Every year in the last week of May, the representatives of 194 countries who are the Member States of World Health Organization (WHO) meet at Geneva in the World Health Assembly (WHA) to endorse a number of reports and adopt a number of resolutions. Considering the high prevalence of international meetings that amount to little more than discussions without subsequent action, it might be alluring to overlook the importance of the annual WHA. But that would be a mistake.

The WHO is the pre-eminent organization in setting the agenda at the global level. But unlike in other sectors, WHO reports and resolutions influences the technical and administrative design of health interventions across most countries- but especially across all low- and middle-income countries (LMICs). Take for example an agenda like Universal Health Coverage. In 2005, it was not a term in use. In 2010 it was being hailed as the biggest innovation of the 21^st century and all countries  sworn allegiance to achieving it. Alternatively, on a more detailed level, after the WHO introduced the DOTS strategy, every nation pledged its support, hailing it as the most significant development in tuberculosis management. A few years later, DOTS became DOTS plus and a few years later when the End TB strategy was announced DOTS was “denounced” and a slew of new strategies followed. So, it has been the same for HIV, Malaria, Neglected Tropical Diseases, Non-communicable diseases, mental health and so on and forth. Within one to three years of WHO adopting a strategy or operational design, almost all countries modify their respective strategies to conform. There is no parallel for this in say the education sector, or in natural resource management, or in energy sector etc. And this is despite the fact, that most commitments in the WHA are not binding commitments.

To a significant degree, the WHO’s role in setting agendas is well endorsed, and there’s a necessity to safeguard this role, especially when it faces criticism from global financial institutions and specific high-income nations, notably the USA, which tends to be particularly assertive in its opposition.. The annual WHA is the highest governance institution of the WHO. The WHO  is an inter-governmental representative body operating on the principle of one country one vote, unlike almost all other global health and financial institutions. Its democratic essence has been significantly undermined since the mid-eighties, as its funding, previously derived predominantly from a mandatory and equitable cess levied on member states—amounting to over 80% of its budget—now constitutes only around 22% of its total budget.  . The rest of the budget flows from bilateral donors whose funds come with specific obligations. Nevertheless, partly due to past tradition and partly due to the role required of it, the functioning of the WHO is more democratic and this character requires to be defended and expanded.  But keeping it that way is a challenge. WHO’s actions are usually a negotiation between what it must do to satisfy its main bilateral donors, which are select high-income countries and corporate philanthropies like Bill and Melinda Gates Foundation, and what it must do to honour its Health For All mandate. The two are often not aligned.

Public health especially global public health clearly is not a neutral technical terrain, but a highly contested political terrain. One could miss this sober reality if one went only by the very diplomatic and euphemistic terms and expressions in which global policy documents are written. In the nineties LMICs gave away many rights, especially in the trade arena and in structural adjustment, partly because they did not understand the implications of what they were signing away. As the pandemic negotiations show, that danger is less now.  But still across all health themes, including such apparently technical topics like Neglected Tropical Diseases (NTDs), concerns remain as to whether these policies are prioritising profits for big pharma and other corporates over health equity and social justice.

Often the negotiations remain limited to the corporate interests, the interests of high income nations and the elite and business interests within developing nations. The most important stake-holder which is the community is absent in the negotiating table. To paraphrase Virchow, it falls on the public health professionals (and civil society activists) as  “the natural attorneys of the poor” to raise the concerns related to equity and social justice. The PHM commentary is one essential tool that helps those interested in Health for All and health equity to unpack the language of these global policy drafts and bring some of these concerns and the possible alternative formulations into the poliicy discourse.

Item alerts and commentaries on WHA 77 agenda will continue to be issued by PHM in the next few days. The record of discussions that took place in the assembly would also put up in the WHO Tracker over the next few month.  For those interested in global health policy and its impact on national policies, WHO Tracker is a huge resource, to scan the entire area and to follow up on issues which are of specific interest to them.