Douglas Noble on the World Health Assembly

douglas nobleI recall when I first attended a medical science teaching committee meeting at St Andrews University in 1995.  I was overawed by the complexity of running a medical curriculum, bringing all the academics on board, and agreeing teaching plans.  I was there because someone thought it was a good idea to have a student in the room.

From 17 to 21 May 2010 the 63rd World Health Assembly took place at the United Nations in Geneva, Switzerland. As I sat in the viewing gallery above the main committee room, I realised the uncomplicated nature of every other committee meeting I’ve attended compared to this one. 

The room was circular, non-cultural in appearance, with a central area where secretaries furiously recorded minutes. The president chaired the meeting from the front, with ever increasing concentric rings of tables fanning out from the “top table.”  It reminded me of the Palm Jebel-Ali housing development in Dubai.  Representatives from different countries sat in alphabetical order, from Afghanistan to Zimbabwe. 193 countries were there and each had two seats at the table and two behind. Ministers of health, chief medical officers, and senior health officials from every country sat in pole position – some concentrating, some furiously scribbling, some looking worried – one on Facebook.  Over-serious looking advisors sat behind passing notes, laptops open, texting with purpose. One painted her nails.
The psychology of this committee was unique.  Great patience is required as many rely on translators, who were sitting opposite me above the room in various individual booths – the appearance was half-way between a box at Stamford Bridge and something from Sydney Pollack’s 2005 blockbuster “The Interpreter.”  I could probably have convinced myself that the translator in the box to the right above the top table vaguely resembled Nicole Kidman.  She looked very serious, but Matobo were not represented. 

Respect is paramount.  Proceedings are slow, tortuous, and at times seem to go on forever. Yet, positive results for public health abound.  A resolution was passed on strategies to reduce the harmful use of alcohol.  Heated debate took place about the progress on millennium development goals (MDGs).  Harsh criticism in this environment is unusual, but it is not bereft of challenge.  Margaret Chan, in feisty form, addressed a technical session to the side of the main committee room instructing them vociferously, in a memorable address about MDGs: “There is more talk than walk.”   

Public health interventions have never been straightforward, but there are few other medical specialities with such an international hierarchy.  It is here in Geneva each year that international health policy is declared.  Returning to countries far and wide, delegates take home the news of support to eradicate Chagas’ disease, to improve child and maternal health, and to get closer to those elusive MDGs by 2015. 

Lobbying begins on Monday in a hundred countries: “Last week at the World Health Assembly member states were agreed that……minister, secretary for health, chief medical officer – how will you ‘walk the talk?'”

Douglas Noble has worked in surgery, emergency medicine, public health and for the WHO . From 2006 to 2008 he was clinical adviser to the chief medical officer for England.