You may have noticed that the World Health Organisation is looking for a new head. No, I don’t mean that it’s been decapitated. Neutered, yes, but not decapitated. Edna Mode’s decade as DG is about to come to an end, and ‘the race is on’ to find her replacement. Who will it be?


Since April 2016, each of the WHO’s 194 member countries has had an opportunity to select and nominate a candidate. In an effort to be more transparent – though not particularly democratic – the nominations received are considered by the WHO’s Executive Board (EB). Guided by a list of criteria (see below), it chooses three names to go through to a final vote by the Organisation’s members at the World Health Assembly.

Wow, that must take the EB ages – all those member countries nominating their candidate, 194 CVs to sift through, what a pain! Yes, you’d think there’d be 194 nominations, wouldn’t you. I mean, come on, which country wouldn’t want its representative to lead the WHO? Well, I’m sorry to disappoint but it’s not 194, it’s 6: Tedros Adhanom Ghebreyesus; Flavia Bustreo; Philippe Douste-Blazy; Sania Nishtar; Miklos Szocska; and David Nabarro.

Why only 6? Not sure, but most likely because member countries’ diplomats have been working their magic, trading candidate nominations for individual and collective advantage. And anyway, how could the administrative capacity of the WHO manage 194 individual candidates – impossible, right?

But wait, I want to be DG of the WHO. I’ve done some stuff, travelled a bit, got an education, watched House on TV. Heck, I can even sing! I could do that job! Good for you, all you have to do is get a member state to submit your candidature, and the job is practically yours.

Well, almost. It takes a very special kind of person to be DG of the WHO. Very special. First of all, you have to be a diplomatic titan. Literally, a titan. Editor of the Lancet, Richard Horton, expects you to ‘speak the truth to power’ (please, please, can people stop saying that). Chris Murray (doctor) hopes for a “visionary, highly principled leader who always did what [they] thought was needed for the world” – attributes that might equally apply to both Gandhi and Hitler. Derek Yach (ex-senior vice president of Global Health and Agriculture Policy at PepsiCo) expects nothing short of “global influence” from his DG. Fortunately, the EB has more to go on than these duck-billed platitudes – it has a list of criteria:

“Under resolution WHA65.15 the candidates nominated by the Board should fulfil the following criteria, while underscoring the paramount importance of professional qualifications and integrity and the need to pay due regard to equitable geographical representation, as well as gender balance:

  1. A strong technical background in a health field, including experience in public health;
  2. Exposure to and extensive experience in international health;
  3. Demonstrable leadership skills and experience;
  4. Excellent communication and advocacy skills;
  5. Demonstrable competence in organizational management;
  6. Sensitivity to cultural, social and political differences;
  7. Strong commitment to the mission and objectives of WHO;
  8. Good health conditions required of all staff members of the Organization;
  9. Sufficient skill in at least one of the official working languages of the Executive Board and the Health Assembly”.

I think this is a pretty good list of qualities, but – importantly – a check list I bet many of us could quite easily tick off. It would seem that the EB is not looking for someone who can hold the world on their shoulders, just someone who can do the job. And while it’s probably not an easy job – few jobs are – I bet it’s a lot easier than most. And it pays well, unlike teaching or fishing or mining or looking after a family, on your own, on benefits, or waiting, or maggot-farming, etc.

Electing the DG of the WHO by lot.

So how might you get the job. Well, there are two ways: the WHO way, and another – the outline of which I’ll describe below.

The WHO way is more transparent than it used to be, but still pretty opaque. I repeat my earlier question – why only 6 nominations? We still don’t know anything about the process that went on behind the scenes, and which resulted in such a small pool of candidates. True, anyone can in theory put their name forward, but they can’t just stroll up to WHO HQ and drop their name in the EB’s hat; no, they have to be proposed by a member country. And there’s the rub – it becomes a political selection.

Inevitably, that means a small pool of candidates with an equally narrow range of life-experiences, work experiences, and qualifications (how many of the nominees are medically trained – answer 5). It’s worth recalling that just 3% of WHO’s staff have non-medical skills, so now really is the time to diversify. It also means a tendency to attract the kind of person who won’t – pace Horton – speak the truth to power, because on one level, at least, they are the product of power. They have got to where they are today because they have repeatedly said ‘yes’ and not ‘no’. Mainstream politics is, after all, a system that selects for obedience.

In a new book by David Van Reybrouck, the case is made for doing away with elections and introducing sortition – the drawing of lots if you didn’t know (I didn’t). There’s a good reason for this: our current (electoral representative) democratic system is utterly discredited – “a beauty contest for ugly people” as one wag observed; the culmination of quite deliberate efforts over the years to “depute power from the many, to a few of the most wise and good” noted another. Reybrouck describes the historical trend thus:

“There was something unavoidably vertical about it, always above and below, always a government and its subjects. Voting became the service lift that brought a few to the top, retaining therefore something of an elective feudalism, a form of internal colonialism that everyone endorsed” (Reybrouck, p105).

For any democratic institution to flourish, there must be a diversity of voices, sure, but there should also be political equality – remember government by the people? This is not achieved through the current system, even with the recent reforms in place. So, how do we achieve political equality in electing the next head of the WHO?

Fundamentally, sortition should be institutionalised throughout the Organisation, starting with the head. Anyone satisfying the broad – and sensible – criteria listed above should be free to submit their nomination. Crucially, candidates should not require national approval. The nominations would form a pool of candidates, and from this pool one person would be chosen by lot (i.e. randomly). Their term would be restricted to 1-3 years and, once completed, a new person would be chosen by lot to replace them.

Beneath the head, an Executive Board, also elected through lot, would provide oversight, while much larger pools of voluntary candidates would be allotted to fulfil the various governance functions required of a world health organisation: agenda setting, specialist technical panels, rules councils and policy juries.

A crazy idea? I don’t think so, just an idea whose time has come. “Our democracy is being wrecked by being limited to elections” argues Reybrouck. A similar argument might be applied to the institutions that govern global health. If not “wrecked” then at least in need of urgent, and profound, democratic reform. The WHO is our world health organisation – perhaps it’s time we led it?

This post was first published on asiplease.uk on 14th Oct, 2016