An African Prescription for Global Health

I think I speak for many people around the world who’ve been genuinely surprised—and hopefully energized—by the election of Dr. Tedros Adhanom Ghebreyesus of Ethiopia as Director General of the World Health Organization.

The news offers an incredibly hopeful signpost from the depressing vortex of the daily news cycle. With each new example of Western world populism and insularity, it seemed we should be bracing for a myriad global health policies that deny the modern world’s inter-connectedness. And with mounting evidence of the current U.S. presidential administration’s contempt for the United Nations system, hopes for a near-term global health renaissance seemed dim.

But after two years of intense competition, political brokering and outright verbal knife-fighting, Dr. Tedros emerged as the clear winner in a vote that felt almost inevitably Europe-bound. After all, the W.H.O. had not only been steered by an Asian for the past decade, that leader was also a woman. Time to knock a few heads and return things to their “rightful order,” yes?

However, in the realm of global health, the past few decades have produced irrefutable evidence that no region of the Earth is superior--or immune. Western pretensions of public health invincibility were shattered first by the HIV/AIDS crisis, then again after the first time a case of avian flu was confirmed in a “First World” nation. By the time the deadly West African Ebola outbreak created global panic, there was no way to deny our universally massive vulnerability.

This complex geographical public health tapestry is what makes the significance of an African W.H.O. chief so intriguing. The historical dynamic between non-governmental organizations and the public health sectors in developing countries is freighted by a choke-hold of tension versus expectations. The need to provide urgently-needed humanitarian services is often derailed by resentment of perceived paternalism and heavy-handed authoritarianism.

In plain speak, some Western leaders have decried the “begging bowl” mentality of public health officials in developing countries who've considered a health care blank check a foregone conclusion. When it’s time to be held accountable for funds, though, the victim mentality is trotted out to neutralize inquiries.

On the other hand, physicians, researchers and public health staffers in host countries who’ve watched Asians, Europeans and Americans jet in and out of their homelands—while enjoying per diems that eclipse their yearly salaries—can’t really be blamed for questioning the philanthropy of their benefactors.

Will the election of Dr. Tedros automatically change this dynamic? Absolutely not. The flaws in the United Nations system won’t be corrected easily, as the hobbled response to the Ebola outbreak proved. Also, an ongoing lack of internal fiscal responsibility leaves the W.H.O. all too open to criticism.

So what has this election yielded?

A phenomenal consciousness-raising. Having challenged the “Africa Rising” trope of the past decade myself, I experienced a bit of a seismic brain quake while absorbing the news. I'd been so thoroughly resigned to the inevitability of a white male W.H.O. chief, I almost fell off my chair before clicking on the headline.

Having worked closely with the Ministry of Health in Kenya—and interacted often with its counterparts in Ethiopia, Uganda, Tanzania, and Rwanda—I could immediately visualize the significance of this election in East Africa. In many quantifiable ways, that corner of the continent could make impressive strides in health care policy and delivery—IF issues of financial corruption, poor infrastructure and health care “brain drain” are confronted.

Dr. Tedros, a malaria expert, offers a powerful example of what’s possible on the African continent. As reported in the New York Times, he is best known for having drastically cut deaths from malaria, AIDS, tuberculosis and neonatal problems when he was Ethiopia’s health minister. He trained 40,000 female health workers, hired outbreak investigators, improved the national laboratory, organized an ambulance system and oversaw a tenfold increase in medical school graduates.

Still, his detractors say these achievements are overshadowed by Ethiopia’s troubling human rights record. As a journalist who's trained and/or mentored hundreds of African reporters, I can’t ignore the irony of a global health leader hailing from a country with an appalling record of media oppression, and which is accused of persecuting its Amhara and Oromo citizens. And as with other countries in the region, poor infrastructure leaves Ethiopia at risk for cholera outbreaks, drought and malnutrition, among other challenges to public health.

Then there’s the impact of class, culture and tradition in African nations. As Americans debate whether quality health care is a right or a privilege, there’s no denying that in too many African countries, it’s simply non-existent. Quality maternal health care, which I have long championed as a national development issue for African nations, is far too sparse. Too often, women and children are still considered expendable resources, better off seen and not heard and easily replaced. Too many people die from easily preventable illnesses in African nations, while efforts to build hospitals and provide screenings or fund vaccinations never make it off the drawing board—without funding from NGOs, private philanthropies or foreign governments.

The wealthy in those same nations—politicians, businessmen and other elites—don’t prioritize improved health care because they rarely use in-country services. They can hop the first flight to Europe or the U.S. for treatment.

With that in mind, I suppose there’s a chance that many African public health officials might see Dr. Tedros’s ascension as a potential money grab. Will they adopt what’s described in Kenyan circles as the “It’s OUR turn to eat” mentality? This means that with an African heading a U.N. body, health care policy makers might think they’ll be first in line for funding, with far less fettered access.

Here’s what I believe. Had this moment in time been different, that could have been a distinct possibility. For example, had this historic election occurred before last decade’s global economic meltdown, a fairly robust cash grab might have been attempted, at least for a time.

Or if this election had taken place before the Ebola outbreak, which shook the whole world’s core about our common susceptibilities—and the need for accountability and consequences.

Or if it had happened before Brexit, and before Donald Trump, whose administration has not only proposed massive cuts to the United States Agency for International Development (USAID), but is determined to drastically curtail health care access for Americans, let alone the rest of the world.

Now more than ever before, the United Nations system’s Achilles heel is exposed and rife for a mortal wound.

That’s why I predict that the election of an African World Health Organization chief will spark a measurable shift in African health policy. Public health agencies that have chafed at donor demands for accountability and evidence-based results in recent years should be bracing for what the next few years may bring.

Just ask Kenya’s Ministry of Health, still reeling from the suspension of 21 million dollars in U.S. funding due to ongoing corruption concerns.

If nothing else, Dr. Tedros’s tenure likely will be analyzed and criticized more than any previous W.H.O. Director General because he is African. Any hint of favoritism to his home continent will make his detractors blow a gasket. Granted, per diems and perks won’t disappear overnight, but you can be sure those “brown envelopes” won’t be a thick as they used to be.

I’d like to believe that this global scrutiny of an African World Health Organization leader, coupled with rising education levels on the continent, support for African-based research and a more educated, proactive public (fueled by increased access to information from the media) could translate into an improved quality of health for millions of Africans within the next decade.

For too long, too many African leaders have accepted low life-expectancies, poor maternal and child health and appalling rates of preventable illness and death as unavoidable facts of life—even God’s will, at times.

Having an African man embody the global responsibility to guarantee improved public health for all offers an astonishingly potent rallying cry. It’s the kind of symbolism you can’t place a dollar value on, if only African leaders will embrace the opportunity.