The world has changed since the World Health Organization (WHO) was founded 75 years ago. Established as the specialized health agency of the United Nations in 1948, WHO has played a critical role in addressing global health challenges, disease control, and providing health services to neglected populations ever since. 

This week, global health leaders gathered for a panel alongside the agency’s 152nd Executive Board meeting to discuss the future direction. Vast advances in medical science mean that the challenges the WHO faces today are different from those in its past, but not any less numerous. From climate change to growing global economic inequalities, to pandemics like COVID-19, global health is under attack on all fronts. 

Between technological advancements in artificial intelligence, medical science, and digital health systems and the threats of climate change, growing economic inequalities and future pandemics, the global health picture for the coming 25 years is as menacing as it is hopeful. 

“By 2050, the future of health will be significantly different,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. “Robots in the operating room – I think initially was science fiction – but that happened in 1998, and now is very common,” he added, highlighting the exponential pace of scientific advancement. 

“But it’s not the last 75 years that matter now, it’s the next 75 years,” Tedros said. “All roads must lead to universal health coverage. So the question is, how do we create a future that will bring health to everybody?”

Too slow to adapt: WHO must modernize

Like its sister United Nations agencies and the multilateral development banks created to underpin the post-war international order, WHO has been slow to adapt to the ever-increasing pace of change in the modern world. 

“WHO was established 75 years ago. Its processes, its structures, and most importantly its mindset are stuck in the time 75 years ago when it was established,” said Bruce Aylward, Tedros’s Senior Advisor on Organizational Change. 

Achim Steiner, head of the UN Development Programme, echoed Aylward, saying the UN and its agencies must pivot away from being products of “post-Second World War realities” and towards 21st-century opportunities. 

Despite the slow pace of institutional change, WHO has achieved some historic victories. The eradication of smallpox in 1980, a virus estimated to have killed over 300 million people since 1900 alone, is justly seen as a medical miracle.

Efforts by WHO and partners also spearheaded the global campaign against polio, leading to a 99% decline in cases since the launch of the Global Polio Eradication Initiative in 1988, and led the charge in the fight against HIV/AIDS, providing technical and financial support to affected countries and working to improve access to treatment, care and prevention services.

But it has also faced its share of criticisms. Recent examples include its slow response to the 2014 outbreak of Ebola on the African continent and its handling of the early stages of the COVID-19 pandemic in 2020, when many argued that WHO was too slow to declare a global health emergency and coordinate a global response.

The agency is also chronically underfunded. With a budget of just $6 billion for the 2022-2023 period, the agency’s vast mandate often clashes with tight financial restrictions limiting what it can accomplish. A lack of trust in WHO within the communities it works with has also been a major obstacle to achieving its goals.

“If we had the trust of the communities we were working with, Ebola would have stopped way fast. COVID would have been managed way better,” Aylward said. “So we’ve got to be trusted in a way we aren’t today. We’re going to have to earn that.”

Civil society and younger generations need to be more involved

Part of the modernisation programme undertaken by WHO under Tedros’s leadership is the creation of the Youth Council, a network of youth representatives from health and non-health organizations aiming to leverage the “expertise, energy and ideas” of younger generations to assist WHO decision-making. 

“If you want to do something for young people, you have to involve young people,” said Dr Kerstin Vesna Petrič, chair of the WHO Executive Board. “The same is true if you want to do something for the most vulnerable, or for society in general: you have to involve civil society.”

The Youth Council met for the first time just four days ago, nearly 75 years after the agency’s establishment. Two other bodies – the Science Council, a research division, and the Innovation Hub, an accelerator programme – were established in April and May 2021 respectively. 

That these bodies are new reveals the historically insular nature of WHO, but also reflects a wider shift within the organization to expand its horizons beyond the bubble of the health world. 

“We have to move away from being a sectoral organization to a much broader one,” Aylward said. “It should be self-evident at this point: civil society has part of the answers, and the private sector has a big part of the answers.”

Nanjira Sambuli, a researcher and policy analyst at the civil society group Digital Impact Alliance, noted how long it has taken international institutions to engage with communities and stakeholders beyond Geneva.

“Multilateralism over the last 25 years has not really been a system accustomed to working with outsiders,” she said. “But I’m convinced that at the very least if we can leave behind systems and institutions that have done the groundwork, this generation that is inheriting these complexities lead the charge.”

UN agencies working as one

In an era of overlapping crises, WHO and its sister UN agencies have realized the need to deepen collaboration – a shift UN Development Programme director Achim Steiner said must continue. 

“We need integrated approaches. Health is as much dependent on addressing poverty as poverty is a way in which we have to look at the impact of climate change, and the need for adaptation,” Steiner said. 

An example of this kind of integrated approach is the WHO’s One Health Initiative, which launched its first joint plan of action at the World Health Summit in Berlin in October last year. 

The plan – a collaborative effort with the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), and the World Organisation for Animal Health (WOAH) – aims to break down the silos that have historically separated the work of these agencies to address threats to both health and the environment.

“We have to believe in interdependence,” Tedros said.

Digitization does not fix inequality

One of the inescapable forces driving changes to health systems is digitization. The potential for digitization to accelerate the progress of healthcare systems, improve in quality of care, and assist the world in achieving the Sustainable Development Goal of universal health coverage is enormous.  

But the speed of digitization, and the infrastructure needed to benefit from it, threatens to leave some of the world behind – and create new inequalities.

“Digital technologies will amplify what already exists,” said Nanjira Sambuli, a researcher and policy analyst at the civil society group Digital Impact Alliance. “We must not fall into the trap of imagining that poorly functioning public health systems can merely leapfrog ahead into the digital age.”

As developed countries enter a new era of digitized health systems, nearly one billion people in low- and middle-income countries lack access to health facilities with reliable electricity, with over 430 million people served by facilities with no electricity at all.

“Digital public infrastructure and a deep commitment to equitable access are fundamental,” Steiner said. “At the end of the day, much of what happens in our world is ultimately premised on either the ability to invest, to buy, or to afford to pay for a service.”

‘The World Happiness Organization’

As the panel drew to a close, a final question was raised: should the WHO consider a change in name to reflect the new scope of the organization’s definition of health – perhaps to “The World Happiness Organization”, the moderator mused.

Tedros said he saw no need to change the acronym – after all, as long as human beings are around, there will be health issues to contend with – suggesting instead that the world’s defence ministries that shift their mission towards happiness, and away from war.

“Two trillion US dollars a year are being spent on defence, to kill each other,” Tedros said.  “Then when we say we need more money for health, it doesn’t exist.”

The budget of the WHO is currently $6 billion, 0.3% of what the world spends on defence.  

Image Credits: United States Mission Geneva, John Samuel.