We should welcome the opportunity to decentralize the PAHO from Washington, D.C., reimagining its core functions to better address the priorities of the countries where it is most needed.
By Irene Torres & Daniel Lopez (Latinoamerica21)
HAVANA TIMES -The outcry of health experts at the announcement of the United States’ withdrawal from the World Health Organization (WHO) reveals, from our perspective, deeper issues about the structures of global health governance beyond the potential financial and operational gaps experts may say they are concerned with. How global health priorities are determined, and by whom, reveal hierarchies of power reflecting colonial histories around the world; this imbalance has an equally important effect on the mission of WHO and its regional offices as the loss of funding.
The US has played a critical role in the development of WHO over its 76 years of existence; directly and indirectly, the country has also steered the politics and the economies of different Latin American and Caribbean (LAC) states for the past two centuries. Hence, it is not surprising that the US is the largest contributor to both the WHO and the Pan American Health Organization (PAHO). It is important to note that PAHO was founded before WHO, in 1902, at the initiative of the US government and other countries in the region concerned over the spread of infectious diseases as international maritime commerce grew. That the organization has been headquartered in the US since its inception and that the US provides over half of all the countries’ assessed contributions (54%) speak to the colonialist legacy of US dominance in the Americas.
Recently, academics alerted us about the influence that the US may lose by leaving the WHO; we view this reaction as a greater source of concern for the LAC region than the possibility of seeing PAHO funding reduced, especially since the same academics make it clear that they worry about the future of US-based WHO collaborating centers (72 out of the 180 in total). Shouldn’t those advocating for equity seek a greater balance among countries? At least in the Americas, we should welcome the opportunity to decenter PAHO from Washington, D.C., reimagining its core functions to more adequately address the priorities of countries where it is most needed. Besides, relocating PAHO/WHO headquarters and some collaborating centers to the LAC region would reduce operational costs and bring a shift in the background and experience of PAHO experts and external collaborators, allowing for more regionally relevant contributions.
Furthermore, the comparatively better health outcomes in some LAC countries point to the prospect that the knowledge we need may lie outside the US. For instance, Chile, Costa Rica, and Panama have higher life expectancy than the US. Indeed, the US is considered to have an “exceptionally weak overall performance” (with lower life expectancy and higher rates of death and disease than comparable countries) considering its high health expenditure; unincorporated US territories have even poorer health outcomes. Health and human development rankings also place the US well behind other high-income peers (such as Canada). Perhaps US-based academics should rather focus on US public health challenges and the role PAHO/WHO could have in supporting reforms.
After more than a century of global and regional health decision-making and implementation that depended heavily on funding from the US government and US-based organizations such as the Gates Foundation, GAVI Alliance, and Rotary International, it may be time for LAC governments to take ownership of their own health governance. Decentering PAHO, physically, financially, and politically, from Washington, DC, would enable it to more adequately focus its health agenda on LAC priorities and become more empowered to address the needs of the different populations across the Americas. As a predecessor of WHO, PAHO has the capacity to find ways to remain true to its mission “to lead strategic collaborative efforts among Member States and other partners to promote equity in health, to combat disease, and to improve the quality of, and lengthen, the lives of the peoples of the Americas”.
A preoccupation with global health issues, such as global health governance (e.g., international health regulations, a pandemic treaty), does not justify one country’s outsized influence on the future of any single multilateral organization. Indeed, the longstanding dependence of LAC economies on the US reinforces the power imbalances that have led to systemic inequities in health outcomes in the region. Breaking away from this legacy towards more equitable and collaborative efforts is a positive path forward for LAC countries.
Read more from Cuba and Nicaragua here on Havana Times.
