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Seeking a seat at the WHO table
By Lin Shih-chia ªL¥@¹Å
Sunday, Feb 07, 2010, Page 8
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 ¡X Palestine ¡X 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.
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