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                           <cite>
                                    
                                    <span id="article-slug-jnl-abbr">
                                 <abbr title="Journal of Epidemiology and Community Health" class="">
                                    J Epidemiol Community Health</abbr>
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                              <span title="10.1136/jech-2013-203272" class="">
                                 doi:10.1136/jech-2013-203272
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                        <ul class=""><li>Commentary</li></ul>
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                              <h1 id="article-title-1" itemprop="headline">International institutional legitimacy and the World Health Organization</h1>
                              
                              <div class="">
                                 <ol class="" id="contrib-group-1"><li class="" id="contrib-1"><span class=""><a class="" href="http://jech.bmj.com/search?author1=Jennifer+Prah+Ruger&sortspec=date&submit=Submit">Jennifer Prah Ruger</a></span></li>
</ol>
                                 <ol class=""><li class="" id="corresp-1"><span class="">Correspondence to</span> Jennifer Prah Ruger, University of Pennsylvania Perelman School of Medicine; <a href="mailto:jenpr@mail.med.upenn.edu">jenpr@mail.med.upenn.edu</a></li>
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                              <p id="p-1">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,<span class="">1–4</span>
 to use its treaty abilities more regularly and to give it enforcement 
powers—all in the absence of real institutional alternatives.
                              </p>
                              
                              <p id="p-2">But today's WHO is a compromised institution; some interrogate its relevance altogether<span class="">2</span> and WHO Director-General Margaret Chan herself questions WHO's ability to respond to global health challenges.<span class="">5</span>
 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.
                              </p>
                              
                              <p id="p-3">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 … 
                              </p>
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              <div class="">
                                 <a href="http://jech.bmj.com/content/early/2014/03/05/jech-2013-203272.full">[Full text of this article]</a>
                                 
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