[Ip-health] Buse et al. in The Lancet: WHOse agenda for WHOm? Analysing the manifestos of the candidates for Director-General of WHO

Thiru Balasubramaniam thiru at keionline.org
Sat Jan 7 00:30:36 PST 2017


http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32611-3/fulltext

<SNIP>

First, moving from what actions to take to how to implement them is
generally absent from the candidates' agendas. For example, despite strong
prioritisation of non-communicable diseases (NCDs), only one candidate
mentions evidence-informed interventions identified by WHO and the World
Economic Forum as “best-buys for NCDs”5—Szócska calls for an “efficient
public health regulatory agenda”. Similarly, although all candidates
propose commitment to universal health coverage, only three candidates
mention resource mobilisation or the health-care workforce. All candidates
mention access to medicines; however, none mentions trade-related aspects
of intellectual property rights flexibilities—a policy lever for affordable
generic drugs.

--

Volume 389, No. 10064, p33–34, 7 January 2017
Correspondence

WHOse agenda for WHOm? Analysing the manifestos of the candidates for
Director-General of WHO

Kent Buse, Iwan Williams, Sarah Hawkes
Published: 07 January 2017
DOI: http://dx.doi.org/10.1016/S0140-6736(16)32611-3

Article Info


A Lancet Special Report (Oct 29, p 2072)1 provided the six candidates
competing for the post of the next Director-General of WHO an opportunity
to briefly present their manifestos. The candidates' priorities are
important because they will influence the agenda of WHO, the institution
mandated as the directing and coordinating authority on international
health.

The extent to which the candidates' manifestos aligned with the political
priorities expressed in the UN Agenda 2030 for Sustainable Development
(Agenda 2030) health-related targets2 was analysed (appendix). Alignment
with these ambitious yet appropriate targets3 is crucial because WHO is
expected to provide the international community leadership and technical
support in their realisation. The following three further principles of
Agenda 2030 will be equally important for realising the health-related
targets: leaving no one behind, rights-based approaches, and
gender-sensitivity (a determinant of ill-health, health-seeking behaviour,
and health outcomes).4 Moreover, Agenda 2030 requires different methods of
working for WHO, including intersectoral collaboration, engagement with
non-state actors (particularly civil society and the private sector), and
addressing the social determinants of health, all of which are included in
this analysis.1

Candidates prioritise certain targets and issues over others. David Nabarro
mentions the highest number of targets and issues in his manifesto (19),
whereas Miklós Szócska mentions the least (11). Surprisingly, many of the
targets do not feature among the priorities of any candidate. Substance
misuse, road traffic injuries, and neglected tropical diseases are not
featured, and sexual and reproductive health are not covered, with the
exception of Nabarro if “completing the unfinished work for the Millennium
Development Goals” is accepted as a proxy.

This analysis raises five issues that are relevant to compare the
candidates and to move their agendas forward.

First, moving from what actions to take to how to implement them is
generally absent from the candidates' agendas. For example, despite strong
prioritisation of non-communicable diseases (NCDs), only one candidate
mentions evidence-informed interventions identified by WHO and the World
Economic Forum as “best-buys for NCDs”5—Szócska calls for an “efficient
public health regulatory agenda”. Similarly, although all candidates
propose commitment to universal health coverage, only three candidates
mention resource mobilisation or the health-care workforce. All candidates
mention access to medicines; however, none mentions trade-related aspects
of intellectual property rights flexibilities—a policy lever for affordable
generic drugs.

Second, the right to health is mentioned by five candidates, but fewer
mention the specific needs of susceptible or marginalised groups. All
candidates mention equality, but only Sania Nishtar mentions gender
equality, whereas Flavia Bustreo refers to her experience mainstreaming
gender through WHO. Special attention to the needs of, and
non-discrimination against, less powerful groups will help address the
major health inequalities (including access to health care) experienced by
minority and marginalised6 populations around the world, and should be
prioritised by all candidates.

Third, several health issues with substantial contributions to the global
burden of disease are not on the agenda. It might be argued that in voicing
their support for Agenda 2030 or universal health coverage, the candidates
implicitly endorsed all the health-related targets. This justification
raises questions regarding how candidates prioritised and selected the
agendas presented while ignoring other equally important health issues.7

Fourth, leadership on divisive issues is absent. Rather than clear
leadership informed by evidence of the burden of disease, the candidates
avoided the ideological divide on sexual and reproductive health and
rights. Similarly, although all candidates propose to engage more with the
commercial sector, no candidates offer solutions to address the commercial
drivers of ill health (diet, alcohol, road traffic accidents; only two
mention tobacco) and only one refers to the WHO Framework of Engagement
with Non-State Actors and how to safeguard WHO against risks from
interaction with the private sector.

Finally, the candidates did not give adequate consideration to the root
causes of susceptibility and risk of illness. For example, all candidates
mention the need for intersectoral collaboration, but only four seek to
address social determinants of health—despite a wealth of evidence from WHO
on their importance—and only Nabarro and Nishtar are robust on the issue.8
Although four candidates refer to climate change as a determinant of ill
health, they do so in relation to its effect on health and health-care
systems rather than how to deal with climate change itself. Similarly, five
candidates mention environmental pollution; however, none of the candidates
address how to deal with its determinants.

The candidates' manifestos are expected to evolve as the campaign
progresses. Ultimately, health is a political issue (five of the candidates
allude to this) and the selection process is a political one.9 The
executive board of WHO will meet in January, 2017, to put forward a
shortlist of three candidates. Civil society, experts, and member states
must now push all six candidates to adopt more politically courageous,
evidence-informed manifestos, aligned with globally agreed targets, to
which the successful candidate can be held to account by member states and
individuals whose health they serve.

We declare no competing interests.

Supplementary Material



References

Horton, R and Samarasekera, U. WHO's Director-General candidates: visions
and priorities. Lancet. 2016; 388: 2072–2095

UN General Assembly. Transforming our world: the 2030 Agenda for
Sustainable Development. Resolution adopted by the General Assembly on Sept
25, 2015. A/RES/70/1.
http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E.
((accessed Nov 5, 2016).)

Buse, K and Hawkes, S. Health in the sustainable development goals: ready
for a paradigm shift?.Global Health. 2015; 11: 13

Hawkes, S and Buse, K. Gender and global health: evidence, policy, and
inconvenient truths.Lancet. 2013; 381: 1783–1787

WHO and World Economic Forum. From burden to “best buys”: reducing the
economic impact of non-communicable diseases in low- and middle-income
countries. Sept 18, 2011.
http://www.who.int/nmh/publications/best_buys_summary.pdf. ((accessed Nov
12, 2016).)

Beyrer, C, Baral, S, Collins, C et al. The global response to HIV in men
who have sex with men.Lancet. 2016; 388: 198–206


Bachrach, P and Barataz, MS. Decisions and non-decisions: an analytical
framework. Am Polit Sci Rev. 1963; 57: 641–651

Marmot, M. Social determinants of health inequalities. Lancet. 2005; 365:
1099–1104

Kickbusch, I, Woods, N, Piot, P et al. How to choose the world's top health
diplomat. BMJ. 2016;355: i5746



More information about the Ip-health mailing list