The world situation and WHO

Abstract

This reality, however, should not lead to the conclusion that the primary conflict today is between developed and developing countries. Such an interpretation is seen, for example, in the UN Development Programme (UNDP) Human Development Reports. In describing the world social situation, these reports contrast such things as the amount of money spent by people on feeding their pets in developed countries with the amount of money spent on feeding children in poorer countries. 3 This type of presentation and analysis, besides making people from economically advanced countries feel guilty, seems to carry the message that the problem of famine in children in poorer countries—one of the largest public health problems 4 —could be solved by transferring funds from the people living in wealthy countries (funds saved by not feeding pets) to feed children in developing countries. This analysis is wrong and naively apolitical; it erroneously assumes that famine and poverty in developing countries are caused by a lack of funds (and other resources). But the well documented reality is that these countries have enough resources to feed populations many times their size. 5 Even Bangladesh and Haiti, to mention just two countries where famine is endemic, have enough productive land to feed their populations five times over. To be fair to the UNDP, however, this position is now being questioned within the organisation, but the view is still prevalent in that agency, as well as in many human development and foreign aid agencies of the UN. This division of the world ignores the fact that the distribution of economic, political, and cultural resources is highly concentrated in specific areas in both high and low income countries. 1 Frequently forgotten is that 20% of the richest people in the world live in developing countries. 6 The extremely luxurious standard of living of Arab sheiks who reside in a sea of poverty in some Arab countries is an example of a situation common in developing countries. It is precisely this concentration of economic, political, and cultural power among and within all countries that is at the root of the world’s most important social (including health) problems. What is usually referred to as the world order (though better described as world disorder) is based on an alliance of the dominant classes (and other social groups) of the developed world with the dominant classes (and other social groups) of developing regions who are against a redistribution of resources that would adversely affect their interests. The evidence for this situation is overwhelming. 1 Moreover, we cannot understand the behaviour of today’s international agencies, including the International Monetary Fund (IMF), World Bank, and World Trade Organisation (WTO), without understanding their articulation in this set of alliances. How WHO fits into this situation Within the context described above, what are the patterns of influence over WHO? This is certainly an understudied area of policy research. But there are some strong pointers that can help us with an initial diagnosis. The economic, political, and health institutions in developed countries, and especially the USA (including its federal agencies, foundations, and leading academic institutions), have an enormous effect on the culture, discourse, practices, and policies of WHO (and of the Pan American Health Organisation [PAHO]). The dominant ideologies in such institutions (especially in the USA) are seen in WHO documents shortly after surfacing in mainstream medical and economics journals. One example is the WHO report evaluating countries’ health systems. 7