IHP news #382

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Editorial

WHO Afro meeting in Addis

By on August 26, 2016   Dear colleagues,

These days the air (including here at ITM) is full of Theories of Change (ToC). That is certainly timely as our times seem to be chock-full of change (or is it shocks?).  Still, the ToC question is not an easy one to answer, and not just because some people – depending on their personality, worldview and quality of their sleep last night – are tempted to come up with ‘Theories of Chaos’ or even ‘Theories of Cynicism’ instead 🙂  . (PS: the heat wave that hit Belgium this week also didn’t help much on the tricky path towards coherent ToCs! ).

However, my own opinion is that ToCs are important and well worth the intellectual effort, even more so in a time of change and turmoil. We face a hard choice, though. Just one example. On the one hand – and most scientists find themselves probably on this side – many of us tend to accept ‘resource scarcity’ for social sectors as a given  (or at least the premise that ‘resources are and will always be scarce’, even if we like to grumble a bit about it). And thus we publish reports and give advice to decision makers within these constraints, trying to sound ‘rational’ (as is more or less expected from scientists). To fill the remaining gaps, we count on money from foundations (or lately, on “leveraging money from the private sector”), and then we hope in the end for the fairytale ending that ‘no one will be left behind’. Some of us (call them “the Bernies”), on the other hand, push for ‘transformative change’, refuse to accept a concept like ‘resource scarcity’ and go after the political determinants. The latter is not an obvious stance for scientists; it’ s more something you would expect from civil society and some politicians, at least when it comes to taking the lead towards this transformative change.

It’s a controversial question, and not just for global health experts. I refer to a similar debate this week in Belgium, on the rather sorry state of geriatric care in my country. On the op-ed pages in a national newspaper, a geriatric nurse said, yesterday: “Experts talk all the time about evidence-based practices, empowerment, trans-and multidisciplinary working, assessment, transition management, etc.  The more exotic the terminology, the better, it seems. Yet, when somebody working in the field comes up with a blunt remark like  ‘With our limited staff, we are actually very happy if we get our elderly out of the bed & washed by 11 am. There’s no time for anything else’, these remarks are easily brushed aside as anecdotal, or worse, experts state, “staff resources are a matter of policy, politics & money, and claim they have no say/control over this.”  Enter Pontius Pilate.

In a way, it’s obvious that this geriatric nurse has no trust anymore in the experts in his field, and who could blame him, given the daily predicament he faces in the nursing home?  Something similar you see happening in our Western democracies, where there’s not just a wide distrust in the political establishment in many corners, but also a pervasive lack of trust in experts (as evidenced in the Brexit), even if Jean Pisani-Ferry rightly claimed, earlier this week, that  ‘democracy requires trusted experts’.

Although I don’t qualify as an expert, I wonder whether part of the reason why so many experts are distrusted now by so many people (there are many reasons for this distrust, of course, and some are no doubt not justified) is because too many of us have chosen to work within the ‘political constraints’, buying the TINA mantra, while hiding in technocratic jargon. Until the situation explodes.  Put differently, the more ‘rational’ experts in social sectors behave, the more ‘irrational’ many ordinary citizens might eventually become. Stiglitz put it nicely in a piece related to the euro & the Brexit earlier this week (focusing more on the role of decision makers though),  “As we’ve already seen this summer in the United Kingdom, if European leaders can’t or won’t make the hard decisions, European voters will make the decisions for them – and the leaders may not be happy with the results.”     (and neither is Martin McKee, who still doesn’t “get” the Brexit, I’d add 🙂 )

It’s clear that, whether you believe this was the case (i.e. that experts are less and less trusted, at least partly because they’ve been too focused on ‘what’s politically feasible’ rather than what needed to be done to make the world a fairer place), or not, will affect our own Theories of Change for the future. By way of example, for  UHC, finding the right balance between technocracy & politics will be key too. Rob Yates certainly seems to find that balance (though not on Twitter 🙂 ), but we need many more like him. I have a hunch, though, that more and more experts and scientists are rediscovering their’ inner Bernie’. Let’s see in Vancouver!

In this week’s Featured article, Esther Nakkazi gives her take on a new malaria framework in Africa, as announced earlier this week at a WHO AFRO meeting.

 

Enjoy your reading.

The editorial team

 

(you find the pdf-version of the newsletter here: IHPn382 )

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