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<DIV><FONT size=2><SPAN class=MainText_module_italic><SPAN
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<DIV><FONT face=Arial size=2><SPAN class=MainText_module_italic><SPAN
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<DIV><FONT size=2><SPAN class=MainText_module_italic><SPAN
style="FONT-SIZE: 14pt; FONT-FAMILY: Verdana"><FONT color=#000000><FONT
size=2><FONT face=Arial><SPAN class=ja50-ce-title>What's next for WHO?</SPAN> by
<SPAN class=ja50-ce-author><A class=authorLink
href="http://www.thelancet.com/search/results?search_mode=cluster&search_area=cluster&search_cluster=thelancet&search_sort=date&restrictname_author=author&restricttype_author=author&restrictterm_author=nordstr_m_a&restrictdesc_author=Anders Nordstr?m"><FONT
color=#000000>Anders</FONT> <FONT
color=#000000>Nordström</FONT></A> was publishe at
<P class=MainText_module><SPAN class=MainText_module_italic>The
Lancet</SPAN> 2006; <SPAN
class=MainText_module_strong>368</SPAN>:177-179 on July 15, 2006</P></SPAN>Hope
you find this article
interesting</FONT></FONT></FONT></SPAN></SPAN></FONT></DIV>
<DIV><SPAN class=MainText_module_italic><SPAN
style="FONT-SIZE: 14pt; FONT-FAMILY: Verdana"><FONT face=Arial><FONT
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<P class=MainText_module>Ghassan Shahrour, MD</P>
<P class=MainText_module>Al-Yarmouk</P>
<P class=MainText_module>Damascus Syria</P>
<P class=MainText_module><A
href="mailto:yarmouk@medinews.com">yarmouk@medinews.com</A></P>
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style="FONT-SIZE: 14pt; FONT-FAMILY: Verdana"><FONT color=#000000><FONT
size=2><FONT face=Arial><SPAN class=ja50-ce-title>What's next for WHO?</SPAN>
</FONT></FONT></FONT></SPAN></SPAN></P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">The unexpected and shocking death of Lee
Jong-wook, Director-General of WHO, on May 22, the first morning of the
Fifty-ninth World Health Assembly, placed WHO in the unprecedented situation of
being without its leader at a peak decision-making season.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Where does Dr Lee's death leave WHO?
Remarkably, WHO has not been incapacitated, although his loss continues to be
deeply felt. The organisation has maintained momentum in part because of his
management style, which strategically devolved responsibility, and also because
of a change in the way in which WHO is finding solutions to global health
problems. In the past, there was sometimes a conceptual divide between the
adoption of a resolution by the governing bodies as a generally good principle
and the more painful realisation of it in practice in countries. The watershed
came with tobacco control. The process to arrive at the WHO Framework Convention
on Tobacco Control was slow and difficult, fraught with legal complexities, and
detailed negotiations over texts. But the end product is a powerful instrument
that is already proving useful to Member States in enforcing a rigorous,
internationally supported approach to improving health.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">The rapid and destructive spread of H5N1
avian influenza throughout the world, and its related threats to human health,
have similarly triggered direct engagement in the voluntary early implementation
of the revised International Health Regulations (2005).<A
class=ja50-ce-cross-ref title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib1"
name=back-bib1><SPAN class=ja50-ce-sup>1</SPAN></A> The significance of this
agreement to early compliance goes beyond the practical implications for
improving surveillance and early warning systems, essential though those are.
The added value is that it represents a real energy and drive to build the
necessary capacity in countries.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">The reforms introduced by Dr Lee have
given WHO greater credibility, accountability, and purpose. Those directions are
most clearly shown in his 10-year global health agenda, Engaging for Health, for
WHO, its Member States, and partners. This vision for the future was adopted by
the World Health Assembly only days after Dr Lee's death.<A
class=ja50-ce-cross-ref title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib2"
name=back-bib2><SPAN class=ja50-ce-sup>2</SPAN></A> Drafted, negotiated, and
consulted on for more than a year, this overarching framework has evolved
substantially. The framework includes a new focus, for example, on health and
security, universal coverage, health-related human rights, determinants of
health, and strengthening health systems.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Over the past few years we have been
building a platform of agreed positions, based on good science, global health
priorities, and political realism. Simultaneously we have been refining the
secretariat of WHO as a useful mechanism through which to support programme and
policy implementation in countries.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Preparedness is vital—and not just for
the advent of pandemic influenza, although that is a pressing responsibility. We
also have a long-term responsibility to support countries' health systems to
advance to the point where they are more or less self-sufficient, maintaining
the flexibility to respond where we are needed.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Dr Lee wrote: “Natural disasters—whether
climatic, seismic or infectious—illustrate how quickly situations can change and
how precarious health can be. We have to plan for this unpredictability.”<A
class=ja50-ce-cross-ref title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib3"
name=back-bib3><SPAN class=ja50-ce-sup>3</SPAN></A> Countries have seen us
respond quickly and effectively to unexpected public-health events and
emergencies of all sorts. In this response we are supported by modern
communications resources, a massive oncall network of skilled medical and
scientific experts, through mechanisms such as the Global Alert and Response
Network, and our partners in non-governmental organisations, civil society, the
UN community, and the private sector.</P>
<DIV class=ja50-simple-article>
<DIV class=ja50-body>
<DIV class=ja50-ce-sections>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">In its most immediate sense, all of
WHO's work is to do with building long-term health security in countries. The
role of infectious diseases in security is one aspect that WHO will bring to the
table at today's G8 meeting in St Petersburg. It is also the topic of next
year's <I>World Health Report</I>. There are certain areas, however, where
insecurity is particularly critical. Two such areas are the absence of a trained
health workforce, and the continuing vulnerability of the health of women and
children. These two areas are not easy issues to tackle, but there is momentum
to work on them. We are working towards building health security and supporting
the essential building blocks of the health workforce. We launched the Health
Workforce Alliance during the recent World Health Assembly in May, which will
directly help countries to put into practice the 10-year action plan set out in
the <I>World Health Report 2006</I>.<A class=ja50-ce-cross-ref title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib4"
name=back-bib4><SPAN class=ja50-ce-sup>4</SPAN></A></P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">A great deal still needs to be done to
improve women's health and wellbeing. Women are being killed, maimed, or
physically and mentally debilitated, by disease, by deprivation or
malnourishment, and by cultural practices such as female genital mutilation.
Rape is considerably more frequent, and much harder to prevent or redress, in
populations displaced by war or natural disaster. The worst situation is when
pregnancy and childbirth result in death or harm to either mother or child.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Like many of the most difficult
problems, achieving change in the right places will result from a combination of
approaches, applied to a single end. Unilateral, disconnected efforts—through
health, education, financing, environmental change—have not brought the results
that we need. The newly launched Partnership on Maternal, Newborn, and Child
Health will be an important force for coalition and joint action in this
regard.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">On June 16 (to continue a series of such
meetings), I met with Dr Thorya Obaid, the Executive Director of UNFPA, and her
senior staff. We agreed to accelerate action on improving maternal and newborn
health. This action includes immediate plans to capitalise on the global
strategy for the prevention and control of sexually transmitted infections,
approved just weeks before at the World Health Assembly, pilot introduction of
vaccination against human papillomavirus, and joint plans for supporting
countries in implementing the reproductive health strategy.<A
class=ja50-ce-cross-refs
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib5"
name=back-bib5><SPAN class=ja50-ce-sup>5,6</SPAN></A> Violence against women is
being addressed, for example, through a new strategy against sexual violence,
and the 2005 multicountry study on domestic violence.<A class=ja50-ce-cross-ref
title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib7"
name=back-bib7><SPAN class=ja50-ce-sup>7</SPAN></A> In the wider field of
efforts to ensure equity, health-related human rights, and gender equity in
policymaking, WHO is developing a strategy on gender equity.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Immunisation and the range of skills
associated with that degree of community outreach remain a cornerstone of our
work. It will play an even larger role in future, as new vaccines, such as those
against rotavirus and pneumococcal infections, come onstream. Dr Lee was
determined to finish poliomyelitis eradication. Poliomyelitis remains endemic in
only four countries: Afghanistan, India, Nigeria, and Pakistan. We are committed
to his ideal. In this effort we rely on the continued support of the
international community. We are working urgently to capitalise on the excellent
infrastructure and resources of the poliomyelitis staff network (which spans
some 50 countries) to support surveillance and reporting on avian and pandemic
influenza as well as on other infectious diseases. The vaccine delivery systems
are already successfully bringing other antigens and life-saving interventions
to communities, such as vitamin A supplementation, anthelminthics, and
insecticide-treated bednets.<A class=ja50-ce-cross-ref title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib8"
name=back-bib8><SPAN class=ja50-ce-sup>8</SPAN></A></P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">The 2004 Global Strategy on Diet,
Physical Activity and Health, followed by the launch last October of the global
report on chronic disease, clearly articulated the action needed to tackle the
major risk factors for non-communicable diseases and other causes of
illhealth.<A class=ja50-ce-cross-refs
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib9"
name=back-bib9><SPAN class=ja50-ce-sup>9,10</SPAN></A> “If these determinants
are to be dealt with effectively, the boundaries of public health have to
change.”<A class=ja50-ce-cross-ref title=""
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext#bib3"
name=back-bib3><SPAN class=ja50-ce-sup>3</SPAN></A> The Commission on the Social
Determinants of Health launched a year ago is further building the case for
strong collaborative action in this area.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Meanwhile, growing numbers of people are
going on long-term treatment, and not only for diseases such as cancers, stroke,
cardiovascular disease, and diabetes. AIDS is also a chronic condition. The
issue of access to drugs was vitally important to Dr Lee. Although the 3 by 5
numerical targets were not met, the initiative's longer-term aim of universal
access is being addressed now through WHO's new 5-year strategy that emphasises
the essential continuum between prevention, treatment, and care. I will draw
attention at G8 to the urgency of continued support to work on HIV, and also
promote this strategy at the XVI International AIDS Conference in Toronto.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">Over the past 3 years, we have been
working to clarify what resources and skills WHO needs (and does not need) to
carry out its mandate. Those decisions reflect a continuing evolution in WHO.
They depend on what our core functions are, and a forecast of the future
challenges and opportunities: the global health agenda. WHO's roles and
functions are redefined in this agenda, and the related management reforms and
programme budgets take them forward. The repeated themes are of increased
accountability, and of adjustment to a functional shape and structure that
allows us to work best, providing the right kind of resources promptly. This is
work that is relevant beyond WHO, and which we are sharing with others in the UN
system to support reform.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">In the successful completion of the
Health Assembly's agenda, and the flood of messages and support from all sides
that followed Dr Lee's death, the central theme was one of commitment to sustain
progress and to deliver. This Health Assembly was a meeting that pressed on with
its agenda, and worked out solutions, even when they were on subjects as
contentious as intellectual property rights.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">The position of Director-General is
similarly complex, allowing for a range of decisions that are personal,
political, and corporate. That is why it matters very much indeed who the next
incumbent will be. We will soon know. As a result of the Executive Board's
negotiations, Member States agreed on a process to accelerate the consideration
of candidatures, and the election of the new Director-General will be completed
on Nov 9, 2006. In one sense, the question of where we are heading is amply
answered by looking at the mandates given by our Member States.</P>
<P class=ja50-ce-para
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">This is a fascinating and crucial time
for WHO. We have been given the green light on so many issues of pressing
public-health significance by our Member States—our constituency. We know that
we have their support and motivation to put those plans into action, and we
intend to do just that. With my team, I am dedicated to continuing the
directions set by Lee Jong-wook, and also to give our full support to the new
Director-General so that WHO can go on to play an even more active role in world
health.</P>
<P class="ja50-ce-para ja50-role-acknowledgement"
xmlns:bib="http://elsevier.co.uk/namespaces/2001/bibliotek"
xmlns:hsp="urn:com.elsevier.elslon.hsp">I declare that I have no conflict of
interest.</P><!--start simple-tail=-->
<DIV class=ja50-ce-bibliography id=bibliography
xmlns:hsp="urn:com.elsevier.elslon.hsp">
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