INTERNATIONAL INSTITUTIONAL LEGITIMACY AND THE WORLD HEALTH ORGANIZATION
Today, the WHO is a compromised institution. On a theoretical level, WHO lacks a substantive justice-oriented conception of international institutional legitimacy, and on a pragmatic plane, WHO is riddled with budgetary weaknesses, power politics and diminishing reputation and effectiveness. This article offers an analysis of the international institutional legitimacy of WHO and an alternative view of global justice that reworks the terms of international cooperation and the structure of international institutions.
International institutional legitimacy is the basis for an international institution’s right to rule or exercise power. WHO’s legitimacy is flawed as the organization cannot demand recognition by those not party to the social contract. Furthermore, it fails to provide the basis for holding WHO accountable to individuals or groups; it has no legitimacy to enact policies for the world’s population, only states. Legitimate international institutions visibly articulate and enforce the rule of law. WHO procedures and contracts lack a moral foundation, reinforcing de facto asymmetries and manipulations of power.
This analysis purport that the global health community is better off with a WHO with a legitimate, rather than a deficient, exercise of authority, one that is rooted in a substantive, justice-based conception of international institutional legitimacy and division of institutional responsibilities for global health justice and labor as put forth in the provincial globalism and shared health governance view.
WHO’s problems result from an underlying framework based on mutual advantage maximization and state-based consent, which yields suboptimal results in global health policy. Global health governance, with WHO at the center, must separate and limit WHO functions and articulate the functions and responsibilities of other entities, in a global health constitution arching over the WHO constitution.