The World Health Organization have elected the Ethiopian candidate, Tedros Adhanom Ghebreyesus, as the Director General at the 70th World Health Assembly. There is no doubt that Ghebreyesus has some major challenges ahead of him, but what should his priorities be? IDS researchers set out what they think should be at the top of the list.
Melissa Leach – Director, IDS
The World Health Organization’s (WHO) new DG comes to power at a time of critical challenges and opportunities, in which linking global and local communities and contexts is more important than ever. People’s health is increasingly shaped by global interconnections – as internationally-mobile people and microbes amplify infectious disease outbreaks, planetary climate and environmental change create new health hazards, global food systems shape vulnerability to non-communicable disease, or anti-microbial resistance overspills borders.
The WHO’s long-established and respected responsibility to protect and promote everyone’s health as a global public good for a global community is critical, and must be strengthened even in the face of pressures for fragmentation from nationalistic or private interests and funding. Yet recent experiences also drive home the importance of connectedness with local communities and contexts, whether in responding to health emergencies, where the Ebola crisis laid bare the life-and-death need for anthropologically-informed engagement with communities’ anxieties and socio-cultural practices, or in implementing universal health coverage, where innovations in local health system and community provision have proved transformative.
To link global and local in this way also requires traditional boundaries and hierarchies to be overcome, forging new integration between technical and social interventions; human, animal and ecosystem health; and medical and social science research and knowledge. The WHO has an impressive history of examples of such integration. Now is the time to bring the lessons of these experiences to the fore and embed them fully across the organisation.
Take a ‘One Health’ approach
Ian Scoones – Research Fellow, IDS and Director, STEPS Centre
Multiple global health challenges suggest three big priorities for the new WHO DG. Firstly, the Ebola crisis in West Africa showed how human, animal and ecosystem health do not exist in isolation from one another. The new DG must make a ‘One Health’ approach central to WHO work. This means building capacities for integrated approaches, reflecting this in organisational restructuring, staff hiring priorities and cross-UN alliance building.
Secondly, the new DG will have to resist the pressures of ‘big pharma’, separating WHO policymaking from regulatory functions and implementation activities. This must go hand in hand with a requirement for open data for all pharmaceutical trials.
Finally, there must be a wholehearted commitment to the Sustainable Development Goals and Agenda 2030. Health is not a singular issue, and the new DG must strive to link health and wellbeing across the goals, making issues of inequality, ‘structural violence’ and health central to global development debates.
Listen to all voices and ensure all interests are addressed
Hayley MacGregor – Research Fellow, IDS
The new DG will need to be able to hear the perspectives from different parts of the world and build consensus around how to address the global health challenge of our age. The SDGs have outlined those challenges in general terms, and emphasise that improved health will require collaboration in between and across sectors.
Furthermore, many parts of the world face rapid social change and enormous inequalities persist in the provision of basic public health and affordable and accessible health services. This is a political challenge as much as anything else, and will require skills in dialogue to get a broader agreement of what responses might be just and sustainable for a wide constituency. This will inevitably require trade-offs. In global agreements and responses, the WHO director-general will need to ensure that not only the interests of the powerful or the rich are protected and addressed.
Re-establish the WHO as a trusted steward
Annie Wilkinson – Research Fellow, IDS
The WHO has come to be seen more as a technical organisation, and has been much criticised for being weak, too slow or too close to the pharmaceutical industry. This is a world away from the WHO which faced down opposition from the pharmaceutical industry to establish Essential Medicines Lists (pdf) to ensure that poorer countries had access to life saving drugs.
The new DG would do well to return to the core values of the 1978 Alma-Ata Declaration (pdf) which still makes powerful reading today. The declaration called for action in the face of unjustifiable health inequalities and defined health broadly, acknowledging the social and economic determinants of health and the role of those sectors in supporting health.
To make meaningful progress on the Sustainable Development Goals, achieve universal health coverage, to address the growing threat of resistance to antibiotics, or of zoonotic diseases, the WHO will need to find a way to tackle the interests of powerful lobbies where they conflict with health – be they pharma, food, tobacco, agriculture, textiles, energy or some other – in addition to continuing their work with national governments and in setting international norms and standards.
The scale of this challenge should not be underestimated when the networks of these organisations are international and their budgets often dwarf those of national governments and the WHO itself, but this is all the more need for the WHO to re-establish itself as a trusted steward, standing up for people’s health everywhere.