From the Brownstone Institute

By David Bell, Ramesh Thakur  

If we were designing a new WHO now, no sane model would base its funding and direction primarily on the interests and advice of those who profit from illness. Rather, these would be based on accurate estimates of localized risks of the big killer diseases. The WHO was once independent of private interests, mostly core-funded, and able to set rational priorities. That WHO is gone.

The WHO was originally intended primarily to transfer capacity to struggling states emerging from colonialism and address their higher burdens of disease but lower administrative and financial capabilities. This prioritized fundamentals like sanitation, good nutrition, and competent health services that had brought long life to people in wealthier countries. Its focus now is more on stocking shelves with manufactured commodities. Its budget, staffing, and remit expand as actual country need and infectious disease mortality decline over the years.

While major gaps in underlying health equality remain, and were recently exacerbated by the WHO’s Covid-19 policies, the world is a very different place from 1948 when it was formed. Rather than acknowledging progress, however, we are told we are simply in an ‘inter-pandemic period,’ and the WHO and its partners should be given ever more responsibility and resources to save us from the next hypothetical outbreak (like Disease-X). Increasingly dependent on ‘specified’ funding from national and private interests heavily invested in profitable biotech fixes rather than the underlying drivers of good health,  the WHO looks more and more like other public-private partnerships that channel taxpayer money to the priorities of private industry.

Pandemics happen, but a proven natural one of major impact on life expectancy has not happened since pre-antibiotic era Spanish flu over a hundred years ago. We all understand that better nutrition, sewers, potable water, living conditions, antibiotics, and modern medicines protect us, yet we are told to be ever more fearful of the next outbreak. Covid happened, but it overwhelmingly affected the elderly in Europe and the Americas. Moreover, it looks, as the US government now makes clear, almost certainly a laboratory mistake by the very pandemic industry that is promoting the WHO’s new approach.

Collaborating on health internationally remains popular, as it should be in a heavily interdependent world. It also makes sense to prepare for severe rare events – most of us buy insurance. But we don’t exaggerate flood risk in order to expand the flood insurance industry, as anything we spend is money taken from our other needs.

Public health is no different. If we were designing a new WHO now, no sane model would base its funding and direction primarily on the interests and advice of those who profit from illness. Rather, these would be based on accurate estimates of localized risks of the big killer diseases. The WHO was once independent of private interests, mostly core-funded, and able to set rational priorities. That WHO is gone.

Over the past 80 years, the world has also changed. It makes no sense now to base thousands of health staff in one of the world’s most expensive (and healthiest!) cities, and it makes no sense in a technologically advancing world to keep centralizing control there. The WHO was structured in a time when most mail still went by steamship. It stands increasingly as an anomaly to its mission and to the world in which it works. Would a network of regional bodies tied to their local context not be more responsive and effective than a distant, disconnected, and centralized bureaucracy of thousands?

Amidst the broader turmoil roiling the post-1945 international liberal order, the recent US notice of withdrawal from the WHO presents a unique opportunity to rethink the type of international health institution the world needs, how that should operate, where, for what purpose, and for how long.

What should be the use-by date of an international institution? In the WHO’s case, either health is getting better as countries build capacity and it should be downsizing. Or health is getting worse, in which case the model has failed and we need something more fit for purpose.

The Trump administration’s actions are an opportunity to rebase international health cooperation on widely recognized standards of ethics and human rights. Countries and populations should be back in control, and those seeking profit from illness should have no role in decision-making. The WHO, at nearly 80 years old, comes from a bygone era, and is increasingly estranged from its world. We can do better. Fundamental change in the way we manage international health cooperation will be painful but ultimately healthy.

Authors

David Bell

David Bell, Senior Scholar at Brownstone Institute, is a public health physician and biotech consultant in global health. David is a former medical officer and scientist at the World Health Organization (WHO), Programme Head for malaria and febrile diseases at the Foundation for Innovative New Diagnostics (FIND) in Geneva, Switzerland, and Director of Global Health Technologies at Intellectual Ventures Global Good Fund in Bellevue, WA, USA.

Ramesh Thakur

Ramesh Thakur, a Brownstone Institute Senior Scholar, is a former United Nations Assistant Secretary-General, and emeritus professor in the Crawford School of Public Policy, The Australian National University.

From the Fraser Institute

By Mackenzie Moir

It’s unusual to see a provincial government take on health-care reform. But not so in Alberta, where major reforms have been underway for almost a year. The province has long struggled with lengthy waits for non-emergency care and a majority (58 per cent) of Albertans last year were unsatisfied with the government’s handling of health care.

And who could blame them?

The median wait last year in Alberta was 19.2 weeks to see a specialist (after getting a referral from a family doctor) followed by the same amount of time to receive treatment. This combined 38.4-week wait marked the longest delay for non-emergency care in Alberta since data were first published more than 30 years ago. Also last year, an estimated 208,000 patients waited for care in Alberta. These waits are not benign and can result in prolonged pain and discomfort, psychological distress, and can impact our ability to work and earn money.

In fact, according to our new study, last year health-care wait times in Alberta cost patients $778 million—or more than $3,700 per-patient waiting. This estimate, however, doesn’t include leisure time after work or on weekends. When this time was included in the calculation, the total cost of these waits balloons to more than $2.3 billion or around $11,000 per patient.

Again, to its credit, the Smith government has not shied away from reform. It’s reorganized one of province’s largest employers (Alberta Health Services) with the goal of improving health-care delivery, it plans to change how hospitals are funded to deliver more care, and it continues to contract out publicly funded surgeries to private clinics. Here, the government should look at expanding, based on the success the Saskatchewan Surgical Initiative (SSI), which helped increase that province’s surgical capacity by delivering publicly funded surgeries through private clinics and shortened the median health-care wait from 26.5 weeks in 2010 to 14.2 weeks by 2014.

The SSI also “pooled” referrals in Saskatchewan together and allowed patients to choose which specialist they wanted to see for treatment, and patients received estimates of how long they would wait before choosing.

In Alberta, however, family doctors still refer patients to one specific specialist at a time yet remain potentially unaware of other appropriate doctors with shorter waits. But if Alberta also put specialist wait lists and referrals into one list, and provided updated wait times information, a family doctor could help patients choose a specialist with a shorter wait time. Or better yet, if Albertans could access that information online with an Alberta health card, they could make that decision on their own while working with their family doctor.

Make no mistake, change is in the air for health care in Alberta. And while key policy changes are now underway, the Smith government should consider more options while this window for reform remains open.