Last week I was physically and mentally consumed by the World Health Assembly; it was wonderful. Attending meetings from 9am to 9pm, Monday through Friday, the gears constantly turned within my brain and never took pause. I was constantly thinking and concentrating. Never before had I transcribed so many notes within the span of a 120-hour period. Never before had I stood in front of so many public health leaders — heroes whose names filled my textbooks and news feed. Following the intensively inspiring experience in global health diplomacy, I sunk into the weekend ready to review everything again, as I sought to achieve clarity and insight amidst the troves of information saved in my notes. Reading hundreds of pages of transcribed speeches, several words stood out amongst the others: transparent, evidence-based, and inter-disciplinary. Ultimately, this brought me to question not only the significance of these words, but also the context in which they achieved this sense of significance. Taking this consideration with me to the World Health Organization Headquarters this morning, I again repeatedly heard these terms sprinkled throughout the presentations delivered. Leaders in public health — covering everything from reproductive health, neglected tropical diseases, career opportunities, maternal and child health, child right and international code, and noncommunicable diseases — emphasized these three words without fail. Throughout today, which we spent delving into the inner workings of the WHO, our class was given a strong picture of not only WHO’s purpose, but also the power it maintains and, potentially more important to consider, the power it lacks. In exploring these ideas, WHO leaders also delved into the very reason that transparency, evidence-based practices, and an interdisciplinary approach are so significant.
Transparent. The start of our daylong tour of the World Health Organization began with an introductory discussion led by Dorine van der Wal of the WHO Briefing Service. In introducing the World Health Organization, she emphasized the need for the WHO to remain neutral. Explaining the history of this basis in neutrality, she briefly discussed the H1N1 scare in which the credibility of the WHO was aggressively questioned. Anticipating a hugely dangerous, deadly, and massive flu epidemic to arise, WHO advised countries to purchase large amounts of pharmaceuticals in preparation. When this proposed outbreak did not arrive, WHO was accused of unethically being influenced by pharmaceutical companies . Although independent investigations following this incident concluded that WHO did not make decisions based on any inappropriate industry affiliations or influences, the accusations alone put severe pressures on the organization to present a strong veil of transparency into the future. This effort to maintain neutrality, however, appears to potentially hold back the organization’s ability to influence communities, for WHO cautiously advises its representatives to refuse any invitations to speak at conventions also spoken at by tobacco representatives. With this goal of maintaining neutrality through transparency, the WHO also holds the policy that no donations from tobacco agencies or individuals related to big tobacco may be accepted. With this logic, one might assume that other companies responsible for selling unhealthy products (e.g., alcohol, sugar-sweetened beverages, high fat foods, baby formula) would also be disallowed from voluntarily contributing funds. Surprisingly, however, this is not the case. Only tobacco companies are 100% banned from making donations; other companies known to promote unhealthy lifestyles stand in an ethical gray area. It is this very gray area related to transparency that Francesco Rio also mentioned, specifically through the example of informed consent within the realm of publicly-administered health services (e.g., iodine administered through salt, folic acid administered through orange juice, fluoride administered through tap water). Tracing the history of informed consent throughout WHO’s history, Francesco agreed that the WHO used to operate autonomously without the need to receive explicit consent from citizens for any public health promotion efforts (e.g., spraying neighborhoods and peoples with DDT). However, he believes that as transparency continues to increase within the realm of global health governance, we are moving into an age where consent soon will be possible and required for ALL public health interventions.
Evidence-Based. In keeping with this theme of neutrality and transparency, Dorine van der Wal also emphasized the significance of basing all WHO policies and decisions on evidence in order to (1) effectively eliminate suspicion of industry influence and (2) provide nations with valuable and viable guidance. The biggest message I got throughout all of today’s presentations was that evidence comes before all else. In order for any resolution to be passed within the WHA or within the WHO itself, the technical officers and researchers involved must have addressed all findings without any personal bias. All guidance passed on to member states must have a foundation in thorough research findings. As a human biology student, I would never consider this policy to present an issue; however, today in a discussion led by reproductive health technical officer Avni Amin, I learned that many public health issues lacking large amounts of data fail to advance within public health advocacy efforts simply because no resolutions or research reports may be submitted without substantial previous research. Therein, this can present an issue within fields such as that of violence against women, which is clearly evident in society, but failed to achieve recognition due to the difficult nature of data collection in the field. Herein, due to the inability to effectively produce data, women continued to be violated for decades without any serious mention of the issue at the WHA . Alternatively, with no solution to this issue of potentially maintaining too high a dependence on data, we also learned of another concern: resolutions resting on a tall bed of evidence may still not be ratified due solely to political reasons. Herein lies the very cause of repeated pain I felt throughout the previous week at the World Health Assembly, when I heard about numerous examples of powerful industries manipulating delegates to side with financial wealth over health security. This very concern was best elaborated in our discussions today with Marcus Stahlhofer of the Maternal, Newborn, and Child Health Division, as he described the immense influence dairy and formula companies pose on the implementation of policies surrounding infant formula marketing practices. Ultimately, we find time and time again that formula-producing companies have won out despite the evidence formulas are dangerous and expensive. Therein, evidence — though an immensely powerful tool — is necessary but not sufficient in efforts to bring about health promotion policies.
Interdisciplinary. In efforts to not only draft but also implement effective resolutions, the WHO heavy relies on collaborative teams composed of individuals from a diverse range of fields. In this way the WHO defies the common misconception that health promotion is solely controlled by the human healthcare sector. Instead, public health must be promoted by multiple approaches, including, but not limited to preventative chemotherapy, veterinary public health, safe-drinking water sanitation and hygiene, vector control, and intensified case-management. As Francesco Rio described in his discussion today surrounding neglected tropical diseases, all of these different approaches are necessary but insufficient independently. Without one element, nothing can be accomplished. Herein lies the most important message, I believe: collaboration is necessary for survival. Although often accused of being slow-acting and bureaucratic in nature, I am thankful that the WHO continues to effectively promote health as a universal right around the world by advocating for transparent, evidence-based, and interdisciplinary approaches to health advancement.
Cristina Gago is working to earn a B.S. in Human Biology and an M.P.H. in Global Health Leadership through the University of Southern California.
The USC Institute for Global Health organizes an annual trip to the World Health Assembly in Geneva, Switzerland, as part of the course “Global Health Governance & Diplomacy in Practice in Geneva at the World Health Assembly.” This year, a group of 12 students are embedded as delegates to NCD Alliance members at the 69th World Health Assembly May 23-28.