Bruntland makes waves in her first six months at the WHO
Karen Birmingham
New York
Gro Harlem Brundtland
Speaking at the World Economic Forum in Davos, Switzerland on January 30th,
Director General of the World Health Organization (WHO) Gro Harlem Brundtland
announced a new partnership with three major pharmaceutical companies—Bristol
Myers Squibb, Pharmacia & UpJohn and Novartis. The companies, which manufacture
nicotine dependence treatments, have agreed to support the WHO's Tobacco Free
Initiative, and will give $250,000 each to tobacco awareness programs over
the next three years. The announcement coincided with the end of Brundtland's
first six months as head of the WHO, and embodies one of the objectives that
she laid down for the organization when she came to office, which is to increase
WHO's partnerships with the private sector.
The financial and physical health costs of tobacco are well known, and
in her speech Brundtland stressed what has become the WHO's central message
under her leadership—that investing in health is sound economics. "From
being perceived as an unproductive consumer of public budgets, wise investment
in health is now increasingly understood to be key to productivity itself,"
she said. She believes the WHO can win attention for this message by having
a "firmer grasp of the political agenda."
Brundtland is using her background as a physician and former prime minister
to focus attention on health and improve government commitment to this area.
She has taken the cause to the White House and the Chinese president and prime
minister, plus other government officials around the world. In an interview
with Nature Medicine, she explained that health ministers in every
country should feel the weight of the WHO behind them as they negotiate government
budgets. "We find that health ministers are often isolated. They need the
support of the WHO to get the attention of their finance minister and prime
minister to stress the importance of health in economic terms. Health has
to be discussed at the government table to be taken seriously."
She has introduced that same political ambience into the WHO's Geneva headquarters.
On her first day, she established a new senior management team of nine executive
directors known as the Cabinet and re-structured the entire organization around
the 'clusters' lead by each of these directors. Not surprisingly though, there
are signs of discomfort from within the establishment. "Dr Brundtland is a
politician, and to some people it seems as though what has been instituted
is a political transition," revealed one senior WHO employee who wished to
remain anonymous. "What's upsetting some internal staff is a tendency to explain
the reasons for the new approaches by criticizing what was done in the past.
In comes a new 'party' and blames the problems on the old one."
The employee insists that staff are not opposing change per se,
and describes Brundtland as an infinite improvement on the previous Director
General. But they are worried that the process of change is being driven too
much by political appearance. Frustration crept in, says the source, in December,
as people realized changes were not coming to closure as quickly as promised.
Not all staff are disgruntled, and it is difficult to assess how wide the
divide is. Many newcomers insist that they would not have joined the organization
were it not for Brundtland's leadership. Chris Murray, a Harvard professor
who joined the WHO on a 3-year sabbatical to work in the newly established
Global Programme on Evidence for Health Policy, is one. He says that more
"new blood" will enter the WHO in the coming months. Grants given by the Turner
and the Rockefeller Foundations, as a measure of confidence in Brundtland,
have established a Global Health Leadership Fellows Program, and Murray's
department alone had 550 applicants for fellowship positions. "The idea of
people taking time off from their career and wanting to work here is extraordinary.
Nobody would have done that before—nobody was willing to give the money
before." Murray believes Bruntland has re-introduced a real sense of mission
and purpose that had faded under the old regime.
Brundtland also has the backing, in principle, of the Executive Board.
"It's still early days, but there's a great sense of purpose and a feeling
of change and improvement," says Chairman of the Board, Sir Kenneth Calman.
"We're happy with the direction and the priorities of the DG's budget which
will be presented to the Assembly in May." However, a split vote at the Board's
annual meeting in January means that it will not recommend Brundtland's request
for a 19 percent budget increase (to $958 million) to member countries of
the General Assembly.
Given that the WHO has received zero nominal growth for the last 10 years,
its income has reduced by 20 percent in real terms, and perhaps the best Brundtland
can hope for is to be awarded zero real growth, which will give roughly $30
million over the present funds.
