Understanding global security - Peter Hough

HEALTH THREATS TO SECURITY
of WHO activities from the mid-1970s. Godlee comments that the new strategy of
primary health care ‘marked a new policy direction for WHO, leading the organisation
out of the quiet waters of technological consensus into the much more troubled
waters of political controversy’ (Godlee 1994 : 1492).
The horizontal approach to global health has met resistance from some states
because technical quick-fixes remain popular in spite of some notable setbacks. As
seen in other global issue areas, disasters trigger responses from the international
community better than ‘routine’ suffering, and tackling epidemics head-on remains
an instinctive response. In addition, despite the retreat over malaria, other ‘fire fighting’
successes, such as with smallpox and polio, continue to encourage the vertical
strategy. The extra-budgetary funds allocated to the WHO, which finance the diseasespecific
programmes, have grown since the late 1970s while the regular budget has
been frozen. This has had the effect of counter-acting against the horizontal ethos
expounded by the World Health Assembly and Executive Board and, in the minds
of some, has served to undermine the achievement of global health security.
it is not clear whether diverting health budgets from primary health care
towards HIV projects is necessarily serving best even those affected by the
disease . . . more effort seems to have been put into finding a vaccination or
cure through medication. The question remains, however, whether the majority
of those falling ill in the poorer countries would ever be able to have access to
the cure if it existed.
(Koivusalo and Ollila 1997: 221–222)
The WHO’s horizontal strategy also steered it into troubled waters by
challenging the orthodoxy on economic development by seeming to favour greater
LDC independence and local empowerment over MNC investment. This was most
clearly demonstrated in the ‘essential drugs’ campaign, launched in 1977, which
promoted the domestic development of pharmaceuticals in the Third World over
their import from the First World. A contributory factor here was that the WHO, like
the UN General Assembly, had become radicalized by the arrival of new member
states from Africa and Asia, keen to vent their frustrations against their past and
present dominators and able to do so through its egalitarian voting system. The USA,
as the state most supportive of the spread of MNC influence, became increasingly
exasperated with the new, bolder WHO. A humiliating 118 to 1 vote at the 1981 World
Health Assembly, on adopting an international code to curb the export of infant
milk substitutes to LDCs, and long running disagreement over the essential drugs
programme contributed to the USA’s general disillusionment with the whole UN
system that saw them cut their regular budget contributions in the mid-1980s.
The USA’s protest had the effect of tempering WHO ‘radicalism’ and, although
primary health care remains a core ideal, Godlee contends that the organization
in the 1990s had ‘sunk into a political vacuum’ (Godlee 1994 : 1495). As evidence of
this she contrasts the modest 1990s WHO crusade to discourage cigarette smoking
in LDCs against the vigorous and successful 1980s campaign against infant milk
substitutes, which followed on the back of the adoption of the International Code.
Similarly, the Lancet contended that the WHO had lost its direction and suffered
a ‘loss of the intellectual leadership’ (Lancet 1995: 203). The WHO in the 1990s
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