Recently the
Health Systems Global (HSG) program working group for the Dubai symposium reached out
to various Thematic Working Groups to find out how the 2020 Dubai
theme and sub-themes are
being interpreted, understood and linked to by the HPSR community in different
contexts and geographies. As you recall, the Dubai symposium will be
themed ‘Re-imagining health systems for better health and social justice’.
Here I offer
just a few quick remarks/humble suggestions from my point of view, mostly
pertaining to sub-theme 1 (‘engaging political forces’) and 2 (‘engaging
social, economic and environmental forces’).
First a quick
clarification on what I mean by ‘my point of view’: I’m a 46-year old man from a Northern
country, fan of both Greta Thunberg & Michel Houellebecq (I
suspect I’m not the only one) :) Also, I don’t really qualify as a health
policy & systems researcher, even if I am an HSG member and have been to
all global symposia so far.
Anyway.
· In
general, first of all I hope the Dubai symposium will manage to convey a proper ‘sense of urgency’, paying plenty of attention
to the major tipping points (ecological, political, social …) that are approaching
fast now (if they’re not passed already), and their impact on health policies
& systems. When it comes to climate change, it would thus be good to
reframe the enormous challenge ahead in terms of ‘climate breakdown’ / ‘climate emergency’…. and probably make it clearer that this
presents an existential threat to humanity (with the impact you can expect on global health progress of the past decades, health systems, ...). As for politics
& power, I think the UAE are rather well placed to understand how
close certain nasty tipping points really are, at this moment in time – I just
read an
article this morning on the UAE partly withdrawing from the war in
Yemen, among others because they’re getting worried that in case of a war
between US (& Saudi Arabia) and Iran, the UAE could soon find itself in the
line of fire.
So some sort of (re-)framing, like ‘Re-imagining health systems before
the world is going down altogether’ ( as
an Indian friend of mine quipped ), might work wonders, to convey this
sense of urgency :)
· Linked
to the above, and more in general, I hope
we won’t self-censor ourselves (too much) in Dubai. I’m not referring here
to the social media constraints in the UAE (an issue in itself), rather to the
analysis that more and more of us know, deep down, that this capitalist system
has to go, and soon. If not, we’re on the road to hell. So I hope we can really
discuss post-capitalism, post-growth, etc. (and invite relevant thinkers on these
discourses & paradigms), and think through what this could imply for health systems & policies ( PS: another
good reason for these sorts of debates: the many links between
capitalism/imperialism and the decoloniality debate in global health). Even
if some of the Big Funders of the symposium aren’t very sympathetic towards
this sort of ‘alternative’/’unrealistic’ thinking. The same goes, by the way, for discussing as
much as possible the root causes of
migration, fragility, … instead of (only) assessing what health systems can and
should do for the victims, so that nobody is ‘left behind’. Only if we don’t self-censor, (i.e. making
statements and using framing palatable
to some of the big funders of the symposium, also trying not to offend anybody ),
we can truly re-imagine health systems for better health and social justice, instead of mitigating the worst excesses of an unfair and destructive system.
· Still
on engaging political forces & power, given the location, I think it’d be
lovely to zoom in on patriarchy and
its impact on 'Health for All'. You have
probably come across some of the recent headlines on the UAE yourself. I’m amongst those who believe SDG 5 is
absolutely crucial in the whole SDG agenda. Apart from that, I’ll refrain from engaging in
this debate, as I usually get in trouble with my progressive/liberal female
colleagues on some of these issues:)
· I
also wonder to what extent the “global health community” (with its seemingly never-ending
love affair with ‘partnerships’) is still in sync with how the world is
developing. Not just because increasingly it’s a fight “between
oligarchy and the rest of us”, as Robert Reich put it, and so it
seems high time to take sides, instead of ‘partnering’ with some actors. Or at the
very least require them to pay proper taxes before they can ‘partner’. And so, ‘Winners take all’ (by Anand Giridharadas) should
perhaps be required background reading material for symposium participants, and
hopefully also inspire a strong paragraph in the “Dubai statement” afterwards,
on philantrocapitalism, the Corporate Private Sector & their role in global
health/health systems. While I will never deny the enormous merit of Bill Gates
& his foundation, current fundraising for the Global Fund Replenishment (with
the ridiculous goal of getting 1 billion from the private sector) is a case in
point of how unfit global health fundraising has become for our day and age.
It’s time to put ‘replenishment’ cases in starkly different terms: that
billionaires & MNCs should contribute to tax, globally and nationally, the
way they actually should, and not freeriding like, for example, Amazon has done
in its 25 years of existence. All over the world, people are fed up with
this, both on the ‘left’ and ‘right’. For the ones among you who like ‘Beyond…’
mantras: in global health, it’s more than time to go ‘Beyond Philantrocapitalism’ :)
· As
for the current “SDG health era”:
there again, it would be good if we
acknowledged that the SDGs are not just ‘off track’, but instead, in spite of
all the ongoing SDG-washing (by corporate and other sectors), going absolutely nowhere (see the just
released civil society Spotlight
report, which argues for not just a ‘software’ update but also a
‘hardware’ update (of governance & institutions at all levels)). And that’s even
making abstraction of the current ‘disabling’ (instead of enabling )
international environment (as Jens Martens has put it, accurately, in this
Spotlight report), which, I admit, doesn't help much on the SDG 2030 journey.
Put slightly differently: it’s probably relatively easy to go to Dubai with a story on
climate-smart health systems, and link it with UHC. It’s probably far more
difficult to say and argue we need a post-capitalist system sooner rather than
later, or else UHC and Health for All will still be distant dreams in 2050 and beyond ( plus get Bill Gates or USAID to fund this :)).
The same goes for commercial determinants of health, STAX, access to medicines,
etc. :
let’s really take all these
debates “beyond capitalism”. Even if ‘thinking beyond capitalism’ might be
a bit too early still.
As it’s more than necessary. Just this week, a new report thoroughly debunked decoupling, highlighting “the need for
the rethinking of green growth policies and to complement efficiency with sufficiency”. Focusing on countries in
the ‘North’, that sounded like this: “Policy-makers have to acknowledge the fact that addressing
environmental breakdown may require a direct downscaling of economic production
and consumption in the wealthiest countries.” So yes, let’s also not refrain from making
clear what the “SDG agenda” entails for our countries in the North, including the
very tricky political economy (& fairness) issues around this - as the yellow vests movement has proven.
But hey, I’m
just a 46-year old bloke from the North. So I’ll be more than happy to read
many other takes on how the symposium theme & subthemes are interpreted and
understood elsewhere in the world, from different angles.
