Jim Kim became the twelfth President of the World Bank on July 1, 2012. A year into his first 5-year term, what has he achieved? When he was plucked out of academia—he was President of Dartmouth College at the time of Barack Obama's unexpected call—his friends were amazed, delighted, and fearful. Amazed, because it was an incredible achievement to be handed one of the most powerful jobs in international affairs. He can call any head of state and expect immediate access. Delighted, because the health community knows Jim Kim as a vocal pro-civil-society activist. Here was a man with an unprecedented opportunity to do global politics a different way. And fearful, because he is a non-economist in an economics institution. How, his friends reasoned, would he survive in a setting where economic credentials are the standards by which one is so ruthlessly judged? Despite these concerns, Jim Kim's first few months were a glorious honeymoon. His appointment seemed the beginning of a hopeful new era for equity and rights in human development.

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But then President Kim became caught in the undertow of the Bank's treacherous cultural tides. At the IMF and World Bank annual meetings, held in Tokyo last October, he looked tired and overwhelmed. Dragged from audience to audience, surrounded by Bank officials who kept friends and supporters away, he was required to give brief speeches mostly empty of substantive content. Good people, who could have been his allies, were allowed to leave the Bank. Although he let go those who did not warm to his appointment, he was unable to find high-level replacements who could be the nucleus of a new executive team. He invited old friends to roam the corridors of 1818 H Street. What they found was a deep aversion to accountability, resistance to monitoring and evaluation, and a refusal to admit, let alone disclose, failure. A small group of Bank employees pledged to support him. But some mis-steps—for example, an invitation to one iconoclastic minister of health to join the Bank as a reforming vice-president, which had to be hastily retracted—raised questions about judgment and leadership. The cumulative result has been stasis and a sense of drift. But then came last week.

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Jim Kim returned with a vengeance. “You remember me I hope”, he said with sharp irony, opening a briefing next to Margaret Chan, WHO's Director-General, at the World Health Assembly in Geneva. In his speech to delegates, he rekindled the now distant vision of Alma-Ata—”development in the spirit of social justice”. He reinterpreted this vision in the context of the current movement towards universal health coverage, a movement that must ensure, he argued, an end to user fees. He committed the Bank to the goal of ending extreme poverty by 2030. He promised the Bank would address and measure progress for the world's poorest people. He made a special reference to maternal and child mortality, “a critical test of our commitment to health equity”. And in his first articulation of a specific manifesto for global health, written with Paul Farmer and Michael Porter, he argued that the biggest obstacle to global health today is a failure of delivery. Instead of focusing on interventions and commodities—bednets or antiretrovirals, for example—global health must focus instead on the needs of the person in a community. His Lancet paper and speech at the World Health Assembly signalled an intellectually vigorous comeback, one that must now be translated into a revised and refreshed programme of work at the Bank. Two actions could strengthen the possibility for success. First, the creation of an independent, transparent, and inclusive accountability mechanism to monitor and review progress on delivering the Bank's promises. Second, the inauguration of an externally led Commission on Global Growth, Development, and Sustainability reporting directly to the President. As we approach a post-MDG era, there is a persistent unwillingness among nations to accept that sustainability means balancing the desire for growth today with the need to conserve resources for tomorrow. Our economic models for development must adapt. The Bank can, and should, lead this global reassessment of our economic futures. As Jim Kim has said, the biggest obstacle to global health is a failure of delivery. The same is true also of human development.

Copyright © 2013 RIchard Horton

Article Info Publication History Identification DOI: https://doi.org/10.1016/S0140-6736(13)61121-6 Copyright © 2013 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect