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Healthy Governance: How the WHO Can Regain Its Relevance

June 1, 2012

Devi Sridhar, Lawrence O. Gostin, and Derek Yach in Foreign Affairs:

After 15 years of heralded progress on pandemic preparedness, tuberculosis control, tobacco regulation, and health metrics, the World Health Organization faces confusion over its future. In 2011, after a yearlong consultation with member states, WHO Director-General Margaret Chan described the agency as overextended and unable to respond with speed and agility to today’s global health challenges. The most serious examples: the WHO’s inability to address noncommunicable disease (NCD) prevention globally, to improve access to health systems, and to set global priorities in health.

In the years after the WHO was founded in 1948, the organization plucked a lot of low-hanging fruit. It helped governments improve hygiene and environmental health. It also supported the development and application of new technologies to control major infectious diseases such as malaria, syphilis, tuberculosis, and yaws. These missions largely went hand in hand with postwar reconstruction efforts. The WHO’s most cited success from its early years was its initiative to eradicate smallpox, which began in 1958 and was certified complete in 1979.

Yet even in this golden era, the WHO struggled with an internal debate over its fundamental mission. There was an ongoing tension between a “vertical” approach, which tackled specific diseases without addressing general health services and prevention needs, and a “horizontal” one, which looked to strengthen whole health systems and support basic-care services that would deliver broad-based, integrative, and long-term improvements in public health. (…)

Like a pendulum, the vertical-versus-horizontal debate has regularly swung over the past 50 years. The result: The WHO has embraced elements of both approaches. There are vertical programs for AIDS, tuberculosis, and malaria. At the same time, the WHO pushes for universal health coverage and improved health systems in many countries, focusing especially on broad issues such as maternal and child health. Yet, over the last two decades, as globalization expanded, urbanization accelerated, and lifestyles grew more sedentary, a baseline shift transformed the public’s health demands. [More]

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