The wrong question?

Yesterday, Richard Horton started a discussion on Twitter with the following tweet: “A friend (male) of mine has just written to me saying that global health is such a “boy’s club.” It surely is. How do we change that?”

Lots of people weighed in, as you can imagine, many with valid suggestions.

My own take on this: the situation is slowly improving, global health is becoming more diverse, to some reason due to the important work of Global Health 50/50 and Women (Leaders) in Global Health; other reasons are demographic and geopolitical changes in the global health world, and of course there’s the work on the ground by countless women, a clear majority (over 70 %).

However, the question is perhaps the wrong one.

“Global health”, for all its flaws, has been key in making progress in recent decades, first in the MDG health era, and now at the beginning of the SDG health era there are still hopes of a “Grand Convergence” by 2030. However, if that is to happen, chances are a ‘planetary health’ era will be required. ‘Global health’ can only go this far, versus the challenges the world faces in the 21^st century, that is increasingly becoming obvious.  Including perhaps when it comes to more (gender) diversity at the top.

There are many angles to look at this.

As many have pointed out already, there’s of course the challenge of climate change (& planetary boundaries in general), which makes it urgent to find a new (in my view, post-capitalist) global economic system. Deep down, much of “Global health” has its roots in (the values of) (neoliberal) capitalism, trying to capitalize on the merits of the current economic system (to get global health results), while trying to overcome ( or work around) its flaws (though not in a radical way). The World Bank (at least lately), Gates Foundation, GAVI, Global Fund, Bloomberg Philantropies,… have all done (and are still doing) great work and have great ‘global health’ impact via a business-style approach focused on ‘results’ and value for money.

The downside of this (comparatively low-cost) approach - as it shies away from systemic change - is becoming clear now, though. It’s not just that the world, even with a “green growth” approach (for example), probably won’t be able  to avoid catastrophic climate change, it also increasingly looks as if a world where many ‘global health’ (shortcut, though very important) achievements (lower child mortality etc) are being reached, might turn out politically unsustainable.

Thomas Bollyky hints at this, in his latest book “Plagues and the Paradox of Progress”.  “Recent reductions in infectious disease have not been accompanied by the same improvements in income, job opportunities, and governance that occurred with these changes in wealthier countries decades ago….”

While it’s obviously great that more and more people survive beyond early childhood, all around the globe, it’s also clear that if we don’t manage to let all these people contribute to society in a meaningful way, this is becoming a recipe for major political instability (or worse) - and this also around the globe. And that’s even making abstraction of the coming AI ( and industrial revolution 4.0) tsunami.

The rise of populism has at least partly to do with this (ask the Greeks & Italians), and it seems unlikely that Africa can escape this global trend, as demographic, employment and other challenges are far more huge over there. The pressure on African leaders, like elsewhere, will only increase.

In short, the current global economic system (focusing on ever more effectiveness & efficiency, with as little resources as possible, and whereby one is expected to compete with the whole planet, …), is not just a recipe for ecological but also for political disaster, as it’s increasingly being perceived as unfair by big parts of the population.  So the system has to go.

From that point of view, the challenge seems clear: we need to make the switch from ‘Global Health’ (steeped in an economic system that is no longer fit for this century) to ‘planetary health’. The latter requires a paradigm shift in values, division of labour, work-life balance, leadership … that we can only start to imagine.

But I’m convinced that the question Horton raised is connected to that, at least if the answer is to be positive. Let’s not forget that it’s only a certain type of men that reaches “the top” in the current economic system (including global health), and the same goes for many of the women currently reaching the top, the likes of Lagarde, May et al.   

Another indicator perhaps: in spite of all the good done in recent decades, “Global health” (at least “power” in global health) is still way too close to the 0.01 %. Many feel more comfortable in Davos than when meeting social movement leaders from the South.

I surely hope ‘planetary health’ will be different. To get there, “Planetary health” will need to find a balance between the (undeniable) good in the current economic system (a certain amount of meritocracy, striving for excellence & effectiveness & efficiency, competition, … are certainly needed, but they should only be ‘means’ to a fair and sustainable system), while doing something substantial about its flaws,  thus making sure that nobody has to feel like a ‘loser’ or precarious, via decent employment, or any other way to contribute meaningfully to society (as compared to taking on low-paid jobs desperately trying to make ends meet, as many do in this world)… ). I’m convinced that such an economic system will not lead to political “hiccups” like Donald Trump or Brexit. And hopefully, it’ll also allow a planet with 10+ billion people by the end of the century.

If that’s the case, ‘planetary health’ leadership will not be a ‘boy’s club’ anymore, I bet, but the very diverse club it ought be. In fact, we will all be planetary health leaders then, as we all have a stake in planetary health, broadly defined.

Global health cannot provide (all) the answers for this century, it’s time for planetary health.