In last week’s IHP newsletter intro, Kristof wondered  what “the real story” is. Because in the past few weeks, I too felt really delusional, I decided to go for a reality check – what, indeed, is the real story?

Phenomenological accounts of delusions suggest that delusions are not nonsense, but more adequately understood as a different kind of reality experience. My personal delusion is related to the realities of ongoing massacres of innocent people in Gaza and Ukraine; more than 117 million people displaced worldwide; 25% of global humanitarian funding going to Ukraine, Syria and Yemen (in 2023) while all other crises are largely ignored; and, worst of all, no interest in the millions of people NOW (already) dying as a result of the greatest health threat of the 21^st century, the climate crisis! And then there’s the other “reality” I currently live in: anxiety, depression and excitement in my bubble Utrecht, in the privileged Netherlands, are these days exclusively focused on the adventures of football teams at the European Championships. The disconnect between these two realities is horrendous.

So what is the ‘real’ story? First we need to understand that the meaning of concepts such as equal representation and democracy is shifting. Scientists are perplexed because obvious truths are ignored by politicians and not trusted by the public. This anti-intellectualism, “a social attitude that systematically undermines science-based facts, academic and institutional authorities, and the pursuit of theory and knowledge” is gaining momentum globally.

That goes hand in hand with a global yearning for direct democracy’, where  a strong leader is wanted, who is seen to speak for ‘the people’ (different from more democratic forms of direct democracy such as referenda). Followers see this person to be the direct and sole representative of the people – no need for “checks and balances”, as Ian Buruma argued in a recent Project Syndicate op-ed. Think Mussolini, Modi, Hitler, Wilders, Stalin, Trump, and a whole range of autocrats and would-be autocrats up to today.  

Against that ‘new normal’, I assessed a new BMJ blog by Richard Smith (UK Health Alliance on Climate Change),  “A thought experiment: what should be our priorities when we finally “declare war” on climate change and the destruction of nature”? An excellent idea! Smith, focusing on the UK here (but his argument clearly goes broader), explains how we would just have to slash the use of fossil fuels, increase renewable energy, reduce energy consumption, transform agriculture, and transform the economy. Although he ‘covers his back’ by claiming this is just a ‘though experiment’, I still think it is fairly naïve. Why? Because his first assumption is: ‘get the governance right.’ As you recall, even in (pandemic) Covid-19 times we failed to do so. And so he is missing the essential point: the ‘real story’.  

If we were serious and all thought alike, the war against climate change would not be difficult at all. Just see what was possible in times of a “real war”, like World War II. Powers were unleashed that were not even considered in Covid-19 times. Among others, the top individual tax rate in the U.S. was set at 94 percent – until 1948! The rich paid extra for the war and reconstruction of the economy and did not suffer from it. While capital might be more mobile now than in those days, the option to redistribute the obscene wealth of the super-rich has never been easier: we know who they are, where their money is, and the ‘supertax’ can even be seen as a‘political vaccine against the far right.’ There is certainly no lack of funds – but alas, there is no international solidarity, no governance. We have not even been able yet to come to a WHO Pandemic Agreement… 

So how to explain these parallel worlds?  What helps me somewhat understand my delusional image of seeing smart students struggle to stock up on beer in the supermarket before the football games begin in these times of doom? Or is there no doom?

My own ‘conspiracy theory’

Enter the age-old principle of the mob needing bread and circuses. But who organizes these games and free beer in the first place?  So here is my conspiracy theory, loosely based on the idea that you can perhaps be labelled “paranoid”, but that does not mean they are not after you.

The current quest for direct democracy and rising popularity of autocratic leaders are no coincidence. Capitalism has a way of organizing its own reality to protect and preserve its essential precondition:  everlasting economic growth. In our late-capitalist times, Adam Smith’s “invisible hand” can be seen in three examples:  

1. The threat of climate change is very well understood in the boardrooms of multinationals. In fact, the fossil fuel industry has misled the people for decades, and Shell invested 5 times as much in in oil and gas as in renewables energy solutions. By now, it’s clear the oil industry is geared to squeeze the last dollar out of the last drop of oil before alternative energy is taken seriously. And COPs in oil-rich authoritarian countries will certainly not change that.
2. The socio-technical regime of Dutch (and Flemish) agriculture is largely responsible for the nitrogen crisis. The theory of ‘optimal agriculture’, developed at the University of Wageningen, Netherlands, says that farms must ‘intensify’ their production, and that can only be done through growth. In my country, the agro-industry financed the advertisement bureau ReMarkAble to set up the ‘Boeren-Burger-Beweging’, a new political force on the far right that claims national identity building, based on an overly romantic view of the past. And not only in the Netherlands, by the way: Bayer-Monsanto is similarly working on image building while making profit at the cost of health in quite a few areas of their business.
3. The war in the Ukraine, a massive and criminal tragedy, also happens to benefit the military–industrial complex  including fossil fuel companies. “After posting record gains in 2022 off the back of soaring energy prices, the big five fossil fuel companies paid shareholders an unprecedented $111 billion in 2023. In the hottest year ever recorded, this figure is some 158 times what was pledged to vulnerable nations at last year’s COP28 climate summit.”

Yet, power is not concentrated in one place. Yes, power is in the boardrooms, but politicians also have (some) power, and let’s not forget about the power of the ‘crowds’. We also exercise power through our own behavior – and not just by taking to the streets or ventilating our anger online. Put differently: not all multinationals and big companies are bad, not all philanthropists have secret agendas, and not all people are dumb. It’s the system, stupid!

The more vile parts of boardroom power are now struggling with the power of public opinion. The battle for the last oil and agri-dollars is ferocious. Climate denial does not work anymore. Big law firms are even hesitant to further defend the oil industry. Extinction Rebellion gets broad support (well, at least in my country). But just like the General Motors streetcar conspiracy that brought down the East US railway connections in favor of automobiles in the US in the early 20^th century, there will  always be “opportunities” for cunning businessmen with a short-term vision. Their instruments? (1) To lure the public into believing that it can (still) all be done, and even presents a ‘win-win’ in the medium term (see example 1;  ‘green growth’ also comes to mind). (2) Or construct another reality (example 2). (3) Or stimulate the growth-industry by political schemes that are unheard of, or simply well-hidden from the public (example 3, or take a look here (German corporate support for Hitler’s rise) or here or here or here). Short term greed precedes over even fascist consequences – because the real rich will never be on the losing side (except when you happen to be Jewish in the wrong country.)

A real conspiracy theory goes over the top at some point. Try this: the deaths of climate change are usually projected in the future, but for many the future is now. If the system does not change right now, hundreds of millions of people will have died in the countries that had little part in causing climate change before it is tackled seriously in the countries that caused it. The present-day right-wing populist, extreme/far right and racist political groups are useful idiots for the purposes of the money-people. Xenophobe right wing policies aim to keep people away from the richness that is defined as ‘ours’ in the West, spreading the population replacement theory in the process. That helps to keep (most) people out – only those that are needed for the really filthy work are allowed in. So by building walls and fences, the worst effects of climate change are reserved for the others, while we stay on the (relatively) safe side ourselves, and will see the problem solving itself, as “the invisible hand of the (late-capitalist) market” literally wipes out the bottom billion(s).

I am afraid, however, that this is not a conspiracy theory at all. It sure looks increasingly like the current reality. It helps to understand the relationship between the incredible inaction versus the climate, the growth of the military-industrial complex, the constant war-mongering of our leaders, and the rise of the extreme right.

My delusion, or my disappointment?

But what about my delusion then? Okay, to be fair, my real delusion has little to do with the football fans. My real delusion is that the community of Global Health  is not doing much – if anything – about the abovementioned staggering reality. In terms of biomedical and clinical progress, life goes on as usual. But the Global Health approach seems invisible in many of the major crises in the current polycrisis era. And that makes us, as (largely) ‘Global Health’ people I’m afraid, complicit. As Krugman described it aptly in a blog on Medium, “with our apathetic, neutral and vehemently depoliticized stance, we can comfortably conduct our randomized control trials, behavioral interventions, and epidemiological surveillance among systematically oppressed peoples”. A very modest beginning would be to get rid of the presumptuous capitals in ‘Global Health’, trying to revive some of the ideal of ‘global health’. And look at other players, such as the People’s Health Movement (who tend to “occupy” the far lesser paid jobs).

The Global Health world (with Capitals) is happy when Bill Gates talks (at last!) about health systems – and tells governments to pay for access, or when Bloomberg donates a billion to Johns Hopkins University (could it not have been somewhere else?). My delusion is that so few people seem to realize this – that so many colleagues choose to continue to operate in a different reality.

It is painful to realize that, as far as we are players in Global Health, we are part of the system we ought to change. We spend our time on things like a Global Coalition for Social Justice, and a Second World Summit for Social Development (and they’re not even the worst in this respect). There, during High-Level panels and other Fire Chats, we talk for hours on how the world should be. We know that it will change (virtually) nothing. But it keeps our bullshit jobs safe. That is my disappointment.

And oh, I almost forgot to disclose my positionality (to assert my identity) – another trick to keep us too busy to address the real dangers, if you ask me:  I am a somewhat delusional, somewhat older white male who is reaching retirement age fast, and who realizes that during his career no transformative system change whatsoever has been achieved on this planet.

So no time to celebrate or party, but time get to the real work. So I will retire from Global Health, and hope to contribute to the real struggle.