WHO under siege from private sector
Reflecting on the growing public concern about the World Health Organisation's linkages with the corporate world, Tom Fawthrop wonders whether world health policy is in danger of falling into the clutches of the unelected gnomes of Davos.
IT was symbolic of the crisis facing the United Nations' World Health Organisation that billionaire Bill Gates, the Chairman of Microsoft, was the special guest speaker addressing last year's World Health Assembly (WHA) of WHO member states.
This followed from Gates' previous address at the 2005 edition of the WHA. Commenting on the then unprecedented invitation extended to Gates to deliver a keynote speech at the WHA, the People's Health Movement (PHM) viewed it as 'part of an alarming trend of various UN organisations, including WHO, kowtowing to global multinational corporations under the guise of the "Global Compact" and so-called "Public-Private Partnerships"'.
'It is time to either declare Microsoft a WHO member country, or stop the shameful promotion of global corporations at important UN meetings,' said a PHM spokesperson.
The membership of the PHM is made up of doctors, public health specialists and health activists committed to the principles of free universal health systems.
While Gates was ostensibly invited to the 2011 WHA in his capacity as co-chair of the Bill & Melinda Gates Foundation, activist groups say that the line dividing his philanthropy from his links to pharmaceutical interests and his company's business strategy is very thin.
Many corporate giants have been adopted by WHO since 2010, as private sector partners working together for 'better global health'.
The origins of this public-private sector partnership process can be traced to WHO's chronic funding problems. Over 80% of its budget is based on emergency services and voluntary contributions, as opposed to compulsory financial commitments from member states.1
Hence, in the WHO search for extra resources, the private sector came up with the Global Fund to Fight AIDS, Tuberculosis and Malaria. The private-sector-funded Global Fund has emerged as a new player on the increasingly fragmented field of world health alongside the World Bank, the Gates Foundation, and other charities and non-governmental organisations (NGOs).
Australian health researcher David Legge points out: 'The reform proposals that [WHO Director-General] Margaret Chan took to the WHA in 2011 had clearly been discussed in advance with Bill Gates. They came up with a package that included an evaluation of WHO and a proposal for a "World Health Forum" to include drug companies, the development banks, and big foundations.'
Naturally Chan needed to reassure member states that WHO, in 'the interest of safeguarding public health', was 'not afraid to speak out against entities that are far richer, more powerful, and better connected politically than health will ever be', adding that 'we need to maintain vigilance against any real or perceived conflicts of interest'.
But the question is: have her actions in promoting public-private partnerships been at odds with her speeches on defending the basic mandate of WHO to promote the public health interest on the global stage?
Whatever the role of the Director-General, the private sector package presented by Chan has raised much concern among member states.
There is little doubt that Chan understands to some degree the conflict of interest posed by private sector forces ranged against the WHO commitment to public health systems, in contrast to their promotion of privatised healthcare. The principle of partnership with the private sector has created a dangerous blurring between dedication to public health on one side, and the ambivalent role of philanthropy and the private sector on the other. In the case of the private sector Chan seems to think that it can be wooed away from its role in profiting from global health problems and made to share the burden of funding solutions.
Nowhere was this contradiction more evident than at the UN General Assembly special meeting on non-communicable diseases (NCDs) held in New York in September.
The problems arising from WHO sharing the same bed with private corporations became very obvious during the meeting. That's because non-communicable diseases - such as heart disease, stroke, cancer, diabetes and emphysema - are deeply entangled with important global industries, not only tobacco but also food, pharmaceuticals, advertising, transportation and construction. And NCDs are the planet's biggest health problem, responsible for 63% of all deaths each year, with incidence growing steeply in the rapidly urbanising low-income nations of the world.
A Washington Post report queried: 'What is the responsibility of rich countries, and the pharmaceutical companies located in them, to improve medical care in poor countries, where 40% of deaths from non-communicable diseases occur before age 60?'
At a UN meeting in June billed as an opportunity for charities, NGOs and the public to voice their views on the outcome document of the September NCD summit, the tabled speakers included representatives of the International Federation of Pharmaceutical Manufacturers and Associations, the International Food and Beverage Alliance, and the World Federation of the Sporting Goods Industry.
Among those attending the September meeting itself on behalf of 'civil society' were industry representatives, according to the BMJ (British Medical Journal). The journal also reported that GlaxoSmithKline, Sanofi-Aventis and the Global Alcohol Consumers Group were included within the official US delegation. And one well-attended breakfast for conference delegates was hosted by PepsiCo.
Over 100 NGOs and medical groups signed a petition in July saying that there needed to be a code of conduct with industry, as there was a 'lack of clarity of roles for the industry sector in UN health policy setting and shaping'.
'Our position is that partnership isn't the right word. It implies trust and respect,' said Patti Rundall, who has helped run the campaign against the marketing of baby formula for the last 30 years. 'The allegiance of the food companies is to create profits. Their voluntary commitments are only good for as long as they want to keep them,' she said.
The Davos-inspired assault on WHO
During the 1980s the World Bank effectively sidelined WHO as the primary influence on health policies of governments of the South. The Bank's Structural Adjustment Programmes (SAPs) imposed major cuts to public health services. At the same time privatisation of healthcare was assiduously promoted.
Today key areas of public health and policymaking across the globe such as prevention of disease, strengthening public health systems and primary healthcare - the key terrain of WHO and the responsibilities of member states - are being coveted by private interest groups led by the new 'rulers of the world' known as the World Economic Forum.
It is all part of the WEF's Global Redesign Initiative to rebuild institutions and mechanisms of global governance, according to Garance Upham, a researcher on health issues.
Upham, who delivered a lecture at the International Association of Health Policy - Europe conference held in Ankara, Turkey last year, explained that the WEF advocates a new governance paradigm for dealing with global health issues which requires a drastic reform of WHO.
The WEF, which holds its high-profile annual meetings in Davos, Switzerland, argues that 'The model of development characterised by donors and recipients is dead ... In place we need to think about collective responsibility. A world where an increasing number of stakeholders should have a role in shaping and making policy is a given. Governance does not equal governments alone.'
Indeed WHO and public health is not only about governments. Other stakeholders are doctors, nurses, patients and communities, but these stakeholders are missing or marginalised in the Davos blueprint. The Davos-distorted definition of 'stakeholders' is clearly set out in the proposal to establish a World Health Forum, perhaps modelled on their very own WEF.
The Davos group is advocating that private donors to global health campaigns should enjoy more or less equal seating alongside WHO in formulating policymaking and supervising global health initiatives. All this is coming at a time of growing economic crisis, with many governments only too eager to cut back on health budgets and their contributions to WHO.
It perhaps comes as no surprise that, along with Tony Blair and Kofi Annan, Peter Brabeck, a former CEO and current Chairman of Nestle, is a board member of the WEF.
Upham argues that all this would downgrade WHO from its vital role in intervening to control epidemics, supervising international health standards and promoting primary healthcare, to a more humble role mediating between major donors to the Global Fund, private medical charities like the Gates Foundation and even certain drug companies.
Within this paradigm, 'health is an area in which entrepreneurship can flourish', according to a write-up on the WEF website. 'It is the mission of the Forum's Health team to galvanise business to take action in global health.'
A response to this comes from public health academic A Shukla, who writes: 'Private involvement carries large overhead costs and simply needs to deliver some form of profit. There is thus simply an insurmountable gap between public interest and private privilege. Only through putting pressure on the state will the excesses of the private sector in health be eventually done away with.'
It is clear that public-private partnerships are a dangerous path for any vulnerable UN agency to go down. A coalition of conflicting interests usually results in one partner swallowing the other or bullying it into submission.
A fundamental issue is at stake here: whether our world health policy is in the hands of health professionals, health ministries and grassroots NGOs, or falls into the clutches of the unelected gnomes of Davos and their business blueprints for ever greater control over the vital sector of public health.
Tom Fawthrop is a journalist and filmmaker who attended the first People's Health Assembly - the founding conference of the People's Health Movement - in 2000 and also participated in the second People's Health Assembly in 2005. He is the director of Swimming Against the Tide, a documentary on the Cuban health system. DVDs are available from Eurekafilmsdocos@gmail.com.
*Third World Resurgence No. 257/258, January/February 2012, pp 2-4