Health: WHO DG-elect faces herculean task on "Health as Rights issue"

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 quoted.

[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 ideas. SUNS].

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 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," 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 development".

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 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 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 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.

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 countries."

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 regime.

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 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 neo-liberal economic priorities - without an intervention from the WHO.

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.

By D. Ravi Kanth.

Source: SUNS - South North Development Monitor, SUNS #8471 Tuesday 30 May 2017.