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League of Nations started to gain control of the production of the list, one British diplomat noted that "an influential clique in the French Foreign Office is moving heaven and earth to retain the Office Internationale unaltered" (Société des Nations, box R822, 1921). The United States became a key participant when it refused to join the League of Nations, leaving the OIHP as broker between the United States and the League of Nations. They tried to squeeze out the International Institute of Statistics as advisors. This led the director of that organization to complain that: "The new masters of the world are laying down their law, without any consideration for the rights of others and for an international organization that has received universal respect to this time" (WHO archives 45533). |
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Relationships among developed and less-developed countries figure large in the construction of the ICD. For the former, with access to the latest computer equipment, some kind of state-of-the-art expert system could handle more data and detail, more flexibly, than has ever been possible in the past. For other members of the WHO, however, lacking a computer infrastructure capable of implementing the sophisticated software, the list would be useless. Or, it could be seen as an administrative burden imposed by colonialist interests. |
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Even if it were possible technically, this level of granularity is unnecessary for many countries. As the director of health statistics at the WHO in the 1980s explained to us, death in his country (Indonesia) is overwhelmingly caused by infant diarrhea via contaminated water supplies. Why spend precious resources codifying at a finer level when the problem is so obvious? Until these issues are solved, who cares about the incidence of rarer diseases? The question is not rhetoricalother member nations do care, since they want to be able to trace the etiology and development of epidemics that are likely to affect their populations (flu, AIDS, etc.) throughout the world. |
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In this fashion, international cooperation has been hampered within each nation by the diversity of ways of recording and reporting, by cultures with varying stigma and prestige for certain diseases, by local medical cultures and by the different "national character" of some diseases. It has been hampered among nations by the issue of control of the prestigious ICD and by the medical and epidemiological needs of the different nations. The public health policymakers involved before this apparently simple, homogeneous list could be compiled and implemented included government officials, statisticians, anthropologists, medical analysts, epidemiologists, and diplomats. We can easily see parallels with power struggles, control, and containment in the |
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