Taking on the World Health Organization
Published by Newsweek on 1998-01-01
When Prime Minister Gro Harlem Brundtland of Norway abruptly left office a couple of years ago, it was widely assumed that she would campaign for the top job at the United Nations. Oslo was fine for preaching benign, Nordic-style socialism, but Turtle Bay offered a world platform for promoting Brundtland's favored cause, sustainable development. After all, Brundtland had injected "sustainable development" into the global vocabulary during her tenure in the 1980s as head of the UN's World Commission on Environment and Development; the moniker, "Mother Earth," inevitably stuck. In the event, Kofi Annan of Ghana slid into the slot that Brundtland supposedly sought. (Since Annan's expertise lay in peace keeping, not environment and development, nobody ventured to call him "Father Earth"; the developmental jury is still out on Annan a year after he became UN Secretary General.)
Now Brundtland has become Director General of the beleaguered World Health Organization, after a spirited election that also featured developing country candidates who argued that the problems of poverty were best tackled by those who sprang from poverty. Still, sustainable development -defined generally as environmental security and economic progress- finally has a heavyweight in a position to translate soapy rhetoric into specific programs. Brundtland, a physician, says that she will move swiftly to put health where it belongs--at the top of the global development agenda, alongside poverty alleviation and job creation. "Health is the core of human development," Brundtland says. "The fundamental core is economic and social development. It is the empowerment of both women and men. It is in this overall framework that we shall place our combat for global health." It surely helps to hail from a donor country flush with oil revenues in order to make brave pledges like that.
When Brundtland turns up to take stewardship at WHO headquarters shortly, they will welcome her with polite greeting, of course, and they will accept anticipated new Nordic largesse with polished gratitude. But the 59 year-old Brundtland will soon learn that winning elections is one thing, delivering on campaign promises to twin health and sustainable development is entirely another matter.
That is because multilateral institutions established specifically for alleviating poverty and promoting economic social progress--the World Bank, the United Nations Development Programme, and WHO, among others--are finding themselves increasingly sidelined. Implementation of of global development agendas is severely crimped by financial watchdogs such as the International Monetary Fund. The IMF is now running the economies of some 80 countries--nearly half of the UN's membership- whose sovereign fiscal management has proven inadequate. Sustainable development is scarcely a priority when budgets need to be balanced; IMF monitors don't fancy themselves as developmentalists, especially in countries where the development pie has been notoriously consumed by corrupt politicians and their bureaucratic henchmen.
Notwithstanding the IMF's concerns about fiscal rectitude, the fact remains that the developing world's already formidable health and social problems are steadily escalating. Consider the following: One billion people, or a sixth of the world's population, are at immediate risk from potentially fatal infectious diseases because of poor sanitary conditions; more than a third of all children in the developing world are malnourished, and their mortality rate is six times higher than in the industrialized countries; the world's population is increasingly at the rate of 100 million annually (that's adding a new Nigeria each year), with 90 percent of the growth in the 127 poorest countries of the developing world; almost a million women die in pregnancy and childbirth each year, most in poor countries (that's 1 in 13 women in sub-Saharan Africa alone); every year, a million children, mostly girls in Asia, are forced into prostitution to support their families; of the 1.3 billion people living in extreme poverty (with an income of under $300 annually), 70 percent are women.
Alarming? You bet. Equally alarming is the fact that despite the expenditure of $5 trillion on development since 1950, the global cohort of the poor is growing: fully a half of the world's population will be officially living under the poverty line by the year 2000 (that's 3 billion people). And despite all the warm talk of globalization and enhanced private-sector involvement in development, donor-country aid (known in the parlance as ODA--Official Development Assistance) and private investment are both either stagnant or declining. ODA in 1998 is expected to be barely $50 billion, a 10 percent decline from last year.
How Brundtland manages WHO will be a test case for a new model of development that needs to be fashioned: development based on service oriented international agencies that increasingly invite local resources and grassroots participation in sustainability issues such as health and development. WHO is a billion-dollar-a-year agency that nestles nicely in the third-world's capital, Geneva; international bureaucracies are not susceptible to good intentions, let alone marching orders that require povertycrats to relocate to the field. But more WHO personnel need to be transferred to developing countries to work in cooperation with local authorities to combat widely prevalent maladies such as malaria, polio, measles, leprosy, onchocerciasis, lymphatic filariasis, Chagas disease and Guineaworm. These diseases don? lend themselves to remote-control management from Geneva.
Unfortunately, Brundtland has a hard act to follow. Her predecessor, the incoherent but cunning Dr. Hiroshi Nakajima of Japan, packed WHO headquarters with well-paid healthocrats possessing lifetime tenure (and, it would appear, post-lifetime consultancies). Thickening the bureaucracy to more than 5,000 people broadened Nakajima's constituency and enabled him to sustain himself in office even in the face of opposition from donors such as the United States. As a politician back in Norway, Brundtland was a skilled practitioner of the art of the possible; as head of the world's most bloated health agency, she will need to focus on the seemingly impossible: trimming WHO? work force in Geneva; getting more personnel into the field in developing countries suffering from the AIDS pandemic and other frightening diseases; and highlighting issues such as reproductive health for women, insufficient access to clean water, sanitation, food supplies, transport, and education.
She will also need to bring WHO more into the overall organism of the UN system. For much too long, competing satrapies have had overlapping jurisdictions; this has often led to financial waste and duplication of programs concerning urbanization, increased violence, mental illness, alcohol and drug abuse and a deteriorating environment. Kofi Annan's reconstituted Development Group--supervised by UNDP's James Gustave Speth--offers a timely opportunity for WHO to be part of a methodical multilateral assault on global health and development problems, albeit on a scaled-down basis.
Because of her longstanding commitment to a sound human environment, Brundtland enjoys a unique and respected voice. But with a cacophony of economic and social concerns out there these days, it's not enough to possess a voice. Brundtland must bolster her message with a transparent and speedy demonstration of transforming WHO into a dynamic, relevant agency. Otherwise, her most significant accomplishment would only be winning an election. Physician, heal thy own agency.
Senior Writer and Global-Affairs Columnist