A Timely History: Examining the History of the World Health Organization to Frame the Future of Global Health Governance

Abstract

The authors frame these challenges through a focus on WHO's leaders, a focus they continue throughout the book, seeing the WHO directorgeneral as setting the political direction of the organization- shifting WHO between a sociomedical and biomedical approach to health 3 Without a political counterweight to the United States and its capitalist allies, WHO shifted its efforts to parallel Western funding, providing technical assistance to low-income countries as a means to minimize communist influence Where WHO's vertical campaigns repeatedly failed (as Cueto et al illustrate in the boom and bust of the Malaria Eradication Program), a Cold War detente opened a political path in the 1970s to achieve WHO's principal technological success: the eradication of smallpox 4 This triumph over disease depended as much on political cooperation as on biomedical technology, with international political support for social medicine proving essential to WHO's principal policy success: the 1978 Declaration of Alma-Ata In responding to the threats of a globalizing world, other institutions sought a leadership role in health, with the rise of UN AIDS (Joint United Nations Programme on HIV and AIDS) to coordinate the HIV/AIDS pandemic response, UNICEF (United Nations Children's Fund) to lead child survival efforts, and the World Bank to fund health initiatives Amid attacks on WHO's leadership from its member states-which increasingly turned to bilateral assistance, new partnerships, and neoliberal policies-WHO sought to refashion itself to stay relevant in the expanding global health governance landscape 6 Cueto et al describe the 1990s as a period of new challenges for WHO, but their focus on the top-down decisions of the WHO director-general overlooks the progressive rise of bottom-up advocacy through social movements