Res Medica, Volume 21, Issue 1 Page 1 of 11 SPECIAL ARTICLE The World Health Report 1995-2013: A personal retrospective Thomson Prentice Former Managing Editor World Health Organization Correspondence email: [email protected] Abstract Thomson Prentice shares his personal experiences of being part of the World Health Reports (WHR) from 1995-2013. Copyright Royal Medical Society. All rights reserved. The copyright is retained by the author and the Royal Medical Society, except where explicitly otherwise stated. Scans have been produced by the Digital Imaging Unit at Edinburgh University Library. Res Medica is supported by the University of Edinburgh’s Journal Hosting Service: http://journals.ed.ac.uk ISSN: 2051-7580 (Online) ISSN: 0482-3206 (Print) Res Medica is published by the Royal Medical Society, 5/5 Bristo Square, Edinburgh, EH8 9AL Res Medica, 2013, 21(1):2-11 doi: 10.2218/resmedica.v21i1.510 Prentice, T. The World Health Report 1995-2013: A personal retrospective. Res Medica 2013, 21(1), pp.2-11 doi:10.2218/resmedica.v21i1.510 Prentice T. http://journals.ed.ac.uk/resmedica Introduction In my experience, I can say that every report SPECIAL The launch of The World Health Report has been a unique exercise, invariably (WHR) 2013 in Beijing in September of this complex, involving many people in WHO year brought the total of such reports to 16 HQ, Regional Offices and elsewhere, and since the World Health Organization many individual contributors. The work usually spanned about 12 months. Often (WHO) brought out the first edition in 1995.1 During that time the WHR has that seemed barely long enough for some of become WHO’s flagship publication and an us, and far too long for others. Meeting indispensable resource for everyone engaged deadlines was almost always a recurring in global public health. nightmare for everyone concerned. Its main purpose has been described as Invariably, too, the process of getting from providing policy-makers, donor agencies, early conceptual discussions to a high-quality international organizations and others with print and website publication released in at the information they need to help them least six languages (Arabic, Chinese, English make appropriate health policy and funding French, Russian and Spanish are WHO’s decisions. However, the report is also official languages) was exhausting and accessible to a wider audience, such as stressful for those most closely involved. universities, journalists and the public at large. It is expected that anyone, with a This retrospective first of all considers the professional or personal interest in origins of the WHR and the reasons why it international health issues, will be able to was established. It goes on to trace the read and make use of the report.2 various contexts in which successive editions were produced, and the four consecutive It can also be of particular interest to WHO Director-Generals, who to varying medical students who are considering a extents, made it their own manifesto. The career in international public health, as it impact of the reports over the years is also provides many insights into how countries briefly assessed. collaborate in gathering and exchanging health data, participating in disease This is predominantly a personal surveillance, and working with international retrospective based on my role as editor, organizations such as WHO, other United writer and co-ordinator in each World Nations agencies, and non-governmental Health Report process. Although it is a organizations (NGOs). subjective account, I have tried to stay loyal to my journalistic principles of accuracy As a professional staff member of WHO at balance and objectivity. its headquarters in Geneva, Switzerland, I was closely and continuously involved in the Although I can claim to have written parts production of every WHR from 1995-2009. or almost all of some of the reports, over the Volume 21, Issue 1 2 Res Medica The World Health Report 1995-2013: A personal retrospective years my writing role diminished as I took primary health care and the “health for all” on the wider responsibilities of managing concept, perceived as little less than a hero editor of the whole editorial and production by many WHO staff and widely praised and process. The main credit for the content of respected in the international community.4 many of the WHRs, therefore, should go to the leading writers (usually senior WHO Mahler was therefore a hard act for specialists or their counterparts from other Nakajima to follow. He was a poor institutions). I have named only some of communicator, ill-at-ease in the public eye, SPECIAL them here and apologize for any omissions. and was seen as lacking authority, leadership or vision. Partly as a consequence, WHO’s The origins status declined during the late 1980s and early 1990s. The organization appeared to be When I joined the World Health adrift, with no clear direction. Organization in March 1992, I had been a UK-based newspaper journalist for over 20 Although WHO still earned high respect for years, specializing during the 1980s in its work on HIV/AIDS, even that area was covering health and medicine for The Times coming under a cloud. Conflicts over policy, in London. In particular, I covered on an direction and funding grew between almost daily basis the AIDS epidemic (HIV Nakajima and Mann. In 1991, Mann had not yet been identified as the causative resigned, with considerable bitterness, and virus) as it emerged in the UK, and, the image of WHO was further tarnished. increasingly the global pandemic. I thus came to know many of WHO’s senior Another blow came with the publication in figures and AIDS specialists, and this led me 1993 of the World Bank’s World Development eventually to move to WHO as a writer and Report. The first World Bank report devoted media communications officer. entirely to health, it identified major 5 problems in international health systems. Because of AIDS, WHO’s international To many of WHO’s Member States, senior profile was higher at this time than it had staff and others, it was a direct challenge: the been for many years. The charismatic leader World Bank was stealing WHO turf. The of the WHO campaign, Dr Jonathan Mann, World Health Assembly then passed a was a tireless advocate for action, traveling resolution instructing Dr Nakajima to the world to make keynote speeches at produce a response in the form of a new international health meetings and standing in publication on the state of the world’s health constant demand for media interviews.3 as soon as possible. By contrast, the incumbent Director- A special project team was formed and General, Dr Hiroshi Nakajima, of Japan, was worked feverishly throughout 1994 to a rather dull technocrat who had gradually compile a mass of international health data risen through the WHO ranks and was and information. The results, however, were elected to succeed Dr Halfden Mahler in shapeless, with no clear theme or narrative. 1988. Mahler, a Dane, was an almost An experienced writer was required, and legendary figure, the torch-bearer for Volume 21, Issue 1 3 Res Medica Prentice T. http://journals.ed.ac.uk/resmedica with my journalistic background, I was But it was a start, and I found I had created seconded to the project. During the winter a niche for myself. of 1994-1995, I and a small editorial team set SPECIAL about the task. The next two reports were devoted to communicable diseases and Consequently, in May 1995, “Bridging the noncommunicable diseases respectively Gaps” was published at the World Health (“Fighting disease, fostering development” and Assembly. The World Health Report was “Conquering suffering, enriching humanity”). born. The themes were chosen by the Director- I was given unusual freedom in writing it. General’s office, and in each case an Assistant Approaching it as a journalist, I went for Director-General was put in charge of the what seemed to me the strongest angle: project (an American ADG, Dr Ralph poverty. So the introductory paragraph read: Henderson for 1996, and Dr Nikolai “The world’s most ruthless killer and the Napalkov, his Russian counterpart for 1997 – a greatest cause of suffering on earth is listed reflection, perhaps of internal WHO politics). in the latest edition of WHO’s International Classification of Diseases, an A-Z of all ailments known to medical science, under the code Z59.5. It stands for extreme poverty.” I also ghosted the Message from the Director-General. It concluded: “The World Health Report is about many things, but most of all it is about people, particularly those whose plight is most desperate, and I had overall responsibility for writing the whose needs are greatest. Their fate, like the two reports from technical contributions. report itself, is in your hands. I urge you not Both were intent on being topical –the 1996 to set it lightly aside.” report highlighted the emergence of new diseases and failures in controlling older Nor was it. It gained international media ones; in 1997 the focus was on the coverage, was well-received in the global emergence of non-communicable, “lifestyle” public health community, and went only diseases in regions where they had some way towards restoring WHO’s image. previously little impact. It was an account of Volume 21, Issue 1 4 Res Medica The World Health Report 1995-2013: A personal retrospective the global epidemiological transition which a fistful of new policies which linked human is so widely-recognized today. and economic development; she launched a new anti-malaria campaign; and began a determined attack on tobacco which led to the Framework Convention on Tobacco Control – the first international treaty negotiated under WHO auspices – which 7 entered into force in February 2005.