220,000, and produced almost one-third of all crops and live- stock. By 1963, the top three percent of all farms was producing more than the bottom 78 percent.*'^ POLITICAL, AND ECONOMIC TRENDS The political role of the farmer and the response of the Congress to the needs of the farmer appear to have been affected by the techno- logical revolution in agriculture. Around 1800, something like 90 per- cent of all citizens of the United States lived on farms. Much of the legislation between 1800 and 1900 had a rural or agricultural bias, including the Northwest Ordinance, creation of the Department of Agriculture, the land grant colleges, the Homestead Act, railroad land grants and subsidies, the Interstate Commerce Commission, and sustained support for agricultural research. But urbanization began to take its toll before the end of the century. By about 1890, the Nation was divided 50-50 between urban and rural populations, and thereafter the disproportion proceeded swiftly. By 1970 it was approaching 95 urban and five rural. Concern for the non-agricultural sector was indicated in the creation of Departments of Commerce, Labor, and Housing and Urban Development. The gross value of agricultural production in the United States climbed steadily throughout the latter half of the 19th century — from $4.1 billion annually during the decade 1869-1878 to $8.4 billion in the years 1897-1901. Thereafter, it remained fairly constant through 1936 ($9.8 billion), and then began to creep upward again, reaching $14.1 billion in 1955.*^^ It is interesting however, to compare farm and non- farm productivity during these years. (See table 1) 81 "Series K 61-72. Farms and Land ia Farms, by Size of Farm : 1880 to 1954." In. U.S. Department of Commerce. Bureau of the Census. "Historical Statistics of the United States. Colonial Times to 1957." (Washington, U.S. Government Printing Office, 1960), page 279. ^2 Edward Higbee. "Farms and Farmers in an Urban Age." (New Yorli, The Twentieth Century Fund, 1963), page 3. *• "Series F 44^8. Gross Domestic Product Originating in Private Farm and Nonfarm Sectors and Government, in 1929 Prices : 1869-1955." In "Historical Statistics of the United States : Colonial Times to 1957." op. cit., page 140-1. 4.1 6.8 8.4 27.4 9.8 83.2 12.3 116.4 14.1 198.8 643 TABLE 1.— GROSS DOMESTIC PRODUCT, PRIVATE FARM AND NONFARM SECTORS, SELECTED YEARS' [Billions of 1929 dollars] Years Farm Nonfarm 1869-78 - 1897-1901 , -- 1936...- 1941 1955 1 Source: Adapted from "Historical Statistics of the United States: Colonial Times to 1957," op. cit. Accordingly, "There is, in the mid-1960's, virtually no theoretical limit to possible increases in agricultural productivity over the next several years, although gains in productivity will tend to level off . . ."®* A contemporary analysis suggests that this leveling-off process is at hand as man begins to take account of some of the adverse conse- quences of farm technology. This concern for the environment — * * * would operate to protect and improve man's environment, to render technological developments more sophisticated and more costly, to increase the cost of producing food, to slow the rate of output expansion and to drive farm prices upward. This, indeed, would be a new era for farmers of the developed world.® The great expansion in U.S. agriculture during the 19th century had important impacts on Europe. The industrial revolution brought to that continent a population increase of more than 200 million, and European agriculture was unequal to the task of feeding those in its cities and industries. Accordingly : "By the close of the century, the gravity point of world agriculture shifted decisively from Europe to the United States: the significance of [the vast expansion of acreage] brought under cultivation in the United States, in the period 1860-1900, was tremendous." <=« SOME DIPLOMATIC COXSEQUENCES OF AGRICULTURAL CHANGE During the 19th century, despite the progressively smaller percent- age of the U.S. population engaged in agriculture, the Nation's highly technological fanns became progressively more significant as a factor on the world scene. Four aspects of technology related to agriculture have emerged as important for present and future diplomacy : 1. The population explosion, worldwide, will necessitate resort to the best available technology on a worldwide basis, if famine is to be averted. Technology employed on U.S. farms is not necessarily appro- priate elsewhere; what is more likely to be needed is the building of the same kinds of research institutions in developing countries that were created in the United States during its initial period of growth. The question remaining is whether there is time for such a long-range approach. "^ Wayne D. Rasmussen. "Scientific Agriculture." In Melvin Kranzberg and Carroll W. Pursell, Jr., ed. "Technology in Western Civilization. Volume II : Technology in the Twentieth Century." (New York, Oxford University Press, 1967), page 353. ^^Willard W. Cochrane. "American Farm Policy in a Tumultuous World." [From Min- nesota Agricultural Experiment Station Misc. J. Series No. 7325.] In "Commercial Farm Policy." Extension of remarks of the Hon. Donald M. Eraser. Congressional Record. (Octo- ber 14, 1970), pages B 9404-9. The quotations appear at page E9406. <» George Borgstrom. "Food from the Sea." In Technology in Western Civilization. Volume II : Technology in the Twentieth Century." Op. cit., page 424. 644 2. The use of U.S. agricultural surpluses abroad as an instrument of diplomacy presents increasingly awkward and complicated prob- lems of balancing such factors as — (a) Domestic U.S. prices of farm products ; (b) Specific quantitative requirements of countries for U.S. aid; (c) Humanitarian considerations of urgent need, and the de- sirability of maintaining emergency reserves of food stocks; (d) The question of obligations of nations receiving U.S. aid in the form of agricultural surpluses ; ^ (e) Distinctions between "assistance" and "dumping"; and (/) Effects of U.S. food contributions on the agricultural econ- omies of developing nations. 3. The need also exists to encourage increased agricultural produc- tivity in developing countries to provide an agricultural surplus for export against the purchase of industrial and social overhead capital, and to enable labor in these countries to leave the farm to accept indus- trial employment. This concept is firmly associated with that of bal- anced economic growth. Involved also is the question of devising or applying agricultural technology in these countries. On this subject, the President's Task Force on Science Policy has warned : Advanced agricultural techniques which are of great imi>ortance in the United States may have little or no effectiveness in a country where the pointed stick is one of the most widely used farm implements. The Task Force believes that much greater emphasis must be placed on the transfer of research and development capabilities, rather than of technology it- self, if we hope to increase the effectiveness of our assistance to underdeveloped countries. We must place stress on the transfer of methods for technical research and education within the ethnic and environmental framework of the receiving country itself, rather than within our framework.*^ 4. The impact on the euAironment of measures to increase agricul- tural productivity raises another set of questions. Whether couched in J(;ffersonian terms or in those of contemporary "environmentalists," objections can be foreseen to the application abroad of technologies judged injurious in the United States. For example, one report of the President's Science Advisory Committee urged restraint in the use of pesticides as "toxic to beneficial plants and animals, including man" while another called for a sixfold increase in U.S. shipments of these chemicals to the developing world.^^ There are many other questions concerning the interaction of farm technology, and resulting agricultural productivity, with diplomacy. What diplomatic consequences might be foreseen for possible break- throughs in the technology of tropical agriculture, that might yield vast increases in foods from tropical rain forests ? How dependent is the world's second-largest nation, India, on relief shipments of T"''.S, food, and what are the effects of this reliance on U.S. foreign policy goals and decisions? To what extent is food a legitimate instrument of foreign policy; is it — like atomic weapons — too decisive and «' U.S. The President's Task Force on Science Policy." "Science and Technolog.v : Tools for Progress."' The Report of the President's Task Force on Science Policy." (Washing- ton, U.S. Government Printing Office, April 1970), page 41. «» Chapter Fifteen. "The Insecticide. Fungicide and Rodentlcide Act of 1947." In U.S. Congress. House. Committee on Science and Astronautics. "Technical Information for Congress." Report to the Subcommittee on Scienx?e, Research, and Development of the. . . . 91st Congress, first session. Prepared b.v The Science Policy Research Division, Legislative Reference Service. Library of Congress. April 25. 1969. House Document No. 91-137. (Washington, U,S. Government Printing Office, 1969), page 409. 645 repugnant a compulsion to be employed? To what extent are the chemical technologies used in modern agriculture necessary to feed the world, and to what extent do they affect the environment so ad- versely as to require international agreement to halt their widespread use? Supporting Elements of National Technological Change National ability to exploit technology for specific fields of produc- tion depends on many supporting conditions that need to develop along with the technology they support. Authorities differ as to the precise range of these elements and as to their relative importance. Those cited may be considered illustrative of the general range of elements of the technological "infrastructure." DIFFERENT VIEWS OF "iNFRASTRUCTUBe" Barbara Ward stresses the idea of equality, the idea of progress, the fact of human population increase, and the application of science and capital to nearly all forms of human activity.^^ David C. McClelland suggests that an important element is the at- titudes and quality of the leaders and managers of industry and com- merce in a nation : The crucial issue [seems to be] what kind of men are in which sector. . . . What kind of men are available for leadership positions in economic organiza- tions in various countries? For in the long run it is they, and their primary concerns, whether for achievement, affiliation, power, or something else, that determine the rate at which the economy of their country develops."" In a later discussion. Miss Ward suggests that the availability of capital to support the process of technological development is crucial : The world economy is the creation of technology. Technology in turn is the creation of two factors which first appeared in a decisive alliance, inside the Atlantic community. One, of course, is experiment leading to invention. The other is capital or savings.'^ Walt W. Rostow relates the acquisition of capital to agriculture: Technically, the preconditions for sustained industrialization have generally required radical change in three nonindustrial sectors. First, a build-up of social overhead capital, notably in transport. . . . Second, a technological rev- olution in agriculture. . . . Third, an expansion in imix»rts financed by the more efficient production and marketing of some natural resources plus, where possible, capital imports.'" Martin Goland, President of Southwest Research Institute, enumer- ate six essential ingredients of technological evolution : First, the technical knowledge which makes new technology possible ; Second, a social climate which is receptive to a more material way of life ; Third, a political and governmental structure which encourages new tech- nology ; Fourth, the availability of the necessary labor and management skills, coupled with an entrepreneurial attitude ; Fifth, the availability of venture capital ; and Sixth, an effective distril,)ution and marketing system. o» Barbara Ward. "The Rich Nations and the Poor Nations." (New Yorl£, W. W. Norton and Compan.v, Inc., 1962), pages 13-6. ™ David C. McClelland. "The Achieving Society." (New York, The Free Press, 1961), page .300. ^ Barbara Ward. "Technological Change and the World Market." In U.S. Congress. House. Committee on Science and Astronautics. "Applied Science and World Economy." A Compila- tion of Papers Prepared for the Ninth Meeting of the Panel on Science and Technology, 1968. (Washington, U.S. Government Printing Office. 196S). pages 7-9. ■^2 w. W. Rostow. "The Process of Economic Growth." Second Edition. (New York, W. W. Norton and Company, Inc., 1962), page 31.3. 646 Science and engineering, he notes, ". . . which are normally thought to be the backbone of technology, actually represent only one-sixth of the process." ^^ W. Arthur Lewis suggests that in any specific case systematic analysis is required to determine which elements of infrastructure are needed, should be accorded priority, .and should be related to other elements of growth of a national economy/* Infrastructure requirements deemed necessary by U.S. industrial managers, according to a recent United Nations survey, are listed in descending order as follows : 1. Availability of labour 2. Convenience of markets 3. Availability of property 4. Costs of labour 5. Availability of raw materials 6. Degree of unionization 7. Co-operativeness of local area 8. Location of management 9. Suitability of climate 10. Costs of transportation 11. Adequacy of power 12. Location of industry centre 13. Adequacy of transportation 14. Decentralization of operation 15. Favourability of tax structure 16. Extent of financial aid. It is to be not^d that this list suggests the relative importance of trained labor as the paramount ingredient of the infrastructure. EDUCATION AND TRAINING In his study, Lewis suggests a quantitative relationship between education and such other elements of development as agricultural and industrial occupations. He suggests as a rough approximation the following table: TABLE 2.— SUGGESTED REQUIRED LEVELS OF SCHOOL ENROLLMENT Percent of occupied in agriculture Percent completing secondary school Percent completing higher edu- cation 70 6 0.8 fin 9 1.1 sn 13 1.6 40 - . 18 2.3 30 21 2.6 '^ Martin Golaiwl. "What Makes Technology Run?" In House. Committee on Science and Astronautics. "Applied Science and World Economy." A Compilation of Papers. . . . Op. cit., pages 87-8. ''^W. Arthur Lewis. "Development Planning: The Essentials of Economic Policy." (New York, Harper and Row, Publishers, 1966) , pages 97-8, and generally 97-111. 647 Education has long been recognized by students of the development process as a paramount element of the technological infrastructure." The characteristic pattern of education in the United States, by com- parison with several nations of Western Europe, was discussed by the U.S. delegation to the 6th session of the Industry Committee of the Organization for Economic Co-operation and Development, March, 1968. It noted that diversity of educational backgrounds, characteristic of the United States, "... seems to be an advantage, for broad possibilities of matching the education of workers with educational requirements for specific types of work." Conversely, the miifonnity of educational attainment in Western Europe made for reduced flexibility and adaptability of labor in those countries. It was also important, said the OECD Committee report, that in- dusti-y and the universities maintain contact "so that the former can make known its requirements and the latter make known what they can offer." "^ At the other extreme, Paul G. Hoffman, Managing Director of the United Nations Special Fund, declared : "Of the 1,300 million people living in the less developed countries for which the United Nations has some responsibility, almost half cannot read or write." '" HEALTH Health as an essential element of the "living infrastructure" was stressed by Dr. M. G. Candau, Director-General of the World Health Organization, who told the United Nations Conference on the Ap- plication of Science and Technology, 1963, that "the health of a people is among its greatest assets, and an indispensable source of its wealth." '« In the past [Oandau continued], neglect of these obvious facts has had un- fortunate consequences. . . . History is full of the records of the effects of killing and disabling diseases. Malaria has destroyed civilizations; great pes- tilences like plague have brought misery, poverty, and the destruction of society in their train ; i)oisons like opium and alcohol can eat insidiously into the life and prosi)erity of a community.™ According to W. Arthur Lewis, the principal opportunities for social investment were in public health : The spectacular fall in the death rate over the past hundred years owes very little to curative medicine. The great killers have been wiped out at relatively small cost, using the services of only a handful of doctors, either by improve- ments in the water supply — which have curbed cholera, typhoid and dysentery — or by environmental sanitation which has materially reduced the incidence of '5 United Nations. "Science and Technology for Development. Volume I. World of Opportunity." Report on the United Nations Conference on the Application of Science and Technology for the Benefit of the Less Developed Areas. (New York, United Nations, 19.36). page 56". The quotation is by -Professor M. S. Thaeker, president of the United Nations Conference on the Application of Science and Technology for the Benefits of the Less Developed Areas, at Geneva, Switzerland, in February, 1963. At the same conference, Pro- fessor V. K. R. V. Rao, director of the Institute of Economic Growth, in the University of Delhi, India, declared that 'Even if we could get all the capital in the world, that would not give us the kind of rate of economic growth that we want." What was important was the "human factor" — the development of human resources. He declared : "The human being has got to be trained, has got to acquire knowledge, and has got to be given the capacity, and organized to use that knowledge." (Ibid., page 59.) ™ Organisation for Economic Co-Operation and Development. "United States Industrial Policies." Observations presented by the U.S. Delegation before the Industry Committee at its 6th Session, March 1968. (Paris, Organisation for Economic Co-Operation and Develop- ment, 1970), page 64. •^ Ibid., pages 62.-65. '« United Nations. "Science and Technology for Development. Volume I. World of Oppor- tunity." Op. cit., page 58. ™ Ibid., p. 56. -^ 648 malaria, yellow fever and tuberculosis — or by vaccmation — which has nearly eliminated smallpox, diphtheria and poliomyelitis. One dan see this by comparing statistics for developed and underdeveloped countries. The death rate is now about the same in Jamaica as in the United States.*" POWER Three interlocked networks of technology provide an indispensable underpinning for all raw material supply, transfer of materials and products, manufacturing, and marketing. These are the networks of power, transportation, and communications. With respect to power — It was the accessibility of fossil fuels and metallic ores in Britain, Europe, North America and the USSR which, first with the steam-engine and later with the oil-engine, gave countries there the impetus of industrialization which now rates them as "highly developed." Countries which, during the nineteenth cen- tury and the first half of this century, had not accessible energy resources and contiguous minerals of this kind could not have comi^irable industries and, what- ever their innate capacities, remained the suppliers of raw materials and food for the factories and workers of the geologically favored nations.*' A recent Congressional report describes the impact of energy on transportation and production technology in these terms: Today human labor provides energy for far less than 1 percent of the work performed in factories, refineries, and mills in the production of their products. Literally, our economy and our way of life could not continue without use of vast amounts of energy. One measure of this situation is the increase in the total power for all engines, turbines and work animals over the past 3 decades. [There has been an] increase from 2.7 billion horsepower available in the United States in 1940 to 17.9 billion in 1968. Of this, engines in trucks, buses, and automobiles accounted for by far the largest part, increasing from 2.5 billion horsepower in 1940 to 16.9 billion horsepower in 1968. Over the same period, the power of ejectric gen- erating stations increased from 53 million horseixjwer to 371 million horse- power.*^ Characteristically, developmg countries are deficient in electric power and also in fuel for either electric or steam power. 83 TRANSPORTATION Transportation facilities are of similar importance. In the words of Hilaire Bellpc, "A road system, once established, develops at its points of concentration tJie nerve centers of the society it serves ; and we remark that the rise and decline of a state are better measured by the condition of its communications — that is, of its roads — than by any other criterion." ^* A geographic analysis of transportation stresses that good trans- portation ". . . permits the development of regional specialization in production." Unless goods could be readily moved from places of excess to regions of deficiency, each region would be compelled to produce all the kinds of things * Lewis. "Development Planning: The Essentials of Economic Policy." Op. cit., page 111. ^ United Nations. "Science and Technology for Development. Volume I. World of Oppor- tunity." Op. eit., page 10. ^ U.S. Congress. Joint Economic Committee. "The Economy, Energy, and the Environ- ment." A Background Study prepared for the use of the ... By the Environmental Policy Division, Legislative Reference Service, Library of Congress, September 1, 1970. 91s"t Congress, 2d session. (Washington U.S. Government Printing Office, 1970), page 1. [Joint Committee Print.] 83 United Nations. "Science and Technology for Development. Volume I. World of Oppor- tunity." Op. cit., page 82. ^ Hilaire Belloc. "The Road." (New York, Harper and Brothers, 1925), Introduction. 649 needed in just the right quantities — no more and no less than could be consumed' at home. Where communications are adequately developed, however, there is- no such inhibiting influence, and regions are permitted to specialize in those- types of production that they are best fitted by natural endowment or cultural heritage to do and at the same time neglect those for which they are less well equipped.*^ Historically, transportation investment was an important character- istic of the American system as it approached technological leadership.. According to one early study — We [i.e., the United States] have built almost as many miles of railroad as the whole of Europe, and consequently have used in their construction almost as many rails, and now use almost as many railroad cars and locomotives. At the close of 1881 this country had 100,000 miles of railroad, Europe had about 106,000 miles, and all the rest of the world had about 45,000 miles. The United: States had nineteen miles of railroad to every 10,000 of iwpulation^ while Europe had a little more than three miles to the same population.™ In the developing countries, transportation is a foremost need and the most expensive element of teclmological infrastructure. Transport costs form by far the largest single element in building up the economic infrastructure. It has been estimated that they represent as much as 30 per cent of the cost of finished goods in countries with a high cost-structure,, and in areas where the iMjpulation is widely scattered and industrial activity is dispersed, expenditure on transport equipment and operations can amount to 33% percent and more of the national income.*' COMMUNICATIONS Communication is even more widely varied in character; One vie\^ is that "the prime function of communications is to bridge the gap between the leaders and the masses and thus to enable the people to. participate in the modern world." From this point of view— The imijortance of an effective communications system to assist in establish- ing the new outlook and attitudes is obvious. Furthermore, if a nation exi>ects to exist as such and to maintain a place in the modem world it must create and. maintain a system commensurate with its larger expectations. In short, com- munications must be an integral part of the national economy. UNESCO has suggested that eflScacious mass communications can be assured' when for every 100 inhabitants of any country there are at least 10 copies of a. daily newspaper, 5 radio sets, 2 cinema seats and 2 television receivers. This minimum has not been attained by 2,000 million people ; one hundred States in Asia, Africa and Latin America fall below this level. Vast disparities are evident between nations, as to their use of mass communications. "For example, Australia with an annual inoome- of more than $US800 fer caput^ has about the same population as Tanganyika with only $US100 of such income but has nearly 900 times the newspaper circulation and perhaps 750 times as many radio, receivers." Increasingly the United States has seen the evolution of a truly national system of telecommunications. Into this complex is now being introduced the transmission of television programs and the facilities of the digital computer as a repository and source of electronically 8^Vernor C. Finch and Glenn T. Trewartha. "Elements of Geography." (New York,. McGraw-Hill Book Company, Inc., 19316), page 653. '"Benjamin Rand, compiler. "Selections Illustrating Economic History Since the Sevens Years' War." (Cambridge, John Wilson and Son, 1895), page 435. *^ United Nations. "Science and Technology for Development. Volume I. World- of- Oppor- tunity." Op. cit., pa^es 135-6. 97-400 O - 77 - 4 650 communicated information. The national management of information as an adjunct of the national communications net makes for a closer integration of national technology and other forms of social orga- nization. The still more recent development of commmiications satel- lites extends the reach of this national network to other nations and can be expected to effect a similar integration of culture, technology, knowl- edge, and trade on a virtually global basis. INTERNATIONAL ASPECTS OF INFRASTRUCTURE The foregoing discussion of the importance of infrastructure as the basis of a nation's technology indicates the complexity of a total national system of industry and commerce. Human resources are sug- gested as more important than material wealth. Science contributes to technological systems as a necessary, but insufficient, condition. In short : "The advance of scientific technology can only be part of a concerted national programme of educational, economic, industrial and social change." ^^ Although the total pattern of a nation's infrastructure is a matter of primarily domestic concern, there are many international aspects to the separate ingredients. Even the total pattern is of some concern internationally; within a developing country, for example, if U.S. policy calls for a program of aid to help with its industrialization, the improvement of these conditions of growth become a U.S. problem. Even the definition of the components of the infrastructure in order to assure their proper recognition and support becomes an inter- national problem, to be studied in AID, in the United Nations, in the various specialized U.N. agencies, in O.E.C.D., and elsewhere. In addition, the various elements of infrastructure discussed in this subsection have their own international aspects. Thus, education and training raises questions involving the gain or loss of trained man- power, the planning of institutions to train technicians for interna- tional service, establishment of standards of comparative national educational achievement, exchange of educational personnel, and dis- semination of knowledge. Although health is primarily a domestic problem, it lias vast im- plications for diplomacy : the wealthy nations of the world ignore the health problems of the less developed nations at their peril. Modern transportation systems make possible the global spread of infectious disease with great speed. Pockets of disease and disease vectors serve as natural time bombs, threatening danger at any t-ime. Drugs and sera — their development, production, and availability in time of need — are of concern to all nations. Organizations for the detexjtion of disease and medical problems cannot be other than international. Similarly, the world as a global unit is concerned with the total availability and dis- tribution of trained public health and medical ser\dces, and with the standards of health and medical care. International transfer of electric power is of no great consequence but the transfer of power technology — particularly atomic power — is of wide international concern. Control of the facilities, the fuel, and the processing of spent fuel elements are all international problems. 88 Ibid., page 53. The statement is by Professor P. H. S. Blackett. 651 Supplies of coal, natural gas, petroleum, and other fossil fuels are not uniformly distributed among the nations of the world and raise ques- tions of international adjustment and accommodation. The global problems of air pollution and dis])osal of radioactive materials are also €losely related to power generation. Ground transportation is already an internatioiinl network in Europe and North America ; similar networks are of increasing impor- tance in Africa and South America. Air transportation is clearly global, with enormous problems of safety standards, prevention of dis- semination of disease vectors, standardization of operational training, specialized international language and codes, procedures for interna- tional air shipment, security of air cargoes, international sales of air- craft and engines, and — most recently — the competitive development of three large supersonic transport aircraft. Communications networks are inherently global, and promise to become more so with the advent of communications satellites for tele- phone, radio, and television. Some of the international diplomatic aspects of this subject will be discussed in a later study. Involved are allocation of the electromagnetic spectrum, content of international television programs, standardization of codes and procedures, and many more. The role of the computer in association with international communications has yet to be defined, but appears certain to be a major one. Also of importance is the economic power of the large corpora- tions specializing in the development and production of communica- tions and computer hardware ; this field of activity received primary attention in the French study of the penetration of Europe by Ameri- can corporations.^® Recapitulation: Diplomatic Conseqiiences of Technology It is no easy matter to inventory the myriad of international con- sequences flowing from the four kinds of technology discussed in this section. Foremost, perhaps, is the conclusion that international com- petition for primacy among nations is to a very large extent a tech- nological race. Nuclear weapons and atomic power have profoundly influenced the international scene in many subtle and unexpected ways : creating the need for a deeper mutual understanding between the superpowers as a means toward their mutual security; creating opportunities for large multipurpose projects to open desert regions of the world to habitation; and generating a host of international agencies and ac- tivities to control and exploit this still new product of science. Space exploration has led to a similar need for closer understand- ing and cooperation among nations, as well as conferring prestige and power upon the leaders in this technology. The securing of various new benefits by all nations from space teclinology requires cooperative agreement and joint action. Planet Earth has been shown visibly and coherently as a single unit whose artificial divisions by mankind can be ignored in the global study of weather, resources of land and ocean, and even the superficial changes brought about by industry, agricul- ture, and human settlement. The mundane field of agTicultural technology', among the first at- tempted by man, has also generated its worldwide conflicts and ten- ^ J. J. Servan-Schreiber. "The American Challenge," Op. cit. 652 sions as we'l as offering solutions to global problems. It has required study by international bodies, international exchange of information, negotiation to resolve new issues, and an awareness of the A^alue of cooperation among governments as well as among peoples. Even the primarily domestic aspect of tec-hnological infrastruc- ture is found to have significant international aspects. Programs in technical assistance, international activities in education and health, exchange of technical information about transportation, counnunica- tions and power, all provide a basis for closer relations among gov- ernments and individuals. Some aspects of infrastnicture are themselves taking on an inter- national character, such as air transportation and satellite communica- tions. These can serve both to help and hinder the work of the diplo- mat: While information can now be transmitted virtually instantane- ously, to facilitate long-range bargaining, the time available for deci- sion-making has decreased. The traditional conduct of secret, official diplomacy tends to be nullified by radio and television propaganda and by educational, cultural, and scientific exchanges. Swift transit of trouble-shooting negotiators to points of tension by air transport or for consultation with national leaders is counteracted by the ability of trouble-makers and dissident groups to use these same means of travel. It seems evident that modern diplomats and policy-makers re- quire special training in understanding and using technolog}^, and in "formulating plans that involve the new uses or development of new kinds of technology. Parliaments are called upon to evaluate and ap- prove agreements and treaties with a technological content. New in- formation is needed for assessing the relationship between technologi- cal information and practical politics. IV. The Internationalization or Technology The preceding section (III) demonstrated a consistent series of trends in nuclear weaponry and atomic power, space development, agriculture, and technological infrastructure. In each case, the evolv- ing teclinology generated problems for diplomacy, postulated inter- national enterprises, attracted international interest, and implied a need for the design of a U.S. policy to ensure that the de\'elopment and its international consequences served U.S. foreign policy goals. The question to be explored in the rest of the chapter is whether future technology can be purposefully exploited to serve the purposes of diplomacy. The discussion in this section will describe the processes by which technology becomes internationalized, i.e., managed and applied internationally. The concluding section will identify some of the major issues in the use of international technology to advance the foreign policy of the United States. Assessment of National and International Technology Since 1966, numerous articles and papers have offered proposals for institutions to monitor and control the imperfections of modern tech- nology .^° There are many notions as to the definition and solution of *' U.S. Congress. House. Committee on Science and Astronautics. "Teclinology Assess- ment : Annotated Bibliography and Inventory of Congressional Organization for Science and Technology." Prepared for the Subcommittee on Science, Research, and Development, 91st Congress, second session. July 15, 1970. (Washington, U.S. Government Printing Office, 1970), 92 pages. [Committee Print.] 653 this broad problem. Some critics attack technology itself as the villain. Others charge society with using technology improperly. However, there appears to be a consensus that beneficial technological innova- tions tend to have unexpected, unplanned, and adverse secondary con- sequences. In some cases, a defective innovation is questioned at the outset, but eagerness for its adoption is so great that it is rushed into wide use without adequate testing or assessment. (Such was the case with enzymes for stain removal.^^) In other cases, a teclmologj^ meets con- ventional tests and is later found to be defective in ways that conven- tional testing had not disclosed. (This was the case with the drug. Thalidomide.^^) Still other technologies reveal flaws when the mass effect of their wide public use magnifies their imperfections. (Examples are the automobile and DDT.) Technological shortcomings also result from many kinds of interactions, of one technology with another, or of some technology with an "eco-system," or a subtle effect that in- novative technology is needed to detect, and so on. Since the only justification for the adoption of a technology is its benefits to man, it is appropriate for society to be assured that the benefits oA-erweigh the costs. Assessment will also be concerned with seeking out alternative ways of increasing the benefits or reducing the costs. The need for an assessment institution is intensified in cases where different persons or groups receive the benefits of a technology from those who bear the costs of the adverse secondary consequences of the technology. Problems arise, for example, when a plant dumps pollut- ing waste into a stream that impairs the value of the water for down- stream users, or when a smoke plume dirties clothes and houses down- wind. This circumstance can be international as, for example, when plants at Niagara Falls send smoke into Canadian communities. Sometimes it is unclear as to whether a consequence is adverse or not : for instance, there is no agreement as to whether the waste heat from a power plant dumped into a lake or bay is thermal pollution or thermal ennchment. The adverse consequences can appear as a tenu- ous chain of circumstances : as an example, the DDT spread on a bean field may destroy a nearby hive of honeybees, and thereby prevent pol- lination of a fruit orchard a half-mile away, raising the price of fruit in a city 50 miles away. The wide dissemination of lead in gasoline and paints, the general use of asbestos in brake linings and household in- sulation, and the use of toxic chemicals as plastic additives are all viewed as general hazards to mankind. Proposals to institutionalize the assessment of beneficial and adverse impacts of technology have included establishment of assessment units in various technologically-oriented departments and agencies, estab- lishment of an independent agency or board in the form of a regula- tory agency, the creation of an advisory body to the Congress, and «' ". . . A clothes-washing compound featuring an enzyme for protein stain removal could be and was developed, manufactured, advertised, distributed, and sold — and then pumped into sewage treatment plants all over the country in a matter of weeks — with no formal consideration of the possible consequences of a new ingredient." U.S. (President Nixon's) National Goals Research Staff. "Toward Balanced Growth : Quantity with Quality." Report of the National Goals Research Staff. July 4, 1970. (Washington, U.S. Government Printing Office, 1970) , page 126. *- See Chapter Fourteen. "Thalidomide : The Complex Problem of Drug Control In a Free Market." In House. Committee on Science and Astronautics. "Technical Information for Congress," Op. cit., pages 375-85. 654 various combinations of tliese.^^ An analysis of 14 cases of congres- sional decisionmaking on technological issues since 1945 has shown that there are available no standards and no systematic procedure for this task. It was observed that there was a need for early identification of technological issues to enable their orderly analysis before political pressures could operate to obscure or bias the findings. 94 INTERNATIONAL ASPECTS OF TECHNOLOCxY ASSESSMENT Because of the widespread interest in the subject of technology assessment in the United States, it was only to be expected that inter- est in it would go abroad. According to John Lear : The technology -assessment idea is * * * being pursued on the international front : in UNESCO, in the Organization for Economic Cooperation and Develop- ment (OECD). in the Council of Europe, and in the North Atlantic Treaty Organization (NATO).*^ One of the more perceptive statements on the subject was offered by Anthony Wedgwood Benn, Labour Government Minister of Tech- nology in the United Kingdom. He wrote that it was necessary to "* * * identify the main problems facing society and [to] find ways and means of converting these needs into real demands which can be met best by the use of technology." ^'^ In the 14 case studies referred to above, there were five that were primarily international in scope,"^ and another three cases with sub- stantial international implications.**^ An increasing number of tech- nological developments are appearing tliat seem to have international aspects. For example : The developed nations in Europe and elsewhere have a special responsibility to the less developed ones. We advise them to industrialize cleanly in order to escape what we are suffering, yiet they turn and ask us why they should handicap their products in the world market while we continue to be dirty. We can do no less than make a determined effort to clean up internationally.*® With the appearance of technologies of global impact and influence, the question of international regulation begins to be asked : As technology has made the world more a "village world," there has been a growing tendency since the foundation of the United Nations for international bodies to concern themselves with matters . . . which were formerly held to be the exclusive province of a nation-state. It is in the fields of science and technology »3 For a summary of some of these proposals, see : Franklin P. Huddle. "Government Technology Assessment : The Role of the Social Sciences." Panel-Round Table at Annual Meeting of the American Political Science Association." October 2, 1970. (Multilith, Science Policy Research Division, Legislative Reference Service, Library of Congress, 1970), 45 pages. (70-246 SP.) "■' See : House, Committee on Science and Astronautics. "Technical Information for Congress," op. cit., especially pages 519-.521. This reference states that "The hypothesis is this : If an issue can be certified for congressional study at an early point and surveillance maintained over it by skilled people, the process of maturation can occur without con- suming congressional time and attention, until the need for action is manifest. Issues might then be dealt with by the Congress on an orderly time schedule, with less reliance on crash decisionmaking and a reduced frequency of sudden sensational alarms." (Page 519.) ^'^ John Lear. "Predicting the Consequences of Technology." Saturday Review. (March 28, 1970), page 46. . »« Anthony Wedgwood Benn. "Technology and the quality of life." Technology plus So- ciety. (May 1970, Vol. 6, No. 1), page 7. *' These were : the Test Ban Treaty, the Point IV Program, the Peace Corps, the Thalid- omide Case, and Camelot. <"* These were : the control of pesticides, high energy physics, and the Mohole project. ** Frank Fraser Darling. "Thinking planet-wise." New Scientist, (April 16. 1970), pages 106-108. Dr. Darling is a member of the standing Royal Commission on Environmental Pollution of the U.K. 655 that this need for international rather than national action is most strongly felt, and for many reasons. These reasons were: the traditionally international character of science, the need for international cooperation in inherently global activities such as civil aviation, the need for control of dangerous teclinologies like atomic energy, and the regulation of global dissemi- nation of pollutants. With respect to the last item, the author observes : (Combating pollution will inevitably require international rather than national regulation as its starting point. First, pollution originating in a single nation- state might well spread, through one of the components of the environment such as the air or oceans, into the territories of other nation-states. Secondly, in the context of current patterns for modernization of economies by the export from the most advanced countries of capital equipment for technological manufacturing, a plant which fails to contain adequate anti-polluting equipment will spread pollu- tion by the very fact of its export. Thirdly, the measures to combat pollution need to be internationally prescribed and enforced for they will undoubtedly affect costs, and states which fail to observe them will gain a competitive advantage over those who do.^"* As a corollary of the author's third point, U.S. insistence on the incorporation of anti-smog devices on American cars for domestic use might be regarded as a form of trade barrier by nations exporting cars to the United States, unless such devices are freely available under cross-licensing arrangements. SUGGESTIONS FOR USTTERISTATIOXAL INSTITUTIONS A proposal has been advanced for an international assessment agency under the aegis of the United Nations, in an article by Dennis Living- ston of Case Western Reserve University.^"^ His plan relies on three propositions: (1) there is already a considerable assessment activity in international bodies, (2) adverse secondary consequences of tech- nology are often international in their impacts, and (3) assessment of technology is involved in the processes of aid to developing countries, with respect to their own policies in the adoption of technology, in eval- uation of impoited technology, and in evaluating technological trends and their social consequences in the developed countries. Professor Livingston cites niunerous instances of assessments under existing international arrangements, such as : Outer space ; Pollution abatement; . Civilian nuclear reactors ; Resources management ; International brain research ; Nuclear energy research ; Research in the "planetary biosphere" ; Safeguards for nuclear reactors and materials ; The seabed ; and Oil pollution on the high seas. ^o" Allan McKnight. "International Regulation of Science and Technology," Interna- tional Journal, "Autumn, 1970," pages 745-746. ifi Dennis Livingston. "International Technology Assessment and The United Nations System." American Journal of International Law, (September 1970, Vol. 64), page 163-172. 656 Other items might well have been added to this list, such as : Control and testing of proprietary drugs ; Usesof nuclear explosions for civil purposes ; Weather modification, control, and prediction ; Persistent pesticides ; Communications satellites ; Genetic engineering ; Arms control ; Aircraft noise and environmental effects ; Human resources management: the international movement and concentrations of scientific and technological talent; Inadvertent weather modification ; and Control of infectious disease and disease A^ectors. Ac-cordingly., Professor Livingston proposes the creation of an "In- ternational Technology Assessment Board, charged with four func- tions: (1) contracting out specific technology assessment studies, (2) liaison and cooperation with national technology assessment bodies, (3) issuance of an annual report on the use of science and technology for mankind, and (4) provision of fact-finding and mediation services. He elaborates on all of these, but his comment on the fourth point is -especially illuminating : This is a function not contemplated in the reports for a U.S. asse.ssment agency, but iJotentially useful on the international level. Some of the important disputes among states involve disagreements about the anticipated effects of large-scale technological projects, particularly the multi-utilization of international river systems and the carrying out of space experiments. . . . [Provision of such .^services] would not be unprecedented. ICSU's Committee on Space Research established a Consultative Group on Potentially Harmful Effects of Space Experiments. ... At the adjudicatory level, several cases of air and water pol- lution exist in wfhich states claimed damages resulting to their territories by the harmful activities of neighboring states, with the issue resolved by tribunals or courts."^ It is not evident whether or not the world is yet ready for an inter- national agency of technology assessment. Indeed, in the United States the issue as to the desirability of a domestic agency for this purpose has not yet been resolved. Nevertheless, sentiment seems to be increas- ing in the direction of some sort of international concordance regard- ing the global impact of technology. For instance, the first annual report of tlie Council on Environmental Quality "^ tabulated inter- national agencies currently engaged in "international cooperation on •environmental matters," in many of which the United States was a participant. Tliese included: A. The United Nations : Economic Commission for Europe (ECE) : ^ Intergovernmental Maritime Consultative Organization (IMCO); U.N. Educational, Scientific and Cultural Organization (UNESCO) ; World Health Organization (WHO) ; Food and Agriculture Organization (FAO) ; World Meteorological Organization (WMO) ; International Atomic Energy Agency (IAEA) ; and U.N. Conference on the Human Environment. 102 Ibid., pages 166-170. i<" U.S. President's Council on Environmental Quality. "Environmental Quality : The ^rst Annual Report of the Council on Environmental Quality together with The Presl- ■dent's Message to Congress." (Washington, U.S. Government Printing Office, 1970), pages 199-209. 657 B. Other Intergovernmental Bodies : NATO Committee on Challenges of Modern Society (CCMS); Organization for Economic Cooperation and Development (OECD); Organization of African Unity (OAU) ; Organization of American States (OAS) ; and Council of Europe. C. Bilateral Cooperation (with the United States) : Japan ,-^ Germany ; France; Soviet Union ; and Canada, D. Nongovernmental Organizations : International Biological Program of Intemationai Council of Scientific Unions ; and International Union for Conservation of Nature and Natural Kesources (lUCN). In this same context, Senator Warren Magnuson has proposed the creation of a "World Environmental Institute" to serve as a central information center for all nations. Every nation— regardless of its form of government or its international and domestic policies — could consult the Institute for expert advice on all forms of environmental problems. The Institute would serve both as a research cen- ter and as the repository of that worldwide pool of knowledge and talent. Through the use of computers, any country could obtain a thorough guide to the scientists and scientific studies around the world that relate to a particular en- vironmental problem. Under the auspices of the Institute [Senator Magnuson continued], a con- tinual exchange of scientists and technological information between the coun- tries of the world would be possible on a non-political basis — not simply on the unilateral scale of today but on a multilateral level never dreamed of be- fore. Task forces could be set up — consultants who would work as a team and on request visit the distant parts of the globe to undertake special projects.^** THE ASSESSMENT ROLE OF INTERNATIONAL LAW Just as the legal profession has taken an increasing interest in. teclmology assessment as related to the processes of law in the United States, the role of international law has also been seen as importantly linked to the global function of technology assessment. Herman Pollack, director of the Bureau of International Scientific and Technological Affairs of the Department of State, suggests the need for "systematic technological assessment" at the international level, where it — * * * also encompasses an evaluation of the adequacy of international law, arrangements and institutions for the management of technologies which are- inherently international in their scope, such as those relating to weather modification and communications.^'^ JVIr. Pollack's point was enlarged on in an article by C. Wilfred Jenks, Principal Deputy Director-General, International Labour Office. He declared that "the progress of advanced technology poses immediate practical problems of legal regulation and legal liability. 104 "\ World View of the Environment." Remarks of Sen. Warren G. Magnuson before the second annual International Geoscience Electronics Symposium, Washington, D.C. April 16, 1970. In "Senator Magnuson's Plan for a World Environmental Institute." Re- marks of the Honorable Mike Mansfield on the floor of the Senate. Congressional Record, (April 23, 1970), page S6069. 106 Testimony before Subcommittee on Science, Research, and Development, House Com- mittee on Science and Astronautics, July 28, 1970. (Mimeo), page 7. 658 The question becomes that of whether we can foresee and take effective action concerning these problems before they become insoluble or whether law must always lag behind life. It took the Titanic disaster to produce the Safety of Life at Sea Convention. It has taken the Torrey Canyon disaster to prompt vigorous action conc-erning the oil-pollution risk from giant tankers. Must the progress of the law to cope with the new problems arising from the progress of science and technology always wait upon disaster? There are clearly fields, notable among them that of nuclear energy, in which the consequences of disaster may be so far-reaching that the failure of the law to keep in step with life may involve not merely frustration, hardship and injustice, but the collapse of the whole legal order. He noted that there were prototypes such as the U.N. Conventions on the Law of the Sea, the Antarctic Treaty, the Moscow Nuclear Test Ban Treaty, the Nuclear Liability Conventions, and the Space Treaty. Others were needed, such as an Open Depths Treaty, an Arctic Treaty, a Radioactive Pollution Treaty, and a World Weather Treaty. In- deed — "We may . . . within the next few years need a Sonic Boom Treaty, a Center of the Earth Treaty, a Cybernetics Treaty and a Molecular Biological Treaty.'' However, he questioned whether it would be adequate to deal separately with each of these problems. They were all "aspects of the broader problem of the role of law, internationally as well as nationally, in the social control of the new relationship between man and his environment created by contempo- rary scientific and teclmological progress." Accordingly — The social control of science and technology takes its place with the renuncia- tion of force as an instrument of national policy, the promotion of economic stability and growth, the protection of civil liberties and the progress of social justice among the major objectives of policy which are giving altogether new dimensions to international law in our time and gradually but relentlessly trans- forming it from a law between States only and exclusively into the common law of mankind.^'* The need for a general strengthening of institutions for interna- tional assessment and control of technology was seen by Allan Mc- Knight, formerly Inspector-General of the International Atomic Energy Agency : If the scale of international regulation of science and technology increases (and this writer believes that it must), then the content of the business of our Institutions mu.st change. These consequential changes will include : (a) much closer links between foreign ministries and the scientific coonmunity, ( & ) much greater concern within scientific communities with r^ula- tion of activities rather than positive conduct of activities, (c) a larger component of scientific skills and knowledge within foreign ministries, (d) a deeper concern with regulation within the governing bodies and secretariats of international organizations, (e) closer links all over between scientists, technologists, politicians, and lawyers, (/) above all, a logical process for achieving Lnternational regu- lation.'*" The Internationalization of Military Technology Of the three options that Rostow sees as open to a technologically advanced nation ^"^ the first seems to have been largely blunted by technology itself. In the face of a nuclear weapons capability, mili- tary conquest in the future dare not be too ambitious ; war must be ^"^ C. Wilfred Jenks. "The New Science and tlie Law of Nations." International and Comparative Law Quarterly. (April 1968, Volume 17), pages 328-332. 10^ McKnight. "International Regulation of Science and Technology," op. cit., pages 752-3. 108 These were : military expansionism, achievement of a high-consumption economy, and development of the welfare state ; see page 14. 659 limited in scope and for limited objectives. Nuclear missiles have demonstrated their negative value to assure inaction ; but they do not appear useful as a means of positive action. Nevertheless, a long chain of diplomatic exchanges have resulted from this ultimate weapon. For example: A considerable amount of the business of the United Nations has been concerned with nuclear disarmament, nuclear limitation, and arrangements for the regulation of atomic power operations. A lively dialogue has continued between the United States and the Soviet Union to develop international understanding as to the limits of military commitment short of nuclear confrontation. The mutuality of interest in avoiding nuclear exchange, or for that matter the serious threat of such an exchange, has led to an increase in exchange of views and even to the provision of a tech- nological mechanism (the "Hot Line") for emergency consulta- tion between Chief Executives of the two powers. Worldwide surveillance has been established, in the form of seismic and air-sampling detection systems, to detect nuclear weapons tests. Nuclear-armed bases on the territories of a number of aligned States have been negotiated for. Extensive negotiations have been undertaken toward the goal of refusing the admission of nuclear weapons to entire continents ( in particular, Africa and South America) . FACTORS OF SUB-NUCLEAR TECHXOLOGY Though strategic war has apparently been eliminated as a viable instrument of policy, capabilities still exist in most States for the conduct of limited, sub-nuclear war. Nuclear powers maintain these capabilities to enlarge their power options, to influence the course of combat among States where their interests are involved, and to stabi- lize or otherwise atfect the military balance of strength among lesser powers. Technology is also involved extensively in these activities in ways that are of diplomatic concern. For example : — There is considerable agitation over the U.S. use of herbicide tecluiology in Vietnam, and a more general concern as to what kinds of technolog}^ ought to be foresworn by belligerents under international law. — Extension of U.S. arms technolog}^ and even the development of international technological standards of armaments to the many participating countries have resulted from the various re- gional treaties of mutual security (NATO. SEATO. OAS. etc.). — Construction of large, expensive, air-defense networks has occurred or is in process in many countries (emplo^'ing U.S. tech- nologies for radar, computers, display tubes, and various sub- systems of active defense) . — Various forms of U.S. military assistance have been provided by negotiation, such as supply of combat aircraft, ground support equipment, ordnance, and communications ; training arrangements have also been provided in the use and maintenance of the equip- ment, and in basic science and technology to understand its opera- tion and design. — The deployment of U.S. troops abroad, and their use in asso- ciation with indigenous troops or people has had the derivative effect of being a teclmological training device. 660 — The wide deployment of U.S. troops and the Fleet means^ that U.S. service people are frequently in a position to aid local populations in time of emergency or natural disaster, or even as a routine activity, with the effect of demonstrating the operational utility of U.S. technology in the process. There is one body of opinion that holds that the role of subnuclear conflict is tending to diminish. The rationale behind this view is that as the spheres of influence of the Great Powers become more sharply defined, both functionally and territorially, there wnll be less and less occasion for initiatives and ventures involving the productive use of force. It Avill be in the interest of these Powers, also, to try to damp out any violent quarrels among lesser States, in order to avoid the possi- bility of nuclear confrontation. The implication of this trend — to the extent that the hypothesis is valid— would seem to be that a principal remaining avenue for the ex- ercise of national influence is in competitive technology. This view is expressed in the following passage by Victor Basiuk of the Institute of War and Peace Studies at Columbia University : Over the centuries, nonmilitary technology has been one of the major causes of change in the distribution of worid power. In recent times, nations have grown powerful thanks in large part to the peace-time technologies which made it pos- sible for them to become great industrial centers. Military power usually fol- lowed in the wake of industrial capability. . . . There is no sign of the emergence of a stalemate to prevent nonmilitary technology from effecting changes in the distribution of power of nations and regions. The evolution of nonmilitary technology suggests at least one important con- clusion. Because nonmilitary technology now occupies a larger part of the spec- trum of technologies capable of changing the distribution of world power and because its share of the non-stalemated spectrum is growing, its importance prom- ises to be greater than it was heretofore.^™ However, even under this hypothesis, tliere are many points of inter- national contact involving technology in Avhich U.S. military and paramilitary agencies can participate. For example, a report by the U.S. Coast Guard of its "involvement in international affairs'' list« 20 international agencies and 15 international activities in which it is a. participant. Among the international programs are Loran stations, the ocean station program, the automated merchant vessel report (AMVER) system, training of foreign nationals, and sea-air rescue technology and studies. Of the AMVER program, the Coast Guard reports : » Close liaison with foreign embassies, foreign governments, foreign shipping in- terests, foreign communications representatives and foreign airlines is required to encourage participation in the AMVER program and to arrange for the neces- sary communications for exchanging the ship reports and passing surface pic- tures. General instructions for participation in AMVER have been reproduced in twelve foreign languages. The International Radio-Medical Center, Rome- (CIRM ROMA) is an active interested correspondent. . . ."" By various agreements or treaties, the Coast Guard has established its Loran stations on the territories of 14 countries, and provides tech- nical assistance and replacement parts to 43 Loran stations manned by host nations. What has been said about the far-flung international contacts of the Coast Guard on technological matters applies with greater force 109 Victor Basiuk. "Technology and World Power." Foreign Policy Association, Headline Series. (April, 1970), page 53. "" U.S. Department of Transportation. Coast Guard. "Participation in International Aflfairs." [1968.] (Mimeo, May 22, 1968), pages A-2, B-2, B-5, and B-7. (CG-389.), 661 for the three military departments and for the Department of Defense generally. The Inc7'easv)ig Scope of Global Technology The growth has been described of international participation in Earth satellite systems for global communications, resource surveys, weather prediction, navigation, and other useful services derived from the space program. One effect of this activity has been to advertise globally the teclmologiciil accomplishments of the United States in a difficult and costly field. Another effect has been to encourage a global attitude toward the Earth itself — perceivmg it as itself a "space sliip,'- whose passengers share its fate, irrespective of country or re- gion. A third effect is to tie together into single systems global com- munications, transportation systems, resources, environmental effects, and weather and climate. International participation in space projects is demonstrably being stimulated by the opportmiities for tangible benefit as well as by the prestige they afford. As tecluiologies grow in size, cost, complexity, sophistication, and range of effects, they may tax the willingness (if not indeed the physi- cal means) of individual nations to support their development. This effect has already been observed in the case of the Concorde super- sonic transport aircraft, whose development is currently being shared by France with the United Kingdom. As Basiuk notes — First, confronted by rising costs and problems of increasing scale, even the superpowers individually may lack the capability of taking advantage of the full potential of future technology. This factor will increasingly generate pressure for international cooperation among the middle-rank powers (e.g. Britain, France, Germany, Japan), between the superpowers and the Western Euroi)ean powers and Japan — and perhaps between the superpowers themselves. Second, some forms of future technology such as large-scale climate modification, wili require international cooperation not so much because of the costs involved but because more than one geographic region will be affected and the participation of those concerned will be esisential."^ Numerous proposals for large-scale international technologies or developments have been advanced in recent years. Among the more notable have been proposals for damming the Bering Straits, for large-scale transfer of water from Canada to the Great Basin of the United States, large agro-industrial-nuclear desalinization projects for desert regions, and systematic extraction of materials from the sea bed. Leadership in large international projects of technology con- tributes to diplomatic influence at the same time that diplomatic skills are needed in the design and construction of international consortia to execute such projects. HAZARDS OF ECONOMIES OF SCALE The exploitation of economies of scale has led to remarkable in- 'creases in the size of many technological installations. With increased size may also come the possibility of danger to nearby populations or to the environment from technical flaw, operating error, act of Nature, or even sal3otage. The oil spill at Santa Barbara and the Torrey Canyon episode illustrate these dangers. A number of tragic aircraft accidents in recent history serve to highlight the possibility that as 1^' Basiuk. "Technology and World Power," op. cit., page 16. • 662 aircraft continue to grow in size and passenger capacity the numbers wiped out in single disasters will likewise increase. Safety of mankind and his environment, in the face of this growth of technological units, calls for an increase in intergovernmental relations to enforce uni- form standards of design reliability, uniform codes of operating be- havior, and reasonable standards of environmental quality. It would seem that closer international ties are postulated not only to construct the supersize units of present and future technology but also to pro- tect mankind and his world from their faults. Tlie Internationalization of Commercial Technologies Many international networks have been constructed that involve the exploitation by private companies of innovative products with world markets. Servan-Schreiber regards these networks as essentially Amer- ican-built and American-dominated (thanks to the superior public education, management training, and scientific infrastructure in the United States). Being alien to Europe, these networks are also — in his judgment — potentially inimical and divisive. Accepting the Servan-Schreiber thesis, and declaring the existence of a "technological gap" between Western Europe and the United States, Aurelio Peccei declares that technological change is bringing about disruptions that threaten "assured and possibly total disaster." He cited as the special advantages possessed by the United States in achieving its superior technological posture in industry the following : U.S. lead in computer technology U.S. lead in atomic energy, aircraft, and space U.S. lead in comprehensive communications systems Greater U.S. effort in research and development Greater size of American firms, with superior profit picture Superior U.S. managerial skills The flow of European scientists to the United States Higher U.S. expenditures on education (especially technical) Mobility of movement geographically and institutionally Superior communications among and within institutions Absence of trade barriers within a large market area Flexibility and adaptability of social and economic institutions. According to Peccei, Americans refuse to admit to the existence of this gap, and this conflict in views "has been a point of contention at the comitless meetings and conference devoted to the subject in the last few years." "2 A rejoinder to the Servan-Schreiber thesis is presented by John B. '"Rhodes, who declares that the capabilities of the industry of Western Europe and the United States are both "being matched or surpassed in many products by those of Japan," that many new manufacturing centers were emerging outside the United States, that "There are few goods available to the American consumer that are not produced at competitive prices in Europe," and that on balance "the odds favor a significant role for European industry even in those fields [such as atomic energy and space] where it now seems far behind." In less limited fields, the resilience of industry in Europe has been remark- able. . . . The European automobile industry is vital and growing even after some .50 years of competition from General Motors and Ford. IBM has been successful in Europe, but not noticeably more so than in the United States, and is bound to face increasing competition in the years ahead both abroad and at iu> "xhe Transatlantic Cleavage — The Technological Gap." From the Atlantic Union. In "The Transatlantic Cleavage — The Technological Gap." Extension of remarks of the Hon. Howard W. Robison, Congressional Record, (September 30, 1970), pages ES785-89. 663 home. In fields such as power generation, primary metals, road and rail trans- portation, consumer durables, and communications, European companies are among the world leaders."^ AMERICAN HIGH-TECHNOLOGY BIAS Another American view, by Arnold Kramish, suggests that not only does a technological gap exist, but that it is likely to persist. He ob- serves: (1) "... At any given moment, the rate of a nation's tech- nological growth is proportional to the external pressures, and to a vague factor incorporating national awareness and will." and (2) ". . . The United States will never be content with anything less thaji a position of world technological leadership, a position which is rein- forced by her determination to maintain strategic superiority over any other country. She will thus continue to have a high investment in esoteric or pioneer forms of technology." ^^* It was this U.S. preoccupation with strategic (i.e., military) hard- ware that diverted American technologists from "prosaic problems such as those of improving old processes or dealing with air pollution and waste disposal." He noted that the British had perfected an Ameri- can invention of "float glass" and today enjoy a strong international position in a lucrative field, "Why was not this process developed in the United States, since it was American in origin?" Kramish's ex- planation is that Europeans have a greater interest in increasing the efficiency and productivity of commonplace processes, rather than risking development of "frontier" teclinology."^ TABLE 3— HOW TRADE FOLLOWS RESEARCH AND DEVELOPMENT |A comparison of competitive trade performance in 18 U.S. industries witli research and development) Industry Aircraft _ Office machinery Drugs Other machinery I nstruments Chemicals, except drugs Electrical equipment Rubber Motor vehicles Petroleum refining Fabricated metal products... Nonferrous metals Paper and allied products.,. Stone, clay, glass products.. Other transport equipment. . Lumber and wood products. Textile mill products Primary ferrous metals U.S. exports as percent of Scientists and exports by 10 engineers in R. leading indus- & D. as percent trial countries, of employment, 1962 January 1961 59.52 7.71 35.00 5.09 33.09 6.10 32.27 1.39 27.98 4.58 27.32 3.63 26.75 4.40 23.30 2.95 22.62 1.14 20.59 2.02 19.62 0.51 18.06 0.69 15.79 0.47 15.22 0.60 13.71 0.46 11.68 0.08 10.92 0.29 9.14 0.43 Source: D. Keesing, The Impact of Research and Development on United States Trade, International Economics Workshop, Columbia University, February 1966. (As reproduced in: Christopher Layton. "European Advanced Technology, A Pro- gramme for Integration" (London, George Allen PEP, 1969), p. 278.) U3 " 'The American Challenge' Challenged." Harvard Business Review, (September- October, 1969), pages 46-49, 52. ^* Arnold Kramish. "Atlantic Technological Imbalance : An American Perspective." Defense Technology and the Western Alliance. Institute for Strategic Studies, (occasional paper, 1967). Mr. Kramish is author of Atomic Energy in the Soviet Union (1959) and The Peaceful Atom in Foreign Policy (1963) ; he is co-author (with E. M. Zuckert) of Atomic Energy for Your Business (1956) . ^5 Ibid., page 4. 664 That American export trade reflects this bias toward "exotic" tech- nological products is confirmed by several sources. One confirmation is presented in Table 3. A similar view was recently offered by Patrick E. Haggerty, chairman of Texas Instruments, Incorporated. He -asserted that only in technology-intensive products does the United States have a favorable commercial balance in its trade with the rest of the world. This balance (for such products) amounted to $8 or $9 billion annually. Mr. Haggerty's main thesis, however, was that ". . . •even in technology-intensive products, and after our tremendous na- tional expenditures for research and development, our lead over our industrial competitors and customers in the industrialized world is narrowing rapidly," ^^^ However, in the field of computers, which are widely considered "among the most significant indicators of the new technology," the United States has installed 56,000 compared with 20,000 in Western Europe, 5500 in the Soviet Union, and 6000 in Japan. "A look ahead to the late 1970s is instructive, when the United States will have about 100,000 of a world total of 215,000 computers, Western Europe 50,000, the USSR 35,000, Japan 20,000, and the remaining three-quarters of the world only 10,000." ^" By comparison, long-established technologies appear to be lagging in the United States. According to Walter J. Campbell, editor of In- dustrial Week, American steel production — while still leading the world — had declined in world markets from 57 percent to 31 percent and domestic sales from 99 percent to 90 percent, from 1950 to 1969. Quantitatively, while U.S. production of steel had risen during this period from 96 million tons to 141, Japan's steel production had in- creased from 5 million tons to about 90 million. Similarly, the auto- mobile industry, which in 1950 supplied more than 75 percent of the world market, now served only 34 percent."^ THE SPREAD OF MULTINATIONAL BUSINESSES Too much should not be made of visible trade balances. Trade statistics do not reflect the fact that many American corporations are •doing business on foreign soil and are actually contributing to trade deficits in particular areas. The Servan-Schreiber thesis relies heavily on the fact of the extensive penetration of American corporations into European countries, either through wholly-owned subsidiaries or in consortia with European partners. There has indeed been a great outward movement of U.S. capital in recent years. During the 15-year period after 1950, external U.S. investments tripled and investment in Europe rose more than tenfold. Information on the vutnber of American firms operating in Europe is more diflSeult to obtain tlian information on the flow of funds. One survey shows that there were over 3.700 "new operations" — acquisitions, expansions of existing plant, or ne~w establishments — by American firms In Europe in the eight years 1958-65, of which over 2,800 were in the countries of the EEC [Common Market] "* Testimony before Subcommittee on Science, Research, and Development, House 'Committee on Science and Astronautics, on National Science Policy, (Mimeo, August 13, 1970). "' Lee Stull. "Continuity and Change in the International E^nvironment." Foreign Service Journal (January, 1970), page 17. ii8Walter.J. Campbell. "Shrinking Share." Industry Week. ("October 19, 1970), editorial 3>age. 665 and most of the remainder in the United Kingdom and Switzerland. More than 60 per cent of these operations represented new establishments, 20-30 per cent were acquisitions, and the remainder were expansions of existing direct invest- ments. [It is probable that] many American firms began operations in the European market for the first time."* NATIONAL CONTROL OF INTERNATIONAL CORPORATIONS The study identifies three sets of problems "created for national control by the international mobility of business''; these are: Problems created, or allegedly created, by the foreign-owned enterprise for the countries in which investment takes place ; problems created for the country of the parent firm ; and problems created for host countries by the government of the home country. Under the first heading are comjjlaints "that foreign firms do not export enough, that they give preference to suppliers in the home country and hence enlarge imports, that they igTiore local employ- ment practices, that they do not contribute to local charities, that they rob the country of research, that they interfere with national planning." Under the second heading (control problems for the home country) is the allegation that high mobility of these business establishments offers the possibility of escape from both taxation and regulation, including disclosure of operations. Under the heading of inter-governmental problems is the comment that "In order to make its regulations effective in the face of interna- tional mobility ... a country may be tempted to reach out to its firms operating abroad. This involves the unilateral extension of jurisdic- tion into areas of potential conflict with other jurisdictions." COMMERCIAL TRANSFERS OF TECHNOLOGY On the subject of international technological transfer, the study reports : Nati:onal differences in technological skills and knowledge, like national differences in the capital stock available per worker, can provide the basis for profitable specialization and trade. But as in the case of capital, technical knowledge is traversing national boundaries with increasing speed and in increasing volume. The movement of technology is often associated with direct investment abroad; indeed, the rationale for the investment may be special technical knowledge embodied in a patented process or product. But increasing- ly technology moves by itself, disembodied from capital movements. In 1965, for example, residents of the United States earned over $1 billion in royalties and licensing fees (excluding movie royalties), largely earnings on technical know-how, and over $300 million of this was not associated with American direct investment oi)erations abroad. 9|f 3|* #1* r|5 *J* ^P ^^ The extensive trade in technology has two implications : first . . . differences in production possibilities based on technology will gradually disappear over time ; second, countries such as the United States, which have relied extensively on new products for a strong export position, will find it increasingly difficult to do so, since the new techniques of production may move in international trade as easily as the new products themselves.^ lie Richard N. Cooper. "The Economics of Interdependence : Economic Policy in the Atlantic Community. " A volume in the series "The Atlantic Policy Studies". (New York, Published for the Council on Foreign Relations by McGraw-Hill Book Co., 1968), pages 82, 85. 120 Ibid., pages 105-106. 97-400 O - 77 666 One characteristic of multinational corporations with American, participation is that the research and development function cannot easily be decentralized and ", . . most companies carry out the bulk of it in the United States." Coordination of international li&D en- counters differences in product needs and standards of teclinical proficiency, as well as difficulties in communication. One solution has been the use of technical specialists or technical liaison groups who go the coi-porate rounds to keep management, new product develop- ment, and national sales outlets in touch.^^^ One industrial machinery coiporate executive (international operations) described a formal arrangement in his organization to achieve this coordination by means of formalized technical meetings of teclinical executives drawn from his far-flung subsidiaries : One of the major communication devices we have established is an interna- tional engineering conference, which is held every 18 months on an alternating basis here at our home office and at one of our overseas locations. This confer- ence is attended by the managing directors and chief engineers of all our inter- national associates. All of our major manufacturing associates as well as per- sonnel from our engineering department at home office present pai>ers during the week-long conference, outlining product improvements and the results of research and development during the prior 18 months at each of the various locations throughout the world. . . . We make special efforts to ensure that our various operations throughout the world know the research progi'ams that we are working on ; and they, in turn, keep us Informed of the programs that they are working on."* TECHNOLOGICAL OBSTACLES TO U.S. EXPORT TRADE The fact that U.S. industries in "non-high-technology" fields lag behind their European counterparts has several explanations : superior attention in Europe to minor improvements on conventional products and processes, tested routines, established markets, and lower wages. However, European industry has begun a vigorous program in one area of general importance: to harmonize technical standards. The general use of the metric system tends to be restrictive to non-users. Now standards are being adopted in Europe for reliability and (Quality control.^^^ In comment on this situation. Ambassador Carl Gilbert, the President's Special Representative for Trade Negotiations, de- clared : For a country which has long pursued a course of minimal Government inter- vention, exc-ept where public health or safety is involved and the Congress has determined there was no acceptable alternative, the standards systems being developed abroad today will, if we desire to participate and to insure that our own products are not placed at a disadvantage, require in all likelihood new forms of government-industry cooperation and new institutions to act on an international basis."* Similarly, Lawrence C. McQuade, as Assistant Secretary of Com- m.erce, called attention to the role of standards as a form of trade barrier: "21 Michael G. Duerr. "R and D in the Multinational Company: A Survey." (National Industrial Conference Board, 1970), pages 2, 20, 44—5. (Managing International Business, No. 8.) 122 Ibid., page 51. 123 "Competition Comes Home to Haunt Us." Industry Week, (July 6, 1970). page 51. i2< "U.S. Foreign Trade Policies for the 1970's." Speech delivered September 30, 1970, Raleigh, North Carolina. In "The Trade Bill of 1970." Remarks of the Hon. .Tacob Javits on the floor of the Senate. Congressional Record, (October 12, 1970), page S 17684. 667 The Amoriean businessman who has been kept f>nt of a foreign market because his product — quality and performance notwitlistanding — does not meet foreign standards is well aware that standards can he a crucial factor in international trade. Various groups, including the I'anel ou Engineering and Commodity Standards of the Commerce Ttn-hnical Advisory Board (the LtiQue Committee), have suggested that the role of the United States in international .^standardization .should he strengthened. Unlike the other indu.sl rialized countries, tlie United States is not represented ofhcially by government delegates in international standardization organizations. This means that we cannot effectively encourage the international adoption of staiidards which would be more liarnmnious with American technological and industrial ju-actices. Legislation has been proposed to improve this sitmition. An international standardization bill pending in Congress would provide grants to qualified standardization organizations for participation in the international standards process and for information activities.'^ rp:giux.\l oug.vxiz.miox.s fou tkcjixouogy The hypotliesis appears to be tliat U.S. tecliiioloiiical superiority does exist, that it is a uece.ssary cousequeiu-e of I'^.S. concei-u for na- tional security, and that it has alienated European nations. .V])par- ently, ])()wer is ecjnated with lii^h technolojxy rather tlian with profi- ciency in the producti(ni of jihiss, textiles, shoes, and the like. To re- store the vitality of tlie NATO Alliance by dealino: directly with this source of commercial dissatisfaction was the theme of an analysis by the late Ed,;\v. .Suinnier. I'.M'iT. In "" Transnational 'J i ans.iclidns. Teelinolo;.'y and tlie Law : an .\nalysls of Cnricnt 'Lrends.' " Extension of remarks of the Hon. .John IJrademas. Conirressioiial Kecord. (I'ebniary 7, 190S). jiajre 10(ii!4. iji •■Western Alliance Development and Terlmolofrieal Cooperation." International Studios Quarterly, (Deeenilier, I'.MjT, V'olume 11. Niimher 4) \r,\'^c '.','■','.). The article was originally written for the House Heimliliean Committee on X.VTO and the Atlantie Comniunit.v. Furniss was director of the Mershon Center for Education in Xational Security, Ohio State I'niversitv. i-'^EdK:ir S. Furniss, .Tr. •■-\. Xew Task for XATO?" International Studies Quarterly. (Deeenil.ev I'.lfiT. Volume 11. Xu)iil)e)- 4 I. padres :'AT,, :\,A~'2. i^r.S. President (Harry S. Truman). Inau;.'ural address. .Tan. 20. 1040. In l'..S. Conpress. Senate. Committee <^n ForeijiU Kel.itious. Development of teclinicil .assistance programs: Background information and documents. Sulicommittee on Technical .\ssistance Programs (•ursuaiit to S. lies. 214, S;;d Coui.'. Xov. Tl. l!».-i4. S.'ld Coufr. 2d sess., Committee I'rint. (Washington, U.S. Government Printing Ollice, 10.j4), pages 0o-o4. 668 had little experience with colonies or undeveloped regions, with lan- guage and cultural barriers, with national economic planning, or with the complex phenomenon of technology transfer. The program went forward on the simplistic notion that the developing countries wanted "American know-how" and that sending U.S. experts abroad would provide it.^-^ One difficulty with the program was that its objectives were seen differently by the various groups involved ; various of its supporters looked for different outcomes. Was it a humanitarian program to raise living standards in poor countries ? Was it intended to effect political stabilization of these regions to halt the spread of communism, under the containment doctrine of the period? Was it to render the political soil less fertile for subversion ? Was it to strengthen with gi\atitude U.S. relations with less- favored nations? Was it to provide assured future sources of essential materials for U.S. industry or possible wartime military requirements? All of these were offered at one time or another during the two years in which the Point IV Program wa^ debated in Congress. When John F. Kennedy came to the Wiite House in 1961, he called for a sweeping review and revision of the program, and the design of a new effort ". . . tailored to meet the needs and resource potential of each individual country instead of a series of individual unrelated projects." He criticized past efforts because "our development goals and projects have not been undertaken as integral steps in a long- range economic development program." "° However, again the goals recognized by the President were to develop lagging economies and technologies, without explicit statement as to why this should be done by the United States, or why the United States was the appropriate instrument for raising the technological/economic level of the unde- veloped world. PRESIDENT NIXON's FOKEIGN POLICY In his special message to the Congress, February 18, 1970, on "United States Foreign Policy for the 1970's", President Nixon fur- ther developed the theme of foreign aid and technical assistance. He described the goal of U.S. foreign policy as being the creation of a "durable structure of international relationships which inhibits or removes the causes of war." The^ means would be (a) partnership with all friendly nations, (2) strength to match the strength of any potential aggressor, l)ut coupled with willingness to accept cooperative arrange- ments for the control of arms, and (3) willingness to negotiate differ- ences, toward the building of a durable structure of peaceful relations. His criteria were that the specifics of foreign policy needed to be crea- tive, systematic, based on factual knowledge, selective among alterna- tives, competently responsive to crises while seeking to anticipate them, and — finally — capable of being carried out effectively. American foreign policy [the President declared] must not be merely the result of a series of piecemeal tactical decisions forced by the pressures of ''^ Some of the rleficiencies of this early program are discussed in Chapter Four — "The Point IV Projrram : Technological Transfer as the Basis of Aid to Developing Countries," In "Technical Information for Congress." op. cit.. page 61 sq. ^^0 President ,Tohn F. Kenned.v. "Special message to the Congress on foreign aid." March 22. Ifl61. In Public Papers of the Presidents of the United States. John F. Kennedy. Con- taining the public messages, speeches and statements of the President Jan. 20-Dec. 31, 1969. (Washington, U.S. Government Printing Office, 1962), page 206. 669 events. If our policy is to embody a coherent vision of the world and a rational conception of America's interests, our specific actions must be the products of rational and deliberate choice. We need a system which forces considera- tion of problems before they become emergencies, which enables us to make our basic determinations of purjMJse before being pressed by events, and to mesh policies.^ "With respect to the Western Hemisphere Nations (emphasized in the message) , the President offered the beginning of a comprehensive program with a substantial technological content. He urged that bi- lateral relations be replaced by a multilateral approach, developed multilaterally. Other points were an increase of trade, eased AID restrictions, establishment of the post of Under Secretary of State for Western Hemisphere Affairs, the support of regional cooperation, and easing of the burden of debt. "To help turn science to the service of the hemisphere," the President proposed : We will contribute to the support and financing of initiatives in these fields, including research and development, regional training centers, and transfer of technology. We are developing a program for training and orientation of Latin American specialists in the field of scientific and technical inform'ation. The 0[rganization of] A[merican] S[tates] will sponsor a conference next jear on the application of science and technology to Latin America."^ With respect to general foreign assistance, the President again stressed the importance of multilateral rather than bilateral relations, and of the need for the developing countries to take the initiative in charting their own development strategies. He recalled that, Septem- ber 18, in his address to the UN General Assembly he had suggested a number of specific undertakings to that body, many of them, tech- nological in essence. Then he declared : In an era when man possesses the power both to explore the heavens and desolate the earth, science and technology must be marshalled and' shared in the cause of peaceful progress, whatever the political differences among nations. Innumerous and varied fields — the peaceful use of atomic energy, the exploration and uses of outer space, the development of the resources of the ocean and the seabeds, the protection of our environment, the uses of satellites, the development of revolutionary transportation systems — we are working with others to channel .the products of technological progress to the benefit of mankind."^ Within the broader context of national science policy, a presidential advisory task force offered a prescriptive formula, April, 1970, for "International Initiatives Utilizing Science and Technology." The formula involved U.S. leadership in large projects, shared efforts on mutual problems, technical assistance where appropriate, and the building of national capabilities for scientific self-help. Excerpts : — The intrinsic nature of science results in imusual opportunities for inter- national scientific cooperation and assistance. — Some technological enterprises — the space program, for example — offer unusual opportunities for foreign policy and international initiative. — Universal human interests crossing all international boundaries — in agri- culture, health, clean air and water, education, and communications— all suggest similar though more diffuse opportunities. — . . . The Federal Government is presently making insufficient use of our extensive sciemtiflc and technological capabilities as instruments of foreign cooperation and understanding. 131 U.S. President. (Richard Nixon.) "United States Foreign Policy for the 1970's, A New Strategy for Peace." A report to the Congress, February 18, 1970. (Mimeograph), pages 3, 11-13. ^ Ibid., pages 33-35. i» Ibid., pages 78, 82-83. 670 — The question of international technology transfer — the delivery and applica- tion of scientific and technological knowledge, methods, and techniques fronL one nation to another — is one which the United States should give very searching consideration in its formulation of a more effective science policy. — . . . It is unlikely that indiscriminate efforts to transfer technology will be effective ; technology, to be useful, must be related properly to local environment and cultural and economic restrictions. — . . . Much greater emphasis must be placed on the transfer of research and development capabilities, rather than of technology itself. — . . . An enlarged program of educational assistance in areas of science and technology should be made an essential element in our foreign aid program."* President Nixon's message on foreign policy for the 1970s made reference to two studies of foreign assistance. One of these, conducted by a task force under the chairmanship of Rudolph A, Peterson, presi- dent of the Bank of America, dealt exclusively with U.S. aid policy. The other, a report by the Commission on International Development, chaired by Lester B. Pearson, former Prime Minister of Canada, was made to the President of the International Bank for Reconstruction and Development (World Bank) and discussed generally what the rich countries and the poor countries ought to do to help the poor countries. REVIEW OF U.S. TECHNICAL AID PROGRAM The Peterson Report, March 4, 1970, told the President that "For the first time in history, it appears feasible to approach this world problem [i.e., international development] on a worldwide basis." The report called for a less prominent and obtrusive role for the United States in extending aid to developing countries. It urged greater partnership with developing countries, with the aided countries carry- ing out more of the strategic planning. It urged repeatedly that bi- lateral assistance should be reduced and multilateral assistance in- creased. The goal should be the achievement by the aided countries of a self-sustaining posture of development. To implement the proposed change in emphasis of the U.S. aid program, the task force recom- mended the establishment of four institutions. These were (1) a U.S. International Development Bank, (2) a U.S. International Develop- ment Institute, (3) the Overseas Private Investment Corporation (OPIC) which the task force noted had already been authorized by the Congress, and (4) a U.S. International Development Council. The Peterson Report strongly emphasized the funding of aid, and devoted less attention to the functional role of technology in the field of foreign assistance. For example, the International Development Council was proposed to correct an executive deficiency which the task force described as follows : Presidential interests in international development are not adequately served by existing decisionmaking machinery. International development does not re- ceive enough emphasis in the determination of U.S. trade, investment, financial, agricultural, and export-promotion policies. A number of departments and agencies have competing interests and responsibilities in this general area, with the result that too many isisues go to the President for resolution. Furthermore, opportunities to take initiatives in policies toward developing countries are sometimes lost. "* U.S. President's Task Force on Science Policy. "Science and Technology : Tools for Progress." The report of the President's Task Force on Science Policy. April 1970. (Wash- ington, U.S. Government Printing Office, 1970), pages 40-42. 671 The significance of technology in diplomatic relations generally^ and with specific reference to the developing countries, has been sub- stantially documented in the present study. Yet, the membership of the proposed Council, as advanced by the Peterson Report, would consist of the Secretaries of State, Treasury and Agriculture, the President's Special Trade Representative, the President of the Export- Import Bank, the Director of the Peace Corps, the President of the (proposed) U.S. Development Bank, the Director of the (proposed) U.S. International Development Institute, and the President of the (pending) Overseas Private Investment Corporation. It does not ap- pear that provision was made for a strong input from the scientific and technological .sectors of the Government and its advisory system. The proposed U.S. International Development Institute would have four principal areas of concern : ( 1 ) research on the population prob- lem; (2) research at home and abroad on problems and teclmologies of development, but emphasizing local institutions in developing coim- tries; (3) training [and strengthening the training function in developing countries] in vocational, commercial, agricultural, indus- trial, scientific, and professional skills; and (4) support of social development. The Institute would concentrate on a limited number of specific problems, it would work principally and increasingly through private channels, and it would seek to develop self-sustaining and continuing programs in its field. In substantiation of the second area, research, the report said : New technologies are urgently needed to provide breakthroughs in a variety of fields essential to broad-based development. They must be adapted to the needs of the developing countries and related to programs and local institutions that can ensure practical applications and evaluation of results. The successful com- bination of the development of new seeds for rice and wheat, and the programs to apply them, are a model. The United States should strongly support similar long- range efforts in agriculture, health, education, and other fields through national, regional, and international projects."^ The report gave some attention to the need for more coherence in aid programs — (Bringing coherence to the work of international development organizations is essential to the success of the new approach to foreign assistance we recommend. The various international institutions do not now make up a system. A wide area of overlapping and sometimes competing responsibility exists. The same is true for the individual programs of the industrial countries. . . . Constructing an effective international system and establishing international development pri- orities in concert with others would do much to advance what must be a global enterprise, (p. 26) However, in seeming contradiction with the above, the report said : The recommended program for reorganizing foreign assistance calls for much smaller field representation than now exists. The [proposed] U.S. International Development Bank and the [proposed] U.S. International Development Institute will need regional representatives and in some cases country representatives, but the principal operating decisions will be made in Washington, (p. 36) A succinct assessment of the Peterson Report, generally favorable, was offered by John Franklin Campbell, formerly staff assistant to the Under Secretary of State. He interpreted the report to signify i3« U.S. President's 'Task Force on International Development. "U.S. Foreign Assistance in the 1970's : A New Anproach." Report to the President From the Task Force on Inter- national Development. March 4, 1970. (Washington. U.S. Government Printing Office, 1970), especially pages 4, 29-30, and 34. (Peterson report.) 672 that ". . . most of the 5,234 U.S. Aid employees abroad [would] come home and that this agency [would] be abolished." Bilateral pro- grams would be administered directly through the economic sections of embassies. In Washington there would be ". . . a modestly staffed development bank and an institute for technical assistance, which would channel most of our future foreign aid through international institutions." This approach, he said, would (a) "remove foreign aid from its cold war context of political expediency," and (b) "prom- ise a more serious aid program which is in accord with the realities of development." ^^^ TJ.N. STUDY OF TECHNICAL, ASSISTANCE In view of the insistence of presidential and presidential advisory sources on multilateral over bilateral approaches to aid, it seems ap- propriate to examine what the Pearson Report, prepared under United Nations or World Bank auspices, recommends for the international uses of technology. Its stated goals were not dissimilar to those ex- pressed in the Peterson Report: "Concern with the needs of other and poorer nations is the expression of a new and fundamental aspect of the modern age — the awareness that we live in a village world, that we belong to a world community." "^ And there was also the underlying uncertainty — ... The acceleration of history, which is largely the result of the bewildering impact of modern technology, has changed the whole concept of national interest. Who can now ask where his country will be in a few decades without asking where the world will be? (p. 9) Wliat needed to be done, therefore, was ". . . to put the less devel- oped countries as soon as possible in a position where they can realize their aspirations with regard to economic progress without relying on foreign aid." (p. 11) The aid and development strategy proposed in the Pearson Report had 10 elements : To create a framework for free and equitable inter- national trade ; to promote mutually beneficial flows of foreign private investment ; to establish a better partnership, a clearer purpose, and a greater coherence in development aid ; to increase the volume of aid ; to meet the problem of mounting debts; to make aid administration more effective ; to redirect technical assistance ; to slow the growth of population; to revitalize aid to education and research; and to strengthen the multilateral aid system, (pp. 14-21) In some of these particulars, the Pearson Report and the Peterson Report stress the same points, such as the need for more organiza- tional coherence. However, not all the effects of the existing profusion of agencies were adverse. "The emergence of consortia, consultative groups, and the multilateral procedures of the Alliance for Progress serve very considerably to increase the effectiveness of aid by making it possible for donors, whether bilateral or multilateral, to help recip- ients develop policies more likely to promote self-sustaining growth." (p. 129) J^John Franklin Campbell. "What Is to Be Done?" Foreign Affairs, (October, 1970), ^ Commission on International Development. "Partners in Development." Report of tha Commission on International Development. (New York, Praeger Publishers, 1969), page 8. (Pearson report.) 673 The Pea|:^on Report takes a realistic view of the deficiencies of mul- tinational agencies and programs. There were reasons, it noted, why nearly 90 percent of official development assistance (in 1967) was bilat- eral. Apart from historical colonial relationships, bilateral aid was often more efficient. Personnel recruitment was less of a problem. Bi- lateral programs could be more flexible and experimental in their pro- cedures. They could encompass a wider scope of responses to real need. There were also important political considerations : Most countries will usually feel that at least some multilateral agencies are unduly dominated by the 'wrong' countries, whether aid-givers or recipients ; or that they are following erroneous aid philosophies, either too hard or too soft, too interventionist, or too lax ; or that they are simply badly run and that their procedures are slow and expensive, (p. 209) Reasons in favor of multilateral aid were also set forth. It reduced any overtones of charity or interv^entionism. It helped provide a frame- work within which bilateral aid to whole nations could be better inte- grated into a total program. It would reduce unequal geographical preferences in aid distribution. It would stunulate regional integra- tion among developing countries. It would pave the way for interna- tional centers of documentation, advice, and guidance, (pp. 213-214) The Pearson Report emphasized the need for assistance programs to be controlled and developed within and by the receiving nation. Too often, such programs tended to be an extension of the thought and culture of the donor country. Sometimes a program developed a "life of its own, little related either in donor or recipient countries to national or global development objectives." In particular, the Re- port recommended that : (1) specialists and planners in developing countries consult regularly to de- termine their priority needs for advisory services, institution building, project aid, and the operation of educational and other public services, and (2) develop- ing countries program technical assistance requirements by spelling out the sequence of operations, the performance objectives of the i)ersonnel and of the training schemes, the cost of each stage, and their own commitments to institu- tional and structural change, (p. 183) It was also important that technical assistance be used to facilitate the transfer of technology and management. To this end, it was recom- mended "that international technical assistance be strengthened by the creation of national and international corps of technical assistance personnel with adequate career opportunities." (p. 185) PRESIDENTIAL POLICY FOR FUTURE TECHNICAL AID The President acted on the Peterson Report in a message to Con- gress, September 15, 1970, on "Foreign Assistance for the 'Seventies.' " In it he accepted virtually in full the report's recommendations. With respect to the proposed U.S. International Development Institute, he announced : I shall propose establishment [of the Institute! which will bring U.S. science and technology to bear on the problems of development. The Institute will fill a major gap in the international development network. It will match our vast talents in science and technology with institutions and problems abroad. Research has created the basis for the Green Revolution — the major breakthrough in agricultural production — ^but continued, progress in the 1970's will require the lower income countries to deal with more, and more com- plex, problems. The Institute will concentrate on selected areas and focus U.S. 674 technology on critical problems. This requires flexibility, imagination and a minimum of red tape. If we can provide this Institute with the operational flexi- bility enjoyed by our private foundations, we can make a major contribution to the lower income countries at modest exi)ense. An Institute, so organized, could — 'Concentrate U.S. scientific and technological talent on the problems of develoipment. — Help to develop research competence in the lower income countries themselves. — Help develop in^itutional competence of governments to plan and manage their own development programs. — ^Support expanded research programs in population. — ^Help finance the programs of U.S.-sponsored Schools, hospitals, and other institutions abroad. — Carry out a cooperative program of technical exchange and reimbursable technical services with those developing countries that do not require finan- cial assistance. — Cooperate in social development and training programs. — Administer our technical assistance programs. — Permit greater reliance On private organizations and researchers.^ One innovation proposed by the President that had not been in the Peterson Report was the suggestion that : As a long-run contribution to the funding of development, the U.S. wiU seek the utilization of revenues derived from the economic resources of the seabed for development asssistance to lower income countries. I have recently proposed that all nations enter into a treaty to establish an international regime for the ex- ploitation of these vast resources, and that royalties derived therefrom be uti- lized principally for providing economic assistance to developing countries parties ipating in the treaty.^'' Assertedly, the new foreign assistance institutions which are pro- posed to replace the existing AID structure, would also coordinate the funding activities of the various overseas credit institutions supported by the United States. These new institutions would also relate to the assistance operations of the United Nations, and to its lending opera- tions. And, in addition, the evolution of regional institutions (such as .the 'Central American Common Market, the Alliance for Progress, etc.) and regional credit institutions (Central American Bank for Economic Integration, Caribbean Development Bank, Andean Devel- opment Corporation, Inter- American Development Bank, Asian De- velopment Bank, etc.), implies the eventual need for a relationship with U.S. institutions for foreign assistance. It se-ems like a heavy burden of policy planning, for the same agency to administer three sets of relationships, toward three sets of national, regional, and global objectives. SOME FUTURE PROBLEMS IN TECHNICAL ASSISTANCE The issue of multilateral versus bilateral aid is complicated by a practical political consideration. Some of the objectives ascribed to the early Truman program, still persuasive for some groups, are largely incompatible with the patterns of cooperation essential in a multi- lateral program. A multinational program of assistance is likely to find few friends and fewer sponsors. It may be easier to win political sup- 138 U.S. President (Richard Nixon.) "Foreign Assistance for the Seventies: The Presi- dent's Message to the Congress Proposing Reform of the United States Foreign Assistance Program." September 15, 1970. WeelJly Compilation of Presidential Documents, (September 21. 1970), pages 1220-21. ^ Ibid, page 1224. 675 port for foreign assistance, no matter how strongly supported by theoretical or policy considerations, if the U.S. electorate can identify directly the relationship with the recipient. And finally, the problem remains unsolved of how to assess the im- pacts of present and future technology at all these different levels, in relation to the various sets of national and international objectives. The United States is only beginning to appreciate the difficulty of as- sessing technology domestically. The task is recognized as one of trans- cendent difficulty. The power of teclinology to alter the human ' con- dition, so evident in the United States, can be equally potent on the world scene. Effects of technology can be favorable or adverse. Com- binations of technological effects can operate synergistically toward good or bad results. The many nations of the world differ widely in their sophistication, their grasp of these considerations. How far the United States should go in exercising leadership, globally, in the in- ternational transfer of technology, and in the effort to separate good from bad technology, in view of all the other elements of this great catscradle must remain an open question. V. The Emerging Policy Issues of International Technology Preceding sections of this chapter explored the evolution of tech- nology as the dominant factor of change that has shaped the modern world. Its effects have been shown to be both beneficial and injurious. The point has been made that technology is the most obvious avenue to national strength and international influence. Technology has also been shown to be a potent force, linking the world together by many threads. Technology itself has an evident propensity to "go global." The United States, by virtue of tremendous vigor and public ex- penditure for the past two decades, currently enjoys a commanding technological lead among the nations of the world. As Herman Pollack has said : Our preeminence in science and technology is now one of the pillars of U.S. strength and image abroad. The attraction generated by this preeminence among the nations of the world, especially those in the process of development, is perhaps one of the lesser understood buit more i)ervasively powerful forces at work in international relationships today.^^ He added that "If we are wise and imaginative and vigorous, these forces can be turned to our advantage in support of our foreign policy objectives and our hopes for a stable and peaceful world." The emerging question posed by the onrush of technology, and its effect on the relations among the countries of the world, is whether this potent factor of change and national power is to operate in a random way, or whether it is possible, and desirable, to devise a na- tional strategy to guide and direct it, to stimulate imiovation in some directions, and possibly to slow and inhibit innovation in others. The Issue of NalMonal Strategy in Technological Innovation In a recent article in Science, Professor Robert Gilpin, of the Center of International Studies, Princeton University, identifies three major 1*0 U.S. Congress. House. Committee on Science and Astronautics. "1970 National Science Foundation Authorization." Hearings before the Subcommittee on Science, Research, and Development of the . . . on H.R. 4283. March 17. 18. 20, 24. 25. 26, 27, 28 ; April 1, 1969. 91st Congress, first session. (Washington, U.S. Government Printing Office, 1969), page 488, 676 interrelated economic consequences of modern technology. The first is the "increased interdependence among national economies and the consequent greater sensitivity of foreign trade to changes in economic conditions." The second is the "enhanced role of technological inno- vation in economic growth and competition." The third is the rapid spread of multinational corporations, primarily dominated by Amer- ican capital. He suggests that a "new international economy" is devel- oping, under the stimulus of technology. There are, Gilpin's argument continues, three alternative national strategies in response to this development: (1) "to support scientific and technological development across the broadest front possible;" (2) scientific and technological specialization; and (3) the importa- tion of foreign technology. The United States and the Soviet Union have followed the first strategy ; Sweden, Great Britain, and a number of other countries have followed the second ; while Japan and West Germany have in general followed the third. Although the U.S. strat- egy has been relatively successful, particularly in fields of high tech- nolo^ like space and the computer, it has begun to show defects, and, in Gilpin's opinion, "the direction of America's technological strategy will become an increasingly important political issue." In the first place, even America does not have the economic and technical re- sources to support all projects of importance ; it too must choose. Second, a high proportion of the limited resources has gone into military and military-related projects, while pressing social and economic needs of the society have been neglected. Third, the devastating consequence of technological advance for the environment has suddenly emerged as a major national concern. . . . Accordingly, thought might be given ". . . to the formulation of a more explicit technological strategy designed to increase the social return of its immense investment in science and teclmology and to minimize its negative environmental effects." Gilpin concludes with a prediction that : ... To a degree perhaps unparalleled in the past, economic and technological considerations will shape the ways in which political interests and conflicts seek their expression and work themselves out. In a world where nuclear weaponry has inhibited the use of military power and where social and economic demands play an inordinate role in political life, the choice, success, or failure of a na- tion's technological strategy will influence in large measure its place in the international pecking order and its capacity to solve its domestic problems.^" In Riesman's book, "The Lonely Crowd," he develops a theory of a society divided into persons characterized as "Inner-Directed" and "Other-Directed." If nations were so categorized, in aspects of their behavior, it might be said that in the field of technology the United States to a considerable degree is "Other-Directed." The great efforts of the United States in science and technology — since 1940, at least — were inspired by external events. The Manhattan Project was initiated from fear that Nazi Germany might achieve nuclear power first. Work on the H-bomb was impelled by the conviction that it was necessary to beat the Russians to it. The Polaris ballistic misstte submarine was a response to the Soviet missile threat. The whole first decade of the space race was an effort to catch and pass the Soviets in an area in which they had assumed a lead. The great technological programs 1*1 Robert Gilpin. "Technological Strategies and National Purpose." Science, (July 31, 1970, volume 169), pp. 441-2. 677 supported by the United States are still in military, atomic, and space developments, and all are motivated by events outside the United States or else support for them wanes. Professor Harvey Brooks of Harvard declares that national defense is too often used as justification for doing what is needed to be done for the good of American society. It was a "convenient route for doing the things that needed to be done without the necessity of engineering the large scale democratic consensus that would have been necessary had the same things been done under civilian auspices." For example, "We backed into federal support of higher education while stoutly insisting that we were only buying necessary military research results. We entered upon school curriculum reform, long overdue, on the grounds that it was needed to make our engineers and scientists better than their Soviet counterparts. We laimched a gigantic interstate highway program on the grounds that it was needed for national defense. We fostered the study of international affairs and the development of foreign area research on the grounds that a great power needed this knowledge to maintain its power position.^*^ It seems paradoxical that the United States, best equipped to apply science and technology to the solution of man's global problems, and credited with the highest development of managerial skills, has been reluctant to devise and implement a positive technological strategy of its own. There would seem to be no lack of opportimities : earth re- sources satellites, ocean and ocean floor development, urban improve- ment, recovery of resources from all forms of waste, the Oak Ridge pro- posal for large agricultural-industrial-nuclear complexes, and many more. One of the consequences of this "Other-Directed" syndrome in na- tional technological strategy is that the United States has concentrated its efforts on technologies characteristically remote from everyday experience. It has supported the laser but not the science of processing garbage. There are lags in the technological levels of a number of in- dustries in the United States; such lags may in time impair the credibility of the U.S. posture of world technological leadership. On this point, one issue of U.S. technological strategy would seem to be a conscious set of decisions as to the domestic technological gaps to be closed or ignored. Wliat older technologies might be revitalized by an infusion of fresh technological effort, such as the railroads, glass and ceramics, coal, lumber, and textiles? "What would be the diplomatic consequences of a vigorous technological effort in one, several, or all of these fields ? And more generally, how strong or superior should the United States aspire to be in technology ? It has been shown repeatedly in the recent past that enormous outlays of public funds by the United States to support a new field of research brought only a short-lived technological advantage that quickly disappeared. Other nations came into the act and duplicated the U.S. successes, wliile avoiding the fail- ures and blind alleys that are an inescapable part of pioneering. Clearly, there are added costs as well as benefits in the hard-earned role of technological leader. The various fields of science and technology may offer their own version of national "comparative advantage" such 1*^ Harvey Brooks. "Appendix E. Impact of the Defense Establishment on Science and Education, October 1970." In U.S. Congress. House. Committee on Science and Astronautics. "National Science Policy, H. Con. Res. 666." Hearings before the Subcommittee on Science, Research, and Development of the . . . 91st Cong. 2d sess. July, August, September, 1970. (Washington, U.S. Government Printing Office, 1970), page 962i. 678 that specialization may be of mutual benefit within the community of nations. But to exploit in the field of technology tliis long-established economic principle would require a conscious decision to abjure lead- ership in favor of an international partnership in technological progress. Finally, what are the policy resources the United States can bring to bear on these issues of national strategy in technology? U.S. efforts have been concentrated in fields of high technology in a reaction against external threats; the result has been to assemble large organi- zations in the fields of military, space, and atomic teclinologies. That these fields continue to be important is not questioned. But in the de- sign of a total national strategy of technology, the effect of their being already on the scene in great numbers is to provide pressures for the United States to keep on doing what it has been doing. Where can objective analysis and innovative policy be found that can examine alternatives or additions to the national program ? The Issues of Global Strategy in Technological Inncn^ation Examination of the history of a number of fields of technology has demonstrated the tendency for technology to cross national boundaries, to generate problems involving many nations, to offer opportunities for general global benefit, and to effect profound changes in the world scene for better or worse. Perhaps the most significant fact about tech- nology is this force for interdependence among nations. Tlie philosopher, Kant, proposed the "Categorical Imperative," an ethical principle to govern human behaAdor. It postulated that man should "Act as if the maxim from which you act were to become tlirough your will a universal law." In other words, one should inquire of his actions as to what the effect would be if everybody did them. Perhaps the same principle warrants examination as applied to nations. Are there some general principles governing the develop- ment, application, and sharing of technology that should be incor- porated in a Technology Treaty ? Reference has been made to the growing cost and scope of some fields or projects of technology : exploration of space, weather modifica- tion, global resource surveys, and the like are examples. T\Tien projects of this sort are not only costly but also inherently affect many nations, would it be feasible to mobilize all interested nations in a joint en- deavor ? For example, throughout all the literature on foreign assist- ance runs the theme of the population explosion and what to do about it. Examination of this problem would be a major function of the U.S. International Development Institute the Peterson Report recom- mended and the President has proposed to the Congress. The food/ population balance and the threat of widespread starvation are pre- dicted to become a major crisis of the late 1970s. A global strategy mobilizing the teclmological resources of many nations, with general funding support, and a central coordinating administration might serve beyond the capabilities of any single nation to achieve a goal or aA'ert a catrastrophe. Can the United Nations be used as an institu- tion to devise a global strategy in the application of technology for the betterment of all mankind ? The President has suggested the use 679 of the resources of the seabed to finance U.N. programs of teclinological aid. Should this concept be expanded ? Many criticisms have been directed at the multiplicity of loosely affiliated agencies under the umbrella of the United Nations. An obvious issue is whether management principles applied in such tightly and effectively organized agencies as AEC and NASA could be transferred to international application. It is axiomatic, for example, that an institution with a diffused structure requires tight policy con- trol at the top, supported by an abimdant and accurate flow of in- formation from all its elements. Policy decisions require information about the organization itself, its persomiel, projects and results ; and about the status, needs, and future prospects of the areas it serves. At the same time, the access of the public to this same information enables a closer understanding of the problems and opportunities of the or- ganization and a means for improving its performance through gen- eral review and criticism. How well has the congeries of U.N. agen- cies performed in this respect ? If the United States is indeed technologically "Other-Directed", the same can probably also be said of the Soviet Union. To the extent that this is true of both countries, there are repeated pressures on both to "catch up" in some field of technology in which the other has scored an advance. Under these conditions, the more joint programs of technology in which both countries can participate, the less of this pressure is generated and the more progress with less effort toward shared goals. Some evidence of this technological teamwork already exists with respect to the exchange of meteorological information, and there have been discussions as to the possibility of a joint program of cancer research. However, it is not evident that there is any particular merit in maintaining such teamwork efforts on a bilateral basis. The possibility is open for the United States and the Soviet Union to provide joint leadership within the United Nations system to mount global projects in some directions. Who in the Federal Government is currently responsible for thinking up innovative possibilities for further cooperation along these lines ? It is a truism that the nation coming last to exploitation of a tech- nology achieves the highest level of efficiency and the highest sophis- tication of design. What use is made of this principle in the extending of technical assistance to developing countries? Moreover, is there opportunity for a general feedback of technological information from countries with advanced technologies to those with lagging tech- nologies ? Lags occur when a technology involves heavy initial outlay and commits an industry to a pattern of capital equipment that is superseded elsewhere. This happened in the steel industry in the United States when Ij-D oxygen converters went into use abroad. It happened in the glass industry with the development of float glass. When a large industry is confronted with this situation, it has the alternatives of seeing its markets dwindle as it fails in competition, or of gathering resources to replace its outmoded equipment. Looked at from a global perspective, this is an inefficient and costly arrangement. Before World War II, it was widely resolved by the emergence of interna- tional cartels that allocated markets and fixed prices. The emergence of the multinational corporation suggests that a similar accommoda- 680 tion may be in prospect for the future. What alternative solutions are there, and is this an appropriate subject for study within the United Nations ? The Ultimate Issue: Reconciling National and Global TecJmological Advance Technology emerges as a powerful force — perhaps the most power- ful of all forces — for change in the modem world. Excellence in tech- nolo^ serves to establish a new measure of a nation's leadership withm the community of nations. At the same time, it affords a means by which all nations can progress toward their own internal goals of reducing human hardship and enlarging human opportunity^. How are these two effects of technology to be reconciled ? Wliat policies and what compromises are suggested for the United States, to optimise the benefits and minimize the adverse effects of technology within the United States and globally ? There is no mistaking the potencj of nationalism as a spur to action. It ranks with personal gain, religious devotion, and ideological com- mitment, as human motivations compelling man to achieve and surpass. No comparable sentiment exists to unite or mobilize to action the nations of the world and their peoples. Participation in international technological efforts and programs may be, as the President and others have said, a necessary course for the achievement of peace and progress. Moreover, as the President has also said, "Peace and progress are impossible without a major American role." The appropriate motivation has also been suggested by the President : "If our policy is to embody a coherent vision of the world and a rational conception of America's interests, our specific actions must be the products of rational and deliberate choice." Chapter 10— The Politics of Global Health 97-400 n - T! CONTENTS Page I. Introduction 685 Scope and Limitations of the Study 685 The Evolution of Preventive Medicine 687 Historical Overview of World Healtli Cooperation 688 Early Efforts Toward International Collaboration G91 Establishment of a Permanent Quarantine Office 692 The First International Health Organization 693 The League of Nations Health Organization 694 II. The World Health Organization 696 Constitutionnl Foundations of the World Health Organization — 696 Organization and Structure of WHO 698 WHO'S Epidemiological Intelligence Network 702 The Network Organization and its Activities 702 Current Problems of Epidemic Control 703 U.S. Involvement in Epidemiological Problems 704 Recent Evaluations of the World Health Organization 706 Politics and Diplomacy in the World Health Organization 709 WHO'h Intent To Be Xon-Pohtical 709 U.S. Membership: The First Big Test 709 The Test of Soviet Bloc Withdrawals 710 Return of the USSR and Eastern European States 712 The China Question Considered Political 712 Consensus Versus Regulation on Pharmaceutical Questions.- 713 Political Proltlems Outside of the World Health Organization — 715 The Development of Political Blocs Outside of WHO 715 Political Problems in the Eastern Mediterranean Region 717 Some Difficulties in Achieving and Sustaining International Cooperation in Health Through WHO 720 Persistent Tendency To Neglect Health as an International Goal- 722 Cost of U.S. Participation in the World Health Organization 723 Some Aspects of U.S. Support of the WHO Budget 724 The Impact of Development Studies of WHO 726 Total Cost of WHO Activities and Total U.S. Contribution— 728 III. U.S. Agencies Supporting International Health Programs 729 International Health Activities of the Department of State 729 AID'S International Health Activities 730 Trends in the Level of Support for AID'a Health Activities- 731 AID Health Technicians 732 Continuing Resources of AID 733 Recapitulation of A/D Activities 733 International Activities of the Department of Health, Educa- tion, and Welfare 734 Overseas Units of the National Institutes of Heath 734 The Fogarty International Center 73.j The Rise and Decline of PHS and NIH Grants in Inter- national Health 736 Role of HEW in Multilateral Project Support 737 Failure of Bill To Support International Health Training-- 738 Recapitulation of HEW Activities 739 International Health Activities of the Department of Defen.'je.. 739 Overseas Offices of the Department of Defense 740 DOD Medical Research Laboratories Overseas 741 (683) 684 Page IV. International Health Organizations and the U.S. Congress 7J3 The Problem of U.S. Funding of World Health Programs 743 In the Senate 745 In the House of Representatives 747 Recapitulation of U.S. Legislative Problem 748 Cost/Benefit Analysis as a Possible Solution 748 Some Examples of Approaches to Cost/Benefit Analysis in Health Programs 749 The Complex Issue of Health and Overpopulation 751 Policy Issues of World Health — A Summary 754 U.S. Benefits from Increased Investment in World Health 755 V. Summary, Conclusions, and Comments 756 TABLES 1. Recent Evolution of the WHO Budget and U.S. Assessments 725 2. Source and Amount of Total Funds Administered by WHO, Including Total U.S. Contributions (1968) 728 3. AID Dollars Contribution and Withdrawals for Country Use of Coun- terpart Funds and U.S. Owned Local Currency, 1956-65 732 4. AID Technical Cooperation Projects in Fiscal Year 1969 by Field of Activity 732 5. XIH Special Foreign Currency Program 736 6. Biomedical Research and Training Grants or Contracts Awarded by NIH to Institutions in Foreign Countries and to International Orga- nizations, Fiscal Year 1969 737 7. PHS Research and Training Grants and Contract Support to W^orld Health Organization, Pan American Health Organization, and Insti- tute of Nutrition of Central America and Panama 738 8. DOD Contracts and Grants for Medical Research Performed in For- eign Countries (Fiscal Year 1969) . 741 9. DOD Medical Research Laboratories Overseas S _ 741 10. Contributions to International Organizations 744 11. Voluntary Contributions to Multilateral Organizations and Programs — 744 FIGURES 1. WHO Regional Offices and the Areas They Serve 700 2. Network of Epidemiological Radio-Telegraphic Communications 701 CHAPTER 10— THE POLITICS OF GLOBAL HEALTH I. In'TRODUCTTOX The purpose of this study on the politics of global health is to open up the subject of international health to greater visibility. The degree of freedom from epidemic disease enjoyed by Americans is the result of many steps taken by physicians and statesmen over many decades, toward improving global health conditions. The American people contribute to a large variety of vitally es- sential but unglamorous programs with health benefits in small trop- ical villages and thriving modern cities all over the world. The un- publicized programs of worldwide disease surveillance and health assistance are supported by the commitments of the U.S. Government to the AVorld Health Organization and the Parf American Health Or- ganization. There is little awareness as to why or how these oriianiza- tions came into existence, what tliey have achieved, or what they are supposed to accomplish. The closest voluntary involvement of the public is with T'XICEF, the United Nations Children's Fund, many of whose activities are worked out with the advice and assistance of the "World Health Organization wliich. like T'^NICEF, is a specialized agency of the United Xations. Benefits from these programs accrue not only to the less developed countries of the world but also to the highly urbanized industrial nations. The benefits are likely to be greatly in excess of the costs, but little evidence has been offered to show this. Scope and .LimHations of the Sfiidy The study describes the origin of early international agree- ments for control of epidemic disease, up to the broader and more comprehensive constitutional machinery under which international health experts now operate. Questions are raised about how pur- poseful the world's governments were, over the years, in establish- ing conventions to control the spread of disease ; the extent to which national sovereignty yielded to international health imperatives: the use of health airreements in foreign policy objectives; and whethor health technology remains an appropriate area of exploitation for national interests. In formulating the elements of diplomatic policy having to do with world medicine and improved conditions of public "health, national leaders have historically been strongly influenced by such other consid- erations as trade advantage, national prestige, and the quest for profits abroad. Althou2:h commanding high respect and priority as a nolitical and economic force within most nations, public health and medicine have yet to become an attractive base to srlamorize institutional re- form of the relations among nation states. The question persists : "Wliy a concern so important to all mankind — personal and public health — has not become a more effectn-e. comprehensive, and dynamic focus of inten^.ntional cooyyeration. Note : This chapter was prepared in 1971 by Freeman H. Quinsy. (685) 686 Other questions emerge about present perspectives on the implica- tions of global health : About the practical necessity of a healthy world in order to safeguard health in the United States, and about the possibility that health programs for the "world village" may be o:rossly undercapitalized as compared with growing demands for individual health care in the United States. Indeed, there are striking differences between the emphasis of international health agencies on highly cost-effective, preventive medical care and the curative emphasis of U.S. medicine, which only an affluent society can afford — if even such a society can. Another interpretatic^n available from the data and trends presented in the study is that public health and preventive medicine may have already played their major role in histoiy, and that the future solution to health problems lies in the character of the curative-oriented Ameri- can medical enterprise and its emulation by other countries around the Avorld. It may be that the international health machinery for which there were such high hopes twenty-five years ago has run its course, that a technolog;\' with predictable but unexciting results has failed to enlist world support, and that the apathy surrounding international health activities in both political and medical circles will reduce further the lonely concern with which only a relatively fcAv com]>etent Ameriraji scientists and statesmen are now engaged. The study deals with an immensely complex subject. It is a piece- meal attempt to provide an adequate picture of the situations and changes in U.S. involvement in global health institutions. The ap- proach is to select and deal in some depth with several elenionts crucial to underetanding and policy, rather than to provide a cursory overall treatment of the subject. The elements selected include: — The historical perspective of international health conventions; — The objective and functions of international health organizations; — The ability of international health institutions to function effec- tively under cold war conditions ; — The cost of U.S. participation in international health organiza- tions ; — The activities and trends of U.S. Federal agencies in overseas biomedical work; and — The links and barriers between congressional committees and the Federal agencies responsible for the administration of U.S. com- mitments to international health organizations. In the effort, to concentrate research effort on activities of the highest current concern, in which the decisions of the U.S. Congress could be most decisive, many fields of global medicine were glossed over or virtually ignored. The global network of industrial corporations and international corporations dealing in drugs and medical supplies was not considered. Little space was given to the health activities of the Communist World, or to bilateral arrangements of the Soviet Union with aided countries. The various programs of imperial countries to extend health services to their colonies, or former colonies, and the various "World War II health programs by the United States over much of the world were not researched, although in particular areas they may well have been of decisive importance. In short, the study is largely future-oriented : being concerned with those kinds of inter- national health activity judged of high cost/effectiveness, and with 687 an appropriate claim to the attention of congressional decisionmakers at the present time. The Evolution of Preventive Medicine Xothing is more international than disease. It recognjzes no political boundaries and few natural ones. It moves freely across national frontiers and spreads as conditions permit from one area to another. The picture usually drawn is that of great pestilences moving from backward regions to the more modern countries. But disease can also go the other way, as shown in numerous accounts of aboriginal popu- lations' becoming infected by the customary diseases of tlie missionary, trader, explorer, and traveler. If one extends the problem to include the diseases of plants and animals, there is little doubt today that pathogenic organisms themselves are either already globally distrib- uted or can rather rapidly become so. However, large numbers of these organisms, and the diseases which they cause, remain largely seques- tered in regions Avhere unsanitary conditions and certain insect vectors prevail. These conditions are the reasons for tlie generally endemic nature of such diseases as cholera, malaria, and plague in the less developed countries. Preventive medicine, like disease, is inherently international. Had there not been the problem of preventing the entrance of disease from one country to another and of controlling the spread of disease v.ithin countries, preventive medicine would not have developed as early as it did. Public outcry demanded that corrective measures be taken against recun-ing epidemics based upon the observed- association be- tween polluted water and disease. Thus was born the first phase of preventive medicine — sanitary engineering and public hygiene. Historically, the origin of this phase is marked by legislative Acts in England like the Great Keform Bill of 18S2, the Metropolis Water Act of 1852, and the Public Health Act of 1875. In England, at least, the origin of preventive medicine and its early institutionalization as a public health service was essentially a layman's movement. The scientific or experimental phase of preventive medicine, which both overlapped and followed the sanitation movement, provided the factual foundation upon Avhich sanitary water and sewage disposal remain in their pt^sent practice. It also provided a foundation for more intelligent decisions regarding the limitations of sanitation, and on whether or not to quarantine and for how^ long. A ^ast array of vaccines and other measures for the prevention and control of com- municable disease evolved. This experimental phase of preventive medicine can be called the era of bacteriolog;\\ Although as a discipline it goes well beyond bacteriology, the early classical discoveries vrhich revolutionized the nnders<-an(linss the political and ideological gulfs that divide mankind. Health is something that all nations desire, and no nation by the process of gaining it takes it away from another. There is not a limited supply of health for which nations must compete. Rather, every nation by promoting its own health adds to the better health of other nations, just, as by assisting in the public health efforts of other nations it protects itself.^ ^ Rprip Diibns. "Mnn Adapting. " CNew Havpr. Talp TTn1vpr<;ltT Pfpss. If>fi5), pagps !?37-.9. spanl F. Russell. "Intprnatinnal Preventive MedJcine." The Scientific Monthlv (Decem- ber R. 1950). pages 39S-4. » Austin T. Kerr, e<1. "Bulldlne the Health Bridpe : Selection from the Works of Fred L. Soper, M.D." (Bloomington. Indiana I'niversity Presp. 19701. faceplate. 689 And as Rutli Masters stated two years later : Today there are few spheres of governmental activity in which states so readily agree to pool experience, to render each other assistance, to harmonize their administrative practices, and to share their knowledge freely, as in that of public health/ But even in public health, today's level of international coopera- tion was not easily achieved nor is it easily sustained. Historically, the cycles of pestilence were accepted as a fact of life. There was a series of di^ase invasions beginning with the Christian era, running on through the fall of Rome, and climaxing in the Black Death of the fourteenth century. Most of this was probably plague, but typhus came into the early picture too and it is now known that "more cru- saders were slaughtered by typhus and plague at the gates of Antioch and Jerusalem than by the infidel." Much laiter it was thought in the developed countries that the scourges of plague and cholera could be kept awuy by sanitary practices at home. The fact is, however, that many infectious diseases can threaten advanced countries. It was not cholera or plague which took the lives of twenty million people in 1918-1919, but rather a particularly virulent strain of influenza in pandemic — twice the number of casualties produced by World War I itself. These casualties occurred in the developed world where death re<5ords were kept; uncounted additional deaths occurred elsewhere." In the early deliberations (1850-1900) of nations on public health there occurred the )iow well-known phenomenon of scientific dispute. The paucity and uncertainty of scientific knowledge about health and medicine left much room for debate, and the doctors could more easily align themselves with views held vital to the national interest- of their countries. The quarrel between French and British doctors about how to control the spread of international disease was intensified and em- bittered by traditional Anglo-French political rivalry. The German members of the International Sanitary Council of Constantinople made decisions of little consequence to disease but calculated to expand the political dominance of Germany in one instance and to weaken British commercial dominance in the other.^ According to Masters, Turkey rarely observed sanitary rules, holding that the whole system was a tool of imperialist power politics rather than a system for the protection of Europe against epidemic invasions.^ British physicians, even with French scientists ridiculing their logic, had little difficulty in supporting British foreign shipping interests by downgrading the importance of quarantine restrictions. The "medical plank" which most of the British doctors were sup- porting is described in the 1849 British Report on Quarantine, which concluded "that the only real security against epidemic disease is an abundant and constant supply of pure air * * * and that ventilation «Ruth D. Masters. "International Organization in the Field of Public Health," (Wash- ington, D.C., 1947). page 2. ^^. ^ sihld., p .^1. Onlv recently, as the instrnmentR of war have reache'' the capacity of high kill, have their (toll In casualties exceeded that of disease. Not until World War II did more soldiers die from bullets than from disease. As for the great World War I Influenza i^n- demic, it must be stated in all fairness that the deaths were low compared with the 700,- 000.000 people who came down with the disease. There were hardly that many soldiers or civilians exposed to bullets, gas. or any other deliberate weaponry. So, while the deaths were relatively low, the casualties were enormoun. Then as now the primary enemies of man were diBeaf^e and disease-producing organisms. •Ihld., page .S8. ' Ibid., pages 7-8. 690 and dispersion can dissipate any contagion." ^ This notion continued for at least another 30 years, as can be seen in the Governor of Ber- muda's 1878 report on "Climate and Public Health": It is singular that with such a summer atmosphere, and with a considerable portion of its surface occupied by un- drained marshes, the exhalations from which must neces- sarily be more or less prejudicial, Bermuda should have no local summer fevers, such as prevail at Malta and at Gibral- tar. This immunity from local disease may probably be due to the small extent of land surface, and its distribution in long narrow bands separated by arms of the sea and raised but slightly above its surface, so that the whole area of each island is frequently swept by the sea breeze which carries away with it every unwholesome emanation.^ And in the same year from the report from Penang : The gaol was at the moment of outbreak overcrowded, and the probable cause of the outbreak [cholera] was the admis- sion of an incipient case of the disease into an atmosphere rendered, through overcrowding, suitable for its generation and rapid dissemination.^" An even more disturbing note of the times was that the medical men were seemingly trjang to get out of the argument altogether : In England the conviction that quarantines are ineffective against epidemics has advanced with greater decision and rapidity among non-professional persons engaged in com- mercial and public life than among medical men. It is not a technical question, but one of evidence, on which a person capable of observation is as competent a judge as any physician.^^ This state of ignorance and fear, of political and economic domi- nance, of unilateral 40-day quarantine periods based upon arbitrary grounds, of resentment by the Moslem States that their coimtries were regarded as less than clean, of medical argument instead of experi- mentation, and of an extraordinary pursuit of national interests at the risk of national and global health, dominated the picture of inter- national discussion of communicable disease during the entire second half of the nineteenth century. 8 Ibid., page 37. * "Papers Relating to Her Majesty's Colonial Possessions, Reports for 1876 and 1877. Presented to both Houses of Parliament by Comni:mf! of Her Majesty" (London, George E. Eyre and William Spotteswoode, Printers, August 1878), page 25. 1" Ibid., page 327. The treatment for this disease was worse than ideas on its transmis- sion : "Thirty-three cases, of which 27 were fatal, were treated by hypodermic injections of chloral hydrate; 6, of which 4 were fatal, with camphor : and 36, of which Tt were fatal, by inhalation of sulphur fumes • * * tliis treatment was supplemented by half drachm doses of dilute sulphuric acid, and a plentiful supply of iced water to drink" (pages 327- 328) The treatment did not have to be this way. In a brilliant monograph published by Dr. William P.rooke O Shauglinessy in The Lancet in May 1R.''.2, an effective fluid therapy for sufferers of cholera was described. It was similar to that used today. The thesis was lost for over a century. However, Dr. O'Shaughnessy could not even apply it at the time to London where cholera was devastating the city. He had been educated in Edinburgh and moved to Lundnn. He was not jiermitted to practice medicine within seven miles of the city because he did not have a license from the Royal College of Physicians". (See Abel Wolman. "The Unreasonable Man", Second WHO/PAHO Lecture of Biomedical Sciences, Pan Ameri- can Health Organization, 1867, page 1,4.) " Masters, op. cit., page 37. 691 Early Efforts Toward International Collaboration It is to the credit of diplomacy in international action under these circumstances that the nations sought a constructive plan to control the spread of disease. It was a long step forward, for example, when in 1851 the French government convened the first international quar- antine congress. The 12 nations which sent delegations to the congress in Paris were fully aware of the "* * * pressures of the non-mai-itime powers to bar the entrance of disease, at any cost [and of] the great shipper, the United Kingdom * * * at any cost, to keep commerce and traffic moving." ^^ Knowledge of the origin and transmission of infectious disease was not well enough advanced to impose a purely technological decision. Nevertheless, the participants from time to time seemed willing to do just that and to do it as a basis for international action. The scientific community, such as it was at the time, was di- vided between the sanitarians and the quarantinists. It is interesting to point out that their views were both wrong as single solutions to the problem, but both correct as combined approaches to it. Today, sanitary control and quarantine are significant components of the man- agement of international epidemics. When the delegates to Paris in 1851 got down to work it was with considerably more skill in negotiation than knowledge of epidemi- ology. In an atmosphere of ignorance concerning the origin and trans- mission of diseases like cholera and plague, diplomacy was faced with a unique challenge. Since the medical men were unable or unwilling to agree on whether or not certain diseases were contagious, the diplomats were forced to use a political strategy regarding the retention or abo- lition of international ship quarantine practices. Meanwhile, delegates from the same nation were free to exercise difi'erent motives and even to vote against each other. Thus — Each nation was represented by a doctor and a diplomatist, and it was decided at the outset that they should vote individually. This set up tensions between medical men and the administrators, making the voting at times useless, since they tended to cancel each other out.^' Accordingly, it was possible for the diplomat from France to express the concern of the central government with the effect of prevailing reg- ulations on trade, while the French expert familiar with epidemics in- troduced by travellers at the port of Marseilles advocated strict ap- plication of the regulations. This pattern of one diplomat and one doctor from each country continued during ten international sanitary conferences which followed between 1851 and the end of that century. Although this first conference ended on a predictably inconclusive scientific note, the diplomats and doctors finally were able to put to- gether 137 articles on international sanitary regulations. There is evi- dence of a considerable amount of patience behind this achievement; it required six months of work involving 48 plenary sessions. In perspective it seems to have matterea little that the Convention was not ratified by all the governments, or indeed that it lapsed com- pletely in 1865. TTie fact remains that a number of important inter- national rules were established to promote uniformity m quarantine 1= H. van Zile Hyde. "The International Health Program," an address before the Army Medical Service Graduate School, Walter Reed Army Medical Center (Washington, B.C. March 9, 1954), pace 4. "John Taylor, 'Tlrst Steps." World Health (World Health Organization, March 1968), pa?:e 5. 692 procedure and many of the main rules continued in j>ractice for the remainder of the century. What is more important is that for the first time doctors and diplomats from the then European powers had met in earnest to discuss common global disease problems. And as a practical matter, diplomacy rather than science "saved the day" for this first congress. Although arguments over rival scientific theories oc- cupied most of the time, the French diplomatic representative who was president of Mi*^ conference continued to seek workable solutions. In addition, the diplomats appeared to have had definite instructions not to vote for either of the extreme scientific positions. Subsequent events and discoveries suggest that this compromise was all to the good.^* International quarantine congresses continued to be called. In suc- cession they oc<5urred in Constantinople in 1866, in Vienna in 1874, in Washington in 1881, in Rome in 1885, and in Venice in 1892. Three other agreements which followed in 1893, 1894, and 1897, and which like many of the others dealt with protection against cholera at spe- cific places, were later combined in a single International Sanitary Convention in 1903. Estdblishment of a Permament Quarantine Office Finally, as knowledge advanced and statesmen agreed on the need for contmued international cooperation, a permanent International Office of Public Hygiene was created. The Office was set up in Paris in 1909 as a result of a 1907 meeting in Rome of twelve major nations, including the United States. According to Russell the advantage of the 1909 convention over its many predecessors was that the inter- governmental correspondence regarding the codes and regulations did not go "* * * through departments of state and foreign affairs * * *. It provided an operating agency outside lay diplomatic channels." ^° The disadvantage of the International Office of Public Hygiene in Paris was its functional limitation to only those aspects of public health having to do with quarantine and the notification of cases of communicable disease. Its work was confined to its secretariat and its influence was limited even in the control of epidemics. It was ex- pressly forbidden to "meddle in the administration of the several states" supporting it.^^ With national sovereignty, ports, and bound- aries protected at every point there was still nonmedical resistance to the idea of the International Office of Public Hygiene. The resistance came from Germany, Austria-Hungary, and Great Britain. Great Britain, however, later changed its views and supported the "Paris Office", doing so under the consideraJble pressure of spokesmen for its doctors, who were apparently beginning to give more professional content to their thoughts and recommendations regarding interna- tional health. According to Goodman, the British medical journal, the Lancet, had severely castigated the parochial attitude of the Brit- ish delegation.^'^ In this way the "Paris Office" of 1909 became the first international quarantine organization involving the major European powers and 1* N. M. Goodman. "International Health Organizations." (Philadelphia and New York, The Blaklaton Co., 1952), pages 40--41. ^s Russell, op. cit., page 394. i« Masters, op. cit., page 49. ^^ Goodman, op. cit., pages 81-82. 693 the United States. As in 1851 the French had taken the .initiative, this time under the leadei*ship of dij)lomatist Camille Barrere, French Ambassador to Rome. Although later resisting the absorption of his "Paris Office" by the Health Office of the League of Nations, it was diplomat Barrere who brought order out of chaos in international quarantine during the 1907-1909 period.^s The "Paris Office" con- tinued to function through both World War I and World War II, and was not dissolved until the World Health Organization came into existence. Tlie First Infetmxitwn million in 1045 to $7-'^ million for 1971,^*' plus $50 million or more from other sources which the Organi- zation will administer in 1071. Today WHO : — Has IHl Member States and Associate ^Members. — Continues its six regional offices and committees in Copen!\ageii. Alexandria, Brazzaville, Manila. New Delhi, and Washington. with headquarters in Geneva. (See Fig. 1 ) — Maintains hundreds of reference centers or laboratoiio all o\er the world. — Has formal working interfaces with some 82 major health- relevant international goveinmental and non-governmental oiganizations. — Has a total staff in the order of 4500. Ai)proximately a fourth of these are at headquarters with the remainder in regional and zone offices and in the countries. — Is supported technically by some 45 Advisory Pane's and Plxi)ert Committees in virtually every health or health-related subject area, including air pollution, food additives, cancer, drug de- pendence, human genetics, insecticides, nutrition, occupational health, medical research, international quarantine, venereal disease, mental health, and environmental health programs. — Initiates per year about 200 co]hil)oi"ati\e research conti-acts. lOd training and exchange grants, aiid l')500 fellowships. — Manages an extensive woild-wide malaria eradication and control program. — Administers the 107 Article, International Health Regulations, adopted by the World Health Assembly in 1969. — Operates as a part of the above regulations a global intelligence network on the principal epidemic diseases of the world. (See Fig. 2) ^Personal communication with Howard B. Calderwood. (November 25.1970). "As adopted by the 23rd World Health Assembly. WHO Chronicle (Geneva, World Health Organization, July 1970), page 293. 699 — Is a major publisher of biomedical liferature. WHO ])iiblishes numerous monographs, technical reports, directories and guides, special scientific papers, and six periodicals. The monograi)hs and technical reports often represent, in effect, a world r-cientific or medical consensus. Perhaps more frequently they are the collecti\ e views of international experts which do not necessarily represent the decision or policy of WHO. The international reference centers are usually prerexisting insti- tutions designated to function as a part of the WHO network of competent and specialized units. The technical excellence required here may tend to skew the centers towards the developed nations. There are for example, 40 institutions in the United States particii)ating in .support of WHO programs. The forty-five or so WHO advisor}' panels and expert committees are also well represented iby the technically advanced nations including, of course, the United States. The effect of this arrangement is that this network of reference centers and the advisory committees — who con- tribute to WHO on a cooperatiAe ( i.e., reimbursable) basis, i-ather than as beneficiaries under its budget — makes for a considerable expansion in the total" WHO apparatus. As advanced technological expertise is being chaiineled into this apparatus by this arnvngement, WHO is able to coordinate and tap a large, global resource of talent and information. 700 701 en oc p. •H J3 CO c H en u 00 702 who's E pidemiologicaZ Intelligence Network The service performed by WHO in regard to international epi- demiological intelligence deserves special emphasis for three reasons : (1) Disease surveillance and quarantine were the original bases for international collaboration in public health ma*t«rs and they remain among the more difficult and dramatic aspects of such collaboration; (2) WHO has a unique semi-legislaitive authority over international epidemiological and quarantine procedures; and (3) the network may serve as a model of international authority with respect to the control of global diseases of as yet unknown etiology, as well as the manage- ment of emerging global environmental problems. THE NETWORK ORGANIZATION AND ITS ACTIVITIES The WHO Epidemiological Intelligence Network is an international system of surveillance and quarantine designed to rex;eive and provide rapid information in order to prevent the outbreak and to control the spread of communica;ble disease anywhere in the world. As in the past, but under new "International Health Regulations", the health admin- istrators of governments are obliged to inform WHO of the first cases or suspect cases of cholera, plague, smallpox, and yellow fever.^^ The information must be supplier! within 24 hours of disease identi- fication, by means of telegram or telex directly to the intelligence head- quarters in Geneva. The information is then given in a daily radio bulletin broadcast from Geneva and retransmitted throughout the world. Over 3,000 such disease case intelligence notifications come into Geneva every year. (Governments can obtain WHO assistance in investigating and controlling outbreaks of these reportable diseases.) This rapid information service is essential in view of the risk of high-speed international spread of potentially epidemic diseases through the ever increasing volume and range of air traffic. The speed of dissemination of pathogenic micro-organisms (either the organisms themselves in infectious materials, or in vectors like mosquitoes and rats, or in carriers like human beings with or without obvi- ous symptoms) , may be even greater than at present with the advent and extensive use of large transcontinental aircraft. The new regulations impose stricter requirements at ports and air- ports to ensure greater protection for and from the international traveler. Vaccination certificates are required for such diseases as cholera, yellow fever, and smallpox. Ships and aircraft arriving from ports outside a given territory are required to submit a declaration of health concerning all persons on board. Cargo, goods, and containers are subject to regulations and requirements to assure within practicable limits that they are free of infectious material, vectors, or rodents.'*" Ships, aircraft, trains, and road vehicles, depending on circumstances and the disease in question, are subject to quarantine or isolation. Per- sons on an international voyage not showing evidence of protection from a disease (like smallpox) may be placed under sun^eillance by =» Loiise-borne typhus, relapsin,? fevpr. viral influenza, paralytic poliomyelitis, any one of a series of "hot" virnses. may also he reported, but .ire not suhlect to quarantine. There is a single special provision for malaria. Resrardless of snecific disease a health authorit.v may act to control the discharge from any ship of sewage and refuse which mifht con- taminate the waters of a port, river, or canal. Also, no matter capable of causing any epidemic disease shall be thrown or allowed to fall from an aircraft when it is in flight. ^o "Initernational Health Regulations." Chapter V. (Geneva, World Health Organization), page 15. 703 a national health administrator. If a person requires vaccination in the interest of public health and refuses the vaccination, he may be isolated for a period up to foui-teen days.*'^ Ships, aircraft, trains, and road vehicles are also subject to disinsecting or disinfection, depend- ing on circumstances at the port of arrival. Further health measures may be applied to any vehicle as determined by conditions on board during the voyage or which exist at the time of medical examination bv the port health authority. ■"The United States' part of the WHO epidemiological intelligence network is operated by the Public Health Service Center for Disease Control in Atlanta, Georgia. The Center also serves as the Interna- tional Influenza Center of the Americas and the Arborvirus Center for the Western Hemisphere; it is also the International Center for Shigellosis (a form of dysentery). To implement the International Health Regulations and to protect the United States from the importation of disease from abroad, the Public Health Service spends about $10 million annually and checks about 140 million international travelers arriving at some 400 differ- ent points of entry. The Public Health Service also maintains physi- cians on duty in more than 30 nations in order to examine an average of 250,000 applicants per year for visas to the United States. CURRENT PR0BLE3IS OF EPIDEMIC CONTROL Perhaps the main problem in implementing the International Health Regiilations is a tendency on the part of some governments not to report diseases for fear of restrictive action that would affect trade and travel.*^ This problem came to the fore recently when WHO reported the presence of cholera in Guinea without awaiting notification of the serious outbreak there from the Guinea Health Ministry. WHO's notification of 2,000 cases and 60 deaths from cholera in Guinea came as it was completing its preparations for an emergency anticholera training program for African countries. The present epidemic (which began nearly a decade ago) has penetrated south of the Sahara where cholera had not been seen for more than a century.*^ WHO had earlier provided technical assistance for use in Conakry, the capitol of Guinea, when the government reported 230 cases of an unidentified illness which had already caused 27 deaths.** The outcome of WHO's report of the nature and extent of cholera in Guinea were (1) a threat from the Guinea Government to withdraw from WHO in protest to the report *^ and (2) "no further news" from Guinea as of September 8, 1970, when the first WHO notification oc- curred concerning 2,000 cases of cholera there.*^ Notifications have been received from Dubai [one of the Trucial States], Israel, Lebanon, Libya, and the U.S.S.R. ; however, Iran and the United Arab Republic have repeatedly denied the presence of cholera.*^ As the Medical Tnhune states, "it seems clear that the haziness surrounding the exact locations outside the officially notified areas where cholera has appeared " IWH. Chaptpr IV. napp 24. « WHO Chronicle (World Health Orsanization. June 1970). page 262. "Medical Tribnne (September 21. 1970). page 3. ♦•Medical Tribune (Sentemher 7. 19701. pR?p 1. ** Medical Tribune (September 21. 1970). page 3. « The Lancet (September 12. 1970) , page 578. " Ibid. 704 is a gesture of self-protection [not against the disease itself but] against possible reprisals by other countries." *^ This situation is a reminder of exactly how far the world has — or has not — progressed since the quarantine regulations of over a century ago were reluctantly adopted despite ignorance, fear, and vested interests. U.S. INVOLVEMENT IN EPIDEMIOLOGICAL PROBLEMS Cholera may not be of immediate geographic concern to the Amer- icas, but poliomyelitis is a growing problem in several countries in Central and South America *^ and viral influenza is an annual seasonal hazard in the United States. If the American political and diplomatic community is somewhat indifferent to tropical disease in the tropics, perhaps it should be more interested in Asian disease in the United States. For example, the new strains of influenza virus A2 in the Hong Kong epidemic of 1968 later spread and reached the temperate areas of the northern hemisphere, causing numerous epidemics in the 1968- 1969 influenza season. In the United States the outbreak was exten- sive, covering nearly all of the States and "was associated with a large number of deaths from acute respiratory disease." ^° In testimony before the House Subcommittee on National Security Policy and Scientific Developments in December, 1969. Dr. Joshua Lederberg warned that the American public health authorities were not "suffi- ciently sensitive to the possibilitv of a devastating worldwide epi- demic." He used the example of the Hong Kong flu as a foretaste of what could have happened and of what could happen in the future: I think there is a considerable amount of sel f -delusion that the antibiotics will take care of any bacterial infection ; we need never worry about the plague again : the plague has been conquered by medicine ; that virus infections will somehow be taken care of, although when you see a pandemic like the Hong Kong flu, you have a foretaste of what really can happen. That was a world-wide epidemic. The attack rate was some- thing like 20 to 30 percent of the world's population that was infected by this virus. It was not a particularly lethal one, but it is only a minor accident that it is not a lethal virus. Such events are undoubtedly going to occur in the future that will be very much nastier, and we have simply not been oriented to take a sufficiently aggressive and sensitive view about this matter.^^ Throughout his testimony. Dr. Lederberar saw public health defense as a global parallel to defense against biological warfare ; he consid- ered pathogenic micro-organisms to be the natural enemies of man, and recommended two measures of worldwide self -protection : (1) The establishment of central, international labora- tories to monitor the occurrence of threatening organisms and "8 Medical Tribune (September 7, 1970), page 1. « "The World's Poliomyelites." The Lancet (September 26, 1970), pa^e 646. w WHO Chronicle (June 1970) , pages 263-4. ^ U.S. Congress. House. Committee on Foreign Affairs. "Chemical-Biological Warfare : U.S. Policies and International Effects." Hearings before the Subcommittee on National Security Policy and Scientific Developments of the . . . November and December 1969. 91st Congress, first session. (Washington, U.S. Government Printing Office, 1969), page 128. 705 to liolp develo}) ofenerally available means of protection against them; [and] * * * (2) A general acceleration of research and health services to minimize the incidence of infections disease, particnlarly in underdeveloped countries. No situation could be better de- signed for the evolution of serious new vinises than the exis- tence of crov.'ded, underfed human populations in which foci could spread with a minimum of medical control.^- During 1969, WHO extended the scope and activities of its refer- ence centers and collaborating laboratories on the viruses in general and established a new regional center for the enteroviruses at the Enterovirology Unit, Center for Disease Control, Atlanta, Georgia. The Center, Emory University, and WHO jointly conducted a con- ference on Hong Kong influenza and published the results.^^ The WHO Director-General's report of 1969 expressed the belief that the cooperation of national centers had resulted in a degree of control of influenza : To cope with [influenza], a world network consisting of two international centres and 85 national centres in 55 countries has been established. WHO plays the role of central- izing agent, receiving and passing on to all INIember States, as rapidly as possible, the significant information that reaches it through the international network. Perhaps it is not by mere chance that the many foci of influenza re}X)rted during the past year in the southern as well as the northern hemis- phere remained limited in extent.^* Wliether or not the United States contributes to WHO for the global monitoring, control, and eradication of communicable diseases, or to some other organization over which it might have more direct power, the fact remains that the United States is subject to worsening hazards domestically in the infectious disease area. In the developed countries, including the United States, the natural decline in the in- cidence of tuberculosis is slowing down; malaria and yellow fever are within the national boundaries ; and there is an observed upward trend in the incidence of gonorrhea. Resistant forms of some of these diseases (malaria and gonorrhea) acquired by troops in Viet-Nam are not likely to become less resistant when troops with residual organisms return home. Plague may not be importable by American troops from Viet-Nam; nevertheless the disease is there. In 1969 "the highest in- cidence of plague was again in the Republic of Viet-Nam, where the numl)er of cases was greater than the combined total for all other countries." ^ As the Director-General of the World Health Organization stated a few years ago, "* * * the quarantineable diseases, which many people think of as scourges of the past, are still daily realities.'' "= Ihif'.. i)a,'re 90 s'! Bulletin of the World Health Organization (Vol. 41, Nos. 3, 4, and 5. 1969). " WHO Chronicle (.Tulv 1970), page 292. •"*■■ WHO Chronicle (.Tune 1970), page 269. 706 RECENT EVALUATIONS OF THE WORLD HEALTH ORGANIZATION G. E. W. Wolstenholme of the Ciba Foundation in London has praised the achievements of WHO and deplores the lack of news cov- erage concerning its constructive work. Of all the special United Na- tions agencies, fie says, none "* * * contributes more to current im- provements in our daily lives and gives more hope of a better future for all mankind than the WHO." Many people in positions of respon- sibility were totally ignorant of the work of this agency. In a recent symposium giving emphasis on our "stressful, diseased, crowded, ill- educated and uncooperative world," he said : ^ WHO is a world intelligence agency for communicable diseases, on which all quarantine measures are based. It spon- sors international reference laboratories for diseases which scorn national frontiers. It is the ultimate authority on the health standards of foods, on vaccines, drugs, systems of disease classification and diagnostic procedures, and it runs the counter-spy system against the traffic in illicit and dan- gerous drugs of addiction. As the recorder of rare reactions to drugs, it may forestall another thalidomide-like tragedy. It awards some 2,500 fellowships a year for postgraduate training in medicine, nursing and environmental health. It organizes each year about 40 short instruction courses and around 80 technical conferences. It contributes at any one time, in manpower and in money, to 1,000 health projects in 150 countries. WHO is an organization which between 1948 and 1963 treated, for example, 43 million people in 45 countries for the syphilis-like disease of yaws, and set lf)0,000 trained workers to the task of essentially eliminating malaria, to which half the world's peoples were exposed — and almost one-third of the world's population has by now been given protection from malaria, though 360 million remain at risk. It is WHO which lends hundreds of experts and teaches thousands of health workers to attack a host of disorders and diseases: for ex- ample, smallpox (a campaign to vaccinate 220 million in one year has just begun, to continue over ten years) ; tuberculosis (still some two to three million preventable deaths each year) ; leprosy (about 15 million j^eople in 50 or 60 countries blighted by its mutilation) ; maternal and infant mortality (a ten- fold difference between the most fortunate and the unhappiest countries) ; cancer, heart disease, rheumatism (the bijr killers and cripplers with widely varying incidence in different areas) : water, soil and air T)ollntion (in tlie world as a whole it is said that one in four hospital patients is ill because of infectefd ^^ater^ : blindness (10 to 12 million siirhtless) : deaf- ness (millions still uncounted) : infestations by parasites (many hundreds of millions of people chronically weakened and defeated by three or four such diseases together) ; mental illness ; senility ; accidents ; malnutrition : and animal diseases. ^■^ G. F. W. Wolstenhnliup. In "Health of Mankinrt," A Ciba Foundation Symposium. (Bos- ton. Little Brown and Company, 1967), pages 254-6. 707 The last details in this hasty, impressionistic sketch of WHO refer to its work on the co-ordination and stimulation of medical research, such as that on human genetics, heart diseases, cancer, dental health, bacterial resistance of insecti- cides — wherever a comparison from different areas may be revealing, or where a condition, a reaction to a drug for instance, may be too rare to excite attention in any one country. It is an impressive record — yet this is only preliminary work in bringing to most people in the world a modest chance to enjoy the health which imtil recently has been the blessing of a privileged few. And already we have such an increased expectancy of life and so many more children survive that the problem of population growth makes almost every other problem trivial. Impressive — ^but WHO can only act on request from gov- ernments. Its expert advisers operate only within national limits. And because of lack of money or skilled manpower not all requests can be met. Where it is able to help, WHO does its best to encourage the mobilization and creation of the local infrastructure which will maintain, or at least not wholly throw away, the value of WHO's efforts in disease control. A year later (1968), in the Br itish Medical Journal^ Sir John Charles took a similar measure of WHO for the 1960 to 1965 time period: In 1960 the UN and WHO were faced with a serious emergency in the newly independent Republic of the Congo ( Leopold ville). Owing to the political crisis the health situa- tion had gravely deteriorated. WHO demonstrated its co- ordinating and advisory functions in a variety of ways. [It placed] 37 Red Cross medical teams where they were most needed. By recruiting a few key health persoimel it helped to avert the breakdown of environmental services and strength- ened the control of disease. Finally, looking beyond the immediate present to the future stalling of the health services, it worked out a long-term programme of education and train- ing of doctors and other personnel which is now bearing fruit. Altogether it was a highly successful reply to a challenge. Another factor in increasing WHO's African responsi- bilities was the rapid accession of many states to independ- ence, followed by their admission to the Organization as full members. At the end of 1960 only seven governments in the Africa Region were members of WHO. Five years later there were 27. "WHO's serious interest in national health planning can be traced to Latin American activities which began in 1959. It extended to the African Region in 1963, when the Organiza- tion became associated with the governments of five African countries in the preparation of health plans which were to be integral part of the national plans for social and economic development. It is now an advisory activity of major importance. 708 Population problems in many parts of the world have been a major concern of the United Nations for several years, and their rei>ercussions have affected WHO. They arise not only from population increase but are associated with urbaniza- tion, industrialization, and changes in the age structure of the population, and involve questions of family planning and Jhuman reproduction. This complex of difficult problems re- ;sulted in AVHO's establishing a Human Reproduction Unit in 1965, About the same time the Assembly authorized the provi- :sion of technical advice on the subject to such member states as requested it. This IS only one example of the continuing extension of who's interests. Sometimes the activity is an entirely new venture, as with human reproduction and the even more re- cently created Division for Research in Epidemiology and the Conununication Sciences. At other times it is a more vigorous and comprehensive attack on an old -standing health problem. Typical of this approach are the community water supply programme and the world-wide smallpox eradication campaign, both of wliich were launched in 1965. It is, as yet, difficult to measure that achievement in quanti- tative terms. Improved health statistics in many parts of the world are some indications of success, but the mere existence of a service or laboratory can also be evidence of an advance. Nevertheless it is possible to recognize certain positive achievements. First amono^ them is the universality of WHO. This is shown by its memoership of 129 states. It is manifest in the system of regional offices serving as foci of advice and action. It is seen again in the network of reference laboratories and services for the collection of epidemiological data. Next there are the results of the great campaigns against such diseases as malaria, yaws, and tuberculosis, which have saved inmmierable lives, and been of imnieasuraWe benefit to the economy of many developing countries. There is the major contribution which has been made to educational activities of member governments in helping them to raise the total of medical schools in their territories from 553 about 1950 to 717 in 1966. Another facet of tliis activity is the granting of fellowships to individuals, who now total some 3,500 each year. The strengthening of health services, always one of who's primary functions, has extended into the planning of national health services as a concurrent and integral part of economic and social development. And at the local level the development of the basic health services idea is an equally great achievement. Then there is the international co-ordination of medical research in certain fields, and the communication and sharing of the results. Finally, though the list could be continued, there is the accomplished fact of getting the nations to work together." 5' Sir John Charles. "Origins. History iind Achievements of the World Health Organiza- tion," British Medical Journal (May 4, 1968), pages 295-6. 709 Politics and Diplomacy in the World Health Organization WffO'S INTENT TO BE NON-POLITICAL The World Health Organization has long regarded itself as a tech- nical and non-political organization. Opponents of various proposals and amendments, whether they won or lost on issues before the Assem- bly, have based their opposition on this cherished assumption. For example, in dealing with applic^itions for membership, the "Assembly has been more interested in the capacity of the applicant to fulfill the obligations of a ^Member than in the question of the applicant's pos- sessing the attributes of sovereignty." ^® While the International Health Conference agreed to consider mem- bership in the United Nations as a basis upon which the WHO should enter into force (when 26 members of the United Nations had accepted the WHO Constitution), it rejected the criterion of membership in the United Nations as a standard requirement for membership in WHO. Before the First Assembly met, it was decided that those non- membei-s of the UN that had been invited to send observers to the planning conference could become members of WHO merely by ac- cepting the WHO Constitution. Questions concerning the competence of the Health Assembly to determine statehood before exercising its authority to admit a member were deferred to agreements between the UN and WHO.^'' Although it would be a mistake to assume that ques- tions of WHO membership have not been influenced by actions of the United Nations, the fact remains tha;t both the Assembly and the Director-General have asserted the autonomy of WHO in the deter- mination of membership questions.^" Spain was dissuaded from apply- ing for membership in WHO as a result of the recommendation of the UN General Assembly of 1946 that that country not be admitted to any international organization in the UN family. When this barrier to admission was rescinded by the UN, Spain applied for membership in WHO in 1951 and was admitted in that year. U.S. MEMBERSHIP : THE FIRST BIG TEST Before WHO entered into force (Sept. 1, 1948) the question of United States membership came before WHO'S Interim Commission. Once again, the Health Assembly asserted its competence to interpret or apply the Constitution concerning membership, and powerful na- tions who were already members took functional and realistic stances rather than legal ones in dealing with the unusual United States case. The situation was that the I'.fe. instrument of acceptance, submitted in June 1948, stated that U.S. acceptance of the WHO Constitution was subject to certain reservations. Not only was the United States the first nation to pose reservations in its application, but there was no provision in the WHO Constitution for reservations to acceptance. The U.S. reservations, of course, were statutory : The President is hereby authorized to accept membership for the United States in the World Health Organization * * *. 55 Howard B. Calderwood, "Membership in the World Health Organization" (unpublisheH draft), page 3. '^ Ibid., page 3. o" Ibid., page 5. 710 The Congress does so witli the understanding that, in the absence ol" any provision for withdrawal from the Organi- zation, the United States reserves its right to wnthdraw from the Organization on a one-year notice : Provided, however, tliat the financial obligations of the United States to the Organization slia)! be met in full for tlie Organization's cnr- rent fiscal year. [Also] the Congress does so with the under- standing that nothing in the Constitution of the World Health Oiganization in any maimer commits the United States to enact any specific legislative program regarding any matters referred to in said Constitution.*'^ The Credentials Committee Avas undistui-l^ed by the restn'\ation and the Health Assembly at its second plenary session seated the United States delegation with full rights, on the understanding that the prob- lem of U.S. reservations would be discussed at a later date.*'- When the problem did come uj) for discussion on July 2, lO-tS, India, the United Kingdom, and the USSR placed emphasis on evidence of participation of the United States in international health activities and on assurances given by its chief delegate that the U.S. would ful- fill its responsibilities under the WHO Constitution. The representa- tives of the USSR, speaking before the Assembly proposed that the United States "* * * be accepted for membership." '^^ The representative of India stated that an ''* * * unwilling ]\Ieml)er might withdraw in one of many ways [and the U.S.] provision for termination on a year's notice be considered a more straightforward method than other possibilities." *""* The Assembly accepted the proposal of its President that the United States should be admitted as a full member of WHO.''^ Obviously striving for universality of membership and global function, the Assembl}^ not only accepted the United States as an im- portant technical and financial contributor to WHO, but at the same time refused to permit termination of membership to become an issue for the future or for the U.S. method of termination to become acceptable for other members. The representative of India proposed that the Assembly "* * * lay down a proposition of general applica- tion that any Member State may terminate its meml)ership on a yeai-'s notice." ^'^ However, no observations were made with respect to his proposal at that time, and when subsequent withdrawals did occur tlie Assemblies made no reference to the U.S. technique of formalizing tliem. THE TEST or SOVIET BLOC WT!'] IDKAWALS Withdrawals did occur, however, and tlie manner in which tliey Avere handled by the Assembly was undoubtedly more im|)Oitant tlian the terminations themselves or the alleged reasons underlvino- them. In 1949, three Soviet States, the USSR, the Ukrainian SSR and Bye- lorussia, notified the Director-General of WHO that they no longer considered themselves as Members. As might l)e expected, tliere fol- "1 TTnited States CocTe, titlp 22. pafjcs 4477-447S. "'-' Cildorwood. on. cit.. p;ifri' 10. "3 "Official Records of WHO" (13), pages 77-79. "* Il)id., pasre 7R. "^ Ibid., page 80. Of course, as a practical matter the right of unilateral withdrawal Trom such a coiiimitin<'nt inheres in national sovereignty even witliout explicit statntury provision. «« Ibid., page 48. 711 lowed withdrawals by Bulgaiia, Ivunuinia, Albania, Czeclioslovakia, Hiingaiy, and Poland. Iceland's withdrawal, which brought the termi- nations to a total of nine countries, occurred on Aug. 15, 1050.'^' Tlie criticisms otYered by the USSK had to do with WHO"s failure to abide by the activities proposed for it in 1946, its failure to accomplish the prevention and control of disease at the international level, and the high cost of who's administrative machinery.*^** The six Eastern States provided similar reasons for withdrawing and added a new- one that the Organization was under U.S. domination.*''' The eastern members of the Soviet Bloc argued for medical supplies for the war-devastated countries — insecticides, vaccines, antibiotics, drugs, and materials for research and education; their charge of '"subordination" may have meant that the United States was not sup- plying such materials through WHO in the amounts requested. The theme of the USSR from the beginning w-as that WHO should direct its efforts and organize its activities for the consolidation and de- velopment of national health services. Once again, this attitude em- pliasizes the view^ at that time of the USSR and other Members of the Soviet Bloc that W^HO should provide national health adminis- trators wirh supplies, medical literature, and the results of research.""^ Political or otherwise, the official W^HO reaction to all this was essentially non-reactive: (1) The Director-General requested an invitation from the USSR to visit Moscow, (2) A draft resolution for the Assembly took account of the prevailing sentiment that llie Mem- bers concerned reconsider their decisions and resume active participa- tion in WHO, and (3) A resolution was passed by the Assembly (4^^0-6) stating that the objectives of WHO required the cooperation of all countries ; expressing regret o\er the absence of these States from WHO ; pointing to their loss to the work of the Organization ; hoping that in the near future they mi^ht w'ish to reconsider their position; and inviting them to join, if possible, tlie present and following session of the Health Assembly.'^ These and certain ''non-developments'' in- dicated that the Members of the Assembly were primarily motivated by the desire to have the withdrawn States return to the Organiza- tion. The non-developments were the almost complete silence of the Assembly on tlie withdrawal actions and on the implications of such withdrawals on the financial condition of the Organization.'- Subsequent resolutions reiterated the desire of the Assembly for the non-participating States to resume full cooperation in WHO. In the meantime, expenditure levels were adjusted, but the Assembly assumed that the contribution of what they called "inactive Members" would eventually be paid. The Second Assembly refused to recognize the withdi-aAval of the Soviet States, and Members were generally opposed to taking ]X)sitive steps to suspend services to these States. Assembly after Assembly labored with assessment and budget prob- lems but continued to assess the "inactive Members" for contributions which in all likelihood would not be paid. It was difficult to get any 6- "Official Records of WHO" (17). pages 52-53; "Official Records of WHO" (28), luitrps ri."i.'!— ■'1.-4. s^ "Official Records of WHO" (17). page 52. "'"Official Records of WHO" (28), pages 553-554, "Official Records of WHO' (35). pases .SSO-SSt. •» "Official Records of WHO" (13), pages 39-72, and 120-147. ■^ "Official Records of WHO" (21 ). ■- Calderwood. "Membership in the WHO ', op. cit., page IT. 712 proposal through the Assembly which assumed that the "inactive Members-' would not eventually renew their participation in AVHO." RETURN OF THE VSSR AXD EASTERN EUROPEAN STATES Thus by a "fictitious position" that Member States who had termi- nated their memberehip in "WHO were nevertheless Members ("in- active") ; by continuing to assess them as if they were active ISIembers; by refusing to resort to any type of punitive acts or by "lecturing'' against them in the Assemblies: by continuing to invite them back into the fold ; and by preparing the way for settlement of payments in arrears, the resumption of active partici]:)ation of Russia and the Soviet Bloo States in WHO became a reality. Albania, Bulgaria, Poland and the I'SSR were represented at the tenth Health Assembly of WHO in May 1957. Czechoslovakia and Rumania resumed active participation in 1958, and Hungary became an active member in 1963. For what it is worth as a lesson in diplomacv, the patient ex])ressions and actions of the Members and the Assembly were specifically de- signed to facilitate the return of the separated States of WHO back to active participation. "Little attention was given to the legal and other relevant aspects, although they were not completely ignored." ''* Although all of the States concerned had originally notified the Orga- nization that they no longer considered themselves Meml^ers of WHO, none objected to the Assembly's persistent thesis that they were merely resuming active participation. '^^ THE CHINA QUESTION CONSIDERED POLITICAL The political question of the Republic of China vei-sus Red China came u]) early in the liistorv of WHO. The third Health Assembly ■"-as notified that the Republic of China wished to withdraw from WHO, presumably promj^ted by financial considerations. The notifi- cation wa'^ by telegram, dated 5 ]May 1950. Another telegram from the Central People's Government of the People's Rei^ublic of China, dated 13 May 1950, advised that the Republic of China should not be seated at the Assembly anyway, since it was not the legal government representing the Chinese people.'^ Finally, the Assembly (in plenary) accepted a resolution, without discussion or vote, which substituted "China" for "Republic of China" and which stated that "the resurnp- tion of China of full participation in the work of the Organization will be welcomed." ^^ However, as Calderwood states : By treating the communication from Formosa as a com- munication from a Member of the Assembly, in effect, [the action] recognized the Government in Formosa as the Gov- ernment of China [all China]. The Assembly's subsequent decision * * * inregard to the settlement of China's financial obligations to the Organization when China resumed active participation, had the same effect. ^^ "^ Ibid. pajTPS 21-22. . '* Thid.. nacTP 2fl. "= Ibifl.. pasre 26. ™ "Offleial Records of WHO," (2S). pasos 555-556. '■ Calderwood. op. cit., "Memhersliip in the WHO"', page 2S. ~^ Ibid., page 27. 713 The final solution to the question of China's financial obligation to "\^TH[0 was not worked out until the meeting of the Sixth Assembly ( 1954) . Calderwood says : The practice followed at the Sixtli Assembly in r-egard to the question of China's financial obligations is illustrative of the Assembly's attitude in dealing with almost every controversial issue, particularly one having a political aspect. The resolu- tion which was finally accepted was the product of many in- formal conversations and meetings. Representatives of the Republic of China were consulted at various stages of these conversations, largely arranged on its behalf by representa- tives of States friendly to the Government in Formosa. The Secretariat wa^ consulted as to the feasibility of sue:o:ested courses of action under consideration. These were also dis- cussed with representatives of the Members that had recog- nized the People's Republic of China, with a view to finding a solution acceptable to a substantial majority of the Assembly.'^ Calderwood does not note that by the time of the Sixth Assembly the number of Members present that had recognized the People's Republic of China was somewhat limited l)ecause of the prior with- drawal of the Eastern European States. Tlie politics of the situation was kept in hand because of their temporary absence. On the whole, WHO has dealt successfully with politically moti- vated proposals or proposals with distinct political connotations. Although some of these have been resolved for the time being they are likely to reappear. Some of these will have to do with the credentials of the Chinese Delegation, the Arab-Israeli dispute, suspension of cer- tain rights of South Africa and Portugal, radiation, nuclear testing, and disarmament. At the Twentieth World Health Assembly the United States and 39 other Members abstained on a vote in plenary session urging IVIembers of the UN to implement a resolution of the General Assembly with respect to the use of poisonous and other gases. The United States had argued in Committee that the World Health Assembly was not the proper forum for resolution of this issue.*"' CONSENSUS VERSUS REGUL.VTION ON PHARMACEUTICAL QUESTIONS •ilk The questions of drug safety, well within the domain of considera- tion by WHO, though non-political are controversial. Resolutions to warn countries about the use of "wonder dru^,'' ^' and narcotic and psychotropic drugs ^^ have met with little resistance. However, as in the United States, resolutions which have become controversial invohed the establishment of an international system for monitoring the adverse side efi'ects of drugs, drug efficacy,''^ quality of drugs,-* and ]5harmaceutical advertising.*^ ^9 Ibid., page 30. 8" Twentieth World Health Assembly, Resolution No. 54. In "Handboolv of Resolutions." (Eighth Edition. 1948-1967.) ^ Fifth World Health Assembly, Resolution No. 76, In Ibid. s2 Eighteenth World Health Assembly, Resolution 47 and Twentieth World Health Assem- bly Resolution 43. In Ibid. S3 Fifteenth World Health Assembly, Resolution 41 : Sixteenth World Health Assemtilv. Resolution 36. Tv,entleth World Health Assembly, Resolution 51. and Twentv-third World Health Assembly. Resolution 13.. In Ibid. 8* Twenty-first World Health Assemblv, Resolution 41, In Ibid. ^ Twelfth World Health Assembly, Resolution 3S. Twentieth World Health Assemblv Resolution 34, Twentieth World Health Assembly, Resolution 51, and Twenty-third \\ orlii Health Assembly, Resolution 13. In Ibid. 714 T)n one of these issues, it was the absence of a systematic interna- tional warning system, among other things, which precipitated tlie thalidomide tragedy j-^*^ and WHO has only recently initiated steps toward a fully operational system for international dnig monitoring. But the delay has been more of a technical problem than a political one.*' In recent years pressure has increased within WHO to adopt health regulations concerning phannaceutical products. Under Article 22 of the Constitution, the Health Assembly has the authority to bring such regulations into force (if it were to pass them) "for all members after due notice has been given of their adaption by the Plealth Assembly •except for such members as may notify the Director-General of rejec- tion or reservations within the period stated in the notice." ^* Also Article 21 points directly to "standards with respect to the safety, purity and potency of biological, pharmaceutical and similar l^roducts moving in international commerce; advertising and labeling of biological, pharmaceutical and similar products moving in inter- national commerce." *^ As a general practice, however, in this area as well as others, the Assembly has preferred to make recommendations in order to obtain uniform practices rather than adopting conventions or regulations under constitutional provisions.^" With few exceptions, ever since the First Assembly the attitude of ^VHO has been to rely on the discretion of Members as to the methods to be employed to attain the objectives of Assembly resolutions.^^ In some instances the Assem- bly has sought to achieve the objectives of WHO by simply declaring itself against certain practices rather than regulating against those practices. For example: The Assembly "* * * considers that any with- holding of scientific or t«drninistration matter. The Health Assembly ^-^ constitutionally empovored to redefine the member composition of "\"\T^IO's recional areas, but apparently has not been disposed to remove Israel from the Eastern Mediterranean resrion for political convenience or expedien^p. Once again, therefore, while the World Health Assembly has exercised diplomacy in handling political problems related to health, it con- tinues to reject political solutions to political problems. In the mean- time, health services as requested of T\TFTO have been provided to all of iihe countries involved, and the United States continues to cooperate with both Is^-ael and the Arab States on health matters throufirh various bilateral instrmnents. 104 "Offioiil ■Rp'^ords nf WHO " n!i!rr>« 4'>fi-427. i<« Kohort Berkov. "The World Hpalth Organization: A StiKlv in Decent rnlizod Inter- Tiati'innl Administration' ^Geneva. T/ibrarie K. Droz. If*")?), paces 183-4. 719 But tlie continuation of function of WHO in this most difficult situation is not limited to services rendered to the countries involved. One of the resolutions of the World Health Assembly in attempting to deal with this problem was to take the regional contestants out of thc- same arena. To accomplish this it established two subcommittees, Sub- committee B essentially for Israel, and Subcommittee A for the other States in the Eastern Mediterranean group. Both the Secretary Gen- eral of WHO and the Eegional Director have made every effort to con- vene both subcommittees but the Regional Director was unable to convene a meeting of the "Israel"' (B) subcommittee in either 1969 or 1970. Under these circumstances, and according to the 33rd Resolution of the Seventh World Health Assembly, Subcommittee (A) submitted its "opinion" (report) to the Director-General. It had met in Lebanon during Sej)tember 1970, with regrets being expressed that- Ethiopia and Jordan did not attend. France sent a delegate who chanced to be located in an Eastern Mediterranean French territory- ; and, of course, Israel was not supposed to attend. It had been a "Sub- committee B" country for several years. But the meeting came off well just the same, with 19 members and associate members attending, as well as representatives of the UN, the UNDP, UNICEF, FAO, and some 14 international non-governmental and intergovernmental or- ganizations. The 35-page report to the Direct or- General dealt with environmental deterioration, clironic and coimnunicable disease, the Pearson and Jackson Reports, the integration of family planning liealth services into maternal and child care, the shortage of health manpower, and medical education.^"® In fact, an impressive agenda was competently handled by this rather makeshaft rump session. Its ac^^omplishment reveals both the abilit}' of who's participants to overcome adversity and the prospect of still larger benefits that could result if the dissident factions cx)uld find a viable coui'se to more general cooperation. On this basis, it is worth- while to examine in detail the achievements of Subcommittee A at its 1970 meeting. The Director's report stated that the "brain drain" was being over- come with the assistance of WHO, that there were new efforts to eradicate smallpox in Ethiopia, and that a poliomyelitis outbreak in Lebanon had been controlled with WHO assistance. A WHO scientist had surveyed X-ray equipment and safety measui-es in 15 countries. A number of recommendations were macle with respect to the control of cholera and tuberculosis and to the strengthening of national health services through a network of health centers. The Subcommittee gave high priority to the training of national manpower; the control and eradication of communicable diseases; and improvement in environ- mental health, community water supplies, laboratory services, nutri- tion, medical research, and radiation protection. The report spoke of improved working and housing conditions and of special attention to vulnerable populations. The responsibility of national authorities concerning the health manpower problem was repeatedly emphasized. It was estimated that 5000 new teachers would. K* "Report of the 1970 Session of Snb-Committee A of the Regional Committee for the Eastern Mediterranean" (November .'50, 1970). 720 bo required in the Region in the next fi\e or ten years, and there was an extraordinaiy emphasis that such medical teachei"S know how to teach as well as to possess an aderpiate knowledge of the subject matter. There was a discussion on how to reduce the present pressure on hospital beds by means of preventive measures, less si^ecialized hos- pitals, and the removal of disabled patients for rehabilitation and ambulatory care elsewhere. The medical schools in the region had increased to 46 with six more planned to start next year. WHO had supplied teachers, consultants, fellowships and means for exchange visits of medical faculty members within the Eegion. The 1972 budget for tlie Eastern Mediterranean Region, including UNDP and Funds-in-Trust, was approximately $12,000,000. The Regu- lar budget showed a 9 percent increase over the 1971 figure. (This regular budget increase was about the same as that for WHO as a whole, and is ah example of one of the primary sources of WHO budg- etary increases over the years — the regional requirements.) Some Difficulties in Achieving and Sustaining Internationa]. Coopera- tion In Health Through WHO In the Introduction to tliis study, the statement was made that inter- national cooperation in public health Avas not easily achieved nor is it easily sustained. This statement refers to the World Health Organiza- tion, but it applies to any of WHO'S predecessor organizations involv- ing more than two gOA^ernments. The birth of such multinational organizations as the Office of International Hygiene, the Health Organization of the League of Nations, and the World Health Organization was difficult despite the evident need for such international health treaties. It is t-empting at first to ascribe blame for such difficulties to the natural political orientation of go^'ernments ■per se. Indeed, there is no doubt that scientists, engineers, and physicians have less friction at international congresses and that public health workers get work done more expeditiously when they do not have to worry about the position of their governments or when long-term national commitments on behalf of their governments are not involved. But when either pei-sonal or governmental interests are at stake in i)ermanent international agreements, professional medical people are often as politiail as their professional diplomatic counter- parts are expected to be. For example, there is every reason to believe that the inordinate two-year delay of the United States in ratifying the constitution of WHO was motivated by lx>th medical-political and national-political considerations. According to Allen ^°' and Goodman ^°^ there were fears that WHO would become involved in such questions as health insurance and socialized medicine. Agreements concerning the Pan American Health Organization (PAHO) and the World Health Organization were delayed even longer. It was not until 1950 that an agreement between PAHO and the Organization of American States (OAS) authorized the former to act as a regional organization of the World Health Organization in the Western Hemisphere. In this c^ipacity, PAHO w^as to remain "" C. E. Allen, "World Health and World Politics," International Organization (Vol. 4, 19r,0),page27. 1'^'* Goodman, "International Health Organizations." op. cit.. page 20. 721 an Inter-American specialized organization, to continue to enjoy the fullest autonomy and to respond to the recommendations of the OAS Council. ^°^ This action by the OAS left hanging an earlier (1949) "first step-' integration agreement between PA HO and WHO and the issue has not been revived.^^°. A few months after the Internatioual Health Conference of 1946 had made provision for integration of PAHO with WHO (Article 54) , the Directing Council of PAHO adopted a resolution deliberately designed to prevent such integration from : * * * affecting the identity of tlie Bureau, lessening its administrativ^e autonomy, limiting its economic independence, disturbing its essential develoi)nient and detracting from its character as a continental, coordinated health organization of the people of the Americas.^^^ The Directing Council of PAHO went e\ en further and " * * * advised the American States in ratifying the World Health Orga- nization Constitution, to make a reservation that w^ould recognize the supremacy of the Pan American Haalth Organization over the Con- stitution of the World Health Organization." ^^- The obstacle to full integi'ation was made essentially insurmount- able in a charter adapted by OAS in June, 1948. Article 100 of that charter was apparently aimed directly at the 1946 AVHO Constitution. That article states : The specialized organizations shall establish cooiDerative relations with world agencies of the same character in order to coordiuute their activities. In concluding agreements with international agencies of a worldwide character, the Inter- American specialized organizations shall preserve their iden- tity and their status as integral parts of the Organization of American States, even when they perform regional functions of international agencies.-" AVhatever it was that PAHO or OAS had in 1946 that it Avished to ])rotect from full integration with WHO is not evident. The situa- tion and the outcome are not altogether unlike those of the final devel- opments concerning the "Paris Office" and the Health Organization of the League — ^the coexistence of two international organizations, one regional and the other universal, with the regional organization ful- filling obligations to two different international agreements and with overlapping regional interests. This latter specific problem in PAHO was solved by providing that all meetings of the Directing Council or of the Pan American Sani- tary Conference would be at the same time meetings of the Regional Committee of the World Health Organization, except when constitu- tional or juridical matters were under consideration. Accordingly, representatives of tlie European States with territorial interests in tlie Americas have attended PAHO meetings with full voting rights since 1951."* "*' Calderwoofl. "The World Heullli Orjianii^ation aiul Its Regional Organizations," op cit., jiMfre 24. ""Ibicl.. page 25. 1" Ibifl., page 23. "- Ibid., page 23. ""Ibid., page 23. "' Ibid.. pa.£rps 24 5. 722 lliG ^YHO concept of a single international health organization re- mains technically unfulfilled. Meanwhile, in accordance with prior agreements, the Pan American Sanitary Bureau functions much as do the other Regional Offices of WHO."=^ The Pan American Health Or- ganization remains legally an Inter- American specialized organiza- tion of OAS. But the arrangement is working and the technicalities are being ignored. Persistent Tendency to Neglect Health oh an Internatloval Goal Apart from the scientific and political difficulties of establishing multinational machinery for cooperation in health, it is disconcerting to note that on at least' two major occasions formal diplomacy came close to overlooking global health altogether. Both the Health Or- ganization of the League of Nations and the World Health Organi- zation were last-minute additions to the Covenant of the league and the IT.N. Charter. Dr. K. E^^ang of the Health Services of Norway recalls : One interesting historic exami)le is that health was "for- gotten" M-hen the Covenant of the Tieague of Nations Avas drafted after the first World War. Only at the last moment was world health brought in, producing the Health Section of the League of Nations, one of the forerunners of the pres- ent FAO, as well as of WHO. Althougli international par- ticipation in the League of Nations was limited, the Health Section of the League developed into one of the most success- ful and non-controversial parts of the organization, making itself indispensable through its statutory functions. Who Avould have thought, therefore, that health would again be "forgotten" when the Charter of the United Nations was drafted at the end of the Second World War? However, tliis was exactly what happened, and the matter of world health again had to be introduced more or less ad hoc at the United Nations conference at San Francisco in the spring of 1945."'' It was only the vigorous intervention of the national delegations from Brazil, China, and Norway that held a plac« for an international health organization under the United Nations.^^'^ Three advisers in health matters. Dr. De Paula Souza, Dr. Szeming Sze, and Dr. K. Evang— hardly diplomats or politicians in the usual sense — took the initiative which ultimately resulted in the World Health Organization. Evang is quick to note that the reluctantly-launched WHO Avas not to be in for smooth sailing : The World Health Organization came into being just nt the time (1948) when the political honeymoon which the United Nations had enjoved for a short period after the Second World War had definitely come to an end, and the "cold war" had started. It was of coiu-se a most unfortunate political cli- mate for a newcomer which was supposed to act non-politi- cs Ibid., paK*' 24. "" ••Rcaltli of Miiiikiiul," oil. cit.. i)ai,'(s 202-::. ^ ^ „, ,^ ""Ibid., page 20;i. See also: Charles. "Origiii>', bistor.v. and achievements of the World Health Ovgaiiization," op. cit., page 294. 723 cally in the field of internatioiiul health, but which was built and run by member governments. Tlie withdrawal for a short period into "inactive membership'' of the group of Eastern European countries was a blow to the organization, from which, however, it recovered. The lacli of success in bringiiig the People's Republic of China in as a member, was — and still is — much worse. It means that a whole wall is missing in the building. The Arab- Israel conflict also created some trou- ble. As if this was not enough, influential political forces of a more general character made themselves felt through the UN itself, threatening the independence and technical integ- rity of WHO and other specialized agencies. The ver}^ prin- ciple established at San Francisco in 1945, namely to give scientists, technicians and administrators a chance, in the specialized agencies and independently of political considera- tions, to build international co-operation on a broad scale, was in the process of being betrayed. The most dangerous attack came through the proposal in the UN for a "consolidated budget". In principle this meant that all the member states of the UN would liave had to pay only one contribution, namely directly to the United Nations. Like the individual ministries in a national government, the various specialized agencies would have to produce their sep- arate programmes. A clear-cut political body, namely the UN itself, would then have discussed, accepted or rejected these programmes, decided priorities and finally allotted to each specialized agency one part of the total consolidated budget. If I am not wrongly informed, high credit goes to the Di rectors- Greneral of the most important specialized agencies at that time — Morse, Iloxley, Boyd Orr and Chisholm — for stopping this frontal attack to get political control over the specialized agencies. A weaker and more indirect attempt was made later when the UN progrannne of technical assistance was introduced, but this also worked out in a satisfactory way on the whole. Again great credit for political wisdom goes to the non- political heads of these organizations, including Dr. Candau (AYHO)."^ Cost of U.S. Participation in ths World Health Organization Few problems have come before the governing bodies of WHO so regularly and have remained so stubbornly controversial as the ques- tion of how nnich money it should spend on its work. In the early period of the Organization's history C. E. A. Winslow tried to lay out the general guidelines : The tavsk is a vast and difficult one. It is particularly chal- lenging to the World Health Organization, because it seems clear that a public health program adapted to the individual needs of each area offei-s the most economical method of break- ing the chains of disease and poverty and initiating an up- ward cycle of social evolution. To accomolish the end in view 1"* "Health of Mankind," op. cit., pages 205-206. 724 two things are necessary. The first essential is an analysis by each country — at whatever stage of health evolution it may be — of the most vital health problems which may be attacked with maximum results at minimum cost. The second essential is the development of cooperative prog-rams of technical as- sistance, in whicli the more fortunate areas may cooperate with those of less advanced development for the common goal of a healthful, prosperous, and peaceful world.^^^ Xevertheless, disagreement has persisted. On the one hand, ancl speaking for a number of countries, Dr. Evang told the third World Health Assembly : If half, or one-third, or even one-tenth of the present scien- tific knowledge of medicine had been spelt out in terms of public health administrations, hospitals, sick insurance schemes, doctors, nurses and auxiliary personnel, in a proper production and distribution of drugs and insecticides, medical literature and equipment, the picture of the Avhole world would have been very different indeed from that which meets the eve today * * =^\ "The vast majority of the peoples of the world still live in bondage to disease and misery. Science knows the means to rapid improvement, and we know how to administer the proper health measures. We are not dreamers, but practical men. Nevertheless, a majority of the member countries them- selves voted a budget for WHO which is disastrously inade- quate. Wliy has this situation arisen and why do we uphold it ? I am not offering an explanation, because I know of none which would satisfy you and me.^^*^ Representatives of other nations at the same Assembly dissented and expressed other concerns : . * * * Ivest the Organization attempt to cover too much ground superficially, and pointed out that it was essential to limit its activities to work that could only be done through inter- national machinery or particularly lent itself to international action. That international funds should be spent sparingly, and primarily to help countries face problems for which their own resources are inadequate, has been repeatedly emphasized by representatives of all governments and is one of the funda- mental principles on which international w^ork rests.^-^ SOME ASPECTS OF U.S. SUPPORT OF THE WHO BUDGET As the activities of WHO began to appear rewarding, and as the number of member nations increased, the Organization received more requests for aid and assistance. The Director-General's budgets re- flected this growing need for funds and the World Health Assembly with few exceptions voted approval of the increased budgets each year. The budgetary approvals often resulted from the large vote "9 C. E. A. Winslow. "The cost of sickness and the i)riep of health.'' WHO Monograph Series, No. 7 (Geneva. 1951), pages 9-10. 12" Third World Health Assemhly, 1950. 121 WHO Chronicle, (July 1960). 725 from llu' new luid needy countries. The United States rarely voted for approval of the bndget, and has recently Avorked with the other major contribntjng States ("the Geneva Group"') to try to reduce it. One of the few times that the United States did vote for the Director-Gen- eral's working budget as proposed was in i5).3h. On this occasion the budget was approved by ac(damation. TABLE l.-RECENT EVOLUTION OF THE WHO BUDGET AND U.S. ASSESSMENTS' (CALENDAR YEAR) Year 197P 1970_ 1969. 1968. 1967. 1966. 1965 1964. 1963. 1962. 1961. WHO regular budget Percent increase over previous year U.S. assessment Percent U.S. assessment to regular budget _ $73,230,000 8.2 8.9 10.7 7.8 li.7 12.6 14.4 13.6 22.2 25.7 16.9 $23, 648. 660 21,680,810 19, 533, 130 18,075,620 16, 627, 320 13,578,420 12,327,120 10, 852, 040 9,611,280 7, 657, 430 5, 999, 700 30 87 67,650,000 30.87 62,121,700 31,20 56,123.000 31.20 52,075,600 31.20 44,481,800 39,507,000 31.20 31.29 34,542,750 31.29 30,394,100 31.12 24,863,800 31.71 19,780,448 31.70 1 Figures obtained from Office of International Health, Public Health Service. In 1958 a statutory limitation was placsd upon tiie U.S. payment which lequired that for any fiscal year it could not exceed 33)^ percent of the total assessments of the active members of WHO for that year. - Proposed. Beginning in about 1060 the WHO regulai- budget increased each year in increments var3'ing between $3 and $6 million (see table 1). The budget for 1971 was roughly 31/2 times larger than that for 1961. The percent of increase per year over this same j^eriod, hoAvever, showed a generally downward trend from 16.9 percent in 1961 to 8.2 percent in 1971. The average increase 196f)-1971 was 9.5 percent. The table reflects the continued growth of the United States' assessed con- tribution. The recent preoccupation of the United States, and of some other major contributors/-^ is to stabilize the WHO budget and i-educe the rate of increase. Although U.S. participation in WHO has been influenced by neces- sary budgetary restraint in recent years, there is reason to believe that other restraining factors of one sort or another have been operating from the very beginning. Some of these factors seem well established in spite of the good performance of the T'nited States in voluntary contributions to international health activities in general and its faithful ])ayment of assessments to WHO in particular. For example, early congressional actions with res])ect to WHO were not enthusias- tic, as has been documented by Ivussell in a paper on '"International Preventive Medicine" ])ul)lished in 1950: Although .Vmeiican leaders in preventive medicine had a prominent part in laying the groundwork for WHO, the Ignited States Congress has thus far given it reluctant and limited support. ^-^ Slow to ratify the | AVHO] constitution. Congress arbi- trarily fixed ourannual pai-ticipation in the budget of WHO iKIn i;)(V2: U.S. share, 31.7 percent; U.S.S.R., 12,48; United Kiugdom, 7.13; France, 5.86 ; Federal Republic of Germany, 4.88 : China (Taiwan). 4.59 ; Canada, 2.85 ; India, 2.25 ; Italy, 2.06: Japan, 2.01; Australia. 1.64; Sweden. 1.27: Poland, 1.25; Belgium, 1.19; Argentina. 1.02. Mo.st of the member nations contributed less than 1 percent. ^-' RussoU. ■"International Preventive Medicine." op. cit., page 397. 726 at 1.9 niiJlioii dollai-s '"'' (moanwhilo appropriatinir tens of millions for fshoi-t-terin bilateral health aid * '•' '■"■.) ^-'' A measure recently passed by Conaress j^ermits onr an- nual a])prC)iiriation for WHO to be increased np to H mil- lion dollars ^^^ * * * this new bill met stiff opposition.^-* Such hesitant cooperation is regrettable, for (^onixre'^s, has re]>eatedly demonstrated oi-eat interest in public health. Doubtless this o])position is simply the reflection of a lack of active and informed concern on the part of laymen and most physicians about the subject of international preven- tive medicine.^^ Perhaps two hypotheses can I)© derixed from Ixussell's points con- cernine: the prominent role of American leaders in layinjs; the ground- work for WHO and the lack of active and informed concern on the ])art of most American physicians in international preventive medi- cine : ( 1 ) The American leaders involved in the planni ng of WHO were more likely to have been mostly diplomats and specialists in preventive ined'ichie or piihlic healfli. rather than ex{)erts in curative mediehie lolth hidivuJiial patient orientation, the latter dominating the power structure of American medical practice at the time. (2) The concern of American physicians during the planning and Congressional rati- fication of WHO may have involved the implications of health insurance jind socialized medicine in. an international context rather than the problems of preventive medicine on an international scale.^^° THE IMPACT OF DEVELOPMENT STUDIES ON WHO Little in the recent studies available to the Congress concerning international deA'elopment focuses attention adequately on the extent to which poor health impedes social and economic progress of man- kind. The Pearson Report,"^ for example, dismisses international healtli ])roblems in two pages (of some 400), vet conveys the impres- sion of sweeping advances in the control of infectious diseases and the sweeping spread of therapeutic health services worldwide. It credits to "\^TTO achievements which that agency Avould not itself claim; as a practical matter, the unsolved health problems confronting WHO and other international health institutions are extensive and diflficult. Of the report the New England Journal of Medicine states : The cursory and grossly inaccurate treatment afforded health is representative of current economic thought.^^^ The Jackson Report ^^^ appears to deemphasize the World Health 12= This action In effect fixed the size of WHO's regular budget, because of the assessment formula. 1^ Russell, "International Preventive Medicine," op. cit., page 397. ^^ This action, too, in effect fixed the size of WHO's regular budget. 1^ Russell, "International Preventive Medicine," op. cit., page 397. ^ Idem. 130 Allen, "World Health and World Politics," op. cit, page 27, and Goodman. "Inter- national Health Organization," op. cit., page 20. See also WHO Constitutional Function, "P," Part 11. 1=^ Lester B. Pearson, "Partners in Development," Report of the Commission on Inter- national Development. (Set up at the request of Robert S. McNamara, President of the International Bank for Reconstruction and Development.) (New York, Praeger Publishers, September 15, 1966), pages 12, 40-41. 13^ "Medical Research as Measured Against the Needs -of All," op. cit., page 537. 133 "X Study of the Capacity of the United Nations Development System," Vol. 1, (Geneva, United Nations, September 30, 1969). Organization in favor of a reorganized United Nations Development Program as the focal point of funds, coordination, review, ancl deci- sion in technical assistance for country-centered health programs. It proposes that somehow the UNDP can simultaneously coordinate and decentralize. Using WHO as an example, this report tells the member governments that they can stabilize that Organization's budget at its present level. On the basis of the Jackson Capacity Study, one could hardly expect present and future appropriation committees to expand the budget of WHO, even though full implementation of the United Nations Development Cooperation Cycle (UNDCC) con- cept, which the report recommends, may be several years away. The Peterson Task Force report ^^ would rely on multilateral orga- nizations like WHO in place of AID, but there is no specific rec- ommendation that AID funds in health and sanitation be transferred to WHO. There is also little reason to believe that new breakthroughs in science and technology as anticipated through a proposed U.S. International Development Institute represent a primary need at this time for WHO or any other organization working in the field of inter- national health. The report doesn't mention WHO and rarely mentions health, but its philosophical stance warrants elaboration in a later section.. The economists, international organization experts, bankers, and fiscal managers who prepared these three reports are distinguished scholars and businessmen whose conclusions deserve serious considera- tion in the long run. However, for the immediate future and possibly for the next few years appropriation committees of Congress might also examine the growing budgets of WHO and PAHO and the U.S. contributions thereto in the light of applying the technology already available to alleviate the mass misery of ill health abroad as well as at home. A report of this type, by Dr. John Bryant of the Rockefeller Foundation, is commended by The New England Journal of Medicine, citing especially the following paragraph from the preface of Dr. Bryant's book: Large numbers of the world's people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have. The grim irony is that dazzling advances in biomedical sciences are scarcely felt in areas where need is greatest. Vast numbers of people are dying of preventable and curable diseases, or surviving with phji-sical and intellectual impair- ment for lack of even the simplest measures of modern medicine.^^^ The Journal notes incidentally that "Bryant's excellent study bene- fited from an Advisory Committee, representing a broad experience in the international health field, and including senior staff members of the World Health Organization.'^^ 13* ' r.S. Foreign Assistance in the 1970's : A New Approacli.' Report to the President from the Task Force on International Development. March 4. 1970. (Washington. U.S. Government Printing OflBce, 1970). page 2. i»6 John Bryant. "Health and the Developing World." (Ithaca, Cornell University Press, 19R9). preface, and page IX. "« "Medical Research as Measured Against the Needs of All," op. cit., page 538. 728 The cost of international collaboration in public health through multilateral organizations may be relatively less in the future than in the past. The "engineering'' lessons have been learned and institu- tions can now devise more cost-eifective designs. Much is known about, how, where, and when to provide technical assistance in international healtli. As Bryant says, "to give effectively is an exacting task. To give without doing harm is, surprisingly, equally exacting." ^^^ TOTAL COST OF WHO ACTIVITIES AND TOTAL U.S. CONTRIBUTION Actually, the United States contributes larger funds to WHO than those indicated in Table 1 "The Recent Evolution of the WHO Budget and U.S. Assessments." WHO's regular budget on which assessments are based does not adequately reflect the total amount of funds avail- able to the Organization and for which it is administratively respon- sible. Table 2 provides some estimated data for 1968 to enable comparison of sources of all funds administered directly or indirectly by WHO and the U. S. assessed and voluntary contributions to those sources as utilized by WHO. Since one study (Jackson) suggests that the WHO regular budget might be. fixed at its present level and that future voluntary funds for technical assistance be centralized under a "beefed up" and re- organized UNDP, it becomes possible to visualize stronger U.S. influ- ence over any future expansion of international health activities. TABLE 2.— SOURCE AND AMOUNT OF TOTAL FUNDS ADMINISTERED BY WHO, INCLUDING TOTAL U.S. CONTRIBUTIONS (1968) 1968 obligations for activities funded directly U.S. contributions or indirectly to WHO Source of funds by WHO activities— 1968 Regular budget $56,123,000 $17,989,000 UNDP: Expanded program of technical assistance U.N. Special Fund 7.616,526 3,046,810 Voluntary funds for health protection 6. 922, 419 1, 288, 930 International Center for Research on Cancer 1,600,000 150,000 UNICEF 17,000,000 12,000,000 PAHO (regular and other) 14,589,460 8,479,825 Total .., 107,073,731 43,249,645 Funds-in-trust. -_ 2,860,499 That is to say, unlike the AVHO Executive Board and Health Assembly where the U.S. has one vote out of 24 and 181 re^spectively, in the UNDP the United States sits as a memloer of the Governing Council wliich is composed of equal numbei'S of representatives of developed and less developed States. In addition, the UNDP at the present time is under strong and competent management by an American administrator. The implications of these prospects become even greater, if a larger amount of T".S. funds for loans, foreign aid, and technical assistance are transferred from bilateral programs to such multilateral agencies as the UNDP and others. It does not necessarily follow that increased United States technical and programatic influence over international health activities is the "' Bryant, op. cit., page 29.S. 729 clue to a substantially improved health picture for the world. A greater U.S. influence, however, would satisfy the demands of American policymakers that such influence exists. The Congress can also be expected to find merit in the equal representation of donor and recipient countries on the UNDP Governing Council as well as improA-ed coordination of international health work through that Council. For comparative purposes it is useful to show the relative amounts which the United States contributes to international health (WHO) through involuntary assessment and the amount which it spends on certain related activities. The U.S. assessed contribution to WHO for 1971 represents approximately: — One dollar for every 800 dollars which the Federal Government appropriates in one way or another to its own total health budget ; — One dollar for every 2000 dollars which United States citizens spend for health care ; —Less than one half of one percent of the total outflow of funds for overall technical assistance to the lesser developed countries; — About 15 percent of the total assessed contributions of the U.S. to all international organizations; and — Abont 20 percent of the total U.S. assessed contributions to the UN and its Specialized Agencies. III. U.S. Agencies Supportixg International Health Programs There are 20 U.S. Government units w^hich in one way or another are involved in international health and related programs. The latest estimate for the amount of funds provided annually by the U.S. Government in support of this omnibus category is "$175 million, exclusive of the Food for Peace Program, foreign currencies generated by repayment of loans and the sale of agricultural surpluses under Public Law 480, and the funds made available through the internaitional lending agencies." "^ Apparently, overseas scientific activities, including biomedical research, peaked around 1965 and together with AID health activities have been gradually declining since then. The major U.S. Government departments or agencies which support programs of research, technical assistance, or economic aid in health and related subjects overseas, are the Department of State, the Depart- ment of Health, Education, and Welfare, and the Department of Defense. International Health Acticities of the Department of State The two principal organizations in the Department of State that have to do Avith international health matters are the Bureau of Inter- national Organization Affairs and the Agency for International Development (AID). The Bureau of International Organization Affairs administei"S the U.S. contributions to international and Inter- American organizations and to certain special programs. These activities, especially as they relate to WHO and PAHO, are discussed in Section IV. '38 "International Cooperation in Health and Sanitation Programs." Draft prepared by the U.S. Department of Health. Education, and Welfare, and the Agency for International Development (November 8, 1965), page 18.5. 730 AID administei"S the bulk of United States bilateral technical find economic assistance, inchidino- healtli and sanitation projects, and makes voluntary contributions to multilateral organizations like the United Nations Development Program. Although the U.S. foreign aid program has luidergone many changes, is re-organizing now and will doubtless reorganize again, the original objective remains essentially intact. The concept as it applies to the health of the less developed countries was described several years ago by David E. Bell, administrator of AID at that time : — to help them act to meet their most immediate health problems — of which the most conspicuous are malaria and the water-borne diseases — and — to help them create the trained personnel and the functioning institutions to enable them progressively to overcome their health problems. The most urgent of these institutional changes are generally taken to be those which are concerned with training health personnel, those concerned with the provision of public health services, and those concerned with the study of a nation's health problems and with planning how to meet them." ^^^ In what may be considered a well-phrased political objective, the health progi^ams supported by AID are : * * * Measures that bring better health to the whole popu- lation, or a large segment of it, lay a basis for a bix>ader distribution of political power, for where only the elite are healthy and vigorous and most of the people are lethargic from sickness, power tends to remain concentrated and demo- cratic institutions are not likely to develop. 140 AID'S INTERNAmONAL HEALTH ACTIVITIES It is difficult to determine from AID's diverse activities in health matters which ones should be regarded as clearly emergency or relief as against longer term public health pi'ograms, or indeed which pro- grams are bilateral and which multilateral. Tlie war on hunger, the green revolution, population and family planning, nutrition and child feeding, and food from the sea, as described in the Foreign Assistance Program report for 1969,"^ are crucial to the health of all populations and especially those where malnutrition and endemic disease work together in the production of high morbidity and mortality. Also what may appear to be a straight ward engineering operation may have a most profound significance for public health. For example, one of the largest health programs, in financial terms, which AID has supported was that for community water supply development and sewerage and waste disposal. The financial assistance (from about 1961 to 1965) was nearly $400 million, but was largely in the form of loans from international lending agencies. These funds, together with local ex- penditures made by the developing countries involved, constituted an $800 million improvement in water supply and sewage dis})osal sys- tems."^ Tliis type of cooperative venture does not require a pliysician "9 Ibid., piige 69. "" Ihid.. pnges 75-76. 141 "The Foreign Assistance Program, Auniial Report to Congress for FY 1969" (Wash- ington, U.S. Government Printing OflSce, 1970), pages 11-14. >" 'International Cooperation in Health and Sanitation Programs," op. clt., page 76. 731 either from the United States or in the host country, but it is never- theless "preventive medicine" and in this sense is a health program. It will be noted in a later paragraph that AID is still active in promo- tion of the management, operation, and maintenance of water and sewerage systems. AID health work is bilateral, except for U.S. voluntary contribu- tions from the AID appropriation to the United Nations Development Program ($71 million in 1969), a part of which is utilized by WHO; or contributions to UNICEF, much of which is administered by WIIO."^ AID also contributes to the Special Development Assistance Fund of the Organization of American States which supports multi- lateral activities."* A general de^scription of AID's health activities was presented in the 1969 AID report to Congress : AID health programs in fiscal 1969, amounting to $123 million [iiichiding $45.4 million for population programs], were coordinated Avith those of international organizations, such as the World Health Organization, Pan American Health Organization and the United Nations Children's Fimd. Support for malaria eradication programs was provided in 18 countries under bilateral agreements. Of a population of 753 million in the malarious areas, 256 million now live in areas where the disease has been eradicated and 189 million where malaria transmission has been stopped. An active anti- malaria campaign is protecting an additional 288 million people. ^leasles control and smallpox eradication programs covered 19 countries in Central and West Africa where more than 68.4 million people have been vaccinated against smallpox and 11 million children vaccinated against measles. In environmental health activities, the management, oper- ation and maintenance of water and sewerage systems con- tinued to be emphasized in efforts to lessen the danger of dis- eases caused by pollution. Research projects have developed new approaches to the control and eradication of epidemic and endemic diseases. Promising leads to possible immunization techniques for the prevention of malaria were established. The major causes of death in infancy and childhood were also studied."^ TRENDS IN THE LEVEL OF SUPPORT FOR AID'S HEALTH ACTIVITIES Beginning in 1956, the overall trend in AID dollar contributions in support of health and sanitation programs and the use of counter- "' "The Foreign Assistance Program.'" op. cit.. page 42. There are two t.vpes of appropria- tions involved in the State Department from which funds may be utilized for health work In fi>rpi?' '•■>i'nt''f< On^ Jiiiproiirintion is rMre^-tl.v to State for the assessed contributions Of the United State® to international organizations. The others are pursuant to the Foreign Assistance Act (AID) in "Funds Appropriated to the President." (See: "The Budget of the United States Government, Appendix, Fiscal Tear 1971," Washington, U.S. Government Printing Office, 1970), page 80. When funds from the later source are con- tributed to an international organization, AID's bilateral character becomes functionally multilateral. When a multilateral organization, such as WHO or PAHO sets up a project wtth a host country, the agreement is a bilateral one — between the international organi- zation and the host country. The difference in the latter case is that the agreement is not country with country. 144 "The Fore 'gn Assistance Program." op. cit.. page 3?. U6 "The Fort gn Assistance Program," op. cit.. page 15. 732 part funds for these programs is one of general increase up to 1963 and 1964. In 1965 these funds were sharply decreased to $48 million each. Table 3, below, shows the figures for the 1956-1965 time period. TABLE 3.— AID DOLLAR CONTRIBUTION AND WITHDRAWALS FOR COUNTRY USE OF COUNTERPART FUNDS AND U.S. OWNED LOCAL CURRENCY. 1956-€5 (Millions of dollars or dollar equivalent] < Category 1956 1957 1958 1959 1960 1961 1962 1963 1964 Esti- mated 1965 Dollars _ _ Dollar equivalent in local currency . 34.2 5.7 45.6 3.7 45 5 38.3 15.6 48.7 36.0 48.2 1.9 63.4 78.9 88.5 67.4 67.3 118.8 48.5 48.1 Total. . 39.9 49.3 50 53.9 84.7 50.1 142.3 155.9 186.1 96.6 > Report on the health and sanitation activities of the Agency for International Development for fiscal year 1967. Pre- pared by the Office of International Health, Department of Health. Education, and Welfare (1968), p. 79. This decreasing trend continues into recent years where it may be followed by observing the health and sanitation category in AID's tables on technical cooperation. For example the amount of pro]ect assistance in health and sanitation was $35.5 million in 1967 "®, $18.4 million in 1968,"^ and $13.2 million in 1969. Table 4, below, shows the level of AID health and sanitation projection assistance in 1969 of $13.2 million as compared with other fields of activity, totaling $250.3 million. TABLE 4.— AID TECHNICAL COOPERATION PROJECTS IN FISCAL YEAR 1959 BY FIELD OF ACTIVITY' [In millions of dollars] Field of activity Technical cooperation Total project assistance 2 263. 5 Regional and cou ntry programs 209. 5 Food and agriculture 38. 2 Industry and mining 6.0 Transportation. 6. 3 Labor. 9.1 Health and sanitation 13.2 Education. _ . 44. 5 Public safety 6.7 Field of activity Technical cooperation Regional and country programs— Continued Public administration. 14.0 Community development and social welfare... 3.0 Housing... 1. 1 Private enterprise promotion... 2. 5 General and miscellaneous.. 28. 2 Technical support 36.8 Nonregional projects 54. • Foreign assistance program, 1959. op. cit., p. 51. 2 Project total only; excludes $7,400,000 in program (nonproject) assistance funded from the technical cooperation/ development grant appropriation. AID HEALTH TECHNICIANS The number of U.S. technicians in health programs financed by AID declined much earlier than did the available fimds. There were 366 AID technicians in health and sanitation in 1960, 328 in 1962, and 215 in 1965. The reduction in South America was particularly marked, declining from 93 to 25 during the years 1960 to 1965.^** Both AID and Public Health Officials expected this downward trend in the number of U.S. technicians and advisers to be reversed. And by June 1967 it was ; there was at that time a total direct-hire and PHS i« Ibid., Attachment 5. 147 "The Foreign Assistance Program, Annual Report to Congress for FT 1&68," (Wash- ington, U.S. Government Printing Office, 1969), page 45. 148 "Report on Health and Sanitation Activities of AID for FY 1967," op. cit., pages 7-9. 733 AID-financed staff of 501 people (health, sanitation, and administra- tion). One hundred nineteen of these Avere located in Washington at AID and PHS and 197 were in Vietnam. The remainder were dis- tributed as follows : ^*^ Africa 82 East Asia 39 Latin America 34 Near East and South Asia 30 Total 185 CONTINUING RESOURCES OF AID In spite of continuing reduction in funds appropriated to AID it remains a sizeable organization. It had nearly 4,000 permanent posi- tions in 1970 as compared with 23,266 for the entire Department of State.^^" By direct-hire or interagency agreement AID employs thou- sands of additional people. Eighty-one U.S. voluntary agencies (most of them health-related) are registered with AID's Advisory Committee on Foreign Aid for the purpose of receiving overseas freight payments of supplies donated by numerous tj^pes of religious, regional, welfare, and national or ethnic interest groups. In 1969 this freight bill was about $5,000,000.^^^ U.S. Government excess property may also be shipped out under this ar- rangement, as well as food and drug surpluses of industry ; these last are transferred by donating the surplus to one of the registered volun- tary agencies. Some 500 nonprofit organizations, foundations, and missionary groups maintain overseas programs. In order to provide a central source of information concerning these various types of assistance projects, AID arranges under contract for the publishing of directo- ries by the Technical Assistance Information Clearing House. This idea is not unlike that recommended by the Public Health Service evaluation group as a result of a study conducted in Latin America in 1952. If these directories are complete and are utilized it should be possible to prevent duplicate materials from piling up on sliipping docks and air terminals as well as preventing technical assistance and missionaries from "stTimbling over each other" in a country in need at any given time. What is required, of course, are country registers: records of who is giving short and long-term assistance to a country and what the amount and nature of tliat assistance is. Such registers do not exist, very likely because of the high cost of assembling the data. RECAPITULATION OF AID ACTIVITIES In summary', AID has established unique guidelines and machinery for operations in international health work. However, funds available for sucli operations have been decreasing, year by year. AID still con- tributes significant amounts of money to ]nultilateral organizations such as the L^nited Nations Development Program, the U.N. Special i« Ihid., page 9. 150 "The Budget of the United States GovernniPiit. Fiscal Year 1972, Appendix," pages 77 and 6S4', 151 "xhe Foreign Assistance Program, Annual Report to Congress for FY 1909," op. cit., page 7.5. 734 Poi)uhuinii Fund, and UXICKF. Some of tliese funds are made avail- able to WHO and PAHO. The principal limitations of AID as an organization to serve the Nation's interests in health in all parts of the world are its lack of ade- (luate stati' in the medical field and its practice of concentrating as- sistance in relatively few countries. In the fiscal year 1060. 87 percent of aid's countrv assistance went to only 15 nations. [nfiriKitional Actlvitic.s of the Department of Health, Education, and Welfare Tiie Public Ilealtli Service (PHS) in the Department of Health. Education, and Welfare (DHEW), is the primary U.S. (iovermnont resouiT7> ill both national and international health. It is tiie official teclinic:i! liaision of the U.S. Government with the World Health Organization and the Pan American Health Organization. (The liai- son is in the Office of International Health, now under the Assistant Secretary for Health and Scientific xVffairs.) Its Chief Medical Officer played a major role in the drafting of the WHO constitution and has usually served as the liead of the U.S. delegation to the World Health Assembly. In addition to its constitutional role in WHO. PHS prepares tlie U.S. teclmical i)osition ])apcrs for the World Health Assembly, sup- plies or assists in providing experts for the WHO advisory commit- tees, and is tiio teclmical point of contact between the World Health Organization and the U.S. (lovcrnment. Many of DIIEW's ]al>oratories and institutes participate as Refer- ence Centers for the World Health Organization. There are 40 such WHO renters or laboratories in tlie United States. The National Cen- ter for Disease Control in Atlanta. Georgia, is the home of at least 8 of these Reference Centei's for the World Health Organization at the present time. The Department's prominent role in international health organiza- tions does not make for an exclusively multilateral orientation on its part. It ••"• * * has actively participated in bilateral health and sanita- tion ]>i-ograms supported by the I'.S. Government in many countries since World War II." ^ '- t'nder interagency agreements witli AID. 200 or more PHS staff membei-s work in cooperation with AID head- quarters or are on field location with AID missions. Additional PHS medical officei-s and other officers are assigned to the Peace Corps. ovf:rskas I'xrrs of iiif, xatioxal ixstitutes or health The National Institutes of Health (NIH) maintains overseas offices in U.S. E:iil)assies in Paris. Rio de Janeii-o, Tokyo, and New Delhi. It also supports research laboratories in the Panama Canal Zone (the Middle America Research T'nit), in Puerto Rico (Laboratory of Peri- natal Diseases), in Guam (Epidemiology and Genetics Centers) ; and adniipisteis tlie Pakistan (^holera Research Lal)oratory for SEATO.^^^ 3-- •Iiiteriiatioiial Cdoperation in Health and Sanitation Programs," (19Go), op. clt., IKitif !i4. 'M"Nin Almanac, 1970," (Washing-ton U.S. Government Printing Office, 1970), pages IMT-tt : See also: U.S. Congre.^s, House, Committee on Science and Astronautics. "The PMrtiiip.itioii 1,1" Federal A-incies in International Scientific Programs," Rei)ort of the Science I'ldicv Research and Foreign Affairs Divisions, Legislative Reference Service, to the Subconiiiiittee on Science. Research, and Development, 90th Congress, first session, (Wash- ington, I'.S. (J.ivernment I'rinting Ottice, 19G7), pages 137-9. 735 Other overseas laboratories supported by NIH are administered through grants to American universities. This is a five-laboratory program called the International Centers for Medical Rese^arch and Training.^^^ The total cost of the supporting grants in 1969 was about $2.3 million. The five centers are located as follows: 1. The Institute for Medical Research, Kuala Lumpur, Malaysia 2. All-India Institute of Hygiene and Public Health, Calcutta, India 3. Center at the University of Costa Rica, San Jose, Costa Rica 4. Institute of Hygiene, Lahore, West Pakistan 5. Center at the Universidad del Valle, Call, Colombia. THE FOGARTY INTERNATIONAL CENTER On July 1, 1968, the Congress and the President approved a bill of- fered by Rep. Melvin Laird of Wisconsin to establish the Fogarty In- ternational Center at NIH.^^^ To date, the Center has established pro- grams (1) for encouraging international communication among bio- medical scientists through conferences, seminars, and worksliops; (2) for Scholars-in-Residence, called "Fogarty Scholars," for the purpose of making advanced contributions to the health sciences, including philosophical, social, economic, and legal issues; and (3) for an Inter- national Visitors' Center as the focal point at NIH for the reception of international dignitaries and scientists. Tr> addition, the Fogarty International Center now administers the NIH International Postdoctoral Fellowship Program and the Special Foreign Currency Program. Under the Fellowship Program young scientists come to the United States for one or two years of advanced research training. The fellows come from about 40 countries. In Fiscal Year 1969, 173 fellowships were awarded (new and second-year) at a cost of $1,408,102. The Special Foreign Currency Program, earlier called the "Spe- cial International Research Program" (SIRP) , is a system of overseas health research projects utilizing P.L. 480 funds. These cooperative re- search agreements are usually set up for three- to five-year periods. Unless there has been a very recent change in the situation with respect to the availability of foreign currencies to NIH, it is correct to state that this program has been undergoing a rapid decline. As of June 30, 1966 current projects numbered 143 and the U.S. dollar equivalent in- volved was over $19 million ; ^^^ the 1967 appropriation Congress re- duced this program to $10 million ; ^^^ and the program was further reduced in 1969, as seen in Table 5 below: 164 "NIH Almanac. 1970," op. cit., page 139. IK "NIH Annual Report of International Activities, FY 1969," Prepared by the Fogarty International Center, National Institutes of Health. (Washington, U.S. Government Printing OfQce, February 1, 1970), pages 1—5. 156 'The Participation of Federal Agencies in International Scientific Programs," op. cit., page 138. ^" Ibid., page 144. 736 TABLE 5.-N1H SPECIAL FOREIGN CURRENCY PROGRAM' Name of country Number of projects Amount awarded fiscal year 969 Poland - . . - - 7 6 4 1 23 3 $1,254,309 Yugoslavia - 492, 830 United Arab Republic - - 478, 701 Israel 1,000 India - - 2.017,525 Pakistan . . - - 3,068,057 Total - : 44 7,312,442 I "NIH Annual Report of International Activities, fiscal year 1969," op. cit., pp. 141-153. THE RISE AND DECLINE OF PHS AND NIH GRANTS ^N INTERNATIONAL HEALTH I PHS and NIH awarded a limited number of grants to institutions in foreign countries and to international organizations between 1944 and 1960. The basic Public Health Service Act of July 1, 1944, was interpreted as providing sufficient legislative authority to empower the Secretary and the Surgeon General to conduct and support re- search overseas during that period. However, on July 12, 1960, new statutory authority for international health activities was provided : July 12, 1960 — Recognizing the importance of cooperation in international health research, Congress passed the Inter- national Health Research Act. Under the new law the Surgeon General was authorized to establish and make grants for fellowships in the United States and participating foreign countries; make grants or loans of equipment and other ma- terials to participating foreign countries for use by public or nonprofit institutions and agencies; participate in interna- tional health meetings, conferences, and other activities ; and facilitate the interchange of research scientists and experts between the United States and participating foreign coun- tries. ( Public Law 86-610, 74 Stat. L. 364. ) ^'^ For several years following the passage of this act, PHS and NIH international activities of all types were increased. Two additional programs have to do with research and training performed overseas. The programs differ primarily in the nature of the performer. In the Research and Trainees Abroad Program, the performer is an American scientist who goes to an institution in a foreign country for additional research and training. The institution is selected by the applicant and is usually located in a developed nation where biomedical research is well established and where the institution has won recognition of excellence in research. In the other program, of Research and Training Grants Awarded to Foreign Institutions, the research is performed by foreign nationals in these institutions. Once again, although many nations are recipients of these awards, the bias is in favor of the dei^eloped countries and the work is heavily research- oriented. These programs have also been declining. For example, the research grants awarded by NIH and the Bureau of State Services to foreign institutions in FY 1963 were 1,001 in number at a total cost 1-9 As summarized in the "NIH Almanac, 1970," op. clt., page 16. 737 of $15,477,000. In lOGO the coiTesixHuliiig- figures were 707 and $10,710,000.^*=^ By FY 10G9 the number of .such projects had decreased to 360 and tlie level of supi>ort to $5,00!),0(')0. The country distribution of projects and funds for FY lOGO are shown in the Table G, below: TABLE 6.— BIOMEDICAL RESEARCH AND TRAINING GRANTS OR CONTRACTS AWARDED BY NIH TO INSTITUTIONS IN FOREIGN COUNTRIES AND TO INTERNATIONAL ORGANIZATIONS, FISCAL YEAR 19691. Number of ArLOUiit Number of Amount Name of country projects awarded Name of country projects awarded Argentina 15 15 $20R. 571 204 332 Nigeria 1 45, 900 Australia Norway . . 3 75, 680 Austria 2 9.094 Pakistan.. 1 2,500 Belgium 7 79 SS2 Papua and New Guinea . 1 3,050 Brazil 12 120 eriod (1966 to 1969) the overseas biomedical research grants and contracts of DOD were reduced by a factor of between four and five. The 1969 country distribution of funds for medical research projects by the three services is shown in Table 8 below : 163 "The Participation of Federal Agencies in International Scientific Programs," op. cit., page 128. "« Ibid., paire 1.30. '"^ Letter from A. E. Ha.vward, Acting Deputy Director for Research and Technology, Office of the Director of Defense Research and Engineering to Charles S. Sheldon II, Chief, Science Policy Research Division, Congressional Research Service, Library of Congress, .Tanuary 20, 1971. 741 TABLE 8. --DOD CONTRACTS AND GRANTS FOR MEDICAL RESEARCH PERFORMED IN FOREIGM COUNTRIES.' (FISCAL YEAR 1969) . ^ ' [In thousands of dollars] Country India West Germany U nited Kingdom France Pakistan Australia Egypt Brazil Canada ■_. Republic of China. _ Israel. _. Italy Japan _l South Korea Malaysia Peru_ Philippines. Thailand Chile Ceylon Austria Belgium Holland Total 563.1 Army Navy 2 Air Force DOD total 200.7 3i."4" 15.0 15.2 10.0 11.0 215.7 6.0 ... 39.1 21.2 80.5 32.3 ... 43.3 283.1 -. 12.8 283.1 4.3 16.8 303. . . 303.0 - 106.9 - -. 106.9 45.4 ... 45.4 26.7 ... 26.7 53.7 ... 53.7 37.4 . . 37.4 41.6 .... 32.7 .... 27.9 41.6 32.7 27.9 22.7 . 22.7 7.6 . -. 7.6 18.8 ._. 27.0 18.8 27.0 1.0.... 15.0.... 1.0 15.0 15.0 15.0 2.0... 2.0 831.0 51.2 1,445.3 ' Letter, Hayward to Sheldon, January 20. 1971, op. cit. 2 Includes Public Law 480 special foreign currency funds. DOD MEDICAL RESE.VRCII LA P,OR.\ TORIES OVERSEAS For a great many years the Army and Xavy, have conducted medi- oal rescarcli in overseas lalxiratories which they own and operate nnder aj^reement with t]ie local go>p]-ninen.t and in cooperation with tlie scientists of the country in Avhich tlie hibovatory is located. The laboratories are usually located where tropical diseases (parasitic and infectious) can be stiidiecL A comprehensive summary of relevant information on these international health actiA'ities as they exist today is presented in Table 9, below : TABLE 9.-D0D MEDICAL RESEARCH LABORATORIES OVERSEAS' Unit Major program area Total Fiscal Total other Total year 1969 DOD per- U.S. per- foreign Area size (thou- sonnel sonnel nationals ft.2 sand) 2 U.S. Army Medical Component. SEATO Infectious diseases.. Medical Research Laboratory, Bangkok, Thailand. U.S. Army WRAIR Medical Research Unit, do Saigon. Vietnam. U.S. Army Medical Research Unit, Mid- do die America Research Unit. Canal Zone, Panama. U.S. Army Medical Research Unit Insti- do tute for Medical Research, Kuala Lumpur, Malaysia. U.S. Army Medical Research Unit, Nuclear medicine Landstuhl, Germany. U.S. Navy Medical Research Unit No. 2 Infectious diseases.. Taipai, Taiwan. U.S. Navy Medical Research Unit No. 3 do Cairo, Egypt.5 ' Letter, Hayward to Sheldon, January 20, 1971, op. cit. 2 Does not include military salaries. 3 National Institutes of Health. * Total laboratory, 40.700 sq. ft. 5 There is a small extension unit of this laboratory in Addis Ababa. 65 325 100. OCO 41 15 10,000 16 ! 12 44 4 5. 000 6 60 10,000 7 5,100 36 342 89.000 38 220 217.800 $1,374 251 155 176 15 1,168 1,372 742 Unlike overseas health research grants from all agencies, which have declined precipitously during the past five years, and unlike the five overseas laboratories of the National Institutes of Health, which have held their own in size and level of support, the DOD Medical Research Units Overseas have doubled their operating budgets. The Navy installation at Cairo is nearly twice the size it was five years ago and the number of foreign nationals working in the Navy units at Taipei and Cairo has increased significantly. The combined total of foreign nationals on the staff and in the overall work force of these two labora- tories is now 562. In view of the declines in almost every other aspect of international collaborative research in the health field, including military grants and contracts, this development must be regarded as an encouraging one to those interested and concerned with global pre- ventive medicine. In a recent pai>er, Dr. John C. Cutler, Professor of International Health and Director of the Population Division, T'niversity of Pitts- burgh, ])oints to the imiiwrtance of military medical experience abroad as it benefits health work among U.S. nationals both abroad and at home. He sums up this picture of experienced medical manpower in connection with industry, bilateral and multilatei'al organizations, and pri\ate foundations as follows : With the passing of the colonial era it has been interesting to note that the military has taken on responsibility for filling the need for technical medical and health work abroad and bringing back to this countiy and to other countries the bene- fits of this experience for the protection of our own manpower here as well as abroad. American industry has drawn very heavily upon military experience in this respect and I think it is interesting to note the magnitude. In Wright's study of a few years ago 83 natiA^e American corporations were studied. 24 replied describing 49 programs in 27 countries. They had 58 hospitals totaling 5,000 beds with approximately 313 American physicians working in these installations, 33 den- tists, and almost 1,000 nurses, at a total budget of $27,000,000. And the involvement of industry is increasing rapidly. The per capita expenditure on health services by American indus- try in every country in which work is carried on is much greater than that provided by the Governments of the coun- tries themselves, although not usually available to the entire population * * *. With the decline in teaching of tropical medicine in United States medical schools about the only way a physician can jjrepare to deal with exotic diseases such as malaria is through the experience he had as a military medical person, or by working abroad in industry, or from experience in one of the international health programs either multilateral or bi- lateral. Unfortunately it is to the discredit of American medi- cal education that we have with few exceptions discontinued completel^y the type of teaching required to prepare American medical professionals to deal intelligently with the health prol>lems of the increasing international movement of Ameri- can tourists today. 743 It is unfortunate from the political point of view that we have not made sufficient study of the yield from the group of American health professionals who have served abroad in the bilateral programs of the United States since the 2nd Woild War, nor of the large yield from returned military who lia\e had this experience and avIio developed while abroad both increased adaptability and motivitation. The public is mifor- tunately also quite unaware of the returns to our country from service with the international multi-lateral organizations and with the many volimtary organizations. Yet we can put our fingers on large numbers of individuals in key positions and say, on the basis of individual case studies, that their exper- ience abroad was crucial to them. It is essential that we docu- ment this very much more, and publicize it ; because otherwise we shall continue to see further cuts in the U-S. budget for health work in the foreign aid programs. 166 IV. International Health Organizations and the U.S. Congress The U.S. share of funding supjx)rt of the World Health Organiza- tion and the Pan American Health Organization is implemented through the Department of State, under "Contributions to Interna- tional Organizations." The Department presents a budget justification each year before two committees of the Congress : In the House, before the Subcommittee on Department of State, Justice, Commerce, the Judiciary, and Related Agencies Appropriations of the Committee on Appropriations; "^ and in the Senate, before the Subcommittee of the Committee on Appropriations ^^^ (same agency units as in the House) . The Problem of U.S. Fumding of World Health Programs The State Department presents its request for funds in support of WHO as part of a total package that includes the United Nations and its nine specialized agencies (of which WHO is one) . The package also includes six inter- American organizations (including the Pan American Health Organization) ; seven regional organizations (in- cluding NATO) ; and 15 miscellaneous bodies. So far as WHO and PAHO are concerned, the Committees see two tables, one on Con- tributions to International Organizations (see Table 10) and one on Voluntary Contributions to Multilateral Organizations and Pro grams (see Table 11). There are back-up tables on legislative authori- zation, a formal budgetary defense, and some discussion. W9 John C. Cutler. "Dividends to Americans from Experience Abroad." American Review of World Health. (Published by the American Association for World Health, Inc., Vol. 18, No. 1, 1970), pages 16-17. (Quoted in part. Dr. Cutler is Professor of International Health and Director of the Population Division, University of Pittsburgh.) ^'' U.S. Congress. House. Committee on Appropriations. "Departments of State, Justice, Commerce, the Judiciary, and Related Agencies Appropriataon® for 1971." Hearings before a Subcommittee of the . . . Pant 2. 91&t Congress, second session. (Washington, U.S. Government Printing Office, 1970), pages 349-414. "« U.S. Congress. Senate. Committee on Appropriations. "State, Justice, Commerce, the Judiciary and Related Agencies Appropriations. FY 1971 on H.R. 17575." 91st Congress, second session. (Washington, U.S. Government Printing Office, 1970), pages 436-^78. 744 TABLE 10.— CONTRIBUTIONS TO INTERNATIONAL ORGANIZATIONS! Increase (+) or Program by activities - 1971 decrease (—) A. United Nations and specialized agencies: 1. United Nations $46,450,986 +$5,181,137 2. United Nations Educational Scientific, and Cultural Organization... 10,531,058 3. International Civil Aviation Organization 3,769,464 +38,486 4. World Health Organization. 21,680,810 +2,147,680 5. Food and Agriculture Organization 10,085,782 +1,749,700 6. International Labor Organization 7,458,875 +805,691 7. International Telecommunication Union 642,175 +26,447 8. World Meteorological Organization 774,565 +75,970 9. Intergovernmental Maritime Consultative Organization.. 121,659 +10,605 10. International Atomic Energy Agency 3,672,502 +298,267 Subtotal 105,187,876 +10,333,983 B. Inter- American organizations: 1. Inter-American Indian Institute. 61,561 2. Inter-American Institute of Agricultural Sciences. 2,758,800 +321,708 3. Pan American Institute of Geography and History 90,300 4. Pan American Railway Congress Association 5,000 5. Pan American Health Organization 9,263,557 +861,092 6. Organization of American States 16,155,404 +2,514,035 Subtotal....:..... 28,334,622 +3,696,835 Total, 1971 estimate 144,611,000 14,824,000 1 House. "Departments of State, Justice, Commerce, the Judiciary, and Related Agencies Appropriations for 1971," hearings, op. cit., pp. 350-1. TABLE 11.— VOLUNTARY CONTRIBUTIONS TO MULTILATERAL ORGANIZATIONS AND PROGRAMS' Fiscal yeai 1971 proposed Technical assistance: U.N. Development Program... _ $100,000,000 U.N. Children's Fund 13,000,000 U.N. Technical and Operational Assistance to the Congo U.N. Food and Agriculture Organization, World Food Program 1,500,000 UN. Population Program 3,500,000 U.N. Institute for Training and Research ^.._ 400,000 U.N. Programs for Southern Africans. _. Special Contributions for Vietnam 950,000 International Atomic Energy Agency. Operational Program 1, 500, 000 Wolrd Health Organization-Medical Research 150,000 Wolrd Meteoroglocial Organization A/oluntary Assistance Program 1, 550,000 I nternational Secretariat for Volunteer Service 70, 000 Subtotal 122,620,000 Supporting assistance: U.N. Relief and Works Agency 2 13,300,000 U.N. Force in Cyprus 6,000,000 Subtotal 19,300,000 URWA-Arab Refugee Training, Subtotal 1,000,000 Total.. _ 142,920,000 ' House. "Department"! of State, Justice, Commerce, the Judiciary, and Related Agencies Appropriations for 1971," hearings, op. cit.. pp 413. 2 Plus commodities available under Public Law 480, title, II valued at $8,900,000. Most recently, Assistant Secretary of State, Samuel DePalma ^®® justified this total package in such terms as : "in our national interest" : as work "where many important steps are being taken to build a better world order"'; and as "some activities of direct benefit to the TTnited States''. The World Health Orcranization was one of three UN specialized agencies mentioned by Mr. De Palma as an example of benefit to the United States. ^^ Senate. "State. Justice, Commerce, the Judiciary and Related Agencies Appropriations, FY 1971.' op. cit.. p. 4.92. 745 These recent hearings records on budgetary justification for in- ternational organizations do not deal with the nature and merit of the substantive work of the specialized agencies, including WHO, or with the inter-Ajnerican agencies, including PAHO. Attention is largely focused on increasing budgets and balance of payments; this concern applies to all of the international organizations, regardless of their somewhat different objectives, achievements, and potential. It would appear that the pre^'ailing view holds the United States to be- over-assessed in the first place, and overcommitteed to ever-increasing organizational budgets : assessments from multilateral enterprises are viewed as one more form of foreign aid. International health has not been spared from the growing doubts about costs, about lack of control over the budgets, and about tiie desire to restrict the outflow of 'American dollars. Indeed, international health organizations were most often singled out for budgetary dis- cussion in the Senate and House Appropriations Hearings. The gen- eral climate under which international health organizations are con- sidered can be seen in the following items of testimony. IN THE SENATE Convinced as we [in the Department of State] are of the benefits of U.S. participation in international organizations, we are nevertheless seriously concerned about the increases in their budgets. I can assure you that we have fully taken into account the views expressed by the Senate Appropriiitions Committee last year and that we have made every effort to keep the budget as low as possible."^ * * * In the World Health Organization, which has the largest assessed budget of any of the specialized agencies, we [State] concerted throughout the budget process with other major contributors to keep down the budget. I would point out that for the fii^t time the WHO Assembly, as a result of U.S. leadership, rejected the Director-General's proposed budget. However, we were unable to obtain support for an acceptable compix)mise figure and consequently we voted against the budget as adopted.^"^ * * * We also, of course, sought to restrain budget increases in the organizations outside of the UN system. In the Pan Amer- ican Health Organization, the strong approaches of the Ignited States to other members last year resulted in a re- duction in the original budget proposed by the Director. This was the first time in at least fifteen yeare that the Directing Council of that organization was prevailed upon to vote for a budget smaller than the Director's request.^^- * * * Senator McClellan: With respect to the agreements that are now in force, have you re-evaluated them and found where our participation could be modified or reduced ? ^'^ Mr. De Palma. AVe have made a continuous check on them.-"^ i™ Ibid., pp. 43.5-434. 1" Ibid., pp. 43.5-4.36. !«! Ibid., p. 436. "3 Ibid., p. 44.5. I'Mbid., p. 445. 97-4on n - 77 746 Senator MgClelian. In our contribution to these agencies have we in some measure contributed to the imbalance of payments ? Mr. De Palma, Actually, sir, our estimate is — based on data provided by the organizations — that our overall balance of payments benefit by our participation in these interna- tional organizations. In fiscal year 1970 we estimate that they spent $25 million more in the United States than was con- tributed. It is beciause of substantial expenditures here by the U.N, and the OAS, for example. Senator McClellan. We benefit ? Mr. De Palma. Actuall}' we benefit. There is a net inflow. It is small, but it is actually a net inflow. Senator McClellan. Then there is no way, as now con- stituted and operating, that it would contribute to the imbal- ance of payments, that is your statement ? Mr. De Palma. Yes, sir.^^^ , Senator Ellknder. Mr. Chairman, it indicates that the Pan-American Organization receives a contribution from us of 66 percent. Senator McClellan. On what? Senator Ellender. Pan American Health Organization, the Organization of American States. Our contribution is 66 percent. That organization was established in 1925. Senator McClellan. If those countries down there don't care enough to try to improve the health of their people. I don't think we will improve it very much by just spending money.^^^ Mr. De Palma (continuing from prepared statement). In fact, close to two-thirds of the increase we are requesting for the United Nations, for example, is attributable chiefly to rising prices and salaries. By far the largest part of the increase requested for the fiscal year 1971 is for the ITnited Nations and the specialized agencies, and is mainly due to increases in the budgets of the U.N., the World Health Organization, the Food and Agricul- ture Organization, and the International Labor Organization. In each of these organizations we pressed hard for budg- etary restraint. In my prepared statement, I explain specifi- cally what we did in each case to control the rise in the budgets. I'sihld.. p. 471. !■« Ibid., p. 477. 747 I can assure you, Mr. Chairman, that we will continue to press for tight budget levels in the future. As in the past, we will continue to approach the executive heads of the major organizations to urge them to prepare reasonable budgets before they put pen to paper because we do not have the votes in the organizations on budget matters, and the best time to influence budget levels is before the estimates become frozen in a printed document. We will also, of course, push for budgetary stringency in the governmental bodies of the organizations. Throughout the process we will continue to concert with other major con- tributors to try to maximize our impact on the programs and budgets. A dozen of the largest contributors have developed the practice of coordinating their positions on these matters in the major specialized agencies. For example, I attended a 2-day meeting of these major contributors in Geneva last March. This meeting devoted a great deal of attention to the problem of rising budgets. There was wide agreement on the need to promote a policy of budgetary restraint, and plans were made to pursue this objective during this year. At the same time, I have to note that while other major contributors share our desire for effi- ciency and economy, not all of them think that the budgets of these organizations are excessive. In fact, we often find it very difficult to persuade them to join us in pushing for budget levels as low as we like. We are also working to estab- lish better administrative and fiscal procedures to promote efficiency and economy in these organizations. Again, in my statement, I have pointed out a few of the things that are being done. I will not go into them at this point. In addition to these efforts to improve the operations of the international organizations, we are also trying to make our own participation in international organizations as effective as possible. On the 8th of January of this year the White House issued a memorandum which conveyed the President's wish that the Secretary of State direct, coordinate, and super- vise the activities of the executive agencies relating to our participation in international organizations. To implement this memorandum, I held a meeting of an interdepartmental committee on international organizations, consisting of offi- cials from 15 Government agencies, and I asked for their help in carrying out the President's directive. I particularly asked them for help in assessing the programs of the organizations in terms of current and future priorities.^" IN THE HOUSE OF RErRESEXTATIVTSS ]Mr, RooNEY. I feel this committee has been wasting the taxpayers' money with the Government Printing Office in printing each year an admonition in our report to cut down »" Ibid., page 443. 748 our contributions to these international organizations. We just don't get anywhere doing that, do we ? ^'* Mr. De Pai.ma. We have not succeeded in slowing the rate of increase ; no sir * * * there have been two principal reasons for the increase [$14.8 million for total increased U.S. con- tributions to all international organizations=10%], Mr. Chairman. A substantial portion has to do with just main- taining the current level of activity in the face of rising prices and wages.^^^ Mr. De Palma. * * * We have managed in every case to work out certain savings in the budgets as proposed. We have not managed to prevent increases. We have not done that, sir, because in the first place we did not have the votes * * *. We have also been unable to do it, because in some cases even some of the major contributors have felt that the ceilings we were trying to impose were unjustified. ^^° RECAPITULATION OF U.S. LEGISLATIVE PROBLEM There is no question but that the costs and benefits of external activities of the United States, after an impressive outpouring of wealth in World War II and large foreign assistance and military activities thereafter, are coming under increasing public scrutiny. Congressional control of policies and programs is historically exerted by means of the purse strings. Accordingly, funding levels of U.S. foreign programs are a proper subject for congressional examination. However, it seems also to be an important question as to precisely what the consequences are of such U.S. expenditures, in terms of benefits to the United States. It is suggested that these aspects are not sufficiently examined ; and the reason seems to be the enormous range and complex- ity of the subje^'t matter. Accordingly, the possibility might be enter- tained of enlisting the services of a qualified research institution to make a thorough investigation, in depth, of the relationship between actual costs and direct and indirect benefits of foreign assistance, with particular reference to international agencies concerned with health. Few fields of international activity present more difficult problems of fiscal accountability than do health and medicine. Cost /Benefit Analysis as a Possible Solution Few programs of major significance become or remain a fruitful effort which do not rest on a mutual understanding of objectives and costs on the part of the practitioners and the politicians. WHO and PAHO are major international health programs, and to present their costs in the absence of information concerning their qualitative and quantitative benefits makes the entire appropriation process an exercise in arithmetic. If the American taxpayers' investment in global health is not achieving the results ex]>ected from that investment, what institutional and policy reforms can be implemented to change the situation? And how does one determine that benefits are consistent with cost ? A rational basis for the determination of priorities and in 1'* HniiRp. "Dvpartments of State, .Tustice, Commerce, the Judiciary, and Related Ajrencies Appropriations for 1971," Hearings, op. cit. page 401. "9 Idem. '80 Ibid., page 404. 749 promoting the efficient use of available resources faces obvious ethical and moral obstacles. Nevertheless the economics of health and disease is a legitimate way of evaluating certain kinds of international cam- paigns against disease and the techniques of cost/benefit analysis are proving of value in a number of other fields of medicine. In additioii to international health activities which would have to be explained and justified to Congress along non-quantifiable lines, there remains the possibility of satisfying the Congress as to the nature of failures and successes with numbers or with concepts derived from a numerical approach of one kind or another. As Dr. John Bryant states : The major, analytical tool used to evaluate alternative health programs in the United States has been cost-benefit analy- sis * * *. Benefits are generally measured in terms of number of lives saved, amount of disability prevented, or amount of economic loss avoided * * *, There are special problems in ex- tending [these] concepts * * * to the less developed coun- tries * * *. Still, the concepts of cost -benefit analysis are very important, whether applied with carefullv derived data or as an aid to common sense in making decisions on health programs.^®^ Some Examples of Approax)hes to Cost/Benefit Analysis in Health Programs The difficulty of obtaining quantitative information about the results of health nro^rrams 1vis been a liistorir^a^ obstacle to their orderly pres- entation in the budget and accounting process. Nevertheless, some sources of quantitative information are available, and these may not be adequately exploited for policy purposes. The following is a brief sampling from the literature of such sources. 1. A study of the control of poliomyelitis in the USSR showed that the cost of vaccinating 127 million people amounted to nearly 46 million roubles; l:>enefits were evaluated bv comparing actual incidence of the disease following vaccination with estimated incidence in the absence of the program : The benefits were evaluated by working out the number of cases that would have occurred in the period 1958-1965 (as- suming a continuation of the 1958 morbidity figure), the cost of treating them, and the financial losses due to disablement and deatli. On tl\is bapis. the l~>enefit was found to l)e over 8000 million roubles, or 66 roubles saved for every rouble spent. The assumption of a continuation of the 1958 morbidity level may well have given this estimate an upward bias, but a benefit so much greater than the cost allows ample scope for more strin- gent assumptions.^^^ 2. In a Yugoslavian program to reduce infant mortality from its existing level of 44 per thousand live births to 20 or below, two alter- nate methods were used: (a) a child health dispensary and a 12-bed unit for normal deliveries, staffed by a pediatrician and two nurses ; and (b) a clinic staffed by a midwife, supported by periodic visits (three times a week for six hours) of a general practitioner. "After '^ Bryant. "Health and the Developing World." op. cit., pnges 106-7. 182 "Economics of Health and Disease," WHO Chronicle (January 1970), page 22. 750 ten years, infant mortality in [the (a) area] had fallen to 17.1, while in [the (b) area] it had fallen to 18.1." It was concluded that these results were essentially the same, although the cost of the (b) method was much less, "* * * an experience which may be of value to developing countries where both financial resources and highly trained health personnel are in short supply." ^^^ 3. The productivity of labor was used in one U.S. study to illustrate a method of formally calculating the monetary value of health services. For example — * * * The health costs of producing a member of the United States labor force, aged eighteen, in 1960 were about $1,000; therefore, the 73 million persons in the labor force in 1,960 represent a 73-billion-dollar investment. Other costs of up- bringing would of course be added to this figure. The costs would then be compared with the return on investment in terms of labor productivity. The study notes that in less developed countries a different pattern of costs and productivity would prevail, but that "one of the troubles in [such countries] is that there is too much unproductive investment." High rates of death and disability detract from the economic return from the investment in feeding and bringing up of a new generation for productive work.^^* 4. Tliree sets of calculations as to the differential productivity of the U.S. working population with and without health care show large value differences : (a) In the years 1900-1960, with 1900 death rate assumed through- out, compared with actual reduced death rates, an additional 13 mil- lion population yielded in excess of $60 billion in additional national income ; (b) In the period 1938-1952, the use of antibiotics and chemotherapy in pneumonia and influenza saved 1.1 million lives, and as a consequence national income in 1952 was enlarged by more than a billion dollars; (c) The asset value in 1960 of the labor product attributable to workers "added to the labor force by reduction in mortality rates since 1900" was estimated at $820 billion. That sum is to be weighed against investment in public health over this period, which is of course a much smaller figure.^^^ 5. Absenteeism of labor due to malaria in one area of the Philippines was reduced by an antimalaria program from 35 percent to less than 4 percent; at the same time, labor productivity rose by 20 to 25 percent.^^^ 6. A yaws eradication campaign in Haiti returned an estimated 100,000 incapacitated workers to their jobs.^^^ 7. On a broader basis, an analysis conducted on 22 less developed countries, in 1970, showed a very high inverse relationship "between variations in infant mortality rates and variations in changes in sub- sequent agricultural output." In fact, in this study, it was found that 183 Ibid., page 21. 'w Bryant, '^Health and the Developing World," op. cit., page 105. i« Ihid., pages 10.5-100. 1S8 Ihid., page OS. '" Ibid., page 90. 751 the relationship between health (plus education) and agricultural productivity was "more vigorous"' than that of labor and fertilizer, the more usual indices of changed agricultural productivity.^*^ In summary : There does emerge clearly the evidence of an output response in the rural parts of poor lands when acti\dty in the health field changes, and this in a society and economy where popular arguments notwithstanding — labor is a relatively under-utilized resource. The health influence may thus not ODerate simply tlirough more man-hours * * *; it is rather, or also, a consequence of attitude shifts on the part of the laborer.^^^ Output per person in Africa, Asia, and Latin America has increased in recent decades even as population growth reached record rates of expansion * * *. On the record, therefore, economic progress has begun even as population growth expanded.^®" Malenbaum considers health benefits so obvious that there is little effort to quantify them. When that effort is made a whole spectrum of social and economic indicators (in 115 countries) showed that health variables tended to be the most highly correlated with all measures of progress.^®^ He states further that the use of statistics which lump urban and rural data together tends to conceal rather than reveal the benefits of health service to poor people in poor nations. Cost/ benefit statistics in such countries must be worked up below the national level because national statistics obscure too many important subnational or regional differences : Preliminary statistical analysis of changes in health and in health programs in poor areas, where labor is the dominant factor of production, suggests a positive effect of health inputs on subsequent output. There is an economic rationale for such a relationship in poor lands, through changes in the \dgor and motivation of the self-employed workers who are predominant in the labor force. Such a positive role also fits new doctrines of growth, in which quality of factor inputs receives greater weight than quantity of labor or capital. There exists a need for such additional statistical analyses, and especially in small areas (villages, counties, districts), where outputs and pro- duction processes are more homogeneous than in nations as a whole.i»2 The Complex Issue of Health and Overpopulation The most provocative dilerama of all faces those who would try to show by analysis that, on a short-term basis at least, the saving of lives which increases population also produces a net economic gain in today's low-income, non-developed lands. There is a gain in production, includ- ing food, but there is also reduction in morbidity rates which increases 188 Wilfred Malenbaum. "Progre» in Health: What Index of Progress?" The Annals of the American Academy of Political and Social Science. (January 1971), pages 109-113. i8» Ibid., page 114. i^o Ibid., page 110. i°i Ibid., page 110. »=' Ibid., page 113. 752 birth rates and life expectancy — so that the number of consumers is equal to or greater than the gains in production. Malenbaum's claim is that all or most developed nations have gone through this transition of high population growth rates and that the dilemma is solved when the percentage gain in output exceeds that in population.^^^ But this argument assumes a course of growth in the developing nations similar to that of the Industrial Revolution in the Western world. It also assumes an ultimate socioeconomic status like that of the United States where in 1960 middle and upper income families were averaging three and two children per family, respectively."* The theory of the relationship of population growth to improve- ment in public health measures combined with rising standards of living is not well developed. In the nations of Western Europe, \A'hen living standards rose during a period of improved public health and sanitation, populations tended to rise more slowly. On the other hand, in the developing countries, population increases have responded to public health measures by proceeding at even steeper rates, while living standards have increased slightly if at all. Observation of this set of conditions has tended to cast doubt on the idea that declining rates of population in these countries ^o hand in hand with rising standards of living. Moreover, the implication is that because of the threat of pojiulation explosion, public health measures should be de- ferred until the populations of the less developed countries have been brought under control. This thesis is challenged by Dr. John Bryant, who contends that there is still some validity in the concept that rela- tive stability of populations is coupled with economic and health fac- tors. In particular, he warns that it is contrary to the values of the medical profession or of civilized society to solve the problem of the population explosion by relying on ill-health, under-nourishment, and the misery of poverty; on the contrary, he declares that population control is incompatible with such conditioning. As we think about the interrelationships of health, popu- lation, and economic development at a national level, we must not lose sight of the meaning of these terms for individual families and communities. Consider, for a moment, the find- ings of Aguirre and Wray in a small Colombian community. They found that 42 percent of children under six years of age were malnourished and 30 percent had diarrhea at any one time. In seeking cultural, social and economic reasons for the malnutrition, they found a dramatic correlation with factors that lead to a low per capita expenditure on food. With increasing age, incomes of fathers remained static be- cause as untrained workers their value did not increase with age. But they had increasing numbers of children, and there was, therefore, a steady decrease in the amount of food money for each child. Just as steadily, there was a mounting propor- tion of malnourished children. Aguirre and Wray initiated a nutritional supplementation program simple enough and economical enough to be within the resources of the community, and this led to a drop in the 103 Ibid., page 110. "« Arthur K. .Ipnson. "IQ and Scholastic Achievement." Harvard Educational Review (Winter 1969), page 98. 753 incidence of both malnutrition and diarrhea. But there should be no underestimating the awesome difficulties of searching for the best answers among such tangled relationships. The number of children in a family may al-ready be at insupport- able levels, and another life saved would depress even more the amount of food-money per child. Indeed, the study re- vealed the desperate efforts of these people to limit the num- bers of their children. But acting in ignorance, their efforts were often futile or tragic. It is important to recoa^nize that while health services have contributed to increased rates of population growth, they also have an essential role in limiting population growth. Walsh McDermott has described a fertility-mortality cycle in which high fertility leads to large numbers of children, often crowded into a setting of poverty and ignorance with a resulting high childhood mortality, which in turn sustains hi^h fertility. He argues that reducing the death rate in small children is a necessary precondition for reducing fertility. McDermott's thesis has historical support. Fertility and in- fant mortality have always been highly correlated, and in- creasing evidence indicates that a lowered infant mortality must antedate lowered fertility. * * * Itwproved health if< a precond'/tion to reduced ferfilHy}^^ [Emphasis supplied.] Moreover, Bryant goes on to say — The hsue mu!e%-eloping World." op. cit.. pages 100. 102-3; Also described In : John H. Br.vant. '"The Gap between Modern Biomedical Technology and Health Needs m Developing Countries.' In "Science and Technology in Developing Countries," (Cam- bridge Univpisity Press, 1969 ) . "•Bryant, "Health and the Developing World," op. clt., pages 99-100. 754 controlling the rate of reproduction. The widely acclaimed family planning program of Taiwan may, at most, have somewhat speeded the later phase of fertility decline that would have occurred anyway because of modernization. Even so, the aim of the program is that women should have the numbers of children they want, a number that currently aver- ages 4.5 children each. Even if social choices change and the Taiwanese women decrease their wishes for children to the United States level for 1966 of 3.4, this would yield a long- run rate of natural increase of 1.7 percent per year and a dou- bling of population in forty-one years. Davis points out that the characteristics that make family planning acceptable are the very characteristics that make it meffective for population control. By stressing the right of parents to have the number of children they want, it evades the basic question of population policy — how to give societies the number of children they need. By offering only the means for couples to control fertility, it neglects the means for societies to do so. By sanctifying the doctrine that each woman should have the number of children she wants, and hy assuming that if she has only that number this will automat- ically curl) population growth to the necessary degree, the leaders of current policies escape havittg to ask why icomen desire so many children and. how this desire can he in-fiuenced.^^' [Emphasis supplied.] Policy Issues of World Health — A Sum,mary In this section on what, in effect, is an approach to establishing a better dialogue between the international health profession and the people, Congress, and Government of the United States, an attempt is made to extract from the literature examples of how one might some- how close this very serious communications gap. The arguments from these examples is more convincing where the cost/benefit equation is obviously attractive, less convincing when questions of goals and man- agement are raised, and difficult in connection with the population problems. But the international health literature shows that better cost/effective programs are being established as time goes on, that definitive goal setting and improved management practices are mak- ing headway in the less developed countries, and that there is some progress with the dilemma of health and population. On the latter problem it was pointed out ( 1 ) that developing nations can be expected to go through a transition of high population growth, (2) that in a Colombian community ignorance rather than indifference was the cause of failure to limit the size of families, (3) and that McDermott's thesis concerning improved health as a precondition to fertility con- trol is biologically and historically sound. While it is true that governments of poor countries which have popu- lation policies do not have very effective ones, it might be noted that any government of a rich or poor country which utilized coercion today to control the birth rate would very soon be out of power. At any rate, until the countries understand and agree on the number of human beings which can be supported by the earth and its resources, ^»' Ibid., pages 101-102. 755 there seenm little 'point in icithholding medical assistance and advice to lesser developed countries on the grounds that the more lives we save the more lives there are. Obviously, one should expect some long over- due philosophical and educational assistance along these lines from non-medical sources. It is not the business of doctors to make social decisions simply because they know how to implement them. U.S. Benefits From Increased Investment in World Health It is difficult to present an explicit statement of the return to the United States taxpayer of a vigorously supported and ex- panding program of global jjreventive medicine under the aegis of the World Health Organization. The scope of the canvass is too large, and the options for improvement are too varied and detailed. However, a general statement of the proposition may be in order. Several lines of oppoitunity are given as illustrations : 1. Pockets of infectious and communicable disease exist all over the world — not only in the less developed countries but in the ad- vanced countries as well. Under conditions of social disruption, floods, hurricanes, and other natural disasters, these pockets can become sources of world epidemics. Conversely, by a relatively modest in- vestment in each case, they can be eradicated or controlled. 2. Heavy U.S. investnient in capital equipment has for two decades gone to the less developed countries to advance their productivity. However, measured in terms of labor productivity alone, the dollar investment in the capital of public health has yielded higher returns. 3. Arrangements for global medical surveillance and early warning of the dangerous spread of disease have hardly scratched the surface. The benefits of a more thorough system of early warning, especially in influenza and the more lethal viruses, and of an ability to take prompt remedial measures of global control, seem obvious. More controls mean international surveillance, rapid identification, rapid vaccine development, and rapid application to susceptible populations. 4. Smallpox eradication, already a global campaign of WHO, could be brought to a much earlier and effective conclusion with additional funds and effort among the cooperating countries. This would be particularly valuable to the United States, which must now contend with the cost of protecting its people against this infrequent but dan- gerous, incurable, and highly infectious disease. 5. With the growing problem of medical education and increasing demands for health care in the developed nations there is need in the World Health Organization for a greater sharing of country experi- ences and experiments in the delivery of health service. It would ap- pear that the United States could benefit greatly by evaluating some of the various systems of health care now in operation around the world. 6. The United States might benefit from a set of international standards and guidelines accepted by WHO on : a. electronic medical diagnostic equipment b. water and air pollution c. methods of choice in the treatment of alcoholics and heroiu addicts d. safety and efficacy of drugs. 756 7. The United States would also benefit by a set of international standards ao;reed upon by WHO and the FAOi ( Food and Aoriculture Organization) with respect to the amount of lieavy metals to be per- mitted in edible foods. 8. Severe protein-calorie malnutrition does not exist with sufficient identifiable frequency in the United States to permit in-depth study of malnutrition on development, especially the effect of prenatal and postnatal protein malnutrition on earlv development and subsequent learning ability. WHO, FAO, INCAP have both the methodology and the observable populations at their disposal. Such studies are already underway, but the importance of the results on possibly im- paired future physical and mental health justifies a greater interna- tional research effort. The economic considerations are important to developed and developing countries alike. 9. Populations for the study of groups and conditions resistant to certain types of cauf^er and heart dipease are not available in sufficient numbers in the United States. The WHO International Agency for Research and Cancer nt Lyons, France, is an example of a WHO effort which could be expanded on behalf of the developed nations. Cardio- vascular diseases mav deserve a siimilar international approach for the same reasons and for the same developed countries Avhere degenera- tive diseases are among the leading causes of death. V. Summary, Conclusions, and Comments During the earh- history of man, famine, disease, and pestilence in combination were essentially global for the then known world. Pandemics raged on through the middle ages, at one time destroying up to a quarter of the population. With only a slight change in the pre- vailing biological conditions, the entire human race in Europe might have been eliminated. Later, the provision of clean water and sanitary w^'xste disposal, to- gether with geographic climatic conditions unfavorable and favor- able to the prevalence of disease vectors, divided tlie world into lesser and greater diseased parts. When this division was recognized, un- organized efforts were taken to isolate and quarantine people and materials against the introduction of disease from one area to another. By 1851, Nation-States began formal coonerative efforts to control the spread of communicable dtsease, but labored under the lack of knowledge and under the distorting influence of the special interests of commerce. After some 50 years of contimiing diplomatic efforts and gains in the understanding of the cause of disease, modest, non-intrusive in- ternational agreements were reached and a permanent organization was set up to manage the control of communicable disease on the part of the signatory nations. Two such organizations appeared on the international scene almost simultaneously, shortly after the turn of the 20th century. These were the Office of International Hygiene in Europe and the Pan American Sanitary Bureau in the New World. The world in 1900 A.D. was a relatively small one, commercially, and so was its total human population. It was, however, relatively large in reference to the barrier protection offered by the oceans and the atmosphere, the limited amount of goods and people moving to and 757 fro, the slow speed of such movement, and the general agrarian dis- persal of the population. Today the world is small in these latter re- spects, is rapidly becoming a unit, epidemiologically speaking, and urban sprawl threatens to renew the dangers which were inherent in the unsanitary conditions of the past. International health institutions, the public health profession, in- dividual nations in bilateral agreements, and the private foundations have attempted to keep pace with these explosive developments. The nature of the problems was such that most of these efforts have focused on large sections of a country, on large geographic regions, or on vir- tually the entire globe. All of the efforts liave been temporarily in- terrupted by the great wars; conditions against which such efforts were aimed have been worsened by these wars. Public health on a worldwide scale has yet to command the atten- tion of governments which a global perspective of health would appear to require. The nature of the work is undramatic; the subject offers little in the way of political capital as do so many other medical topics. Disciplinary development and professional status for public health and preventive medicine are low compared with those of modern diagnostic and curative medicine in the United States and other de- veloped countries. The public and its elected representatives may not be aware of the miracles which have been achieved in the field of pre- ventive medicine ; it was these, rather than the glamorous surgical and pharmaceutical inventions of recent vintage, which so dramatically changed the life expectancy of man. The world was made a relatively safe place in which to live and travel many years ago by the application of what now appear to be rather simple biological, medical, and engi- neering facts. Indeed, the tecliniques of preventive medicine have been so successful in developed lands that neither cris'is nor controversy worthy of intensive political attention has emerged in i-ecent years. In the less developed lands, tlie power to improve human health at least cost still lies in the application of proven teclinology in the pub- lic health and sanitation field. Curative medicine in the poor countries has as much appeal as it does in advanced countries with large popula- tions of people with various forms of degenerative disease, but there are lacking the medicines, the doctors, and the places in which to ap- ply the cures. In many of these developing areas, the services of sani- tary engineer, hydrologist, or geologist are more essential to permanent health gains than is the increased availability of doctors and clinics. Plant geneticists and agrarian reform, together with culturally adapted population policies, will contribute more at this time to a revolution in the health of some of the economically depressed coun- tries than will the importation of modern medical technolog\'. The skills to prevent or control the spread of a new virulent "germ" lie in the now vast and potent technologj'^ embracing physical and chemical detection, microbiology, biochemistry, molecular biolog}', water treatment and rapid A'accine development. These are perhaps the more modern elements of preventive medicine. Some students be- lieve that a resurgence of the preventive medicine and public health point of view will also prove to be the most incisive channels of ex- ploiting modern biological knowledge on behalf of the degenerative diseases. Lederberg, for example, has noted the high cost of a cure of cancer after the fact, versus the application of existing knowledge ,758 and of knowledge yet to be gained for preventing some forms of the disease in the first place."'^ Other experts have made similar arguments with respect to cardiovascular diseases. The magic of health as a rallying point for international unity does exist to a degree but it is not as persuasive as some well-turned phrases would imply. Transnational medical work, of course, is performed with greater ease by private organizations (such as, for example, the hookworm eradication program of the Rockefeller. Foundation), but multilateral institutions are necessary and might function almost as well if fewer reservations and restraints were imposed upon them. Thus the hypothesis is advanced that it may be the attitudes of member governments of international health institutions which are in need of change, as well as the priorities and management l^ractices of the institutions themselves. The nations have experimented for 70 years with organized intergovernmental cooperation in the control of disease and more recently in the direct promotion of health. From agreement to agreement, it is generally held among health authorities that the member states have been overcautious and have either stmctured the organizations to protect their sovereign interests or have avoided full coiiunitment to the regional or global health objectives which were formalized in the charter of those organizations. When special circumstances kept member governments occupied with other important matters, so that the health institutionc were left to their own devices, a great deal somehow was accomplished, even with very modest resources. The Health Organization of the League of Na- tions is an example of this. However, when relative bigness and in- creased autliority prevail, as in WHO and PAHO, there is some anxiety about new international health regulations, concern over the high arid growing costs of operations, and sus])icion and fear that global health philosophies might challenge traditional health care systems of any given country. The pharmaceutical industry may be especially wary of resolutions and regulations affecting their products and their profits. The WHO/PAHO arrangement grew slowly at first, adapted to many kinds of anticipated resistance and to some difficulties which M-ere not anticipated — the cold war, the Korean conflict, the Vietnam war, and even to the situation in WHO's Eastern Mediterranean region. But the system of international health institutions flourished anyway and it continues to grow in worldwide influence. There are several reasons for this relative success : 1. There was work to be done; it was needed, as statesmen and doctors had agreed when they established prior conventions, offices, and organizations over a period of many years. 2. WHO has utilized di idiomatic assistance both during the structur- ing of its constitution and hi subsequent problem 'olving, but WHO is a professional, scientifically based, international complex. Wliile all of its halls may not be decked with eminent scientists and physicians it still has them at its disposal. It appears to have followed at least two of the axioms of successful international technical enterprise : a. If se/enf/-'^.fs or enfjineerfi con render technical a^shtance to a ilevelo'ping country it can succeed }) est with good science at the helm. »' .Toshua Lederberg. "Cancpr 'Cure' Has Limitations." The Washington Post (t'eb- riiary 14. 1971), page C-2. It is well known among dermatologists, for example, that an important reduction in the incidence of skin cancers of the most prevalent type could be eflFected by the simple expedient of shielding the body from the sun more carefully, especially in subtropical latitudes and in open-air occupations. 759 jb. If sGie/titlsts of many nations find it necessary to pool tfieiv reso%irG€8 and talents on a global prohleTn th'at trdTiscends national boundaiies^ thsy will do well to he in control of the enterprise as a .3. WHO worjfed out solutions to some political and controversial issues, or refused to deal with others because they were political. It continues to -function effectively even in the presence of unresolved political, problems. ■ 4. Its members are bound by treaty to support it at a budgetary level deterrnined by the organization itself. 5. Th^ member states ho,nor their commitments to international health organizatioiis today more than they did in the past. '"On time'' collections pyer the period 1958 to 196T were over 96 percent. The United States is the chief contributor to WHO and is also one of tlie chief sources of complaint — principally with its heavy share of the financial burden as matched against its lack of direct control over the WHO programs. A ReJDort of the Comptroller General of the United States"^ was critical of WHO and many agencies connected with it. As a result the UN, the Department of State, and Health, Edu- cation, and Welfare have sought to improve WHO 's fiscal and admin- istrative practices. AVHO itself recently ' set up a Headquarters Program Review Committee (HPRC).^"^ But the climate in the Congress is cool, with the Federal agencies unable to change the apathy, the outlook, or the nature and extent of the dialogue. In addi- tion, the !N^ation*s health practitioners, researchers, and medical edu- cators are very much preoccupied' with their own problems. Indeed the entire tripod of support (goverhment-industry-education)^°^ essential to the success of any technicallj^ based enterprise is missing. Yet the United States abides by its treaty obligations to WHO. Through other channels, the United , States provides additional sup- port to both WHO andPAHO by means of voluntary contributions whicli more than double the amount it is, obliged to provide under the United Nations scale of assessment. There is no doubt about it : For some reason the moral support for international health institutions as seen in the public record is extremely low-keyed, yet the overall level of financial support provided by the United States to the multilateral health organizations is actually quite substantial. It is important that this multilateral support continue and that the level of it increase somewhat each year, because other foT*ms of U.S. supported direct or related activities in international health have been extensively curtailed in recent years. W^ith the exception of a few overseas laboratories operated by NIH and DOD, the activities of a number of Federal agencies relevant to health, and especially the health and sanitation work of AID, have been reduced to very small percentagesof their earlier peak levels. . Recent trends reflect the deliberate movement of international health activities from bilateral program? to multilateral ones such as the United Nations Development Program and the World Health i»B "U.S. Participation In the World Health Organization." Report to the Congress by the Comptroller General of the United States. (Washington. IGBS"), page 1. »" Airgram from U.S. Mission Geneva, to the Secretary of State re : Information. Office of International Health, Department of Health, Education, and Welfare. December 24. 1970.: , , .. - - *<^ Caryl P. Haskins. "Science and Policy for a New Decade." Foreign Affairs (January 1971), page 251. 760 Organization. Various studies have recommended this approach. In particular, President Nixon's initiatives along these lines appear to be based on the report of the Peterson task force,^- the study group which was appointed by the President to advise him on the appropri- ate role of the United States in foreign assistance. The report repeat- edly urged that bilateral assistance be decreased and that multilateral assistance be increased. The move in this direction has already started, beginning with the multilateralization of the malaria eradication programs — Current U.S. policy indications are for as rapid a thrust toward withdrawal of U.S. technicians as may be consistent with minimum determined staffing requirements. This will be carefully managed to avoid too precipitous withdrawal of U.S. staff with undesirable effects on the program and the individuals involved. A sufficient interim j>eriod is required for the necessary services to be transferred to an effective level of "WHO financial and manpower resources; however, this need not be a long or difficult transition. While WHO budget development and approval are lengthv processes, WHO has a considerable field force already at work in country malaria programs, and host governments may have improved technical capacity reducing advisory needs * * *. A major trend in U.S. foreign assistance is toward reducing overseas U.S. personnel in bilateral assistance programs while encouraging increased responsibility of multilateral agencies for development programs. The world- wide malaria eradication program is a case in point * * *. A.I.D. fully supports this important effort. However, we now are looking to WHO to take greater responsibility for most technical assistance to host governments in their malaria programs. In conformance with the resolutions of the World Health Assembly for malaria eradication, WHO is already providing the greater part of the technical services requested by participating governments in this program * * *.-''^ Peterson's point that "a predominantly bilateral U.S. program is no longer politically tenable in our relations with many developing countries * * *," ^o* is partly undone by another reality, namely that the Peterson "approach is not certain to commend itself to Con- gress." 205 Certainly the hearings records examined during the prep- aration of this study show Congress to be clearly on the side of bilateral programs. For this reason one might be expected to dis- miss a report like Peterson's, especially since it does not even mention international health institutions. But there is cause to continue along two lines : First, and almost surely without knowing it, a good deal of the "thrust*" of the Peterson report, matches the mode of oi>eration of the «"' "U.S. Foreign Assistance in the 1970's" op. clt. *^ "A.I.D. Policy for Malaria Eradication — Multilateralization of Technical Services." Airgram Department of State, August 8, 1970. (Quoted in part.) 2IH "XT.s. Foreign Assistance in the 1970s," op. clt., page 22. »»John Franklin Campbell. "What is to be Done?" Foreign Affairs (October 1970), page 97. 761 World Health Organization — "work out programs and performance standards with developing countries * * * establishing their own priorities * * * the [unrealistic] expectation of immediate results * * * policies and new technologies adapted to the local government * * * strengthening of local institutions * * * the principle that administra- tors are accountable for achieving objectives * * * restrictions on op- erations should be held to a minimum * * * all people, rich and poor alike, have a common interest in peace, in the eradication of poverty and disease, in a healthful environment * * ♦.'■^oe Second, a key conclusion of the Peterson Report is its distinct turn away from the short-term, national interest, foreign policy orientation of past U.S. participation in international institutions : This country should not look for gratitude or votes, or any specific short-term foreign policy gains from our participa- tion in international development. Nor should it expect to influence others to adopt U.S. cultural values or institutions. Neither can it assume that development will necessarily bring political stability. Development implies change — political and social, as well as economic — and such change, for a time, may be disruptive.^"' If the national objectives of the United States as a member of WHO and PAHO are perceived within the philosophy of the above paragraph, it might be appropriate to consider a change in the De- partment of State as the prime mover of the U.S. administrative ma- chinery for these organizations. The line of reasoning for such a change is as follows : The expansion of national public health interests to global dimen- sions calls not only for diplomacy or statesmanship of the conventional type; it calls for worldwide experience with science, medicine, and public health as political systems themselves and for experts in the subject matter. The more reliance there is on multilateral organiza- tions for controlling disease and assisting all the countries of the world in improving their state of health, the less need there is for a national or bilateral point of view. The more the health of the State becomes de- pendent upon the health of the world, the more the interests and tech- nology of the State become blended into those of the world. If and when it appears that the only feasible approach to the problems of human health is indeed a worldwide approach, it will be necessary for knowl- edge to be shared and exchanged by those who are in possession of it and who by tradition and practice are used to sharing and exchanging it. The multilateral health organizations are simply institutional devices for encouraging this process in the international health profession. For guidelines on what to change to, if the Department of State does not appear to be the logical home for the WHO and PAHO of the future, the following is a possible alternative for consideration : Let it be supposed that the national objective of U.S. participation in WHO and PAHO is to protect Americans from disease from abroad by means of rational and accepted public health procedures. ;<« ..jT s Foreign Assistance in the 1970's." op. clt., selected passages. "" Ibid., nuec 2. *" Ibid., page 2 97-400 O - 77 - 11 762 Let a second objective be to attacjv those diseases endemic to .the less developed c.oi;i,ntries a,nd amenable to .eradication or control by means of , scientifically based sanitary and medical practices, ar^d to mount sych attacks in the common interest of economic and social progress of both the less developed countries and the United States, Finally, consider a thirid objective to be to promote on a generally global scale tjie utilization of readily available and effective mpdical and engineering technology towards the improvement of the state of health of the human species. If these objectives are a reasonable. approximation of the Anierican purpose in contributions to and participation in the activities of WHO, it may follow that the structure of policy and the working .re- lations between the United States and WHO are a combined function of the Congress in general and of an expert Federal health agency in particular. Technical asn'ifitcnce is technical cwd it is good or had tecJinicaUy before if cam hecowe anything else. As and if U.S. tech- nical assistance in health matters becomes more concentrated in multi- national health organizations, the greater the need will be to appraise its results and to apply American technical competence in that field. The Department of Health, Education and Welfare might well be considered as the future and more emphatic focal point of technical documentation, plaiming, review, and analysis of issues in connection with U.S. participation in AVHO. PAHO, and certain bilateral bio- medical programs. DHEW successfully explains and defends a multi- billion dollar program before the Congress, which includes overseas laboratories and grants. The extension of that performance to V.S. participation in international health organizations sliould not be be- yond its capacity. By training, by alnlation. by profes'^ional contacts with counterpart experts around the world, the DHEW seems to be a logical Federal a.Qency to establish and maintain a working liaisojn. between Congressional appropriation committees and international; health organizations to which the appropriations are made. The World Health Organization is chartered to do a great deal about the health of human beings. It appears to be a satisfactory in- stitution for arriving at international health priorities, even if it is often criticized for not stating categorically what these are. It pro-i vides technical assistance and advice to national health services where the need appeai-s to be greatest, but those needs far exceed its resources. The Regional Directors and Committees of WHO bring both de- mands and influence from their sections of the world. The World Health Assembly yields to this influence and supports the Secretaryr General's program, wliich is in effect tlie sum of the reg'onal requii^e- ments. The power of WHO's Secretariat, its Executive Board, and its Assembly far exceeds the amount of money which is acquired and dispensed each yeaj- by the organization. The funds v.hich WHO spends to maintain its stafl' at Geneva and elsewhere and the amount it si^rinkles around the world on activities it rarely has time to follow up on, is a drop in the international monetary bucket. The power of WHO is not in its budget but rather in the universality of its membership, the high regard in which it is held among scientific and public health people of the world, and its acceptance as the highest medical forum or final consensus of world medical opinion. 763 It would seem appropriate for the United States to utilize the au- thority of WHO and the power of its international voice in the sup- port of national as well as infernational programs. Tliis country has the resources, the systems skills, and the biomedical technology for making "WHO a better institution than it now is. The United States can be the instrumentality for preparing and shaping WHO to manage the common global health problems of the future. Yet WHO will shape nothing without stronger support than is now evident for international health institutions, in the Congress or at Secretarial levels in the Departments of State and of Health, Ed- ucation and Welfare. The situation seems to be a most peculiar one for world health, namely, commitment without involvement. The United States is meeting its fiscal obligations to WHO and PAHO with very little organizational evidence as yet that it also intends to play a posi- tive determinant role -°^ in an area where American technical com- petence is at its best, where its presence is least offensive, and indeed where American leadership is fully expected by the rest of the world. Perhaps there is need to mount an educational program so that a larger segment of the public is included in the discourse surrounding the issues of national and global public health. The status of the world's health might become a public issue; and that issue could stimulate scientific, medical, and economic debate. For in the United States, at least, debate is absolutely essential to both clarification and political action. 208 Ibid., page 2. Chapter 11 — Beyond Malthus: The Food/People Equation CONTENTS Page I. Introduction 769 U.S. Stake in Resolving the Food/Population Problem 769 Growth of Population Versus Balanced Development 770 Scope and Limitations of the Study 770 II. Defining the Food/People Equation in Developing Countries 772 Famine as Perceived in an Affluent Country 772 Achievement and Maintenance of Adequate Diet in Europe 773 The Malthusian Hypothesis and Its Revival 774 Weaknesses in the Fundamental Data on Food and Agriculture 775 Weaknesses in the Fundamental Data on Population 776 Technical and Cultural Barriers to Birth Control 777 Summary Statement of the Food/Population Problem 779 III. Meeting Food Requirements of Developing Countries 781 Defining Calorie Shortages of the LDCs 781 Varying Needs for Fuel-Foods 781 Food and Metabolism 783 Technological Opportunities Opened by Plant Genetics 784 Successes of the Green Revolution 784 The Incomi)lete Promise of the Green Revolution 785 The Problem of Water 786 The Problem of Fertilizer 787 The Problem of Farm Mechanization 788 The Problem of Pests 789 The Problem of Marketing 792 The Problem of Taste 793 Dealing With Shortages of Protein in the LDCs 793 High-Protein Foods 794 Easing the Shortage of Protein 794 New Protein Sources 795 Fortifying Foods 795 Expansion of Traditional Protein Sources 797 Vitamin Deficiencies and Corrective Measures 798 Thiamine 798 Riboflavin 799 Niacin 799 Vitamin A Deficiency 799 Calcium Intake 799 Other Nutritional Deficiencies 800 Dietary Deficiencies. Public Health, and Economic Development- 800 IV. The Politics and Diplomacy of Food 803 Evolution of U.S. Technical Assistance to Agriculture in the LDCs 803 LT.S. Food Aid to Developing Countries 804 Present Status of Public Law 480 805 Institutional Resources for Orderly Development of Agri- culture 807 Conflicting Agricultural Plans and Programs 809 An Enumeration of Non-Technical Obstacles 810 Surplus Versus Shortage 811 Economic Dislocations 811 Human Dislocations 814 The Need for Social Reform 814 Agricultural and Social Revolution 816 The Impact of Food Programs on U.S. Diplomacy 817 Trade Demands of the LDCs 818 The Necessity for Balanced Development 819 Requirements Impo.sed on U.S. Diplomacy 820 (767) 768 Page V. Technology for Controlling the Population Explosion 822 Current Growth Rates in Asia, Africa, and Latin America 822 The Impact of Population Growth on Economic Development — 824 Opposition to the Limiting of Population Growth 827 The Technology of Controlling Conception and Birth 827 The Oral Contraceptive (The Pill) . 828 The Intrauterine Device (lUD) 829 Sterilization 829 Conventional Methods 830 New Lines of Scientific Research 830 Abortion 831 The Problem of Medical Support 833 VI. Political and Diplomatic Issues of the Population Problem in the LDCs 834 Social Resistance to Birth Control and Family Planning Pro- grams 834 The Status of AVomen 834 The Masculine Image 83-1 Cultural Inertia 835 Religion and Population 836 Administrative Weaknesses in the LDCs 838 U.S. Diplomatic Mobilization To Deal With the Population Issue_ 839 Evolution of U.S. Concern 839 The Strengthening of U.S. Policy 840 U.S. Policy Today 844 U.S. Agencies With Overseas Population Programs 844 The Department of State 845 The Department of Health, IMucation, and Welfare 845 The United States Information Agency 846 The Peace Corps 847 The Agency for International Development 847 AID Assessment of Program Requirements 849 The Congressional Role 851 Multilateral Programs Dealing With the Population Problem 852 Recommendations for Future U.N. Population Measures 854 VII. Future Diplomatic Issues of the Food/People Equation 855 The Politics ond Diplomacy of Food for the Future 856 Multilateral Approaches to Problems Generated by the Green Revolution 858 The Politics and Diplomacy of Stemming the Population Ex- plosion 859 Political and Diplomatic Problems of the Food/People Equa- tion 861 TABLES 1. Expansion of Acreages in High-Yielding Grain Varieties — Selected Countries 785 2. Losses of Potential Crop Production by Region 790 3. Protein Content of Selected Food Staples 794 4. Population Growth Rate, Selected Countries 822 5. The 15 Most Populous Countries 823 6. Summary of AID Dollar Obligations for Population and Family Plan- ning Projects, by Fiscal Years 843 7. Students Receiving Family Planning and Population Training in AID- Funded Courses Given in the United States 849 8. Selected Measures of Family Planning Program Performance 850 CHAPTER 11— BEYOND MALTHUS: THE FOOD/PEOPLE EQUATION I. Introduction This study explores the interaction of science, technology, and American diplomacy in the extraordinarily complex problem of the changing balance between food and population in the less developed countries (LDCs) of the world. It shows how foreign aflfairs institu- tions of the United States Government have responded to the chal- lenges of this problem. Analysis of this particular issue, it was as- sumed at the outset, would furnish clues to a better understanding of problems involved in the interplay of science, technology, and diplo- macy in general. The substantive conclusion of the study is that the growth of world population is outpacing food production, while available techniques are not being sufficiently applied to improve agricultural production and marketing efficiency on the one hand, or to slow the rate of popula- tion increase on the other. Achievement of a global balance of food and population calls for many explicit improvements in political, economic, social, and diplomatic organization and management to achieve stronger human motivation, to improve the acquisition and dissemination of pertinent information, and to design and implement coordinated social programs which can apply existing technology more effectively. Without all of these, the goal of balance will continue to recede with results that seem likely to be tragic. Science and technology have had an increasingly significant impact on the modern world, penetrating deeply into the substance and con- duct of international relations. Traditional modes of diplomacy may not always be appropriate to the resolution of international problems with a substantial technical content; diplomacy may need new capa- bilities to deal with such problems. There are encouraging signs that this development may in fact be taking place. The question is whether, in the particular issue at hand, it is proceeding fast enough and com- prehensively enouarh. It seems clear that in devising programs to deal with both sides of the food/population balance, urgency is of para- mount importance. U.S. Stake in Resolving the Food/ Population Prohlem For some twenty-five years, through bilateral pacts and multilateral channels, the United States has been furnishing aid to the LDCs. Other developed nations have followed suit. U.S. motivation in pro- vidinsr development assistance has both humanitarian and political elements. These converge in the goal of fostering orderly political and economic progress, rapid and palpable enough to dissuade the people of the LDCs from destructively radical political solutions in their senrch for a better life. In the pursuit of this aim, the United States has made the largest national contribution to the modernization efforts of the LDCs. Total U.S. assistance to these countries, 1946-1970. Note : This chapter was prepared in 1971 by Allan S. Nanes. (769) 770 amounted to some $93 billion.^ Food represents a significant portion of thattota].^^ fe r (ri'ou-fh of Population versus Balanced Developriient As long as hard-won expansions in food production are matched by population increase in an LDC, the outlook for balanced development and the future of development assistance will be dim. The fact is that from a global standpoint, population has tended to increase faster than food production in the years since World War 11. If population in- creases too fast, it can halt economic development in the LDCs and even worsen conditions in these countries. Recognition of this fact has led in recent years to substantial funding of population-limiting programs by U.S.A.I.D.^ If economic development becomes a kind of treadmill, with gains in production nullified by gains in population, development aid will have failed. The United States will then have spent many bil- lions of dollars of foreign assistance to no lasting purpose. U.S. public opinion would probably not long tolerate such an outcome. Should run- away population growth lead to a termination of U.S. foreign as- sistance, the task of U.S. diplomacy in the underdeveloped world could become far more difficult than it already is. On the other hand, while a solution of the food/population issue will not guarantee the success of U.S. and other development assistance pro- grams, it would presumably enable the assignment of additional re- sources to other phases of development now receiving less attention. Today, a large investment of resources and technical skills is directed to the improvement of food supplies in preference to other sectors. If it proves possible to strike a balance between food resources and popula- tion, the LDCs should then be able to proceed with a better overall balance in their development programs. Such a result would be to their interest, as well as to the interest of the more affluent countries provid- ing the assistance. Whatever solution is found to the food/population problem, it is evident that it cannot be separated from the total process of develop- ment. An important conclusion of this study is that development is a seamless web. One cannot think exclusively in terms of the food/ population equation. Rather the problem must be seen in the whole context of development as it relates to attracting investment, creating new jobs, training manpower in new industrial skills, improving pub- lic health, and all the other elements that go into the development process. Scope and Limitations of the Study The dual subject of this study introduces a great range of highly technical ramifications which cannot be fully explored. However the study does attempt to identify and put in perspective the most salient ' U.S. Agency for International Development. "U.S. Overseas Loans and Grants. Pre- llmlnRry F.Y. 1970 and Trend Data." Washington. U.S. Government Printing Office, 1970), page 2. (By comparison, the United States had spent some S120 billion on mili- tary assistance and action In Vietnam in the six fiscal years 1966-1971. nlus an addi- tional several hundred million dollars annually in economic assistance. The U.S. space program, military and civilian, up to the end of the fiscal year 1971. ha"? cost an estl- I'lated f62.2 billion. See: U.S. Congress. Senate. Commlttep on Foreign RplaMons. "Imnnct of the Vietnam War." 92d Congress, 1st session. June 30, 1971. (Washington, U.S. Gov- ernment Printing Office, 1971. 36 pages. Committee Print.) «The total of U.S. assistance in food throughout the program 1-= listed as ll.^,- 371.000,000. ^Expenditure for population and famllv planning programs under Title 10 of the f'oreign Aid Act of 1961 Is listed nt $165,172,000 since 1965. 771 technical issues. To discuss the balance between two variables requires discussion of both. The study needs to deal with food, its availability, the qualities of foods req^uired, and the technologies related to food production and distribution. It needs also to deal with population growth, the technology of birth limitation, and the motivations neces- sary to forestall the increasingly rapid expansion of population. And finally, the study must be concerned with the orgamzational concepts, plans, programs, and international arrangemente to operate on these variables. The technologies of food availability and birth control are discussed sufficiently to show their technical feasibility and to make it clear that the problem lies elsewhere. On the other hand, the enormous complex- ity of the human side of the problem — social, cultural, economic, reli- gious, administrative, political, diplomatic — can only be touched on in barest outline. Enough is said, however, to demonstrate that the prob- lem is real, but that its dimensions are potentially manageable, given concerted and determined cooperative effort among all nations concerned. II. Defining the Food/People Equation In Developing Countries The consequences of population pressure pn insufficient food sup- plies are generally recognized. The technologies of expanding agri- cultural output and of exercising control within the family on num- bers of progeny are sufficiently advanced to make famine generally avoidable. The problem of holding food and population in balance appears to lie elsewhere: (1) in stimulating public recognition of the need for concerted action, (2) in devising economic incentives for action, and (3) in developing political programs to make necessary actions feasible and acceptable. The history of western civilization during the epochal events of the Industrial Revolution affords insufficient guidance for the coun- tries now striving for development and encountering unprecedented pressures of population. The industrialization of Western Europe coincided with enormous emigration to the open lands of America, the expansion of American agricultural productivity, and the broad ac-