May 13, 1998

Infectious disease is the world's leading cause of death. In the last 20 years, we have witnessed the birth of at least 30 new infectious diseases, and news reports of Ebola hemorrhagic fever and the advent of HIV/AIDS have brought the threat into every living room.

This week, I am in Geneva to celebrate the 50th birthday of the World Health Organization. Founded in 1948, this United Nations agency has a simple but ambitious mandate: "the attainment by all peoples of the highest possible level of health."

Despite successes, though, such as the eradication of smallpox in 1980, WHO faces new threats to global health each day. At the same time, older scourges such as cholera, malaria, diphtheria and tuberculosis continue to kill.

Tuberculosis is of particular concern. Declared a global emergency by WHO in 1993, TB is the leading infectious-disease killer of adults in the world. Although we have a treatment that works, one-third of the world's population is infected, and more people will die from TB this year -- 2 million -- than in any other year in history.

WHO's ambitious TB treatment strategy reminds us of the agency's importance. With experts on the ground in every country and a multilateral mandate, the organization is in a unique position to provide information and technical support across borders, set standards, make epidemiological forecasts and offer treatment guidelines.

Thanks in large part to WHO's global immunization programs, the world's infant mortality rate has fallen by more than 37 percent. Today, 80 percent of the world's children are protected against six major childhood diseases -- diphtheria, whooping cough, tetanus, measles, tuberculosis and polio, which is on target for elimination by the year 2000.

But new threats such as HIV/AIDS persist, and old ones such as malaria continue to ravage parts of whole nations. For example, malaria causes nearly 3 million deaths a year, and rising resistance to anti-malarial drugs and insecticides threatens even greater increases.

WHO is working to promote child survival, breast feeding and the control of HIV/AIDS, diarrhea and pneumonia among children. In addition, the agency is working to improve maternal and women's health. Every day, at least 1,600 women die of complications from pregnancy and childbirth, and WHO has resolved to cut this number in half by the year 2000. As the World Health Report 1998 released just this week notes: "Women's health is inextricably linked to their status in society. ... Today, the status and well-being of countless millions of women worldwide remain tragically low."

The World Health Organization was born in the wake of World War II when the United States spearheaded the creation of the United Nations. The benefits of this world body, which includes WHO, are tangible -- the treatment of disease, efforts to protect the world from nuclear calamity, humanitarian programs such as caring for refugees, and international standards that make the skies safer for travelers and food safer for consumers.

Of course, U.N. forces also keep the peace in areas vital to our national interests, from the Balkans to the Persian Gulf, Haiti and the Middle East. I know that the majority of Americans support the work of the United Nations, particularly when its diplomatic efforts work successfully to avert conflict that may involve U.S. troops.

And I know that the majority of Americans think we should pay our bills.

As I review the benefits Americans enjoy from U.N. action -- such as public health improvements -- I am distressed and embarrassed that political maneuvering in Congress has prevented us from paying our past-due bills of more than $1 billion to the United Nations and its agencies. Our arrears to the World Health Organization alone are $39 million. I hope that every American will support this administration as it continues to urge Congress to appropriate these funds -- not only to maintain American leaders hip but also to strengthen the work of these important organizations.

We are living at a time of remarkable global integration. Every day, powerful new forces bring us closer together, chipping away the walls that separate us as people and as nations. As the barriers fall, we are faced with new opportunities but also with new challenges, including threats to our health, our environment and our national security.

Disease knows no borders. Nor does environmental degradation or terrorism. The real cost of not paying our U.N. debt is the undermining of American leadership around the world at a time when we should be working in partnership with the United Nations and other countries to meet the global challenges we face as we enter the next century.