Environmental Scanning of the WHO, Research Paper Example

Introduction

The World Health Organization (WHO), headquartered in Geneva, Switzerland, was organized in 1948 as an agency of the United Nations. The primary responsibilities of the WHO include improving health care around the world through vaccinations, better sanitary conditions, and access to medicines and preventing the spread of diseases like HIV AIDS, cholera, malaria, and influenza (McKenzie, et al, 2011, p. 35). When one enumerates the difficulties that international cooperation on health has faced from different quarters, certain questions arise. How have these difficulties, whatever their nature or origin, influenced the successful implementation of the WHO’s program and policies? Have these difficulties been necessarily detrimental to the WHO, or has the WHO utilized them as focal points for improvements? Could the problems have been avoided? Finally, how have the difficulties influenced the overall ideology and approach of the WHO towards health issues? An environmental scan of effectiveness should shed light on some of these questions.

In an approach that has been validated over the last two decades, Bryson (2011, p. 156) outlined a series of categories that can be scanned (environmental scanning) to keep the organization current and relevant in the industry. This paper conducts a comprehensive theoretical environmental scanning of all those categories described by Bryson (2011).

Cultural and Sociological Forces

This introduces the sociological perspective and illustrates how sociological forces help the WHO understand issues related to health. Using a sociological perspective means focusing on social patterns rather than on individual behaviors. Built upon the global understanding of the necessity for reduction in environmental impact and the current paradigm of the threefold model, the Kyoto Protocol was designed as an international agreement which would require the most advanced capitalist countries to take responsibility for global warming and reduce carbon dioxide emissions. The targeted reductions were to reach approximately 5 percent below 1990 levels by 2012.  The Protocol, however, met enormous resistance from these countries, especially China and the United States (Foster, 2000).

Even though failure to address the problem would trigger a chain reaction of negative environmental impacts, the capitalist motto of “consume today, pay tomorrow” made commitment to such a socially conscious agreement antithetical (McCraw, 1997). In fact, one of the century’s premier capitalists, Milton Friedman, has declared that it is immoral to be socially conscious as a capitalist, especially if one is part of a publicly held corporation.  As Henry Ford learned when he lost a suit to the Dodge brothers because he was too kind to his employees in terms of sharing profits, capitalist ventures are built solely upon the predicate of making money and anything that gets in the way of that objective is considered immoral (McCraw, 1997).

The main objective of the Kyoto Protocol is to reverse the exponential growth of carbon dioxide and other greenhouse gases within the earth’s atmosphere. If wealthy, industrialized nations were to return to 5 percent below the 1990 level of greenhouse gas emissions by 2012, this growth would be significantly reduced, thus improving the quality of life for all and stabilizing the world’s future potential (Foster, 2000).  Once this former level is reached, the next goal would be to maintain this level such that emissions would increase but not exponentially as they are currently (Foster, 2000).

Environmental solutions for industrialized countries often are envisioned in the forms of technological innovations.  Future advances are expected to raise the efficiency of energy consumption so that increases in production do not cause annual increases of carbon dioxide levels in the atmosphere.  This theory is especially used in reference to reducing the impact of automobile usage in the form of cars with higher gas mileage.  This practice was successful in the decade following the Organization of Petroleum Exporting Countries (OPEC) oil crisis of 1973 when wealthy capitalist countries produced smaller cars with higher gas mileage in order to lower their overall energy consumption.  As oil prices dropped to account for lower usage, gas mileage rose once more (Foster, 2000).

Two of the founding theorists behind the concept of monopoly capitalism, Thorstein Veblen and Rudolf Hilferding emphasized the intrinsic wastefulness of capitalism. Even though capitalism promotes a narrow definition of bottom-line efficiency, the system as a whole is incredibly wasteful.  Citing the oil industry for its “clamorous waste and mishandling,” he makes a historic causal analysis between this mismanagement and the eventual system of monopoly control (Veblen, 2004, p. 200-201).  For Veblen monopoly capitalism was an industrial system which was essentially a system of “absentee ownership” that recklessly and unreasonably consumed huge amounts of human and natural resources.  This waste was precipitated and perpetuated by the capitalist monetary mindset, placing profit above rational consumption (Veblen, 2004, p. 300).

Ecological Forces

In most Western countries, the population is aging rapidly. What impact does this have on the services the WHO deliver? And how will an aging workforce impact the ability of the WHO to meet service demands in the future? Although between 1950 and 2010 the world population more than doubled, there is evidence to suggest that it will not double again in the next 50 years of the 21^st century (Kebede-Francis, 2011, p. 167). This is because most countries have either completed or are in process of completing their demographic transition periods. For example, Europe, most of the Americas, the Middle East and Arab states, and the FSU states and some developing countries have completed their demographic transition periods (p. 167). In this respect, the WHO, governments of least developed countries, NGOs, and the medical communities must focus their attention on demographic trends, especially fertility rates.

Physical, emotional, and environmental changes generally accompany aging (Kozma et al, 1997). These changes can occur suddenly, such as with the death of spouse, or gradually, such as with deteriorating health. However, not all changes associated with aging are negative. There are elderly who perceive retirement and freedom from responsibility of rearing a family as a positive change. Research on successful aging in western countries has increased in recent years due to the rapid increased or shifts in the proportion of older individuals in the population. I feel that one of the issues that must be focused on by aging services is to understand the factors that affect the subjective well-being of the elderly. Studying the complex structure of subjective well-being among them will enhance our understanding of the elderly perception of happiness, the psychological and biological changes that accompany aging and processes of adaptation that influence affect and life satisfaction.

One other issue confronting the provision of aging services is the accelerated pace of growth of the elderly population. As such policies, facilities, and other resources need to be in place to support this development. If not, adequate care will not be accorded to them. The National Research Council (2001) explained that the world’s population is aging at an accelerated rate. Declining fertility rates combined with steady improvements in life expectancy over the latter half of the 20^th century have produced dramatic growth in the world’s elderly population (NRC, 2001). People aged 65 and over, comprise a greater share of the world’s population than ever before, and this proportion will increase during the 21^st century. This trend has immense implications for many countries around the globe because of its potential to overburden existing social institutions for the elderly (NRC, 2001). This phenomenon will affect not only most countries globally.

Global aging was envisions or viewed as a looming catastrophe, as populations top-heavy with frail, retired elderly drain pension and social security funds, overwhelm health care systems, and rely for support on a dwindling working-age population (NRC, 2001). The number of elderly (65 and older) increased more than threefold since 1950, from approximately 130 million (about 4 percent of global population) to 419 million (6.9 percent) in 2000 (NRC, 2001). The number of elderly is now increasing by 8 million per year; by 2030, this increase will reach 24 million per year. The most rapid acceleration in aging will occur after 2010, when the large post World War II baby boom cohorts begin to reach age 65 (NRC, 2001).

Globalization and modernization have tremendous impact on the family system. The exodus of working age adults to jobs abroad has established a pattern of the older persons assuming surrogate parental roles. The responsibility of providing parental care over grandchildren whose parents have left as overseas workers is entrusted to the elderly. This situation imposes undue strain on the physical, psychosocial and financial capacities of older persons. The needs of the elderly were sacrificed which puts the elderly to a situation of disadvantaged. This life condition of the elders will possibly affect their happiness.

Economic Forces

Economic tides wreak havoc with public sector and the WHO dependent in large measure on third parties for funding. The vicissitudes of market conditions must be considered as the WHO plots its fiscal plan and paint broader strategic canvas.

Projected expenditures of the WHO in the biennium 2010-2011 was $US 3700 million with 50% of estimated cost spent at staff salaries, 15% of direct financial cooperation at country level, 12% on research and consultancies, 10% on medical supplies, 8% on travel expenditures; and the remaining 5% on other expenses (WHO, 2010). There is an unhelpful resource ration of 18% to 82% between assessed contributions and voluntary contributions (Shashikant, 2011) – funding which is largely earmarked for specific activities – which severely hampers the WHO’s ability to carry out its core work. The WHO intends to redress the imbalance of earmarked funding, and the restrictions this places on activities by 2013 (Shashikant, 2011). However, the latest proposed program budget for biennium 2010-2011 shows even greater imbalance (Shashikant, 2011). This poses a major threat to the WHO’s financial health.

Capitalism is an economic system that seeks accumulation and growth for its own sake. Driven by the single-minded need for profit, businesses are designed to secure greater and greater amounts of capital with each passing day.  Marx’s derisive account of the capitalists in his work entitled Capital was, “Accumulate, accumulate! That is Moses and the Prophets!” (vol. 1, ch. 24, section 3)  There are no intrinsic impediments to this process except that of other capitalist competitive interests, periodic economic crises, and the objective forces of market economics (Foster, 2000).

The idealistic rhetoric of capitalism has always claimed that it is a system that is dedicated not only to the pursuit of wealth but to the increasingly better satisfaction of human needs.  In practice, however, the first goal entirely overrides the second and transforms the concept of human need.  Since capitalists do not limit their business to those commodities that satisfy basic human needs, but extend the commoditization of human life to products which satisfy the pleasure-pain principle within human nature.  These commodities, which very often have to do with entertainment, safety, and comfort, are then advertised and marketed as necessities or as normative parts of capitalist society so that every person feels they need these non-necessities. This transforms the baseline of needs in a society, showing the dominance of market dynamics over societal norms and the satisfaction of human needs.

For capitalists, profit becomes an end in itself, and whether or not a commodity is actually useful or necessary becomes completely immaterial.  The exchange value rather than the use value becomes dominant and over-consumptive lifestyles and practices on the part of consumers is encouraged and also made normative for the sake of corporate profit margins (Foster, 2000). Thus, even goods that are needed are over-consumed and result in destructive practices both to human health and the earth itself and, worse, goods that are obviously destructive to all of nature are produced and marketed without restraint (Sweezy, 1989).

No other social system displays this overwhelming obsession with capital accumulation.  This obsession is the reason why it never reaches homeostasis or becomes static.  In fact, as Joseph Schumpeter explains, stationary capitalism is a contradiction in terms (Schumpeter, 2004, p. 29).  The critical driving force behind the continual race for accumulation via better performance and profitability is competition.  This race is unending and blind in that all its participants see is the road before them – they do not see who or what they plow over in their paths.  This tendency toward “creative destruction” is creative in that it continually attempts to innovate by inventing new and more efficient products and means of distribution while it is destructive in that it destroys the previous forms and products.  In this unrelenting race to accumulate and win, the actual needs of humanity and nature are viewed as little more than obstacles to be overcome (Schumpeter, 2004).

Technological Forces

The question that remains is whether the fundamental hypothesis that more efficient technology spawns less consumption is valid.  Jevons’ (1865) analysis in The Coal Question indicates that when technologies are created that reduce consumption of a natural resource such as coal results not in less but in more usage and more demand because the improvements result in increased desire and ability to produce more goods.  It is not increased efficiency that lowers consumption but decreased profits.  When prices rise such that they outstrip the current level of affluence, then consumption drops because it is no longer beneficial to the consumer to continue to consume at the same level.  In fact, the more efficient technologies lead to an increase of consumption unless it is paired with a drop in profitability or affluence.  The same principles apply, with even greater force and distinctiveness to the use of such a general agent as coal (Jevons, 1865). Expanding this notion to that of civilization in general, civilization itself can be defined as an economy built upon power and however that power is generated creates the foundation of industry.  Thus, since power itself is the foundation of civilization, the more efficient use of it will simply create more consumption, not less.

This dilemma, called the Jevons paradox, is notable in contemporary American society with respect to the use of the automobile. When more energy-efficient vehicles were created in the 1970’s, and the demand for fuel did not ultimately decrease but increased as people resumed former driving habits and the number of cars on the road doubled.  Another case in point is that of refrigeration.  When more efficient refrigerators were introduced, the need for and consumption of larger refrigerators actually increased energy usage (Foster, 2000).

Despite the above limitations on technology as the solution to environmental over-consumption, there are two ways in which technological change does lessen environmental impact. First, technological innovations can reduce the amount of materials consumed as well as the amount of energy used per unit of output.  Secondly, newer technologies can be used as substitutes for more harmful ones. For instance, air quality in the nineteenth century was far worse than that of the late twentieth century, mainly because of better technologies which reduced the smoke and sulfur dioxide emissions from coal-burning energy producing factories and plants (Foster, 2000)

Political Forces

The environmental problems of the third world could be explained as the result of population growth rather than technology or affluence. The environmental problems experienced in less developed countries like those of the former Soviet bloc and newly industrialized nations were attributed to inferior technology, because these technologies have lower efficiency in material usage and energy consumption per unit of output which in turn created high toxicity in the local environments.  For their part, Western countries’ main environmental problem could not be the result of rampant population growth or poor technology, because these problems did not exist to the extent that they did elsewhere. Rather, under this model the West becomes a victim of its affluence and the burden of increasing technological growth and consumption (Foster, 2000).

The political action that the WHO can take, and discuss, is limited to that which is required to support national political action in the field of health, and which the country has itself asked for. When asked, the WHO can use its constitutional roles as coordinating authority on international health work to lead to the definition by member states of collective policy which can then act as a frame of reference for corresponding national policy. In doing so, the WHO has a ‘sacred’ obligation to promote health of people in all countries as demanded by its constitution, which underlines cooperation among member states and with others to “promote and protect the health of all people”. In this context, then, the politics of health refers to how the WHO can, when asked, assist national governments to use their power to improve the health of their nationals. This is one aspect of the positive form of politics. Also, when it is possible for the WHO to support governments and people in taking political action in support of policies for health that have been agreed collective at the World Health Assembly, it cannot enforce compliance with this or any other policy or with ethical or commercial codes of any kind.

Sadly, there are many diseases that pose significant threats to human being and reminders of just how permeable are national borders. Malaria is a major threat to global health, with the Center for Disease Control reporting 350 to 500 million cases of malaria annually, of which over one million result in death (CDC Malaria Fact Sheet, 2009). This is tragic because the disease, which is transmitted by mosquitoes to humans, is largely preventable and treatable. Efforts to combat the spread of the disease include the distribution of millions of insecticide-treated bed nets (CDC Malaria Fact Sheet, 2009).

Avian flu, the so-called bird flu, is also of global concern as, according to the WHO, the current outbreak “has been the deadliest” (Worldwatch Institute, 2007, p. 90). Since the outbreak in 2003, at least 262 people have died from the disease (WHO, 2009) and hundreds of millions of chickens, ducks, and other birds have been killed in an effort to curb its spread.

What makes influenza from other global disease is the frightening ease with which it spread. Another deadly strain of influenza, one that crossed the species barrier between pigs and people is known as HINI or swine flu has recently captured global attention as policy makers and healthcare officials have raced to combat the infectious disease through public health measures. First appearing in Mexico 2009 and then spreading quickly to the United States, according to the WHO the virus has now appeared in at least 168 countries and overseas territories (Kegley, & Blanton, 2010, p. 502).

The spread and control of infectious diseases such as AIDS, tuberculosis, malaria, Lassa fever, Ebola, lymphatic, filariasis, Avian flu, mad cow disease, and swine flu have established themselves on the radar screen of the WHO throughout the world (Kegley, & Blanton, 2010, p. 502). They will not vanish from sight anytime soon, and are a stark reminder of the transitional threats that are present in borderless world and necessitate global cooperation and coordination.

Solving the political crisis for any type of country for the WHO, then, reduces to altering the factor in the formula that is out of balance. Since the earth’s fundamental capacity of natural resources is finite and can only expand so much in order to accommodate the rapidly increasing demands that are being placed on it, somehow, regardless of the type of country, a method for reducing consumption and impact on the earth must be devised in order to reestablish harmony and balance.

Interestingly, the very innovations that are creatively destructive as products of capitalism are often viewed as the solution to problems caused by lack of affluence. For instance, affluent countries are perceived as having an advantage over others within this formula by virtue of their technological prowess.  This prowess was expected to allow them to create improvements which would positively impact the environment or reduce the current impact through higher efficiency.  Thus, innovation theoretically allows the wealthiest countries to expand and grow and consumption while simultaneously reducing their environmental impact (Foster, 2000).

Legal and Ethical Forces

The WHO is not a regulatory agency, but for many countries that cannot afford a robust regulatory system or have not yet developed one, the WHO is very important source of validation for drugs and vaccines. Because there are many drugs and vaccines that inadequate tested, counterfeit, adulterated, or otherwise inappropriate for treatment of patients, many countries rely on the WHO’s prequalification system to quality the drugs and vaccines they purchase (Chin, & Bairu, 2011, p. 12).

In 2011, the WHO set up a drug prequalification system “to facilitate access to medicines that meet unified standards for quality, safety, and efficacy for HIV/AIDS, malaria, and tuberculosis”, as well as for some additional diseases (Chin, & Bairu, 2011, p. 12). The original intent was to help agencies such as UNAIDS, UNICEF, UNFPA, and the World Bank to determine which drugs were of high and dependable quality. However, the system has now evolved to a point where multiple agencies, countries, and other groups rely on the certification process to ensure that the drugs they purchase are of high quality (12).

As of 2010, 42 proprietary and 61 generic medicines had undergone the prequalification process successfully (WHO, 2011). Many of the drugs are for diseases with an extremely high burden of illness in developing countries, such as drugs for HIV, malaria and tuberculosis.

The stated criteria for assessment of drugs are “the same as those used by the European Agency for the Evaluation of Medicinal Products (EMEA) and the Food and Drug Administration (FDA). In other words, the prequalification assessment team evaluates the required data, including the vivo bioequivalence tests carried out by the manufacturers” (cited in Chin, & Bairu, 2011, p. 14). However, in practice, the ability of the WHO to conduct the assessment is limited by the resources and personnel available, which are substantially less than those available to the FDA and EMEA (p. 14).

Although the WHO prequalification process is intended to be akin to harmonization systems such as the Pharmaceutical Inspection Convention and Pharmaceutical Inspection Cooperation Scheme (PIC/S) and ICH, in practice it has evolved into a pseudo-regulatory approval system for those countries without a robust regulatory system (Chin, & Bairu, 2011, p. 14).

The WHO often relies on a team of experts drawn from national regulatory authorities. The team conducts review of the data, conducts site inspection, and compiles a report. The WHO then will determine whether the drug should be prequalified and the results will be communicated to the sponsor. Following the process, the manufacturers need to keep the WHO informed of any changes or variances to the previous manufacturing process, and re-evaluations are performed at least at five-year intervals.

Conclusion                                                                

The present structure and membership of the WHO are the end product of much conflict and controversy over the six decades of the WHO’s history. Moreover, the division of the WHO’s membership, both now and historically, into political and regional blocs has at times detracted from the internationalist sentiment that considered universal membership so crucial for the WHO at the time of its formation: universality and unity have not gone hand in hand. These difficulties present a recurrent theme of negative challenges to the WHO’s structural aspirations. The danger that challenges pose to the future of international organization is rarely due to an individual incident, but rather to the impression they create collectively of an enduring pattern of worsening situation which over time has become habitual.

The WHO should also be strengthened in certain roles to assume the maximum amount of responsibility because it could be in an excellent position to do certain things that other parties cannot. What are these things that other parties cannot do? The WHO still enjoys a very strong reputation among many developing countries. A good example is the swine flu: the WHO has been brokering to encourage all countries that have cases of swine flu to make biological samples available to the industry (Bartholomew et al, 2011, p. 90). Had the WHO not brokered certain of these initiatives, it would have been much more difficult to get the samples out and do further research in countries with more sophisticated research infrastructure. So there is something of a coordination role for the WHO in trying to bring different parties together. But again, the WHO should be very cautious not to enter conflicts of interest, which unfortunately, they are doing already. Now, the WHO should be much stronger in pointing out the research gaps and much more vocal in pointing out what drug research needs to be done to help certain populations that face a particular health care hazard, and also in ensuring that someone will produce these drugs.

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