WHO: where there is no vision, the people perish

Abstract

Your Sept 13 editorial1Editorial. WHO: where there is no vision, the people perish.Lancet. 1997; 350: 749Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar on the recommendations of the Independent Group for Global Health on reforming WHO, and your open letter to the Executive Board of that international health agency,2The Lancet. Open letter to Executive Board of WHO.Lancet. 1997; 350: 751Summary Full Text Full Text PDF Google Scholar includes good questions and recommendations. Your analysis of what is wrong in WHO and what can be done, however, only touches on the managerial and social sensibilities required from the new Director General. WHO's problems are more extensive than having the right person to lead WHO. Some of us predicted many years ago that the blueprint for change in health for all the world would fall short, as has occurred.3Navarro V Critique of the ideological and political positions of the Willy Brandt report and the WHO Alma Ata Declaration.Soc Sci Med. 1984; 18: 467-474Crossref PubMed Scopus (47) Google Scholar Public-health institutions, including international ones, too often ignore the analysis by one of the founders of public health, Virchow, who noted that “medicine is not only a biological, but also a social intervention and politics is public health in the most profound sense”.4Taylor R Rieger A Medicine as social science: Rudolf Virchow on the typhus epidemic in Upper Silesia.Int J Health Serv. 1985; 15: 547-560Crossref PubMed Scopus (68) Google Scholar Unless the political context that shapes the budget and priorities of WHO changes, not much will be accomplished. How is it, for example, that WHO has not documented the growing social inequalities in health worldwide (the result of public policies supported by some of the major WHO financial backers)? How is it that WHO has not criticised some of the policies of both the World Bank and the International Monetary Fund that favour the structural-adjustment policies that are exacerbating those inequalities? To see the problems of WHO as a lack of vision of the Director General and poor management skills of its staff is to miss the point.