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International Institutional Legitimacy and the World Health Organization

The global health community continues to look to the World Health Organization (WHO) to solve current global health governance (GHG) problems. But today’s WHO is a compromised institution. On a theoretical level, WHO lacks a substantive justice oriented conception of international institutional legitimacy. On a more pragmatic plane, WHO is riddled with budgetary weaknesses, power politics and diminishing reputation and effectiveness. WHO’s early successes were laudable and the organisation has the potential to make an impact on future global health problems, but the institution lacks a number of key ingredients of success: coordination capacity, authority, accountability, fairness, a master global health plan, effectiveness and credible compliance mechanisms. While WHO reforms could help it do its job better, a new vision, based on a substantive conception of justice and legitimacy, and associated reforms in the broader GHG system will more effectively and efficiently serve GHG functions and the WHO itself. This article first assesses the basis of international institutional legitimacy that creates a faulty foundation for WHO and then analyses structural problems in WHO and its constitution that undermine its governance role. The article presents an alternative view of international institutional legitimacy and global justice that reworks the terms of international cooperation and the structure of international institutions. This in turn affects the configuration and norms of GHG and offers an ethical perspective for evaluating the WHO and guiding GHG reforms for a more effective WHO role.