Education And Debate

WHO in retreat: is it losing its influence?

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6967.1491 (Published 03 December 1994) Cite this as: BMJ 1994;309:1491
  1. Fiona Godlee, assistant editora
  1. a British Medical Journal, London WC1H 9JR
  1. Correspondence to: Department of Ambulatory Care and Prevention, Harvard Medical School, 126 Brookline Avenue, Boston, MA 02215, USA.

    WHO says it has three main functions: to set normative standards; to provide technical advice and assistance on medical matters; and to advocate changes in health policy. During its 46 year history the first two functions have been a constant and uncontroversial backbone through which WHO has earned its reputation for scientific excellence. The third function, advocacy, came to the fore with the launch of Health for All in 1977, after which WHO took a key role in influencing international health policy. WHO's friends and critics alike now say that the organisation is losing its influence and retreating into its technical and biomedical shell. This article maps the changes in WHO's approach over the past 46 years and considers whether fears about its loss of influence are justified.

    This is the second in a series examining the role of the World Health Organisation, its current problems, and its future prospects

    WHO's first 25 years were, as Dr Gill Walt of the London School of Hygiene and Tropical Medicine describes, characterised by caution and stability.1 Between 1948 and 1973 the organisation had only two directors general, and its technical role as a specialist agency for health spared it the political conflicts that were wracking the rest of the United Nations. Dominated by doctors, WHO took an approach to health that was largely disease oriented, and it studiously avoided political or cultural controversy. In 1952 it decided not to undertake a population programme because of the religious and political implications. Fifteen years later, when concern over population growth was heightening, WHO softened this decision, saying that it would give technical advice on family planning but only on request from member states.

    From technical consensus to political controversy

    WHO's policy of sticking to uncontroversial medical matters was reaffirmed in the late 1960s. By this time the organisation's membership …

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