Cuadernos Médico Sociales [Medico-Social Notebooks]. Debate: el pólemico informe de la Organización Mundial de la Salud. [Debate: the polemical report of the World Health Organization.] Cuadernos Médico Sociales [Medico-Social Notebooks] (Rosario, Argentina) 2001 April; 79: 95-118.
Objectives: To present four documents critical of the World Health Report for the year 2000, produced by the World Health Organization (WHO). Three documents were produced in Brazil and the other in Argentina.
Methodology: Analytic and interpretative in some documents, with statistical methodology, in others, to question the indicators used by WHO.
Results: The first document from Brazil is an official response of the National Plenary Health Council of the federal Ministry of Health. This document mainly questions: a) the indicators used, as well as the data and analysis, based on comparisons among very different health systems and economic situations; b) a lack of consideration of the stabilization programs, undertaken under pressure from the International Monetary Fund and the World bank, that determined the effective reduction of resources targeting health, in order to target payment of the external debt; and c) the preponderance of technocrats who produced the report.
The second document from Brazil, elaborated by the director of the National School of Public Health and Oswaldo Cruz Foundation, analyzes the objectives and methods of the report, and the methodological failures based on data that was neither always complete nor trustworthy nor homogeneous among countries. Likewise, the paper criticizes ignorance about the Brazilian health system, the methodology used to collect information, the scarce number of persons interviewed (only 33 informants in Brazil), and the scarce number of responses obtained at the world level (only 30 countries among 191 responded to the questionnaire). The document also questions the validity of the data collected in order to consider the cost of health care for families and shows that WHO only obtained this information for 21 countries. All the inferences were made, therefore, based on theoretical calculations elaborated with the hypothesis that reflected the ideological positioning of the authors and not the reality of the countries.
A group of researchers from the Oswaldo Cruz Foundation produced the third Brazilian document. The document presents a detailed critical analysis of the indicators and concludes that they are incapable of evaluating inequity and performance of health systems. The paper also questions the lack of data for all the countries and demonstrates that the comparison of countries was done using indicators calculated with different methodologies and that lacked transparency in the utilized methodological procedures.
The fourth document, produced by the Argentine National Academy of Medicine, synthesizes the WHO report, in order to make evident later its accomplishments, including choice of focus and indicators that contribute a distinct viewpoint for the evaluation of health systems. The paper agrees with the other documents regarding the identified methodological problems.
Conclusions: The documents presented represent a fundamental contribution for understanding the debate that the WHO report has generated worldwide.
Copyright 2007 University of New Mexico