A friend I had not seen for a long time met me at the airport and asked where I was working. I said I worked for PAHO. Mystified, he asked, "Who?" And I said "Yes." Even more confused, he replied, "Say what?" "Not what," I responded, "WHO. The World Health Organization, and I work for PAHO, the Pan American Health Organization, the Regional Office for the Americas of WHO." "Great!" he exclaimed, "Now that you've told me who's WHO, maybe we can talk about what's what." "There's no WHAT," I countered, "only WHO, and we are WHO." "We who?" he inquired. "All of us, everywhere," I answered. "Governments, people, in every country, every part of the globe. That's WHO."

WHO, the World Health Organization, was officially given life on April 7, 1948, in the aftermath of World War II. A world which, to many, had been going to hell in a handbasket now needed to go to health in a hurry. The ravages of the war and its psychological as well as physical traumas prompted a definition of health that went beyond a fixation with disease. In its Constitution, WHO defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity."

This definition of health is itself a challenge as it conflicts with the conventional wisdom. Most of us consider ourselves lucky and healthy when we don't have a disease or when we can earn our daily bread without too much physical discomfort. The attainment of a state of complete physical, mental, and social well-being while within our reach is many times outside the scope of either our imaginations or aspirations.

It is why the visible victories of WHO, like the eradication of smallpox, the fight against polio, measles, cholera, malaria and other communicable diseases capture the public imagination more than its work in the noncommunicable diseases and in improving the quality of human life. In the past 50 years, human longevity worldwide has increased by more than 40 percent. From an average life expectancy of 46 years in the early 1950s, we achieved an average life expectancy of 65 years in 1996. This adding of years to human life is perhaps the most important public health achievement of this century.

But what about adding life to years? Increasingly, this has emerged as the challenge for the future and has led WHO back to the basics of what is called primary health care, the strategy it adopted in 1978 to achieve health for all. When I first joined PAHO my experience was primarily in communication and management. At one of my early meetings, one of my female colleagues, a health educator, mentioned the Declaration of Alma-Ata that established the primary health care strategy and the extent to which it had impacted on health. Unfortunately, I had heard "Alma Arthur."

"Who is she?" I asked naively. Immediately, I received a look that was potent enough to shatter my mental well-being and almost cause disease or infirmity. When she realized that I was not being facetious but was merely more confused than usual, my colleague explained what Alma-Ata really was. However, I still sometimes cling to my vision of Alma Arthur with her husband King Arthur who with his magic sword Excalibur fights diseases and maintains a pristine health environment in his utopian kingdom of Camelot.

The present reality, however, is far from utopian. There is no magic sword or bullet for many of the world's ills. As many countries continue to deal with communicable diseases, some of which like tuberculosis have reemerged to pose an even greater threat, they now face diseases of lifestyle that, while preventable, require radical behavior change. Most people, however, seem to prefer to change their governments than their lifestyles, so the battle is all uphill and is more like one step forward, two steps back. In some ways it is like the "good news/bad news" joke about a pilot who spoke to his passengers on the intercom of a plane high over the Atlantic Ocean. "I have good news and bad news," he announced. "The bad news is that all our engines have conked out and we are plummeting into the ocean. The good news is that we are making excellent time."

WHO, by itself, cannot keep us from drowning. Health for all can only be achieved by all, and not by WHO alone. Fifty years after World War II and the birth of WHO, the battle takes place continuously in, and for, the heads, hearts, and minds of every individual who has to make choices about health while simultaneously trying to make sense of a bewildering and constant explosion of information and expectations. At the same time, millions of people live in abject poverty and are prey to diseases of the body and soul. For the fortunate, WHO provides options as the basis of informed health choices. For the unfortunate, those who live in the daily midst of disease and deprivation, WHO provides three vital keys for the future-help, health, and hope.

(Tony Deyal was last seen saying now that we know WHO, we have to concentrate on what, when, where, why and how.)