On UHC & social contracts (fit for the 21st century)

I largely agree with Thomas Schwarz (MMI) ’s assessment of the “Key Asks from the UHC movement”    – it’s a strong and powerful document, and if a 7^th Ask is eventually added, in line with what Women in Global Health advocate for, it might even become stronger. However, as I was re-watching – online - the lovely session Moving Forward Together: Key Asks from the UHC Movement for the UN HLM at the Graduate Institute  (watch that gentle grin on Kickbusch’s face when Thomas almost wrecks the word ‘multi-stakeholder’ 😊), I started reflecting a bit more on some of the political economy (& causality) aspects around the notion of a social contract, certainly given the fact that UHC 2030 sees itself as a multi-stakeholder “We’re all in this Together” platform. 

The notion ‘social contract’ is mentioned in Key Ask 1 (“Ensure political leadership beyond health – Commit to achieve UHC for healthy lives and wellbeing for all at all stages, as a social contract”)) and I certainly agree with Thomas (and Kickbusch) that this notion of social contract is vital, and thus really good to have in the Key Asks.   

Broken social contracts

Nowadays, however, the starting point in this debate should perhaps be the following: in many countries, and certainly in the North, citizens have increasingly the feeling that earlier (post- WW II) social contracts are broken (or at least not in very good shape anymore). As a result, many – see Ask 2 – feel, ahum, ‘Left Behind’. Enter all the commotion in the streets and nastiness on social media, the yellow vests, populism and “political surprises” in a number of recent elections, certainly in richer countries.  

Against that backdrop, Ask 6 (Move Together: Establish multi-stakeholder mechanisms for engaging the whole of society for a healthier world)  feels a bit ambiguous, at least for me. As it’s precisely the private (corporate) sector (aka Big Business & Big Finance), that is considered a key culprit by many citizens in this breakdown of the social contract in our – until recently - neoliberal globalization era. Not the only culprit perhaps, but certainly a big one.  They are basically seen as having taking over 'the world as we know it'. You might say this is not very relevant for the ((L)MIC)countries the UHC movement is focusing on, but the SDG era is a universal agenda, and given globalization, we’re all in this together now, with often similar challenges (even if not to the same extent perhaps), and vested interests.

If UHC is first and foremost a political choice and political will key, as dr. Tedros and many others (rightly) stress, it will be absolutely essential  that the corporate sector does its part (or perhaps more accurately, starts doing its part again, in countries in the North), when it comes to building up a new social contract fit for the 21^st century. If that happens, it will become so much easier to ‘trust’ the private sector in a multi-stakeholder partnership like UHC 2030, as the WEF representative advocated for during the session.

For now, however, a pretty common perception among many ordinary citizens in the world is that Big corporations, Big Finance, Big Pharma, Big Soda, Big Tech, … don’t contribute much ( certainly not according to their ability, cfr. “the strongest shoulders”) to these social contracts in countries around the globe, and even shirk their responsibilities altogether in a number of cases. This is already the case now (see above), and many citizens fear this might get even worse in the (Fourth Industrial Revolution) future.

Instead of contributing to this social contract, many of these Big Fellas are thus considered ‘freeriders’ or worse, paying a low amount of taxation, preferring “going to the moon” over ensuring decent work conditions and salaries to employees (with many even planning further automation & robotization to get rid of workers altogether in the future, at least if they can get away with it), not to mention the enormous ecological havoc they cause in the process. Others try everything in order not to have to pay sin taxes (sugar, alcohol, tobacco, …) - or STAX, if you prefer that term. The financial sector (see the financial crisis) and Big Pharma are a story in their own right, when it comes to their role in the (disrupted) social contracts in recent years.

In short, Big Corporations & Big Finance are a big reason, if not thé reason, why social contracts are broken or at least under severe pressure in many countries in the North, among others via the pathway of underfinanced public goods & sectors. As for the South, there they are probably a big reason why social contracts never were established in the first place. But I’m not well placed to dwell on that.

People sense, all around the globe, that all this ‘People Planet Profit’ talk remains mostly empty talk, even in the SDG era, the only stakeholder to which multinationals really feel accountable are their shareholders. The economic system is seen as anything but fair, globally and nationally. In these kinds of circumstances, it will not exactly be a piece of cake to build up new social contracts.

To let UHC thus play its role, as the Key Asks advocate, as part of (building) an overall ‘social contract’ between citizens and the state, we’ll first and foremost have to get big companies contribute (again) their fair share to societies, via fair taxation, decent work & salaries, etc.    In the absence of that,  the whole idea is a non-starter, in my opinion, even a fata morgana.

How about the social contract with future generations?

A last (but equally important) comment: and how about the social contract with future generations? Although the Key Asks emphasize that we aim for a ‘healthier world’, there’s not much in them that talks about a social contract with future generations, in order to make sure that they are not ‘Left Behind’. Seems like a gap that needs addressing too, before the High-Level Meeting on UHC in September starts.  In the 21^st century, given our increasingly ecologically fragile world, a social contract between citizens who live now and the state no longer suffices.

To conclude: it would be good if UHC 2030 made it a bit clearer on what exactly it will take to get to such a ‘social contract’ via a strong UHC commitment. For example towards its ‘private sector constituency’ : )