There it was again. The phrase, “according to the World Health Organization…” or sometimes its, “as recommended by the World Health Organization.”
In the world of public health you will be unable to escape hearing about the World Health Organization. ‘WHO’ for short. And if you’ve never heard of it before, you might be living under a rock, because WHO is EVERYWHERE.
So, who put WHO in charge? Is the WHO really the robust international health organization we think it is?
The World Health Organization was not the first attempt to organize and empower countries to work together in order to conquer deadly and infectious diseases. The world has long suffered contagions such as smallpox, cholera, bubonic plague, tuberculosis and famine. Transmission of disease increased progressively throughout the 19th and 20th century and in the aftermath of WWII, governments agreed to take international action. 
In 1945, replacing the League of Nation, 51 member states agreed to form the United Nations which then approved the first constitution of the World Health Organization by 1948. The WHO now has a total of 194 participating member states and coordinates world wide initiatives between other governmental, non-governmental, private, and public institutions and is the global reigning body of expertise on all health matters.
What followed was a sequence of world wide health campaigns, international research and development, vaccines, antibiotics, reduction in famine, the eradication of smallpox, control of communicable diseases, provision of high-quality primary care, the establishment of environmental standards for clean air and water worldwide, and a general grand improvement of the standard of living of billions of people.
The global impact of the WHO in recent history of human health and quality of life is undeniable. More than eradicate deadly disease, the WHO has paved the way for an exponential growth of international coordination and partnership/collaboration. It has “developed uniform metrics and methods, standardized interventions, gathered epidemiological intelligence, and has the means to evaluate the efficacy of programs.” Its presence is ubiquitous.
BUT, the WHO requires more authority or it needs to improve the balance between its normative and operational functions. The WHO is the “directing and co-ordinating authority on international health work.” It also obligates its participating members to complete whatever norms and standards it establishes. However, as it stands today, there are no consequences or methods of enforcement to its regulations. So, has the international community really agreed on the function of the WHO?
As citizens of countries who participate in the WHO and as public health workers, we should all be demanding more from our governments to lend the WHO more legitimacy. Over the past 30 years the WHO has become increasingly politicized and beholden to its financial backers more than to its constituents. A recent report from the EEU alerted us that 412,000 people died of premature death in Europe in 2016 due to poor air quality. All EU members are also WHO members, and yet, “sixteen of the EU’s 28 member states reported levels of nitrogen dioxide that surpass legal EU limits and are far from reaching the WHO standards,»
What purpose does the WHO serve if it has no authority, no transparency, no power over its member states? And lets not forget about the member states that have very little financial or governing power, whose citizens we are supposed to protect.
The 2014 Ebola outbreak is an example of how under-developed countries are most affected by the inefficacy of the WHO.
Yes there were many factors that contributed to the severity of the outbreak that were not possible to control. But there were also blatant shortcomings, like negligible timing and lack of personnel for which the WHO is 100% responsible. Most of these issues boil down to lack of funding which brings us to another issue that has developed in recent years. The WHO has become political in its actions and can no longer make objective and authoritative decisions. After the outbreak of 2014 we know that The result was a humanitarian crisis that was conclusively preventable.
Moreover, at this rate, things will continue to get worse. Most agree that climate change will lead to more severe disasters and create conditions favorable to the spread of disease and increased famine and inequality. The urgency to collaborate and cooperate is more dire than ever. WHO will take action???
The creation of the World Health Organization is an achievement of the 20th century. We would be much worse off than we are now without it. However, we are in the 21st century and it has brought us new challenges. We have spent over a hundred years working together to eliminate deadly disease and decrease famine. Now it is time to become better stewards of our planet and better neighbors to each other. It is in the application and execution of our humanist views that we are failing miserably and there is no excuse for failure when we have come so far as to create a renowned and monumental institution like the World Health Organization.
Thanks for your interesting article Bethany 🙂 . After working for a few years in conflict countries, I can say I also share this sense of disappointment with the UN and all other organizations under the UN umbrella. But it helps me to remember that the UN is not the «world police», and it’s actually formed by member states so those member countries have to take responsibility for UN decisions and lack of them. It ends up really as a reflection of the current political and geopolitical struggles that are frankly something to be ashamed of as humans. The UN was designed at another time of history and now really needs deep reform. I think as public health workers we often find ourselves powerless and on the margins of politics, but I’m convinced that its something we need to consider getting into in order to create real change.
I liked a lot this article, fundamentally because it reminds me of an issue that I think is crucial in today’s panorama of (world) health. This matter is the implicit or explicit relation between politics and health. And I only can face it with questions.
The first one is partially motivated by the other comment you have here, in which it is said «[…] the UN is not the <>[…]». Why not? And I think this question is not trivial. Only within current states there is still a debate about which is the actual structure of these states, which implies the question about which institutions guarantee validity of law. This problem reaches high levels of difficulty when we talk about international law. At this moment, I think there is not a real surety in which we can trust to see countries respecting what they accord to do. My present opinion, setted by a position of deep ignorance, is that most of international organizations are either a lie or a useless way to placate guiltyness.
The other question(s) are about the relation between health and politics itself. It seems to me that either health as a discipline has to be subordinated to politics, so we should not talk about that; or helath discipline is bound to politics, so we should talk specifically about politics (which implies talking about law, diplomacy, resources, states rivalry…).
I don’t know if this comment contributes at all, or even if it is written decently. But I think it shows how interesting and hard is this for me. Thank you very much for the article!
Hi César, in reference to my comment here is a small clarification: What I mean is that that the UN is not the «world police», given that law and governance belong to sovereign states. The UN does not police heads of state and is thus only as strong as member states who represent their head of state. So–bad head of state and bad lawmakers = bad member state = poor-performing UN. I’m not defending the UN, of course, I just think that lots of people have unreal expectations on what the mandate of the UN actually is. Of course, it would be great to have world police or a world government that forces states to respect human rights, to keep their people healthy and safe. But can you imagine how many states would refuse to sign up for this?
Hi Mar! Probably I didn’t explain myself, because in fact I 100% agree with you: the UN is nobody’s police. I wanted to express more like a wish, because I feel that without a complex structure that functions as a state (not only with laws, but also with institutions that assure them), the UN and similar organizations won’t be but weak deals between governments that really don’t want to agree with each other.