Dr Gro Harlem Brundtland is to stand down as director general of the World Health Organization (WHO) in July 2003, after only one term.
This will be the first time that a WHO director general has not been in office for at least two consecutive terms.
In an interview with the BMJ immediately after the announcement, she said that her decision reflected the fact that she would be 69 at the end of a second term. “I don't want to get into a situation in my life where I'm not fully energetic and able to do my job,” she said.
Dr Brundtland, a former prime minister of Norway, took over the leadership of the WHO in July 1998, promising major organisational reform. She took office at a time when many in the global health community felt that the organisation had become ineffective as a global health agency and mired in bureaucracy .
Her major achievement, she believes, has been to anchor health firmly on the development agenda. “People cannot move out of poverty unless they are healthy,” she said. She added that her successor should be able to build on the WHO's work on supporting governments in achieving the United Nations millennium development goals, set in 2000, for sustaining development and eliminating poverty.
Dr Julio Frenk, Mexico's minister of health and a former member of Dr Brundtland's cabinet at the WHO, said that her reforms have had three other major successes: making the WHO relevant to both developed and developing countries; giving it a corporate strategy and a better management structure; and “expanding the scope of actors with whom the WHO engages, especially from industry.”
Dr Brundtland's decision came as a surprise to many WHO staff, and it has led to speculation among them that her decision may have been influenced by two particular difficulties she has faced.
She was criticised after publication of the World Health Report 2000, which ranked the performance of different countries' health systems in a league table. The report angered some countries , such as Brazil, which was ranked 125th; other critics argued that it did little to help countries to choose policies that would improve their health systems .
A second difficulty, say some WHO staff, has been that Dr Brundtland has found it hard to move her structural reforms beyond the headquarters and into the WHO's regional offices.
Dr Frenk, one of the major architects of Dr Brundtland's reform process, said that “the structural change has gone much farther in the headquarters than in the regions. The major agenda for the next period must be to look at the regions.” 