A 1999 World Bank analysis of its own donations for health projects in the previous ten years demonstrated that over two thirds of them had failed to deliver the expected benefits, and were deemed “failures.” Such is the world of aid, that even internal audits of projects show massive failure.
As a result, faith in the usefulness of aid and in the reputations of the dispensing agencies, has diminished from its peak in the 1960s. After 50 years of pursuing the U.N. aid model, its flaws are becoming too obvious to ignore. Aid expenditure continued to fall as a percentage of GDP to the end of the century, when AIDS gave it a shot in the arm.
Today, the World Health Organization (WHO) is benefiting from a turn in the tide of aid fatigue. Tens of billions of dollars are being pledged to deliver treatment to those afflicted by HIV/AIDS. But has anything really changed at the WHO?
Not really. The politically minded Dr. Gro Harlem Brundtland, who took over as general director in 1998, did much to raise the organization’s profile. Her predecessor, Dr. Hiroshi Nakajima, oversaw an ineffectual, and some said, corrupt regime, and there were high hopes for Dr. Brundtland. Although AIDS was a huge medical issue at that time, there was little political interest and it did not feature as a target for her time in charge. Instead, she chose to halve the number of global malaria cases and to establish a tobacco-control convention.
The “Roll Back Malaria” initiative has failed disastrously in the five-plus years it has been operating. Rather than reducing malaria rates, the number has increased by about ten percent since the WHO put political niceties above medical expediency. The WHO will not adopt insecticide spraying, which is the cheapest method for reducing the number of mosquitoes that transmit the disease.
The tobacco convention is in place, but one wonders why. Rather than going after infectious diseases (like cholera or dengue) in poor countries, or at least “involuntary” disease in rich countries (like cancer or hypertension), the WHO decided to go after “voluntary” smokers. It’s debatable whether smoking-related diseases should be classified as a public health issue at all–surely, it’s a private matter if you decide to smoke.
While there is merit in heading off a future problem, the main effect of the anti-tobacco convention has been to introduce a far-reaching power base from which WHO has launched other initiatives that encroach deep into private life.
No critical analyst or journalist seriously believed WHO that the tobacco convention was the only one WHO would establish in its campaign against lifestyle choices. Back in 2001, I attended one of the tobacco-control workshops organized by WHO. One journalist in the audience asked whether “alcohol and food were next.” The WHO officials insisted tobacco was different from other lifestyle issues. But, no sooner was the convention signed last fall, than the WHO announced an obesity initiative.
Of course, officially, this was set up by Dr. Brundtland’s successor, the Korean doctor, Lee Jong-wook. Dr. Lee himself is more interested in AIDS, but lower-level officials have been pushing hard for the obesity initiative. They have engaged in a fairly rancorous battle with William Steigers (aide to Health and Human Services Secretary Tommy Thompson), who has become a thorn in the side of the anti-corporate WHO obesity initiative. Targeting the Coca-Cola vending machines in schools seems to be the main thrust of the WHO obesity plan.
Dr. Lee has set AIDS as his main target. He, laudably, wants to treat three million Africans in a few years, trumping the two million target of President Bush. On account of the lack of public-health capacity, the high incidence of poverty, and the absence of political will in many African countries, this target is doomed to failure. But with insiders claiming that Dr. Lee wants to win the Nobel Peace Prize for promoting AIDS treatment in Africa, an heroic failure may do the trick.
The now-infamous report of the WHO Commission on Macroeconomics and Health advocates health investment as a “means to achieving other development goals relating to poverty reduction.” Essentially, the WHO is saying that countries, owing to disease, are too poor to grow. Although at first sight this seems a common-sense argument, it is obviously false, as no country in history could have ever developed! It takes managerial incompetence to really hold up development, but bureaucracies are immune to such nuance.
The commission says it needs $22 billion per year by 2007, and $31 billion dollars per year by 2015, in order to save eight million lives a year. These “saved” lives, it calculates, will become economically active and boost GDP many-fold, thereby repaying all costs. This is an awful lot of money based on an awful lot of supposition, but even this is only the beginning.
Naturally, most of the expenditure will come via WHO, since it apparently houses “the expertise.” As the U.S. is the largest funder of the WHO, it has the most to lose from failed policies. Fortunately, some Senate committees, notably Health, Education, Labor and Pensions, are beginning to look carefully at appropriations for AIDS. It’s not a moment too soon.
–Dr. Roger Bate is a visiting fellow at the American Enterprise Institute and a director of health-advocacy group, Africa Fighting Malaria.