The WHO: change or die

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6979.543 (Published 04 March 1995) Cite this as: BMJ 1995;310:543
  1. Richard Smith
  1. Editor BMJ London WC1H 9JR

    Reform must begin now but will depend on a new leader

    We need a worldwide body for health. Many health problems cannot be tackled by individual countries alone. Some problems—like infectious diseases, drug misuse, and the health consequences of climatic change—pay no attention to national boundaries. Disasters like those that have happened in Rwanda and Bosnia need a response that cannot be mounted by single countries. Many poor countries must tackle immense health problems with hopelessly limited resources, and they need good technical help and advice. And all countries, including rich ones, need international leadership on health that sets standards. Perhaps, for instance, an effective world body for health could help the United States respond to its dreadful health problems, which give many of its citizens Third World health standards.

    Unfortunately, we don't have an effective, efficient, responsive, well managed body to provide the world with leadership on health. What we have is the World Health Organisation, which—despite some spectacular successes in the past and some continuing successes now—is in poor shape. As Fiona Godlee has illustrated in her series that ends today (p 583), the WHO lacks effective leadership and is unclear about its mandate, direction, and priorities. In addition, it is overcentralised at headquarters and regions, top …

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