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5. The WHO in Crisis
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124 5 THE WHO IN CRISIS 1. “Health for All and Development,” Address by Dr. H. Mahler, Director-General of the World Health Organization at the Conference on Italian Health Cooperation Activities in African Countries, Rome, Italy, 3–4 December 1987. WHO Library. The missionary zeal that characterized Mahler turned into despair toward the end of his tenure. In an address in December 1987, Mahler mourned the failure of North-South talks. I have to say in all sadness that negotiations over any kind of new international economic order have reached beyond the state of even being frustrating; they have simply been shelved. And when they did take place, instead of dialogues they took the form of parallel monologues . . . . [It] is a matter of serious soul-searching. For not only has the gap between the “haves” and “have-nots” remained steadfast, it has grown even greater. Admittedly, some few “have-nots” have graduated to the ranks of the “haves,” but the plight of the majority has become more sorry than ever.1 The demise of the New International Economic Order was reflected in the disintegration of NIEO-related programs, including Health for All and primary health care at the WHO. The crisis was not limited to specific programs, and it extended to the organization itself. Starting in the late-1980s, the WHO suffered from financial instability, its authority was undermined by competing institutions , and its stature as a legitimate institution was put into question. THE WHO IN CRISIS 125 The financial, authority, and legitimacy predicaments at the WHO were caused by a radical transformation in the exogenous environment: starting under the leadership of President Ronald Reagan,and with pressure from an impatient Congress , the U.S. government made explicit its discontent with the dominance of Third World countries in UN agencies and vowed to fight back. Opposition to the NIEO, which advocated economic nationalism, intensified due to the rise of neoliberal thought spearheaded by the Reagan administration in the United States and elsewhere, which posited that economic growth could only be achieved through the self-efficiency of markets (Harvey 2005). Criticisms were aimed at UN-led initiatives and programs,but also at the alleged organizational malfunctioning of UN agencies, including irresponsible budget growth and managerial incompetence. To generate the desired policy changes,the United States exploited the intensified economic vulnerability of developing countries in the context of the major debt crisis of the early 1980s. Taking advantage of developing countries’ pressing need for renewed loans, the Reagan administration not only put an end to NIEO negotiations, but also introduced policies compatible with the neoliberal agenda into international organizations, especially the IMF and the World Bank. Under the new conditions, the United States and other industrial countries were also able to exploit, to a greater extent than in the 1970s, the resource dependence of international organizations. As a result of these pressures, the WHO experienced a crisis during the transition to the neoliberal logic. The WHO, which in the past had been highly regarded, was now resented for its NIEO-compatible policies, especially those affecting multinational companies. Starting in the early 1980s, and peaking during the tenure of Director-General Hiroshi Nakajima, who succeeded Mahler in 1988, the WHO experienced mounting exogenous pressures, which threatened the organization’s finances and undermined its authority. The financial crisis was the result of a new budget policy, of zero growth, which developed countries forced on UN agencies. In addition, some countries, including the United States, did not pay their assessments in full. Rich countries also began contributing voluntary, rather than mandatory, donations to the WHO, which provided the donors, rather than the World Health Assembly as a whole, control over those funds. The authority crisis, in turn, occurred when other international organizations, including the World Bank and, in 1996, a newly established Joint United Nations Programme on HIV/AIDS (UNAIDS) developed global health policies and programs that directly competed with the WHO. In addition, the WHO suffered from a leadership crisis, as Hiroshi Nakajima, who was elected director-general against the position of the U.S. government, was blamed for weak leadership, poor management, and even cronyism and corruption. The mistrust in Nakajima likely contributed to the financial and authority crises, and it made the WHO secretariat unable to effectively respond to them. [44.200.101.170] Project MUSE (2024-03-28 13:46 GMT) 126 CHAPTER 5 2. “U.S. Policy in the United Nations,” Hearings and Markup before the Committee on Foreign...