Gro Harlem Brundtland

Former Norwegian Prime Minister Gro Harlem Brundtland has swept into office as the new chief of the prestigious but troubled World Health Organization like a bracing wind out of the north. She was elected on a promise to reform and reenergize the Geneva-headquartered public-health arm of the United Nations, which declined precipitously under the uninspired leadership of Hiroshi Nakajima of Japan.

Brundtland lost no time making good on her pledge. Her first day on the job, in July, Brundtland imposed a new administrative structure on the WHO, staffed mainly by newcomers from outside the agency; issued a tough new set of ethical guidelines for the staff; and identified a clear set of priorities for the organization. She also pledged to forge new links to foundations, private health organizations and business, and shrewdly, given the increasingly large role business plays in the world, pointed out the links between health conditions in developing countries and their attractiveness to investors.

Brundtland and her backers, including the United States, want to return the WHO to the days when it was a model U.N. agency rather than an egregious example of what’s wrong with the world body. The organization, which has 3,700 employees, regional offices in six countries and an annual budget of more than $840 million, does not directly provide health services to individuals. Instead, it offers training, guidelines, research, funding and expertise to national health ministries, mainly in poor countries.

In the past, the WHO has been credited with stamping out smallpox, curtailing polio, funding immunization programs for hundreds of millions of children and alerting the globe to the worldwide threat of AIDS. Under Nakajima’s 10-year reign, however, it suffered from administrative drift, bureaucratic bloat and political infighting.

Brundtland’s supporters say few others are as well equipped for this job. Brundtland, 59, said she was inspired to go into medicine by her father, a physician who specialized in rehabilitation medicine. She grew up in Norway, the United States and Egypt, where her father did a stint with the U.N. After graduating from medical school at the University of Oslo and receiving a master’s from the Harvard School of Public Health, Brundtland combined a career in public health with a passion for politics. A member of the left-leaning Labor Party, she moved steadily up the political ladder, winning her first Cabinet job--as minister of the environment in 1974. Seven years later she became her country’s first woman prime minister, a post she held for 10 of the next 15 years.

After her retirement from politics in 1996, Brundtland was immediately rumored to be a candidate for high positions at the United Nations. Sources there say she turned down the post of deputy secretary general--the second-highest position. Instead, Brundtland campaigned for a five-year term as WHO director general and easily won election by the organization’s executive board in January.

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Question: In your early speeches, you’ve identified three priorities for world health protection: curtailing use of tobacco products, rolling back the spread of malaria and fighting AIDS. Can we talk about those one at a time? Let’s start with tobacco.

Answer: When you analyze the burden of disease and, even more, when you calculate the future burden of disease 20 years from now, tobacco is a major killer. . . . It’s a global issue, and we can add to what is being done today around the world. . . . It’s an issue where increased awareness and increased knowledge lead to action. . . . Tobacco marketing activities in developing countries have been increasing and are . . . really having an effect--especially on young people and children. This is really dangerous. It should be prevented, and we should help.

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Q: And what about malaria, a disease many Americans think of as contained to isolated, tropical regions of the world?

A: Over the years, the world came to believe that the new pesticides, such as DDT, could wipe out malaria, [but] it turned out it was really not that easy. For the last 15 years, people have stopped talking about eradicating malaria and, to the contrary, we have seen it increasing in many places. . . . It also has become resistant to some of the drugs that usually took care of the disease. . . . Malaria is in no way over, and it is now a threat to Americans and Europeans and whoever . . . visits other parts of the world. . . .

The World Bank, by the way, also is active in this--because it really has a lot of consequence for economic development in a lot of countries. The burden that malaria brings is not only mortality. . . . More than anything, the number of sick days in a year is immensely increased by a malaria epidemic. There’s a lot of loss of productivity.

There are African countries where I’m sure that their potential and their ability to attract investment they need for economic development is really hampered by malaria. . . .

On malaria, we really need a multifaceted approach, one that includes environmental action, local community approaches, education, getting people treated more quickly. . . . If you can treat quickly, then the disease can be pushed back much more effectively. People need to know where they can go to get basic health service, and it needs to be close enough to be practical.

So that enters us into the issue of what is the necessary level of health services to provide for malaria treatment, childhood immunizations, polio, a broad range of issues. Because without a fundamental health service at the community level, you cannot reach people to prevent and treat illnesses like malaria and HIV-AIDS and get the education in place that is necessary to avoid the spread of the diseases. . . . This is an epidemiological circle we have to break at several points. . . .

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Q: There’s also some question about the commitment of drug companies to conduct research on malaria, since it may not be a profitable market.

A: Well, that’s part of the intention of the roll-back-malaria campaign. If the drug companies understand that there will now be a long-term major effort to fight malaria effectively across the world, they will also know there will be a growing market, an increased market for the drugs they develop. If you more or less have given up on malaria, and accept that it lives as an endemic disease in poor parts of the world, then that’s not an incentive for the drug companies to come forward and invest in finding solutions.

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Q: There are some issues involving HIV that also affect the drug industry. The recent AIDS conference highlighted the gap between poor countries with high rates of HIV infection--one in four people in some parts of Africa--and the U.S. and Western Europe, where the epidemic is under better control and patients are benefiting from advanced drug treatment. Part of the variance is attributed to the cost of drugs. Will the conflict between availability of drugs and protecting drug-company patent rights be an issue for WHO?

A: Oh, yes, that’s a key issue. It really is. . . . Five years ago these AIDS drugs were completely new and very few people had tried them. Gradually, as more and more people have use of them, and you see them working, the demand to have this available in other parts of the world is growing, naturally. To solve that problem we have to work with the private sector and try to inspire and convince them that together we can find an answer to the cost problem and the availability problem. And, of course, the African governments have to work with us, too. . . .

It’s not easy, but it’s an example of the gaps and the need to redistribute and really give more attention to the poorest countries and those in greatest need . . . and seeing if we can find partners who are willing to go together with the public sector and other partners to make a difference. It’s a major challenge.

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Q: You’ve talked about involving government officials beyond health ministries, even presidents and prime ministers, as well as business and civic organizations, in an attempt to give health-care issues greater public attention. Do you have specific plans about how WHO can form these new partnerships?

A: Well, we have made one cabinet member responsible for government ministers and external relations . . . but it’s also something I personally will be doing. . . . I can reach out and speak with political leaders about health as an important development and economic issue--not only a humanitarian issue. . . . People are not aware sufficiently about the evidence that we have about the connections between health and economic development.

For instance, in January, when I was nominated here, I went directly from Geneva to Davos [Switzerland, for the World Economic forum] to meet with all the kinds of people I had been meeting as a prime minister over the years and had direct access to many people who were in key positions. So I will use my background and my network of people whom I know to spread the message and advocate a new way of making health more central on the political agenda. . . .

Even those whom I haven’t met I feel confident being able to talk with if I find it a burning issue.

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Q: This is a big, unwieldy organization that’s generally considered hostile to reform. You have arrived proposing sweeping change. How much bureaucratic resistance do you expect?

A: I think if there is a positive message and belief that we can do things better, and that that inspiration spreads through the organization, through all its staff and levels, then people, instead of being pessimistic and skeptical about change, can look upon it as something positive. . . . It is possible to have a culture where instead of saying, “No, that can’t be done,” they start saying, “We need to do it. How do we do it?”