The nomination by the US Government of physician Jim Yong Kim for the World Bank Presidency triggered the usual debate over the fairness of the electoral process, as well as intense scrutiny of Kim’s qualifications and experience. But missing in all this furor was what the appointment of Dr Kim, a leading figure in global health and a former director of the HIV/AIDS department at the World Health Organization, would mean for global health.
Global health is in crisis. The Global Fund to Fight AIDS, Tuberculosis and Malaria is facing a funding shortfall; the World Health Organization (WHO) is in an even more dire state with a $1 billion dollar shortfall and lay-offs of hundreds of staff. Health did not make the agenda of the last G8 and G20 meetings. While the Gates Foundation and other philanthropies have been attempting to offset these cutbacks, the health community is searching for leadership at this crucial time.
Here is where Dr Kim's election as World Bank President can make a difference. Even though the WHO is the recognized director and coordinator of international health work, it is the World Bank that is arguably the most powerful and influential actor in this space. It is the largest financial contributor to health-related and nutrition projects, and combines intellectual prestige with financial power. While the WHO talks to ministries of health, the World Bank works directly with ministries of finance.
Despite this key role, the World Bank has been heavily critiqued for its involvement in, among other things, pushing neoliberal ideology, user fees and structural adjustment on poor countries. The challenge for the Bank has been in making 'social' problems such as health into economic ones. Within the Bank, the discipline of economics can be viewed as hegemonic, the only way to examine problems and suggest solutions. The strength of economic knowledge is seen to lie in its ability to manage the details of a local issue, reduce the complexity, and extract indicators and specific policy goals. Local knowledge is considered messy, complicated, political, and incomprehensible to the institution.
For the above reasons, the Bank has been described as an 'economic fortress' by its staff, with internal operations and activities dominated by economic paradigms and frameworks such as cost-effectiveness and human capital. This is true within the Bank’s health sector, which has often been run by an economist who ensures that potential project loans are designed to be consistent with the Bank's economic framework and legal mandate. This principle is a constraining factor on staff who would like to justify loans or Bank involvement on other, i.e. human rights, grounds.
Dr Kim, an anthropologist by training, has shown in his previous work how a different approach is needed when developing policy for health – one that is grounded in human rights and social justice. And his approach has been successful, seen for example in initiatives such as Partners in Health, which he co-founded, and the WHO’s 3 by 5 Initiative aimed at getting 3 million people on AIDS treatment by 2005, which formed part of the unprecedented global response to HIV/AIDS. He has demonstrated through his work that addressing health challenges requires more than economic blueprints and that the right to health must underscore programmes and projects.
As World Bank President, Kim can make a huge difference to health. When Robert McNamara, US Secretary of Defense (1961-68), became President of the World Bank in 1968, he brought an agenda outlining the moral imperative of foreign aid both for humanitarian and national security purposes. Kim now has an opportunity to make the Bank an admired leader in global health – one that recognizes that health is special and unlike any other commodity. Given all he has achieved so far in his work and his commitment to improving the life of poor people, his appointment marks the start of a new era for global health governance.