November 7th, 2020



With Covid-19 cases again rising around the globe, the World Health Organization (WHO) has faced increased scrutiny from governments on its handling of the early pandemic. Today, the organization plays a key role in defining global public health and coordinating responses to disease, but this mandate has shifted over time.

A 2011 paper by THEODORE BROWN, MARCOS CUETO, and ELIZABETH FEE investigates the origins of WHO's current global public health program and its partnerships with non-governmental institutions.

From the paper:

"In January 1992, the Executive Board of the World Health Assembly decided to appoint a 'working group' to recommend how WHO could be most effective in international health work in light of the 'global change' rapidly overtaking the world. The executive board may have been responding, in part, to the Children’s Vaccine Initiative, perceived within WHO as an attempted 'coup' by UNICEF, the World Bank, the UN Development Program, the Rockefeller Foundation, and several other players seeking to wrest control of vaccine development. The working group’s final report of May 1993 recommended that WHO—if it was to maintain leadership of the health sector—must overhaul its fragmented management of global, regional, and country programs, diminish the competition between regular and extrabudgetary programs, and, above all, increase the emphasis within WHO on global health issues and WHO’s coordinating role in that domain.

In 1998, the World Health Assembly reached outside the ranks of WHO for a new leader who could restore credibility to the organization and provide it with a new vision: Gro Harlem Brundtland, former prime minister of Norway and a physician and public health professional. She established a Commission on Macroeconomics and Health, chaired by economist Jeffrey Sachs of Harvard University and including former ministers of finance and officers from the World Bank, the International Monetary Fund, the World Trade Organization, and the UN Development Program, as well as public health leaders. The commission issued a report in December 2001, which argued that improving health in developing countries was essential to their economic development. The report identified a set of disease priorities that would require focused intervention. Brundtland also began to strengthen WHO’s financial position, largely by organizing 'global partnerships' and 'global funds' to bring together 'stakeholders'—private donors, governments, and bilateral and multilateral agencies—to concentrate on specific targets. A very significant player in these partnerships was the Bill & Melinda Gates Foundation, which committed more than $1.7 billion between 1998 and 2000 to an international program to prevent or eliminate diseases in the world’s poorest nations, mainly through vaccines and immunization programs.Within a few years, some 70 'global health partnerships' had been created."

Link to the piece.

  • Anne-Emanuelle Birn and Nikolai Kremenstov offer an account of the 1978 Alma-Ata conference, which was hosted by the Soviet Union and advocated for a WHO focus on primary health care. Link. David A. Tejada de Rivero recounts WHO's move to selective primary health care, relying on smaller, low-cost interventions. Link.
  • "Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected." By Eeva Ollila. Link.
  • "Although the [World Bank's] role in generating and disseminating global health knowledge is important, its main advantage compared with other international institutions is its ability to mobilize financial resources." Jennifer Prah Ruger looks at the role of the World Bank, which began to increase its influence in global public health in the 1980s. Link.
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