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The next WHO DG: how about a tough cookie with a bold transformative vision?

By Kristof Decoster
on September 26, 2016

Over the weekend, Laurie Garrett rightly noted that the upcoming WHO DG (s)election might be the first one that will also play out on social media. Still, she acknowledged social media probably won’t have much impact on the outcome, as  the “MOH vote is based on deals not tweets” .  Assuming that social media might just have a tiny bit of influence in this whole global health governance exercise, though, let me offer a few ideas and suggestions of my own. It’s a rather important vacancy, after all! (endorsing this or that candidate I leave for the real experts, though 🙂  ) .

The two suggestions I provide below are also relevant for other important top jobs (in global health or in the global arena (US presidency) …) at this important point in time, where things could go either way, as Justin Forsyth, deputy executive director of Unicef, put it last week in New York: “I think the world could tip either way to be honest. There’s a battle of hearts and minds going on about whether these issues are going to be front and centre for politicians. …” (he was referring to the refugee crisis and how governments deal with it (or not)).

The ongoing ‘battle of hearts and minds’ also has implications for the sort of leadership we need, though, now. Two simple suggestions in this respect.

 

Resilience

Coincidentally, I have been facilitating a (still ongoing) discussion on resilience (and health systems) in recent weeks, for the new EV batch (together with Remco van de Pas). I’m still anything but a resilience expert now, but this much I know for sure: I really would like to see a ‘resilient leader’ at the helm of WHO in the coming years.  Somebody on top of his/her game, in good physical & mental health, for whom 16-hour workdays are sort of fun; somebody who never gives up after a setback, sees an opportunity in every challenge/crisis, … Well, you get the idea. Margaret (aka “tough cookie”) Chan did pretty well against that benchmark, I think.

At the same time, the next WHO DG should also understand that the ‘condition humaine’ is such that most ordinary people don’t exactly consider it as their “ultimate goal in life” to become resilient citizens. And that resilience of people, while something that should be encouraged (as it helps to deal with the hiccups and tragedies in life), should never be assumed or expected from citizens – as Tony Blair and others did some years ago, basically saying that human beings should all become (more) “resilient”, as this is the only way to survive in this new era of increasing globalization and competition (and shocks). Human beings should never be reduced to resilient citizens “surfing the waves of insecurity and enjoying every single bit of it”, even if instability and change are clearly part of life. Resilience is not what life is about.

So yes, I expect leaders to be resilient, at least during the years they’re leading (a country or organization), but I hope these leaders also grasp the fact that not everybody is like them (nor needs to be like them). People are diverse – some are resilient, others are less resilient, many are even vulnerable and fragile for a number of reasons. One day, even very resilient leaders will find that out for themselves.

In short, resilience is a quality I expect from leaders, certainly in difficult and volatile times like now. It is not something that should be required from ordinary citizens.  We can only try to help people to become more resilient (first of all, ourselves…).

 

The need to “speak truth to power” ?

Many global health voices say the next WHO DG should  be less of a consensus leader,  but instead  ‘speak truth to power’ (Horton).  Bold transformative leadership is now needed. In the words of David Heymann, for example: “ In the past there have been two types of director-generals: “political leaders” who place their vision in front of member states and justify it with evidence, and “consensus leaders” who take their lead from member states. Right now WHO needs the former”.

I personally think it depends on the situation & area. Sometimes it pays off to be a diplomat, sometimes you better don’t mince words and “speak truth to power”.  ( Side note: I noticed that Richard Horton was rather diplomatic himself on Twitter last week, commenting on the launch of the Hollande-Zuma commission report, when Hollande & Zuma addressed the audience… J)

I also think some of the qualities one would like to see in one leader, ideally at least, often tend to be available in a number of people instead. For example, it is rare that a leader is charismatic, ànd articulate, ànd effective, ànd empathic, efficient, hands-on, disruptive if need be, …. Even Obama couldn’t pull that off. Applying this to WHO, the amount of decisiveness and determination needed to take quick (and sometimes difficult ) decisions in outbreaks is perhaps not the same as in other global health areas (like NCDs), where a bold vision is perhaps needed more, before acting upon this vision.

I might be biased (correction: I AM biased) but it seems vital that the next WHO DG has a thorough understanding of the “real” enemy of global (and planetary) health. Neoliberalism, that is.  Put differently, perhaps: the next WHO DG should “read” the rise of populist movements around the globe (and certainly in the North) accurately, and not just consider most Trump fans or Brexit voters as “ignorant fools” or worse. The 20-30 people who still take most decisions in global health policy making (for better or for worse), certainly do a lot of valuable work, but I don’t think they really “get” why so many common people feel left behind by globalization – as they are mostly part of the 1 % themselves (and some even of the 0.01 %).

The next WHO DG should internalize and radiate the new SDG wisdom that global health is truly ‘global’ now, applies to both North & South (which increasingly thus lose their meaning), and we’re all on the same boat (with exception of the 0.01 % perhaps).  He or should try to understand why so many people feel angry now. It’s not rocket science, actually. Human beings are social animals. If our sense of justice is – again and again –  trampled upon or made fun of by elites, and views of ordinary citizens are over and over disregarded (as being “too simple”, or because “there is no alternative”) then you shouldn’t be surprised that voters at some point turn ‘irrational’, having become cynics for a long time already.

The next WHO DG needs to have that (transformative) vision, and should then be resilient enough and have the drive  – a global health battery  like Lucy Gilson’s would certainly be a nice add-on  🙂  –  to actually do something about the disastrous global impact of neoliberalism, at all levels.  In her speeches, Margaret Chan often showed glimpses of such a bold transformative vision. The next WHO DG should go further, though. Our times require that he/she is no less than “the WHO equivalent of George Monbiot”, at least in terms of vision.  By now it should be abundantly clear that neoliberalism (and neoliberal globalization) is the disease  (or at least one of the most perverse diseases ever to strike this planet). I bet that when you deal with this enemy head on, a lot of what is valued in global health (UHC, AMR, global health security, access to medicines, …) will suddenly become easier, too.

True, the neoliberalist discourse might already be on its way out, but politicians and technocrats around the world still implement it, and the ‘values’ that give it legitimacy are still thriving (such as ‘meritocracy’ (but not for CEOs),  technocracy instead of real democracy; performance benchmarking (but only for social sectors and aid, never for defense or hedge funds),… ).

In short, there’s no way we can reach ‘health for all’ (and in general, a fairer & ecologically sustainable planet) if the next WHO DG doesn’t put it this way, unequivocally. In that sense, yes, the next WHO DG has to “speak truth to power”.

Yes, WHO reform is important, and I hope countries will finally finance WHO the way they should in the years to come. But the next leader of WHO should most of all not be afraid to frame the battle ahead accurately: neoliberalism is the enemy.

That might not be an easy message in the global health community. It might also not be the shrewdest fundraising strategy for WHO, at least in the short term. Thankfully, a strong ally (who reached the same diagnosis a while ago) is already on hand: pope Francis.  If Francis’ own Boss now also gives a hand in the battle ahead in the coming years, transformative change might just happen! (and if not, there’s still the book of Revelation…  🙂 )

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