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BMJ No 7124 Volume 316
News Saturday 3 January 1998
WHO Special Report
WHO leadership candidate: Dr Gro Harlem Brundtland
BMJ analysis
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Dr Gro Harlem Brundtland (58) is a former prime minister of Norway
and chaired the World Commission on Environment and Development,
which is credited with developing the concept of sustainable development
and led to the 1992 Earth Summit. She is an experienced politician
with well established credentials in health and development. She
has consulted widely about the future of the WHO and has broad
support in Europe. But fear of her reformist zeal may limit her
chances. |
Replies to BMJ questions
What do you see as the major health challenges of the next five
years, and how should the WHO address them?
We must promote equity in health care and never waiver in our
pursuance of the highest attainable standard of health for all
peoples. Today's gaps in health between geographical areas, social
groups, races, and sexes must be narrowed, and women and children
must be a major concern. To obtain more equity we must give priority
to primary health care of good quality, which must be made available
and affordable to all. Essential primary health care includes
treatment by trained staff and availability of essential drugs.
It comprises preventive and environmental health such as clean
water, clean air, and sewage.
The WHO should develop its capacity to give guidance on health
policy organisation and financing of health systems. Renewed weight
must be given to anticipation and prevention of disease. The struggle
against many communicable diseases is underfunded and must be
raised on the political agenda. The WHO should also be in the
forefront in setting standards, training, and research. It should
be the lead agency with regard to countering new and re-emerging
diseases, not least those connected with globalisation, changing
lifestyles, and environmental problems. While the WHO itself does
not command resources of a scale needed to solve these problems,
it can help to develop critical solutions to country-specific
problems, disseminate health standards, and take the lead in generating
the international cooperation in health required for solving such
problems that transcend borders and cannot be dealt with effectively
by countries acting individually.
Should the WHO be addressing the effects of socioeconomic factors
on health, and if so, how?
Poverty breeds ill health, and ill health leads to poverty. There
are no investments in this world that yield higher profits than
investment in people's health and education. With relatively cheap
investment in these basic social services we could lift entire
populations up the development ladder. In addition to the communicable
diseases that already plague many countries, the growth in traffic
accidents, environmental health problems, cancers, and cardiovascular
disease, as well as diseases spreading as a result of international
travel, will increase. These increases will challenge the ability
of all countries to pay for health. This means that to remain
a centre of excellence into the next century, the WHO must harness
and expand its resources in the fields of public health management
and economics.
How should the WHO's activities best reflect the long term needs
of individual countries rather than the short term interests of
donors?
A recent study of the executive board of the WHO found that 70%
of the extrabudgetary funds went to the WHO's priority activities.
This compared with 30% for the regular budget. Many donors have
supported the WHO over many decades and also invest in research
with very long term goals. On the other hand, all countries in
the world have short as well as long term goals. I believe that
the WHO can be a key forum for making sure that international
resources are used according to the most effective mix of short
and long term goals and that it can enhance its role as adviser
to governments on health priorities.
Do you think constitutional reform of the WHO is needed, and what
would you like to see changed?
The writers of the original constitution were far sighted and
forward looking. However, a careful review of the constitution
is an essential part of the reform process. The constitution should
reflect the new and changing world.. For example, there are now
many more players in international health than when the WHO was
established. Any change will require a broad consensus and comprehensive
ratification procedures. Therefore, changes in the constitution
must be seen in a longer term perspective. In the shorter term,
one must continue improving the functioning of the WHO within
the framework of the existing constitution.
How should the WHO respond to the current domination of international
health by the World Bank?
I believe that the World Bank would welcome a stronger role by
the WHO. The bank as well as the WHO should be at the service
of countries and work together with them. During my travels to
most parts of the world, including many developing countries,
I got the clear impression that the WHO and the World Bank are
perceived to have defined and different roles. I perceive an emerging
willingness to work towards common goals and would be looking
forward to strengthening the WHO's relations with the World Bank.
The bank's interest in international health is a great asset.
Each organisation should respond to needs by doing what it does
best. But we can coordinate our efforts even better based on the
traditional division of work, where the WHO provides expertise.
Over the past 10 years, the WHO has suffered a collapse of international
prestige and internal morale. How would you restore faith in the
WHO?
Transparency and accountability are important foundations for
confidence. The WHO commands a lot of knowledge and talent and
is capable of mobilising international expertise. I would bring
my own experience of leading the government of Norway for more
than 10 years, and all of my international political experience,
not least from chairing the World Commission on Environment and
Development. Those who have worked with me, nationally and internationally,
know that I work in a frank, open, and inclusive manner. I am
also used to working under the scrutiny of a free and critical
press. Yet, building faith in the WHO is also a task for its member
countries. We need to find ways to clarify mutual expectations
and then stand accountable to each other for what we have agreed
to do.
Why are you the best person for the job?
I believe that I can make a contribution on the basis of my background
and experience in national and international cooperative efforts.
I have been asked by people from all regions to seek this office.
I decided this spring to do so with the best of my commitment
and compassion. But I am a "we" person, not an "I" person. I have
always worked together with other people, in a team, and this
is what I intend to do, to lead an international team in the interest
of world health.
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