Narratives for global & planetary health: Where are Winston Churchill & Wynona Churchilla when you need them?

Others have no doubt noticed the similarity as well, but I only recently stumbled upon it. (No, I don’t mean a vague resemblance between Winston Churchill & Wynona Ryder 😊. )

Global health leaders (like Bill Gates) and organizations (say, GAVI or the Global Fund) typically want to portray a ‘positive message’ of progress, success (“X many lives saved”) and hope,  in order to convince global citizens, governments and donors to sustain the global health effort. Or so they hope. Till recently, and perhaps throughout the MDG era, they actually had a case, as Rosling and others have mapped – it wasn’t just the ‘global health success cartel’@work.

Along the same lines, it is often said that in the battle against climate change, a similar (largely positive) narrative and framing is needed (instead of the more familiar one of ‘doom & gloom’,  aka ‘time is running out’, ‘we have only 12 more years to get this right’ (or even less, for the Kevin Andersons among you), or ‘humanity is on a suicidal path’ (see UN SG Guterres last week)). You need to give people hope, experts emphasize, otherwise they’ll succumb to despair and cynicism. 

There’s no doubt some truth to this assessment. I myself have a blurred (some would say ‘nebulous’) view on the ideal framing for both global/planetary health, I’m not quite clear what the best framing is – it probably differs a bit depending on your target audience and the way they’re wired. Still, for most people, I’m afraid we get the “balance” in our global health & planetary health framing wrong, focusing too much on the positive and the possible “win-wins”. In disruptive times, I doubt that’s the best strategy.

Let me explain a bit more in detail.

Disruptive times require a different framing

In global health, as this is a time of so many disruptive changes (not just in global health), I wonder whether it still makes sense to mainly point towards progress, results and success (for a recent example, see GAVI’s mid-term review), if the world as we kno(/e)w it, in many cases, seems to be imploding in front of our eyes (more or less in line with the implosion of the neoliberal paradigm). True, there’s a fair amount of scaremongering on pandemics & AMR too in global health, but global health doesn’t really pay much attention to the broader/vague anxiety of many people about the future, whether due to climate change, economic & technological disruption, migration (in the less appealing cases), or a mix of these. If horrible stats are highlighted in global health (like on air pollution), the corollary global health message is always one of hope (plus “best buys” : ) ). Seems to be a conditio sine qua non in global health reports.

Whether we like it or not, however, big chunks of the populace are currently afraid about the future and angry (about a bunch of issues) nowadays, including about the fairness and/or sustainability of the economic system.  Even if the rise of the global middle class is probably undeniable (see Kharas et al), in the SDG era a global story of progress (against all odds) sounds a bit surrealistic in many ears.   Including in my ears, I have to say, and I read Lancet ‘Grand Convergence’ Commissions for a living : )

I wonder whether in times of an increasing backlash against universal human rights, we shouldn’t rather make an aggressive case for values  and even character traits (instead of focusing on global health ‘results’), even if part of public opinion isn’t very fond of some of these values for the time being. Gates’ principle, ‘Every life has equal value’, should perhaps be promoted much more aggressively by global health folks. Implicitly, that happens of course, and explicitly, maybe the UHC movement is doing that, certainly at a national level (unfortunately, not always including migrants).

But it doesn’t feel like the dominant framing, certainly not in times of global health security, at the global level. You always get the feeling that there’s a need ‘to invest’ in health, so that other goodies (economic growth, global health security, social stability, …) will follow. Like manna from heaven. Conversely, if countries fail to invest enough, then ‘global health gains’ of the past decades “risk to be reversed”, is the message. That might be true, but it’s not exactly a message that will blow away your audience. Problem is: most of these (global) messages are catered to decision makers.  Instead, they should start from the point of view of ordinary citizens, all around the globe. Many of these perhaps don’t feel like Job yet, but they worry they might end up like Job, eventually. And in the end, they are the ones who push their decision makers in a certain direction (or not).

In the battle against climate change (and, broader, for planetary health), in the same vein, perhaps we need to make much more forcefully the case for (the interests and wellbeing of) future generations (in addition to stressing the climate change/health “win-wins” of this generation, which, arguably, are also part of the necessary framing). Future generations should also count equally, in our decision making now. They clearly don’t.

Disruptive times require different leadership as well

In both cases – whether you like it or not, global health’s future is now linked to planetary health’s-, I think we also need a lot less philantro-capitalists and leaders of Bretton Woods & other OECD institutions telling us what to do, but perhaps more Winston Churchills (and female equivalents, as this is the 21^st century : )) . You no doubt remember his quote at the start of WW II: “I have nothing to offer but blood, toil, tears and sweat.”   True, Churchill was an Englishman, not a “can do”/ ‘optimism is a moral duty’ American, babbling all the time about multiple “win-wins” in the battle against Dolf. And yes, no doubt he had many flaws too. But Winston didn’t mince words, came up with a bleak but honest assessment of the situation, yet, he still managed to offer a ray of hope.  That’s, in my opinion, the balance needed currently, and the sort of leadership required.

Unfortunately, for the time being, the ones claiming to be global health & planetary health champions are too much associated with the (neoliberal) model of the old times. Bloomberg & Macron, for example, lack the legitimacy to rally citizens behind them in their own countries, so how could they be global leaders?  And while I appreciate Gates’ global health commitment, he’s not the one who will lead humanity to a better, fairer and more sustainable future (although he can and does contribute). I also have zero confidence in the likes of Jim Kim & Christine Lagarde, to lead us – in time, at least – to a truly transformed economy and the new (global and national) social contract we need. These are people to lead perhaps in times when the economic system is more or less fit for the times, but not when it needs massive transformation. The disruption is there, already, but you never get the feeling that they can lead us to a fairer and more sustainable system, thinking truly out of the box.  It goes without saying that the SDG framework  – with its rather sanitized discourse on  ‘leaving no one behind’  and, surprise, surprise, ‘SDG goal X  invariably being … off track’ -  doesn’t quite cut it either, in terms of framing,  in disruptive times like ours.

On a side note, it’s remarkable that in a (still largely) neoliberal world, where ‘ambition’ seems to be the very purpose of life for individual citizens, ‘ambition’ is lacking big time at a collective level in the fight for a sustainable planet.  Instead of saying that we need more ‘ambition, ambition, ambition, ….’  on climate change in 2019 (which is not wrong), maybe we should also have a good look at what ‘ambition’ entails on an individual level, for the neoliberalized subjects we all are, to a bigger or lesser extent. Perhaps part of the answer lies there.

If this is a disruptive era, like the thirties & World War II were, or the end of the Roman empire, the beginning of the Renaissance, the kick-off of the Enlightenment, …   maybe it’d be good to acknowledge this, as the very starting point in our global health reports and advocacy?  And not just treat the current ‘hiccups’ (like Brexit, Trump, gilets jaunes, …) as some kind of bad vibes or geopolitical mosquitoes you want to swat  (“populism”, ‘fake news’ ), hoping that after some time they’ll just go away, populism will get out of vogue again, so that you can basically go on with ‘business as usual’ (while talking about ‘game changers’ every other sentence), towards hopefully a new multilateral and cosmopolitan future. Dream on.  

Most citizens know (or at least sense) now they live in a time of disruption. It’s better to take them and their feelings seriously. Disruption, by all means - as mankind knows from experience - can go both ways. Things can change for the better, but they can also go horribly wrong in the decades ahead.  And no, TINA won’t fly anymore this time. Just ask Macron – Jupiter still doesn’t fully grasp what hit him lately.

Global governance?

Yes, as these are global (governance) challenges, in a way, we would need a “global” Churchill(a). For the time being, there aren’t many Churchill(a)s around.  More Benito's, I’d say.

As future generations are not yet on the planet, perhaps it will take somebody of the next generation, like Greta Thunberg, to take the lead. Ideally, one should identify a Greta from each country, making up a young stakeholder “world committee”, a sort of “moral conscience” of future generations not yet present on the planet.  But she and her young peers will still need to be complemented by a team of real “leaders”, a bunch of Winstons & Wynonas so to speak.  By this, we don’t mean people claiming to speak, cheaply in my opinion, on behalf of ‘the Americans’ or ‘English people’ (if they routinely only represent maximum half of them), or people in which you suspect a hidden personal agenda, when they’re making grand claims about the future of the country or the planet (while dreaming about power). As this is the system that brought them to power, they are just willing to tweak the current system a bit, and will at most manage to convince half of the voters, whether it’s for a new referendum in the UK, towards a Democratic victory in elections, or to appease the ‘gilets jaunes’.

No, we need leaders whose main motivation is ‘to get the job done’: to get to a new economic system & social contract, fit for the 21^st century, and sooner rather than later. Because they know it’s the right thing to do, and they have the authenticity and legitimacy to get most of their fellow citizens behind them.

Even if time is running out, I refuse to think that averting runaway climate change is a harder challenge than it was in 1940 to go after the Nazi axis of evil.  But you need leaders who feel, in their bones and veins, that the economic model is no longer fit for this century.  And who understand that it’s extremely important to also make sure that the Bransons, O’Leary’s and Bezos of this world contribute their fair share (and preferably much more than that). If we want the new social contract to work, we just can’t afford High Net-worth Individuals & multinationals continuing to freeride. That will end in utter political chaos, and probably war. If that’s not clear by now, after this series of so called ‘hiccups’, it’ll never be clear.

This is not a time for win-wins, even if there are no doubt some. Instead, it’s a time of hard choices.

Only leaders who realize this will be able to rally the masses behind them, and let them make the sacrifices needed in our times.  Let’s hope they don’t arrive on the scene too late.

PS: yes, we will also need a “moonshot” on geo-engineering. Not that I like it much, but the WWII resemblance extends to an equivalent of the Manhattan project, I’m afraid.