WHO’s Executive Board tackles tricky topics

At its 107th meeting, held throughout the third week of January, the delegates of the 32 countries making up WHO’s Executive Board had some thorny issues to discuss. A sampling: Should WHO continue to recommend exclusive breastfeeding for the ‘‘first 4 to 6 months’’ of a baby’s life or switch to the first 6 months? Should the organization continue to rank the health systems of its 191 member states, as it did for the first time in its World Health Report 2000? How good a job is WHO doing in responding to epidemics?


WHO currently recommends that babies should be exclusively breastfed ‘‘from birth to 4 to 6 months’’. Some countries, particularly in the developing world, want that statement to read: ‘‘from birth to 6 months’’; others, particularly in the industrialized world, want to keep WHO’s vaguer wording. At issue is how early in life babies could safely be given foods other than breast milk. Related to that issue is what to do about manufacturers and distributors of industrially prepared infant food who do not abide by the International Code of Marketing of Breast-milk Substitutes that WHO issued 20 years ago to combat ‘‘inappropriate sales promotion of infant foods’’.

The Board passed a resolution calling for strengthening of ‘‘national mechanisms to ensure [their] global compliance’’ with the international code.

On the age issue, the Board decided to let the forthcoming May meeting of the World Health Assembly decide. By then a WHO-mandated literature review on the topic will have been completed and a group of experts will have met to discuss the review’s findings.

Ranking of health systems

Last year’s World Health Report erupted onto the international health scene with a ground-breaking table ranking the 191 member states of the organization according to how their health systems were performing. As WHO Director-General Gro Harlem Brundtland admitted in her opening statement to the Board, this exercise provoked not only ‘‘considerable public interest’’ but also ‘‘significant debate ... including critical remarks’’. Some countries were unhappy with the methodology or the data used. Others felt they should have been more involved in the process. Yet others questioned the usefulness of the table. Responding to these criticisms, Dr Brundtland said that the next ranking of health systems — scheduled for 2002, and every two years thereafter — would be based on a broad consultative process conducted at national, regional and global levels. The Board expressed satisfaction at Dr Brundtland’s response and called for continuation of the health system assessments.

Outbreak surveillance and response

WHO is stepping up its outbreak surveillance and response capability. It is taking a leading role in a powerful new ‘‘network of networks’’ that scans the Internet for rumours of outbreaks, investigates suspected cases and verifies outbreaks of international concern. WHO announces confirmed outbreaks on its web site (http://www. who.int/eha/disasters/), together with advice on any travel or trade restrictions. A long-standing problem has been the reluctance of some countries to acknowledge outbreaks and thereby risk a negative impact on tourism and trade. The new procedures being put in place, which are implemented in close collaboration with the affected country, are contributing to prompt notification of outbreaks, mobilization of international assistance and rapid containment of epidemics.

The Board called on the Director-General to provide support to countries to bolster ‘‘their capacity to detect and respond rapidly to communicable disease threats and emergencies’’.

John Maurice, Bulletin, with reporting
by Mary Kay Kindhauser, WHO

World Health Organization Genebra - Genebra - Switzerland
E-mail: bulletin@who.int