{"id":381282,"date":"2019-05-22T13:09:07","date_gmt":"2019-05-22T17:09:07","guid":{"rendered":"http:\/\/www.rochester.edu\/newscenter\/?p=381282"},"modified":"2025-10-20T19:32:20","modified_gmt":"2025-10-20T23:32:20","slug":"has-the-world-health-organization-measured-up-381282","status":"publish","type":"post","link":"https:\/\/www.rochester.edu\/newscenter\/has-the-world-health-organization-measured-up-381282\/","title":{"rendered":"Has the World Health Organization measured up?"},"content":{"rendered":"

\"coverFounded in 1948 in the aftermath of World War II, the\u00a0World Health Organization<\/a>\u00a0is a\u00a0specialized agency of the United Nations focused on international\u00a0public health. Headquartered in Geneva, Switzerland, it was specifically tasked with the lofty goal of ensuring the \u201chighest possible level of health\u201d by all peoples, regardless of race, political belief, religion, economic status, or social condition.<\/p>\n

Seventy years later\u2014has the WHO measured up? The reality is complicated, says Theodore Brown<\/a>, University of Rochester professor emeritus of history and public health sciences.<\/p>\n

A well-known expert on the history of US and international public health, Brown\u2019s research interests run the gamut from US health policy and politics, to the history of psychosomatic medicine, stress research, and biopsychosocial approaches to clinical practice.<\/p>\n

The struggle between \u2018verticalists\u2019 and \u2018horizontalists\u2019<\/strong><\/h3>\n

The constant undercurrent at the WHO has been a struggle in vision between two dueling camps: on one side the agency\u2019s \u201cverticalists\u201d who believe that the primary actions should be biomedically-based technical interventions\u2014and on the other side the \u201chorizontalists\u201d who believe that the role of international agencies is to help countries and areas build up their own health infrastructures, while getting local players involved in maintaining and preserving their populations\u2019 health.<\/p>\n

These two main perspectives essentially govern all of the agency\u2019s actions, explains Brown: The preamble to the WHO\u2019s constitution holds that diseases are caused and sustained socially and economically, requiring a broad societal response\u2014the view espoused by the \u201chorizontalists.\u201d However, the second, vertical perspective presumes that epidemic diseases are biomedical events that need technical interventions alone to tame them, such as better vaccines and improved technologies.<\/p>\n

\u201cThat\u2019s a battle that\u2019s been raging within international health for well over a century,\u201d says Brown, who had been the University\u2019s Charles E. and Dale L. Phelps Professor of Public Health and Policy for five years, before he retired in 2018.<\/p>\n

Brown set out with two co-authors\u2014Marcos Cueto<\/a>, a professor at the Casa de Oswaldo Cruz, a unit of Fiocruz, the main Brazilian biomedical institute, and the late Elizabeth Fee<\/a>, who was the senior historian at the National Library of Medicine\u2014to evaluate the successes and failures of critical WHO campaigns, among them eradication programs for malaria and smallpox, to today\u2019s continued struggles against Ebola.<\/p>\n

The result is The World Health Organization: A History<\/em><\/a>\u00a0(Cambridge University Press, 2019), a comprehensive look at how world politics\u2014including the dynamics of the Cold War in the early decades, and later the increasing involvement of governmental and private players\u2014have influenced and shaped the organization, its operations, and ultimately affected the fate of its mission.<\/p>\n

The problems with the vertical approach is that it\u2019s usually a top-down approach to public health that gives little consideration to the participation of the community, argues co-author Cueto. Often that means an overemphasis on technological solutions\u2014such as trying to find a \u201cgolden bullet\u201d like DDT for malaria\u2014instead of striking a balance between biomedical technology, and improving the living conditions, lifestyles and environment of poor communities.\u201d The problem, Cueto says, is that this vertical approach usually focuses on a specific\u2014often infectious\u2014 disease instead of a comprehensive attack on a series of diseases.<\/p>\n

Successes<\/strong><\/h3>\n

According to the authors, during its first decades, the United Nations\u2019 specialized health agency was the \u201cacknowledged international leader on matters of health and disease and was at the center of a global network of scientists, physicians, and health policy makers.\u201d During the second half of the 20th century, the WHO \u201cplayed a preeminent role in the political validation of international health as a field and helped shape the notion of technical health assistance for developing countries.\u201d<\/p>\n

\"Theodore
Theodore Brown<\/a>, University of Rochester professor emeritus of history and public health sciences, has co-authored a new comprehensive history of the World Health Organization, looking at how world politics have shaped the institution and its mission. (University of Rochester photo \/ Richard Baker)<\/figcaption><\/figure>\n

By 1980 the WHO could take substantial credit for ending smallpox, making it the first disease in human history to be eradicated. \u201cA shining moment of international cooperation,\u201d says Brown, who points out that that was no small feat during the Cold War. \u201cThe United States and the Soviet Union would still be bickering with one another about international treaties, nuclear weapons and chemical weapons, but somehow in the health domain they were able to work together.\u201d<\/p>\n

The organization also developed uniform metrics, methods, and measures to deal with international health crises and pandemics. The result were standardized interventions, the gathering of epidemiological intelligence, and the means to evaluate the efficacy of programs.<\/p>\n

Some of the most successful WHO programs led to access to essential drugs and antiretroviral treatment, childhood immunizations, and the control of tobacco use\u2014often through a vertical approach\u2014the three authors argue. The WHO also pushed for the development of basic, local health systems instead of centralized, top-down interventions\u2014following essentially the ideals of the \u201chorizontalists.\u201d<\/p>\n

But most importantly, argues Brown, was the agency\u2019s role in \u201carticulating a vision and creating high aspirational goals, which inspired lots and lots of people.\u201d The WHO\u2019s main goal\u2014health for all, including physical, mental and social wellbeing\u2014was regarded as a fundamental human right. The WHO\u2019s Alma-Ata Declaration in 1978<\/a>\u00a0(now Almaty, Kazakhstan) stands out to Brown as its finest hour because \u201cpeople perceived that there really was a common human aspirational framework and set of principles for health.\u201d<\/p>\n

Failures<\/strong><\/h3>\n

The authors point to a shift at the end of the 1980s, when the agency increasingly came under widespread criticism from many sides\u2014health policy experts, international entities such as the World Bank, and specific countries\u2014for its inefficiency, lack of transparency, politicization, and ultimately irrelevance.<\/p>\n

University of Rochester professor emeritus of history, Theodore Brown, was invited to this year’s World Health Assembly meeting in Geneva to give a presentation about his new co-authored book at the United Nations Sustainable Development Goals Health Summit in May.<\/div>\n

A largely fair criticism\u2014agrees Brown. He argues that the WHO\u2019s both Geneva-based headquarters\u00a0and <\/em>regional structure\u2014\u201coften a bureaucratic nightmare\u201d that the US had insisted on at outset of the organization as a \u201cstring-pulling control mechanism\u201d\u2014impeded quick and decisive decision-making in crisis situations. That\u2019s one of the reasons for the delayed response to the Ebola epidemic, says Brown.<\/p>\n

Moreover, large donor countries, especially the United States, drastically cut contributions to the WHO amid squabbles over the agency\u2019s direction and policy priorities. As a result, it suffered a loss of financial capability and stature, increasingly competing with public and private organizations such as the World Bank and the Bill and Melinda Gates Foundation.<\/p>\n

Ultimately, one of the agency\u2019s largest failures, says Brown, was that it \u201callowed itself to become so politicized. I expected there to be political contamination or intrusion, but I didn\u2019t expect it to be so pervasive,\u201d he admits. Part of the reason was that the United States contributed an outsized portion of the agency\u2019s budget in its early years. That meant that US policymakers believed they were entitled to set policy, says Brown, pitting the US often directly against the Soviet Union.<\/p>\n

In later decades, a different set of funders began to assume a large role in the WHO\u2019s direction. Private and public donors brought both benefits and drawbacks, says Brown: \u201cYou gain resources, but you lose control and a coherent sense of governance in which those countries and people most in need of help and intervention have the least say in what these interventions should be.\u201d While these partnerships have helped reduce morbidity and mortality, they usually rely on short-term and ultimately limited strategies, write Brown and his co-authors. The loss of truly democratic decision-making marked an unfortunate return to the vertical approach that put technical expertise before local input, argue the authors.<\/p>\n

What role does the WHO play today? <\/strong><\/h3>\n

\u00a0<\/strong>Fast forward to the 2000s. There\u2019s been a surprising resurgence of the WHO, argues Brown. Since the mid-teens of the new century, the agency has regained a certain amount of authority and credibility\u2014among governments and private players alike\u2014very likely \u201cbecause the world of global health has become so chaotic, and there have been so many competing interests that even those with the big resources realized that there is no way of achieving any kind of uniform consensus about what programs should be initiated,\u201d says Brown. It seems, says Brown, that the \u201chorizontalist\u201d approach is gaining once again a stronger standing, even among the vertically-inclined private players. Essentially, the WHO has become a reinvented place for decision making and ultimately offering legitimacy for programs, Brown argues.<\/p>\n

There\u2019s reason to be optimistic, says Brown who favors the horizontal approach: the man who has been selected as the WHO\u2019s newest director general is the first African to hold that position\u2014Tedros Adhanom Ghebreyesus from Ethiopia<\/a>\u2014marking a conscious shift toward giving greater voice to local interests, away from the large economic and political powerhouses that have thus far largely shaped the organization\u2019s direction.<\/p>\n","protected":false},"excerpt":{"rendered":"

In a new history, Rochester professor emeritus Theodore Brown looks at how well the organization, founded in the aftermath of World War II, has met its lofty mission of ensuring the \u201chighest possible level of health\u201d by all peoples.<\/p>\n","protected":false},"author":942,"featured_media":383222,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[456],"tags":[21422,18772,18572,16072],"class_list":["post-381282","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-society-culture","tag-department-of-history","tag-department-of-public-health-sciences","tag-research-finding","tag-school-of-arts-and-sciences"],"acf":[],"yoast_head":"\nHas the World Health Organization measured up?<\/title>\n<meta name=\"description\" content=\"In a new history, Theodore Brown looks at how the WHO has met its mission of ensuring the \u201chighest 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