Making choices

Al-Ahram Weekly, 31 Oct. - 6 Nov. 2002 Issue No. 610

GRO HARLEM BRUNDTLAND has been WHO director general for four years. A long-term environmentalist and former prime minister of Norway, she has recently announced that she will not be running for another term. While in Cairo this month, Brundtland talked to Al-Ahram Weekly of the fine line one has to tread between mandate and compromise.

AW: During the World Summit for Sustainable Development in Johannesburg, you said that the world is "living dangerously" and that millions worldwide were short of the food, water, and security. You alluded to the fact that this is because people either have little choice or make the wrong choice. Please elaborate.

GHB: Unless you invest in health -- in the health [of] all people -- you cannot have sustainable development. In most cases, people do not have a choice, because they are poor. They are very threatened by adverse health consequences. One has to turn this around [and] use health as a bridge to getting [people] out of poverty.

Environment is very much linked to health. Threats from the environment are obvious, starting with the pollution resulting from the burning of fossil fuel and even from the burning processes that take place inside a small house when cooking. The child sits on the mother's shoulder [as] she is cooking. Not only does she take in the fumes, damaging her health, but the child can also get respiratory illness, which -- along with diarrhoea -- form the two major causes of death in children.

Choosing the wrong life style applies [also] to people who have resources but [opt for] unhealthy diets; alcohol and smoking tobacco all lead to ill health. Over-consumption also adds to the problem of environmental damage because of the misuse of [natural] resources.

AW: With your political and professional background why did it take the WHO that long to venture into investigating depleted uranium (DU) in Iraq?

GHB: With DU, the question is: who should investigate the issue? There are many international institutions with mandates [in situations] where certain issues are more closely linked to one institution or another. It is also a complex issue [for reasons] linked to both the lack of capacity and the lack of access, as is the case when any international institution is looking into issues related to war and conflict situations.

When I came into office, DU was not something coming out of the blue. There are so many years [of work] behind. The question was: who would be looking into it? You have the Security Council of the UN. You also have the United Nations Environment Programme (UNEP), because this is an environment concern more broadly. But perhaps it should be the International Atomic Energy Agency in Vienna [investigating this matter] because we are dealing with a highly technically complicated field. So, other institutions are already in there.

That is how you have to understand it. It starts with UNEP and the Vienna Agency and then gradually, as the health aspect comes more clearly onto the agenda, because it takes time [for this process] to materialise, WHO becomes part of the whole issue.

This happened in the last two to three years, when we really entered into the issue -- once the two other agencies have established [that] DU was actually there. WHO does not investigate the presence of uranium.

AW: In what way did WHO's committee visit to Iraq in 2001 help you to envisage the agency's role in the case?

GHB: We are still investigating cancer and other related health consequences. Up till now, we do not have a full report. The visiting group reported certain observations, but the lack in having an epidemiological map, [one] that makes it possible to draw conclusion, persists. We are still working with our cancer agency to gather sufficient data to make clearer conclusions. We are as yet in the process of evaluation and study, before we can fully report to the World Health Assembly.

AW: Israel denied you permission to visit the occupied Palestinian territories, as requested by the World Health Assembly last May, to assess the deteriorating status of health and pump in more support. How do you intend to go about this issue?

GHB: It is clear that one of the reasons why we want to go is to know better how to do more. Not being able to get in illustrates [the difficult aspects of] the situation on the ground.

Together with NGOs and the participation of WHO people -- at a junior level -- present there, we try to give our support. However there are the limitations [creating] barriers to more action.

The political situation and the conflict and war situation in that area pose the real difficulty. We just talked about Iraq, where we also have other kinds of limitations making things difficult. In Palestine, we still have war, or something close to it, going on. So, we have problems. Nobody would wish anything less than the best. There is no disagreement on any front on this. People are suffering, but limitations to what can be done are there. That is the tragedy.

AW: As physician and a politician working within the framework of UN in a disturbed and confusing global political situation, to what extent do you have to compromise?

GHB: It is part of life in any case, wherever you are, because you are never on your own. You are dependent on other people and other forces. If you want to promote change, you have to be looking [at] where [the] obstacles are and [thinking of] how to remove or lessen them and move between them to get forward. I always have this kind of thinking on my mind at certain stages when things are difficult.

I do not know if "compromise" is the right word, because you are not a dictator in any case. You do not have a personal right or authority. It is all vested in a democratic process that has elected or nominated you to do something. All the time, you are dependent on sufficient support to be able to move in the right direction. It becomes an interpretation of how you can move at the quickest possible pace towards the good results.

I think that is really what you are asking. You have to see how you can do your best to move things forward. In that sense, if you are too impatient and feel that if everything everyday [is] not exactly like you would have preferred [it to be] then you would give up. That's not my style. But you can push people by making strong statements sometimes at the right time and the right moment.

AW: With your term approaching its end, what is it that you see as your best achievement?

GHB: In a way, if we get the Tobacco Control Convention signed, this would illustrate [the] higher efficiency of WHO [in] getting health higher on the political agenda and mobilising member states and civil society to really promote public health in an effective way. That would be one definite illustration.

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