The United Nations and its offshoot the World Health Organization love lists and setting deadlines. Both, of course, are necessary constructs for organizations charged with nudging humanity’s progress toward a safer, healthier and more equitable world. But what if all those targets and statements have become little more than tick-box exercises in merely appearing to do the right thing?
The organizations themselves will not – cannot – ever admit such a thing. Yet a sense of the desperation at the very top of the twin organizations leaked out this month in a call to arms by Dr Tedros Ghebreyesus, the WHO’s director general. On January 13 he released a list of 13 “urgent global health challenges,” reflecting “deep concern that leaders are failing to invest enough resources in core health priorities and systems, [putting] lives, livelihoods and economies in jeopardy.”
None of the issues was simple to address, he conceded, but they were within reach. His remarks echoed those of UN Deputy Secretary General Amina Mohammed, made in New York as 2019 drew to a close. There was, she reminded member states, just a decade left to hit the UN’s 17 Sustainable Development Goals. Four years in, she said, “we are seeing growing awareness … but our collective efforts are not approaching the scale we need if we are to deliver the SDGs by 2030.” The world, she concluded, had “an enormous hill to climb.”
It has, and it is unlikely to reach the summit.
The problem lies not with the good intentions of the UN or WHO, but with the hill itself, the slopes of which are littered with the detritus of the geopolitical complexities of the modern world, which has a habit of disrupting the best plans laid in committee rooms and meeting halls in New York and Geneva. The increasingly destabilizing impact of climate change is pressing in on all countries and their economies, throwing future prospects into uncertainty and substituting widespread inaction for the fine words spoken at UN climate-change conferences.
The real world, in other words, is exposing the hopes and dreams of the world’s two great talking shops as hopelessly unrealistic.
Signing up costs nothing and any state that subscribes to multiple international initiatives can point convincingly to the documented evidence that it cares. Where the UN and WHO have been far less effective is in following up on such commitments
There is, of course, no shortage of paper commitment from the world’s nations to ambitions to achieve universal global equality in health care and life chances. Signing up costs nothing and any state that subscribes to multiple international initiatives can point convincingly to the documented evidence that it cares. Where the UN and WHO have been far less effective is in following up on such commitments and scrutinizing each nation’s actual progress toward achieving them.
Take malaria. In 2016, the WHO identified 21 countries that could defeat the disease by 2020. According to the latest progress report on the so-called E-2020 initiative, published last July, with just 17 months to go things weren’t looking too hopeful. A “substantial commitment” was still needed, said Dr Pedro Alonso, director of the Global Malaria Program, “to get at least 10 countries across the finish line.”
Outside of the 21 nations selected back in 2016 – hubristically, as it turns out – for the apparent ease with which malaria could be conquered, the disease remains a vast problem for many others. In 2018 there were at least 228 million cases and 405,000 deaths worldwide. These were mostly in sub-Saharan Africa, but malaria remains endemic in six countries in the WHO’s Eastern Mediterranean Region – Sudan, Yemen, Pakistan, Somalia, Djibouti and Afghanistan.
Some of the causes identified by the WHO to explain the apparent imminent failure of its E-2020 program are specific to malaria. Others, however, can be applied to almost any UN or WHO initiative in which success proves elusive. “Ill-targeted actions, insufficient funding, competing priorities, inadequate training, limited outreach and weak cross-border collaboration” are component frustrations of many a stalled international initiative, and speak to the real-world complexities with which idealistic programs handed down in New York or Geneva cannot hope to survive contact.
In the WHO’s Eastern Mediterranean Region, Iran and Saudi Arabia, two nations in which malaria was previously endemic, are on track to eliminate indigenous cases by the end of 2020. In 2018 Iran reported no cases for the first time, there were just 61 in Saudi Arabia, and neither country has seen a death for more than three years.
Why? True commitment, the translation of fine words into relentless public health programs and – above all – spending. Saudi Arabia invests an average of more than US$12 per person at risk of malaria. In Yemen, Afghanistan and Pakistan, the preventive investment is under a dollar.
The reneging of nations on their commitments to funding plays a part in the failure of many UN and WHO programs. Instead of the $5 billion internationally agreed WHO malaria fighting fund for 2018, just $2.7 billion was raised.
The scale of the problems facing the UN, and the unwieldy nature of its very existence, can be seen in the agenda of its High-Level Political Forum on Sustainable Development, which meets annually to monitor progress toward the Sustainable Development Goals.
At the next meeting, in New York in July, nations will be expected to present their Voluntary National Reviews, a system of self-reporting conceived to “facilitate the sharing of experiences, including successes, challenges and lessons learned, with a view to accelerating the implementation of the 2030 Agenda.” In practice, spokespeople from just a handful of countries will read their well-polished prepared statements from the dais. Only 54 countries actually offered to submit a voluntary review and, because of time restrictions, only 49 – of which only Syria represents the Middle East – will actually be called upon to do so.
At that rate, with only a decade to go, it will be another four years before all 197 member-states have submitted their progress reviews. And by then, it is probably safe to say, the world will not have a chance of hitting the 17 Sustainable Development Goals by 2030.
This article was provided by Syndication Bureau, which holds copyright.