WHO Cares?

The World Health Organization cares more about its own life than the lives of the poor.

Paul Dietrich was visiting Mozambique's capital city, Maputo, during its civil war in 1984, when an educational billboard taught him a lesson he never forgot.

Dietrich, a former publisher of the old weekly Saturday Review, was in Africa working with a Catholic charity. He was driving in his Land Rover, the only working motorized vehicle for miles. Poverty-stricken people surrounded him, most of them on foot, though a lucky few rode oxen. The billboard was the only one he'd seen in all Mozambique. Though most of the chaotic, war-torn country was plagued by regular power outages, the sign had its own electrical supply. This billboard was paid for by the World Health Organization (WHO), the international bureaucracy created, in the words of its constitution, to "promote and protect the health of all peoples."

It urged the people of Mozambique to remember to buckle their seatbelts.

It also helped cement Dietrich's doubts about WHO's vision and mission. After seeing that billboard, and contemplating what it said about WHO's priorities and goals, he became one of WHO's most vocal critics. In the early 1990s, Dietrich served on the development committee of the Pan American Health Organization (which functions as an American branch office for WHO). He has also been president of the Institute for International Health and Development. Dietrich wrote about WHO frequently for The Wall Street Journal, and provided material for exposés of WHO shenanigans on 60 Minutes and various TV documentaries in Europe (where WHO's activities are minded far more closely than in the United States, even though the U.S. provides 22 percent of the organization's regular budget).

Dietrich publicly and repeatedly complained that WHO was a bureaucracy for bureaucracy's sake, mired in useless statement-making and conference-giving. He thought it focused too much on First World concerns -- such as seatbelt campaigns and smoking -- and not enough on the developing world's sick and poor.

For his troubles, Dietrich became the target of a WHO-sponsored investigator who dug into his and his wife's background, finances, and politics. Dietrich only learned of the investigation when a mole in WHO's Geneva headquarters faxed him a copy of the final report. WHO singled out Dietrich, now an investment banker, in an August 2000 report that received heavy play in the New York Times and Washington Post. The report, dedicated to the tobacco industry, claimed Dietrich's motives were purely mercenary. He was named as a paid agent in a sinister international tobacco industry scheme to discredit WHO. The truth, Dietrich tells me, is far less sexy: A law firm he had worked for did work for tobacco companies, along with almost every other Fortune 500 company.

To WHO, which claims to be devoted to science in the name of public health, Dietrich's observations and conclusions should be nullified by its ad hominem assault. Dietrich's primary complaint, though, will resonate with anyone who assumes that an international health organization's resources should be primarily aimed at the direct control and eradication of infectious diseases, rather than at behavior modification programs concerned with such matters as seatbelts and smoking.

But WHO's agenda is more ambitious than merely bringing medical care to the world's disadvantaged. Health, in a definition the group adopted over 20 years ago, is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." That is a totalist vision, and an alarming one. Armed with a bureaucrat's mentality, an arsenal of questionable data and conclusions, and a billion dollars in taxpayer money donated by governments around the world, WHO's goal seems not so much to bring the world "health" as a physical condition as it is to bring the world under the control of the international mavens of "public health," the sociopolitical discipline.

But WHO is more an organization fighting for its life than one fighting for real power. As curable infectious diseases become a less significant factor in world mortality rates, WHO's budget has stagnated at around $1 billion a year for nearly a decade now. Various other huge bureaucracies -- such as the U.S. Centers for Disease Control and the World Bank, whose budget on international health matters is slightly higher than WHO's -- have poached on its turf.

Why, to borrow Paul Dietrich's question, is WHO concerned with seatbelts and smoking when the world's poor are still dying of measles and tuberculosis? Public choice analysis -- which presumes that government agencies, like their private-sector counterparts, seek to grow their market share -- suggests an answer: Since the WHO's funding is mostly from First World governments, making them its relevant "customer base," it caters to First World concerns. WHO's recent history has been a vivid example of bureaucratic mission creep. In expanding its purview far beyond the merely medical, WHO is trying to stave off extinction.

Amazing Journey

War, the radical journalist Randolph Bourne wrote, is the health of the state. Bourne meant that war creates a sense of crisis and embattlement, making citizens ready to cede their liberty to gain a sense of security.

But governments continually seek new excuses to expand their authority. Nearly a century after Bourne wrote his famous words, risk protection has become a central mission for governmental bodies. As Sheldon Richman, editor of the libertarian journal Ideas on Liberty, has put it, health is now the health of the state. Richman's observation deserves to be carved in marble in the plush Geneva offices of WHO.

WHO was founded in the wake of World War II, in a wave of optimism over the ability of international bureaucracies to create and direct a safe and sane world. With its mission concentrated on managing or eradicating infectious diseases worldwide, the group had some notable successes and some near-successes. It helped coordinate the international effort to eliminate smallpox, officially vanquished as of 1977. A WHO document uses clotted official prose to describe the group's role in the smallpox battle. WHO says its contribution was in "its energy and prestige as a catalyser of global efforts bringing together scientists, governments, health workers, and ordinary citizens," and that "technical difficulties -- were overcome through prompt WHO-coordinated research." The group also stressed the importance of "its neutrality and independence of national rivalries and suspicions."

WHO also played a major coordinating role in controlling yaws in the late 1940s and onchocerciasis ("river blindness"), leprosy, and polio in the past three decades. A WHO-organized Malaria Eradication Program in the '60s made substantial progress in stemming that disease. As late as 1964, WHO publications expressed optimism that malaria would be wiped out. Alas, malaria resisted eradication and the disease still kills over 1 million people a year. (The demonization of the U.S.-banned pesticide DDT, the cheapest and most efficient tool for killing the mosquitoes that spread the disease, bears a large part of the blame for the continued death toll.)

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