In 2013, The Lancet Commission on Investing in Health showed that a ‘Grand Convergence in global health’ was possible by 2035, i.e. “within one generation”, by boosting focused health sector investments. Infectious, child & maternal deaths can all be reduced to the levels of the best-performing middle-income countries by then, was the message, if the right policies are implemented. Among the authors: Dean Jamison, Lawrence Summers, Julio Frenk, and many others. Last week, at the UHC Forum in Tokyo, we heard that’s not going very well.
For the time being, it appears that instead we’re heading for another (not so) ‘Grand Convergence’, well before 2035: one whereby the US and the EU are more and more resembling China, while not exactly copying the best traits of ‘Governance with Chinese characteristics’.
The news on budget-related self-censorship at CDC might perhaps not be as awful as it initially sounded over the weekend, the trend seems nevertheless clear. Self-censorship becomes more likely, now also in the ‘Land of the Free’. ‘Orwellian’ is a term often used for China, certainly under Xi Jinping. I like China (and its people), but journalists in China will be the first ones to admit that there’s indeed a bunch of words, phrases and themes they better refrain from using if they don’t want to get in trouble. And that was even before Big Data kicked in. So self-censorship is a skill every journalist in China masters. The same is, by the way, (once again) true for social scientists, under Xi’s “strongman” leadership. True, the words you can’t use in China are different ones than the ones Trump et al don’t seem to like much, but the pattern feels oddly similar, even if ‘Orwellian’ sounds a bit too planned for what’s happening in Trump’s wacko plutocrat land.
Still, self-censorship is not exactly a new phenomenon. In recent years, scientists around the globe, and certainly also in the West, less secure of “core financing” than before, have been increasingly framing their research proposals along lines they think will “get the ear” (and wallets) of funders (the Gates Foundation being one of them, in global health). What is an “easy sell”, in vogue, sounds ‘innovative’ enough, amounts to a good ‘investment case’, etc… So even before the US turn to “alternative news land”, there was already a fair amount of self-censorship going on in the 21st century “science system”. Global health-related science was (and is) certainly no exception.
Against that backdrop, there’s a certain wry irony about the fact that science, which has been aiming relentlessly for “excellence” in recent years, now increasingly faces leaders who don’t quite like the sound of terms like ‘evidence based’ & ‘science-based’ much. Oops.
And guess what, many of the ones who have been on the (economic) science forefront over the past decades have at least partly themselves to blame for this situation – including a few of the very writers of ‘Global health 2035: a world converging within a generation’. As Dani Rodrik rightly stresses, for example, economists are responsible for Trump & Brexit . Larry certainly fits the bill. Among others. I’d add the high-profile economists’ many “happy companions” in international institutions (like WB, IMF, … ), with their equally uncritical embracement of globalization and free trade, at least till recently. As well as philantro-capitalists, the somewhat ‘gentler faces’ of neoliberal globalization, pushing for quick wins while ignoring more political issues (including the (increasing) inequality within quite a few countries in the North). As Branko Milanovic says, economic dissatisfaction was the key factor in the rise of (even right-wing) populism, even if many don’t agree with this assessment: “ …studies tend to suggest that the underlying reason for what is called ‘populism’ or, I suppose, election or support of non-mainstream leaders or parties, was economic. That it was channelled through the cultural channel…”
Anyhow, as mentioned above, self-censorship is thus nothing new, including in the North; it just takes a different form now, with – let’s call them “somewhat less Davos-friendly” – leaders & (state) funders around.
As for the ‘values’ of the US and EU, well… anybody who still dares to claim moral superiority of our values in the West hasn’t paid much attention over the past years (and before, many would argue). The US doesn’t need much words nowadays, and as far as the Old continent goes, the latest case in point of EU “values”: nobody from our current crop of leaders seems to take issue with the new extreme-right ‘partner’ in the Austrian government. Our migration “policy” is another outrageous example, of course, of our current “solidarity with the most vulnerable”: we prefer to call it the ‘development-security nexus’, a very sanitized term indeed. And as you all recall, after the financial crisis, even if most West-European countries successfully resisted the worst Anglo-saxon version of capitalism (and inequity), the way the EU dumped the Greeks for murky reasons will remain an eternal spot on the EU’s track record, ideals and how it pretends to care for the ones ‘left behind’.
In sum, chances are that well before the global health ‘Grand Convergence’, another grand convergence will have taken place. Due to the backlash against neoliberal globalization, the world is fast becoming more authoritarian – or perhaps, more accurately, more obviously authoritarian than was the case before (trade & investment agreements were of course already quite favourable for certain actors (multinationals, Big Pharma & others …), while kicking others further in the ground), but their stranglehold was a bit more hidden than the current wave of strongmen’s lust for power (and alternative facts), certainly for the (mostly (upper-)middle-class) people benefitting from globalization in the North).
Of course: like most of you reading this, we also hope that the Democrats will win the 2018 parliamentary elections in the US, and that the EU becomes, little by little, more social and fair (finally erecting the (by now near-mythical) ‘social pillar’ – even at our rather advanced age, we still prefer to believe in fairytales : ) ). And that China/Russia will someday get rid of its ‘strong men’ governance, … For now, though, things looks bleak.
Yes, some (of the smartest) economists (including Larry Summers), leaders of international institutions and even philantro-capitalists like Gates are having a change of heart now, suddenly (re-) discovering inequality and politics, but they don’t control the international game anymore, the way they used to a decade ago, when Davos men & women still ruled the world. Like the rest of the mainstream (politicians, top bureaucrats & other elites), they’re now faced with vicious feedback loops they helped create in the first place. They are in the defense now. Not as powerless as the average citizen, perhaps, as they still flock together at High-Level Breakfasts and summits, but definitely not in the lead (anymore).
Like for climate change, the question is increasingly: will this ‘change of heart’ of a big chunk of the global elite come in time, to still avoid the worst, ànd is this ‘change of heart’ sincere enough, or is it mostly ‘inclusive babbling’? After all, even if Democrats were to win in 2018, I wonder whether they’d go for really progressive policies this time, or rather (again) for a somewhat softened version of neoliberal globalization, as they’ve done in the past. The latter would be downright stupid, but can’t be ruled out.
I’m a bit of a simpleton, arguably, but for me, it’s clear that if we don’t get enough Corbyns & Sanders in big countries, soon, we’re heading for some really dark ages. As you know, the latter also tend to impose a “Convergence” of sorts…
So, Larry et al, team up with Bernie & co. Before it’s too late. Piketty already gave the example. Follow suit.
With that, I wish you all a merry Christmas : )