Let’s face it: WHO is always in an awkward position. It’s designed to serve sovereign nations, advise and dispense technical advice. To effect change within countries, it must depend on evidence, persuasion and diplomacy. Protecting health then across borders requires canny leadership. WHO Director-General candidate David Nabarro says he’s up to the challenge.
Nabarro, in this final installment of GHN's Q&A with him, says he will bring “strategic and sensitive” leadership to WHO and will diplomatically broker deals while also calling out nations that aren’t living by international regulations. He says he will strengthen the capabilities of countries—especially poor countries— and will invest in the WHO regional offices to achieve this. “I will upgrade WHO’s responses to disease outbreaks ensuring that it is both relevant and effective at all times,” Nabarro says.
One of the great challenges for the next DG would be to bridge the gap between what WHO does and what’s expected of it. How would you do this?
As strategic leader for world health, WHO must appreciate and be responsive to the needs of Member States and their people. This means that WHO serves national governments in the pursuit of health objectives, providing excellent technical advice, identifying gaps in national capacities and engaging in political advocacy to ensure such gaps are addressed. At the same time, just as world leaders pledged to leave no one behind when they adopted the 2030 Agenda for Sustainable Development, WHO must strive to listen and respond to all stakeholders, ensuring that the most vulnerable and those that are hardest to reach have access to quality health services.
In this context leadership is vital: it must be both strategic and sensitive. WHO’s personnel must be able to use diplomatic skills to broker constructive agreement and avoid gridlock when national interests and the demands of public health diverge. They need to make it clear at the highest levels of government when states appear not to be honoring international regulations and [putting] the health of their own or neighbors’ populations at risk. They need to use the power of evidence to help states review their own performance.
Governments need the WHO to help them respond to threats of disease. They need the WHO’s advice when deciding how best to make sure that those who need to access health care can do so. Because patterns of sickness and disease vary between locations, WHO must be relevant and nimble in response. That calls for effective leadership—and it is needed now more than ever.
So, how would you practice effective leadership as DG?
If I am Director-General of the WHO, I will focus on strengthening capabilities within countries: ensuring that poorer countries receive the support they need to empower their people and enable them to remain healthy. I will ensure that worldwide systems for responding to outbreaks function impartially and reflect people’s needs. I will seek the resources needed to invest in the WHO regional offices so that they can better support what is being done within individual countries. I will upgrade WHO’s responses to disease outbreaks ensuring that it is both relevant and effective at all times.
A relevant and effective WHO will help close the health gap by identifying inequalities in people’s health experiences and ensuring that they are overcome. I will work for a reduction in the incidence of diseases that are related to people’s lifestyles and I will promote a human rights approach to public health through primary health care in ways that leave no one behind.
When I started my career as an idealistic young doctor, I always wanted the best for my patients. I depended on the guidance from WHO—on nutrition, diarrhea, tuberculosis, surgery and obstetrics. I would explain to patients that we were following WHO standards because they are the world standards—and we were pleased to have this support in our work. Health workers and governments throughout the world turn to the WHO for advice and guidance. The organization must be managed, financed and staffed in ways that maintain trust and credibility.
The WHO must be the lead agency for health—beyond dispute. Communicating clearly what needs to be done and where. Focusing on diseases like malaria, HIV/AIDS, and tuberculosis, diabetes and heart disease, mental illness and accidents, and so much more. Paying attention to the needs of women, children and adolescents, of people with disabilities, of migrants and those caught up in conflict, of older persons. This is always urgent work: people’s illnesses do not wait till we are ready to treat them.
I believe in the power of catalysis and saw WHO do this when I led the Roll Back Malaria project in 1999. It worked: malaria deaths in Africa halved over the past 15 years through the efforts of governments and supportive partners, based on the science-based standards developed by WHO. A massive reduction in suffering and death thanks to the extraordinary efforts of many.
It is now time for WHO to catalyze reductions in NCDs such as cancer, cardiovascular disease and diabetes. In 1985 I was involved in research that led Tanzanian scientists to find high levels of diabetes in the adult population. In 2015 I was a Commissioner tasked with finding better ways to prevent obesity in childhood and reduce the risk of diabetes in later life. More recently I have worked in the UN headquarters advancing interdisciplinary action that promotes health. To advance all this work we need powerful and unrelenting advocacy by the WHO.
One of the great injustices in the world is that health and wealth continue to be unequally distributed. Balancing health inequalities must be a clear and urgent priority of the WHO—because it is unacceptable that such large amounts of people across the world continue to die as a result of preventable disease.
This interview has been edited for clarity and length.
Read other installments of Global Health NOW’s 4-part Q&A with David Nabarro here.
See the recent GHN Q&A series with DG candidate Sania Nishtar here.
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