As geopolitical fragmentation continues to unsettle multilateral institutions, the future of global health cooperation hangs in delicate balance. The 78th World Health Assembly (19–27 May, 2025) concluded with powerful reminders of both the strengths and fragilities of international collaboration. Despite deep divisions in global governance, Member States ratified the long-debated Pandemic Accord, endorsed the World Health Organization’s (WHO) Global ActionPlan on Climate Change and Health, and initiated broader discussions on the restructuring of global health financing, all signaling a stubborn resilience of multilateralism even in fractured times.
The crisis in global health governance is not merely about looming funding shortfalls or geopolitical competition. It is fundamentally about the erosion of trust, the disintegration of solidarity, and the systemic weakening of institutional cooperation. This is at a moment when global health threats routinely transcend national borders. In this climate of uncertainty, revisiting the origins of the WHO and reinterpreting its foundational definition of health through a historical lens can help reaffirm the enduring value of multilateral systems and their capacity to respond to global crises.
Born of conflict: the post-war vision for international health
The WHO emerged from the ashes of the Second World War as a beacon of international collaboration in public health. Even during the war, remnants of the League of Nations Health Organization, notably Melville Mackenzie, Raymund Gautier, and Yves Biraud, envisioned a unified international hygiene body. In 1944, amidst political uncertainty, Gautier and Biraud began formulating a new constitution for what they called a ‘World Hygiene Organization.’ These efforts persisted quietly in Geneva, despite the earlier political purges of staff under Secretary-General Joseph Avenol.
The turning point came unexpectedly at the 1945 San Francisco Conference, formally the United Nations Conference on International Organization. While health had been excluded from the formal agenda, two medical delegates, Dr. Geraldo de Paula Souza of Brazil and Dr. Shī Shimíng of China, pushed to insert it. After an informal dinner encounter with Alger Hiss, Secretary-General of the conference, the two physicians drafted a declaration overnight. Their proposal to include “health” in the UN Charter received universal support, laying the conceptual foundation for the WHO.
From this unplanned intervention sprang a new institutional architecture. In January 1946, Gautier detailed in a memo the blueprint of discussions that would culminate in the 1946 International Health Conference in New York. There, Dr. Andrija Štampar of Yugoslavia presented Biraud’s full proposal to the Technical Preparatory Committee. The constitution of the World Health Organization was adopted on 22 July 1946 and officially came into force on 7 April 1948, establishing the WHO with 51 UN Member States and 10 additional signatories.
The WHO was not simply created by high-level diplomacy; it was forged in the margins by scientists, public health officers, and mid-level diplomats. It was a statement of principle as much as an institutional act, a belief that health was both a technical domain and a moral imperative of international cooperation.
Health redefined: a vision rooted in international consensus
The constitutional mandate of WHO is closely tied to its operative definition of health. The widely cited World Health Organization (WHO) definition of health, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” was formally adopted in 1946 at the International Health Conference in New York, chaired by U.S. Surgeon General Thomas Parran. This definition marked a significant departure from prevailing biomedical frameworks of the early 20th century that equated health simply with the absence of disease.
The articulation of this holistic view emerged from a convergence of international perspectives. Key figures, such as Thomas Parran (United States), Shī Shimíng (China), Geraldo de Paula Souza (Brazil), and Andrija Štampar (Yugoslavia), each brought public health philosophies shaped by their national experiences and global engagements. They envisioned health not only as a biological condition but as a state profoundly influenced by mental, social, and environmental factors.
Multiple drafts were proposed. Štampar’s version emphasized social determinants such as housing, nutrition, and education as essential to well-being. Shi’s subcommittee added the critical dimensions of mental and social health. The final language, shaped significantly by Parran and the U.S. Public Health Service, incorporated the term “complete well-being” – a phrase reflecting philosophical influences from earlier League of Nations health officials like Raymond Gautier and Yves Biraud, who had long advocated for a socially embedded understanding of health. This trajectory reflects why the WHO’s definition sought to transcend boundaries and promote an inclusive, holistic vision of health.
The origin of the WHO definition of health illustrates how the 1946 formulation reflected broader postwar ideals. It was an aspiration toward human dignity, equity, and collective responsibility. While the term “complete” has since been debated for its utopian tone, the definition’s breadth continues to influence health discourse globally. It remains a guiding framework for contemporary challenges such as mental health promotion, climate-related health vulnerabilities, anti-microbial resistance, and the pursuit of universal health coverage.
Reclaiming solidarity in a fragmented world
Today, the global health order is undergoing a profound stress test. The erosion of multilateral funding, the politicization of aid, and the commodification of health technologies threaten to unravel decades of progress. Current geopolitical trends, including a stronger emphasis on national priorities and transnational approaches, have complicated the international health landscape, challenging the notion of health as a universally shared global public good.
However, history reminds us that international health cooperation was never born from unanimity, it was born from urgency. The WHO emerged not because the world was aligned, but because it was fractured. And yet, in that moment, nations saw in health a domain that demanded unity beyond ideology. To confront today’s fragmentation, we must restore the ethos of solidarity that shaped the WHO’s creation. This means reaffirming today’s global health as a common public good, revamping the global financing architecture, and resisting the drift toward divisions in global order.
As the WHO’s own definition reminds us, health is not just the absence of illness, it is the presence of dignity, stability, and collective responsibility. If multilateralism is to survive in our time, it must once again be guided by the vision that health is foundational to peace, solidarity, equality, and human flourishing.