Aware of the upcoming discussions on the progress of the WHO reform process and related documents, we would like to share with you the perspective of a large group of public-interest NGOs and other concerned citizens, the Democratising Global Health Coalition (DGH).
The World Health Organization's critics accuse it of being bogged down in red tape and internal politics. However, attempts at reform are raising concerns over conflicts of interest. Nigel Hawkes reports.
'We consider the reform process an extraordinary opportunity for WHO to rediscover its fundamental multilateral identity in a globalized world, and it should be made clear from the start that evaluations and recommendations expressed in this letter only stem from the shared aspiration of a stronger organization than today. The WHO reform can produce a considerable impact in designing and defining a more accountable and effective governance for health. We are therefore very concerned about the sense of direction that this reform process could take, noting for example the lack of any in-depth situational analysis of the world’s health challenges in relation to WHO’s constitutional role and objectives. Moreover, while there is a lot of focus on the bureaucratic dimension of the reform, a mature vision of the core values steering the process is sorely absent. Absent is also a political discussion, and a vision, about the WHO of the future'.
We are committed to a strong World Health Organisation, adequately funded, fully utilising the powers of the Constitution and playing the leading role in global health governance. However, the current crisis could compromise WHO's capacity to play this role.
The NCDs initiative is too narrow in particular we believe it should include mental health. It is disappointing that there is no reference to the work of the CSDH in the report. Unhealthy behaviors do play an important role in determining NCDs however there are structural determinants like education, income, gender and ethnicity which are underlying causes of NCDs and behavioral risk factors. Clearly there are important equity dimension of NCDs as emphasized by CSDH and these variations are closely linked to the social and environmental factors; not just individual behaviors.
Both under-nutrition and obesity are linked to the increasing dependence of poor countries on high-income countries for food security, which has been reinforced by trade agreements, climate change, and biofuels. Nutrition strategies should address the complex socioeconomic and political determinants of malnutrition. Governments and international bodies, like WHO, must advocate for the regulation of the trade and marketing of unhealthy foodstuffs, so as to protect the health of populations – and of children in particular – from aggressive corporate influence.
PHM is committed to a stronger WHO, adequately funded, with appropriate powers and owning the leading role in global health governance. PHM follows closely the work of WHO. 30 health activists from over 20 countries have been working through the 64th WHA Agenda with the assistance of high level experts from a number of collaborating networks and NGOs. The following comments on some of the agenda items of the 64th WHA were drafted for your kind consideration.
The WHO is facing a financial crisis: programmes, projects and staffing face the prospect of being disbanded; the dominance of tied donor funding is having a terrible effect on administration. The WHO is also suffering from a crisis of identity and legitimacy; its role and mandate have been diluted and usurped by the proliferation of new actors in the field of global health. Inefficiencies within the organisational processes remain unresolved.
As representatives of organisations working on campaigns for health and social justice, of academia, governments and multilateral institutions, we gathered in New Delhi from 2nd to 4th May 2011, from all parts of the world, to address the need for an effective and accountable global governance for health. In the wake of the Regional Dialogue on the right to health held in Johannesburg at the end of March, the purpose of this global consultation was to achieve a common vision for realizing the human right of everyone “to the highest attainable standard of physical and mental health “, and reignite a health for all movement with shared objectives and actions to this end.