¹ WHA is the legislative organ of WHO. See WHO CONST, arts. 9-23, in WORLD HEALTH ORGANIZATION, BASIC DOCUMENTS 4-8 (38th ed. 1990) [hereinafter WHO, BASIC DOCUMENTS]. The functions of WHA include determining the policies of WHO, appointing WHO's Director-General, reviewing and approving the budget, considering health-related recommendations made by the United Nations General Assembly or other divisions of the United Nations, and promoting and conducting health research. See id. at art. 18, in WHO, BASIC DOCUMENTS, supra, at 6. WHA also enjoys authority to adopt regulations regarding sanitary and quarantine requirements to deter the international spread of disease, and standards for safety, purity, and potency of biological and pharmaceutical products that move in international commerce, among other things. Id. at art. 21, in WHO, BASIC DOCUMENTS, supra, at 7.

² WHA Res. 30.43, 30th World Health Assembly, 14th plen. mtg. (May 19, 1977), compiled in 2 WORLD HEALTH ORGANIZATION, HANDBOOK OF RESOLUTIONS AND DECISIONS OF THE WORLD HEALTH ASSEMBLY AND THE EXECUTIVE BOARD 1973-1984 1 (1985) [hereinafter WHO, HANDBOOK II].

³ See, e.g., Douglas, Williams, The Specialized Agencies And The United Nations 29 (1987)Google Scholar.

⁴ See discussion infra part II.C.

⁵ The World Economic Situation and the Prospects for Health for All by the Year 2000, World Health Assembly, 42d Sess., Provisional Agenda Item 18.2, at 1, WHO Doc. A42/INF.DOC./1 (Apr. 19, 1989) [hereinafter Prospects for Health for All].

⁶ See generally U.N. DEVELOPMENT PROGRAMME, HUMAN DEVELOPMENT REPORT 1991 22-37 [hereinafter HUMAN DEVELOPMENT REPORT 1991] (presenting a number of social, economic, and demographic profiles among and within nations and regions).

⁷ See Prospects for Health for All, supra note 5, at 1.

⁸ DIVISION OF EPIDEMIOLOGICAL SURVEILLANCE AND HEALTH SITUATION AND TREND ASSESSMENT, WORLD HEALTH ORGANIZATION, GLOBAL ESTIMATES FOR HEALTH SITUATION ASSESSMENT AND PROJECTIONS 1990, at 14, WHO Doc. WHO/HST/90.2 (1990) [hereinafter WHO GLOBAL ESTIMATES 1990]. According to WHO's survey, substantial regional differences in health status also exist. For instance, out of 33 countries in the European region, none had a life expectancy below 60 years; by contrast, 38 of the 44 countries in Africa and about half the nations in southeast Asia and the Eastern-Mediterranean for which information was available had a life expectancy below 60. Id.

⁹ HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 27.

¹⁰ M.A. El-Badry, Health and Human Rights, at 5, U.N. Doc. IESA/P/AC.28/9 (Mar. 21, 1989) [hereinafter Health and Human Rights].

¹¹ Id. at 6.

¹² WHO GLOBAL ESTIMATES 1990, supra note 8, at 15.

¹³ Id. at 15-17.

¹⁴ Barbara, Crossette, Study Sees Rise in Child Death Rates, N.Y. TIMES, May 9, 1992, at 4Google Scholar.

¹⁵ See WHO GLOBAL ESTIMATES 1990, supra note 8, at 15. Malaria also poses a serious health concern, particularly in Africa. Of the 110 million cases of malaria reported each year, 90 million occur in Africa, and 1 million African children die. Louis W., Sullivan & Ronald W., Roskens, Child Survival and AIDS in Sub-Saharan Africa: Findings and Recommendations of the Presidential Mission to Africa, 11 B.C. THIRD WORLD LJ. 227, 233 (1991).Google Scholar Other parasitic diseases threatening child survival in Africa are guinea worm and onchocerciasis. Id.

A bacterial infectious disease is caused by a “unicellular prokaryotic microorganism that usually multiplies by cell division and has a cell wall that provides a constancy of form; they may be aerobic or anaerobic, motile or nonmotile, and free-living, saprophytic, parasitic, or pathogenic.” See Thomas L., Stedman, Stedman's Medical Dictionary 167 (25th ed. 1990).Google Scholar A parasitic infectious disease is caused by “organisms that normally grow only in or on the living body of a host.” See id. at 1138. A viral infectious disease is caused by “microbes which … are capable of passing through fine filters that retain most bacteria, and are incapable of growth or reproduction apart from living cells.” See id. at 1717.

¹⁶ Sullivan & Roskens, supra note 15, at 233.

¹⁷ See generally THE WORLD BANK, FINANCING HEALTH SERVICES IN DEVELOPING COUNTRIES: AN AGENDA FOR REFORM 14-18, 57-60 (1987).

¹⁸ Prospects for Health for All, supra note 5, at 3.

¹⁹ See Claude, Robinson, Health: 200 Million, May Die Prematurely in the 1990s, WHO Report, Inter Press Service, Apr. 30, 1990Google Scholar, available in LEXIS, Nexis Library, Int'l File. According to WHO, about 1.8 million people worldwide are infected with vaccine-preventable diseases, and five million die from diarrheal diseases each year. Id.

²⁰ UNITED NATIONS CHILDREN'S FUND, THE STATE OF THE WORLD'S CHILDREN 1991 12 (1991).

²¹ See WHO GLOBAL ESTIMATES 1990, supra note 8, at 17.

²² See Health and Human Rights, supra note 10, at 7-8. The women most at risk of dying during pregnancy in developing nations are those under the age of 15, who are 10 to 15 times more likely to die than women in their twenties. HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 27.

²³ See HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 27.

²⁴ See id.

²⁵ See WHO GLOBAL ESTIMATES 1990, supra note 8, at 15-16. The primary causes of death in rich nations are cardiovascular diseases and cancers. See, e.g., World Health Assembly, Recent Advances in Biological and Physical Sciences and Their Implications for Health Care, at 14, WHO Doc. A43/Technical Discussions/6 (May 1990) [hereinafter Recent Advances].

²⁶ See id. at 12-14.

²⁷ See WHO GLOBAL ESTIMATES 1990, supra note 8, at 48. Also, only about 5% of the world's scientists work in developing countries. Id.

²⁸ See, e.g., Bruce C., Vladeck, The Ideological War over Health Care; A Classic Clash of Political Values, N.Y. TIMES, Feb. 4, 1992, at A21Google Scholar. Other than the United States, “[e]very industrialized country except South Africa long ago adopted a system of universal health insurance. Although all have flaws, all are demonstratably more equitable, satisfying to the public and likely to produce better results than ours. All are also cheaper, by tens of billions of dollars.” Id. On the problems of the health care systems of the former states of the Soviet Union and Eastern Europe, see George A., Gellert, International Health Assistance for Eurasia, 326 NEW ENG. J. MED. 1021 (1992).Google Scholar

²⁹ See, e.g., Thomas, Bodenheimer, Underinsurance in America, 327 NEW ENG. J. MED. 274Google Scholar

³⁰ See Sjaak van der, Geest et al., Primary Health Care in a Multi-Level Perspective: Towards a Research Agenda, 30 Soc. Sci. & MED. 1025, 1027-28 (1990).CrossRefGoogle Scholar

³¹ F.M., Mburu, Non-Governmental Organizations in the Health Field: Collaboration, Integration and Contrasting Aims in Africa, 29 Soc. Sci. & MED. 591, 591 (1989)Google Scholar. The imbalance in the distribution of medical resources between urban and rural sectors is particularly acute in developing regions and aggravates income inequality further since, in many nations, the majority of the poor live in rural zones. See HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 26-27. For a discussion of regional variations in health status and health services, see id. at 29-37.

³² HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 34.

³³ Id. at 36.

³⁴ See WILLIAM, MCGREEVEY, THE WORLD BANK, SOCIAL SECURITY IN LATIN AMERICA: ISSUES AND OPTIONS FOR THE WORLD BANK 3, 9-10, 22 (1990)Google Scholar. Financing and providing health services are the primary functions of many Latin American social security institutes. Id. at 21. With few exceptions throughout Latin America and the Caribbean, the poorest remain largely unprotected by social security. See id. at 9, 10. Brazil, Costa Rica, Mexico, and Ecuador have developed the only social security institutes in the region with special programs to direct primary health care to poor groups in rural zones. See id. at 9. This World Bank study found that, of the social security institutes in 11 countries, none offered to the poorest province even half of what the richest province was provided in terms of population coverage by social security, physicians, or hospital beds. See id. at 21, 58.

³⁵ See Record Year for Cholera Cases, L.A. TIMES, Jan. 6, 1992, at B3. Cholera had reemerged as a significant public health concern in Africa prior to the outbreak in Peru. See Lawrence K., Altman, ‘Catastrophic’ Cholera Is Sweeping Africa, N.Y. TIMES, July 23, 1991, at C2Google Scholar. By mid-1991, WHO reported 45,000 cases of cholera in Africa, primarily in Zambia, Nigeria, and Ghana. See id. In 1992, the U.S. Centers for Disease Control (“CDC“) received reports from 21 Western-hemisphere countries of more than 339,000 cholera cases and 2321 cholera-related deaths; the number of cholera cases reported since the January 1991 outbreak totalled 731,312 and the total number of deaths was 6323. Update: Cholera— Western Hemisphere—1992, 269 JAMA 1369, 1369 (1993) [hereinafter Update: Cholera].

Cholera is a bacterial infection that affects the small intestine and is characterized by profuse watery diarrhea, muscular cramps, vomiting, and dehydration, among other things. See THE MERCK MANUAL OF DIAGNOSIS AND THERAPY 91 (Robert Berkow et al. eds., 15th ed. 1987) [hereinafter MERCK MANUAL]. Endemic to areas of Asia, the Middle East, Africa, and the Gulf Coast of the United States, it is transmitted by the ingestion of water or food contaminated by the excrement of infected persons. See id. at 92.

³⁶ See David, Brown, West Puts Ancient Chinese Malaria Remedy to the Test, WASH. POST, Nov. 25, 1991, at A3.Google Scholar

Malaria is a parasitic infection that involves attacks of chills, fever, and sweating, and affects the spleen, among other things. See MERCK MANUAL, supra note 35, at 205. Transmitted by the bite of an infected mosquito, transfusion of blood from an infected donor, or use of a common syringe, malaria is generally found in tropical areas. See id.

³⁷ Sullivan & Roskens, supra note 15, at 233.

³⁸ Catherine Woodard, TB in NY, NEWSDAY, Mar. 8, 1992, at 4. A 1992 WHO report found that 1.7 billion people are infected with the organism that causes tuberculosis, although a smaller number of people — 20 million — are actively infected with the disease. See Study: World Death Rates Down but Health Unimproved, UPI, May 3, 1992, available in LEXIS, Nexis Library, UPI File; Don Colburn, TB: The Scourge Strikes Again, WASH. POST, Jan. 12, 1993, § Health, at 12-14.

Tuberculosis is caused by the presence of Mycobacterium tuberculosis and may affect almost any body tissue or organ, most commonly the lungs. See STEDMAN, supra note 15, at 1649.

³⁹ See Elisabeth, Rosenthal, Drug-Resistant TB Is Seen Spreading Within Hospitals, N.Y. TIMES, Aug. 1, 1992, at 1.Google Scholar

⁴⁰ See id. AIDS is “characterized by opportunistic infections … and malignancies in immunocompromised persons.” STEDMAN, supra note 15, at 37-38. HIV, communicated by exchange of bodily fluids, such as semen or blood, or by transfused blood products, causes AIDS. See id. at 38.

⁴¹ Number of World AIDS Cases Up Dramatically, Report Says, CHI. TRiB.,Jan. 19, 1993, Evening Update, at 7. WHO has also found that the number of AIDS cases reported worldwide had reached more than 600,000 by the end of 1992. Id. It is expected that at least 30 to 40 million people worldwide will be infected with HIV by the end of this decade. Kenneth G., Castro et al., Perspectives on HIV/AIDS Epidemiology and Prevention from the Eighth International Conference on AIDS, 82 AM. J. PUB. HEALTH 1465, 1468 (1992).Google Scholar

⁴² See generally, Castro et al., supra note 41, at 1468 (“the national and international public health burden of the HIV epidemic increases each year.“).

⁴³ Roberto, Suro, The Cholera Watch, N.Y. TIMES, Mar. 22, 1992, § 6 (Magazine), at 32, 34.Google Scholar

⁴⁴ Peter, Eisner, Cholera in Peru a Lesson for Brazil, NEWSDAY, June 17, 1991, at 15Google Scholar. The CDC have stated that, in 1992, 102 cholera cases were reported in the United States, the highest number since the CDC began surveillance of cholera in 1961. See Update: Cholera, supra note 35.

⁴⁵ See Altman, supra note 35, at C2.

⁴⁶ See Nathaniel C., Nash, Latin Nations Feud Over Cholera Outbreak, N.Y. TIMES, Mar. 10, 1992, at A6.Google Scholar

⁴⁷ Anne, Harrison, Cholera Exposes Weak Latin Health System, UPI, Jan. 3, 1992Google Scholar, available in LEXIS, Nexis Library, UPI File. Another observer of Latin American health systems suggested that “[c]holera has set off a flashing alarm light over the lack of access to potable water and to sewage treatment for a great part of Latin America's population.” James, Brooke, How the Cholera Scare Is Waking Latin America, N.Y. TIMES, Mar. 8, 1992, § 4, at 4.Google Scholar

⁴⁸ See George A., Gellert et al., The Obsolescence of Distinct Domestic and International Health Sectors, 10 J. PUB. HEALTH POL'Y 421, 421 (1989).Google Scholar

⁴⁹ The International Bill of Human Rights, U.N. GAOR, 3d Sess., Supp. No. 1, at 71, U.N. Doc. A/565 (1948), includes: The Universal Declaration of Human Rights, U.N. GAOR, 3d Sess., 67th plen. mtg. at 1, U.N. Doc. A/811 (1948) [hereinafter Universal Declaration], The International Covenant on Economic, Social and Cultural Rights, G.A. Res. 2200, U.N. GAOR, 21st Sess., Supp. No. 16, at 49, U.N. Doc. A/6316 (1966) [hereinafter Covenant], The International Covenant on Civil and Political Rights, G.A. Res. 2200, U.N. GAOR, 21st Sess., Supp. No. 16, at 52, U.N. Doc. A/6316 (1966), and the Optional Protocol to The International Covenant on Civil and Political Rights, G.A. Res. 2200, U.N. GAOR, 21st Sess., Supp. No. 16, at 59, U.N. Doc. A/6316 (1966); see NEW DIRECTIONS IN HUMAN RIGHTS xiv n.l (Ellen L. Lutz et al. eds., 1989).

⁵⁰ Universal Declaration, supra note 49.

⁵¹ The International Covenant on Civil and Political Rights, supra note 49.

⁵² Covenant, supra note 49.

⁵³ LOUIS, HENKIN, THE AGE OF RIGHTS 20 (1990).Google Scholar Professor Henkin points out that, under the International Covenant on Civil and Political Rights, states undertake to respect and ensure those rights that protect and foster life and each individual's physical, psychological, and personal integrity. See id. Under the International Covenant on Economic, Social and Cultural Rights, however, states are obligated to mobilize all available resources in order to achieve the designated rights progressively. Id.

⁵⁴ Covenant, supra note 49. On WHO's role in the drafting of Article 12, see Philip, Alston, The United Nations Specialized Agencies and Implementation of the International Covenant on Economic, Social and Cultural Rights, 18 COLUM. J. TRANSNAT'L L. 79, 88–89 (1979).Google Scholar

⁵⁵ See Covenant, supra note 49, at arts. 2.1, 2.2, 12. For an analysis of the nature of the domestic and international obligations of state parties to the Covenant, see Philip, Alston & Gerard, Quinn, The Nature and Scope of States Parties’ Obligations Under the International Covenant on Economic, Social and Cultural Rights, 9 HUM. RTS. Q. 156, 164-92, (1987).Google Scholar

⁵⁶ Covenant, supra note 49.

⁵⁷ See THE RIGHT TO HEALTH AS A HUMAN RIGHT 149 (Rene-Jean Dupuy ed., 1979) [hereinafter RIGHT TO HEALTH] (remarks of H. de Riedmatten) (“[T]he point in question is the right to certain conditions for health, and not the right to health.“).

⁵⁸ The Covenant reflects that an individual's right to health is not dependent solely or even primarily on the organization of health services. See Covenant, supra note 49, at art. 12.

⁵⁹ See Political Covenant, supra note 49, at art. 6.1.

⁶⁰ See Covenant, supra note 49, at art. 11; see Philip, Alston, International Law and the Right to Food, in FOOD AS A HUMAN RIGHT 162, 164-65 (Asbjorn, Eide et al. eds., 1984)Google Scholar; J.P., Dobbert, Right to Food, in RIGHT TO HEALTH, supra note 57, at 184-85.Google Scholar

⁶¹ See Covenant, supra note 49, at art. 13.

⁶² See Covenant, supra note 49, at art. 9.

⁶³ See Covenant, supra note 49, at art. 2.1.

⁶⁴ HENKIN, supra note 53, at 20 n.*.

⁶⁵ See supra notes 40-42 and accompanying text.

⁶⁶ See Gellert, supra note 48, at 421.

⁶⁷ For a discussion of the tremendous development in multilateral and bilateral aid to the health sector in the last decade, see infra notes 147-156.

⁶⁸ WHO has a complicated, decentralized structure, with a central headquarters in Geneva, six regional offices, and many country and field offices. PAUL F., BASCH, TEXTBOOK OF INTERNATIONAL HEALTH 342 (1990).Google Scholar At the global headquarters, the World Health Assembly determines overall policy. WHO CONST, art. 18, m.WHO, BASIC DOCUMENTS, supra note 1, at 6. The Executive Board, which consists of thirty-one technically qualified individuals, is responsible for giving effect to the policies of the Assembly. Id. at arts. 24-29, in WHO, BASIC DOCUMENTS, supra note 1, at 8-9. The Secretariat consists of the Director-General and a technical and administrative staff. Id. at art. 30, in WHO, BASIC DOCUMENTS, supra note 1, at 9. The Director-General, nominated by the Executive Board, is WHO's chief technical and administrative officer. Id. at art. 31, in WHO, BASIC DOCUMENTS, supra note 1, at 9. For a more detailed description of WHO's history and structure, see BASCH, supra, at 340-49.

⁶⁹ Representatives of 61 states signed the WHO Constitution on July 22, 1946, at the Inter national Health Conference held in New York City from June 19 to July 22, 1946; the Constitution became effective on April 7, 1948. WHO, BASIC DOCUMENTS, supra note 1, at 1 n . l .

⁷⁰ See BASCH, supra note 68, at 326-53 (describing organizations working in international health).

⁷¹ See Miscellanea Medica, 268 JAMA 2145, 2145 (1992) (stating that the admission of the Republic of Kazakhstan and the Republic of Bosnia and Herzegovina increased WHO membership to 181 nations).

⁷² Appropriation Resolution for the Financial Period 1992-1993, WHA Res. 44.35, 44th World Health Assembly, at 32, WHO Doc. WHA44/1991/REC/1 (May 1991).

⁷³ WHO CONST, pmbl, in WHO, BASIC DOCUMENTS, supra note 1, at 1. In addition, Article 2 lists 22 functions that encompass every conceivable area of health. Id. at art. 2, in WHO, BASIC DOCUMENTS, supra note 1, at 2-3.

⁷⁴ Id. at pmbl., in WHO, BASIC DOCUMENTS, supra note 1, at 1. Other relevant provisions of the Constitution that relate to the organization's role in promoting the right to health include section (r) of Article 2 (“to assist in developing an informed public opinion among all peoples on matters of health“) and section (b) of Article 2 (“to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations, professional groups and other such organizations as may be deemed appropriate.“) Id. at art. 2, in WHO, BASIC DOCUMENTS, supra note 1, at 2-3.

⁷⁵ See id. at art. 1, in WHO, BASIC DOCUMENTS, supra note 1, at 2.

⁷⁶ Id. at pmbl., in WHO, BASIC DOCUMENTS, supra note 1, at 1.

⁷⁷ See U.N. CHARTER arts. 1, f 3, 55, 56, 57, 58, 59, 63, and 64, reprinted in 1 THE EUROPA WORLD Y.B. 1992 9, 12-13.

⁷⁸ For an analysis of the objectives of the specialized agencies, see WILLIAMS, supra note 3, at 26-46.

⁷⁹ U.N. CHARTER art. 55, reprinted in 1 THE EUROPA WORLD Y.B., supra note 77, at 12. The Charter further provides that “[t]he various specialized agencies, established by intergovernmental agreement and having wide international responsibilities, as defined in their basic instruments, in economic, social, cultural, educational, health, and related fields shall be brought into relationship with the United Nations” through the creation of special agreements with the Economic and Social Council. See id. at arts. 57, 63, reprinted in 1 THE EUROPA WORLD Y.B., supra note 77, at 12, 13.

⁸⁰ WHO CONST, art. 2(a), in WHO, BASIC DOCUMENTS, supra note 1, at 2.

⁸¹ Alston, supra note 54, at 81.

⁸² See Covenant, supra note 49, at art. 16. (“The States Parties to the present Covenant undertake to submit in conformity with this part of the Covenant reports on the measures which they have adopted and the progress made in achieving the observance of the rights recognized herein.“).

⁸³ See Alston, supra note 54, at 81-82.

⁸⁴ See supra note 73 and accompanying text.

⁸⁵ See supra note 1.

⁸⁶ See supra note 2.

⁸⁷ See WORLD HEALTH ORGANIZATION, PRIMARY HEALTH CARE: REPORT OF THE INTERNATIONAL CONFERENCE ON PRIMARY HEALTH CARE (1978) [hereinafter WHO, PRIMARY HEALTH CARE]. For a discussion of the series of policy decisions within WHO that led up to the Alma-Ata Conference, see WORLD HEALTH ORGANIZATION, FROM ALMA-ATA TO THE YEAR 2000: REFLECTIONS AT THE MIDPOINT 3 (1988) [hereinafter WHO, REFLECTIONS AT MIDPOINT].

Although UNICEF was a co-sponsor of the conference, the policy and strategy for Health for All were conceived and developed by WHO. See Carl, Taylor & Richard, Jolly, The Straw Men of Primary Health Care, 26 Soc. Sci. & MED. 971, 973-75 (1988).Google Scholar

⁸⁸ Declaration of Alma-Ata art. V, in WHO, PRIMARY HEALTH CARE, supra note 87, at 3.

⁸⁹ See WORLD HEALTH ORGANIZATION, GLOBAL STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000 79-87 (1981) [hereinafter WHO, GLOBAL STRATEGY].

⁹⁰ See WORLD HEALTH ORGANIZATION, SEVENTH GENERAL PROGRAMME OF WORK COVERING THE PERIOD 1984-1989 16 (1982) [hereinafter WHO, SEVENTH GENERAL PROGRAMME]. The Seventh General Programme of Work was the first to reflect the shift in WHO's priorities and describes WHO's reorientation to monitor and implement the Health for All strategy. See id. at 7-8.

⁹¹ See generally WORLD HEALTH ORGANIZATION, FORMULATING STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000 (1979) (setting forth a framework for formulating national policies, strategies, and plans of action, as well as regional and global strategies).

⁹² See generally WHA Res. 34.36, 34th World Health Assembly, WHO Doc. WHA34/1981/ REC/1, 35 (May 1981), compiled in WHO, HANDBOOK II, supra note 2, at 5. For details regarding the strategy, see WHO, GLOBAL STRATEGY, supra note 89.

⁹³ Article II provides that “[t]he existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries is politically, socially, and economically unacceptable … .” Declaration of Alma-Ata, in WHO, PRIMARY HEATLH CARE, supra note 87, at 2. Despite this strong affirmation of the appalling disparity of health status internationally and a call for international redistribution, the dominant thrust of the Declaration's policy is national self-reliance in health care. See infra notes 98-101 and accompanying text.

⁹⁴ Declaration of Alma-Ata art. VI, in WHO, PRIMARY HEALTH CARE, supra note 87, at 3-4.

⁹⁵ Id. at art. VII, in WHO, PRIMARY HEALTH CARE, supra note 87, at 4-5.

⁹⁶ See WHO SEVENTH GENERAL PROGRAMME, supra note 90, at 24.

⁹⁷ John H., Bryant, Health Services, Health Manpower and Universities in Relation to Health for All: An Historical and Future Perspective, 74 AM. J. PUB. HEALTH 714, 715 (1984).Google Scholar

⁹⁸ See discussion supra part II.A.

⁹⁹ See WHO, SEVENTH GENERAL PROGRAMME, supra note 90, at 25. WHO has also called for both national political commitment to the strategy and coordination with other national social and economic sectors for cooperative action in health care. See id. WHO has placed less emphasis on, and consequently has been less successful in, achieving these additional goals. See infra discussion at III.D.

¹⁰⁰ See WHO, SEVENTH GENERAL PROGRAMME, supra note 90, at 24-25.

¹⁰¹ See Covenant, supra note 49, at art. 12; Declaration of Alma-Ata arts. V-VI, in WHO, PRIMARY HEALTH CARE, supra note 87, at 3-4.

¹⁰² The portion of WHO's regular budget allocated to the organization of health systems based on primary health care increased from $51,581,000 for the fiscal period 1991-1992 to $64,823,400 proposed for 1992-1993. See WORLD HEALTH ORGANIZATION, PROPOSED PROGRAMME BUDGET FOR THE FINANCIAL PERIOD 1992-1993 A-30 (1990) [hereinafter WHO, PROPOSED PROGRAMME BUDGET 1992-1993].

¹⁰³ See, e.g., id. at B-51 to B-56 (describing WHO's emerging priorities in the organization of health systems based on primary health care).

¹⁰⁴ WHO developed new programs in t h e Eighth General Programme of Work in response to emerging international health issues. See WORLD HEALTH ORGANIZATION, EIGHTH GENERAL PROGRAMME OF WORK COVERING THE PERIOD 1990-1995 37-38 (1987) [hereinafter WHO, EIGHTH GENERAL PROGRAMME]. Some of these new programs are designed to address health systems research and development, informatics, tobacco and toxic chemicals, AIDS, and blindness and deafness. Id.

¹⁰⁵ See Walter R., Sharp, The New World Health Organization, 41 AM. J. INT'L L. 509, 519-20 (1947).Google Scholar The preamble to t he Constitution further declares that the realization of high levels of health the world over may have a vital bearing on the goal of international peace and security, and to this end, “[t]he extension to all peoples of t he benefits of medical, psychological and related knowledge” is an important objective. WHO CONST, pmbl., in WHO, BASIC DOCUMENTS, supra note 1, at 1.

¹⁰⁶ For a critical evaluation of WHO's traditional activities, see CHARLES O., PANNENBORG, A NEW INTERNATIONAL HEALTH ORDER 184-95 (1979).Google Scholar

¹⁰⁷ HAROLD K., JACOBSON, NETWORKS OF INTERDEPENDENCE 33, 300 (2d ed. 1984)Google Scholar. The Conseil supmeur de sanle (Superior Council of Health) of Constantinople, composed of delegates of the Ottoman Empire and the chief maritime states, was established in 1838. Id. It supervised the sanitary regulation of the Turkish port in order to prevent the spread of cholera from Asia to Europe and to deal with attendant communication and commercial implications. Id.

¹⁰⁸ See PANNENBORG, supra note 106, at 181. The activities of the Paris office were “gradually overshadowed” by the Health Organization that the League of Nations established. Id. at 182. The League of Nations Health Organization has been described as the “organic grandfather” of WHO because those involved in WHO's creation “borrowed extensively from the experience of the League in health matters.” See Sharp, supra note 105, at 511.

¹⁰⁹ See WHO CONST, art. 2, in WHO, BASIC DOCUMENTS, supra note 1, at 2-3; PANNENBORG, supra note 106, at 184. Paul Basch suggests that the work of WHO can be divided into two main categories: central technical services and services to governments. BASCH, supra note 68, at 348. Central technical services include epidemiological intelligence; working toward international agreements regarding health-related aspects of travel and commerce; international standardization of vaccines and pharmaceuticals; disseminating knowledge through meetings and reports of expert committees, seminars, study groups, and the publication of technical and similar literature on world health problems; and coordinating the work of several hundred institutes and laboratories across the world that provide expert consultation and services. Id. Services to governments primarily comprise thousands of individual regional projects and some larger cooperative interregional programs. Id.

¹¹⁰ See PANNENBORG, supra note 106, at 185-86.

¹¹¹ WHO regularly formulates and adopts technical recommendations that command much attention because of WHO's reputation for technical expertise. See, e.g., JACOBSON, supra note 107, at 319. “[G]roups of experts prepare reports that contain recommended ways of treating particular diseases … .” Id. Although these reports are not binding, “they are widely regarded by physicians and health services throughout the world as standard guides to practice.” Id. at 124. However, the notion that international health was simply a matter of science and technology and, therefore, could be divorced from the politics of the United Nations system, was quickly dispelled. See, e.g., R.J., Pethybridge, The Influence of International Politics on the Activities of ‘Non- Political’ Specialized Agencies — A Case Study, 13 POL. STUD. 247 (1965)Google Scholar (describing the interorganizational politics of the World Health Assembly during 1959). For a discussion of the traditional functionalism of WHO, see PANNENBORG, supra note 106, at 185-95. For a discussion of functionalism, see JACOBSON, supra note 107, at 62-65; CLIVE, ARCHER, INTERNATIONAL ORGANIZATIONS 83–89 (1983)Google Scholar.

¹¹² WILLIAMS, supra note 3, at 34. The range of services WHO provides has made it a valuable organization for developed and developing countries. See BASCH, supra note 68, at 351-52 (noting that “politically conservative interests in the United States, normally suspicious of all UN organizations, pay grudging respect to the professionalism of the WHO.“). Even the conservative Heritage Foundation has acknowledged the considerable benefit that the United States derives from the organization. See JOHN M., STARRELS, THE WORLD HEALTH ORGANIZATION: RESISTING THIRD WORLD IDEOLOGICAL PRESSURES 35–37 (1985).Google Scholar

¹¹³ The development of international health policy is discussed in Judith, Justice, The Bureaucratic Context of International Health: A Social Scientist's View, 25 Soc. Sci. & MED. 1301-02 (1987).Google Scholar

¹¹⁴ See Bryant, supra note 97, at 714-15; see also E., Najera et al., Health for All as a Strategy and the Role of Health Legislation: Some Issues and Views, 37 INT'L DIE. HEALTH LEGIS. 362, 364 (1986)Google Scholar (discussing philosophical trends).

¹¹⁵ See, e.g., ERNST B., HAAS, WHEN KNOWLEDGE IS POWER: THREE MODELS OF CHANGE IN INTERNATIONAL ORGANIZATIONS 138–40 (1990)Google Scholar. Haas states that, until the early 1970s, WHO's leadership consisted of a coalition of Western governments, and the major Western medical groups planned WHO's program. See id. at 138. “[I]n the early 1970s … the developing countries began to insist that the program was fashioned in the image of Western public health practices and did not address developmental needs adequately.” Id. at 139. WHO eventually developed a new program, “more directly linked to rural development needs in the developing world and less informed by the practices of industrialized countries.” Id.

¹¹⁶ See, e.g.. RIGHT TO HEALTH, supra note 57, at 146-47 (remarks of G. Perrin).

¹¹⁷ See, e.g., Toby, Cohen, Health Care and the Class Struggle, N.Y. TIMES, NOV. 17, 1991, at E17Google Scholar; see also Wendy K., Mariner, Equitable Access to Biomedical Advances: Getting Beyond the Rights Impasse, 21 CONN. L. REV. 571 (1989)Google Scholar (describing the public demand for collective entitlement to health care in the United States); Wartburg, Walter P. von, A Right to Health? Aspects of Constitutional Law and Administrative Practice, in RIGHT TO HEALTH, supra note 57, at 112, 112-15Google Scholar (arguing that the evolving functions of national health services reflect the development of societal attitudes about the responsibility of nations to guarantee medical services).

¹¹⁸ The demands of the world's poorest nations for specific distributive measures to overcome their particular disadvantages has been a prominent international political issue for several decades. Many scholars have proposed a number of moral theories supporting the redistribution of resources, including health resources, from rich to poor nations. Most prominently, some scholars have sought to extend the difference principle developed by John Rawls globally. See JOHN, RAWLS, A THEORY OF JUSTICE (1971)Google Scholar. For a discussion of international distributive justice, see Bryant, , supra note 97, at 714Google Scholar; Charles R., Beitz, Justice and International Relations, in INTERNATIONAL ETHICS 282 (Charles R., Beitz et al. eds., 1985)Google Scholar; see also Oscar, Schachter, Principles of International Social Justice, in JUS ET SOCIETAS: ESSAYS IN TRIBUTE TO WOLFGANG FRIEDMANN 249, 255 (1979).Google Scholar A justice-based obligation to redistribute resources globally has been disputed by other authors. See, e.g., Thomas M., Franck, Is Justice Relevant to the International Legal System?, 64 NOTRE DAME L. REV. 945 (1989).Google Scholar Other grounds for transnational redistribution of resources include moral theories of mutual aid, beneficence, and humanity. See Peter, Singer, Famine, Affluence, and Morality, in INTERNATIONAL ETHICS, supra, at 247.Google Scholar

¹¹⁹ See HAAS, supra note 115, at 140.

¹²⁰ Ernst B. Haas describes WHO's evolution as a successful example of an uncommon organizational change defined as “managed interdependence“:

Id. at 128. The principal purposes of WHO have been scrutinized and transformed in response to “knowledge-mediated decision-making dynamics.” Id. at 4; see also id. at 138-40 (examining WHO as a case study in managed interdependence). See generally THE EVOLUTION OF INTERNATIONAL ORGANIZATIONS (Evan Luard ed., 1966) (discussing mechanics of change in international organizations).

¹²¹ WHO CONST, art. 2(c), in WHO, BASIC DOCUMENTS, supra note 1, at 2.

¹²² See BASCH, supra note 68, at 348.

¹²³ See id.; WHO, EIGHTH GENERAL PROGRAMME, supra note 104, at 18.

¹²⁴ Many have accused WHO of having a bloated bureaucracy. See, e.g., Paul, Dietrich, WHO's to Blame: Fixing World Health Aid, WALL ST. J., May 11, 1990, at A12.Google Scholar Despite WHO's rhetoric concerning the strategic emphasis on national planning and control in the development of domestic Health for All strategies, some observers have noted that WHO and other organizations involved in the Health for All campaign have imposed organizational mandates on national programs without sufficient regard for the cultural realities of individual nations. See generally George M., Foster, Bureaucratic Aspects of International Health Agencies, 25 Soc. Sci. & MED. 1039, 1044-45, 1047 (1987)Google Scholar; Justice, supra note 113, at 1301-06.

¹²⁵ See WHO, REFLECTIONS AT MIDPOINT, supra note 87, at 22-26 (discussing effective national Health for All strategies in industrialized countries and developing countries, such as Thailand, Bangladesh, Mongolia, Finland, Sweden, and Yugoslavia); Bryant, supra note 97, at 717-18 (discussing independent observations of national Health for All strategies in Nigeria, Egypt, Thailand, and India); Genevieve, Pinet, The WHO European Program of Health Legislation and the Health for All Policy, 12 AM. J.L. & MED. 441, 447 (1986)Google Scholar (discussing Health for All programs in Finland, Greece, Italy, and Portugal).

¹²⁶ Even its critics acknowledge that the goal of Health for All constitutes “the basis of a complete revolution in public health thinking.” J.I., Cohen, Health Policy, Management and Economics, in ISSUES IN CONTEMPORARY INTERNATIONAL HEALTH 13, 26 (Thomas A., Lambo & Stacey B., Day eds., 1990).Google Scholar

¹²⁷ See van der Geest, supra note 30, at 1026-28.

¹²⁸ See generally Haas, supra note 115, at 87-88 (discussing organizational authority and legitimacy in the context of public international organizations).

¹²⁹ Id. at 87.

¹³⁰ See, e.g., Justice, supra note 113, at 1302.

¹³¹ News & Comment, Nairobi Perspective: Health for How Many by 2000?, 338 LANCET 239 (1991).

¹³² See supra notes 121-22 and infra note 181 and accompanying text.

¹³³ See supra note 99 and accompanying text.

¹³⁴ See, e.g.. WORLD HEALTH ORGANIZATION, THE WORK OF WHO 1988-1989: BIENNIAL REPORT OF THE DIRECTOR-GENERAL TO THE WORLD HEALTH ASSEMBLY AND TO THE UNITED NATIONS ¶ 3.13, at 20 (1990).

¹³⁵ See WHO GLOBAL ESTIMATES 1990, supra note 8, at 50.

¹³⁶ See id. at 49-50.

¹³⁷ HAAS, supra note 115, at 87; see supra note 129 and accompanying text for Haas's definition of organizational authority. Haas distinguishes organizational legitimacy from organizational authority, noting that “[s]tates may grudgingly meet the organization's expectations without at the same time appreciating or valuing them.” Id.

¹³⁸ Id. at 87.

¹³⁹ See, e.g., Organization of American States, Additional Protocol to The American Convention on Human Rights in The Area of Economic, Social and Cultural Rights, 28 I.L.M. 156 (1989) [hereinafter PROTOCOL OF SAN SALVADOR]. Article 10(1) of the Protocol provides that “[e]veryone shall have the right to health, understood to mean the enjoyment of the highest level of physical, mental and social well-being.” Id., 28 I.L.M. at 164. The parties to the Protocol, recognizing health as a public good, agreed to adopt such measures as primary health care programs, including health education and universal immunization against the principal infectious diseases. Id. at art. 10(2), 28 I.L.M. at 164. Although multilateral conventions and declarations have been largely ineffective in stimulating national action on health, the Protocol of San Salvador may be regarded at least as an expression of states’ evolving recognition of their responsibility to guarantee their citizens access to basic health services, illustrating an example of changing social values. See also ORGANIZATION OF AFRICAN UNITY, BANJUL CHARTER ON HUMAN AND PEOPLES’ RIGHTS, art. 16, O.A.U. Doc. CAB/LEG/67/3/Rev.5 (1981), 21 I.L.M. 58, 61 (1982) [hereinafter BANJUL CHARTER] (reaffirming “the right [of every individual] to enjoy the best attainable state of physical and mental health“).

¹⁴⁰ See Jeffrey, Pfeffer, Understanding the Role of Power in Decision Making, in CLASSICS OF ORGANIZATION THEORY 313 (Jay M., Shafritz et al. eds., 1987).Google Scholar

¹⁴¹ See B., Abel-Smith, The Economics of Health Care, in ISSUES IN CONTEMPORARY INTERNATIONAL HEALTH, supra note 126, at 55, 55–57Google Scholar. The General Assembly has also acknowledged the interrelation between health and development. See, e.g.. International Forum on Health — A Conditionality for Economic Development: Breaking the Cycle for Poverty and Inequity, G.A. Res. 46/17, U.N. GAOR 2d Coram., 46th Sess., 48th plen. mtg., Agenda Item 77(/), U.N. Doc. A/RES/46/17 (1991).

¹⁴² See, e.g., Declaration of Alma-Ata arts. Ill & IV, in WHO, PRIMARY HEALTH CARE, supra note 87, at 2-3. Article III states in pertinent part: “The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.” Article IV provides: “The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.” See also Abel-Smith, supra note 141, at 56.

¹⁴³ See, e.g., WORLD HEALTH ORGANIZATION, THE IMPACT OF DEVELOPMENT POLICIES ON HEALTH (1990) [hereinafter WHO, IMPACT OF DEVELOPMENT]. According to one observer, “[u]nder all the rhetoric, WHO's Health for All program is essentially the application of basic economic principles to health policy-making. The problem is how a society can maximize health out of limited resources and assure that health benefits are equitably distributed.” Abel-Smith, supra note 141, at 56.

¹⁴⁴ See supra note 99 and accompanying text.

¹⁴⁵ Mburu, supra note 31, at 592.

¹⁴⁶ Sharon, Kingman, AIDS Brings Health into Focus, NEW SCIENTIST, May 20, 1989, at 37, 41.Google Scholar

¹⁴⁷ See Lee, Howard, The Evolution of Bilateral and Multilateral Cooperation for Health in Developing Countries, in INTERNATIONAL COOPERATION FOR HEALTH: PROBLEMS, PROSPECTS, AND PRIORITIES 332, 342 (Michael R., Reich & Eiji, Marui eds., 1989)Google Scholar. For example, between 1976 and 1980, available data indicated that five out of 30 bilateral and multilateral agencies (excluding WHO and UNICEF) were active in the health sector in at least half the countries with which they were cooperating. Id.

¹⁴⁸ See id. See also id. at 352 (“[O]fficial bilateral and multilateral agencies have increased in number from none prior to World War II … to a level of approximately 67 official agencies today.“).

Further, the World Bank did not begin direct lending to the health sector until 1980. THE WORLD BANK, supra note 17, at 49. Other development banks, among them the Asian Development Bank and the Inter-American Development Bank, have long included health lending as a component of development financing. Howard, supra’ note 147, at 342.

¹⁴⁹ WHO CONST, art. 2(a), in WHO, BASIC DOCUMENTS, supra note 1, at 2.

¹⁵⁰ See, e.g., WHO, EIGHTH GENERAL PROGRAMME, supra note 104, at 49.

¹⁵¹ Howard, supra note 147, at 350.

¹⁵² Id. at 352.

¹⁵³ /</.

¹⁵⁴ MAHESH S., PATEL, UNICEF, ELIMINATING SOCIAL DISTANCE BETWEEN NORTH AND SOUTH: COST-EFFECTIVE GOALS FOR THE 1990s 47–53 (1989)Google Scholar (describing that the detailed, child-specific goals that UNICEF proposed for the 1990s “operate largely within the framework of the WHO Health for All” strategy); see Taylor & Jolly, supra note 87, at 975. See generally UNICEF, THE STATE OF THE WORLD'S CHILDREN 1991 (1991) (describing UNICEF's strategy for children). The World Bank has focused on the specifics of financing primary health services. See THE WORLD BANK, supra note 17, at 9.

¹⁵⁵ See Sullivan & Roskens, supra note 15, at 243-44.

¹⁵⁶ See, e.g., Mburu, supra note 31, at 592-93.

¹⁵⁷ Since the Declaration of Alma-Ata, a number of social indicators suggest modest improvement in global health statistics, including increased life expectancy and declining infant and maternal mortality and morbidity. See WHO GLOBAL ESTIMATES 1990, supra note 8, at 14, 17-18. The overall trend, however, conceals a diverse set of successes and failures at the national level. See WHO, REFLECTIONS AT MIDPOINT, supra note 87, at 20-26. Overall, health improvement has been slowest in the richest and the poorest countries. Id.

¹⁵⁸ See Verbatim Records of Plenary Meetings, 43d World Health Assembly, at 8, WHO Doc. WHA43/1990/REC/2 (May 8, 1990) (“[T]he year 2000 is very close but health is farther away than ever.“).

¹⁵⁹ See discussion supra part II.A.

¹⁶⁰ See Marlene, Cimons, Checkup on World Health: Many Deaths Preventable, L.A. TIMES, May 4, 1992, at A30.Google Scholar

¹⁶¹ WHA Res. 41.34, 41st World Health Assembly, WHO Doc. WHA41/1988/REC/1, 31 (May 13, 1988), compiled in 3 WORLD HEALTH ORGANIZATION, HANDBOOK OF RESOLUTIONS AND DECISIONS OF THE WORLD HEALTH ASSEMBLY AND THE EXECUTIVE BOARD 1985-1989 25 (1990).

¹⁶² Id. at 25-26.

¹⁶³ According to 1991 surveys from 57 member states (representing 41 % of the total population of all member states), WHO reports that central governments spent an average of 3% of their gross national product (“GNP“) on health. DIVISION OF EPIDEMIOLOGICAL SURVEILLANCE AND HEALTH SITUATION AND TREND ASSESSMENT, WORLD HEALTH ORGANIZATION, GLOBAL HEALTH SITUATION AND PROJECTIONS - ESTIMATES 88, WHO Doc. WHO/HST/92.1 (1992) [hereinafter WHO GLOBAL ESTIMATES 1992]. The figure in developing countries was 0.9%, in the least developed countries 1.4%, and in developed market economies 3.3%. Id.

World Bank statistics show that health sector spending in 1972 constituted an average of 4.6% of total central government expenditures in low-income economies; that figure dropped to 2.7% by 1983. See THE WORLD BANK, supra note 17, at 57. For middle -income economies, the 1972 and 1983 figures are 6.3% and 4.5%, respectively. See id. at 58. In the industrial market economies, however, health sector spending as a percentage of central government expenditures increased marginally from 10% to 11.2% during the same period. See id. at 59. Actual health sector spending as a percentage of central government expenditures may be somewhat higher than the figures above indicate since the World Bank categorizes education, social security, and welfare as separate from health. See id. at 57-60, 79.

¹⁶⁴ See Prospects for Health for Alt, supra note 5, at 1-3. Increased demand for health care services has strained this situation further. Id. at 2.

¹⁶⁵ HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 23.

¹⁶⁶ Id. at 26.

¹⁶⁷ See, e.g., THE ROCKEFELLER FOUNDATION, GOOD HEALTH AT Low COST (Scott B. Halstead et al. eds., 1985) [hereinafter GOOD HEALTH AT Low COST] (Proceedings of a Conference held at Bellagio, Italy, April 29-May 3, 1985) (illustrating that the health gains of some of the poorest nations, including China, Sri Lanka, and Costa Rica, were achieved at relatively modest cost and can serve as a model to other developing nations).

¹⁶⁸ Prospects for Health for All, supra note 5, at 2.

¹⁶⁹ See THE WORLD BANK, supra note 17, at 1.

¹⁷⁰ WHO GLOBAL ESTIMATES 1992, supra note 163.

¹⁷¹ See WHO, REFLECTIONS AT MIDPOINT, supra note 87, at 37.

¹⁷² See Taylor & Jolly, supra note 87, at 976.

¹⁷³ Van der Geest et al., supra note 30, at 1028.

¹⁷⁴ See HUMAN DEVELOPMENT REPORT 1991, supra note 6, at 26-27. In Asia and Africa, the inequitable distribution of health care resources between urban and rural areas exacerbates the effects of income inequality since most of the poor tend to live in rural regions. See id. Meanwhile, primary health care services do not seem to be improving for the growing urban poor. See, e.g., 1 WORLD HEALTH ORGANIZATION, EVALUATION OF THE STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000: SEVENTH REPORT ON THE WORLD HEALTH SITUATION 112 (1987).

¹⁷⁵ Van der Geest, supra note 30, at 1028 (quoting Emil Salim, Primary Health Care Belongs in the Mainstream of Development, 9 WORLD HEALTH F. 307, 308 (1988)).

¹⁷⁶ See Presidential Address, 43d World Health Assembly, 3d plen. mtg. at 8-9, WHO Doc. WHA43/1990/REC/2 (1990) (remarks of Dr. P. Naranjo of Ecuador on May 8, 1990).

¹⁷⁷ Id. at 8.

¹⁷⁸ See, e.g., Reginald H., Green, Politics, Power and Poverty: Health for All in 2000 in the Third World?, 32 Soc. Sci. & MED. 745, 748-50 (1991).Google Scholar

¹⁷⁹ See id.

¹⁸⁰ See supra note 136 and accompanying text.

¹⁸¹ See, e.g., Mburu, supra note 31, at 519 (“Structural poverty arising from intractable inaccessibility to and the maldistribution of wealth cannot be fully changed from outside, however strong the pressure.“).

¹⁸² David P., Forsythe, The Politics of Efficacy: The United Nations and Human Rights, in POLITICS IN THE UNITED NATIONS SYSTEM 246, 267 (Lawrence S., Finkelstein ed., 1988)Google Scholar (quotingjohn G., Ruggie, Human Rights and the Future International Community, 4 DAEDALUS 93, 106 (1983))Google Scholar.

¹⁸³ Id. (quoting Louis, Henkin, The United Nations and Human Rights, 19 INT'L ORG. 504, 514 1965).Google Scholar

¹⁸⁴ Covenant, supra note 49, at art. 2.1.

¹⁸⁵ Covenant, supra note 49, at arts. 2.2, 12.1; see discussion supra part II.B.

¹⁸⁶ See supra note 56 and accompanying text.

¹⁸⁷ See EDWARD, LAWSON, ENCYCLOPEDIA OF HUMAN RIGHTS 222 (1991).Google Scholar

¹⁸⁸ WHO did submit a report to the Economic and Social Council, in accordance with Article 18 of the Covenant, concerning the rights covered by Article 12. See Covenant, supra note 48, at art. 18. The report, however, provides little precision to the scope of legal obligations under Article 12. See Implementation of the International Covenant on Economic, Social and Cultural Rights, U.N. ESCOR, 1st Sess., Provisional Agenda Item 5, at 2-8, U.N. Doc. E/1980/24 (1980) [hereinafter Implementation of the Covenant].

¹⁸⁹ See Declaration on the Rights of Disabled Persons, art. 6, G.A. Res. 3447, U.N. GAOR, 30th Sess., Supp. No. 34, at 88, U.N. Doc. A/10034 (1975); Declaration on the Rights of Mentally Retarded Persons, art. 2, G.A. Res. 2856, U.N. GAOR, 26th Sess., Supp. No. 29, at 93, U.N. Doc. A/8429 (1971). See generally CENTRE FOR HUMAN RICHTS, UNITED NATIONS ACTIONS IN THE FIELD OF HUMAN RICHTS at 170-71, U.N. Doc. ST/HR/2/Rev.3, U.N. Sales No. E.88.XIV.2 (1988). The right to health or medical treatment is also affirmed in a number of legally binding conventions, including the Convention on Elimination of All Forms of Discrimination Against Women, arts. ll(l)(f), 12(1), 12(2), 14(2)(b), G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 196, U.N. Doc. A/34/46 (1979), and the Convention on the Rights of the Child, arts. 24-25, G.A. Res. 44/25, U.N. GAOR, 44th Sess., Agenda Item 108, at 12-13, U.N. Doc. A/RES/44/25 (1989); see also Sanford J., Fox & Diony, Young, International Protection of Children's Right to Health: The Medical Screening of Newborns, 11 B.C. THIRD WORLD L.J. 1 (1991)Google Scholar (arguing that children have legal rights to health, and that both health and the provision of health care are subjects of international law).

Thomas, Buergenthal, International and Regional Human Rights Law and Institutions: Some Examples of Their Interaction, 12 TEX. INT'L L.J. 321, 323 (1977).Google Scholar These texts, however, have not added much precision to the scope of states’ obligations and the nature of the entitlement under the right to health. See, e.g., PROTOCOL OF SAN SALVADOR art. 1-3, supra note 139; BANJUL CHARTER art. 16, supra note 139; EUROPEAN SOCIAL CHARTER, pt. 2, art. 11, 1961 EUR. Y.B. (Council of Europe) 247, 257.

The right to health is also proclaimed in the constitutions of many nations. See, e.g., PAN AMERICAN HEALTH ORGANIZATION, THE RIGHT TO HEALTH IN THE AMERICAS: A COMPARATIVE CONSTITUTIONAL STUDY 622-25, 665-66 (Hernan L. Fuenzalida-Puelma & Susan S. Connor eds., 1989).

¹⁹¹ See OSCAR, SCHACHTER, INTERNATIONAL LAW IN THEORY AND PRACTICE: GENERAL COURSE IN PUBLIC INTERNATIONAL LAW 24–25 (Academy of International Law Offprint from the Collected Courses, Vol. 178 (1982-V))Google Scholar [hereinafter SCHACHTER, INTERNATIONAL LAW] (copy on file with author). For a list of the major theories explaining the basis of obligation in international law, see Oscar Schachter, Towards a Theory of International Obligation, 8 VA.J. INT'L L. 300, 301 (1968) [hereinafter Schachter, Towards a Theory].

¹⁹² See Louis, HENKIN, HOW NATIONS BEHAVE 49 (2d ed. 1979).Google Scholar

¹⁹³ Oscar Schachter refers to this variable as “definiteness.” SCHACHTER, INTERNATIONAL LAW, supra note 191, at 43; see THOMAS M., FRANCK, THE POWER OF LEGITIMACY AMONG NATIONS 50–66 (1990)Google Scholar (describing “determinacy” as one of four indicators of the legitimacy of international rules) Franck asserts that the higher the level of determinacy, the greater the likelihood that the rule will be observed. Id. at 52.

¹⁹⁴ Covenant, supra note 49.

¹⁹⁵ Alston, supra note 54, at 114.

¹⁹⁶ WHO CONST, art. 21, in WHO, BASIC DOCUMENTS, supra note 1, at 7 (conferring authority on WHA to adopt regulations regarding sanitary and quarantine requirements to prevent the international transmission of disease, standards for the purity, safety, and potency of biological and pharmaceutical products traveling in international commerce, among other things).

¹⁹⁷ Id. at art. 19, in WHO, BASIC DOCUMENTS, supra note 1, at 7 (conferring authority on WHA to adopt conventions or agreements concerning any matter within WHO's competence).

¹⁹⁸ Id. at art. 23, in WHO, BASIC DOCUMENTS, supra note 1, at 7 (conferring authority on WHA to make recommendations to member states regarding any matter within WHO's competence).

¹⁹⁹ See S.S., Fluss & Frank, Gutteridge, Some Contributions of the World Health Organization to Legislation, in ISSUES IN CONTEMPORARY INTERNATIONAL HEALTH, supra note 126, at 37.Google Scholar

Article 21 provides:

The Health Assembly, shall have the authority to adopt regulations concerning:

• (a) sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease;

• (b) nomenclatures with respect to disease, causes of death and public health practices;

• (c) standards with respect to diagnostic procedures of international use;

• (d) standards with respect to the safety, purity and potency of biological, pharmaceutical and similar products moving in international commerce;

• (e) advertising and labelling of biological pharmaceutical and similar products moving in international commerce.

WHO CONST., in WHO, BASIC DOCUMENTS, supra note 1, at 7.

²⁰⁰ See Fluss & Gutteridge, supra note 199, at 37. See generally Health, Human Rights and International Law, 82 AM. SOC'Y OF INT'L L. PROC. 122, 129 (1990) (remarks by Susan Connor, Legal Consultant, WHO) (“We have the ability under the WHO Constitution to issue regulations and conventions that can be legally binding in form. We generally do not do that.“).

²⁰¹ See Alston, supra note 54, at 80-81, 81 n.12.

²⁰² See Covenant, supra note 49, at arts. 16.1, 16.2.a; Alston, supra note 54, at 93.

²⁰³ See Covenant, supra note 49, at art. 16.2b; Alston, supra note 54, at 82.

²⁰⁴ See id. at 117-18.

²⁰⁵ See id. at 96-99, 100-01.

²⁰⁶ Peter H., Sand, Lessons Learned in Global Environmental Governance, 18 B.C. ENVTL. AFF. L. REV. 213, 233 (1991).Google Scholar

²⁰⁷ WHO CONST, art. 62, reprinted in WHO, BASIC DOCUMENTS, supra note 1, at 15.

²⁰⁸ Fluss & Gutteridge, supra note 199, at 42.

²⁰⁹ See WORLD HEALTH ORGANIZATION, DEVELOPMENT OF INDICATORS FOR MONITORING PROGRESS TOWARDS HEALTH FOR ALL BY THE YEAR 2000 1-40 (1981) [hereinafter WHO, DEVELOPMENT OF INDICATORS FOR MONITORINC PROGRESS]. For the current focus of the monitoring and supervisory functions of the organization, see WHO, EIGHTH GENERAL PROGRAMME, supra note 104, at 188-93.

²¹⁰ At the regional level, WHO's European office may constitute an exception. The WHO Regional Office for Europe has integrated the creation of national legislation as a part of the “Health for All” strategy. Pinet, supra note 125, at 447-48. For an overview of developments in European health legislation, focusing on national achievements necessary to achieve “Health for AH” as of 1986, see id. at 444-50. For a comprehensive review of the activities that the WHO Regional Office for Europe carried out in the health legislation field through 1986, see id. at 450- 51.

²¹¹ WHO, PRIMARY HEALTH CARE, supra note 87, at 76.

²¹² WHO has organized or participated in some international meetings that have considered either centrally or peripherally the role of health legislation to support the Health for All strategy. See Fluss & Gutteridge, supra note 199, at 47-48. For a description of the current focus of WHO's efforts in national health legislation, see WHO, PROPOSED PROGRAMME BUDGET 1992- 1993, supra note 102, at B-48 to B-50; see also Najera et al., supra note 114, at 363-65 (describing WHO's limited efforts to facilitate the development of national health legislation).

²¹³ See Najera et al., supra note 114, at 363 (“few countries … have expressly enacted legislation or legally binding regulatory instruments on which to base their activities to ensure the protection and care of the health of their peoples.“).

²¹⁴ FRANK P., GRAD, THE PUBLIC HEALTH LAW MANUAL 9 (2d ed. 1990).Google Scholar

²¹⁵ General Policy Review, WHO Executive Board, 87th Sess., Agenda Item 5.1, at 19, WHO Doc. EB/87/1991/REC/2 [hereinafter General Policy Review]. The Director-General further commented:

Id.

²¹⁶ See generally Douglas L., Donoho, Relativism Versus Universalism in Human Rights: The Search for Meaningful Standards, 27 STAN. J. INT'L L. 345, 368-70 (1991).Google Scholar

²¹⁷ Some relativists, however, would not be assuaged by the following analysis because they do not believe that human rights can ever be subject legitimately to international governance. Id. at 352.

²¹⁸ See Mark A., Gray, The United Nations Environment Programme: An Assessment, 20 ENVTL. L. 291, 297–306 (1990).Google Scholar

²¹⁹ See id. See generally Sand, supra note 206 (discussing innovative mechanisms that can promote international cooperation).

²²⁰ See generally Sand, supra note 206.

²²¹ Sept. 16, 1987, 26 I.L.M. 1550, 1559 (1987) [hereinafter Montreal Protocol] (entered into force Jan. 1, 1989).

²²² Opened for signature Mar. 22, 1985, 26 I.L.M. 1529, 1534 (1987).

²²³ On the political background of the Montreal Protocol, see PETER M., HAAS, INTERNATIONAL ENVIRONMENTAL ISSUES 30–37 (1991).Google Scholar

²²⁴ See Montreal Protocol, supra note 221, at art.2, 26 I.L.M. at 1552-54.

²²⁵ See id. at arts. 4, 5, 9, 10, 26 I.L.M. at 1554-57.

²²⁶ Id. On May 10, 1992, South Africa ratified the London Amendment to the Montreal Protocol, thus making the agreement effective on August 10, 1992. See South Africa Becomes 20th Nation to Ratify Montreal Protocol, Pushing It into Force, Int'l Env't Rep. (BNA) No. 10, at 310 (May 20, 1992).

²²⁷ Done on May 9, 1992, 31 I.L.M. 849 (1992) [hereinafter Framework Convention]. See generally JOHAN, KAUFMAN ET AL., THE WORLD IN TURMOIL; TESTING THE UN's CAPACITY 78–86 (1991)Google Scholar; WORKING GROUP III, INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE, POLICYMAKERS SUMMARY OF THE FORMULATION OF RESPONSE STRATEGIES (1990), in HAAS, supra note 223, at app. 2 (discussing recommended national and international measures to alleviate climatic change). The treaty will “enter into force on the ninetieth day after the date of deposit of the fiftieth instrument of ratification, acceptance, approval or accession.” Framework Convention, supra, at art. 23, 31 I.L.M. at 871.

²²⁸ See Edith B., Weiss, Introductory Note: United Nations Conference on Environment and Development, 31 I.L.M. 814, 816 (1992).Google Scholar Nations negotiated the convention under a “free-standing body” created by the United Nations General Assembly, the Intergovernmental Negotiating Committee. See id.

²²⁹ See, e.g., William K., Stevens, Rio: A Start on Managing What's Left of This Place, N.Y. TIMES, May 31, 1992, § 4, at 1Google Scholar. Political consensus over the treaty was reached when developed countries pledged to help defray the cost of introducing clean technology to developing nations. Id.

²³⁰ A month before the conference, the United States pressured both Japan and the European Community nations to drop binding timetables and targets for stabilizing emissions for greenhouse gases from the draft treaty. See Hisao, Takagi, Japan, Europe Give Way on Global-Warming Treaty, THE NIKKEI WEEKLY, May 16, 1992Google Scholar, available in LEXIS, Nexis Library, Nikkei File; Rudy, Abramson, Bid to Press U.S. for Air Pollution Limits Is Failing, L.A. TIMES, June 7, 1992, at A1.Google Scholar

²³¹ See Stevens, supra note 229, at 6.

²³² Japan is expected to issue a unilateral emission-control pledge to reduce the production of greenhouse gases to 1990 levels by the year 2000. Takagi, supra note 230. To meet its target, Japan will have to limit annual growth in energy consumption to less than 1 % for the remainder of the decade. Id. Energy consumption in Japan increased by 3.8% in 1990 and 3.2% in 1991. Id. The European Community has proposed a new energy tax on coal, oil, natural gas, and other non-renewable forms of energy that are harmful to the environment. Marlise, Simons, Europe Sees Oil Tax as a Way to Dampen Demand, N.Y. TIMES, June 1, 1992, at A6.Google Scholar Northern European governments have already imposed new energy taxes that would curtail demand for environmentally harmful fuels. See id. Critics have noted that, despite its rhetoric, the European Community has been slow in implementing its own measures to halt global warming. See Tony, Carritt, Europe's Divisions Weaken Ambitions for Earth Summit, Reuters, May 30, 1992Google Scholar, AM cycle, available in LEXIS, Nexis Library, Reuter File.

²³³ See, e.g., Philip, Shabecoff, Largest U.S. Tanker Spill Spews 270,000 Barrels of Oil off Alaska, N.Y. TIMES, Mar. 25, 1989, at 1.Google Scholar

²³⁴ International Convention on Oil Pollution Preparedness, Response and Cooperation, Nov. 30, 1990, 30 I.L.M. 733 (1991).

²³⁵ Id. n.*. In the United States, the Oil Pollution Act of 1990, Pub. L. No. 101-380, 104 Stat. 484 (Aug. 18, 1990) (codified as amended at 33 U.S.C.A. §§ 2701-61 (West Supp. 1992)), was passed during the negotiations of the international convention.

²³⁶ Van der Geest, supra note 30, at 1028.

STARRELS, supra note 112, at 40.

Many national governments pay inadequate attention to health care policy. See van der Geest, supra note 30, at 1028. However, even if a policy commitment is made, “[t]he give-andtake of cabinet-level decision-making” often diminishes or removes the necessary financial resources. John H., Bryant, Health for All: The Dream and the Reality, 9 WORLD HEALTH F. 291, 294 (1988).Google Scholar “Health does not usually have strong leverage in national councils of power, and shifts in budgetary priorities involve shifts in power. Vision is needed at the policy-making level, and indeed the vision may be there — but not the leverage.” Id.

²³⁷ See, e.g., van der Geest, supra note 30, at 1027. The authors suggest that WHO's policy formerly emphasized “the population's participation and self-reliance,” but now resembles “a more marketing-like strategy.” Id. They also note that WHO avoids making political statements that “openly criticize” a specific government, and produces publications that are “openly apolitical.” Id. As a result, “[t]he plea for community participation carries [a] contradiction, for is it not the case that the most urgent problems of local communities and the solutions to the same problems have been defined at the top? … [T]he plea for self-reliance does not come from those who should be self-reliant [i.e., the public] but from the international health planners.” Id.

²³⁸ See WHO CONST, art. 11, reprinted in WHO, BASIC DOCUMENTS, supra note 1, at 5 (“[DJelegates [representing Members] should be chosen from among persons most qualified by their technical competence in the field of health, preferably representing the national health administration of the Member.“).

²³⁹ Id. at art. 24, in WHO, BASIC DOCUMENTS, supra note 1, at 8 (“The Health Assembly, taking into account equitable geographical distribution, shall elect the Members entitled to designate a person to serve on the Board … . Each of these Members should appoint to the Board a person technically qualified in the field of health … . “ ) .

²⁴⁰ Id. at art. 31, in WHO, BASIC DOCUMENTS, supra note 1, at 9.

²⁴¹ See Presidential Address, 43d World Health Assembly, supra note 176, at 8 (remarks of Dr. P. Naranjo).

²⁴² See Gray, supra note 218, at 301-06. “Least tangible of UNEP's accomplishments but potentially most significant is the unique role it has carved out for itself… . UNEP has repeatedly brought together experts, governments and international organizations, while providing guidance and encouraging a comprehensive approach.” Id. at 302.

²⁴³ See, e.g., HAAS, supra note 223, at 39 (discussing influence of publication of scientific information in developing consensus for the Montreal Protocol).

²⁴⁴ See, e.g., Sand, supra note 206, at 233 (describing the effectiveness of publicizing national compliance with UNEP-sponsored conventions).

²⁴⁵ Id. at 272-73. The United Nations Commission on Human Rights has a similar procedure. Id.

²⁴⁶ Id. at 273.

²⁴⁷ HENKIN, supra note 192, at 229.

²⁴⁸ Id. at 235.

²⁴⁹ See Forsythe, supra note 182, at 262-66.

²⁵⁰ id. at 263.

²⁵¹ See Study on Criteria for Determining Priorities, in Report on the Proposed Programme Budget for the Financial Period 1992-1993, Executive Board, 87th Sess., Annex 8, at 108, 112, WHO Doc. EB87/ 1991/REC/l (1991).

²⁵² See infra notes 261-63 and accompanying text.

²⁵³ For a discussion about the behavioral and situational limitations of public international organizations, see HAAS, supra note 115, at 55-62.

²⁵⁴ See World Health Organization — WHO, in 1 THE EUROPA WORLD Y.B. 1992 85, 87. For a description of the finances of the specialized agencies, see generally WILLIAMS, supra note 3, at 83.

²⁵⁵ General Policy Review, supra note 215, at 16.

²⁵⁶ During 1985, the organization received 90.9% of assessed contributions from member states. See Status of Collection of Assessed Contributions and Status of Advances to the Working Capital Fund, WHO Executive Board, 87th Sess., Provisional Agenda Item 16.1, at 1, WHO Doc. EB87/28 (1991). In 1986, this figure was 72.18%; in 1987, 78.47%; in 1988, 83.88%-; and in 1989, 70.22%. See id. As of December 31, 1990, only 93 out of 162 members had paid their currentyear contributions in full, and 46 members had made no payment. See id. at 2. The organization anticipates a possible shortfall of up to $70 million for 1992-1993. Phil Gunby, 1992 Could Be Pivotal Year in Efforts to Improve Health of People Everywhere, 267 JAMA 15, 17 (1992).

²⁵⁷ See Kahono, Martohadinegoro & Boris P., Prokofiev, Extrabudgetary Resources of the United Nations Towards Transparency of Presentation, Management and Reporting, Joint Inspection Unit, at 10, U.N. Doc. JIU/REP/90/3 (1990)Google Scholar.

²⁵⁸ Resources contributed to WHO from the UNDP and other UN sources have declined from $80 million in 1986-87 to $45 million in 1988-89. See Ivan S., Kojic, Technical Co-operation Between Organizations of the United Nations System and the Least Developed Countries (LDCs), Joint Inspection Unit, at 12, U.N. Doc. JIU/REP/87/5 (1987).Google Scholar

²⁵⁹ “Starting in 1979, the United States either withheld or threatened to withhold portions of its assessed contributions to the UN regular budget. These withholdings were of various types: selective or targeted, contingent or across the board non-contingent cuts.” Jose E., Alvarez, Legal Remedies and the United Nations'A La Carte Problem, 12 MICH. J. INT'L L. 229, 234 (1991).Google Scholar For more specific treatment of U.S. withholdings, see generally id. at 232-42 (examining United States withholdings of its assessed contributions to the United Nations).

The United States has been successful in frustrating some of WHO's endeavors by threatening total financial withdrawal from WHO, as was the case when the Palestine Liberation Organization sought membership in WHO in 1989 and 1990. Id. at 241-42.

A more recent source of strain between the United States and the organization is over WHOsponsored research of RU-486, the “French abortion pill.” During the Bush administration, the U.S. State Department insisted on an accounting from WHO as to whether the organization was spending American dollars to promote the pill's use. See, e.g., Lawrence K., Altman, U.S. Quizzes W.H.O. on Abortion Pill, N.Y. TIMES, Apr. 7, 1991, § 1, at 8.Google Scholar

²⁶⁰ See Incentive Scheme to Promote Timely Payment of Assessed Contributions by Members, 44th World Health Assembly, Annex 11, at 180, WHO Doc. A44/23 (Apr. 12, 1991). The scheme provides for the apportionment among members of interest earned, taking into consideration the timeliness of the assessed contribution payment. Id.

²⁶¹ For a discussion of “realism,” which conceives of international organizations as instruments of policy for member states and as marginal contributors to international relations, see ARCHER, supra note 111, at 74-82.

²⁶² See HAAS, supra note 115, at 55-56.

²⁶³ Id. at 30. Haas argues that “[t]he staff and management serve at the pleasure of the clients. Suppliers are often the dominant coalition. Consumers can vote the management out of office.” Id.

²⁶⁴ WHO has some reason to fear the repercussions of the potential charge of politicizing the organization if it broadly interprets its mandate and aggressively promotes Health for All legislation. Charges of “politicisation” led the United States to withdraw from ILO in 1977 and contributed to American and British withdrawal from the United Nations Educational, Scientific and Cultural Organization in 1984 and 1985, respectively. See generally WILLIAMS, supra note 3, at 55-72 (discussing “politicisation” and the specialized agencies).

²⁶⁵ See generally id. at 26-46 (describing the operations and functions of the main organizations of the U.N. system).

²⁶⁶ Gray, supra note 218, at 303-04.

²⁶⁷ Id. at 295.

²⁶⁸ As do other specialized agencies, WHO has only a treaty relationship with the United Nations. See U.N. CHARTER art. 57, reprinted in 1 THE EUROPA WORLD Y.B., supra note 77, at 12; see also WILLIAMS, supra note 3, at 18-19 (“the main factor to be borne in mind is the autonomous character of the Agencies and the fact that each has its own constitution, its own responsibility for appointing staff (including the election of its own Executive Head) and its own independent sources of funds in the assessed contributions of its members which cover most of its “core” budget“).

²⁶⁹ See Karen A., Mingst, The United States and the World Health Organization, in THE UNITED STATES AND MULTILATERAL INSTITUTIONS: PATTERNS OF CHANGING INSTRUMENTALITY AND INFLUENCE 205, 212-13 (Margaret P., Karns & Karen A., Mingst eds., 1992)Google Scholar. According to Mingst, the U.S. has been reluctant to accept WHO's new operational activities, including the Health for All Strategy, because (1) some of the new policies focus on “economic maldistribution,” which the U.S. believes is beyond WHO's purview; (2) achieving the Health for All goals would require member nations’ regulation of the private sector, including multinationals, which the U.S. government opposes; and (3) the U.S.'s technical superiority in medicine would not be a useful “instrument of influence” under WHO's reorientation because the issues of the new approach to health relate to resource allocation, not to technical capacity. Seeid. at213. But see supra notes 98- 101 and accompanying text (explaining that, while global redistribution is part of the rhetoric of the Health for All strategy, the primary emphasis of the strategy since its inception has been national self-reliance in matters of health); note 155 and accompanying text (illustrating WHO's influence on U.S. efforts to increase child survival worldwide).

²⁷⁰ The United States has, however, threatened to withdraw financial support to the organization in relation to other issues and has not always consistently paid its assessed contribution. See discussion supra note 259.

²⁷¹ E.B. Haas has suggested a number of variables that affect the behavior of public international organizations, including ideology, representation, secretariat autonomy, the status of outside experts, administration, sources of revenue, voting, budgeting, the role of non-governmental organizations, leadership, political goals, decision-making style, bargaining, problem definition, and institutionalization. See HAAS, supra note 115, at 89-92.

²⁷² In the case of international organizations the boundaries between the internal and external environments can be regarded as fairly permeable. See discussion infra note 269.

²⁷³ See The Organizational Culture School, in CLASSICS OF ORGANIZATION THEORY 373, 374, 378 (Jay M., Shafritz & J. Steven, Ott eds., 2nd ed. rev. 1987)Google Scholar; Edgar H., Schein, Defining Organizational Culture, in CLASSICS OF ORGANIZATION THEORY, supra, at 381Google Scholar, 385-86; see also Meryl R., Louis, Organizations as Culture-Bearing Milieux, in CLASSICS OF ORGANIZATION THEORY, supra, at 421, 429.Google Scholar

²⁷⁴ The Organizational Culture School, supra note 273, at 373.

²⁷⁶ Schein, supra note 273, at 385 (emphasis omitted).

²⁷⁷ According to Schein, the following may reflect an organization's culture but are not “the essence of culture“: “observed behavioral regularities,” norms that develop in working groups, central values that an organization supports, the guiding philosophy behind the organization's policy regarding employees or customers, internal organizational “rules of the game,” and the “feeling or climate” of an organization. Schein, supra note 273, at 384 (emphasis omitted). The word “culture,” in Schein's view, “should be reserved for the deeper level of basic assumptions and beliefs that are shared by members of an organization, that operate unconsciously, and that define in a basic ‘taken-for-granted’ fashion an organization's view of itself and its environment.” Id. (emphasis omitted).

²⁷⁸ See, e.g., supra note 200.

²⁷⁹ See Fluss & Gutteridge, supra note 199, at 38-41. “[WHA] has adopted two international regulations under Article 21, paragraphs (a) and (b) [of WHO's Constitution], The first of these were the WHO Regulations No. 1 regarding nomenclature … with respect to diseases and causes of death.” Id. at 38. These regulations were given the short title of Nomenclature Regulations. Id. The second regulations “were first adopted in 1951 as WHO Regulations No. 2, the International Sanitary Regulations. [They] covered the so-called ‘quarantinable diseases,’ namely plague, cholera, yellow fever, small pox, louse-borne typhus, and louse-borne relapsing fever.” Id. at 39. In 1969, a major revision of the text was undertaken and the regulations were renamed “International Health Regulations.” Id. at 40. See also supra notes 107-08, 110 and accompanying text (describing traditional functions of nineteenth and early-twentieth century international health organizations).

²⁸⁰ Fluss & Gutteridge, supra note 199, at 41.

²⁸¹ See WHO, PROPOSED PROGRAMME BUDGET 1992-1993, supra note 102, at B-49 (“WHO will continue to place emphasis on the compilation and transfer of information on all aspects of health legislation at the international and national levels. The centrepiece of this activity will remain the quarterly International Digest of Health Legislation.“).

²⁸² See id. at B-50. The total proposed budget for health legislation, encompassing country, regional, and global activities, is $2,039,200. Id. The total regular budget of WHO for 1992- 1993 is proposed at $808,777,000. See Appropriation Resolution for the Financial Period 1992-1993, supra note 72.

²⁸³ See Fluss & Gutteridge, supra note 199, at 42.

²⁸⁴ But see Implementation of the Covenant, supra note 188, at 2, 7-8. In this report to the Economic and Social Council on the implementation of Article 12 of the Covenant, WHO tacitly associated the Health for All Strategy with the relevant provisions of the Covenant.

²⁸⁵ See The Organizational Culture School, supra note 273, at 373-74. In the literature of organizational theory, organization leaders are credited-for the creation of organizational cultures. See, e.g., Schein, supra note 273, at 381. Since the boundaries between organization and environment tend to be more permeable in public international organizations than in other types of organizations, the policies and purposes of the membership as well as other aspects of the environment are likely to contribute to the creation of an organizational culture. See supra notes 271-76 and accompanying text (explaining relation between internal and external environment in public international organizations).

²⁸⁶ See WHO, DEVELOPMENT OF INDICATORS FOR MONITORING PROCRESS, supra note 209. The global indicators were revised in 1990 to enhance evaluation and three new subindicators on maternal and child mortality and family planning were added. See Progress in Implementing the Global Strategy for Health for All: A Review of the Evaluation Methods, Executive Board, 85th Sess., Annex 2, at 27, WHO Doc. EB/85/1990/REC/1 (1990) Executive Board Doc. EB/85/17 (1989) [hereinafter A Review of the Evaluation Methods].

²⁸⁷ Other indicators measuring health status include national life expectancy and the adult literacy rate. See A Review of the Evaluation Methods, supra note 286, at 28.

²⁸⁸ See supra note 76.