A new strategy is needed

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6979.597a (Published 04 March 1995) Cite this as: BMJ 1995;310:597
  1. Bo Stenson
  1. Senior fellow Karolinska Institutet, Department of International Health and Social Medicine, S-171 77 Stockholm, Sweden

    EDITOR,—Fiona Godlee is right: the World Health Organisation is in crisis.1 In the past it came to occupy a position of leadership in major global undertakings such as the eradication of smallpox, the work resulting in the code on breast milk substitutes, the programme on essential drugs, and the primary health care movement. It grasped the importance of these issues, brought its own resources to bear, and harnessed resources from the outside. It became the instrument by which the global community could agree on common goals and achieve collective action.

    But today's challenges are not being met in a similar manner. Health services are breaking down in many countries as a result of insufficient resources. Widespread privatisation programmes are jeopardising access to health care for poor people in developing and industrialised countries alike. The AIDS pandemic threatens to wipe out the progress with regard to health in many parts of the world. The World Bank, in particular through its report Investing in Health,2 is increasingly taking a leading role in health. Meanwhile, the WHO is occupied by trying to recycle its “health for all” strategy.

    The WHO must recapture its normative functions, including not only the obvious ones such as the setting of standards and classification of diseases but also the dissemination of information, advocacy for health, promotion of research, and, above all, its role as the global leader in health and health policy.3 4 But it needs also to redefine its role. The most important policy issue that faces it is the very notion of health. In its constitution “health” is the main concept. Yet “disease” has been the focus of action for all the 47 years of the WHO's existence. Medical knowledge has developed, and diagnostic and therapeutic tools have been refined to new technological heights. The WHO has taken as its role the application of this knowledge to specific disease problems.

    The time has come to make health and health development the main focus of interest. That would entail focusing more on the aetiology of health and the factors in our environment that are necessary for a healthy life than on pathogenic vectors. It would also mean an end to the medical monopoly on health. Other professionals, such as economists, anthropologists, sociologists, and health planners, would come into the forefront to join with the medical profession in the battle for health.

    Doing the right things has to be accompanied by measures to improve internal efficiency. The most urgent reforms in this regard are the strengthening of health policy and analytical functions at country level and the abolition of an obsolete regional structure.

    The member states of the WHO must now take the lead. It is up to them to define and implement a new strategy in the battle for world health. If they succeed it will also mean the survival of the WHO.


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