Who will be WHO's next leader? Choice critical to global health

Dr. Gro Harlem Brundtland's decision not to run for another term has international health experts worried about the future scope of the organization.

By Victoria Stagg Elliott, AMNews staff. Jan. 20, 2003. Additional information

When the executive board of the World Health Organization gathers in Geneva Jan. 20-28, they will face an important challenge: picking the organization's next director-general.

Dr. Gro Harlem Brundtland, widely credited for transforming the organization from a place where "ideas go to die" into an influential player in global efforts to improve the health of people in developing nations, announced in August 2002 that she would not seek reelection to WHO's top spot.

"There were quite a few folks who would have liked to see her continue," said Ann Marie Kimball, MD, MPH, professor of epidemiology and health services at the University of Washington in Seattle. "And that's really quite a compliment for [someone in] such a difficult, political job," added Dr. Kimball, who was a Fulbright scholar at the organization's headquarters this past summer.

Governments scrambled to come up with nominees with the combination of health experience and political savvy. Of the nine who made the candidate list announced in November 2002, all are physicians. In addition, nearly all have been ministers or secretaries of health in their home countries. And most would follow Dr. Brundtland's path as an outsider. Only Dr. Jong-Wook Lee, MPH, who ran the organization's Stop TB program, is viewed as a WHO insider.

Most experts also expect that it may be the less-developed world's turn to lead an organization that has so much sway in their countries. Most previous WHO leaders have been from the developed world.

This time, though, only one candidate is -- Dr. Peter Piot of Belgium.

9 candidates vie to become director-general of WHO.

There is a feeling that the important consideration is not so much where a candidate is from, but whether he or she has the ability to balance the concerns of all member states.

"The characteristics of a WHO director-general who will be really successful would be an ability to be extremely inclusive in their leadership of the organization, no matter what region they come from," said Dr. Kimball. "It really is a global job."

The election is also being viewed as pivotal because of its timing. WHO rose to prominence through a combination of Dr. Brundtland's leadership and the recognition by other international organizations and foreign policy experts that health is an important consideration in developing nations. International organizations have also become much more important in the age of globalization.

"Global events and specifically the globalization of health concerns have created a general appreciation for the central nature of human health, and WHO is basically the only game in town," said Dr. Kimball.

Important issues for the future

But debate over the future of the organization and its leadership has been raging in the international medical journal, The Lancet. Global health experts are concerned that too much of the WHO budget goes to support its head offices in Geneva and that the emergence of large, privately funded global health-oriented foundations may eclipse its function.

Dr. Brundtland also pioneered many public-private partnerships WHO now benefits from, but there are concerns that private-sector interests may overwhelm the work for the public good. Much has been accomplished in regard to the effects of chronic conditions and environmental influences on health, such as smoking, but some experts worry that this progress could be overshadowed by the private sector's emphasis on infectious diseases.

"Chronic disease and infectious disease are of equal importance to all parts of the world," said Norbert Hirschhorn, MD, public health and preventive medicine specialist and consultant to WHO's tobacco-control program. "The WHO is not simply an organization for very poor countries and children's diarrhea, but there are commercial interests that would like to see the WHO not be engaged in disease control that affects their industries. For example tobacco, fast food."

The 32-member executive body will make its recommendation at the end of January. The candidate it selects will then likely be endorsed by the full World Health Assembly in May.

ADDITIONAL INFORMATION:

WHO could be next

Dr. Awa Marie Coll-Seck, Senegal, minister for health and prevention
Dr. Djamil Fareed, Mauritius, adviser to the minister of health and quality of life
Dr. Karam Karam, Lebanon, minister of tourism and alternate minister of health
Dr. Jong-Wook Lee, MPH, South Korea, director of WHO's Stop TB program
Dr. Pascoal Mocumbi, Mozambique, prime minister
Dr. Julio Frenk Mora, PhD, MPH, Mexico, secretary of health
Dr. Peter Piot, Belgium, UNAIDS executive director and under secretary-general of the United Nations
Dr. Ismail Sallam, Egypt, former minister of health and population
Dr. Joseph Williams, MPH, Cook Islands, former prime minister

Source: The Lancet, Nov. 30, 2002

Weblink

Coverage of the WHO director-general election in The Lancet (http://www.thelancet.com/journal/vol360/iss9349/who_director_general_election/)

WHO office of the director-general (http://www.who.int/dg/)

Live webcast of the WHO Director General Candidate Public Discussion Forum, scheduled for Jan. 19, with archived versions available thereafter, from the Kaiser Family Foundation (http://www.kaisernetwork.org/healthcast/who/19jan03)

HEALTH & SCIENCE