Dubai 2020 symposium theme contextualization from a (middle-aged) Northern point of view

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.