WHO DG-elect faces herculean task on “health as rights issue”

For the incoming head of the World Health Organization, realizing his stated goal of universal health coverage will be fraught with challenges, not least of which is that posed by the dominance of neoliberal economic policies.

by D. Ravi Kanth

GENEVA: As climate change and neoliberal economic policies wreak havoc by increasing the disease burden in the poorest and developing countries, the newly elected Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus from Ethiopia, faces a herculean task of working on his declared basis that “health is a rights issue” and “an end in itself.”

On 23 May, Tedros, a malaria expert, secured the distinction of being the first African candidate to be elected to WHO’s top job. He is also the first Director-General elected democratically through a secret ballot.

Effectively, his election brought about a paradigm shift by discarding the previous non-democratic approach of WHO’s Executive Board of 34 countries choosing the Director-General. Until now, candidates from developed countries made it to WHO’s top job because of the manner in which the Executive Board was manipulated, according to a health ministry official from a developing country who asked not to be quoted.

(Not all earlier Directors-General from developed countries, however, turned out to be reflective of or hew to the North’s agenda. Halfdan Mahler, a Dane who served as WHO head from 1973-88, proved exceptionally to be concerned with pushing for public health solutions to the problems of developing countries, as in his pioneering approach reflected in WHO’s 1978 Alma-Ata Declaration which emphasized primary health care as the key to securing “health for all by the year 2000” – a focus and target that his successors abandoned in favour of the traditional approach to medical care. Mahler brought to his post all his earlier experience as a doctor working in a missionary hospital in India, and with great diplomatic and political skill made Western industrialized societies accept and promote his ideas. – SUNS)

Universal health coverage

In his press conference after being declared the new Director-General, Tedros made significant remarks on how he intends to take up his new assignment. He declared that “health is a rights issue” and “an end in itself”. This is perhaps a landmark pronouncement, rarely heard from his predecessors.

At a time when more than 3 billion people in the world are denied “access to healthcare and universal health coverage,” Tedros has boldly admitted that the goals set out in the WHO Constitution (which entered into force in 1948), the Alma-Ata Declaration and the Sustainable Development Goals are relevant and valid today.

“But still, half of our population doesn’t have access to healthcare and universal health coverage,” he lamented. “I think it’s time to walk the talk, and the world is asking for that.”

The new Director-General says health ought to be “a means to development”. This is an argument advanced by the Nobel economics laureate Amartya Sen in a keynote address to WHO in 1999. In his lecture on “health in development,” Sen famously said that “good health is an integral part of good development” and “given other things, good health and economic prosperity tend to support each other.”

Sen maintained that “the enhancement of good health can be helped by a variety of actions, including public policies (such as the provision of epidemiological services and medical care).”

“Growth-mediated enhancement of health achievement goes well beyond mere expansion of the rate of economic growth,” Sen argued. “Even when an economy is poor, major health improvements can be achieved through using the available resources in a socially productive way,” he pointed out.

“Financial conservatism should be the nightmare of the militarist, not of the doctor, or the schoolteacher, or the hospital nurse,” Sen maintained.

It is therefore significant that Tedros has driven a strong message that “health is a means to development [and] it’s not actually a waste – it’s the smartest thing to invest in.”

“And wherever I have been travelling, that was very visible, and that’s why I said yesterday, all roads should lead to universal health coverage and it should be the centre of gravity of our movement,” Tedros emphasized.

He further clarified that what he means by “universal health coverage” is that governments must address the “financial barrier” and challenges facing “access to [affordable] drugs.”

Tedros said governments must address “the barriers to equality, access to quality of care and diagnosis.”

More important, “universal health coverage should be at the centre to address these barriers,” the Director-General-elect pointed out.

He said that universal health coverage will not appear the same across all countries, stating that there would be tremendous “diversity” as “some countries want to use private services to achieve universal health coverage [while] others use public services only [without commercializing basic health care].”

He mentioned that there are countries that use “a mix of private and public”; some countries use “general tax, others use insurance.” Therefore, “there is no one way or one means of achieving universal health coverage,” he argued.

Tedros suggested that “based on a country’s situation, different ways of achieving universal health coverage” are possible.

Without imposing a one-size-fits-all approach, “we need to have a consensus and agree health is a rights issue” regardless of the “means” that are adopted for achieving that goal.

“But we have to agree that health is a rights issue, an end in itself,” he repeatedly emphasized, suggesting that “universal health coverage should be at the centre, and it has to be tailored to the needs of the countries.”

Given the realities on the ground since the late 1980s when governments in the developing and poorest countries were forced to embrace neoliberal economic policies under pressure from multilateral financial and trade organizations, investments in the health sector, particularly for primary health care and universal health coverage, have come down dramatically.

Moreover, access to affordable medicines for tackling major diseases such as tuberculosis, cancer, HIV/AIDS and several non-communicable diseases has become a nightmare in both developed and developing countries because of the pharmaceutical patent regime. Even though governments can take recourse to compulsory licensing provisions, they were unable to use them because of coercion and pressure from Washington, according to several studies.

Against this backdrop, the South-North Development Monitor (SUNS) asked Tedros whether his emphasis on “health as a rights issue” is achievable when governments are driven by neoliberal economic policies that are contributing to dramatic cuts in investments for the health sector.

He was asked to clarify whether it would be appropriate to leave the policies to be followed for universal health coverage to governments which are increasingly influenced by neoliberal economic priorities – without an intervention from WHO.

Tedros acknowledged that it’s “a very important question” and argued, “If we [WHO] are going to ask commitment from countries, the commitment should be to the goals.”

“As long as we agree on the goal for achieving universal health coverage, the means could be private, public, or a mix,” he maintained. “There are countries who have very robust private, and who have achieved better outcome in terms of universal health coverage.”

“So that’s why WHO should be advocate for the outcome, rather than the means,” Tedros argued, suggesting that “there are many ways of really achieving universal healthcare.”

“Then on the public health investment, there are public health issues that the government should actually be responsible for [and] everything cannot be in the private hands,” Tedros said.

“If you’re talking about those, then of course WHO should really advocate for some of the public health areas or interventions to be entirely done by the government itself, so we have to differentiate the two, so we can do both,” he said.

In crux, Tedros faces a gigantic task in the coming months and years to advance policies within WHO as well as influence governments for pursuing universal health coverage initiatives, according to health officials and experts from developing countries. (SUNS8471)      

Third World Economics, Issue No. 639, 16-30 April 2017, pp6-7