WHO
Obituary
Halfdan Mahler Former Director-General of the World Health Organization. Born on April 21, 1923, in Vivild, Denmark, he died on Dec 14, 2016, in Geneva, Switzerland, aged 93 years. Halfdan Mahler adhered to the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. As WHO’s Director-General from 1973 to 1988, he worked to shift its focus from targeting single diseases like malaria and tuberculosis to promoting and implementing primary health care. “Dr Mahler was a visionary of the unique type that was ahead of his time in many ways. He was a lateral thinker and always considered health in a holistic manner”, says Anne Marie Worning, former Executive Director of the Office of the Director-General at WHO. In 1976, Mahler outlined his vision for a “Health for All by 2000” initiative and, 2 years later in what was then the Kazakh capital Alma-Ata, 134 nations with membership in WHO pledged to implement his approach that focused on education, promoting proper nutrition, providing safe water and basic sanitation, maternal and child health care, immunisations, and access to essential drugs. “The goal was not to eradicate all diseases and illnesses by 2000; we knew that would have been impossible. Our goal was to focus world attention on health inequities and on trying to attain an acceptable level of health, equitably distributed throughout the world”, Mahler told a WHO interviewer in 2008. This broad approach to public health was met with resistance at the time and was quickly revised, to Mahler’s 30
dismay. But today universal health coverage is considered a cornerstone for the United Nation’s Sustainable Development Goals for health. In the 1970s, Mahler argued that health for all is a value system with primary health care as the strategic component. “The key point here that is still applicable today is that a purely analytical approach is not likely to work on its own. Public health needs to engage both hearts and minds”, says Christopher Dye, Director of Strategy in the Office of the Director-General at WHO. Mahler joined WHO in 1951 and spent a decade in India developing the country’s national tuberculosis programme, which became a model for other developing countries. He returned to WHO headquarters in Geneva in 1962 as chief of the tuberculosis unit. A physician with a keen appreciation for mathematical modelling, he commented in 1973 that, “The first model builders in tuberculosis met with considerable opposition from those who maintained that many essential parameters were not established with sufficient precision, although paradoxically, these very opponents apparently had their own intuitive models on which to base highly assertive decisions.” Mahler was adamant that tuberculosis control hinged on general health services: “All communicable disease campaigns have overwhelmingly demonstrated that only through falling back on strong basic health services in developing countries is it possible to achieve an effective consolidation of these campaigns”, he wrote in 1966. In 1969, Mahler became WHO’s Director of Project Systems Analysis and 4 years later was elected WHO’s third DirectorGeneral. Smallpox was eradicated in 1979 during his tenure but despite Mahler’s focus on tuberculosis early in his career, the disease wasn’t a top priority for his administration. As WHO Director-General Mahler “behaved as first among equals”, says Dye. “His approach to all WHO staff was courteous, friendly, engaging, and often amusing, whether he was speaking with junior secretaries or senior directors.” Mahler received his medical degree from the University of Copenhagen in 1948. After retiring from WHO in 1988, he became Director of International Planned Parenthood Federation until 1995. Throughout his career, Mahler emphasised the role of women in promoting health. “Women are the raw material for development”, Worning remembers him saying. He is survived by two sons, Per Bo and Finn, and five grandchildren. Mahler’s wife, psychiatrist Ebba FischerSimonsen, died in 2015. 30 years after the Alma-Ata Declaration, Mahler told the World Health Assembly in 2008: “To make real progress, we must, therefore, stop seeing the world through our medically tainted glasses. Discoveries on the multifactorial causation of disease have, for a long time, called attention to the association between health problems of great importance to man and social, economic, and other environmental factors.”
Alison Snyder www.thelancet.com Vol 389 January 7, 2017
Obituary
Halfdan Mahler Former Director-General of the World Health Organization. Born on April 21, 1923, in Vivild, Denmark, he died on Dec 14, 2016, in Geneva, Switzerland, aged 93 years. Halfdan Mahler adhered to the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. As WHO’s Director-General from 1973 to 1988, he worked to shift its focus from targeting single diseases like malaria and tuberculosis to promoting and implementing primary health care. “Dr Mahler was a visionary of the unique type that was ahead of his time in many ways. He was a lateral thinker and always considered health in a holistic manner”, says Anne Marie Worning, former Executive Director of the Office of the Director-General at WHO. In 1976, Mahler outlined his vision for a “Health for All by 2000” initiative and, 2 years later in what was then the Kazakh capital Alma-Ata, 134 nations with membership in WHO pledged to implement his approach that focused on education, promoting proper nutrition, providing safe water and basic sanitation, maternal and child health care, immunisations, and access to essential drugs. “The goal was not to eradicate all diseases and illnesses by 2000; we knew that would have been impossible. Our goal was to focus world attention on health inequities and on trying to attain an acceptable level of health, equitably distributed throughout the world”, Mahler told a WHO interviewer in 2008. This broad approach to public health was met with resistance at the time and was quickly revised, to Mahler’s 30
dismay. But today universal health coverage is considered a cornerstone for the United Nation’s Sustainable Development Goals for health. In the 1970s, Mahler argued that health for all is a value system with primary health care as the strategic component. “The key point here that is still applicable today is that a purely analytical approach is not likely to work on its own. Public health needs to engage both hearts and minds”, says Christopher Dye, Director of Strategy in the Office of the Director-General at WHO. Mahler joined WHO in 1951 and spent a decade in India developing the country’s national tuberculosis programme, which became a model for other developing countries. He returned to WHO headquarters in Geneva in 1962 as chief of the tuberculosis unit. A physician with a keen appreciation for mathematical modelling, he commented in 1973 that, “The first model builders in tuberculosis met with considerable opposition from those who maintained that many essential parameters were not established with sufficient precision, although paradoxically, these very opponents apparently had their own intuitive models on which to base highly assertive decisions.” Mahler was adamant that tuberculosis control hinged on general health services: “All communicable disease campaigns have overwhelmingly demonstrated that only through falling back on strong basic health services in developing countries is it possible to achieve an effective consolidation of these campaigns”, he wrote in 1966. In 1969, Mahler became WHO’s Director of Project Systems Analysis and 4 years later was elected WHO’s third DirectorGeneral. Smallpox was eradicated in 1979 during his tenure but despite Mahler’s focus on tuberculosis early in his career, the disease wasn’t a top priority for his administration. As WHO Director-General Mahler “behaved as first among equals”, says Dye. “His approach to all WHO staff was courteous, friendly, engaging, and often amusing, whether he was speaking with junior secretaries or senior directors.” Mahler received his medical degree from the University of Copenhagen in 1948. After retiring from WHO in 1988, he became Director of International Planned Parenthood Federation until 1995. Throughout his career, Mahler emphasised the role of women in promoting health. “Women are the raw material for development”, Worning remembers him saying. He is survived by two sons, Per Bo and Finn, and five grandchildren. Mahler’s wife, psychiatrist Ebba FischerSimonsen, died in 2015. 30 years after the Alma-Ata Declaration, Mahler told the World Health Assembly in 2008: “To make real progress, we must, therefore, stop seeing the world through our medically tainted glasses. Discoveries on the multifactorial causation of disease have, for a long time, called attention to the association between health problems of great importance to man and social, economic, and other environmental factors.”
Alison Snyder www.thelancet.com Vol 389 January 7, 2017
