Should the United States insist that the World Bank President be an American? Is Dr. Kim, with his h

The approval of Dr. Jim Kim to head the World Bank signals a real change in the way economic development and the problem of poverty will be approached in the developing world. Dr. Kim’s background of initiating and then managing in the field successful public health programs in the most trying circumstances will serve him well. But it could be that his most important experience will turn out to be what he learned during his tenure at the World Health Organization, where he led the effort to get anti viral drugs to those in Africa and elsewhere infected with the HIV virus. When you see the developing world through the lens of the WHO you learn one big thing: a functioning government beats a miracle medicine any day of the week. The campaign to make affordable generic HIV drugs available in Africa and elsewhere was a series of pitched battles against ignorance and the status quo. At first it was the fight to overcome the entrenched idea that the infected were too unsophisticated to utilize the medicine. Then it was on to the task to drag along the drug companies, the patent holders, who resisted any price structure that made sense and were adamantly against the introduction of generics produced by their potential competitors. The biggest obstacle was confronting governments where studied ignorance of HIV was a political art form and the health needs of their people had always been a low priority. If there was an easy part it was the financing of the drugs and their distributions. The Norwegians made a down payment with money and talent. Then Bill Gates opened his checkbook and President Bush made the fight against HIV/AIDs a U.S. government priority. The WHO is an agency of the United Nations launched after WWII to rebuild the public health infrastructure of a devastated Europe. However, it is a very independent part of the UN. The Director General must be a medical doctor and be elected by the member states with significant votes from each region of the globe. There is no Security Council counterpart where the big players make all the big decisions. There are more than 190 member states and they gather once a year in the Health Assembly to make policy. It is bloc politics with shifting coalitions. Consensus is the very elusive goal. Altruism is mostly found in the speeches. Dr. Kim will have no illusions of how nations act when the finance ministers of the world meet in Washington. However, he has witnessed that a leader with a strong will and moral grounding can indeed lead and oversee a change in direction in a multi-national institution. When the former Norwegian Prime Minister Gro Harlem Brundtland was elected to head the WHO in 1998 it was a mess. It wasn’t working for the countries that paid the bills or those who received the help. And, it was confronting an existential moment. The time had come for WHO to make chronic diseases in developing countries a new focus. There was great resistance by many who were comfortable with and profited by the status quo. Their argument was that WHO was meant to only deal with infectious diseases. Most infectious diseases are treated with cheap, off-patent and readily available medicines. The new tough test for health systems in developing countries is the rapid advance of chronic illnesses, largely heart disease and cancer caused by cigarette smoking. All this meant taking on the power of the tobacco economy and the lucrative global enterprise of selling cigarettes. The cigarette companies had a deep infiltration in WHO. They manipulated researchers to cast doubt on the dangers of second hand smoke; they enlisted state owned tobacco companies to lobby their governments; and they pushed as gospel the economic myth that raising cigarette taxes would decrease government revenue because fewer people would smoke and increase health costs because now these people would live longer. Finance ministers especially loved to repeat these myths as if they were fact. In her first policy speech, Dr. Brundtland simply stated, “tobacco should not be subsidized, advertised or glamorized. Tobacco is a killer.” Within a few short years the Health Assembly voted to send out for ratification a treaty designed to reduce the use of tobacco. It was the first ever use of its power to initiate a treaty. Dr. Kim knows facts count, economics theory doesn’t help much where people have no choices and governments can be made to do the right thing. I think we will see that President Obama made a wise choice.

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