Tobacco Documents Online

NOV, 22 '89 17:30 BURSTON ~RSTELLAR P, 5/9 DEPT, (TX): 0008 Suggested Uses:- ~obacco trade press The World Health Organlsation has ~:he historical credentials and the current capability to be an effective. leading force for better health. ~et, WHO's 64~-page, $655.7 million regulate budget, roposa~al for 1990 91 tells another storys The ntaJority o~ funds are allocated to a bloated bureaucracy cut of step with the evolving health problems oZ the.developing wo~ld. (In ~ddition~ 1n.1990-91 WHO will raise ~7~9 ~illion for specialized through contributzons from ~he Industrial countries. its total budget will be about $1.~ billion). The recent World Health Assembly Im ~eneva cost a whopping $~.S million. WHO meetings -- meetings, not progca~es -- are budgeted at $14 milllon over the next two years. The cost of the World Health Assembly alone for 1990-91 is more than twice the p~oposed budget a11o~atlon for combating malaria in Africa. More than.that of the proposed regular budget is earmarked for activities outside the recipient countries, and 73~ of this money is for salaries and benefits. What do these salarie~ buy? A careful analysis of the budget proposal ~eveals that WHO haJ; generated a multitude of pcogrammes unrelated to the need~ of the count~ies it serves. For example, how do the bureaucrats ~ustify a $2.7 million allocation for "increasing awa~enesl~ of the health implications of the social and beha~ioural aspects of social action and change" when WHO'~|~ total malaria funding will be reduced by one third? What were the data that le~ to the decision to fund a review of "legislation from selected countries that ~equire modification in order to enhance their positive effects on m~ntal health," as opposed to allocating funds to control new types of malaria transmission in Africa? What is the rationale behind funding a WHO "global oral data bank" that can "calculate t~population weighted mean number of decayed mis~i~g orcft~...ed~eeth at 12 years of age" for all the co~ntr~es i~world since 1980, while decreasing funding for tuberculosi~ programmes? Oc behind reducing funds for im=unization iff Southeast Asia, yet making funds available to develop/lists of basic drugs needed in "isolated circumpola=/~re~s" that Is, d~ug lists for the North Pole? / .

NO:~/. 22 '89 17:32 BURSTON ~RSTEt,LAR P. 6/'9 DEPT. (TX): 0008 request. WHO's Own budget proposa~ betrays a pattern of member states' lack of interest in the programmes being offered. An exi'sting programme devoted to "~iealth ~iskz of Potentiall~ Tox£o Chemicals" is ty~ical. In Africa, no member state request~d the assistamce of this ~rogramme. Zn the Eastern ~editerranean, South A~erica ano Western Pacific, these services are provided through other WHO st Asia was environmental prog~am~eso Onl¥.~n Southea there any interest in this pzogramme en the part of a single member state. Yet two new staff p~sitions have been created for this programme, and the budget of $~.2 million received a 31~ increase. The problem is particularly acute in Africa, which sorely needs assistance in health care and health financing. WHO offers the region more than 50 p~ogrammes, but only one-tenth of these hold any significant interest for African countries. Twenty-five WH~ programmes were chosen by fewer than five African count~ies. Six programme~ were chosen by only two, and nine prostates were not chosen at all. According to the budget proposal, the largest request from African nations 'was for "H~man Resources Development" (for instance, training village health workers). Yet, this budget item was reduced by $4 million in real terms. There is nothing inevitable about this state of affairs. I~ is not particularly hard to obtain the information that would let WHO tailor ~udgets and of:~erings to ~he actual needs o~ the member nations. A survey soon to be ~ublished by my institute shows that ministers of health ~n developi~g nations have a clear sense of their countries' prior~tie~|, listing their key needs as i) assistance with financing for health serv£ce~ and 2) management. ~hey realize that the new disease patterns resulting from ra~idly ~o~ing urbanizat~on will require sustainable health care fin~ncing. Zf WHO is slow to react to these ch~nging realities, i~ could be because they are hard to gauge from Geneva. Nearly one third of W~O's staff pos~tions are Geneva-based. Another third a~e distributed among seven ~egional office~ in such hardship post~ as Washin~ton, D.C., and Copenhagen. Labour costs in Geneva; a~e the h~ghest by far, at ~4,385 per professlonal.staf~er and $58,830 per support staffer. Simply ~ransferr~n~ staff from headquarters to the ?ountries they serve would both increase the amount of ~nput from local health officials and reduce costs. we should not begrudge the overall e~xpense that accompanies

NOV, 22 '89 17:33 BURSTON MARSTELLAR P, 7/9 DEPT, (TX): 0008 tht noble and ambitioue goal o~ p~viding badly needed assistance to develol~ing nations. NOr should we, out of despair, begcudge our tax dollars %hat go to support eggorts in international health ca~e. Ou~ concecn instead motivate us ~o call WHo to task go~ £unding wastegul programmes and top-heavy sonument addresses than ~he critical hea~th issues ~n the developing world. ~r Pa~l Dietr~ch, for~e~ publ£she~ and Chie~ o~ Sa~:u~day Review, is President of The Catholic D-n'%'~F~Ttyo--5-f--~,e~ica's Institute Health and Developnent, in washington.