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

(Page 3 of 4)

Treating the behavior of tobacco smoking as a "disease" that must be eradicated by international bureaucrats is bizarre enough. But WHO's full agenda of social control is even more starkly evident in documents surrounding one of their biggest research projects of the 1990s. The project was done in collaboration with the Harvard School of Public Health. (WHO is almost never the sole element in any of its programs.) It was a study on the "Global Burden of Disease and Injury," an attempt to calculate out to the year 2020 what will be the major causes of ill health and death all over the world.

The document is essentially an extended cri de coeur to the world not to let WHO fade away, even as infectious diseases shrink in global significance. (Strangely, WHO has never been a leader in the fight against AIDS, the most-discussed infectious disease of the past 20 years; the group has been relegated to simply one bureaucratic partner, along with the World Bank, UNICEF, and others, in the umbrella program UNAIDS.)

As a result of its embattled position, WHO has a skewed vision of medical progress. Most observers see the shift in leading causes of death -- from communicable diseases such as smallpox and measles to noncommunicable ones such as heart disease and cancer -- as a sign of success. If everyone has to die, better that it should come from being too fat or too old. The shift from communicable to noncommunicable diseases as causes of death reflects general increases in wealth and lifespan. But for WHO, such progress is life-threatening to its own organization.

In the "Global Burden" summary document, WHO admits that its entire 10-volume edifice of quantification is built on a foundation of sand. It claims to be calculating what will end the most lives worldwide by 2020. Yet it admits, "In many countries, even the most basic data -- the number of deaths from particular causes each year -- are not available." Further, "estimates of numbers killed or affected by particular conditions or diseases may be exaggerated beyond their demographically plausible limits by well-intentioned epidemiologists who also find themselves acting as advocates for the affected populations in competition for scarce resources. If the currently available epidemiological estimates for all conditions were right, some people in a given age group or region would have to die twice over to account for all the deaths that are claimed."

The study relied on a bit of numerical chicanery, originally developed by the World Bank: the "disability adjusted life year" (DALY). This is a complicated bit of scientism designed to quantify the effects of illnesses in terms of years of life lost. The DALY is based on the principle that a year living with certain conditions isn't really like a year of living. It allows WHO to make a big deal about "unipolar major depression," which it predicts will be the number two cause of "disease burden" by 2020, even though the ailment is not known to kill many people.

DALY is not objectively verifiable -- WHO came up with its numbers by asking a bunch of health workers how much they thought certain ailments reduced the value of a year of their life. So now science has demonstrated that below-the-knee amputation is somewhere from 0.22 to 0.36 "severity weights" more terrible than vitiligo (the "whitening" disease famously suffered by Michael Jackson) on your face. A small group of people's raw opinions were transformed through WHO's alchemy into hard public-health science.

It is only through the DALY that WHO can weigh mental illnesses as high on their global burden of disease as they do. Emphasizing such illnesses -- WHO claims that 16 percent of "years lost to disability" in sub-Saharan Africa are due to mental illness -- fits in well with the group's totalist agenda. After all, treating such illnesses often requires doing things to the "patient" against his will. At a point in history when its rationale is thankfully diminishing, WHO is maniacally reinventing itself as the agency that might solve every problem that hurts or disables anyone. (They emphasize traffic accidents and injuries in this report, though it is uncertain what a health authority can do to stop them.) The shoddy numbers and tendentious definitions -- smoking, drinking, and sex are all classified as "risk factors for disability or death," a rhetorical trick to disarm anyone who would defend someone's right to indulge in them -- enable an agenda of massive social control.

Let's See Action

When reading WHO's reports, press releases, and other documents, one struggles to find non-abstract nouns and verbs representing actions a human being might need a body to perform. While infectious diseases are thankfully becoming a less significant cause of death globally, they do still kill at least 3 million children every year, so one might expect WHO's rhetoric to be dominated by talk of inoculation and cure. Instead, one overwhelmingly finds talk of forming coalitions to manage and monitor systems that lay the groundwork for plans to coordinate actions to develop the knowledge and skills necessary to begin the process of forming coalitions, repeat as necessary.

WHO's 2000 annual report was dedicated not to improving health, but to improving health systems -- a permanent task for bureaucracies. "Ultimate responsibility for the performance of a country's health system lies with government. The careful and responsible management of the well being of the population -- is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent," Director General Brundtland wrote in her introduction. This emphasis fits perfectly with WHO's love of the bureaucratic and managerial, as opposed to the medical and action-oriented. (Unsurprisingly, WHO ignores the findings of health economists that health care systems qua health care systems don't appear to account for more than a handful of the years of additional lifespan that human beings have gained on average in the past century.) Given the group's agenda, it's no shock that the portion of WHO's budget dedicated to communicable disease prevention, eradication, and control is set to fall by $30 million over the next two fiscal years.

To WHO, health systems are more important than health outcomes. Its rhetoric sometimes acknowledges this, as in a WHO document that avers its activities are aimed to "strengthen the health sector at a country level." And the health of WHO's own system might be the most important thing of all. An analysis of WHO's 1994�95 budget, done by economists Richard Wagner and Robert Tollison, found that WHO spending on meetings and its executive board equaled its spending on immunizations, tuberculosis, and diarrheal diseases combined. (A more recent analysis of spending on bureaucracy vs. programs would be harder to do, since WHO's official budget figures are now broken down only in terms of countries and disease clusters, not what the money is actually spent on. Given that, there's no way to know whether money is spent on, say, a conference dedicated to discussing a disease or actually going into the field to treat it.)

WHO's obsession with system over result can also be seen in the fact that, although the U.S. populace is in most respects healthier than that of Third World countries that try to centrally manage health care, WHO wants to eliminate fee-for-service medicine entirely.

If anything, WHO seems proud of the excessively bureaucratic nature of its work. It issues press releases celebrating its role as middleman between a pharmaceutical company donating needed drugs and the organization Doctors Without Borders, which actually goes into the field to administer them. WHO is an organization by and for bureaucrats and health ministers -- for whom it provides jobs, fellowships, and chances to go to conferences in exotic vacation spots -- not the world's sick. At its worst, it is an active proselytizer for aiming national and international health resources at things irrelevant to actually fighting disease. If the world wants a transnational organization funded from tax dollars to propagandize and nag us about our chosen behaviors, let them try to sell such a proposition openly.

WHO officials defend themselves against accusations of uselessness by stressing that healing the sick isn't really what they are all about. "We're a scientific agency," Dr. Anthony Piel, a former chief advisor to WHO's director general, told a British television reporter. Asked why they keep their headquarters in cushy, elegant, and quite healthy Geneva, Piel said, "We have looked into moving the WHO to other poorer countries -- where the cost would be lower. -- But the last time we studied that we considered, for example, Yugoslavia, we considered Lebanon, Jordan, Tanzania, and Rwanda. -- " WHO seems to have a hard time thinking of any cheap place closer to real health problems that isn't a war zone.

WHO's flaws and misdirected ideology, however sinister their potential implications, are more a matter of bureaucratic turf-building and feather-bedding than a fiendishly executed world control agenda. Faced with the reality that as a science and research organization they are more of a clearinghouse; that as an international researcher and advisor on health matters they often take second place to the World Bank (WHO's own reports are far more likely to site substantive research done by the World Bank than any of its own original work, of which there is very little); and that in their First World-oriented agenda they are merely another bureaucratic layer echoing already existing national health ministries and the initiatives of other non-governmental organizations and international bureaucracies, WHO is scrambling frantically for its life. But it needn't worry too much. Bureaucracies, once created, almost never leave the stage, as their own will to live energizes them to a degree that surpasses their opponents' interest in eliminating them.