Subscribe to our weekly International update on Health Policies

A causal loop diagram for our times

By Kristof Decoster
on November 6, 2014

I’m not a big fan of causal loop diagrams – CLD paintings tend to make me as dizzy as the average Prezi presentation, perhaps my fast increasing brain age has something to do with it (it’s for a reason that I will read with special interest this week’s  Lancet Series on Aging).  But while waiting for the ultimate causal loop diagram of the Ebola outbreak, how about developing a CLD for our murky times? What would it look like?

Our starting point would probably be that within-country inequality has risen recently in many countries, due to a combination of globalization, technology and neoliberal (tax, trade and other) reforms. Awareness of this growing gap between the (0.0)1 % and 99% is, however, also growing steadily  – a nice indicator is that Bono is very much “out” these days and Piketty “in” (they call Thomas a rock star economist for a reason). Nevertheless, for the time being, governments around the (developed) world continue to insist that “we have lived beyond our means” for decades (they mean in terms of government social expenses, not in terms of ecological impact), and push for austerity policies and government budget cuts while central banks are engaging in some financial hocus pocus. Public services need to be trimmed, and the – obviously more efficient – private sector needs to take over (the more lucrative parts).

“Efficiency gains”, “smart government”, “doing less with more”, “cutting too much fat” (deep down every rightwing politician is a plastic surgeon), ‘value for money’…, well, you know the PR jargon.  My dad  who, suffering from dementia, died “mismanaged” and underfed  in a hospital a few years ago knows all about it, sadly, as does my sister who’s getting angrier and more fucked up day after day, working as a nurse in an underresourced nursing home.

On the bright side, it’s increasingly clear to many people that challenges are now universal (perhaps even interstellar?). Anyway, as is well known by now, the middle class, the precariat and many others even lower on the social ranking feel the impact of these austerity policies the most (The growing “middle classes” in LMICs, BRICS and MINT countries might be slightly more optimistic, but many of them are feeling insecure as well, that’s why they sometimes call a big chunk of them the ‘struggling classes’).

Meanwhile, the average Joe and Molly are reading nearly every day in the papers about “industrial scale” tax optimisation and other systematic “transparency issues”  around multinationals, investment funds and extremely rich families (check the  transparency ranking of Berkshire Hathaway for example, or Big Pharma in Luxemburg (which would make a good title for a B-movie, by the way).  Billions stashed away (or is it trillions), … we kind of get lost in figures we can barely imagine.

And guess what: we ain’t very happy. Many of us probably agree with Rob Yates that this undermines UHC worldwide, and other social services.  Many people realize that the implicit social contract in their nations is being rewritten, and not to their advantage. Health for all has is steadily turning into Pills for All and Everything. Preferably pricy ones.

Meanwhile, captains of industry continue to insist that globalization leaves us no other choice than making the poor poorer and the rich richer, and that trade unions refuse to see the “reality of today’s world”. If we borrow a leaf from Deepak Chopra, it is obvious that industry leaders, commercial space tourism entrepreneurs like Richard Branson and no doubt also philantrocapitalists like Bill Gates have reached a higher state  of consciousness about the state of today’s world than common citizens. In spite of all this, some of these far less enlightened people now see Gates suddenly talk about the need for strong health systems in West Africa, after having pushed for techno-fixes and innovative PPPs for more than a decade. But as in the bible, we’re happy with every prodigal son coming home.  Next year, Bill might also issue a new Grand Challenge or even come up with a Taxing Pledge, ‘The time is now for the global health community to tackle the problem of ‘international tax planning’ and fight excessive corporate power’. We’ll have to quote Marx, then.

For the time being, though, many of the above mentioned people also tend to push for “multi-stakeholder” governance mechanisms everywhere (with huge influence of the corporate sector, that goes without saying) to tackle the challenges of the 21st century in a decisive – aka “smart” – way. While hearing constantly about the urgent need for sustainable development, inclusive growth and all that, the less enlightened part of the world reads in the Guardian on (the executive summary of ) the IPCC synthesis report that the picture is still not exactly rosy and getting worse. However, we can still avoid catastrophic climate change, if only there is enough ‘political will’ ( the opium of development think tanks), we are being told. Yes we can, even if that sounds increasingly out of date. Andrew Harmer is surely not the only one who believes the term  ‘governance’ has had its day (after reading Naomi Klein’s new book), and should be replaced by ‘resistance’, among others, against large swathes of corporate and financial industry power.  Resistance, however, probably needs to start in our own organizations and institutions. Come to think of it, they are often ruled by equally enlightened people who are seeing horizons where many of us don’t.

You can try to find the ‘balancing’ and ‘reinforcing’ feedback loops in this CLD for yourself. Slightly worried that it’s a Picasso painting, though.

add a comment

Your email address will not be published. Required fields are marked *