TWN Info Service on Health Issues (May17/05)
31 May 2017
Third World Network
WHO DG-elect faces herculean
task on "Health as Rights issue"
Published in SUNS #8471 dated 30 May 2017
Geneva, 29 May (D. Ravi Kanth) - As climate change and neo-liberal 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), Dr Tedros Adhanom Ghebreyesus from Ethiopia, faces a
herculean task in advancing his goal that "health is a rights issue"
and "an end in itself."
On Tuesday (23 May), Dr Tedros, a malaria expert, secured the distinction of
being the first African candidate to be elected to the WHO's top job. He is
also the first democratically-elected director-general through a secret ballot.
Effectively, his election brought a paradigm shift by discarding the
non-democratic approach of the WHO's Executive Board of 34 countries choosing
the director-general (as hitherto).
Until now, candidates from developed countries made it to the 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
[Not all earlier DGs, from developed countries, however, turned out to be
reflective of or toeing the North's agenda. Dr. Halfdan Mahler, a Dane, elected
in the 1970s, proved exceptionally to be concerned with, and pushing for public
health solutions to the problems of developing countries, as in his pioneering
approach in the Alma Ata declaration with emphasis on Primary Health Care to
secure Health for All by Year 2000 (a focus and target that his successors
abandoned in favour of the traditional approach of medical care). Mahler
brought to his post all his earlier experience as a doctor working in a
missionary hospital in Karnataka, India, and with great diplomatic and
political skill made western industrialised societies to accept and promote his
In his press conference after being declared as the new director-general, Dr
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 a perhaps landmark pronouncement, rarely heard
from his various predecessor directors-general of the WHO.
At a time when more than 3 billion people in the world are denied "access
to healthcare and universal health coverage," Dr Tedros has boldly
admitted that the goals - set out in the WHO Charter in 1948 by governments for
ensuring "Health for All", the 1978 Alma-Ata declaration on Primary
Health Care, and the 2015 Sustainable Development Goals - are relevant and
"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," Dr Tedros maintained, after
acknowledging that "health is a rights issue [and] an end in itself."
The new director-general says health ought to be "a means to
This is an argument advanced by the Nobel-Laureate in economics Amartya Sen in
his keynote address to the 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
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 Dr 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," Dr 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."
Dr 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 new director-general-elect pointed out.
He said the universal health care will not be same across all countries,
arguing 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
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.
Dr 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
Given the realities on the ground since late 1980s when governments in the
developing and poorest countries were forced to embrace neo-liberal 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, and several other non-communicable diseases has become a nightmare
in both developed and developing countries because of the pharmaceutical patent
Even though governments can take recourse to compulsory licence provisions,
they were unable to use them because of coercion and pressure from Washington,
according to several studies.
Against this backdrop, SUNS asked Tedros whether his emphasis on "health
as a right issue" is achievable when governments are driven by neo-liberal
economic policies that are contributing to dramatic cuts in investments for the
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 neo-liberal economic priorities - without an intervention from
Dr Tedros acknowledged that it's "a very important question", and
argued, "If we [WHO]'re 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," he said.
"So, that's why WHO should be advocate for the outcome, rather than the
means," Dr 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," Dr 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, Dr Tedros faces a gigantic task in the coming months and years for
advancing policies within the WHO as well as influencing governments for
pursuing universal health coverage initiatives, according to health officials
and experts from developing countries.