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260 Fighting the Diseases of PovertySuch assertions could be regarded simply as wishful thinking,much like wishing for a peaceable kingdom where lions would liedown peacefully with lambs. Such a statement of wishes wouldnever be confused with reality, and moreover, would hardly besuitable material for a Preamble to a constitution.Yet these assertions must be taken as serious objectives and notjust as fond wishes about some ‘end of history.’ The Preamblereveals that the WHO’s self-identity is that of an entity which possessesprimary responsibility for health conditions throughout theworld. Within such an orientation, the WHO has primary responsibilityfor health, though as the first item in its Preamble states,health is not just as the absence of disease, but is everything thatmight be thought of as curtailing human happiness.Consider the WHO’s concluding assertion that “governmentshave a responsibility for the health of their peoples.” If we generalisethis statement about health to a statement about wealth, itwould read that governments have a responsibility for the wealthof their inhabitants. These formulations suggest that people cannotsecure wealth and health without government, for such things arebeyond personal reach. Unfortunately, the WHO is mired in the sameideas that dominated in the West at the end of World War II, which(while fading) are still a threat to liberty and prosperity.The bureaucratic gap between vision and realityThe WHO, like the other international organisations that were establishedafter World War II, is a global bureaucracy. The gap betweenthe vision characterised by the concepts of smallpox and MotherTeresa and the reality of the WHO’s actual conduct is an understandableresult of the institutional arrangements within which itwas constituted. By now, a considerable literature has developed toexplain the performance properties of public bureaucracies at thenational level. A brief consideration of the central themes of that literaturecan provide a foundation on which to consider the WHO andother international bureaux. 7