A New Leader for a New World Health

Monday, 7th of November 2016

These USAID authors make the remarkable statement that "In 1948, an outbreak of cholera in Egypt left more than 10 000 people dead and convinced the world of the need to establish the World Health Organization (WHO)."

Since WHO was constituted in 1946, one is at a loss to understand how its creation could have been triggered by an epidemic which took place two years later.

Accepted on: Aug 30, 2016

A New Leader for a New World Health

Ariel Pablos-Mendez, MD, MPH, and Susanna Baker, MPA

Ariel Pablos-Mendez and Susanna Baker are with the Bureau of Global Health, US Agency for International Development, Washington, DC.

Correspondence should be send to Susanna Baker, US Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523 (e-mail: sbaker@usaid.gov). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

CONTRIBUTORS

A. Pablos-Mendez conceptualized the piece and wrote key sections of the editorial. S. Baker wrote and managed various drafts of the editorial.

In 1948, an outbreak of cholera in Egypt left more than 10 000 people dead and convinced the world of the need to establish the World Health Organization (WHO). A more recent outbreak of Ebola in West Africa compelled the WHO and its member states to reexamine how the organization could be more effective and responsive to future public health threats.

As the preeminent United Nations agency dedicated to health, the WHO has a critical role to play in defining and promoting public health in this more interconnected world. Throughout history, the WHO has led bold visions, such as the “health for all” declaration at Alma Ata, and has delivered remarkable public health achievements, such as the eradication of smallpox. This is why the next director-general must be someone fit to take on the task of implementing the ambitious and necessary reforms begun by the current director-general, Margaret Chan.

Evaluations following the Ebola crisis found that fragmentation of authorities and resources slowed the WHO´s response. These evaluations resulted in a new Health Emergencies Program that builds on the WHO´s technical, normative, and capacity-building roles. Endorsed by the World Health Assembly in May 2016, the new program seeks to bring speed and predictability to the WHO´s emergency work by establishing one clear line of authority, one workforce, one budget, one set of rules and processes, and one set of standard performance metrics. This new program is highly relevant to the selection of the next director-general. He or she will need to spearhead the WHO reform and follow through with its historical commitment.

In 2000, the United Nations inspired the global community by setting the millennium development goals (MDGs), eight ambitious international development goals with three focused on health. The health goals included reducing child mortality, improving maternal health, and combating HIV, malaria, and other diseases. At the date set for achieving the MDG´s in 2015 great progress had been made in reaching these goals. Encouraged by the impact of the MDGs, the United Nations and the global community expanded the scope of the MDGs by creating the sustainable development goals, which included 13 health targets. To address the sustainable development goals, the WHO needs to be an effective guardian of global health security, must provide guidance to prevent and control the growing wave of noncommunicable diseases and injury, and must be a source of technical assistance as countries move toward universal health coverage for their citizens. This agenda requires the next director-general to be someone who has the right mix of inspiring leadership, sound management, public health experience, and diplomatic skills, which are key to the success of the WHO in the 21st century.

The next director-general will lead a transformed organization that will advance global health and build on reforms to strengthen its critical role in the world. Evidence must inform key decisions, and scientific expertise should be tapped not only in Geneva, Switzerland, but around the world. The WHO needs a strong and strategic leader with country-level health experience and a deep understanding of the workings of international organizations. The candidate must be committed to principles of sound management, efficiency, accountability, transparency, and results-based performance. Boosting member states´ confidence in the WHO is a precondition for much needed increases in the assessed contributions to the regular budget of the organization.

The next director-general must have a broad knowledge of public health programming and a commitment to evidence-based approaches. It is essential that current and future threats be tackled while remaining faithful to WHO founding principles, including equitable access to quality health care, with a particular focus on the poor, women, and other vulnerable and neglected groups. Last, but not least, the future director-general should have strong communication skills to help bridge the differences among member states and other key actors in health.

The pendulum of history is swinging faster than ever. The WHO went from a public health agency in a post–World War II world dominated by colonization to an agency working with newly independent but poor member states that inspired the primary health care movement in the 1970s. In the 1990s, the health sector saw a proliferation of top-down public–private partnerships and a dramatic increase in the number of nongovernmental organizations. Now the WHO operates in a new world, with mixed health systems, a multitude of actors, and a focus on universal health coverage through domestic resource mobilization. In this new scenario, the WHO´s role and leadership are more important than ever as we face new public health challenges in an increasingly complex world.

ACKNOWLEDGMENTS

The authors thank Ann Blackwood at the US Department of State for her early inputs to the editorial.

American Journal of Public Health®