WHO Director general elections debate
The Lancet; Volume 361, Number 9354 25 January 2003
To lead the defense of health as a social right
President of the International Association of Health Policy
Medical Dept, Aristotle University of Thessaloniki, Greece.
“The World Health Organisation’s mandate is to get the evidence right and ensure that is properly used to make the world a healthier place”(1). The new WHO Director-General, in initiating a crucially needed change in the policies of the leading international health agency, could use this statement that Gro Harlem Brundtland made in her message introducing the World Health Report 2002. In fact the content of the World Health Report 2002 recognises widening international health inequalities and acknowledges, albeit not overtly, their socio-economic determinants in focusing on poverty.
This is a substantial change in WHO’s approach to international health issues, especially when compared with the severely criticised approach of the World Health Report 2000(2). Any optimism that this marks a fundamental shift in WHO’s perspective is unfortunately contradicted by the recommendations of the WHR 2002 that focus on individual behavior and unhealthy choices, while neglecting the determining role of the globalised market economy. The accumulating evidence on social inequalities in health worldwide poses a substantial challenge for the new WHO leadership. The burden of health disparities, from the tragedy of the sub-Saharan African populations to the widening marginalisation of populations in Latin America and the developed and former socialist countries is already unbearable. The global division between rich and poor is not merely a topic of scientific interest. It is a key health policy issue, as its impact on the health status of the world population cannot be disregarded anymore. The reality, recognized by the World Health Report 2002, is that “the greatest burden of health risks is borne by the poor countries and by the disadvantaged in all societies”(1). The fact that the risk factors resulting in most of the global disease burden, viz. malnutrition, unsafe water and sanitation, unsafe sex and indoor air pollution are significantly determined by the socioeconomic policies1 can not be dealt with by a mere appeal for healthier lifestyles. Concrete actions and policies to create a more equitable society are urgently needed. Health and its socioeconomic determinants have to assume a higher priority in international and national policies with strong support and advocacy by the new WHO leadership. Regarding health care policies: “the conventional wisdom which promotes managed competition and privatization in the management and delivery of health services”(2) is still the driving approach in the international setting, including WHO. Here again there is accumulating evidence that, besides the overt public funding of for profit private corprorations(3), none of the anticipated targets of this policy is being achieved. To the contrary the picture is more of: budget deficits exploding under the pressure of debts to private companies(4), deregulated services, shortages of human resources, collapsing public health services and a constant increase in numbers of people denied any access to health care services. On the winners side there has been a geometric growth of private sector profits based on the promotion health commodification(5). These are the results of the implementation of the economic policy that the World Trade Organisation is promoting globally through the GATS (the General Agreement on Trade in Services) and TRIPS (Trade-Related Aspects of Intellectual Property) agreements. The new WHO leadership, in advocating for the defense of health and health care as a social right, has the duty to stand up against these devastating policies and consider seriously messages from the growing international movement, some of which is currently gathered at the World Social Forum in Porto Allegre. Millions of desperate people, their governments and health workers all around the world expect and deserve a substantial backing from WHO in their struggle for health and a better world.
1. Gro Harlem Brundtland. Message from the Director -General. World health Report 2002, World health Organisation 2002, Geneva.
2. Navarro V. Can Health Care Systems be compared using a single measure of performance? Am J Public Health 2002, 92:1:31-34.
3. Gaffney D, Pollock A, Price D, Shaoul J. NHS capital expenditure and the private finance initiative -expansion or contraction? BMJ 1999; 319: 48-51. 5. Pollock A. A wake up call for primary care. Br J Gen Practice November 2002:883-884.