Changing sides

doi:10.1136/bmj.318.7187.865

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Kamran Abbasi, assistant editor (kabbasi@bmj.com)

BMJ, London WC1H 9JR

Editorial 822)

This the first in a series of six articles examining the World Bank's role in international health

“Masters of illusion” is how science writer Catherine Caulfield describes the World Bank, and she writes: “There is much truth in the saying that development is largely a matter of poor people in rich countries giving money to rich people in poor countries.”1 The bank has been highly criticised and has many staunch opponents, but in recent years its public image has softened, and it has become a powerful player in international health.

Summary points

The World Bank's aim is to reduce poverty by investing in people

The past decade has seen it change image from uncaring bully to compassionate stakeholder, focusing on health

It has displaced the World Health Organisation as the major influence behind health policy in poor countries because of its greater funding power

Critics argue that the World Bank and International Monetary Fund increase the debt burden of those countries least able to pay, and that debt relief would be the best way to eradicate poverty

Methods

For these articles, which attempt a critical portrayal of the bank, I visited its headquarters in Washington, DC, and interviewed leading policy makers, including the former director of the health, nutrition, and population sector, Richard Feacham, as well as the World Bank's vice president for Africa, Callisto Modavo. I interviewed bank employees and visited bank projects in Bangladesh, India, and Pakistan, where my fluency in the local language was invaluable in speaking with politicians, civil servants, health workers, representatives of non-governmental organisations, journalists, and patients. I carried out a Medline search for articles under the heading “World Bank,” and read a wide selection of World Bank and government documents, from public policy documents to country reports.