Health for all
World Health Organization, WHO, is a specialised UN agency with the task of guaranteeing the best attainable health to all humans, as defined by the WHO Constitution. To achieve this, WHO should lead and coordinate global health work and, among other tasks, monitor the development of health status, promote health research, develop and maintain health related norms, prevent communicable disease epidemics and, on request, support Member States in the development of health policy and in responding to health emergencies. Moreover, WHO can act as a convener for international conventions.
The Constitution defines health as a complete state of physical, mental and social well-being, and not merely as the lack of disease or infirmity. The Constitution also states that enjoyment of the best attainable health is a fundamental right, without any distinction of race, religion, political belief or social condition.
From a medical and communicable disease organisation to an actor for sustainable development.
WHO was established in 1948, with national health ministries as the focal points in Member States. Under the guidance of Member States, WHO developed - within the framework of health systems - into an important medical and communicable disease organisation. At the same time, WHO has always had an important role especially in the promotion of maternal health.
In the domain of communicable disease the single most important achievement of WHO is the eradication of variola in 1980. In recent years, WHO has actively worked to eradicate polio from the world. The activities of WHO and Member States in communicable disease and chemical and radiation emergencies are guided by WHO’s International Health Regulation (2007). The Pandemic Influenza Preparedness Framework (2011) was established to ensure that even the poorest countries have a timely access to influenza vaccines and/or medicines in an influenza pandemic. The emergency programme of WHO, which is there to support countries upon request, was significantly strengthened after the 2015 Ebola epidemic, and has already proved its efficiency. The emergency activities are supported by an emergency fund, which allows immediate release of resources when needed.
The first significant step towards a wider approach on health was the initiative by Gro Harlem Brundtland, Director General in 1998 – 2003, to develop an international convention on tobacco. The scope of the WHO International Convention on Tobacco Control (2003/2005) goes beyond the health system. J. W. Lee, Director General in 2003 – 2006, increased the further the latitude of WHO’s work by establishing the Commission on Social Determinants of Health to report on health determinants and causes of health inequalities across societal sectors and the life span. Health determinants and risk factors have become central notably in the global health discourse on the prevention and control of noncommunicable diseases. On one hand, the improved understanding of the wider connections between health and different societal, economic and trade interests has meaningfully enriched the debate on global health. On the other, not anymore addressing health in isolation has resulted in enhanced politization of global health processes.
Of WHO’s normative work, the perhaps most widely known is the International Classification of Diseases, ICD, the 11th version of which is in currently in the pipeline. Important are also many science-based health related recommendations of WHO.
The Agenda 2030 and the inclusion of health in the sustainable development goals opened a window of opportunity for WHO to strengthen its weight in the UN. The General Programme of Work 2019 – 2023, adopted by the World Health Assembly in 2018, was designed with a view to support the achievement of the health targets of the Agenda 2030. This programme is the first of its kind that reflects the modern concept of public health. Health is seen as a resource for societies and as a source of both wellbeing and economic growth. The health system has its specific role in promoting health and providing health services. Still, health is produced, and it can be endangered, in all environments of our societies, which calls for wide societal actions across sectors for health.
Dr Tedros Adhanom Ghebreyesus was elected in 2016 (- 21) to the Director General of WHO. He is a former health and foreign minister of Ethiopia and Chair of the Board of the Global Fund. The merits of Ghebreyesus in the health domain come in particular from the reorganization of health service delivery in Ethiopia to cover the entire population. The most notable innovations brought to WHO by the new Director General are the moving from output to impact-based assessment of the results of the organisation, attempts towards added value from improved collaboration among global health actors and strengthening the work of WHO at the country level.
The World Health Assembly is the highest governing body of WHO. It meets annually in May and defines the direction of health policy. The Executive Board with its 34 members prepares the World Health Assembly and implements its decisions. The Executive Board meets twice annually.
Finland and WHO
Finland is currently a member of the Board (2018-21). The three earlier memberships were in 1955-58, 1975-78 and 1994-97.
Finland considers that the world needs a strong, efficient, independent and credible WHO and participates actively in the administration of the organisation and in processes that are seen strategically as the most important for public health, often together with the EU.
Finland has a long and confidential relationship with WHO. Finland was a pilot country for primary health care and Health for All 2000 and later the Health for all 2015 Programmes. WHO has evaluated Finland’s health policy three times.
Mental health promotion, health promotion over the sectors of government and Health in All Policies, health in humanitarian emergencies and essential public health functions as a prerequisite to the achievement of the sustainable development goals are examples of issues that Finland focusses on in WHO. In recent years, Finland has worked in different fora to promote global health security. Finland promotes also the rights of women and girls and sexual and reproductive health rights and services, the main targets of Finland’s development policy. In the strategically most important matters, Finland joins the EU’s positions, expressed in the governing bodies mostly by the EU Council Presidency.
The Permanent Mission in Geneva defends Finland’s interests and promotes issues important for Finland bilaterally and together with EU and Nordic countries. The Permanent Mission maintains close contacts with WHO Secretariat and follows, within available resources, also the discourse and trends of global health policy, including at the UN General Assembly. Active participation in the different preparatory meetings and consultations has a central role in the everyday work of the Permanent Mission, which receives its instructions from the Ministry of Social Affairs and Health.
The Ministry of Social Affairs and Health is also responsible for the assessed contribution, the membership fee, of Finland to WHO. In 2017 the assessed contribution was 1.9 million euro. Other similar contributions were made by the Ministry of Social Affairs and Health to the International Agency for Cancer Research (IARC), the Secretariat of the Framework Convention of Tobacco Control (FCTC), and the European Observatory on Health Systems and Policies. In addition, 400000 euro was allocated to support WHO’s work on health security and prison health. Total amount of the funding to WHO was 3,39 million euro. Finland does not currently support WHO from development funds.
UN HIV/AIDS programme UNAIDS
HIV/AIDS as a development challenge
The HIV/AIDS epidemic became in the 1990s the most visible global health challenge. As the impact of the disease for sustainable development was understood, the UN HIV/AIDS Programme UNAIDS was established in 1993 and became functional in 1993. UNAIDS is in charge of promoting and monitoring the implementation of the UN HIV/AIDS declaration. UNAIDS coordinates and funds partially the work of the eleven cosponsoring UN organisations (ILO, UNDP, UNESCO UNFPA UNHCR, UNICEF, UNODC, UN Women, WFP; WHO and the World Bank) according to agreed division of labour. UNAIDS has brought HIV/AIDS to the global political agenda, not only as a health issue, but also as a wider factor that has an impact on societal and economic development, human rights, security and stability.
Since 2009, the Director General has been Michel Sidibé from Mali. UNAIDS is governed by the Programme Coordination Board (PCB). The Board has 27 members, 22 of which represent Member States and five the civil society, the latter without the right to vote. The PCB discusses administrative and substance matters and special themes. The co-sponsoring organisations have the right to attend and speak. Member States work as constituencies. Finland, Denmark and Norway form one of the constituencies, which works closely with the constituency of Austria, Iceland, Sweden and Switzerland. The two constituencies promote good governance for example by having shared statements in most of the PCB agenda items.
Finland and UNAIDS
Finland represents its constituency as a PCB member in 2018-19.
Womens’ and girls’ rights, prevention of new infection in the control of the HIV/AIDS epidemic and a human rights based approach, including sexual and reproductive rights and services and access to comprehensive sexuality education, are Finland’s priorities in UNAIDS.
Finland supported UNAIDS from development funding until 2016. The reduced funding in recent years has forced the programme to seek measures to become more efficient. Recently, UNAIDS has received a lot of negative publicity due to sexual harassment cases. The PCB has started actions to prevent harassment, bullying and abuse of power and to improve the procedures to be followed in such situations.