Millions of lives may depend on the outcome of a secret election at the World Health Organization in Geneva in January.
The United Nations established WHO in 1948 with an ambitious goal:
“The attainment by all peoples of the highest possible level of health.” It defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
That aim is little closer 54 years later.
Millions of people in developing countries, where WHO mainly works, still have the lowest possible level of health. Diseases that can be prevented, treated, or cured - sometimes for a few dollars - continue on a rampage.
A cure for tuberculosis, for instance, has been available for more than 50 years. Nevertheless, TB still kills 2 million people each year, and infects one of every three people in the world.
Malaria, which can be prevented by mosquito control programs and other methods, kills 1 million people annually. About 1 million children under age 5 die each year from diarrhea because treatment costing a few cents a dose is unavailable.
Another 25 million people in Africa are infected with human immunodeficiency virus, the cause of AIDS. Many cases could have been prevented if people had easier access to information on the disease and condoms.
The list goes on. It almost certainly would be longer and more appalling without WHO, which has had its share of successes. But public health experts have long criticized WHO as the epitome of a UN bureaucracy - bloated, top-heavy, slow-moving, and politicized - and claim it could have done much more.
By 1998, that reputation reached an all-time low.
“Those of us working in public health at the time used to say WHO was the place where good ideas go to die,” Nils Daulaire observed in an article in The Lancet, a medical journal. He directs the Global Health Council, an organization of nongovernmental organizations, foundations, and other groups working for world health.
WHO's last secret election started to turn the agency around.
In 1998, Dr. Gro Harlem Brundtland was elected new WHO Director-General. A physician and public health expert, she had served for 10 years as Prime Minister of Norway. Dr. Brundtland shook up WHO with a series of reforms and burnished the agency's reputation around the world.
Dr. Brundtland, however, decided not to run again, and WHO's executive board in January will pick a new Director-General who will shape UN health policy through 2008.
Candidates are from Mozambique, Senegal, South Korea, Belgium, the Cook Islands, Egypt, Mexico, Lebanon, and Mauritius.
Thirty-two executive board members will pick the new director in closed-door sessions Jan. 20-28.
Few people are even aware of the upcoming election.
With so many lives at stake, is this an election that deserves a higher profile?
It will be either forward in Brundtland's footsteps, or back to the graveyard of good ideas.