BMJ  2003;327 (30 August), doi:10.1136/bmj.327.7413.0-f

Editor's choice

Champions and betrayers of public health

The World Health Organization has spent much of this year in limbo waiting for its new director general to take office. Even so it has managed three surprises. Gro Harlem Brundtland's decision to decline a second term was followed by the unexpected election of Jong-Wook Lee when all eyes were on an African succession. And WHO's quick and determined response to SARS was almost as unpredictable as the outbreak itself.

Lee took charge in July and immediately introduced a team of management consultants. Brundtland may have raised WHO's profile and its credibility, but she didn't do enough for staff morale or for relations between headquarters and the regions. Many felt downtrodden and disillusioned by incessant change. Brundtland began with goodwill from within and without, and Lee was close enough to the regime—as head of WHO's Stop TB programme— to see Brundtland's weaknesses and witness how that internal support withered.

Lee, entrenched in WHO's culture, has an advantage in keeping the organisation behind him, but the question is whether it is possible, in management consultant speak, to keep all stakeholders—staff, regions, member states, private and public partners—bought in and on message. At the very least, Lee must be careful not to repeat the mistakes of the past, and setting over ambitious targets (p 466) and reviving Health for All may do just that.

Fiona Fleck's profile of Lee—now the most high profile public health doctor—highlights disparities between the perception of him as a circumspect leader and the inside view of him as a fixer (p 468). Which impression of Lee is nearer the truth remains to be seen—perhaps he is both. And then there are those management consultants. "Cynics say that a consultant borrows your watch and then tells you the time," says Lee. "But maybe from time to time we don't know what time it is, and it is nice to be reminded."

One of Brundtland's triumphs was the framework convention on tobacco control, which was adopted—along with Lee—by the World Health Assembly in May. The BMJ is also "passionately antitobacco," although many readers thought otherwise when we published a paper by James Enstrom and Geoffrey Kabat, which implied that the risk from passive smoking had been overestimated. We received over 140 responses, many accusing us of being hoodwinked by tobacco money and publishing bad science (p 501). Many respondents were angry at the BMJ for betraying public health and doubly cross at the "tabloid" cover on that week's journal and the "sensational" press release. Unusually, this week's letters section comprises solely responses to that particular article, including an explanation of our decision to publish and our policy on tobacco funded research (p 505).

(kabbasi{at}bmj.com)

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