by Will Jones, Daily Sceptic:
Colonial regimes are good employers if you are from the colonising side. They pay well and offer exciting travel to exotic locations. They support your family with benefits and subsidies. And they convince you (because you want to be convinced) that you are benefiting the many whilst, as Rudyard Kipling insisted, carrying their burden. Rather than being an enabler of greed and pillaging, you are really bringing civilisation, such as education or healthcare – sacrificing yourself for the greater good. A humanitarian, even if at the beck and call of rich and powerful people.
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International public health and decolonisation
The World Health Organisation (WHO) arose in the aftermath of World War Two, as much of the world was throwing off the yoke of colonial masters. Colonialist approaches varied, from those who built infrastructure and were seen to provide something for those they ruled, to those whose only interest seems to have been loot. Some had conquered well-functioning states, others replaced regimes as brutal as themselves. However, like slavery, colonialism, or imposing one’s will on others for one’s own benefit, is always wrong. Both probably go back as long as humankind, have been ubiquitous across most of history and remain prevalent today. We have learned to veil them.
The 1950s to 1970s saw half the world move from serving other nations to become more-or-less politically self-governing. It was far from smooth, with European powers ‘freeing’ their colonies based on arbitrary colonial borders and so leaving behind intrinsically unstable states (the Balkans tell us this is not just an Asian or African problem). Another legacy is the ownership of companies that extract resources, with former masters and their allies sometimes going to considerable lengths to maintain this. They ensured that their colonies remained, economically at least, colonies. Companies exist to extract and accumulate wealth, and the rich world wanted their companies to continue gaining higher returns from lower costs after their colonies were lost. Poorer countries tend to have lower costs and less oversight, and with a sufficiently amoral approach they can be kept that way. Wealth can still flow upwards to the former colonial power, even when the colony is officially free.
The WHO in its early days was relevant to this process as it stood for the benefit all, its constitution requiring it be controlled equally by each Member State. Each emerging state had one vote in its governing World Health Assembly – equals of their former colonial rulers. This differs from the United Nations Organisation (UN) itself, where past colonialists on the Security Council retain a power of veto. Though a UN agency, it was decided WHO should better reflect a decolonising world.
For some decades, WHO generally succeeded. Many people like to highlight the caveats – ‘but this Director General once said this’ or ‘another senior officer said that’ – but the organisation was bigger than those few. WHO concentrated on major addressable disease burdens such as malaria, tuberculosis and, later, HIV/AIDS. It helped make others like yaws and leprosy become rare. It prioritised the drivers of infant and child mortality. It also led the smallpox elimination campaign – at least accelerating its elimination.
Recognising the main determinants of longer life – improved living conditions, nutrition and sanitation – WHO prioritised these and emphasised the importance of community structures and primary care to achieve them. The Alma Ata declaration of the late 1970s, a million miles removed from the COVID-19 response of 2020, recognised the importance of local structures to health outcomes, reflecting the reality that improving human capital builds longer lives more reliably than chemicals supported by financial capital. As WHO had no one pushing it to overinflate the risk of profitable diseases, few people actually heard much about it.
Large disease burdens drain economies and prevent communities and countries from getting on their feet, especially when their children and young adults are dying. Inability to address the underlying causes of ill health ensures poverty and aid dependence. Building individual resilience and national capacity should do the opposite, and that was once WHO’s role. Success in this context would be steadily reducing dependency, with reduced requirement for foreign finance and workers. This, up to perhaps about the year 2000, was a common understanding within the international public health workforce. There was supposed to be an endgame to most of this work, where countries support themselves.
International public health and recolonisation
Working with the WHO towards the endgame of healthcare self-reliance (or completing decolonisation) were relatively few organisations. UNICEF (concentrated on child health), a few foundations like the Wellcome Trust, and traditional schools of tropical health and hygiene. Small non-government organisations (NGOs) worked around these. All, even the Wellcome Trust founded by a Pharma magnate, shared an emphasis on capacity building and on high burden diseases. Manufactured commodities such as drugs were part of achieving outcomes, but not the primary focus. Western people would study at Mahidol University in Thailand rather than a public health school in America because public health was about communities rather than funders.
The change since then has been dramatic. The WHO and its major pre-2000 partners are now outnumbered in an increasingly lucrative industry. The Global Fund is the main multilateral grant agency for malaria, tuberculosis and HIV/AIDS. UNITAID, a public private partnership (PPP), is dedicated to establishing markets for vaccines, drugs and diagnostics in low-income countries. Gavi, the vaccine alliance, is a PPP buying and distributing vaccines. CEPI, a PPP founded quite extraordinarily at the World Economic Forum meeting in Davos in 2017 almost 100 years after the last major pandemic, is dedicated solely to vaccines for pandemics. The Gates Foundation, a private charity with strong Pharma alliances, grew to fund and have governing influence over all the above, while the ever-growing World Bank’s health arm houses, among other things, the Pandemic Fund. All these entities share a common interest in expanding markets for commodities or in financing their use. None has the main historical determinants of longer life – improved sanitation, nutrition and living space – as a primary focus. Their work is not devoid of benefit, but the overall emphasis is clear.
Whole new campuses have been built in Switzerland and the United States over the past 15 years to house the thousands administering this profitable approach to managing health in low-income countries. They were not built in Nairobi or Delhi, but Geneva and Seattle. A thriving industry of non-government organisations (NGOs) serves them, headquartered also in high-income countries. These are staffed by recruits who studied ‘global health’ in colleges sponsored by donors whom they now aim to spend the rest of their lives serving. If there is money to be made manufacturing and distributing injectable chemicals, then they will find public health reasons to do it. If their sponsors prioritise climate, then climate will be a threat to health. If pandemics, then we will be told of an existential threat from disease outbreaks. It is the message, rather than truth, that keeps you employed.
