Setting leadership priorities
Dr Cassels was Director of Strategy at WHO in the Office of the Director-General and was closely involved in the work on WHO reform over the past few years. Linda Larsson spoke with him about WHO’s leadership priorities.
Linda Larsson: How were the leadership priorities decided?
Andrew Cassels: We started off with quite a long list of about 26 priorities, in categories suggested by Member States. Since 26 was clearly too many, we then asked, “What are the most important areas where WHO really needs to exercise its leadership over the next 6 years?” These are cross-cutting areas where WHO wishes to influence the global debate and that draw together work across all levels of WHO.
Linda Larsson: Were there other contenders that didn’t make the list?
Andrew Cassels: No, I think not. The priorities are aligned with the Director- General’s manifesto for her second term. They are also closely linked with what is going to happen in the post-2015 agenda. One of the clearest messages we got from Member States, both North and South, was that we need to complete the job of the MDGs; that naturally became the first priority. NCDs clearly need to be part of the global health agenda and is an area where WHO’s leadership is critical. That in itself became a second priority.
“Member States are concerned that WHO should clearly show that it gives priority to the broader causes of ill health and inequity.”
Dr Andrew Cassels
Universal health coverage is a flagship issue of the current leadership and of the Organization, and one that has gained a huge amount of support from Member States, so that found its place fairly easily. Access to medicines is a good example where WHO has a real comparative advantage. It is of concern to the whole Organization to make sure that people have access to medical products they need.
The issue of health security is something for which WHO is well recognized, but we thought that there is a particular focus within that priority to make sure countries have the capacity to implement the IHR. So we narrowed that priority to say, at the very least, countries should have the capacity to implement the IHR by the 2016 deadline. Finally, the social, economic and environmental determinants of health reflects a more fundamental change. It means that WHO is concerned not only with the biomedical causes, but with all the causes of ill health. So we will act as an advocate for health in a variety of other for a that can affect health outcomes.
Linda Larsson: Determinants of health seems to be a difficult concept to understand. Why is that?
Andrew Cassels: I think it is difficult because of its potential breadth and because people understand social determinants of health in different ways. Member States are concerned that WHO should clearly show that it gives priority to the broader causes of ill health and inequity.
When we first started thinking about reform it was pretty clear that there were two big groups of Member States, one that primarily wanted to give highest priority to WHO’s presence in countries – for hands-on support, helping as a neutral broker, given all the different sorts of advice they receive. A second group of Member States saw WHO’s priorities much more in terms of its normative and standards-setting role.
As the reform has progressed, a third group, particularly from the large emerging economies, proposed a third way of thinking about WHO – as an effective political actor in support of health, whether that is in the environmental sphere or in terms of access to medicines, trade, etc. – where WHO seeks to be a much more effective advocate. So my sense is that this is where the real focus of the work on social determinants will lie.
Linda Larsson: Might these priorities change before 2019?
Andrew Cassels: I suspect not, though the balance between them may change. There may well be a situation where the social, economic and political determinants of health becomes more focused, with WHO being more involved in some than in others. With respect to the other priorities, I think that the change is likely to be within WHO’s role rather than the priorities themselves, given that they are fairly broad.