www.rochester.edu Open in urlscan Pro
128.151.77.39  Public Scan

Form analysis
2 forms found in the DOM

GET https://www.rochester.edu/newscenter

<form role="search" aria-label="Search site" method="get" class="search-form" data-js="search-form" action="https://www.rochester.edu/newscenter">
  <div class="search__input-wrap">
    <label class="search__label" data-js="search-label" for="s-675a8021a7673"> Search News Center </label>
    <input type="search" id="s-675a8021a7673" data-js="search-query" class="form-control search-form__query" name="s" value="" placeholder="Search News Center" autofocus="">
    <button class="search-form__submit" type="submit" aria-label="Submit Search">
      <span class="button-text"> Search </span>
    </button>
  </div>
  <div class="dynamic_content">
    <h2 class="widgettitle">Rochester News</h2>
    <div class="menu-cat-nav-container">
      <ul id="menu-cat-nav-1" class="menu">
        <li class="__list-item __list-item--depth-0"><a href="https://www.rochester.edu/newscenter/category/sci-tech/" class="__action __action--depth-0">Science &amp; Technology</a></li>
        <li class="__list-item __list-item--depth-0 __list-item--is-current-parent"><a href="https://www.rochester.edu/newscenter/category/society-culture/" class="__action __action--depth-0">Society &amp; Culture</a></li>
        <li class="__list-item __list-item--depth-0"><a href="https://www.rochester.edu/newscenter/category/the-arts/" class="__action __action--depth-0">Arts</a></li>
        <li class="__list-item __list-item--depth-0"><a href="https://www.rochester.edu/newscenter/category/student-life/" class="__action __action--depth-0">Campus Life</a></li>
        <li class="__list-item __list-item--depth-0"><a href="https://www.rochester.edu/newscenter/category/university-news/" class="__action __action--depth-0">University News</a></li>
        <li class="__list-item __list-item--depth-0"><a href="https://www.rochester.edu/newscenter/from-the-magazine/" class="__action __action--depth-0">From the Magazine</a></li>
      </ul>
    </div>
  </div>
</form>

GET https://www.rochester.edu/search/index.php

<form method="get" class="search-form" data-js="search-form" action="https://www.rochester.edu/search/index.php">
  <label class="search__label" for="s-675a8021afbc6"> Search rochester.edu </label>
  <div class="search__input-wrap">
    <input type="text" id="s-675a8021afbc6" class="search__input" name="q" data-js="search-query" placeholder="Search rochester.edu">
    <button aria-label="Submit Search" class="search-form__submit" type="submit">
      <i class="fa fa-search"></i>
    </button>
  </div>
</form>

Text Content

Skip to content
Search
News Center
University Marketing and Communications
Menu
 * Science & Technology
 * Society & Culture
 * Arts
 * Campus Life
 * University News
 * From the Magazine

 * For the media
 * Contact

Close
Search News Center Search


ROCHESTER NEWS

 * Science & Technology
 * Society & Culture
 * Arts
 * Campus Life
 * University News
 * From the Magazine

Society & Culture


HAS THE WORLD HEALTH ORGANIZATION MEASURED UP?

Sandra Knispel | Communications Specialist
May 22, 2019

 * SHARE

 * Facebook Share on Facebook
 * X/Twitter Share on Twitter
 * LinkedIn Share on LinkedIn

Has the World Health Organization measured up?

   

 * SHARE

   
 * Facebook Share on Facebook
   
 * X/Twitter Share on Twitter
   
 * LinkedIn Share on LinkedIn



Founded in 1948 in the aftermath of World War II, the World Health
Organization is a specialized agency of the United Nations focused on
international public health. Headquartered in Geneva, Switzerland, it was
specifically tasked with the lofty goal of ensuring the “highest possible level
of health” by all peoples, regardless of race, political belief, religion,
economic status, or social condition.

Seventy years later—has the WHO measured up? The reality is complicated, says
Theodore Brown, University of Rochester professor emeritus of history and public
health sciences.

A well-known expert on the history of US and international public health,
Brown’s research interests run the gamut from US health policy and politics, to
the history of psychosomatic medicine, stress research, and biopsychosocial
approaches to clinical practice.


THE STRUGGLE BETWEEN ‘VERTICALISTS’ AND ‘HORIZONTALISTS’

The constant undercurrent at the WHO has been a struggle in vision between two
dueling camps: on one side the agency’s “verticalists” who believe that the
primary actions should be biomedically-based technical interventions—and on the
other side the “horizontalists” who believe that the role of international
agencies is to help countries and areas build up their own health
infrastructures, while getting local players involved in maintaining and
preserving their populations’ health.

These two main perspectives essentially govern all of the agency’s actions,
explains Brown: The preamble to the WHO’s constitution holds that diseases are
caused and sustained socially and economically, requiring a broad societal
response—the view espoused by the “horizontalists.” However, the second,
vertical perspective presumes that epidemic diseases are biomedical events that
need technical interventions alone to tame them, such as better vaccines and
improved technologies.

“That’s a battle that’s been raging within international health for well over a
century,” says Brown, who had been the University’s Charles E. and Dale L.
Phelps Professor of Public Health and Policy for five years, before he retired
in 2018.

Brown set out with two co-authors—Marcos Cueto, a professor at the Casa de
Oswaldo Cruz, a unit of Fiocruz, the main Brazilian biomedical institute, and
the late Elizabeth Fee, who was the senior historian at the National Library of
Medicine—to evaluate the successes and failures of critical WHO campaigns, among
them eradication programs for malaria and smallpox, to today’s continued
struggles against Ebola.

The result is The World Health Organization: A History (Cambridge University
Press, 2019), a comprehensive look at how world politics—including the dynamics
of the Cold War in the early decades, and later the increasing involvement of
governmental and private players—have influenced and shaped the organization,
its operations, and ultimately affected the fate of its mission.

The problems with the vertical approach is that it’s usually a top-down approach
to public health that gives little consideration to the participation of the
community, argues co-author Cueto. Often that means an overemphasis on
technological solutions—such as trying to find a “golden bullet” like DDT for
malaria—instead of striking a balance between biomedical technology, and
improving the living conditions, lifestyles and environment of poor
communities.” The problem, Cueto says, is that this vertical approach usually
focuses on a specific—often infectious— disease instead of a comprehensive
attack on a series of diseases.


SUCCESSES

According to the authors, during its first decades, the United Nations’
specialized health agency was the “acknowledged international leader on matters
of health and disease and was at the center of a global network of scientists,
physicians, and health policy makers.” During the second half of the 20th
century, the WHO “played a preeminent role in the political validation of
international health as a field and helped shape the notion of technical health
assistance for developing countries.”

Theodore Brown, University of Rochester professor emeritus of history and public
health sciences, has co-authored a new comprehensive history of the World Health
Organization, looking at how world politics have shaped the institution and its
mission. (University of Rochester photo / Richard Baker)

By 1980 the WHO could take substantial credit for ending smallpox, making it the
first disease in human history to be eradicated. “A shining moment of
international cooperation,” says Brown, who points out that that was no small
feat during the Cold War. “The United States and the Soviet Union would still be
bickering with one another about international treaties, nuclear weapons and
chemical weapons, but somehow in the health domain they were able to work
together.”

The organization also developed uniform metrics, methods, and measures to deal
with international health crises and pandemics. The result were standardized
interventions, the gathering of epidemiological intelligence, and the means to
evaluate the efficacy of programs.

Some of the most successful WHO programs led to access to essential drugs and
antiretroviral treatment, childhood immunizations, and the control of tobacco
use—often through a vertical approach—the three authors argue. The WHO also
pushed for the development of basic, local health systems instead of
centralized, top-down interventions—following essentially the ideals of the
“horizontalists.”

But most importantly, argues Brown, was the agency’s role in “articulating a
vision and creating high aspirational goals, which inspired lots and lots of
people.” The WHO’s main goal—health for all, including physical, mental and
social wellbeing—was regarded as a fundamental human right. The WHO’s Alma-Ata
Declaration in 1978 (now Almaty, Kazakhstan) stands out to Brown as its finest
hour because “people perceived that there really was a common human aspirational
framework and set of principles for health.”


FAILURES

The authors point to a shift at the end of the 1980s, when the agency
increasingly came under widespread criticism from many sides—health policy
experts, international entities such as the World Bank, and specific
countries—for its inefficiency, lack of transparency, politicization, and
ultimately irrelevance.

University of Rochester professor emeritus of history, Theodore Brown, was
invited to this year’s World Health Assembly meeting in Geneva to give a
presentation about his new co-authored book at the United Nations Sustainable
Development Goals Health Summit in May.

A largely fair criticism—agrees Brown. He argues that the WHO’s both
Geneva-based headquarters and regional structure—“often a bureaucratic
nightmare” that the US had insisted on at outset of the organization as a
“string-pulling control mechanism”—impeded quick and decisive decision-making in
crisis situations. That’s one of the reasons for the delayed response to the
Ebola epidemic, says Brown.

Moreover, large donor countries, especially the United States, drastically cut
contributions to the WHO amid squabbles over the agency’s direction and policy
priorities. As a result, it suffered a loss of financial capability and stature,
increasingly competing with public and private organizations such as the World
Bank and the Bill and Melinda Gates Foundation.

Ultimately, one of the agency’s largest failures, says Brown, was that it
“allowed itself to become so politicized. I expected there to be political
contamination or intrusion, but I didn’t expect it to be so pervasive,” he
admits. Part of the reason was that the United States contributed an outsized
portion of the agency’s budget in its early years. That meant that US
policymakers believed they were entitled to set policy, says Brown, pitting the
US often directly against the Soviet Union.

In later decades, a different set of funders began to assume a large role in the
WHO’s direction. Private and public donors brought both benefits and drawbacks,
says Brown: “You gain resources, but you lose control and a coherent sense of
governance in which those countries and people most in need of help and
intervention have the least say in what these interventions should be.” While
these partnerships have helped reduce morbidity and mortality, they usually rely
on short-term and ultimately limited strategies, write Brown and his co-authors.
The loss of truly democratic decision-making marked an unfortunate return to the
vertical approach that put technical expertise before local input, argue the
authors.


WHAT ROLE DOES THE WHO PLAY TODAY?

 Fast forward to the 2000s. There’s been a surprising resurgence of the WHO,
argues Brown. Since the mid-teens of the new century, the agency has regained a
certain amount of authority and credibility—among governments and private
players alike—very likely “because the world of global health has become so
chaotic, and there have been so many competing interests that even those with
the big resources realized that there is no way of achieving any kind of uniform
consensus about what programs should be initiated,” says Brown. It seems, says
Brown, that the “horizontalist” approach is gaining once again a stronger
standing, even among the vertically-inclined private players. Essentially, the
WHO has become a reinvented place for decision making and ultimately offering
legitimacy for programs, Brown argues.

There’s reason to be optimistic, says Brown who favors the horizontal approach:
the man who has been selected as the WHO’s newest director general is the first
African to hold that position—Tedros Adhanom Ghebreyesus from Ethiopia—marking a
conscious shift toward giving greater voice to local interests, away from the
large economic and political powerhouses that have thus far largely shaped the
organization’s direction.


SOCIETY & CULTURE

Historic Bermuda reshapes our understanding of colonial America

Why the powerful are more likely to cheat

Research-backed ways to bridge America’s political divide

View all related items
Return to the top of the page
Boundless Possibility


Explore our 2030 Strategic Plan

See maps and directions Rochester, NY 14627
Search rochester.edu

    
 1. Accessibility
 2. Nondiscrimination
 3. Privacy
 4. Copyright
 5. Emergency Information

© University of Rochester 1996-2024