PHM-Exch> International institutional legitimacy and the World Health Organization

[Claudio Schuftan]

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  J Epidemiol Community Health  doi:10.1136/jech-2013-203272

   - Commentary

 International institutional legitimacy and the World Health Organization

   1. Jennifer Prah
Ruger<http://jech.bmj.com/search?author1=Jennifer+Prah+Ruger&sortspec=date&submit=Submit>


   1. Correspondence to Jennifer Prah Ruger, University of Pennsylvania
   Perelman School of Medicine; jenpr at mail.med.upenn.edu

 The global health community continues to look to the World Health
Organization (WHO) to solve current global health governance (GHG)
problems. Until the 1990s, nation-states and multilateral organisations
with state members governed international health, and WHO played a
prominent role, coordinating worldwide efforts such as smallpox eradication
with a few partner organisations. WHO also provided international reporting
and handled disease outbreaks through the International Health Regulations.
The world still sees WHO as the leading global health governor, and
proposals abound to reform it,1-4 to use its treaty abilities more
regularly and to give it enforcement powers--all in the absence of real
institutional alternatives.

But today's WHO is a compromised institution; some interrogate its
relevance altogether2 and WHO Director-General Margaret Chan herself
questions WHO's ability to respond to global health challenges.5 On a
theoretical level, WHO lacks a substantive justice oriented conception of
international institutional legitimacy. On a more pragmatic plane, WHO is
riddled with budgetary weaknesses, power politics and diminishing
reputation and effectiveness. WHO's early successes were laudable and the
organisation has the potential to make an impact on future global health
problems, but the institution lacks a number of key ingredients of success:
coordination capacity, authority, accountability, fairness, a master global
health plan, effectiveness and credible compliance mechanisms.

While WHO reforms could help it do its job better, a new vision, based on a
substantive conception of justice and legitimacy, and associated reforms in
the broader GHG system will more effectively and efficiently serve GHG
functions and the WHO itself. WHO Director-General Margaret Chan states
"[t]he level of WHO engagement should not be governed by the size of a
health problem. Instead it should be governed by the extent to which WHO
can have an impact on the problem. Others may be positioned to do a ...
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