Rx for Survival

Politics & Global Health

The United Nations and Global Health

The largest multilateral organization of all is the United Nations, formed in 1945 with 50 founding member states and now consisting of 191 nations. Headquartered in New York City, the UN is governed by its General Assembly, composed of representatives of all member states, each of which has one vote. (For a list of members, see www.un.org/Overview/unmember.html).

While much of the authority in the UN is concentrated in its Security Council, the only UN body with power to impose decisions that other member states must carry out, 10 UN programs and funds engage in significant public health-related activities. All fall under the aegis of the Economic and Social Council, which coordinates several programs, funds, and agencies.

In 2000, a significant shift occurred, however: health moved for the first time onto the agenda of the UN Security Council, whose main responsibility is the maintenance of international peace and security. At the instigation of then-U.S. Ambassador Richard Holbrooke, the Security Council met to debate the impact of AIDS on peace and security in Africa. This meeting resulted in the Security Council's commitment to train peacekeeping forces in AIDS prevention, and in a Security Council resolution calling for member nations to develop strategies to roll back the epidemic, particularly in the military.

How extensive are the global health programs of the UN overall? One way to measure their scope is to look at their cost. All ongoing UN activities are paid for primarily through the biennial budget, which is funded by dues assessed from all 191 General Assembly members on a sliding scale that takes into account the size of each nation's economy. To pass, the biennial budget must be approved by two-thirds of the General Assembly members after a legislative process that involves several committees. Where health programs are concerned, ancillary funding outside the budget can also come into play.

To provide a sense of overall scale, the entire biennial regular budget for the UN during 2004-2005 was $3.6 billion. UN special agencies and funds and its peacekeeping operations during the same period added another $2.8 billion, for a total of $6.4 billion. This is $1 billion less than the budget of Panama during the same period. By comparison, U.S. federal expenditures during 2004 alone were on the order of $2.34 trillion.

Specific United Nations Programs and Funds

Each of the 10 UN programs and funds with health-related activities has its own governing body, budget, standards, and guidelines; and each relies on a combination of contributions from the UN regular budget and voluntary support from governments, organizations, and individuals. The family of programs and funds includes the following:

United Nations Specialized Agencies

Several other autonomous organizations, joined to the UN through special agreements, play a very significant in global public health. These have their own separate governing bodies and budgets, and each has its own community of member states, ranging in number from 160 to 191. All are financed partially through government contributions from member states, based on their ability to pay, and partially through contributions from foundations and non-governmental organizations. (See Private Foundations and NGOs below.) One representative from each member state sits on the governing board of each agency. Agencies with significant health-related activities include the following: