World Health Organization

As the UN specialized agency for health, the World Health Organization (WHO) is the key institution concerned with global health cooperation. The WHO came into formal existence in 1948 as an amalgamation, to some extent, of existing international health organizations dating from as early as the 14th century. At the same time, its founders envisioned an organization with an unprecedented mandate, namely, “the attainment by all peoples of the highest possible level of health.” Over its more than 60-year history, the work of the WHO has focused on achieving this goal, pursued through the political will of its near-universal membership of 193 member-states, network of six regional offices and 149 country offices, and the mobilization of financial and technical resources.

Many patterns of health and disease have historically defied the territorial boundaries of states. Major disease epidemics (e.g., the spread of the bubonic plague along major European sea and land trade routes during the 14th century and the arrival of malaria in the New World via four centuries of the slave trade) have followed human migration patterns. The acceleration of globalization since the late 20th century has intensified the worldwide flow of pathogens. In addition, intensified cross-border flows of capital, goods and services, knowledge and ideas, and people and other life forms has led to recognition that broader social and environmental determinants of health pose new global-scale and transborder challenges for international health organizations.

The need to strengthen health cooperation across countries was accepted after World War II, leading to the creation of the WHO as well as health programs in other UN bodies, aid agencies, and nongovernmental organizations. The widespread changes to societies worldwide from the 1970s, as a result of contemporary globalization, have prompted further efforts to strengthen collective action to address shared health needs. This shift, from international to global health cooperation, has involved engagement with a greater range of public and private interests, both within and beyond the health sector, as well as with forces that flow across the territorial boundaries of states.

As well as working alongside other UN bodies concerned with health, such as UNICEF (the UN Children's Fund) and UNAIDS (the Joint United Nations Programme on HIV/AIDS), since the 1990s, the WHO has been required to adapt to the presence of new global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and new funders such as the World Bank and the Bill & Melinda Gates Foundation. Following decades of chronic underfunding for health development, increased political attention to global health raises hopes that collective action will lead to new successes akin to the historic global eradication of smallpox in 1978.

While this complex institutional environment affirms the higher priority for health on the global policy agenda, this proliferation of institutional arrangements also raises questions about the emerging nature of global health governance. Concerns about the appropriate role of the WHO lie at the heart of such debates. The organization remains respected for the unrivalled breadth of its biomedically based technical expertise, but its overall leadership role in global health faces challenges. There is fierce competition among global health initiatives for available resources, with donor governments shifting substantial funding away from the WHO since the 1980s. This has been due, in part, to dissatisfactions with the organization's performance but also as a controversial means used by [Page 1813]some governments to exert pressure on the organization to reform. The WHO responded by implementing widespread internal reforms from the late 1990s, setting clearer goals, and initiating new campaigns on major issues such as tobacco control and malaria. Its role in spearheading the global response to the SARS (severe acute respiratory syndrome) outbreak in 2002–2003 and strengthening preparedness for pandemic influenza since 2003, including revision of the International Health Regulations in 2005, helped to reinvigorate the standing of the WHO within the global community.

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