Antwerp, 8:50. I get off my train and head towards the end of the train station to rush out into the Jewish neighborhood, its smell of warm bread and its crazy bikers. The weather is crisp but the traffic around the beautiful Central Station, on the sidewalks and in the parks doesn’t leave you the time to get cold and complain about it as you have to inventively slalom between bicycles and pedestrians. By the time I reach the ITM campus, I consider my cardio of the day over – PS: I seriously consider getting one of these bicycle cards to cycle my way through instead of walking. Bikes are also a statement in this city, but a rather different one. It is cheaper, it is eco-friendly, it doesn’t make noise, and denotes a general disgust for consumption as well as a self-awareness of one’s impact on the environment. Well, at least, that’s how I hope these bikers to think.

Sint-Rochusstraat, 9:20. I arrive at ITM’s former convent on the 2nd floor, which features my desk and a warm cup of tea (as well as some other hard working interns). ITM and still no solar panels, recycled material computers or power charging bikes for our mobiles and laptops. ITM, rightly emphasizing the importance of climate change in global health yet still sending far too many staff flying across the globe to conferences, advisory committees and the like. Has ITM done enough in this regard? That’s an ongoing discussion among the ITM sustainability working group, I’ve been told, but it’s also a question central to ITM’s work: what is the right balance between discussions and actions, may it be in the field of climate change or concerning global health as a whole? This is not an easy trade off but it’s a rather common one, and so are the lame excuses to make up for it which, in this regard, seem to be embedded in ITM researchers’ speeches as much as in COP participants’ official declarations.

Later in the afternoon, an internal meeting brought on the table examples of “high politics” global health meetings such as the World Health Summit in Berlin, or the most recent G7 Health Ministers’ summit in Italy. Questions were raised whether these were not too aloof and far from the ground. To take the words of Richard Horton : “For the first time, a G20 Presidency had placed global health at the centre of the group’s discussions. What an opportunity. They flunked it.” This statement didn’t go unnoticed and sparkled quite some controversies at the time – but if that was his take on the G20 summit in Berlin, I wonder what he thinks of the G7 Milan Health Ministers’ Communiqué, a lofty communiqué that aimed to address, among others, climate change issues yet stayed as vague and diplomatic as it could to gain “consensus” among all participants (arguably, not an easy task with the USA among its ranks).

And so the G7 health ministers stated in 47 well-crafted bullet points, 9 pages, everything they had to say: platitudes, mostly. By statement n°5 they had embarked upon a rather wordy wish list sketching the global health agenda without really providing much detail on how to address these issues, finance solutions and take intermediary steps. By statement n°11 they had pretty much addressed everything, yet they had addressed nothing. By statement n°25 they were pushing the hypocrisy so far as to address the question of refugees some of them are themselves bombing (directly or indirectly), creating not only migrants but destruction as well.

I wonder what the bikers would think of these general recommendations on climate change and health. Maybe they should’ve biked to the G7 too. Milan isn’t that far from Bonn after all. And maybe we should too. Maybe showing these health ministers what real commitment towards climate change and global health looks like would make them build this “political momentum” they seemed to “recognize” as being of key importance in their concluding remarks but failed to build when they had the power to in the 8 previous pages. Or if they don’t effectively have this power, if like all of us they are accountable to a bigger boss, then at least they should take the first step to lead the way towards real understanding of global health issues. And maybe they should bike with us too.

In sum, the G7 ministerial meeting was as broad, lofty and general as expected, full of wonderful intentions and reiterating of commitments. As The Lancet had already put it in 2015, reflecting on the G7 summit in  Schloss Elmau, Germany: “Although these commitments are welcome proof of political will, actions (not advocacy) must now follow”. The problem remains so here’s a suggestion: maybe if our health ministers were a little bit less “in the air” and a little bit more “on the ground” they would understand what the real issues at hand are and what needs to be done to address them. Certainly with respect to environmental impacts on health. Yet for that to happen, we have to show them the way.

Conferences gathering researchers from all around the world, to exchange on their science & challenges and to reflect on how to solve them are great but do they manage to tickle Modi’s moustache, Trump’s wig or Xi Jinping’s double chin ? Not at all. As ever, engaging with politicians is crucial. Last time I checked, we hadn’t biked to any G-Conference to make our case yet. So dear (greying & balding) researchers, time to get out of your offices and do some real cardio. Or if you find the big blue room a bit too grey lately, time to install power charging bikes to fuel your computers and send your young interns instead.  

It is undeniable that our society is driven by economic interests. The era of “good” or “bad” ideas was left behind with Hegel. Can an idea be good in itself, taking primacy over human life and reigning upon it almighty? No. Ideas are born in the brain of men who themselves are born in a social and economic context one cannot ignore. It is precisely this context that matters. So when an old all-white panel calls for spreading ideas – some prefer the term ‘best practices’, but in many cases, they mean more or less the same – among the political and intellectual elites of a developing country, as was the case in a pre-event  before the #ECTMIH2017 conference, not only do they reproduce a neocolonialist approach to cooperation called aid, they also reproduce a philosophical school driven by 18th century young German thinkers. But guys. We’ve hit the 21st century for a couple of years now, time to get an update. Given Mr. Stadler seems to think we’re back in the 19th century, you might want to call upon a 19th century German thinker to do just that.

So if society is driven by economic interests and even ideas are born from these economic relations (not to mention the powerlessness of a good idea in a young researcher when he/she becomes appointed ministry of health and has to deal with political and economic interests), why are we not analysing society in terms of these economic relations? The poor and the rich – that’s where the discourse seems to be stuck; at an individual-level analysis of people living in poverty versus those living in abundance. Yet these people come as a coherent whole. They share the same relation to property and ownership. They are the deprived. The masses. The working class. Or as our favorite bearded old man would say: the proletariat. It is not enough to acknowledge that people are poor. One needs to analyse why they are poor. And Marx did it for us.

If you’re not fond of dear Karl, Anne-Emanuelle Birn in her textbook on Global Health  emphasizes the importance for health researchers of analysing society in terms of classes. The Black Report in the UK did just that. The National Health Service was not designed according to social classes but the reports analysis was and it demonstrated increasing inequities and hence the (partial) inefficiency of the NHS : health inequities sparkle from living and working inequities and hence social class. It is this class we need to address. The problem is structural, but that’s too big a truth for governments to be willing to sort data by classes  and for most researchers to wander into analysing them. And why is that? Perhaps because we reject radical ideas as not scientific enough ? Or just because it is not in our interest? As the intellectual elite, the “petit bourgeois” of this capitalist society, we profit from this system. Or at least most of us, ECTMIH participants, still profit more from the system than we are being hit and hammered by it. I am not saying we don’t want to save lives. Everyday around the planet millions of people make admirable efforts into making the lives of their people better. But we have no interest in changing larger systems, in truly ‘transformative’ ways if you want – even if we can’t shut up about the latter.

Yet the system is the problem. Journalist Florence Aubenas decided to delve into the poorest strata of French society, pretending she didn’t have a diploma or work experience. And what she saw was terrible. Her most poignant example concerns dental care. In France, the poorest among us, the ones who clean the floor of your office while you’re sleeping at home or tidy the plane in 5 minutes before you can board, this proletariat that is largely invisible and is dependent on social security, is letting its entire mouth rot. Why? Because if only one of your tooth is carious, social security does not consider it worth the cost required to fix it. So, you would have to wait until all of your teeth are rotten, after which they will pay for a set of false teeth instead of treating them one by one. We’ve all had dental problems and we know how bad it hurts. Imagine this pain in every square centimeter of your mouth, and still having to get up to do the most exhausting job. Keep in mind, that France has good health facilities and relatively good social security – ironically, a result of the struggle of the same masses that the system now increasingly excludes. We have a pharmacy store around the corner, a hospital not too far away and decent public transport to reach it. And yet, this situation prevails. Is that because our health system is not good enough? Or is it because the market still drives up healthcare costs, thereby making it unaffordable for some people? Even in a wealthy France, 14.3% of citizens were considered poor in 2015 and around 3.4 million workers were in a precarious situation in 2016, not to mention that the Gini index is indeed increasing. Does it make sense, then, to waste time compensating for a system that alienates a whole fragment of society? For a system that keeps generating the gross inequalities that we seek to eliminate ?

As health researchers, we know that access to healthcare is not only about building the right health facilities at the right place. But even as mainstream development discourse such as that around the Sustainable Development Goals is recognizing the interdependence of goals and the need for inter-sectoral efforts, we are reluctant to dive head on into influencing systems that perpetuate deprivation and ill health. At the EV debate during ECTMIH, we heard young researchers call for greater engagement of the academic community with social movements and communities at large. Perhaps it is time to join hands and extend solidarities with grassroots struggles led by the proletariat and what modern thinkers like to call the precariat. It is time to do our bit to turn the tides of economic domination. To break this class relationship by engaging into a class struggle. Wait. Are we not almost quoting Karl Marx?

As a pre-event of #ECTMIH2017, Be-cause Health  and the Medicus Mundi International (MMI) network decided to hold a small mass to the community of converted health experts : Health cooperation beyond aid – a reflection amongst Belgian platform members and (international) partners. The subject didn’t seem to be the kind that could shake 40 people out of their post lunch lethargy but the debate soon became quite interesting as the audience didn’t shy away from putting forward difficult questions.. Panelists from NGOs working at different levels, from different global health networks, together with representatives of governmental agencies reported about their diverging approaches to global health and the challenges to their legitimacy : working with consenting governments, working where governments are fragile, working with multiple experts, building a triangle between the private sector, government and civil society, and so on. Some felt there was nothing new in any of this, a bit of a ‘so what’ moment so to say.  “Aren’t you preaching to the converted already”, as a member of the audience nicely put ? “Why don’t we hear about the other side of the story in a conference supposed to rise above simple aid towards collaboration?”, questioned another critique.

As always, it is only when reunions culminate that ideas abound. Strikingly, the panel debate failed to venture beyond the classical  aid dilemma despite the goodwill of experienced panelists and strong push from the audience. Hence it appears that moving the focus of discussions from aid to a systematic analysis of the potential and the inherent challenges of collaboration is harder than we think. Good news remains that it is on everyone’s agenda. As for the necessity of reaching out rather than the usual inward-looking approach in the aid community, this is yet another challenge even experts could not find an answer to. The inherent tension between being a professional and an activist, the dilemma between the requirement to produce results and the desire to foster nuanced and complex research, and the difficult balance between being a health professional as well as a political theorist and a marketing expert are felt more and more strongly as we accumulate evidence and our work shifts from a purely scientific perspective to a political one subject to public approval.

These are all challenges professionals in the field of global health are facing today and will still face tomorrow – and I mean it in the figurative sense but just as well in a literal sense as #ECTMIH2017 will tackle such issues from October 17th to October 20th. The conference is in full swing by now. The meeting did nonetheless rally panelists and the audience around the necessity to reach out to society and especially the youth, as “you are of a certain age and so am I” (said a  panelist to another). The need to proceed with an introspection of our own systems was also defended by several participants : we need to look at ourselves first, for we are not even a good example, we need to have a coherent system if we want to promote global health and development, and the problems happening ‘there’ happen ‘here’ just as well and should not be neglected. Finally the need to make civil society, governments and private actors cooperate perspired in most of the arguments even if no actual members of civil society where present this afternoon to discuss with us their perspective on the necessity of collaboration in global health. Hopefully #ECTMIH2017 and its diversity of nations, professions and experts will take the debate further. The bigger mass is happening now. Do not miss it. There might be some heretics among the crowd.

Note after a few days at the conference: this debate continued (with a Tuesday morning plenary and an afternoon session). The picture is gradually getting clearer. Health cooperation beyond aid, while not easy to conceive, is gradually taking shape. It won’t be easy to change mindsets at institutions and organisations, though.