The World Health Organization between North and South

The World Health Organization between North and South

Nitsan Chorev
Copyright Date: 2012
Edition: 1
Published by: Cornell University Press
Pages: 288
https://www.jstor.org/stable/10.7591/j.ctt7z988
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  • Book Info
    The World Health Organization between North and South
    Book Description:

    Since 1948, the World Health Organization (WHO) has launched numerous programs aimed at improving health conditions around the globe, ranging from efforts to eradicate smallpox to education programs about the health risks of smoking. In setting global health priorities and carrying out initiatives, the WHO bureaucracy has faced the challenge of reconciling the preferences of a small minority of wealthy nations, who fund the organization, with the demands of poorer member countries, who hold the majority of votes. In The World Health Organization between North and South, Nitsan Chorev shows how the WHO bureaucracy has succeeded not only in avoiding having its agenda co-opted by either coalition of member states but also in reaching a consensus that fit the bureaucracy's own principles and interests.

    Chorev assesses the response of the WHO bureaucracy to member-state pressure in two particularly contentious moments: when during the 1970s and early 1980s developing countries forcefully called for a more equal international economic order, and when in the 1990s the United States and other wealthy countries demanded international organizations adopt neoliberal economic reforms. In analyzing these two periods, Chorev demonstrates how strategic maneuvering made it possible for a vulnerable bureaucracy to preserve a relatively autonomous agenda, promote a consistent set of values, and protect its interests in the face of challenges from developing and developed countries alike.

    eISBN: 978-0-8014-6392-1
    Subjects: Political Science

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-xii)
  4. 1 THE WORLD HEALTH ORGANIZATION
    (pp. 1-16)

    In his address before state delegates at the World Health Assembly, on May 15, 1975, the director-general of the World Health Organization (WHO), Dr. Halfdan T. Mahler, spoke of the “changes that are rapidly taking place in the political and economic relationships between Member States.” He boldly predicted that “1974 will be remembered by many of us, and possibly by future historians, as a turning point in our thinking about the future social and economic development of mankind.”¹ In 1974, the United Nations (UN) General Assembly had passed a resolution calling for a New International Economic Order (NIEO), which was...

  5. 2 THE STRATEGIC RESPONSE OF INTERNATIONAL ORGANIZATIONS
    (pp. 17-41)

    How can we explain the selective correspondence between external pressures—the call for a New International Economic Order in the 1970s–1980s and neoliberal thought in the 1990s–2000s—and WHO policies and programs in the respective periods? I address this question by analyzing the strategic response of international bureaucracies to exogenous demands. To that end, the first part of the chapter describes my approach to international organizations. Like constructivist and principal-agent theories, this approach conceptualizes international bureaucracies as purposive actors who function within limits of external constraints. By emphasizing the likely tensions between international bureaucracies and member states, however,...

  6. 3 A NEW INTERNATIONAL ORDER IN HEALTH
    (pp. 42-85)

    By the early 1970s, the global political-economic conditions that had informed the policies of the World Health Organization during its first decades had radically transformed. Decolonization led to the establishment of a large number of independent states, and Third World countries, as they were then called, soon became the majority in the United Nations and its specialized agencies, and therefore an influential force in shaping international policies. Cooperation among Latin American, Asian, and African countries resulted in a unified criticism of the relations of developed countries and transnational enterprises with the developing world, which, these developing countries now argued, had...

  7. 4 APPROPRIATE TECHNOLOGY, INAPPROPRIATE MARKETING
    (pp. 86-123)

    The New International Economic Order intended to transform not only the relations between developing and developed countries, but also between developing countries and multinational companies. As examined in chapter 3, a central tenet of the NIEO was that of economic sovereignty, which promoted independence in economic affairs among developing countries, without interference from developed countries and multinational companies. To allow governments greater control over economic activities under their jurisdiction, the G-77 advocated the principles of national control over natural resources and private foreign investment. The G-77 also wanted UN member states to collectively monitor the behavior of multinational corporations in...

  8. 5 THE WHO IN CRISIS
    (pp. 124-159)

    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...

  9. 6 HEALTH IN ECONOMIC TERMS
    (pp. 160-188)

    When Dr. Gro Harlem Brundtland was elected director-general, in 1998, the political environment of the WHO was markedly different from the environment that had confronted Mahler when he was elected back in 1974: in the new balance of influence, rich countries were now able to exploit the WHO’s dependence on their resources to a much greater extent than poor countries could utilize the organization’s dependence on their votes. This was largely due to the WHO’s severe financial crisis, itself the outcome of rich countries’ institutional manipulation. As described in chapter 5, rich countries enhanced the WHO’s vulnerability and its dependence...

  10. 7 HOW TO WIN FRIENDS AND INFLUENCE ENEMIES
    (pp. 189-225)

    Although describing the WHO as the “lead agency in health,”¹ Director-General Brundtland engaged in a strategy of co-opting other agencies and actors rather than competing with them. In her first speech before the World Health Assembly after her election, Brundtland declared that the WHO must “reach out to others” (cited in Yamey 2002c). As we have seen, the WHO secretariat chose to work with, rather than challenge, more influential international organizations, such as the World Bank. The WHO staff also transformed its relations with the private sector, including both charitable foundations, such as the Bill and Melinda Gates Foundation, and...

  11. Conclusion: STRUCTURAL TRANSFORMATIONS OF THE GLOBAL HEALTH REGIME
    (pp. 226-242)

    In the previous chapters I offered an account of the response of the WHO bureaucracy to external pressures. I showed how both in the 1970s–1980s and the 1990s–2000s, the WHO secretariat adapted to changes in the political environment by advocating policies and programs that could be reconciled with the new dominant logic. In the 1970s–1980s, the WHO secretariat, which was attentive to the majority of votes of the developing countries, sought to follow the call for a New International Economic Order. In the 1990s–2000s, the WHO secretariat, which relied heavily on developed countries’ financial contributions, made...

  12. References
    (pp. 243-264)
  13. Index
    (pp. 265-274)