This week at the World Health Assembly, Member States will debate the relationship they believe the World Health Organization should have with so-called “non-state actors.” Because WHO is a United Nations specialized organization, it’s governed by Member States. In other words, since its inception, WHO has only been accountable to governments, and therefore focused predominantly on inter-governmental concerns.
Change is likely on its way. Partnerships are the new norm in global health and international development, and WHO doesn’t want to be left out.
Over the past several years, WHO has been undergoing a transformation, trying to adapt to the changing landscape of global health and determining what it’s role should be. Some of these major shifts include:
- Recognition that only a small fraction of individual and population health is due to activities within the health sector.
- More actors, whether you’re talking about partnerships, NGOs, or foundations.
- Constrained government financing for health.
- Some of the most influential financing actors in global health are not governments or inter-governmental (read: UN) entities.
- Private sector’s influence in health is significant, whether philanthropically or through direct investment.
And these are just some of the issues under consideration.
Here’s the main point, though. Whether in international development or global health, we’ve come to accept partnerships as the best way to solve complex global challenges. We hear a lot of rhetoric about taking an “inclusive” or “whole-of-society” approach.
But, as I (and co-author Allyn Taylor, a global health law expert and one of the original architects of the Framework Convention on Tobacco Control) questioned in this paper in the U. of Washington’s International Law Journal, should we be taking a more critical look at such partnerships? How do they arise; who is involved; and who benefits?
In short, does public health stand to lose considerably more by partnering with certain companies (e.g., sugary drink or processed food industry) than it gains? Does industry’s increased legitimacy and positive PR win out over any advances in public health, if any at all. (See my previous article on this).
This is what makes some of this week’s discussions at the World Health Assembly about WHO’s engagement with non-state actors particularly relevant and concerning. In reading through the current resolution being negotiated, you’ll see there are several key points that Member States already agree on (highlighted in green).
One big one is:
“Financial and in-kind contributions from private sector entities to WHO’s programmes are only acceptable in the following conditions: the contribution is not used for normative work.”
Okay, now what exactly is normative?
Here’s one definition:
“establishing, relating to, or deriving from a standard or norm, especially of behavior.”
So, the argument here is that WHO is not a normative actor, only that the functions it performs are. There’s a big difference.
And it’s a slippery slope.
Yes, WHO serves important policy-making and standards-setting functions. But the partnerships it engages in are no less normative than it’s nuts-and-bolts public health functions.
WHO is one of the leading global health institutions; the United Nations specialized agency for health. This carries significant political weight and legitimacy. It’s the same reason why when the Director General stands up at the World Health Assembly and declares “the world is not prepared to cope with pandemics” that people listen.
WHO establishes norms not just because of what it does but also because of who it is. And these norms extend to the partnerships and associations it participates in. To say that it can delineate normative from non-normative activities, WHO underestimates its power to legitimize as a UN entity and a leading global health actor.