Ilona Kickbusch: The new director general of WHO and the politics of global health

Ilona Kickbusch discusses the challenges that Dr Tedros will face and how he will need to apply his political focus and determination

The future of the World Health Organization (WHO) will depend on the strategic interplay of two factors. Firstly, the organization will need to concentrate its work on the health challenges of the 21st century, and secondly, fully apply the unique political capital and experience of the newly elected director general (DG), Tedros Adhanom Ghebreyesus. I will focus on the second because so much has been written on the first.

Note the order in which Tedros’ Wikipedia entry introduces him as an “Ethiopian politician, academic, and public health authority.” Indeed the most important qualification for the challenges he will face as DG will be his experience as the Ethiopian foreign minister (2012-2016). In this he is similar to Gro Harlem Brundtland who brought all her savvy and experience as a previous Norwegian prime minister to the position of DG and affected significant change by working differently, tackling new issues, and bringing in new people.

Under Tedros’ leadership, the WHO can help change the politics of the health and development trajectory by upholding two considerations: Firstly, the Sustainable Development Goals (SDGs) are an issue for all countries, not just the developing world, and secondly, many of the most important decisions for health will be taken in other sectoral and political arenas—for example, upholding the Paris climate agreement is critical for global health. Tedros can and must afford to be daring. The new WHO election process means that no other head of a UN organization has the extent of democratic legitimacy from member states (133:50 votes) that his election result reflects. Many of the 50 states who had a preference for another candidate have already shown their full support to WHO with Tedros at its helm.

Tedros knows and understands the world of power. As foreign minister, he served as chair of the Executive Council of the African Union in 2014 and he played a defining role in the Third Financing for Development Conference (FfD3) in Addis Ababa in 2015. Consequently, in 2015 he was named “one of the 100 most influential Africans in the category of politics and public service” (The New African Magazine, 2015). It is therefore comes as no surprise that he was fully backed by the African Union in his bid to become DGthis is not only about health, it is about Africa’s role in the world.

There are two critical and interdependent political opportunities that Tedros will need to take advantage of:

1. High level political processes

In the increasingly multi-polar and politicized world of health, WHO must fully engage in the many major political processes underway. In doing so it must combine technical excellence with political clout and astuteness. This requires a new strategic framework for the organization, with a strong “foreign relations department” that links evidence for the central role of health in the SDG agenda with strong political action, strategic support to its country offices, and strong WHO representations in pivotal political centres such as New York, Brussels, and Addis Ababa. WHO must scan the political environment to apply an integrated “health in all policies” approach that ensures that health is on the political agenda of all countries and where the political action is. Two examples that come to mind, which illustrate that WHO is not a development agency, but an organisation for all countries:

• African Union: WHO must reinforce and help implement the commitment to health, which African leaders gave in their First Ten Year Implementation Plan for Agenda 2063 (which was adopted during Tedros’s tenure) as well as help steer the investment commitments made by other countries towards health and its determinants.

• G20: for the first time the DG of WHO will attend a G20 summit of Heads of State by invitation of the German Chancellor Angela Merkel. One of Tedros’ first trips will take him to Hamburg in early July 2017. WHO’s engagement in the G20 health process will provide a new entry point for WHO to world leaders representing 85% of the world’s population, which must be used to encourage them to support global public goods for health in a time of political turbulence.

2. A new global health compact

The world needs a new global health compact, which tackles issues of financing and of governance far beyond the WHO. The threat that the US might significantly reduce global health funding is the symptom of a larger change which implies that the present donor model for health development is no longer valid. Tedros prioritized a new approach to global health financing in his campaign platform and he must ensure that WHO shows determined leadership in changing the global health paradigm. High level attention to the health rights of people migrating is one example. Here he can also build on other experiences and networks as a member of the High Level Taskforce for Innovative International Financing for Health Systems.

There is an urgent need to challenge the funding and governance models that came out of the MDG era. The interface between domestic investment in health, private sector investments and capital flows, investment and pension funds, philanthropy, and the commercial determinants of health will need to be well thought-out and understood. Investments in universal health coverage and health security are two sides of the same coin, not agendas for one part of the world rather than another. WHO can lead by engaging with business leaders, investors, philanthropists, and bankers. This does not mean that it will give up its independence and commitment to human rights and equalityquite the contrary. Brundtland changed the global health paradigm with the Commission on Macroeconomics of Health. A Commission on 21st century health investments and governancewith very atypical membershipcould be the first step to WHO filling this important space.

This is a historical moment and the large structural issues at stake for global health must be addressed. Tedros will need to ensure that his political focus and determination are not diverted. He and his team will need to be radical and fearless. It is not only the future of the WHO that is at stake.

Ilona Kickbusch is director of Global Health Centre, Graduate Institute for International and Development Studies, Geneva, Switzerland.

Competing interests: None declared.