WHO Cares?

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

Brian Doherty from the January 2002 issue

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WHO's main success story remains its role in eradicating smallpox. Sometimes, though, it seems to believe the world will be impressed with the sort of thing that really occupies it these days. One WHO propaganda book lists five things we'd be missing in "A World Without WHO" -- presumably what it considers its most important achievements. None of them had to do with curing a single disease in a single person. Instead, they aver that in "a world without WHO -- national health officials would not be able to count on global moral support in their battle against tobacco addiction," and "there would be no unifying moral and technical force to galvanize, guide and support countries in achieving health for all by the year 2000."

By the end of the 1970s, WHO's official rhetoric about its core purpose began to shift from simple disease eradication. In 1978, at a joint meeting of WHO and UNICEF in Kazakhstan, in the former Soviet Union, WHO adopted "World Health for All by 2000" as its goal. This conclave of international bureaucrats vowed that, by the close of the 20th century, "All governments will have assumed overall responsibility for the health of their people -- through influencing lifestyles and controlling the physical and psychosocial environment." An "equitable distribution of health reserves, both among countries and within countries -- is therefore fundamental to the strategy." This plan was "part of that fundamental reorganization of human relationships in the world through the search for a New International Economic Order."

Meet the New Boss

By the mid-1990s, WHO was mired in what the British Medical Journal called "a morass of petty corruption and ineffective bureaucracy." Under Director General Hiroshi Nakajima, a Japanese pharmacologist, WHO was so widely understood to be mired in cronyism and financial irregularities that such longtime boosters as Denmark and Sweden slashed their contributions; even the group's official auditor resigned in disgust. Nakajima's prominent position was important to Japanese self-esteem, so Japan embarked on a campaign in 1993 to make sure he was re-elected to a second five-year term. Among other gambits, the Maldives and Jamaica were warned that Japan would stop importing anything from them if Nakajima didn't get their vote.

Nakajima got his second term, but in 1998, with WHO morale and reputation at an all-time low, he was replaced by Gro Harlem Brundtland. With a masters in public health, Brundtland had spent most of her career as a politician, serving three terms as prime minister of Norway. She had also founded and led the UN's World Commission on Environment and Development. As WHO's new head, she promptly announced such vital-to-health goals as ensuring that six of every 10 new hires would be women.

In a world still fighting infectious disease, Brundtland's WHO has issued statements, studies, and reports on such topics as blood clots in people who sit still on airplanes too long, helping people remain active while aging, the hazards of using cell phones while driving, the importance of debt relief for poor countries, how tobacco is "a major obstacle to children's rights," and rates of alcohol abuse among European teens. The Lancet, the respected British medical journal, summed up her priorities thusly: "Brundtland has so far set out a conspicuously political agenda: her targets are poverty, underdevelopment, and social inequality."

To her credit, she has tried to reduce the amount of money spent at WHO's posh headquarters. She has succeeded in lowering her own annual office expenses by $4 million over the next two fiscal years. She has also moved malaria control back near the top of the group's agenda.

Not to her credit, she has continued WHO's turn from combating disease in its traditional -- and curable -- definition of infectious biological entities to an agenda of social control meant to stop people from indulging in freely chosen, if risky, pleasures.

Hence, when Brundtland launched two "cabinet-level" priorities, one was a "Tobacco-Free Initiative" that now costs $14 million a year. (Malaria control is the other.) What does WHO expect to accomplish in aiming its resources and rhetoric at tobacco smoking? In characteristically vague WHO language, the initiative is meant to "galvanize global support for evidence-based tobacco control policies," to "accelerate -- strategic planning," and to "integrate tobacco into the broader agenda."

More specifically, the initiative's goal is to browbeat member nations into banning cigarette advertising and massively increasing cigarette taxes (never mind that such a policy may lead to black markets and attendant criminality). Backing WHO on this are several major pharmaceutical companies that have traditionally been enemies of the organization, which has long criticized what it considered the companies' brutal hegemony over poor nations. The pharmaceutical companies are thrilled that an international agreement might create an enforced market for non-smoking nicotine delivery devices, allowing drug makers to rip a chunk of the nicotine market from the grip of the tobacco barons.

In its war on tobacco, WHO has attempted Orwellian moves of almost absurd incompetence. In 1998, for instance, the group was supposed to release an enormous 10-year study on second-hand smoke's links with lung cancer, the largest ever done in Europe. A small mention of it was printed in a WHO report before the whole study was available. The British Sunday Telegraph tried to get a copy of the study, since the brief reference intriguingly implied that it could not find a statistically significant link between second-hand smoke exposure and lung cancer. The Telegraph implied that WHO was trying to bury the report since its results went against their official anti-tobacco stance.

WHO and other anti-tobacco groups were outraged. One group, Action on Smoking and Health, filed an official complaint with Britain's Press Complaints Commission over the supposedly erroneous reporting. (The commission found in the Telegraph's favor.) WHO responded to reports that its study did not find a statistically significant link between second-hand smoke and lung cancer in a press release headlined, "Passive Smoking Does Cause Lung Cancer, Do Not Let Them Fool You" -- strange, strained language from a supposedly scientific organization.

Underneath that colorful headline, the press release states, in italics, that "passive smoking causes lung cancer in non-smokers." Then, in the very next paragraph, it clarifies, "The study found that there was an estimated 16% increased risk of lung cancer among non-smoking spouses of smokers. For workplace exposure the estimated increase in risk was 17%. However, due to small sample size, neither increased risk was statistically significant." In other words, the Telegraph report was exactly correct: The study had found no statistically significant link between second-hand smoke and cancer.

As for the "suppressed" part, WHO insisted that the paper was merely being peer-reviewed, not hidden. Yet three years later, you'll still find no mention of the report on WHO's list of "Comprehensive Reports on Passive Smoking by Authoritative Scientific Bodies."

Is WHO a Bargain?