Feature Health Policy

What will a doctor bring to the World Bank?

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2921 (Published 26 April 2012) Cite this as: BMJ 2012;344:e2921
  1. Bob Roehr, freelance journalist
  1. 1Washington, DC
  1. BobRoehr{at}aol.com

A popular public health doctor has been appointed to the hotly contested position of president of the World Bank. Bob Roehr looks at his credentials and what is expected of him

Jim Yong Kim, announced last week as the new president of the World Bank, is the first doctor to lead the large development agency. While it continues the hegemony of an American at the head of the nearly 60 year old organisation, in many other ways it represents an important change from what has gone before.

“The World Bank is more than just a bank. It’s one of the most powerful tools we have to reduce poverty and raise standards of living in some of the poorest countries on the planet,” said US president, Barack Obama. “Nobody is more qualified to carry out that mission than Dr Jim Kim.”

Kim, 52, was born in South Korea and came to the US with his parents at the age of 5, growing up in the middle of the country in Iowa. A graduate of Brown University, he earned both a medical degree and a PhD in anthropology from Harvard University. He taught at the Harvard Medical School and School of Public Health before becoming president of prestigious Dartmouth College in 2009. He was elected to the US Institute of Medicine in 2004.

Much of Kim’s career has focused on diseases of the developing world. He created a model programme to treat drug resistant tuberculosis in Peru. And he coordinated the HIV/AIDS programme at the World Health Organization during a campaign to ramp up access to antiretroviral drugs.

Kim cofounded the non-profit organisation Partners in Health with Paul Farmer and other Harvard colleagues. The organisation pioneered delivery of advanced healthcare to impoverished, rural communities in the developing world, such as Haiti, by working with local residents and officials.

Kim was the operational brains of Partners in Health, which has now grown to 13 000 employees worldwide. “He’s sort of a natural executive in a certain way that Paul Farmer is not. Farmer is a saint and a visionary. But Jim could see the vision and turn it into action,” is how surgeon and public scholar Atul Gawande described it to Washington Post columnist and blogger Ezra Klein.

Kim may be driven, but he is not rigid. He is amicable, does not take himself too seriously, and is remarkably willing to adapt to his environment—an extreme example being the rap video he made at Dartmouth as one way of connecting with its students.

Contested election

Kim was a late entry into the race to become president of the World Bank. Two candidates had already come forward, the Nigerian finance minister Ngozi Okonjo-Iweala, who had served as the bank’s managing director, and former Columbian finance minister Jose Antonio Ocampo. Both have fine credentials in the developing and middle income world.

This first contested election was a challenge to the tradition that reserved the bank presidency for an American while its sister organisation, the International Monetary Fund, is headed by a European. The US is the largest shareholder in the bank and voting power is allotted by contribution.

But Kim’s résumé, coupled with a whirlwind tour of global capitals, quickly lined up support from Japan, Russia, Mexico, and other major players. “I am not a politician. I come to this as a development expert,” Kim said at his last stop in Peru. “I am very eager to have a discussion about increasing the voice of developing nations.”

The bank formally announced his selection on 16 April without any details on how the 25 member governing board voted. In June, Kim will assume leadership of the bank and its affiliates.

Health and development

“Health is now seen as essential to development strategies,” part of the investment in human capital, said Andy Haines, a professor at the London School of Hygiene and Tropical Medicine. Twenty years ago health expenditures were deemed to be a drag on growth that should be deferred.

But Haines believes health has remained “a little bit of a side issue at the bank.” He called Kim’s selection “a real acknowledgement that health is now centre stage. [It is] a tremendous opportunity for Jim to ensure that the bank puts human health and welfare at the centre of development, and not just economic growth.”

“The bank is not doing a terrible job on health, but it is not doing as good a job as it needs to be doing,” said Katie Malouf Bous a policy adviser on education and health in the Washington office of the international development organisation Oxfam.

She noted that Kim has worked in very fragile states and experienced first hand the multidimensional complexities of poverty, with health often at its centre. “He has been an activist working for change in those difficult and unstable situations. I don’t think you can beat that kind of first hand experience.”

Bous hopes that Kim’s appointment will give health concerns “a shot in the arm” and help cut through some of the layers of bureaucracy at the bank.

“Our priority is to see the bank move more proactively in removing user fees” as an element of financing healthcare, said Oxfam policy adviser Elizabeth Stuart. While the bank has agreed to this in principle, it often ignores it in practice.

“It needs to spend more time looking for solutions” and offer examples that are tailored to the needs of individual countries. She said the bank’s series of case studies on education, and how user fees have been successfully removed, provides a good model of what should be done for health.

International AIDS activist Gregg Gonsalves called Kim “Outstanding. He has the potential to be transformative for millions of people living in poverty and sickness around the world and for those of us who care about human rights and social justice.”

Why the World Bank matters

  • What is commonly referred to as the World Bank is technically a handful of agencies whose primary focus has become helping developing countries through technical assistance, low interest or interest free loans, and grants

  • It works with governments, non-governmental organisations, and the private sector

  • Capital comes from assessments paid by wealthier nations, the repayment of loans, and agreements with charities such as the Bill and Melinda Gates Foundation

  • Kim faces at least three major challenges:

    • Maintaining the financial commitment of developed nations, which are in the midst of economic recession, slow recovery, and budgetary austerity

    • Integrating emerging economic powerhouses led by Brazil, Russia, India, and China into the financing and governance of the bank and its development activities

    • Shaping development strategies that are environmentally sound, sustainable, and embraced by the developing nations and their governments

  • These will affect progress towards meeting the millennium development goals and funding more focused activities such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria

Notes

Cite this as: BMJ 2012;344:e2921

Footnotes

  • Competing interests: The author has completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; not externally peer reviewed.