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ALISON STEWART, host:

Happy anniversary to WHO. Ah, don't correct my grammar. It's not "to whom." Sixty years ago today, the World Health Organization was founded. The Geneva-based UN Organization's guiding principles, according to its website, are "promoting development in poor countries, fostering healthcare security, strengthening health systems, harnessing research, enhancing partnerships, and improving health relations."

So every year on its birthday, the WHO declares World Health Day, and it highlights one issue it considers critical. This year they're focusing on the impact of climate change on health. Now, with the budget this year of 4.2 billion dollars, is the WHO capable of making a difference on something as big as climate change? Or will its critics have a field day with what's been described as an organization that sometimes engages in posturing?

John Donnelly covered global health issues for the Boston Globe for nine years. He lived in Africa for three, and he's currently a Kaiser Family Foundation media fellow, working on a book about Americans working to help kids in Africa. And he joins us now. Hey, John.

Mr. JOHN DONNELLY (Health Journalist; Media Fellow, Kaiser Family Foundation): Hi. How are you?

STEWART: I'm doing just great. So when is the World Health Organization especially effective? I mean, really, what's been its biggest accomplishment?

Mr. DONNELLY: You know, I think the WHO is great when there's a disaster, when something like SARS - there's a SARS breakout, or the Avian Flu pandemic sort of jumps over into humans. Then the world needs sort of an organizing body that would say, hey, we have to - we have to watch travel from this country to that country. It needs sort of a moral authority to deal with transnational issues like that.

It's also been very effective in setting some big goals for the world. And things like, there should be three million people in Africa to be treated with AIDS drugs by the year 2005. And tobacco companies, you should really stop promotion of your product in this kind of fashion around the world. You should have more regulation. So it's had some big wins in that way.

STEWART: It's also taken quite a few hits. What are some of the WHO's major problems?

Mr. DONNELLY: Well, it's this huge bureaucracy that can't actually effectively move very quickly, and it has all these little fiefdoms around the world. There are six different regional organizations that pretty much dance to their own tune.

So the director general has to pick issues effectively. And the fact that you mentioned how there was a 4.2 billion dollar budget, well, that actually, in the world of global health now, is not that huge.

It goes a lot to salaries, a lot to the bureaucracy. And WHO, unlike the Gates Foundation, unlike the U.S. government, unlike this other group, the Global Fund to Fight AIDS, TB, and Malaria, doesn't really have a lot of money to actually implement programs. So it says it want to go do something, but then it often doesn't have the money to back it up.

STEWART: Well, do they have any oversight over the money that they do share, that they give to smaller aid organizations?

Mr. DONNELLY: Well, they're not so much a grant organization. I mean, I can give you a great story. I was in Lesotho, this small mountainous country in southern Africa, South Africa surrounds it, a couple years ago. This really innovative thinker at WHO, his name is Jim Kim. And he had this great idea of going into one country in Africa and getting everyone tested for HIV, and the health minister was really for it.

And I spent like two or three days with Jim going around the country. Lot of skepticism, he's pushing, pushing, pushing. Finally, at the end, they say, OK, we're going to do it. A great idea, this should happen. It should happen all over Africa. Everyone should know their HIV status. But now, it's been two years later, and there's been very little progress.

And one of the reasons there's been very little progress is that no other people came and no other funders came in behind WHO and said, hey, you know, we've got to put money to this. So it can be an advocate just like today's announcement, you know, with this is - we should look at the human health effects of climate change. And then what?

STEWART: Right.

Mr. DONNELLY: If it doesn't have a big budget to really implement programs, a lot of its best ideas fall flat.

STEWART: Well, that's one of the big issues with its critics out there. They're several. There's this one former executive type who has his own political issues. But he spent quite a bit of time writing about how the World Health Organization is all about study groups and conferences, and not so much about real-life change.

And it's interesting, when I look at their activity set for their 60th anniversary, it is a lot of things like a podcast we're going to put out, and a photo exhibit. And a global snapshot of public health. I mean, are they actually making a difference on the ground, from what you've seen and reported on?

Mr. DONNELLY: It's a mixed record.

STEWART: Yeah.

Mr. DONNELLY: The politics of global health get in the way, and what happens is, you know, the developing countries, the poorer nations around the world really need WHO. But the rich countries really make their own decisions in many ways. I mean, you can look at, like, one huge decision a couple of years ago was - also involved AIDS.

And it involved - should the world allow these companies who make generic drugs to treat AIDS, should they allow that to be introduced in poor countries, and how do you do that? And the U.S. government said, whoa, whoa, whoa. Wait a second, here. We can't just allow this. You know, big pharmaceutical companies said, you know, this could hurt our research-based industry.

And the U.S. government put a lot of pressure on the WHO not to give what's called "prequalification," which is sort of their OK that the drugs are OK, and forced the generic companies and the developing countries to let the whole process go through the U.S. Food and Drug Administration, you know, which was a win for no one. It delayed the distribution of the generic drugs. It showed, really, how the WHO is, when it comes to the U.S., especially, can be really toothless.

STEWART: Well, we put up quite a bit of the money out of 193 countries, right? The United States?

Mr. DONNELLY: We put up quite a bit of money, but more importantly than that, we put up a lot of money for health initiatives. We put up, this year, there's more than four billion dollars that were funding for - to fight HIV and AIDS, close to, you know, a half billion dollars for malaria.

So you know, the U.S. is the biggest contributor in the world for global health. So the U.S. should have a big voice in it, but the voice should be put toward ways of saving lives, and without undo consideration for private enterprise.

STEWART: Before I let you go, today, World Health Day. The focus is on climate change and health. This is an obvious or not obvious choice for the WHO?

Mr. DONNELLY: Both. It's obvious because it's a great issue. You think about if the world starts warming up, what happens to crops?

STEWART: Sure.

Mr. DONNELLY: That could have an effect on malnutrition. What happens to water ways? What happen to - you know, does it cause more drought? Does it cause more floods? That's going to have a huge impact on human health. But then it's not such a great choice in some ways, because what has the WHO ever done on the effects on human health? Very, very little.

STEWART: And it's so big.

Mr. DONNELLY: It's kind of a public relations move for them.

STEWART: John Donnelly, until recently a global health reporter for the Boston Globe, now a Kaiser Family Foundation media fellow writing a book about Americans working to help kids in Africa. Hey, John, thanks for helping us.

Mr. DONNELLY: You're welcome. Thanks a lot.

RACHEL MARTIN, host:

Stay with us. Next on the show, Hillary Clinton's senior strategist is out. What does it mean? John Harris from Politico.com explains. This is the BPP from NPR News.

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