IPN Health Blog

What's up with the WHO's IMPACT?

Back in 2006, WHO created a taskforce for addressing the exploding problem of fake drugs.  Now it seems that the resulting IMPACT body is drifting rudderless, with its future uncertain.

It was widely expected that the WHO would have a resolution formalising IMPACT at this month's World Health Assembly.  But the publically available documents reveal there will be no such resolution.  Instead, Member States will be invited to note a "report" on the WHO's activities to date, including IMPACT.

Seeing as the problem of fake medicines is getting so bad in many developing countries, why isn't the WHO taking the issue more seriously?

Rumours are that India and Brazil have tried to torpedo IMPACT, (wrongly) concerned that efforts to tackle fake drugs may undermine their local generics industries.  In the case of India, many of their smaller companies legitimately churn out copies of such poor quality that they might as well be fake.

We will be watching what happens with IMPACT during the WHA in a couple of weeks.  Maybe a country particularly afflicted by the problem (maybe Nigeria) will put forward a resolution.

While the problem of fake drugs will not be solved by international action alone, we should not let the industrial interests of Brazil and India derail international progress against fake drugs.

WHO should stick to health

It seems no one can open their mouths these days without emitting some judgement on the global economic crisis. Every subject must be related to this obligatory talking point.

The affliction has struck Director-General of the WHO Margaret Chan, who has made a strange foray into the sphere of macro economics and global finance.

In reports last week she was careful to stress that she doesn't exactly oppose free trade. However, she continued:

"But I do have to say this: the market does not solve social problems."

Health is therefore at risk, from such menaces as globalisation, greater market efficiency, and trade liberalisation, reports the article.

It's a shame that those at the top of the WHO are still clinging to such ideology. As explained by Indur Goklany, rapid improvements in health outcomes have coincided with industrialisation, global trade and subsequent economic growth.

During the nineteenth and twentieth centuries, increased globalisation saw food supplies increase, access to clean water increase and infant mortality fall. Life expectancy in Africa has increased from 30 years before the industrial revolution, to 46.6 years in 1950, to 65.4 years today.

We all wish to see this figure increase further, and for people throughout the world to live longer, more prosperous lives. Goklany demonstrates the achievements of the "Cycle of Progress" - economic growth, technological change and free trade. This is how "social problems" are solved.

Bias in the World Health Organization's "Social Determinants of Health" report

I have a letter in the Lancet this week taking the WHO to task for its recent execrable report on the 'Social Determinants of Health.'

The WHO is rarely objective in its policy work, but this report on the 'causes behind the causes of ill health' sinks to new lows.  It is an entirely one-sided presentation of the evidence against markets, economic development, prosperity and economic freedom.

Despite the fact that it masquerades as an objective academic report, it failed to cite a single study that had a more positive story to tell about economic freedom and health.  There are plenty out there.

The report is another example of how WHO's output cannot be relied on a sensible and objective guide for policymaking.

The letter is here.

The socialist determinants of health

The WHO last week released its long-awaited report on the "Social Determinants of Health" - that is, the social and economic factors behind disease.

The report claims that 'social injustice is killing people on a grand scale', and advocates a vertiginous list of  government interventions to help iron out inequality, from town planning to the regulation of sandwich shops.

Unfortunately, their recommendations hover somewhere between the fantastical and insane.  The authors make the case that only a wholesale socialisation of society, business and trade will create a harmonious, healthy planet. 

Chaps, chaps. We tried this before from the 1950s til about the 1980s. I can't see many governments being terribly keen on rewinding the clock back to the good ol' days of shortages, militant labour, strikes and declining living standards.  Except, perhaps, North Korea, Zimbabwe and Cuba. (hang on,Cuba gets significant praise in the WHO report).

How can economic decline - which the report seriously seems to be advocating - be good for health?

While many of the Commission's recommendations can be dismissed as reheated 1960s socialism-lite, the section on free trade is actually offensive: it recommends an end to free trade, and that the governments of developing economies reorient their economies away from exports towards 'domestic production'.

Never mind that free trade is one of the most powerful engines of economic growth and improved health. The WHO's policy, also known as 'import substitution industrialisation', has wreaked economic havoc wherever it has been tried. It is also partly responsible for the creation of slums in countries like Brazil, something the Commission has strong words about.

I have an op-ed on the topic over at the CFD, and readers might also like to examine my longer monograph on "the real determinants of health".

Tim Worstall is also less than impressed with the Commission's more ludicrous suggestions.

So there we have it. The WHO is telling us we can only be healthy if we follow the example set by the comrades in Cuba. 

File this one under 'B' for bonkers.

Democratically Deficient Dinosaurs

Here at the Campaign for Fighting Diseases, we've long been concerned about the way in which unaccountable, unelected international NGOs have been colonising the World Health Organization (itself unaccountable and undemocratic) and influencing policy.

I was at a recent consultation in Stockholm about the strategic direction of the WHO, and was rather taken  aback by the agenda they are proposing for the next decade.  In a nutshell, it read like an Oxfam policy document. And as we know, Oxfam and their ilk cling to a set of outmoded beliefs formed in the Senior Common Rooms of the radical 1960s. 

Anyway, to try and redress this, I thought it would be worth bringing the issue to the attention of the wider public.  You can read the results here.

Health fascism

It looks as if I was slightly inaccurate with the post below.  In fact, the BBC asked a representative of the WHO to appear on their programme to justify their decision to stop hiring smokers.

I can understand the WHO's sudden shyness as it is a slightly ridiculous position to defend.

At this rate, it won't be long before they stop hiring other people who in engage in risky behaviour.  Those who aspire to work at the WHO and are partial to a burger and a bit of booze should probably think about applying elsewhere.

And as for those who drive big, polluting cars...

Cluck cluck

I've been invited on to the BBC World Service's Newshour programme tonight (2000 GMT) to discuss World AIDS Day.

The producers also invited a representative from the World Health Organization to debate the issues with me. But they now seem to have pulled out on the basis that "they don't want to talk with" me.

Bearing in mind the huge amounts of money the WHO spends on PR and communications, you would have thought that they would be able to put up a pretty good spin doctor. But maybe a coherent defence of "3 by 5" is a task too far?

Who's WHO is it anyway?

Next week I'm off to Stockholm in order to participate in a consultation meeting with the WHO. This brings back memories of the few days I spent in Geneva last may for the World Health Assembly.  It turned out to be little more than a two-week boondoggle, at which there was very little meat for the truly sick and vulnerable people of the world.

High on the agenda were spurious initiatives against obesity and a global plan to ‘promote healthy lifestyles’. There was much talk of road safety and blood pressure. But there was not one session on Africa.

What is going on at the WHO?  Bearing in mind its limited resources, it should be focusing on genuine global threats such as avian flu, as well as communicable diseases that disproportionately affect the poor such as water-borne diseases and malaria.

Instead, the WHO has elected itself an international health nanny, lecturing mainly healthy people in rich countries about all kind of politically-correct health issues. It's surprising they don't yet have a global strategy on the dangers of running with scissors.

The problem is that the WHO is funded almost entirely by a handful of wealthy western countries.  So, in order to ensure this cash doesn't dry up, the WHO bureaucrats end up pandering to the priorities of Western politicians, instead of those of people in poor countries.

That means money is wasted on crazy schemes that try to regulate everything from baby formula to food additives, while at the same time millions of children in Africa struggle to eat at all.

The WHO has a chance over the next few years to get back to its core mission and stop trying to regulate the world.  Donor nations should really insist on this.

Read more: The World Health Organization: a time for re-constitution

The UN’s misguided pursuit of equality

It might seem obvious to readers of the CFD blog that market-driven economic growth is the best way to tackle global poverty and improve human health. At the UN, however, there is a firmly held belief that inequality between people and states is the real barrier to progress, and that a host of government-led interventions are needed to close the gap between rich and poor and meet the floundering Millennium Development Goals.

At the heart of this fixation with inequality is the belief that economic growth will only come to the poorest regions of the world if their people are better educated and healthier. What is needed, therefore, is a massive scale up of state education and health services, to be funded by buckets more aid.

Besides being completely unsustainable, this sort of approach is likely to have little impact on outcomes. Such government-run services are often woefully inefficient and corrupt, and their massive expansion would also be likely to crowd out the private sector. We know the private sector is capable of providing more efficient services for the poor - particularly in education, and even in healthcare.

The only way to meet the Millennium Development Goals is to encourage private-sector led economic development. This will improve health and with it labour productivity by allowing people to afford better living conditions, sanitation and health technologies. One study shows that if economic growth in lower-income countries had been just 1.5 per cent higher in the 1980s, at least 500,000 infant deaths could have been prevented.

It is discouraging that the aid industry does not share this perspective. Its obsession with inequality is likely to lead to towards ever more redistributive policy recommendations, which will undermine economic freedom and with it growth.

Isn't it time they tried something that actually works?

This argument is further elaborated in The Real Determinants of Health, published by International Policy Network.

WHO's chronic disease report challenges the activists

The WHO has just released its annual report on the global burden of chronic disease, in which it states that ailments such as cardiovascular disease, cancer and diabetes now account for 45 per cent of the global disease burden. Around 70 per cent of this burden now occurs in lower-income countries.

The WHO is right to point out that poor countries now suffer from an increasingly similar spread of diseases as rich countries. This is in some ways a positive finding, as the rise of chronic diseases is partly the result of more and more people living beyond middle age, thanks to greater global economic growth and prosperity.

What the WHO's findings do show is that activists' attempts to skew funding of R&D away from these so-called 'western' diseases towards tropical and neglected diseases are way off the mark.
People in lower-income countries are in just as much need of drugs for chronic conditions as those in the rich world. It is therefore right that global R&D patterns currently reflect the needs of the enormous number of people around the world that suffer from chronic disease.