Intended for healthcare professionals

Letters World Health Organization

Time to turn the tide: WHO’s engagement with non-state actors and the politics of stakeholder governance and conflicts of interest

BMJ 2014; 348 doi: (Published 19 May 2014) Cite this as: BMJ 2014;348:g3351
  1. Judith Richter, freelance researcher and associate senior research fellow1
  1. 1Institute of Biomedical Ethics, Centre for Ethics of the University of Zurich, CH-8032 Zürich, Switzerland
  1. judith.richter{at}

I am deeply concerned that WHO’s so called reform will sideline those who work in the spirit of “health for all” and expand the influence of business corporations and venture philanthropies over global public health matters, as well as reinforce the trend towards fragmented, plutocratic, global governance.

Three years ago, international non-governmental organisations highlighted the problematic link between the WHO director general’s suggestion to re-fill WHO’s coffers with funds from business and big philanthropies and the sudden introduction of an ambitious agenda for WHO reform, which proposed to include these funders in the shaping of health policies.1 2

Ten days before the 2014 World Health Assembly, the WHO secretariat issued the latest version of its policy “Framework on engagement of non-state actors (A67/6).” There are still widely diverging opinions on the appropriateness of this crucial policy framework.3 To resolve this stalemate we need answers to the following questions:

  • Why must WHO, and all of us, enter into closer relations with corporations as indispensable “stakeholders” in decision making processes?

  • Why must we ignore the blurring of the nature and roles of actors through terms such as “stakeholders” and “non-state actors?”

  • Why do member states find it acceptable that an international public agency can be funded by corporate donors?

  • What action can member states take to increase their core contributions to WHO?

  • When will WHO finally work on the establishment of a genuine institutional conflict of interest policy with accurate definitions and effective procedures?

Without reopening the debate on the premises underlying the reform, WHO’s reform risks continuing to follow a path charted out by the World Economic Forum’s Global Redesign Initiative: a system of stakeholder governance with corporations being the key stakeholders in all kinds of decision making forums; where broad issues can be turned into vertical multi-stakeholder initiatives implemented through market led approaches (such as the post-2015 millennium development goals); and where key global public issues can be removed from UN agencies’ agendas whenever they risk resulting in policies or regulations “unfriendly” to profit maximisation.4 5


Cite this as: BMJ 2014;348:g3351