Of course, we welcome the fact that this year’s theme is related to a “social determinant of health” rather than a particular mental illness. This opens the door to prevention of work-related mental health issues from a non-health perspective, and to a broader public policy perspective. Such a shift from an individual’s illness focus to a psychosocial approach is long overdue.

WHO’s proposal to boost mental health in the workplace suggests a three-pronged approach consisting of: (1) reducing work-related risk factors for health; (2) creating a healthy workplace; and (3) supporting people with mental disorders at work. The second one overlaps with the agenda from the World Economic Forum. Nevertheless, even WHO’s broader three-pronged approach falls short of what is needed to improve mental health in the workplace, basically, because it remains firmly grounded in the capitalist model, which by definition is incompatible with “healthy lives, a healthy planet and social equity”.

There is no magic bullet or “one-size-fits-all” response to the issue of the workplace as a potential generator of suffering and illness. In addition, we need to acknowledge that work “as we know it” is constantly changing. We can look at the mental health impact of the workplace from various angles, whether it’s the rise of the ‘gig’ economy in the North; the high unemployment rates around the world that are expected to rise even further this year (as compared to 2016); the more than 40 million people across the world that are victims of modern slavery (with almost 25 million of these in forced labour), according to a recent report by the International Labour Organization (ILO) and the International Organization for Migration (IOM); or job dismissal, overwork & burn-out, common phenomena now in many “developed” and other countries. Just recently, we heard of one of the many cases of ‘death from overwork’ or karoshi, in Japan, and students forced to work long hours in China.

A while ago, we had the chance to interview Cecilia Ros and Miriam Wlosko, two researchers who have been working on the Lanus National University’s Health, Subjectivity and Work programme for over 20 years in Argentina. An interesting finding from their research concerns the impact of neoliberal policy reforms – aka “adjustments” – on people who are fired, the unemployed and their families and communities. In many cases, they found job dismissals not only to have an impact on those directly affected but also on the people who continue to work in the same place. The so-called ‘survivors’ (or those that are “left behind”, if you want it in inclusive SDG jargon) more often than not have to endure conditions that are not acceptable, or downright precarious. According to Ros and Wlosko, dismissals and precarious working conditions have the purpose of disciplining workers; the threat of being fired has become a managerial strategy in quite a few workplaces around the globe, not just in Argentina – any resemblance with the situation of academics toiling in neoliberal environments is of course purely coincidental .

SDG 8 aims to “promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all”. The International Labour Organization has defined decent work as work that “is productive and delivers a fair income, security in the workplace and social protection for families, better prospects for personal development and social integration, freedom for people to express their concerns, organize and participate in the decisions that affect their lives and equality of opportunity and treatment for all women and men”. Seems like a nice definition, if you ask us; still, many questions can be asked, such as: What is “a fair income”? How much participation should be promoted? How  “decent enough” is work before it can be considered as ’decent work’? And, perhaps even more importantly, is a ‘decent work’ agenda really compatible with a predatory globalized capitalist economy?

Whatever actions are taken to promote and create awareness of mental health in the workplace, we should perhaps get rid of the (somewhat naïve) belief that having a job will always be a guarantee of stability. We need to focus on improved well-being in the workplace, and not just zoom in on specific pathologies such as depression and anxiety. Last but not least, if we are to talk about mental health in the workplace, one needs to have a “workplace” first. As you know, not everybody is that lucky. And that’s even before the robots and other AI tools are going to take over.

Well, at least they won’t need Prozac. 

Photo credit: Inti Ocón

Unfortunately, campaign promises have vanished. Argentina seems to be entering a new period of neoliberalism, as is the case in many other countries in the South American region, after a decade of progressive governments (with many differences, arguably).

Last Friday, researchers that applied for entering in Conicet (the National Council of Scientific and Technical Research), received the results of the contest, and they were surprised when they heard the news that  about 500 of those who were accepted by the different evaluation commissions – that means, people who fulfilled all the requirements –  were rejected by the general board, for reasons that are clearly political – and not just economic – ones.

In response to this, scientists went to the National Ministry of Science on Monday. The crowd was beyond their expectations (i.e. massive). They had a meeting with the minister, but he refused to reconsider the situation. Then, scientists, students and workers organizations decided to occupy the building by way of protest, an occupation that is still ongoing as we write this.

Since Monday, Argentina’s scientific community is fighting a battle that has been gathering momentum for a few days now. For many, they are struggling not just for the nearly 500 researchers that were accepted/rejected, but for the future of scientific policy in Argentina.

A few things have been amazing about this new movement:

– First, people who usually compete with each other for a position, are now unified under a common flag. So called “hard” and “soft” sciences are unified. Scientists from all corners of the country are communicating with each other and getting to know each other via email or WhatsApp. Given the dirty war from the government, which is questioning the relevance of their research projects, scientists from different fields are planning to hold a joint meeting showing research from different disciplines.

-Second, society has supported scientists. Not only the most renowned scientists of Argentina have expressed their support, but also social movements such as the grandmothers of Plaza de Mayo, who thanked scientists for their help in the search of their grandchildren. One of the emblematic mothers of Plaza de Mayo went to an assembly and expressed her support and the “presence” of the 30.000 disappeared in their struggle. Neighbors donate food and water to the protesters. Worker unions such as people on the subway said that they support science and research.

We don’t know how this conflict will end. What we know, is that since Monday, we feel that science is not just the future, but the present of our Country.

Sara and her colleagues are asking for support. They welcome receiving formal support from academic and research institutions from around the world. By letter, or taking pictures, or in any other way that helps them to be heard and seen. It is important that the name of the place or the institution that is giving the support, is visible.  Letters of support can be sent to: jcp.bsas@gmail.com

Argentines are split between those who believe the country needs a “change”, those who believe that some continuity with the current government is needed and those who don’t feel represented by any of these options and distrust both of them. In Latin America, the election is seen as a battle between the regional vision of integration and rejection of imperialism and its return. If Mr. Macri wins, it will be the first time in about 15 years in the region that a left-leaning political party, when in power, will be defeated.

Things are of course more complex than this brief summary can convey. In this short viewpoint, I would like to emphasize one element of the ongoing political game that has captured my attention: the increased role, at least symbolically, of science and scientists in the discourse of both candidates.

It is undeniable that one of the main achievements (and areas of investment) of the Kirchner era concerned scientific development. Science and scientists in Argentina have by and large followed the course of the country’s history over the past decades:  Argentinian science can boast a glorious past including even some Nobel prize winners in chemistry and medicine, but during the 90s scientists were summoned by the economy ministry to “wash dishes”, when they protested about the underinvestment in research and low salaries.  In the last decade, Argentinian science not only saw its budget improve, but also its social prestige. Being a researcher is again appreciated in society– although of course it’s still not comparable with the prestige of being a soccer player.

Scientists popped up in political rhetoric during Cristina de Kirchner’s last election (2011): one of the stories on the recovery of the country pertained to a scientist who was forced to leave Argentina during the last economic crisis, but then came back thanks to the new policies. The slogan used was: “A country may suffer a brain drain, but never a heart drain”. Along with the workers, the elderly, the children and human rights organizations, scientists became social actors taken into acccount by government policies.

In the current election campaign, the two opponents have upped the ante and explicitly introduced science in their rhetoric. Mr. Scioli says that his government will follow the ‘model of science’. In a television spot he claimed: “We will act like science, which advances based on predecessors’ work”. He also emphasizes that under his government the science budget will increase by up to 1% of GDP. On the other side of the political spectrum, Mr. Macri describes science development as one of the key strategies he will use to reach one of his main (proclaimed) aims: poverty reduction. He recognizes the advances in science made by the current administration and says that the next step will be to reduce the gap between science and society, promoting the involvement of scientists in fields such as industry and public management.

In addition, scientists now seem to recognize themselves as (also) political actors. A few days ago, after the names on the ballot were decided, some scientists even turned into activists on social media. A joke that went viral on Facebook identified Mr. Macri as the representative of the (dark) road back to neoliberalism claiming that for scientists, if Mr. Macri won, their future would involve, once again, “washing dishes”. A glorious service to the country, no doubt, but still, scientists can probably contribute to the country’s progress in better ways. In another spot, the institutional logo of CONICET (National Scientific and Technical Research Council) was changed into a pair of dishwashing gloves. On a more serious note, there was a public statement from some scientists saying that they support Mr. Scioli because he guarantees the current national scientific structure.

I don’t know who will be elected in a couple of weeks, and neither do I know the future of science, scientists or Argentinian society. Nevertheless, I celebrate the fact that both protagonists recognize, at least in their rhetoric, that science is needed for Argentina to advance. Given the improved status and the emergence of scientists as a political factor in the Argentinian society, I hope our scientists will help the society to think better and ask the questions needed, before and after the election, and make politics a bit more rational. I know that politics and political decisions are far from being rational, nor should they be, but it’s the responsibility of science to at least try to offer some more rational thinking on policy options, and perhaps even show the way to some ‘out of the box’ policy options, broadening the (policy) horizon of citizens. I really hope our scientists can help Argentinians see beyond the thick cloud of misinformation that we are experiencing in this election, coming from both sides: that might very well be the beloved strategy of politicians, but it’s not the method of science.

The Kirchners provoke passions: you either love them or hate them, and this makes an analysis of Argentina’s progress and problems over the last decade or so difficult. Any opinion will readily be qualified as pro or contra “Kirchnerismo” . The Kirchners rose to power after a severe crisis in Argentina in 2001, comparable with the situation in Greece right now.

If we focus on health, two things stand out after 12 years: first, one has to acknowledge important achievements in the field of social determinants of health. Time will tell if these can be sustained with a change of governments, since sadly, in Argentina policies and actions tend to be linked to persons, and state policies are seldom firmly established, let alone carved in stone. Second, not much has been achieved when it comes to changing “the rules of the game” of the health system.

With respect to social determinants, it cannot be denied that the lives of the poor have improved,  thanks to a higher income more in particular. An emblematic example is the Universal Allocation per Child, although this is not the only policy measure in this area; a series of plans and subsidies for vulnerable groups saw the light. Nevertheless, and although the Gini index has considerably improved through these redistributive measures, the endemic problem of inflation in Argentina remains a constant threat. Because of this, people, although enjoying better lives, cannot save or access credit for housing.

Regarding the health system, in spite of intentions of coordination and stewardship by the Ministry of Health (in a strictly federal country), the system still shows large differences between regions, lack of coordination between municipal, provincial and national levels, and the main problem of the Argentinian health system still stands: segmentation in three subsystems, public, private, social security. This implies that, just like 12 years ago, an Argentine will still have a different destiny and  be treated differently, according to where he/she lives and in which subsystem he/she is taken care of. It is a tragic paradox that the unions, managers of the social security funds, are a key obstacle on the road towards the achievement of more equal healthcare.

Abolishing the segmentation of the health system and the unequal treatment that follows, is a battle that Kirchnerismo did not want or dare to fight. This will remain as one of its great debts to Argentinian society. In this failure it does not stand alone: the same can be said of most populist or center-left governments in Latin America over the last decade.

In the current times of crisis for Greece and the Eurozone (even if ministers and leaders in many Eurozone countries tend to emphasize every six months or so that the crisis is over), many eyes in the world are looking towards the south for some possible answers and solutions. Observers try to learn and understand how some countries here managed to survive in times of recent deep economic crisis, and in some cases, have even seen their economic situation substantially improve after these turbulent times. (The same goes for some of the new political movements in Europe, by the way: Podemos (in Spain) was at least partly inspired by trends, movements and progressive governments in Latin America.)

My country Argentina seems to be one of the preferred examples (I hesitate to call us a “role model”, though) when people are discussing the dire situation in Greece nowadays. In many ways, the situation of the Greeks now looks similar to the mess in Argentina at the turn of the millennium. One can perhaps debate Argentina’s rate of success or failure after the 2001 economic crash, but cannot deny that the 2001 crisis deeply challenged many of the certainties of the Argentinian society and people. Without wanting to sound pretentious, even some convictions in the rest of the world were shattered. When the crisis reached its climax, Argentina had five presidents in one week (guess that’s a world record), a 300% currency devaluation took place in one single day, banks retained people’s savings (some of them were lost forever), and for a country that sees itself as the “breadbasket” of the world, at the time part of the population was actually starving. Even the national football team was rubbish at the time. Until then (this is perhaps not the case anymore today) it had been unthinkable for a developing country to survive outside the rules and frameworks of international financial institutions (IMF etc), or continue without their so called “help”. Argentina showed that although it was extremely painful, the default turned out not to be the end of the world. Life goes on, the Argentinians showed the rest of the world. (And then the world still had to discover Leo Messi! After the mess came Mess(i)  )

Things, of course, always seem clearer with hindsight. Almost 15 years later, it is possible to discern a kind of path or a recovery project, of what really was, at that moment, just a huge gamble. Nevertheless, my Greek friends might want to consider some elements from the Argentinian experience, given their current predicament:

* It is impossible to assess and understand Argentina’s recovery without taking into account the international context after the crisis. The rise in international prices of raw materials, a true commodity price boom –soy beans, notably-, for example, with China as the main buyer, was a gift from God. Also, the rebirth of the idea (or the dream) of the “Great Nation” referring to South America, and more broadly to Latin America, inspired the recovery of countries like Argentina and other countries in the region (such as Ecuador, Brazil, Bolivia, Venezuela (till recently)…) but was also a consequence of it. In spite of all the differences in the region, there seems to be increasingly a common understanding that together (rather than divided) it will be easier to play a role in the globalizing world. A recent example of this was the support of the OAS (Organization of American States) to Argentina in its nasty dispute with the vulture funds. Similarly, it seems impossible to think of a possible Greece recovery without taking into account its European neighbors but also the possible role of other world and regional players (be it the US, Russia, Turkey or even China). A key difference between Greece and Argentina, perhaps, is that the (Latin American) “union” became part of the solution to the crisis for Argentina, while Greece, of course, is already part of the Eurozone now (and many observers think that it’s exactly this what has strangled the Greek economy, after years of harsh “TINA” troika policies). So the similarity only goes this far. Nevertheless, in a globalist era, nationalist left-wing populism can is not the only political (and economic) game in town. The broader (than just national) picture will always have to be considered as well, even if part of the answer to the crisis for Greece might perhaps lay, eventually, in a Grexit. Syriza leaders seem to understand that.

As far as my own country is concerned, a good way to understand the transition that has taken place in Latin America since 2000 is with a couple of songs: the first one, from 1985 is a song from a Chilean band, “Los Prisioneros”. The name of the song I refer to, here, can be translated as “Latin America is a village to the south of the USA”. The song dwells, among other things, about the utter nonsense of regional division. The second one is from “Calle 13”, a band from Puerto Rico, and is called “Latin America” (2012). The song talks about common pride, struggle, resistance and regional identity. It says: “Here, struggle is being breathed… we are standing here”. Nevertheless, in spite of these beautiful words (which no doubt will also resonate in contemporary Greece), things are not a fairytale yet in the “Great Nation”.

There are also big and small countries in Latin America, and common rules affect them in different ways (much like in the Eurozone not everybody can be Germany). An example in our region is Uruguay, a country that recently has been considering to leave Mercosur and look for other commercial partners, outside the region. Economic rules affect small countries like Uruguay in a very different way than big ones like Brazil or Argentina. Of course, the picture is more complex in the Eurozone, with all the interdependencies we’ve seen in recent years between countries, but it remains true that the rules are sometimes interpreted “differently” for small countries.

* It is also impossible to assess the Argentinian recovery without considering the country’s history and path dependency: the nostalgia for its great past (Argentina was less than a century ago one of the richest countries on earth), a history of achievement of social rights, relatively recent immigration, the power of trade unions, and many other local ingredients that help to understand both the crisis and its solutions. Similarly, for outsiders of Greece, whether they’re called Schäuble, Merkel or Dijsselbloem, it’s equally impossible to understand what Greek politicians and the people are doing when trying to cope with the crisis if they don’t try to understand the country’s history. Some European politicians and technocrats seem better at this than others, to put it mildly.

In my opinion, the world – and perhaps Greece- can learn at least one obvious lesson, when reflecting on the Argentinian experience: there is not one “good solution”, instead, there are solutions that will affect certain groups of the society more than others, and vice versa, and then the society will need to take some decisions about what and who to favor. It is not like in a cambalache, not everything is the same when a country faces a deep crisis. There are always options and alternatives, even if one is perhaps seen as “common sense” and “unavoidable” and another one as near utopia by the powers that be.

Despite all the current problems in Argentina –both new ones and old ones that have returned – such as inflation, social polarization, concentration of power, environmental problems, corruption, the Argentinian people opted for including the excluded in the so called ‘earned decade’ (La Decada Ganada), and for being a country that at least tries to choose its own destiny (with all the caveats one can imagine in a globalizing world). Argentina is not the paradise, but it is a country that is very much alive.

From what I hear about the Greeks, they’re a proud people as well. It’s time for them to win that pride back.

Time to end the Cambalache (mess), my Greek friends!

Admittedly, being mentioned in these documents might be just part of being “politically correct” for the ones holding the pen, but we can nevertheless assume that some ground has been gained if there is a perceived need to mention something in documents like these – and in the case of the World Bank, it’s definitely more than just being politically correct.  In addition, let’s not forget, if we consider that mental health refers to the way in which human beings think, feel and behave, it is clear that achievement of a future SDG agenda requires taking into account mental health. As we all know, the current (dire) state of the planet has been human-caused (see all the talk of an “Anthropocene”). So “sustainable development” is the mantra now, for good reason. For this to materialize, we need to change urgently the way we humans think and the things we value in order to make our behavior and lifestyles more sustainable (and improve mental health), while knowing that probably the consequences of those changes won’t be (fully) seen or experienced by us. But they will be witnessed and lived by our children and future generations.

Being part of the “opposition” is obviously quite different from being part of the mainstream. How mental health workers and activists are going to play their cards in the Global Health arena, now that mental health is rising on the agenda, will be a major challenge. This is even more the case as there are many internal disputes in the mental health field (between different professions, between different theoretical traditions, between professionals and non-professionals). I remember for example a story a professor told us when a health team had to deal with an important “natural” disaster some years ago: in order to screen for health related problems, the team had decided to use a single screening tool, with a couple of questions for each area. Mental health specialists were unable to get to an agreement on a simple couple of questions and, because of that, mental health was kept out of the screening.

Going back to how 2015 started well for mental health, we need to be fair: this is not the first time that mental health has been mentioned as part of the global health agenda (some years ago, a World Health Report focused on mental health, for example, and there has also been increasing attention for non-communicable diseases in recent years, with mental health sometimes specifically being mentioned in its slipstream). Yet, it is probably the first time that mental health has been included in a broader development agenda, even if the SDG agenda still has to be finalized. Anyhow, it seems unlikely that the increasing focus on mental health will subside in the coming years. Given this momentum, some things need to be thought over, and I want to address just two of them here.

First, on the post-2015 development agenda, it is clear that mental suffering is huge in our world: economic crises, inequalities, war and “natural” disasters all correlate with mental conditions such as depression, suicide, anxiety and others. But to think about human suffering (caused by other human beings) in terms of mental illness is an oversimplification. Even when in the end it is an individual who cannot sleep, who doesn’t want to live anymore, and is in need of individual care, this doesn’t mean that the problem –and its solution- is just an individual one. I remember a conference about sexual abuse, where the lecturer presented a model of intervention whereby, even if the wounds caused by the traumatic event were addressed at the individual level, the last step of the treatment was the involvement of this person in social movements that fought against this very situation. This is, from my point of view, a change of perspective needed for all health professionals. Maybe it sounds utopian, but we need to include within our goals that the “patient” leaves the consultation room with tools for solving the health problem at the individual as well as at the collective level. Of course, this is not a new statement, but we need to keep arguing for this, and in this respect it might be useful to take an in-depth look at the latest World Bank Report and one of its key ideas: how ‘mental models’ (the ways in which we interpret the environment and give sense to our experiences) shape how we understand problems, and due to that, how we respond to them (for instance, as previously mentioned, one mental model of health workers would be that health solutions at the clinical level are just individual ones).

Second, more specifically zooming in on this World Bank Development Report, given my background as a psychologist, the change of perspective on the understanding of human decision-making, in comparison to the 1993 Report, is quite a surprise. For years psychologists have said that “rational” thinking is not the only way, and many times it has been said that it is not even the most important way in which human beings think and take decisions. In recent years, this has gone mainstream (see for example D Kahneman’s bestseller,  ‘Thinking, fast and slow’). So, it is no doubt also a step forward that the World Bank now takes this into account for policy making. Nevertheless, at the same time, I think we need to be cautious, and by this I mean that while perceived rationality has been used as a powerful tool and argument to impose policies in the past, other ways of understanding human behavior can also be used -and have been used/abused already in some cases – as powerful tools to manipulate.

So, I would say that 2015 challenges mental health workers and activists to introduce more complex ways of understanding and dealing with human suffering and its relationships with sustainable development, and make them comprehensible. No development can be sustainable if it causes suffering among a huge part of the world population and, at the same time, no sustainable development will be achieved without changing the “mental” component of health and life.

The time for mental health has come. It’s up to us to seize it now.