This year’s Assembly was Dr Brundtland’s first as Director-General and was very intensive. In addition to the formal resolutions adopted at every Assembly, roundtable discussions on key health questions were held. Nobel Laureate Amartya Sen spoke on health’s role in development, and numerous associated activities - ranging from presentation of a World Bank report on the economics of tobacco, to briefings on WHO's role in relief work in the Balkans - took place.
BETTER HEALTH CAN DRIVE DEVELOPMENT
“The world is fast discovering how better health can drive development”, WHO Director-General Gro Harlem Brundtland told delegates in her address to the 52nd World Health Assembly in Geneva, earlier this year in May. “In East Asia, life expectancy increased by over 18 years in the two decades that preceded the most dramatic economic take-off in history. Repeat these gains - and we could be launching a new leap forward for human progress and development.”
Although keen to describe these aspirations for world health, Dr Brundtland also referred to the one billion people whom the health revolution has left behind. Nevertheless, she expressed confidence in the world’s knowledge and means to address the “unfinished health agenda of the 20th century”.
A more complex task lies in maintaining health gains and countering growing and new threats to public health. For if we “succeed in curbing poverty and giving populations a real chance to climb the development ladder, then new health threats will follow, from noncommunicable diseases, from the very fact that people live longer, from changing lifestyles and from exposure to threats such as tobacco.”
So while the primary challenge for global public health is directly health-related - to greatly reduce the burden of excess mortality and preventable disability suffered by the poor - three additional challenges outlined by Dr Brundtland are wider in scope. They involve countering potential threats to health from economic crises, unhealthy environments and risky behaviour; developing more effective health systems; and investing in expanding the knowledge base that made the 20th century revolution in health possible.
MAKING A TANGIBLE DIFFERENCE
Only WHO is in a position to meet such challenges, she said. A repository of public health knowledge for the whole world, it also strives for public health on behalf of all. The recognition of the complexity and urgency of the challenges facing WHO, however, has convinced Dr Brundtland that the organization must transform itself. Only then will it become “more effective, more accountable, and more receptive to a changing world”.
The Director-General went on to describe the radical shifts that have occurred at WHO headquarters in Geneva since she took office. The original divisions have been rearranged into nine clusters (see box for details of Health Technology and Pharmaceuticals cluster) and programme resources shifted to priority areas. Ten Executive Directors (five women and five men), representing all regions of the world, have been appointed. The massive under-representation of women in WHO's workforce is being countered by concerted efforts to ensure that 60% of new recruits are female. And Management Support Units - an innovation in the United Nations System - have been created to move management support nearer to the managers, and to facilitate and back up technical work.
Reorganization and new ways of working stretch beyond headquarters. Dr Brundtland reported how, for the first time in WHO's history, WHO Representatives and Liaison Officers were brought to Geneva for a week in February. This was just the start of a process that will place far greater emphasis on how the organization can make a tangible difference in its work with and in countries.
MORE EFFECTIVE PARTNERSHIPS
Dr Brundtland stressed that although WHO is the world’s lead agency for health, it is only one of several key players in the health arena. First and foremost a technical agency devoted to the support of sustainable health systems, it also acts as a catalyst, unleashing the resources of national governments, development banks and bilateral partners in the service of health.
Member States themselves are therefore being challenged to maximise their efforts to promote and create health, including careful prioritising and allocation of budgets for health activities. The Director-General cited one example where US$ 4.9 million from WHO's regular budget had been allocated by a WHO Member State to cover the cost of 428 priority activities in 44 different national health programmes. “That is not the best way to make a difference and should now be considered past history”, she commented.
Additionally, other players in health are being encouraged to work more closely with WHO. Collaboration between the United Nations Children’s Fund and WHO has been strengthened for the home stretch of the polio eradication campaign. Talks between WHO and the United Nations Population Fund have led to greater cooperation between the two organizations in the areas of sexual and reproductive health, particularly at country level. WHO is also combining forces with the Office of the United Nations High Commissioner for Refugees to address the public health challenge generated by the refugee crisis in the Balkans.
Delegates at the World Health Assembly in May 1999 being addressed by Director-General Dr Gro Harlem Brundtland (Photo: WHO)
Furthermore, cooperation is being intensified with the World Bank, and roundtables held with nongovernmental organizations and industry. Concurrently, external and internal studies of WHO's own research agenda have been carried out to ensure that it can meet the needs of the 21st century, and an evaluation is being completed of the way in which WHO works with its Collaborating Centres.
How the Health Technology and Pharmaceuticals cluster was created
Dr Brundtland emphasised that it is in the combined impact of all these efforts that a real contribution can be made to improve health. She was keen to stress, however, that in reaching out to partners, WHO will preserve its public health values and integrity. “We need public voices - and you can count WHO as one - to speak out for all those denied their human rights to health,” concluded the Director-General.