As 2014 draws to a close and 2015 is approaching, a presumably Very Important Year for Humanity, I thought I’d offer a short reflection in line with the harmonious ‘end of the year’ spirit. Deep down, you know, I still dream of a Harmonious World, having lived in Hu Jintao’s wonderfully Harmonious Society for a couple of years.

But the way to get closer to such a Harmonious World is obviously not the fake Confucian/communist-authoritarian way.  Let’s focus here on the global health world that is also dreaming of an “ever closer” world. We global health people like to call such a world the ‘Grand Convergence’ – the term is obviously coined by an exceptional American.  (I just read that the second author of that report, Lawrence Summers, is one of the key investors of Lending Club, a new ‘disruptive innovation’ that will supposedly shake up the global bank world – and make our Grand Convergence even more unlikely in the process, if you ask me – but let’s try to stay sweet and harmonious here, for once).

What I wanted to say in this early Christmas post is that it’s time the global health “mainstream” – still predominantly based in the North, for better or more likely for worse – listens to the precariat, so called ‘losers’ and marginalized in our own (supposedly developed and affluent) societies.  For now, they still don’t.

Nowhere you can see this disconnect better than in a House of Cards episode (first season). At some point, some of the happy few in Washington are holding a fundraising event for some fancy (water well) project in the South – while outside the doors, common people and trade unions are fighting an Education Bill (which will include performance based incentivizing of teachers, among others – sounds familiar).

At some point, Kevin Spacey, the main character in the series, “defuses” the situation in his very own machiavellist way by offering the angry poor people in the street some free pizzas. It’s a complete PR disaster for the trade unions when the demonstrating people accept the pizzas and start eating with the press cameras all over them.

While I adore Kevin Spacey’s machiavellist streak in a tv series, even if he’s even too cynical for my (rather dark) world view,  I do think this episode epitomizes what’s wrong with global health, if we really want to make this a juster world, in North and South. Key global health stakeholders still don’t seem to understand the rising anger in the streets in the North – they look as puzzled as politicians in the US and EU about what they call ‘rising and xenophobic populism’, and don’t understand the increasing pressure from the streets on ODA as a result (when we actually need more global solidarity, not less).

They point at the – obviously still much worse – situation in the Global South to say that common people in the North just have to ‘adapt’ (one of their favourite words) to a new World. But this new world is one whereby philantropists and other wealthy innovators seem to call the shots, and cozy up with multinationals and investment banks like JP Morgan, which have become toxic – for all the right reasons  – in recent years. You can’t expect Joe Average to be happy about all this, and thus global health itself risks to become toxic (by virtue of association). Which, I imagine, would be a shame. So global health has a perception problem, at the very least, by being associated with the winners of globalization (and some of these winners are actually rogue capitalism winners, which makes it even worse).

Moreover, to borrow a line from Band Aid 30, Do They really Know what it’s like to feel powerless, being so used to being the masters of this world? Maybe they do so in their private lives, but in their policy prescriptions they sure give the impression that anything can be “fixed” with the right PPP. Unlike the first aspect, this ‘can do’ mentality is not something you can blame innovators & entrepreneurs for (it’s something I actually admire in them), but it makes it even harder for the many less entrepreneurial people in this world to relate to the mainstream global health discourse – if often feels like a ‘winner’s discourse’, even if they talk plenty of health inequities.

So in sum, I hope Bill Gates, Seth Berkley and all the others with power in global health will come to understand more and more  in 2015 – they’re smart people after all, far smarter than me – that if they really want global health and all lofty and valuable global health causes to succeed, they’ll have to find a way to frame things in line with our new times.  And not just frame them as such, but also understand they have to go beyond words. These are times in which ordinary people in the North increasingly realize that they’re being ripped off by the innovative (and less innovative) happy few (with all the collateral damage that implies for our planet as well), and that it’s time to do something about it. Something substantial.

Equity begins at home.  That might not be a popular thing to say in global health circles, but it’s true nevertheless. As long as global health fairs don’t seem to have a problem with food vouchers and people living in tent camps in their own countries, there’s a problem.

After all, even Gates and Kevin Spacey will feel powerless at some point in their life. It’s only when the People’s Health Movement, national trade unions and the Gates Foundation really begin to listen to each other that this will become a better world. They might want to start in 2015.