• Open Access

Sacrificing the WHO to the highest bidder

By Théodore H. Macdonald with forewords by David Player and Mathura P. Shrestha . Published by Radcliffe Publishing , Oxford . Hardback , 286 pages , with index . ISBN 978-1-84619-252-4 . Price: US$62.00

Reviewed by Priscilla Robinson

School of Public Health, La Trobe University, Victoria

This is really quite an extraordinary book. The general thesis presented herein is reflected in the background of the author: Théodore MacDonald is a consultant to the World Health Organization (WHO), and a health, human rights and social justice specialist from the UK. The book includes two interesting forewords: by David Player, a Scot who is an army physician and HIV/Aids and dermatology specialist, and from Nepalese Nobel prize-winner Mathura Shrestha, who has a long track record in primary healthcare, social responsibility and justice. With working lifetimes of social justice behind them, these three people are well known within the People's Health Movement. But first a warning: some people might find this book easier to follow with a copy of A Dictionary of Modern Thought1 to hand!

Along with its preface and forewords, it was completed before the present global financial crisis (GFC), but whose authors were already discussing the expected crisis in globalisation caused by capitalist financial structures. However, while dense and tightly argued, it is not at all impenetrable. Its nine chapters are organised into two-to-three page subsections, so that although the information it contains needs thinking about, it has a logical order and evolution. This book needs to be read in its entirety – starting with the table of contents and the prefaces. In unpeeling its layers a carefully crafted set of linked stories emerges, and despite a long-standing interest in this area, I learned a great deal about how post-second-world-war international politics influence consequent finance structures and rationale.

The book deals substantively with the history of the WHO, and how it has been infiltrated by the politics of neoliberalism. Water is the subject of considerable analysis, with various useful case studies from both developed and developing countries. A fairly brief chapter deals at some speed with pandemics and possible pandemics (smallpox makes a cameo return here), especially in the contexts of biosecurity and self-defence. Power comes next, in the form of an analysis of the uses and sustainability of nuclear power – here not at all viewed as a clean and renewable resource as our governments seem bent on doing currently, but based on the politics and financing of power supplies. The last chapters cover the right to health, the WHO mandate and the relationship to Alma Ata to current responses to health problems, and the final chapter provides a summary and recommendations.

In reality, nobody believes that the UN, or its associated organisations have ever been, perfect, but in an imperfect world they have in the past provided a way of being able to start to try to provide some sorts of global equity and justice for the peoples of this planet. However, early in the book the impact of the major World Trade Organization General Agreement on Trade in Services (GATS) and the General Agreement on Tariffs and Trade (GATT) in disadvantaging lower income countries because of the imperative to industrialise in order to repay World Bank loans, and the consequent adverse effect on the health of their populations, is explained in stark detail. Even worse is the development of the trade related intellectual property rights (TRIPS) and the straight-jacketing of poorer nations, with respect to both agriculture and pharmaceuticals in particular.

In this book the abuse of natural resources, water in particular, with respect to sustainability, is considered in the context of what the authors calls ‘privatisation by stealth’. This analysis takes the UN Millennium Development Goals (MDGs), showing how the building of partnerships (which is both implicit and explicit, especially in the eighth MDG), makes for powerful public-private partnerships in international trade arena, but without necessarily resulting in an improvement in conditions for the world's least wealthy and powerful peoples. It is interesting that the authors do not draw attention to the other United Nations agencies that profess an interest in these issues; for example, the United Nations High Commissioner for Refugees (UNHCR), which uses a very broad definition of ‘refugee’, claims a primary interest in the effects of climate change (for example Reference 2), but this does not appear to translate into a UNHCR interest in the MDGs. This book highlights these disconnections by their absence.

This book is a bugle call to us all to remember the reasons for, and histories of, Bretton Woods, the United Nations (UN), the WHO and allied organisations.