GLOBAL ROLE OF THE WORLD HEALTH ORGANIZATION
The distribution of health benefits that result from the globalization process depends on preexisting economic, social and political conditions within countries, the fairness of trade and investment agreements, existing political economy, and the strength of the multilateral global health system. Improving health and addressing health inequalities and externalities requires effective global action on health that entails essential global health functions, which promote norms and standards, global action, professional management, financial resource transfer, scientific research capacity, and leadership.
An increasing number of global health actors are joining WHO in influencing global health priorities for research, policy, and investment. This pluralism, while potentially benefiting global health, has ultimately resulted in a splintering of international health agencies and an increasingly fragmented, uncoordinated, ad hoc, and incongruent global health agenda. Can the creation of a leadership gap for an overarching convening and coordinating role be uniquely filled by WHO?
This article considers the shift in WHO’s budgetary allocations and policy priorities away from global normative development toward operational work at the country level and the implications of these changes for the future of global health governance.
We argue that while the demand for both WHO’s core functions and supplementary functions has increased, the majority of new global health actors address primarily operational functions, creating an even greater need for WHO’s core global functions. Under the leadership of Margaret Chan, one saw a shift in expenditure patterns across WHO’s three core functions, with more resources being earmarked for work in countries and regions. Chan focused WHO’s efforts on communicable disease surveillance and response, enhanced training for public health professionals, and collaborations at the local and international level. Furthermore, the 3 by 5 initiative represented a narrowing toward specific diseases and a focus on treatment over broader health determinants and health promotion strategies.
Despite the rise of other entities in disease surveillance academia, the WHO still remains necessary as a global information system. Compared to the 2006/2007 budget, the 2009/2010 budget reflected an emphasis on essential health interventions and specific diseases and a shift in resources from headquarters to the regions, reflecting a WHO that was becoming more operational and less global.
This analysis highlights the need for WHO to engage in the global arena with a stronger hold on its role in integrating, coordinating, and convening the global health agenda through, for example, 1) centering its efforts to converge on major trade issues concerning medicine, 2) involving WHO’s role as an umbrella health agency coordinating international legal and non-legal activities of different organizations, and 3) continuing to reform and update existing global regulations for infectious disease control.