Quotes of the Day

When Gro Harlem Brundtland became director-general of the World Health Organization in 1998, the U.N. agency was in decline, riven by internal feuding and allegations of mismanagement. The Norwegian doctor-politician set about treating those symptoms, while fulfilling her pledge to bring health "to the core of the development agenda." It was, she declared, "the key to poverty reduction and development, underpinned by the values of equity, human dignity and human rights."

As Brundtland, 64, prepares to depart the international stage in July — after three decades in high-profile posts — she leaves behind a strengthened agency, one fighting vigorously for global health on numerous fronts. "My father's medical work for the disabled and for war refugees inspired my own wish to become a doctor," she says. "I wanted to help make changes in society, and stimulate social justice and the rights — for all — to health and education."

Brundtland is widely credited with repairing the sullied reputation of WHO and getting it to take on a broad range of health issues, including communicable diseases, availability of vaccines, environmental hazards, medicine prices and chronic "lifestyle" illnesses — those attributed to smoking, alcohol intake, poor diet and physical inactivity. As WHO battles the outbreak of severe acute respiratory syndrome (SARS), for example, it also has just negotiated the first international treaty in its 55-year history, aimed at reducing tobacco-related deaths and diseases worldwide.

As Brundtland told the just-concluded meeting of the World Health Assembly — which elected Jong Wook Lee of South Korea, director of WHO's Stop TB program, as her successor — she feels "confident that WHO is now stronger and better prepared to rise to new global challenges." Richard Klausner, executive director for global health of the Bill & Melinda Gates Foundation, agrees. "It is clear that the health problems of the developing world are a much higher priority on the global agenda today than they were when Dr. Brundtland became the head of WHO," he says. Her leadership, adds Klausner, "has underscored that most of the health problems facing poor countries are entirely preventable if the world only uses the strategies and technologies at its disposal."

"We meet as we fight to defeat SARS, the first new epidemic of the 21st century," Brundtland told the health assembly — a gathering of WHO's 192 member nations — in Geneva. "The last major new disease of the 20th century, HIV/Aids, is still very much with us, devastating lives and communities." And, she added, the assembly was taking "a giant step to reverse what could otherwise turn out to be the biggest killer for our grandchildren: tobacco smoking."

Weaker than some critics would have liked, the Framework Convention on Tobacco Control — four years in the making — was unanimously adopted by WHO's membership on May 21. It requires signatories to restrict tobacco advertising, promotion and sponsorship, to set up new labeling and indoor-air controls, and to toughen laws to fight tobacco smuggling. Some five million people die annually from tobacco-related illnesses — a toll projected to double by 2020 if the treaty's provisions are not implemented. Seventy per cent of the additional deaths, say WHO experts, would be among young people and those in developing countries — prime consumer targets of the tobacco companies. "Globalization of disease and threats to health means globalization of the fight against them," says Brundtland, who termed the tobacco accord "a real milestone in the history of global public health" and in "international collaboration in a globalized world."

To the surprise and disappointment of many, Brundtland opted to retire rather than seek a second term at WHO that would have been hers for the asking. "That would have meant continuing a high-level, very tough job — traveling and staying away from my grandchildren and the rest of my family," she says. "If you are 69 rather than 64 when you retire, is that better? I don't think so."

Prime Minister of Norway for 10 years and a former Environment Minister — in each case, as at WHO, the first woman to hold the post — Brundtland also was a pioneer of sustainable development. She chaired the 1983 World Commission on Environment and Development, which provided the working definition of substainability ("development that meets the needs of the present without compromising the ability of future generations to meet their own needs"). The Brundtland Commission's 1987 report, "Our Common Future," paved the way for the landmark 1992 Earth Summit in Rio de Janeiro.

Chairing the commission, says Brundtland, coupled with her years of experience in public health and politics, was excellent preparation for eventually leading WHO. "The three years of intense discussion, analysis, sharing background experience and concerns among a group of 23 commissioners meant an exceptional learning curve," she recalls. "Listening, questioning, understanding, and moving to grasp the essentials and the common ground to create agreement was a challenging and inspiring task."

"Brundtland has succeeded," says Nils Daulaire, president of the Global Health Council, an independent health-care alliance, "in bringing together the world's governments, nongovernmental organizations and the private sector for an unprecedented focus on what we can do together to advance global health. Her successor will inherit a revitalized agency."

When Brundtland took over at WHO, mismanagement had resulted in hard-won gains in global health beginning to slip, as donor countries withheld funds. By combining her political skills with a vision of WHO as "the moral voice and the technical leader" in improving global health, Brundtland galvanized the agency with a host of initiatives and partnerships with other U.N. agencies and national health bodies.

In 2000, she launched the Commission on Macroeconomics and Health, comprising 15 of the world's leading economists and economic policymakers. Clarifying the links between health, poverty and development, the commission — headed by the American professor Jeffrey Sachs — determined that good health was essential to equitable development and fair globalization. It then urged funding to meet concrete goals within specific time periods. Armed with the economic data to win over decision-makers, Brundtland pioneered WHO's use of private-sector partners — like the Bill & Melinda Gates Foundation, development banks, NGOs and pharmaceutical companies — which have drawn criticism for allegedly eclipsing WHO's function.

Brundtland stoutly defends programs such as Roll Back Malaria, the Global Alliance for Vaccines and Immunization, and the Global Fund to Fight Aids, TB and Malaria — all of which rely on private donations. "WHO never has been and never will be the prime funder in health," she says. "With these new players, there is a stronger need than ever for an organization that maintains the perspective, the expertise and the ability to build bridges."

As well as private involvement, critics have also focused on WHO's publicly nonconfrontational approach to the drugs industry, which some governments and NGOs have excoriated for not making more life-saving medicines widely and cheaply available to poor countries. Says Brundtland: "Sooner or later, lower prices will be a reality. Fortunately, it looks like it will be sooner." The drug-makers will act, she adds, "because it is the right thing to do and because this is the way of the future."

Indeed, piecemeal concessions have been made by pharmaceutical companies. GlaxoSmithKline, for example, recently announced sharp cuts in the price of its HIV/Aids drugs to sub-Saharan Africa and other desperately poor areas. In bringing the prices closer to those of generic drugs manufactured in countries not adhering to international patent laws, Glaxo may be seeking the custom of the U.N.'s Global Fund and of the U.S., which has pledged to spend some $15 billion over the next five years on fighting HIV/Aids in Africa and in the Caribbean.

While she is most proud of "the renewed credibility of WHO," Brundtland acknowledges that great challenges lie ahead, chief among them "keeping health firmly on the political agenda and moving more resources for health." She adds: "In the past four years, there has been an increase of 70% in voluntary contributions. That needs to continue."

Brundtland's work — including the public-private initiatives — will continue under Lee, WHO's director general-elect, who takes over on July 21. The agency has just announced a special fund to fight SARS, first identified in Vietnam by its own Carlo Urbani, an Italian specialist in infectious diseases who became the 54th victim. Believing that there is currently a window in which SARS can be controlled and its threat eliminated forever, WHO and the World Economic Forum's Global Health Initiative hope to raise an initial $100 million from the business community — particularly from corporations with Asian operations or markets — by September. The funds would be spent on a variety of anti-SARS projects, including building the capacity for surveillance, epidemiology and public-health laboratory facilities in China and nearby countries. Equally importantly, Lee announced, "this new fund and other innovative initiatives like it will help prepare the world to respond to future emerging diseases."

That is music to Brundtland's ears. In her final address to the World Health Assembly, she noted: "We do not have a global fund for health systems and must find the solution to integrate national efforts and international financing. I see this as the most important challenge today — to have a public health system that is robust enough to respond to new threats as they arise, while delivering effective interventions against existing diseases that will help lift the poor out of poverty."

• MARYANN BIRD
• Brundtland Bows leaves WHO much revived