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2011 March blog

Claudio Schuftan

Here is a picture of my dear friend and colleague Dr Ravi Narayan of the Centre for Public Health and Equity, Bangalore. Beginning in 2003, he was the second global secretary of the People's Health Movement (PHM) which, during his years in the post, started to monitor the activities of the World Health Organization and other relevant UN agencies. (For the PHM's comments on the appointment of Ann Veneman as executive director of UNICEF, marshalled by Ravi when he was PHM's global secretary, see the lead news story on the Association's website this month). A central criticism of WHO has been that, for many years, it abandoned its commitment to the primary health care approach in a number of areas, including nutrition.

PHM's People's Charter for Health calls on 'people of the world to demand a radical transformation of the World Health Organization, so that it responds to health challenges in a manner which benefits the poor, avoids vertical approaches, ensures intersectoral work, involves people's organisations views in WHO's annual World Health Assembly, and ensures independence from corporate interests'.

My column this month is drawn from successive People's Health Movement statements, agreed after extensive consultation. Ravi has always been involved in this work. Said statements have repeatedly criticised WHO for too strong a reliance on so-called 'public-private partnerships' with industry for a big part of its budget. This, despite a lack of objective evidence of the effectiveness of this approach in either improving public health and nutrition, or in improving access to care for those who happen to be poor. Despite real and active participation of civil society representatives in WHO's work being crucial, civil society initiatives designed to work with WHO have become increasingly sidelined. WHO's attitude has to change from lukewarm to committed and enthusiastic in this respect.



Margaret Chan, Director-General of WHO, speaking in Mexico on the topic
of prevention of obesity and chronic diseases, on 25 February 2011. Her point
is enjoyed by Mexican President Felipe Calderon, and his Health Minister.
Rates of obesity are rocketing in Mexico. One reason, as Mexican politicians
know, is unfair terms of trade with the US. These also increase poverty and
create destitution among Mexican farming communities

The World Health Organization, the UN agency most responsible for global health decision-making, has so far not fully lived up to the hope expressed in the heading above this section. WHO does not seem to be giving first priority to fairness and justice. To varying degrees, WHO and its leaders in the last decades have not succeeded in encouraging member states in many crucial ways. They have:

Following the money

Civil society organisations expect WHO to be the number one international advocate for their most cherished principles, values and approaches. These include the ethics of nutrition and of public health, equity, primary health care, community-based health care and nutrition, community participation and empowerment, use of appropriate technology, and intersectoral cooperation. Civil society organisations also look to WHO as the standard bearer on health and nutrition issues.

But now this role appears to have been usurped by other organisations, particularly the World Bank. WHO comes with technical advice, the World Bank comes with money; national governments usually prefer the money --despite the indebtedness involved.

Many non-governmental organisations have, from many years ago, formal relations with WHO and thus can have a voice at WHO meetings. Unfortunately these tend to be those that are relatively malleable, without a strong social consciousness. They usually do not actively lobby for agendas that more forcefully address the needs of the poor.

What WHO should do

Here is what the People's Health Movement thinks the World Health Organization should do. The list below is ambitious. Some may say that WHO can do only what its member states instruct it to do. Formally this is true, but WHO still has a duty to set rational and progressive agendas and to guide and help member states to address the social determinants of health, particularly in those countries with least resources. WHO thus should:



Above is what the immediately previous director-general of WHO,
Jong-Wook Lee, said in a meeting with the People's Health Movement
a few years back. He also said: 'It seems so strange for WHO staff,
in Geneva to be talking about poverty, destitution, misery and hunger,
paying 2 Swiss francs for a cup of coffee, while so many millions struggle
to survive and sustain their families on the equivalent of $US 1.25 a day'.

It is time now for WHO to take a new direction. It currently is moving in the wrong direction, towards its control by corporations. The call to the leaders of WHO, beginning with its current Director-General Dr Margaret Chan, is as follows: (Many more points can be added…)

Needed: attention to the people at the grassroots

As shown above in the heading to this section, in a meeting with the People's Health Movement, the immediately past director general of WHO, Jong-Wook Lee, who died when in office, made clear that he knew that people's movements need to be heard. He also said that 'WHO urgently needs to listen to the people and their movements have to say. Many of these organisations have for too long felt powerless. But by uniting forces, they have now reached a critical mass, in part through the People's Health Movement. WHO must now listen to voices from communities'. And he was right.

Needed: new accountability and transparency
The mighty meet in conversation at the World Economic Forum, Davos,
28 January 2011. Left to right: Josette Sheeran, head of the World Food
Programme; Melinda Gates of the Gates Foundation (on-screen);
Margaret Chan of WHO; Bono, the pop star and champion of 'Make
Poverty History'; Muhtar Kent, CEO of Coca-Cola; and Lars Sorensen,
CEO of Nordisk. They hear one another. Are they listening to the people?

Today, WHO's accountability is no longer mainly owed to national governments, who in the UN context are preoccupied with their own status, the trading of favours, and continental rotations of top posts, including that of the director-general. Accountability is primarily owed to the people, legitimately represented by civil society organisations. We in civil society now should demand an open dialogue, to discuss WHO's policies and programmes in all its areas, including public health nutrition.

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. Hundreds of millions of people across the world... [Column] Website of the World Public Health Nutrition Association, March 2011. Obtainable at

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon.

20111 March blog: Claudio Schuftan

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