Rx for WHO.

Abstract

The editorial “Reaching out for world health” by Gro Harlem Brundtland (26 June, p. [2027][1]) was inspiring. As the new Director-General of the World Health Organization (WHO), she should have the best in advice and support. Having completed a year-long study in the effectiveness of WHO last year ([1][2]), we would like to offer both. WHO has been accused of mismanagement, corruption, favoritism in appointments, and drifting without direction across an ocean of special interests. It was not always this way. Beginning in 1948, WHO led the charge against the disease scourges of humanity. For more than 20 years, its mission and commitment attracted first-rate professionals. Its leadership in eradicating smallpox in 1977 was a crowning glory. To take control of her drifting ship, Brundtland will have to establish priorities that reflect the world's health needs. WHO should not pursue goals at the city or national level, where competence exists and communities choose their priorities. WHO must concentrate on its ability to provide global action on priorities recommended in a report ([2][3]) that WHO supported in 1996. The first priority is to combat resurging infectious diseases, which cannot be contained by nations acting alone. Tuberculosis has returned in new, antibiotic-resistant forms and has lately impelled New York and other large cities to spend as much as $1 billion a year in treatment and prevention. Malaria annually strikes a quarter of a billion new victims worldwide and kills a million children. Second, effective global systems of public health should be developed that use the best in computing, telecommunications, and information handling. Ever-vigilant “SWAT teams” should be created to track and respond to outbreaks of dangerous diseases. Such teams could be assembled only by pooling and managing scarce public-health resources from many countries. Third, as mandated by changing demographics, nations should be helped to share the most successful approaches for coping with noncommunicable diseases such as cancer, diabetes (cases of which are likely to treble in the next 30 years), and heart disease. To succeed at this mammoth task, decentralization must occur at WHO. Successful global organizations learn this lesson. One example is Asea Brown Boveri, where 100 managers in the Zurich headquarters (less than 1% of the total staff) oversee a $36 billion global firm with more than 200,000 employees who conduct engineering operations and services. Contrast this efficiency with WHO's profile: more than a third of its 4500 staff sit at desks in Geneva. WHO's business is human lives. There is not another moment or dollar to waste. 1. [↵][4]1. R. W. Nichols, 2. S. U. Raymond , Global Public Health Collaboration: Organizing for a Time of Renewal (New York Academy of Sciences, New York, 1997). 2. [↵][5]1. Ad Hoc Committee on Health Research Relating to Future Intervention Options , Investing in Health, Research, and Development (World Health Organization, Geneva, Switzerland, 1996). [1]: /lookup/doi/10.1126/science.280.5372.2027a [2]: #ref-1 [3]: #ref-2 [4]: #xref-ref-1-1 View reference 1 in text [5]: #xref-ref-2-1 View reference 2 in text