Leadership in Health: A Renewed Opportunity
SCOTT C. RATZAN
‘‘Health is now the most important foreign policy
issue of our time.’’ This quote was heralded on the cover
of the Lancet’s 21 October 2006 edition. Later in 2006, it is anticipated
that three of the leading public health institutions will choose new
leaders — The World Health Organization, the Global Fund to Fight
AIDS, Tuberculosis and malaria, and the World Bank Health Programme
section.
While these have important roles as ‘‘public
health ’’institutions — health as we know it could be
embodied in new health leadership that addresses the fundamental fabric
of society. However, the reality is that the world looks for leadership
when health crises develop, and has created agencies and multilateral
institutions that have not been as effective as they could be.
The World Health Organization and many of the related
UN organizations (e.g. Unicef, UNAIDS, etc.) have good intentions. They
are organized with multi- disciplinary representation recognizing that
diseases such as HIV,avian influenza, and non-communicable diseases
do not carry passports and are transnational by definition.They play
an important role in setting technical standards and regulatory recommendations
for many countries that do not have extensive resources such as the
U.S.Food and Drug Administration or the European Medicines Agency.
The WHO selected Dr.Margaret Chan of China,as their next
Director General. She faces a variety of challenges that will draw upon
her recent expertise of preparing for pandemic flu and work with Sudden
acute respiratory syndrome (SARS).Her experience as Assistant Director-General
should help advance an strategic agenda that includes work she espoused
in prior public health activities in preventive and promotive health
care services,initiatives to improve communicable disease surveillance
and response,enhance training for public health professionals,and to
establish better local and international collaboration.
Yet, as the newly elected leader,now is the time when
the agenda setting and bully pulpit opportunities have great potential.
Eradication of small pox and the Framework Convention on Tobacco Control
are perhaps the most visible success stories of the WHO in the past.
Nearly a year ago,at a pledging conference on avian and
human pandemic influenza held in Beijing (17 –18 January 2006),
Dr.Chan warned: ‘‘Whatever resources you put in place —compared
to the potential pandemic cost — it is peanuts. It is nothing.’’
Such proclamations helped galvanize support as fear motivated
donor governments to action for early warning systems, capacity building
and containment and research. Today, with development of extensively
drug resistant tuberculosis, HIV / AIDS incidence unabating,malaria
challenges as well as the lack of human resource capacity in health
care, a renewed strategic planning and implementation is necessary for
success. A similar proclamation of priorities and request for resources
and integration of health more extensively would be timely.
It is time for the WHO to engage in the larger issues
of our time that expand beyond communicable disease to one of the principal
tasks embodied in the WHO constitution: ‘‘The extension to
all peoples of the benefits of medical, psychological and related knowledge
is essential to the fullest attainment of health.’’
This larger goal requires thinking beyond disease silos
to a value driven, evidence-informed approach to health policy. The
disease preparedness and scientific standards of the WHO should continue
to be the foundation. Dialogue, discourse and action to enhance trust
with the ethical and moral compass should help engage other health leaders
to share the courage to address the health challenges of the 21st Century.
One of the greatest challenges is to adapt and reassert leadership for
a multitude of stakeholders —including large foundations, bilateral
donor programs, civil society institutions and the private sector. We
share an important goal to avert and prevent premature death in both
the developed and lesser-developed world. We may be aware that spending
on medical care alone is misguided as a solution to address such issues,
as it has been estimated to account for only about 10 –15% of premature
deaths.
Attainment of health is a goal that will continue to challenge
humankind. Communication is a key component for galvanizing key leadership
to think ‘big’ and initiate change for the better. Advancing
the World Health Organization ’s goal to advocate for global public
health in multiple arenas is a worthwhile contribution in the crowded
context of modern society.
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Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also is Vice
President, Government Affairs, Europe for Johnson & Johnson with
academic appointments at George Washington University School of Public
Health, Tufts University School of Medicine, Yale University School
of Medicine, The College of Europe, and University of Cambridge.
