Globalisation is affecting health systems and thus requires strong international coordination mechanisms. Experts at the European Health Forum Gastein are discussing how the WHO can manage to assert its leading role in coordinating global health issues because in view of many new actors on the international health stage. Among the major issues related to the organisation’s reform process is the role that NGOs as well as international corporations will play alongside the member states.

Bad Hofgastein, 5 October 2011 -- “The distinction between national and international health problems is losing its importance in the global arena as globalisation effectively changes health policy. Public health, just like global finance, has long become interdependent,” Prof Dr Ilona Kickbusch, Director of the Global Health Program at the Graduate Institute in Geneva and Chairman of the Global Health Europe Task Force, today told the European Health Forum Gastein (EHFG). “Control of health policy issues at a global level therefore becomes ever more important, as well as ever more difficult.” Among other reasons, this is a result of more and more actors becoming involved in international health issues. "At the global level, health policy is no longer the exclusive domain of governments. Large private foundations such as the Bill and Melinda Gates Foundation, innumerable NGOs and, of course, the health care industry are gaining in importance and influence."

In view of such developments, the WHO (World Health Organisation) is faced with the need for reform if it is to maintain its position as a key global player in the health sector. Among other things, that would involve creation of a more effective organisation and review of its basic orientation. “The ongoing WHO-reform debate covers no less than the realignment of the organisation’s core business,” said Prof Kickbusch. “This raises the question, inter alia, of whether the organisation should be more active normatively, i.e. in the development of international agreements, or operationally.”

Of central importance – and therefore intensely debated – is the reform of the organisation’s administration and finances. “Increasingly more activities are expected and demanded of the WHO, while at the same time financing these demands is becoming increasingly difficult,” Prof Kickbusch said. One problem is the specific budgetary situation: in addition to the regular budget, which is based on the compulsory contributions of member countries, there are voluntary contributions that member states can make toward a special budget for financing specific operational tasks. The ratio of the two budgets is 75:25. “The organisation currently has little flexibility between these pots, resulting in a structure that often leads to very unsatisfactory competitive circumstances within the organisation,” the expert noted. “A further complication is that very few member states have a nationally coordinated and coherent WHO policy. A situation often then develops in which representatives of health ministries in one committee are responsible for the regular membership fees and deciding on priorities for the organisation, while on the other hand, representatives of the same country’s state development agencies thwart these priorities.”

As part of the reform process, the member states in particular needed to better coordinate their WHO strategies at the national level and to be represented there by more expertise, according to Prof Kickbusch. “It is common for ambassadors at the UN in New York to have experts who specialise exclusively, for example, in areas such as human rights. It would be likewise desirable if the concept could be applied at Permanent Missions in Geneva in the form of health attachés to the WHO.”

Experts at the EHFG also reported of lively discussion on whether other actors in the global health system will have more opportunities,as a consequence of the organisation’s reform, to participate in the WHO in addition to member states. “The question of how much of a voice industry should have in the organisation is particularly controversial, not so much the issue of NGO participation,” Prof Kickbusch said. The discussions centred not just on the pharmaceutical and medical technology industries, which are to some extent charitably active (by making drugs available free of charge, for example), but also on the IT, food products and alcohol industries. The NGOs, in particular, are very concerned, fearing that industry could gain too much influence in the normative work of WHO.

The EHFG is the most important conference on health care policy in the EU. This year it attracted more than 600 decision-makers from 45 countries for discussions on the latest developments in health care policy.

EHFG Workshop 2 “Global Health: New developments in global health governance.”  5 October 2011

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