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Surveying the Global Governance of Health

Wilson Center Fellow Nitsan Chorev is researching the World Health Organization's evolving health intervention strategies, from technical assistance to market-based solutions. Her forthcoming book will delve into the geopolitical and economic dynamics that have shaped global strategies to fight disease.

When potential pandemics appear, such as the recent swine flu scare, the World Health Organization (WHO) receives a lot of attention from the press, which presents it as a global scientific institute that relies on medical expertise to monitor epidemics.

However, "dealing with diseases is not purely scientific or medical," said Wilson Center Fellow Nitsan Chorev. "There are major political and economic considerations that come into the decision-making process." Her forthcoming book delves into the politics behind the WHO's strategies.

Chorev's research considers three periods in the WHO's history, each characterized by a distinct logic of intervention. During the first phase that began in the 1950s, the WHO focused on utilizing available scientific advances to address specific diseases, such as malaria and smallpox. "This period celebrated WHO as a technical entity," Chorev said, "that intentionally avoided explicit political confrontations."

By the 1970s, the WHO abandoned the strategy of disease-specific interventions. Thus began the second phase, which celebrated equity and focused on helping those who needed it most, particularly the rural populations. "This new agenda focused on primary health care and community health," said Chorev. "The thought was that poorer countries should focus on basic health services, not on high-tech medical treatments."

Basic health and equity meant rebuffing expensive pharmaceuticals and technology, which sparked conflict between the WHO and multinational pharmaceutical companies. Trying to rationalize the market, the WHO urged poor countries not to buy drugs that are not essential, and advocated international regulations for pharmaceutical marketing.

Chorev said the WHO's new focus -reflected broader political-economic transformations in the South, particularly attempts of industrialization by means of import-substitution and calls for a New International Economic Order (NIEO) that would change the rules of exchange between North and South to permit such industrialization.

By the 1990s, however, WHO policies again shifted. Primary health care was abandoned in favor of addressing specific diseases, including, importantly, HIV/AIDS. Unlike the 1950s, however, the WHO found itself in partnerships with other UN agencies and the World Bank. Even more radically, compared to the 1970s, the WHO also forged partnerships with the private sector. Some partnerships focused on distributing existing drugs and vaccines while others were started to develop new drugs.

In her book, Chorev traces these recent developments to the adoption of neo-liberal economic strategies by developing countries, which changed their perception of what role multinational corporations should play. She suggested one of the biggest concerns is the shift from equity to efficiency.

"With the rise of public-private partnerships, UN officials no longer run the show," Chorev said. "Instead, managers and former businesspeople—who tend to think like donors, not like recipient countries—are the ones in charge."

Chorev's book traces the political-economic logic behind each set of global health policies, showing the WHO "as a microcosm encapsulating the changing relations between rich and poor countries, multinational corporations, and the UN."

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