The slowly bleeding and diminished champion of global health, WHO

Most folks in the global health community say they they fully support the mission of the World Health Organization and then often complain — usually privately, but sometimes publicly — about how horribly bureaucratic, risk-averse and cumbersome it is.

This week in Geneva, as most people I’m sure have not noticed, is the 66th meeting of the World Health Assembly in which WHO member states and organizations discuss how best to prevent the spread of threats like pandemic flu, the challenge of polio eradication, progress made against many childhood diseases and basically try to set the global health agenda for the future.

Margaret Chan
Margaret Chan

“In these troubled times, public health looks more and more like a refuge, a safe harbor of hope that allows, and inspires, all countries to work together for the good of humanity,” WHO Director General Margaret Chan, in her opening statement.

That sounds great, except for a few disturbing signs — the declining financial support for the WHO to get us all working together and a shift away from a focus on infectious diseases to the latest fashion in global health, non-communicable diseases (like heart disease, diabetes, high blood pressure and so on).

Laurie Garrett, a journalist-now-expert at the Council on Foreign Relations and one of the world’s leading commentators on global health, sees this funding shift at WHO away from infectious disease as troubling:

“Overall, the proposed WHO 2014-15 budget offers startling changes in the mission and direction of the agency, pushing it significantly away from infectious diseases, HIV, TB, malaria, and outbreaks, and towards addressing disabilities, diabetes, heart disease, cancer, and aging…. The tuberculosis cuts are especially mysterious, as the numbers of individuals worldwide getting treatment have increased substantially over the decade, but so has incidence of multi-drug resistant TB. “

More worrisome overall, Garrett writes in the second installment of her coverage of the World Health Assembly, is the decline in funding for WHO that has forced the tough choices and cutbacks.

While there has been a substantial increase in the past decade for global health funding overall, with the growth of private donors like the Gates Foundation as well as the creation of multi-lateral funding mechanisms like the Global Fund to Fight AID, TB and Malaria, many experts are concerned that the shrinking clout and influence of WHO — as goofy as it can be — risks undermining the primary vehicle needed to globally set global health policy.

Here’s a nice overview of what’s going on by Tim France, at Inis Communications, along with this graphic depiction of the WHO budget:

WHO budget
Inis Communications
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About Author

Editor Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom-at-humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.

  • Ilona Kickbusch

    When can we stop looking at WHO through the eyes of money and focus on its rule making and standard setting powers? WHO does not need the kind of money the BMGF or the GFATM has – and I seem to remember that the GFATM is supposed to deal with TB and some other infectious diseases? Is that not why it was set up? Is there not supposed to be a division of labour among the many global health players?

    The WHO needs sufficient ressources to act independently and fulfull its functions as a global rule setter as set out in its constitution. This is what we advocates of global health should set out to strengthen this function – and that starts with us looking closely how our governments are either weakening or supporting this unique power of the organization.

    We will increasingly need the organization to support global public goods for health – just think of anti microbial resistance. We will also need the organization to be able to respond to the likes of H7N9 and ensure health security.

    We need the organization to be able to stand up to the NCD producing industries and the commercial determinants of health. Why the derogatoty statement about the NCDs being the latest fashion in global health? In my days at the WHO it was the tobacco industry that regularly put forward these arguments – appropiatly published in major newspapers just around the WHA – so that WHO would not embark on the rule setting approach that became the Framework Convention on Tobacco Control.

    The global health debate needs to be more precise as to what we expect each organization to deliver – the WHO DG Dr. Chan is on a clear mission in this regard.