World Development 137 (2021) 105176

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World Development
journal homepage: www.elsevier.com/locate/worlddev

Viewpoint, Policy Forum or Opinion

Unequal discourses: Problems of the current model of world health

development
Jing-Mao Ho a,⇑, Yao-Tai Li b, Katherine Whitworth c
a
Data Science Program, Utica College, USA
b
Department of Sociology, Hong Kong Baptist University, Hong Kong
c
Department of Political Economy, University of Sydney, Australia

a r t i c l e i n f o a b s t r a c t

Article history: The COVID-19 pandemic has exposed institutional deficiencies in world health development. This view-
Available online 9 September 2020 point paper examines the allegations about the partiality and political bias of the World Health
Organization’s (WHO) response to world health emergencies. We draw on quantitative and qualitative
analysis of the WHO’s Director-General’s speeches pertaining to the COVID-19 and EVD outbreaks. We
find that the WHO’s discourse on COVID-19 praised the Chinese government’s role in the containment.
By contrast, the WHO’s discourse on the African countries fighting to contain Ebola centered on the
unpreparedness of these countries. We argue that the WHO’s unbalanced emphasis on different practices
and ‘‘traits” of member states paints a partial picture of global health emergencies, thus it fails to uphold
its founding principles of egalitarianism and impartiality. Finally, we put forward suggestions about a
more equal and fairer model of world health development.
Ó 2020 Elsevier Ltd. All rights reserved.

1. Introduction the WHO vulnerable to the power game of international politics

1.1. The current model of world health development and its
discontents
The World Health Organization (WHO) has been regarded as
playing an important role in advancing global health development
(Brown, Cueto, & Fee, 2006; Magnusson, 2007; Ruger & Yach,
2009), however it is no stranger to calls for institutional reform.
Following the WHO’s handling of the 2014 outbreak of Ebola Virus
Disease (EVD) in West Africa numerous requests for its overhaul or
even dissolution were made (Checchi et al., 2016; Kamradt-Scott,
2016; Negin & Dhillon, 2016). Institutional deficiencies identified
in the WHO, include amongst others (Wenham, 2017), that the
functioning of the WHO is subject to international power struggles.
The current model of global health development has been criti-
cized for its imperialist tendency (Levich, 2015) and the dominant
role of state actors (Adams, Behague, Caduff, Löwy, & Ortega, 2019;
McInnes et al., 2020). Indeed, the governing body of the WHO is
made up of member states, while civil societies, such as profes-
sional associations, academic groups, and non-profit organizations,
only play a very limited role (Checchi et al., 2016). This institu-
tional structure opens the door for political manipulation, making
⇑ Corresponding author.
E-mail addresses: jh2268@cornell.edu (J.-M. Ho), yaotaili@hkbu.edu.hk (Y.-T. Li).
(Kamradt-Scott, 2016). Consequently, global health development
is contingent upon power relations among the WHO’s member
states. Sovereignty and national interests, for example, can con-
found attempts at transnational coordination, rulemaking, and
adjudication (Frenk & Moon, 2013). Certain health programs or ini-
tiatives may be underfunded and underdeveloped because the
countries affected lack the political or financial clout to mobilize
support (Adams et al., 2019; Nunes, 2016). Thus, inequalities in
global health development are perpetuated and exacerbated. A
variety of proposals to address these deficiencies were unveiled
by special commissions and panels. Ideas in the proposals included
splitting the WHO, revising its constitution, and establishing a new
world organization that engages non-state actors (for a summary,
see Mackey, 2016). After reviewing these suggestions, the WHO
decided not to make major, structural changes (Mackey, 2016).
Unfortunately, the COVID-19 pandemic has again exposed the
WHO’s institutional deficiencies. In early December 2019, a ‘‘clus-
ter of pneumonia cases” was identified in Wuhan, China, but offi-
cial, public messages about this novel coronavirus were not
released until 31 December 2019. Despite the absence of indepen-
dent scientific research, on 14 January 2020, the WHO announced
that China had not found ‘‘clear evidence of human-to-human
transmission” of COVID-19. The Director-General of the WHO,
Tedros Adhanom Ghebreyesus, also asserted there was no need
to ‘‘unnecessarily interfere with international travel and trade”
nor implement travel bans on people from China. Even as evidence

https://doi.org/10.1016/j.worlddev.2020.105176
0305-750X/Ó 2020 Elsevier Ltd. All rights reserved.
2 J.-M. Ho et al. / World Development 137 (2021) 105176
mounted that COVID-19 was highly contagious, the WHO delayed
declaring a global pandemic until 11 March 2020. Ghebreyesus, for
example, in late February claimed that COVID-19 is not a pandemic
and is not spreading in an uncontained way. To date, COVID-19 has
resulted in nearly 26 million confirmed cases across the world, and
more than 860 thousand deaths worldwide. The WHO has been
widely criticized for not acting impartially, for failing to coordinate
an immediate international response, and for being too slow to
sound the alarm. It is again facing demands for reform.
We were particularly interested in these allegations of partiality
and political bias because the WHO, as an independent interna-
tional health agency, is expected to be immune from political pres-
sure or intervention from any country and should present fact-
based evidence in an impartial way. Impartiality (and the percep-
tion of it) can be achieved by maintaining consistency in decision
making processes and offering balanced factual information
regardless of who the stakeholders are. Therefore, we decided to
analyze the WHO’s Director-General’s speeches pertaining to
COVID-19 (60 documents from January to April 2020) and EVD
(17 documents from August 2014 to September 2015), to test the
credibility of the above assertions. We found the WHO constructed
markedly different narratives of the countries identified as the
source of these pathogens and appears to have engaged in a selec-
tive presentation of information.
2. The WHO’s markedly different discourses across two global
health emergencies
After quantitatively and qualitatively analyzing the WHO’s offi-
cial discourses on both COVID-19 and EVD, we found the official
WHO narrative disproportionately focused on a single member
state (China) (see Fig. 1) or group of member states (Guinea, Sierra
Leone, and Liberia) (see Fig. 2).
One may argue that frequent mentions of these states should be
expected as ‘‘factual background” considering the first cases of
each pathogen originated there. However, examining the WHO’s
discourses carefully, we find that mentions of China in connection
with COVID-19 often highlighted China’s positive contributions to
controlling the pandemic. Our results show that out of 46 non-
neutral references to China, not one was negative.1 By contrast,
mentions of Guinea, Sierra Leone and Libera were more varied. Out
of 17 non-neutral documents, 7 of them contained negative refer-
ences to the affected African nations highlighting poverty, poor facil-
ities, political instability, and cultural traditions that facilitated the
spread of EVD. 7 were neutral and described facts such as infection
rates and deaths, while only 3 of them were positive commending
efforts to conduct contact tracing.
Turning to our qualitative analysis, similar to Salzberger et al’s
(2020) findings, we find that the WHO emphasized China’s suc-
cessful containment of COVID-19. For example, on January 30,
2020, the Director-General claimed in his speech:
As you know, I was in China just a few days ago, where I met
with President Xi Jinping. I left in absolutely no doubt about
China’s commitment to transparency, and to protecting the world’s
people (emphasis added).
The WHO repeatedly expressed its gratitude toward China’s
efforts of containing the spread. For example, at the Munich Secu-
rity Conference, Ghebreyesus claimed that ‘‘the steps China has
taken to contain the outbreak at its source appear to have bought
the world time” (February 15, 2020). Bruce Aylward, who led a
WHO expert mission to China in February, defended WHO’s narra-
1
We acknowledge that the analysis of media portrayal may produce different
results, but this is not the focus of this study.
tives and said that China had ‘‘worked very hard, very early on” to
identify and detect early cases (April 8, 2020). However, the WHO’s
descriptions could be seen as inconsistent with the findings of pre-
vious research that suggest the Chinese regime tends to withhold
information about public health issues and could pose a threat to
global health governance (Brown & Ladwig, 2020; Chan et al.,
2009; Goldizen, 2016).
In contrast to the praise of China’s efforts of containing COVID-
19, the WHO’s narrative of the West African nations affected by
EVD highlighted their poverty, political instability, and cultural tra-
ditions. For example, in 2014, the then Director-General of the
WHO, Margaret Chan, in her address to the Regional Committee
for Africa, said ‘‘[b]ecause Ebola has historically been confined to
poor African nations. The R&D incentive is virtually non-
existent. . .Ebola, make Africa’s neglected health systems and impov-
erished populations highly visible” (emphasis added). In another
official speech on August 12, 2014, Chan highlighted the affected
African countries’ inability to fight Ebola by claiming ‘‘Guinea,
Liberia, and Sierra Leone have only recently returned to political
stability following years of civil war and conflict, which left health
systems largely destroyed or severely disabled. The outbreak . . .
threatens to push these countries backwards (emphasis added).
In addition to describing the affected African countries as inca-
pable of dealing with the epidemic, the WHO claimed that the EVD
‘‘virus exploited West Africa’s deep-seated cultural traditions and
some of them were the most dangerous because they proved highly
resistant to change” (emphasis added) (March 10, 2015). More
specifically, Chan argued in the same speech:
In Liberia and Sierra Leone, where burial rites are reinforced by
a number of secret societies, some mourners bathe in or anoint
others with rinse water from the washing of corpses. . ..To this
day, communities in Guinea and Sierra Leone continue to hide
patients in homes, conduct secret unsafe burials at night, and
refuse to cooperate with contact tracing teams (emphasis added).
The WHO seemed to attribute the failure of West Africa’s EVD
containment to intrinsic problems with those affected countries
by arguing that ‘‘[d]eep poverty, a disruptive political history,
and centuries-old cultural beliefs and traditions created immense
barriers to rapid containment” (November 2, 2015). Such language
may serve to reinforce the impoverished image of the affected Afri-
can countries amidst Ebola (Jones, 2011; Kapiriri & Ross, 2020).
Here it is not our intention to say that the WHO’s praise of
China undermines its impartiality (e.g., Gilsinan, 2020), nor do
we wish to say that the WHO’s acknowledgement of resource-
based and practice-based challenges faced by clinicians in West
African nations is unfounded. Rather, we wish to highlight that
the WHO’s positive narrative of China’s role in the current pan-
demic and the negative narrative of the capacity of West African
nations to contain EVD created a partial (in both senses of the
term) picture of the respective health crises. The praise of China
may divert attention away from less favorable facts, including
its role as the source of the pandemic and its initial attempts to
restrict information about and reporting on the virus. Similarly,
the WHO’s focus on the vulnerabilities of west African countries
may draw attention and agency away from the work health prac-
titioners did on decontamination, giving the dead dignified but
safe burials, and contact tracing. These unbalanced accounts of
nation states can open the WHO up to allegations of the selective,
or biased presentation of information. These partial narratives
may deepen pre-existing misperceptions and prejudices related
to unequal global development held by the general public and
international community (Kapiriri & Ross, 2020; Leach et al.,
2010).
 J.-M. Ho et al. / World Development 137 (2021) 105176 3

Fig. 1. Counts of the Top 30 Most Frequently Mentioned Countries in the WHO’s Director-General’s Speeches on COVID-19.

3. A call for a more equal and impartial model of world health
development
The dramatic differences in the WHO’s discourses on COVID-19
and EVD remind us that the world is not only divided by health dis-
parities but also by the power plays of international politics. The
WHO’s unbalanced emphasis on different practices and ‘‘traits” of
member states allows us to see that it is not immune to taking
on the biases found in international politics and as a consequence
has failed to uphold the principles of egalitarianism and neutrality
in global health governance upon which it is founded. If the WHO
is to guarantee ‘‘the happiness, harmonious relations and security
of all peoples,” international politics should not be a hinderance
to the efforts to succeed in achieving that purpose (Benatar,
2016). Thus it is again clear that institutional reform is needed to
bring about a more equal and transparent system of global health
development (Lee & Kamradt-Scott, 2014; Ruger, 2006).
We acknowledge that any international body responsible for
health governance must recognize and address the inequalities in
financial capacity and health outcomes found between the global
North and South. However, it should not perpetuate such a divide
ontologically through its narratives (Sastry & Lovari, 2017). As the
world’s authority of health information sources, the WHO ought to
prioritize the presentation of scientific facts rather than political
rhetoric. Factual information about a new disease or virus matters
not only to public understanding but also to public health and
policymaking.
One way to avoid the dissemination of partial narratives would
be increasing the space for and visibility of other actors and their
narratives within and outside the organization. Instead of over-
4 J.-M. Ho et al. / World Development 137 (2021) 105176

Fig. 2. Counts of the Top 15 Most Frequently Mentioned Countries in the WHO’s Director-General’s Speeches on EVD.

whelmingly only focusing on its member state governments, the istration. Yao-Tai Li: Conceptualization, Data curation, Writing -
WHO can and should pay more attention to both local and interna- original draft, Writing - review & editing. Katherine Whitworth:
tional NGOs that are usually in the front line dealing with public Conceptualization, Writing - review & editing.
health emergencies, and their initiatives for and contributions to
global health. Concrete starting points in this vein might be to revi-
Declaration of Competing Interest
sit the text of the WHO’s Framework of Engagement with Non-
State Actors and its membership criteria. Our suggestions may be
The authors declare that they have no known competing finan-
easier said than done, but should serve as a steppingstone along
cial interests or personal relationships that could have appeared
the way to a more sustainable and successful model of world
to influence the work reported in this paper.
health development.

CRediT authorship contribution statement References

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