Deccan Dispatches 1
On 26 August, ice, rock and water came down the Bhote Koshi river in Nepal, and took out towns and villages on both sides of the Nepal-China border. Experts are still arguing about the exact trigger with an avalanche into a glacial lake possibly being one of the prevalent explanations. The UN was on the ground within a day. Our conceptualisation of these (likely) climate disasters is probably the primary problem: the improbable has become routine, and it seems to beat our “templates” in terms of response (I am not talking of the immediate crisis response but the more “slow” systems response here).
In The Great Derangement, Amitav Ghosh’s 2016 book on climate change and the unthinkable, he argues that literary fiction has become resistant to climate change as a subject, because events of that scale feel too improbable for the realist novel.
One of the problems, he said, has to do with the history of the genre. The novel arose in Europe alongside the middle class, whose readers wanted depictions of stable, everyday life. Literature about spectacular events, like fairy tales and epics, faded from popularity. But Ghosh claimed that focusing on mundane life was unrealistic in our era of ever more frequent climate disasters, from floods and droughts to wildfires and heat waves. The type of life represented in most Western novels is currently a fantasy for everyone but a select, wealthy few—and even those few are facing more climate disruptions. Fiction, he said, should try to represent the true pace of catastrophe that the world already faces.
Extract from Amitav Ghosh’s Conversations with Stephanie Bernhard in Orion Magazine
The very form of these novels, or rather what is widely accepted or acceptable as novels – for him – seemed to fail. He calls this a crisis of culture and therefore of the imagination, and this being in his words “the great derangement”.
Global health’s modern novel
The grants and the wider global health financing eco-system too are their own “form” where hopefully works of global health non-fiction are being written; in this case, grant-fiction being infeasible grant or development ideas written to impress that are either unimplementable or even if implemented, not likely to address the actual problems even if they create a useful set of activities that leave stakeholders impressed.
Many funders now respond to the climate change in health with a dedicated climate-health call or have started welcoming climate framings into existing ones. This is fantastic, and there should be more of it. But if you consider the “form” that global health has nurtured across the decades, you will see an enterprise that continues to foreground “global” outcomes relegating the small and local action to being insubstantive, not measurable or not having reasonable “scale”. Yet, the measurable and visualisable macro-projects that many such funding opportunities encourage rarely build local capacity, local ownership even if the funding applications and proposals do ask for these.
The problem is with the “form” of global health funding itself and the fact that by prioritising the “global”, it tends to create more bang for the buck for the funder and pushes academia and the expert world to become the primary drivers of these outcomes rather than the local actors in villages, towns and cities. And therein lies our inability to reimagine global health grants as local change agents.
Whose problem is scale anyway?
For a long time in fact, the issue of scale has bothered me. It appears to be a problem of the one with a large amount of money to be thrown onto a problem. Yes, we need powerful ideas that are feasible at scale, but it cannot be achieved by a “model”. Such scale inherently requires people who seek to bring themselves and their collective energies and passion into the idea. It requires them to imagine the change together and then be those change-agents in their neighbourhoods, towns and their settings. The current form of trying to achieve large-scale impact through development or research consortia will not succeed, neither for climate change nor for other wicked problems of the day if it does not sufficiently look for grounded-ness, local embedding and self-reliance instead of scale. This recalls the imperialising logic of large global health funding which seeks a new form of conquest over the problems of today by allocating large sums of money and getting the right “global” experts to have at it.
On the other hand, imagine if countries, states or local governments would do so with their own resources: an entirely different set of actors would respond to such localised public monies for climate change. It would be NGOs who are not necessarily adept at dealing with large grants and monies, it would be institutions that are heavily locally invested, it would be small affected community-based organisations that have the trust of communities, it would be citizens driven by a desire for neighbourhood change who bring people together for conversations and dialogues.
Climate change as a global issue vs a local one
The ownership over the climate issue is quite variable in many southern countries that I have visited and interacted with. Contrast that with dialogues at the WHO, at the UN agencies, at northern universities, where climate change and climate health is often the talk in seminars and presentations, often by speakers from multiple southern countries far away.
In India, as the climate issue percolates to states and districts, its visibility moves to documents/strategies but evidently not (yet?) driving policy or practice. And further down at sub-districts and village local governments, it is often starkly absent – the action moving to more proximate issues of water supply, roads, sanitation, livelihoods and such: the unfinished business while “global” issues like climate change can wait. I suspect this is the case in many other countries in the African region as well from what I hear in discussions with colleagues.
Across peninsular Indian cities and towns, heat stress is serious, particularly in large cities with mushrooming of built environments that appear unfavourable to extreme heat. People feel it, daily wage and other labour-intensive works happen through it, and it drives various kinds of farm and labour losses as well. Yet, the elephant in the room is not visible in routine administrative meetings unless somebody has convened that meeting for the purpose, and that somebody is usually an NGO or a university from a nearby or faraway city, with a project cycle and measurable outcomes to be delivered…..for someone else typically far away!
Research on climate and health have become knowledge tools and only rarely as a tool for practice, and where practice happens it is episodic, steered by whichever institution holds the grant rather than owned by the local government. Much of this recalls Seye Abimbola’s uses of knowledge debates in global health.
Climate health financing
The financing numbers show the same derangement from the other end. WHO reckons that under 0.5% of multilateral climate finance reaches health, and what exists is hardest to access for the most climate-affected countries. The Belém Health Action Plan is an important attempt but was left with no committed finance. Instead, by creating greater convening power higher up, we may in fact be aggravating the problem! See for instance WHO now being accredited to the Green Climate Fund.
If the series of disasters over the last decade and their increasing frequency teaches global health anything, it is that the amount matters less than who puts up the money and at what level it is convened. A large competitive grant written in the global North cannot manufacture in-country ownership, because ownership cannot be “work-packaged” as well in the real world as wordsmithery can do in a grant application.
We need to adapt the form in which research and development grants support locally held and owned platforms, institutions and movements that are embedded within communities, or governments or in places which convene local actors rather than in large and far-away institutions even if it is more efficient to deliver such initiatives through these large institutions and experts. Ultimately, the reimagined response to climate must happen locally – not through experts and arguably not via a national or global dashboard. And our financing systems need to re-think themselves to accommodate these realities. Ghosh’s point was not that writers were not trying but that the form itself had failed. Within public health, we too need a better form of conceptualising locally owned transformative change.