Sun, Feb 07, 2010 page8

• Seeking a seat at the WHO table

  • By Lin Shih-chia 林世嘉
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  Reports say that Taiwan applied to take part in the meeting of the Executive Board of the WHO, but without success. Faced with the rejection, the Ministry of Foreign Affairs and the Department of Health said the government’s aim of deepening and broadening Taiwan’s participation in WHO activities remained unchanged.

  The WHO’s Executive Board, which is made up of delegates from 34 WHO member states and meets twice a year, is analogous to the board of directors of a commercial company. It is easy to understand that, from the point of view of institutional power, the Executive Board has greater influence over the direction of the WHO than does the World Health Assembly (WHA) with its many members and multitude of contending voices. According to the WHO’s organizational and operational regulations, the Executive Board has never been obliged to invite specific WHA observers to take part, but from its operation in practice it may be noted that WHA observers have indeed taken part from time to time. This year, for example, perhaps because of the WHO’s concern over the aftermath of the earthquake in Haiti, the board has invited the Holy See (the Vatican) and the International Committee of the Red Cross, which have observer status at the WHA, to take part. Haiti is one of Taiwan’s diplomatic allies and Taiwan is a major aid donor to Haiti, but the WHO Executive Board’s failure to invite Taiwan on this occasion cannot be said to contravene the regulations.

  Since last May, when Taiwan was allowed as an observer at the WHA, people have asked whether Taiwan has joined the WHO. The answer is a disappointing one, but we may still consider the question of what Taiwan’s membership of the WHO would really mean. Of course Taiwanese would celebrate if we were to become a full member of the WHO. However, most people would probably agree that we can allow some flexibility with regard to Taiwan’s status in exchange for the chance to participate in a practical way.

  It cannot be denied that, starting from last year, Taiwan has gradually increased its contacts with the WHO on such issues as epidemiology and food safety, and WHO officials no longer avoid Taiwan like the plague, as they once did. Relative to its real public health needs, however, Taiwan’s participation in the WHO still falls far short not just of ordinary countries, but also another observer — Palestine — whose population is just one-quarter that of Taiwan. One can only hope, setting aside for a moment the question of that “obstacle that shall not be named,” that the continued efforts of the foreign ministry and health department will eventually allow Taiwan to have much “deeper and broader” involvement in the WHO than it does today. But there is another question that should be considered, especially by those working in the medical field: Does Taiwan have a global health policy?

  Having been excluded from the WHO and according to the law that where there is no demand, there will be no supply, hardly anyone among those who are practically or academically involved in medicine in Taiwan takes any interest in global health issues. Even overseas medical missions attract the attention of the powers that be only to the extent that they serve as tools for friendly diplomatic relations, and they are even derided as a form of “money diplomacy.”

  These days, health concerns have broadened to encompass various factors beyond the scope of biological medicine that have an effect on health, including international trade, the gap between rich and poor, intellectual property rights and so on. Since the Sept. 11, 2001, terror attacks, they have become even more tied up with other policy concerns such as national security and foreign policy. In addition, a combination of competitive and collaborative relations has emerged in the global health operational environment. Before the financial crisis struck, the global health field, similar to the international financial market, was awash with aid money and projects up for grabs, circulating among developing countries, but there was a lack of coordination between these different projects and sources of funding that led to frequent overlaps and conflicts of interest. At the same time, developed countries, with their aging populations and associated medical care needs, have been poaching medical workers from developing nations.

  The global spread of swine flu, as well as climate change, has presented healthcare providers with challenges that are hard to predict and can only be met by policies that cross sectoral, departmental and national boundaries.

  Taiwan faces difficulties with regard to participation, but global health issues affect it equally. Its status should not prevent us from expressing our opinions on global health issues. We should draw on Taiwan’s diplomatic, environmental and medical strengths, as well as social welfare policies, highlighting the characteristics of Taiwan’s experience, to work out an overall policy direction for Taiwan in global health affairs. In doing so, we may find ourselves a step closer to real membership of the WHO.

  Lin Shih-chia is executive director of the Foundation of Medical Professionals Alliance in Taiwan.

  TRANSLATED BY JULIAN CLEGG
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