WHO is watching over our health?

New World Health Organization head has a chance to utilize Israeli expertise in advancing global health.

margaret chan 298.88 (photo credit: WHO)
margaret chan 298.88
(photo credit: WHO)
Ask Israelis at random what the World Health Organization is and does, and they are likely to give a blank stare or - if you're lucky - respond that those are the people who decide what viral strains are used for annual influenza vaccinations. If you explain that the WHO was founded by the United Nations in 1948 to be in charge of "directing and coordinating authority on international health," they will probably shrug and say that "the UN has been against Israel for decades." In fact, it is an annual ritual for a majority of the WHO's 193 members to pass a resolution attacking Israel for the health situation in the Palestinian Authority, and the number of Israelis working at the organization's headquarters in Geneva is very small - two - only a fraction of the quota assigned to this country. The Israeli Treasury pays over $1 million in annual WHO dues, but since 2000 has not received any financial aid - a development that the former Israeli representative to the organization, the late Pnina Herzog, said was cause for celebration. In 1985, Israel even had to transfer from he WHO's Eastern Mediterranean Region to membership in the European Region (not exactly the continent it's located in but more attuned to its developed-country health, economic and social status and mentality) because most of Israel's Arab neighbors boycotted the Jewish state. However, when this Israeli reporter visited the WHO's headquarters in Geneva last month, she was treated very warmly - even invited to the first reception for the organization's 34-member Executive Board (which has no Israeli representative) held by the new director-general, Dr. Margaret Chan. Health Minister Ya'acov Ben-Yizri met Chan a week later. WELL-ESTABLISHED as a non-recipient member, Israel nevertheless doesn't have a significant impact on the WHO, even though its doctors and other professionals have great expertise in preventive medicine and disease prevention, mobilizing human resources (such as the absorption of immigrant physicians), treatment of the mentally disabled, health insurance and a large variety of other fields, including the two that Chan has declared will be her major focus - women's health and health in Africa. Regarding the latter, Israel has unique experience as a Western country absorbing tens of thousands of Jewish immigrants from Ethiopia. When this reporter mentioned at the Executive Board reception that Israeli expertise was not being adequately used by the WHO, Chan invited Israeli health professionals to contribute their experience and skills. "I welcome any help from every member country," Chan said, expressing much interest in Israel's achievements in the two areas that swill head her priority list. Dr. Marc Danzon, head of the WHO's European Region, told The Post that even though most countries felt their know-how was not adequately tapped by the WHO, Israel "had grounds" for such a feeling. He said the reason wasn't discrimination, but the fact that Israeli health experts tend not to apply for jobs in the lower ranks of the organization, from where they can climb the rungs to senior positions in Geneva. Danzon, who has Israeli relatives and visits the country frequently, said Israeli medical expertise was very high, and that it should be used more by the WHO. PERHAPS THERE is a connection between my encounter with Chan and Danzon and a decision by the WHO to make the second item of its Web site's current home page a story about Nimrod Gutman, a 25-year-old paramedic who works on a Magen David Adom mobile intensive care unit (to see article: www.who.int/healthsystems/health_worker_diaries/emergency_paramedic/en/index.html). In a 450-word story, the former kibbutznik describes a typical day in his life, during which he is called to deliver a baby at home, treat a 60-year-old man having a heart attack, and attend to a young man severely injured in the explosion of a gasoline pipe. Chan, representing China, was elected WHO director-general in November. A Catholic born and raised in Hong Kong, she was a teacher there before moving to Ontario, Canada to join her future husband. After attending a Catholic women's college, she was accepted to the University of Western Ontario's medical school, and after graduation and hospital internship returned to Hong Kong, rising swiftly in the ranks of the public health service. In 1994, she was appointed health director of Hong Kong, and remained on the island until 1997, when it was transferred back to Chinese rule. She grappled with two major health crises there - the SARS (severe acute respiratory syndrome) and avian flu outbreaks - and was regarded as a very well-organized professional who facilitated action. Having worked in public health for nearly three decades, Chan was among 13 candidates for WHO director-general when Dr. Lee Jong-wook of Korea died suddenly last May after undergoing surgery to remove a blood clot on his brain. She thus made history by becoming the first Chinese national to hold the job, even though the Chinese government earned notoriety in 2003 for keeping its first SARS cases secret to avoid bad publicity and the ensuing economic repercussions. Though she was part of her country's health establishment during this crisis, Chan emerged unscathed, as the bureaucratic structure of the Chinese health system was blamed for the delay in reporting and quarantining SARS patients, and because she was a key player in preventing and deciphering the evidence during other infectious disease outbreaks, and vigorously insisted that over a million Hong Kong chickens be killed to prevent the spread of avian flu. CHAN KNOWS the WHO cannot promote "Good Health for All" by a specific date without major contributions from philanthropic organizations and individuals, as membership dues barely cover administrative costs and don't leave much for special campaigns. Thus after taking office, she quickly met with the world's richest couple, Bill and Melinda Gates, who are devoting billions of their personal fortune to the fight against polio, AIDS and other infectious diseases. The WHO has long been criticized for its sluggishness, nepotism (the appointment of unqualified people closely connected to political leaders in member countries) and bureaucracy. The current editor of the British Medical Journal (BMJ), Dr. Fiona Godlee wrote a biting series on the organization 12 years ago when doing a fellowship at Harvard Medical School. Although some of the issues raised have been corrected and two directors-general have since come and gone, many of the problems remain. Fighting AIDS is one project in which international organizations like the WHO have overcome bureaucracy and cooperated to make progress, says Dr. George Schmid, medical officer of UNAIDS. Based in Geneva and established in 1994, this is a joint venture of the United Nations family, bringing together the efforts and resources of 10 UN organizations to help prevent new HIV infections, care for those already infected and mitigate the impact of the epidemic. "UNAIDS was set up to promote political coordination and fundraising. It is not a technical agency. It was expanded by then-WHO director-general Dr. Gro Harlem-Brundtland in 2001, and now has 80 staffers. Shmid, a specialist in internal medicine and infectious diseases, was trained in Chicago and moved to Geneva after working for years at Atlanta's US Centers for Disease Control and Prevention (CDC). "The CDC and the WHO are the two biggest public health organizations in the world. Here at UNAIDS we advise and issue guidance on male circumcision as a way to slow the spread of HIV," said Schmid, who was well informed about the visit of a UN delegation to Israel a few months ago to learn from the Israeli experience in circumcising adult Jewish immigrants for ritual purposes. "Male circumcision will be one of the ways to fight AIDS, but not the only one," said Schmid. "The wide distribution of the AIDS cocktail is one major tool, along with condom use and safe sexual practices. UNAIDS also advocates clean needle exchange among drug users, as there is no strong evidence that supplying free syringes promotes drug use, but it does prevent AIDS transmission. However, an HIV vaccine," he lamented, "is not around the corner. It is a very difficult virus that keeps changing." Catherine Le Gales-Camus, a WHO assistant director-general for noncommunicable diseases and mental health, told The Post that despite the urgency of coping with infectious diseases from AIDS and tuberculosis to malaria and measles, more attention is being given to chronic disorders such as obesity, diabetes, hypertension, heart disease and stroke, which are becoming increasingly common in the developing world as well as in highly industrialized countries. Le-Gales Camus, of France, is not an MD but has a doctorate in economics from the University of Paris, and is an expert in the economics of prevention, measurement of health quality and economic appraisal of medical technology, having previously served as a scientific adviser to the French health minister. "I provide information to member states on cost and effectiveness of intervention and prevention. In the past, chronic non-communicable diseases was found mainly in the affluent world, but this isn't true any more. Even in Africa, where there is a great burden of infectious disease, chronic disease is rising along with obesity due to an increasingly sedentary lifestyle and consumption of junk food, as well as growing tobacco use and untreated mental disorders. This presents a double burden of disease." Health systems, she continued, "are already stretched by infectious disease and the need for child and maternal health. It's clear they're not ready to answer the epidemic of chronic disease. Prevention is the key. Affluent countries and developing countries are coming together; they face the same problems." Her office is proposing a 50% increase in funds for mental health and noncommunicable diseases. "This is our political mandate. Our member states say it is time for us to do more, and we are beginning to see a political will from member ministries of health to deal with these problems." The assistant director-general was well-versed in tobacco enforcement problems in Israel, and the fact that while it is one of the 143 countries to ratify the Framework Convention on Tobacco Control, the smoking rate hasn't gone down in the past few years. "Nevertheless, the Convention is a great success, with up to 80% of the globe's population covered and many countries, such as Ireland, Norway, Italy and Spain making great efforts to reduce smoking. We will publish this year for first time a global tobacco control report, and Israel - like the other ratifiers - will have to tell us in writing what it's doing to enforce it. This will create incentive to do more. We will also encourage the raising of tobacco taxes and enforcing a smoke-free environment." She disclosed that smoking is completely barred at WHO headquarters and other facilities, with those who insist on smoking having to go "outdoors," she said, pointing to the rainy scene beyond her picture windows. Smokers at the WHO are invited to participate in cessation courses, but the organization also has a recruitment policy in favor of non-smokers "so we can lead by showing a good example." The WHO will become a more open organization, according to director-general Chan, who was asked after her election how she would like to be remembered at the end of her term. "I would like to be remembered as a very fair, open, transparent and accountable director-general," she said, adding that she wanted to make progress in six core areas - development for health, health security, health systems capacity, information and knowledge, partnership and performance of the WHO as a whole. "And I would like to... make the WHO a much more efficient and relevant organization." She will be judged at the end of her five-year term.