Conceptual and institutional gaps: Understanding how the WHO can become a more effective cross-sectoral collaborator

Gopinathan, Unni, Watts, Nicholas, Hougendobler, Daniel, Lefebvre, Alex, Cheung, Arthur, Hoffman, Steven J. and Rottingen, John-Arne (2015) Conceptual and institutional gaps: Understanding how the WHO can become a more effective cross-sectoral collaborator. Globalization and Health, 11 46: . doi:10.1186/s12992-015-0128-6

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Author Gopinathan, Unni
Watts, Nicholas
Hougendobler, Daniel
Lefebvre, Alex
Cheung, Arthur
Hoffman, Steven J.
Rottingen, John-Arne
Title Conceptual and institutional gaps: Understanding how the WHO can become a more effective cross-sectoral collaborator
Journal name Globalization and Health   Check publisher's open access policy
ISSN 1744-8603
Publication date 2015-11-24
Year available 2015
Sub-type Article (original research)
DOI 10.1186/s12992-015-0128-6
Open Access Status DOI
Volume 11
Issue 46
Total pages 13
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.

This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?

Analysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.


There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.
Keyword World Health Organization
United NationsGlobal governance
Global health governance
Global governance for health
Social determinants of health
Health in all policies
WHO reform
Cross-sectoral collaboration
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
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