Columbus sailed home from his second voyage with over a thousand captives bound for slave auctions in Cádiz. Thus did the discoverer of the New World become its first transatlantic human trafficker.
Public Health constitutes one basic element and practical ingredient for mankind’s hope for the future.
(Skopje Declaration: Public Health, Peace and Human Rights)
The World Health Organization is an integral part of the United Nations, which is 75 years old this year (26-6-2020). As Dag Hammarskjold said, the United Nations was not created to take mankind to heaven, but to save humanity from hell. As the world now goes through hell on earth with the devil COVID-19 the leadership and coordinating role of the WHO in health crises and in health disaster situations is mandatory. To undermine it is a crime against mankind. The distinguished authors of the Santé mondiale 2030 think tank advocate for The WHO we want, advocacy that should be multiplied by countries-all and supported by all as in Health for All. With what the article advocates no fault should be found while its force of advocacy should be multiplied. However, the self-serving element within the international community is one element of dysfunction not discussed or cited. It should be examined even if it is one of the most difficult aspects to dig out. The challenges are enormous! Much of what the authors call on from the WHO is already being done. Much can be done even better. Thoughtful preparedness will ready the international community to respond to a probable second wave of COVID.
This time around and in several months the coronavirus (SARS 2-COVID-19) has taken hundreds of thousands of lives striking at the more vulnerable citizens of the 3rd and 4th worlds where death is an ongoing affair with or without the virus. We cannot be sure that the Coronavirus pandemic is under control in its first wave, we can’t be sure that there will be no second wave and we can’t be sure that the system can be repaired. In continuum, the best global, regional and national response to COVID-19 comes with scholastic vigilance, transparency, no cover-up, encouragement of global health, support for interdisciplinary public health, health diplomacy and for a strong and reaffirmed World Health Organization (WHO). This would be a good start to pulling humanity through! As with SARS 1 so with SARS 2 racism is exacerbated. Coronavirus is a divider of nations and a super spreader, multiplier and an accelerator of all bad things.
Now, in the time of variable response to COVID-19 the world still has to deal with climate change, whose risk is denied as well as staggering levels of migration, which means resettlement elsewhere as the only practical policy and possible path, in flight from poverty and violence and the impact of artificial intelligence in our lives and its shoring up of an overwhelming surveillance society. But there is nothing to compare to the potential devastation posed by nuclear weapons, the greatest hazard to life on earth with a level of risk close to certainty. Imagine there are no nations and a world without survivors. Should a button be pressed, by accident or intent, time will have run out on humanity, the WHO will have no meaning and the olive branch no symbolism. Evolution will unravel and human consciousness and culture will disintegrate.
The agony of an actress of incredible beauty, a national icon drenched by Hiroshima’s blast of nuclear light, brighter than a thousand suns is always worth repeating. After regaining senses, her one thought was to inform the Emperor of the horror of the atomic bomb. She made it to the river, floated down it for some time and was then pulled out by soldiers. Two weeks later, in Tokyo, her skin was gone, corroded; she had no hair; nothing remained of her youth and beauty. The happiness she gave to her doting audiences was no more.
The 73rd World Health Assembly, 2020 was convened in a climate of international dissent wrapped up in tensions between the USA and China while America and Europe are becoming more divided on China issues; arms control, and trade. Our world already had divisions and is fragmented. The US for some time has been threatening China with trade sanctions, one focus being violations of US intellectual property rights. A further bone of contention is China’s Belt and Road Initiative extending into Europe. The world is well into a new arms race as international treaties one by one are bypassed, ignored, revoked, abandoned making peace promotion much more difficult. As autocratic governance gains greater footing in our world government spending per capita on public health is even further reduced. Even in democracies investment is limited and inadequate and has been set up to fail while countries with a poor-quality public health function have a great burden placed on economic development. Autocratic regimes easily or intentionally withdraw health protections, divert the good offices of public health to evil purpose while their nuclear ambitions grow. They are seriously handicapped by leaders incapable of understanding the health consequences of infectious diseases. China was returned to the UN in 1971. Since then it has only allowed observer status to self-ruling Taiwan in the World Health Assembly. Taiwan’s noted timely performance with COVID-19 is a result of policy and acquired expertise in the management of SARS 1 and a cultivated strong societal public health function. With the withdrawal of the USA, China is being given a great opportunity to exert more influence on global health matters.
When insanity enters the government, social dementia grows, and war. When populism and fanaticism enter politics, disaster is never far behind. In China, doctors were reprimanded for whistleblowing on the Coronavirus while in America an acting inspector general for the Department of Health and Human Services (HHS), was attacked by President Trump for an embarrassing but true report on supply shortages in hospitals during the pandemic. Much of the lack of quality in combating the epidemic can be attributed to failings of professionalism in the systems of society and government. Examples include the inability of governments to accept the overall responsibility to prevent the spread of COVID-19.
The international community does need a retrofitting and is often and wrongly seen as acting through forums lacking substance, an image calling for considerable restoration. Nevertheless, it is nothing less than reprehensible to undermine the World Health Organization in the time of COVID. It, and its parent body, the United Nations have done incredible things for women, children, education, philosophy and health by strengthening the concepts of health for all, health in all policies, a society for all ages, and the sustainable development goals. The right to health was articulated in the WHO Constitution (1946) as a fundamental right of every human being and health defined as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. Health for all was a significant humanitarian milestone.
If two opposites, namely, the happiness and wellbeing of populations and the removal of the threat of a nuclear holocaust can be reconciled it will be as a result of a change in vision and behavior of the international community, a better way of assisting countries, giving more to those with less and an enlightened polity. Only then, can we have a sustainable WHO and a seen as a trustworthy WHO that can deal with the second wave of COVID-19?
Andrija Štampar presided over the first World Health Assembly (1948). He fought quackery, condemned governments for being in the hands of gangsters and kidnappers, likened Balkan banditry to disease, and saw malaria transform land into cemeteries. He saw the WHO as an instrument to solve truly global problems in a spirit of true international cooperation to make the world a better place to live in and in every respect, healthier. At the same time, he was deeply conscious that the bright vista surrounding the drafting of its constitution in a mood of optimistic confidence was not without darker shadows. Andrija Štampar sacked by the King for incompetence was not at all confident that public health would ever pay off in his homeland of Yugoslavia or in China whose authorities he told guns and cannons cannot solve social problems. I am utterly convinced that he would have criticized the construction of camps to house Uighur Muslims in Xinjiang, not President Trump, though later he did order sanctions against China related to the treatment of Uighurs. In China, Stampar was both respected and considered a meddler and foreign devil. His humanity and philosophy of life are expressed in the Preamble of the Constitution.
Halfdan Mahler returned China to the WHO in the midst of the Cold war and oversaw primary health care became the key strategy to achieve health for all people. The Soviet Union covered the costs for the meeting in Alma Ata where in just one year a luxury hotel was built to accommodate the WHO delegates, in 1978. He described the event as a true revolution in thinking but it still lacks universal practical application.
However, the WHO we would like and need today may be out of reach. Out of reach as health threats create submerged platforms for profiteering, prophets and influence pedaling, as social dementia grows as a result of further inhibition-depression of altruistic brain centers while enhancing brain centers supportive of competition; neural correlates that markets would like to manipulate and companies are now working on. But if the WHO needed remains out of reach the planet and humanity will pay the price; racism will prevail, and inequality will be a way of life. A weakened WHO means that its important brake on nuclear danger will be less effective. The WHO we want is dependent on a consistently applied and sustainably nurtured global revolution in public health based on expertise and supported by politics. It happened at Alma Ata in 1978 and much earlier in Greece at the time of a pandemic of dengue fever imported from Syria and Europe panicked. The short-lived Greek public health revolution unfolded to a background of a large refugee influx from Turkey and regional endemic malaria (1928-34). The Athens School of Public Health with its scientific expertise and international connections eradicated malaria to help place Greece on the world map of progressive nations but was finally downgraded in the absent voice of the elite by a so proclaimed socialist government, in 2019. The Greek lighthouse of public health is a wonderful case study of how dogma defeated ethics…
Three hundred years earlier, in 1729, the great Lama Zhabdrung Ngawang Namgyel decreed that a government ought to make the happiness of the citizen an important justification for its existence. It came before both the self-evident truths (1766), that all men are created equal, endowed by their Creator with certain unalienable rights: Life, Liberty and the pursuit of Happiness, secured by government of the people, by the people and for the people and the triptych, liberty, equality, fraternity (1789). However, over the following three centuries of incredible change the world has demonstrated insufficient progress in these five elements in any of the world-systems. To do so consumerism is in need of curtailment, life needs greater and better fulfillment and public health needs strengthening.
In our just before COVID times the Fourth King of Bhutan, His Majesty Jigme Singye Wangchuck and architect of the new, holistic, sustainable development paradigm called Gross National Happiness (GNH) reiterated the Lama’s thought when he said; If at the end of our Five Year Plan period, our people are not happier than they were before, we should know that our plans have failed. But who listens? Thomas Jefferson wondered who was out there listening? The great public health family of the world is asking the same question.
In Europe’s fragile Balkan Region the Dubrovnik Pledge and the Skopje Declaration: Public Health, Peace, and Human Rights (circa 2000) aimed at reducing the vulnerability of its peoples by using public health and disaster preparedness. They expressed the social conscience of public health, proclaimed its union with peace and human rights, and called for support for the ethics and value systems of the United Nations, World Health Organization, and the Council of Europe. On the 50th anniversary of the Association of Schools of Public Health in the European Region, ASPHER (2016), the Athens ASPHER Accord (AAA) reiterated concern for the predicament of rising vulnerability and the need for public health preparation for problems engulfing Europe. All three instruments stated a conviction that public health constitutes one basic element and practical ingredient, for mankind’s hope for a future. They fell silently on political ears. In the case of AAA not one Greek member of the European Parliament responded to it. Since then we have seen a further lowering of public health’s prestige, through Brexit, growth of authoritarianism and dictatorship and a lessening of support for Schools of Public Health. One suggestion is that European governments ensure that the recently revised core competencies for public health by ASPHER are incorporated in educational and training programmes for the public health workforce.
The Corona crisis makes all bad things worse; malnutrition, water scarcity, poverty and inequality, causes a downgrading of already poor educational and health systems and is a challenge to democracy. Never has the need for an effective and efficient coordinating role of WHO in international health crisis been greater, which here and now should be reaffirmed. Never has the need for sustainable multilateralism been more acute.
A World Health Organization (WHO) that we want must be treaty-based with granted authority to prevent, prepare for and to control pandemics such as COVID-19 in a globalized world of increasing authoritarian governance. However, the priorities ahead of that should be that all treaties relating to nuclear weaponry be reinstated and that politics should be better prepared to give more to its constituency and to humanity. We are 90 seconds before midnight with one treaty holding us back heaven forbid, from irrecoverable catastrophe. What purpose then, for the WHO we want.
Burkle F.M. Jr. “Declining public health protections within autocratic regimes: impact on global public health security, infectious disease outbreaks, epidemics, and pandemics”. Prehosp Disaster Med. 2020;35(3):237–246.
Levett Jeffrey. Chinese Chernobyl, American Waterloo, Russian Borodino, from camel to dromedary? 1 June 2020.
Levett Jeffrey. Hidden Devils, Lepers and Warning Bells: we have to put our faith in science, 16 February 2020.
Levett Jeffrey. Societal Dementia, Now and Then, Watched communities, side stepped expertise? 17 September 2019.
Levett Jeffrey. “Disastrous Events and Political Failures”. Prehosp Disaster Med. 2015;30(3):1 2.
Karma Ura, Sabina Alkire, Tshoki Zangmo, Karma Wangdi. An Extensive Analysis of GNH Index, 2012, Centre for Bhutan Studies.
Levett Jeffrey. Severe Acute Respiratory Syndrome (SARS): Loud Clang of the Leper’s Bell, 2003.