The World Health Organisation: WHO in Europe: does it have a role?

WHO is under pressure from all sides to justify its existence. Donors want to know what they are getting for their money, and health professionals question the relevance of the organisation's work. The pressure to justify itself is perhaps strongest of all in Europe, where most member countries have fully fledged health infrastructures and high overall levels of health. Now there is the additional threat of encroachment into the field of public health by the European Union. The disintegration of the Soviet bloc has given WHO's regional office in Europe a new sense of purpose and led to a major shift in resources towards the countries of central and eastern Europe. But WHO's critics are calling for a different shift in the way its European office works: from its current concentration on broad based policy issues to the nitty-gritty of health care management and delivery.

Article 129 of the Maastricht treaty of 1993 gives the European Union “competence” in the field of public health. With the union already funding medical research and taking an interest in disease prevention and data collection, article 129 raises questions about the future of WHO. What, people ask, does WHO do in Europe? Does it need the regional office in Copenhagen? Could there not be a small office within the Geneva headquarters responsible for collecting data, setting normative standards, and producing reports? A recent critical analysis of WHO's budgetary priorities points out that the European office has been allocated $56.6m for 1994–5, compared with $36.6m allocated to programmes dealing with tropical disease.1 The authors argue that European countries are competent to look after their own people and are already spending an average of $642 per person per year on health compared with about $9 in low income countries. Closing the European office would, they …