Book dossier

World health and world politics

by Javed Siddiqi

Amid accusations of ineffectiveness and 'politicization', one of the most important United Nations agencies, the World Health Organization, finds itself engulfed in a crisis of confidence that has led some observers to question its continued viability. Even highly-placed members of WHO's Secretariat fear that conflict and controversy have become endemic to the agency, compromising its effectiveness more than ever before. To assess the validity of these allegations, Javed Siddiqi evaluates the agency's accomplishments from 1948 through 1985, including its massive field effort in the Malaria Eradication Programme. His findings portray an organization that, despite the recurrent intrusions of 'negative politics', has been increasingly successful in realizing structural aspirations of universal membership and workable decentralization but less effective in attempts to eliminate individual diseases. . Using internal documents, meeting records, personal interviews and secondary sources, Siddiqi analyses WHO policies and programmes from a non-medical perspective. He examines charges of politicization and traces their rise over the past two decades, including their recent link to fears about a complete breakdown of multilateral cooperation. Siddiqi also chronicles the Malaria Eradication Programme from its enthusiastic inauguration in the 1950s to its demise and substitution by less ambitious initiatives after 1969. Through this case study he illumines a strategic shift in WHO policyfrom the 'vertical' approach of targeting a single disease to a 'horizontal', multi-pronged attack on a spectrum of health problems. Concluding that politicization and ineffectiveness are not inseparable phenomena of recent origin, Siddiqi explains the WHO's limited effectiveness in terms of both unavoidable constraints and avoidable deterrents. He also highlights the agency's significant achievements and, in doing so, demonstrates that Western charges of ineffectiveness and politicization miss the complexity of these concepts offered by a thorough evaluation of the WHO.