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THE WORLD HEALTH ASSEMBLY SHOULD GET BACK TO HEALTH'

The Forty-First World Health Assembly will convene in Geneva next week. As the policy-making body of the 166-member World Health Organization,, the Assembly will consider a broad range of legitimate health-related questions. The trouble is, as in past yea r s, delegates also will be forced to waste time discussing political issues that have no legitimate link to health. Such political issues will include "assistance to the front-line states" in southern Africa, the medical consequences of nuclear war, and Is raeli policies in the West Bank and Gaza. As usual, most of the nations pushing this politicization of the Assembly's agenda have dubious to dismal health records of their own.

It is particularly disappointing that the World Health Assembly will have to ta ke the time to consider these perpetual agenda items. They will divert the Assembly from concentrating on what have been several hopeful developments at the World Health Organization (WHO) during the past year. Most important, Dr. Hiroshi Nakajima of Japa n has been nominated for the post of Director-General of WHO. He is a well-respected public health official with ex- perience in many different areas of international health policy.

Also encouraging has been the WHO response to the system wide pressure in the U.N. for more input from major donors in the formation of budgets. WHO has adopted a new proce- dure whereby major donors will be consulted fully on budget priorities at all stages of the budget's development. As a result of this, the WHO has been cer t ified by the Reagan Ad- ministration as complying with congressional requirements; this contrasts with the United Na- tions General Assembly, which has been clearly violating congressional requirements. With its certification, WHO is entitled to full fund ing from the U.S., some $75 million this year or 25 percent of the regular WHO budget.

Full U.S. funding, however, should be delayed until Congress closely examines WHO policies and management in three key areas:

Budget Reform and Management. Despite progress in budget process reform, the proposed WHO program budget for 1988-1989 still raises troubling questions !about the organization's priorities. For example, WHO had budgeted $2.7 million for World Health Assem b lies in 1988 and 1989. This represents an increase of 38 percent from the amount budgeted for 1986- 1987 and is more than the proposed regular WHO budget's worldwide expenditure for the elderly and three times the proposed worldwide expenditure for blindn ess. (The largest single growth item within this Assembly's budget is "salary costs," up 48.percent.)

Questionable -too is the $40,000 budgeted for the WHO Management Committee oversee- ing the organization's "Peace Efforts"; an undisclosed amount to ope n two new offices in the Eastern Mediterranean in 1988-1989 - in Libya and Syria; and $10.6 million over two years proposed for "External Coordination," namely, public relations efforts. The U.S. and other Western countries should carefully scrutinize the se and other questionable spending priorities before committing more resources to the organization.

Regulation of Industries and Private Health Care Providers. Ile WHO long has appeared to be ideologically hostile to the private sector's role in providing health care, preferring to em- phasize public sector models and approaches, and frequently proposing stringent and harmful international regulatory schemes. A particular focus of WHO's hostility has been the research- based pharmaceutical industry. Most r e cently, WHO has been developing a so-called Revised Drug Strategy, which aims at global regulation of virtually all aspects of pharmaceutical production, distribution, and usage. This would be dangerous since such activity may detract from the constructiv e role of WHO in assisting developing countries to construct. primary health care pharmaceutical infrastructures.

Equally troublesome would be a "marketing code" on pharmaceuticals. While the WHO has not adopted this yet, many of the goals of this code are being implemented by WHO staff under the "Revised Drug Strategy" label. This includes pushing so-called medical needs criteria in drug approval, criteria which would have the effect of discouraging research into new and better medicines. The WHO thus is g oing far beyond its initial mandate to advise governments on primary health care policies and seems to be seeking a role as a full-fledged international regulatory authority. Ironically, such WHO activities may actually have the ef- fect of impeding acces s to essential drugs in developing countries.

Politicization. As in many other U.N. agencies, the grim shadow of politicization looms ever larger over WHO activities. From endorsing Soviet-inspired disarmament initiatives to injecting itself into contentio us regional issues, the WHO has shown! that even such a relatively noncontroversial subject as health care can be used for political purposes. T'he U.S. delegation to the Assembly should continue to oppose the injection of extraneous political issues on t he WHO agenda and should emphasize longstanding congressional concerns that WHO stick to health-related subjects.

Ile WHO is one of the oldest and most valuable agencies in the U.N. system. Over the years it has done exemplary work in many areas, and it co ntinues to function more efficiently than most U.N. organizations. Yet in a world confronted by a wide and dangerous tvariety of health care deficiencies, the WHO can better serve its purpose by spending its money prudent- ly, avoiding contentious politic al issues, and establishing a better dialogue with private health care providers. Tbomas E.L. Dewey Policy Analyst

For further information:

World Health Organization, "WHO's Revised Drug Strategy," Report by the Director-General, EB81/25, Annex 1, Decembe r 22,1987. Juliana Geran Pilon, "For the World Health Organization: The Moment of Truth,"Heritage Foundation Backgrounder No. 507, April 30, 1986.

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