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Any lessons for global health from the Greek disaster ?

By Kristof Decoster
on June 29, 2015

It’s interesting to see how even in a left-leaning institution like ITM,  people have very different views on the Greek crisis, aka ”The Endgame”, as it is now called: from the almost rational to conspiracy thinking & the nearly paranoid. The fact that it’s extremely hard these days to distinguish between these extremes shows the sorry state European democracy (or what is left of it) is in.

Anyway, as I’m as disgusted as anybody else by the whole “spectacle” in recent weeks, months and years (that’s at least one thing all sides seem to have in common), below are some of my reflections, with a view on the global health community. Is there anything we can learn from this horrendous mess?

Before going into that, though, let’s first emphasize that the obvious thing to do for “the institutions” now, from a machiavellean perspective, is to let the Greek referendum run its course. As human beings are, naturally, afraid of total chaos, and tend to prefer the devil they know, I think the polls are correct. A (narrow) majority of Greeks will indeed vote ‘Yes’ on Sunday, going against the advice of Tsipras’ government. With this outcome, Syriza will be ‘over and out’ and then ‘the institutions’ can do what they want, all over the eurozone, and implement their structural ‘TINA’ reform agenda – at least in the medium term. Starting in Greece, with a so-called ‘government of national unity’ (trust me, they’ll find one).

But so much for machiavellism. Should global health draw some lessons from the latest global finance-induced ‘Debt & Death’ episode? I see at least one.

Mainstream global health circles still think, by and large, that the global (capitalist) economic system is ‘benign’. Yes, there are huge inequities, many even concur with Piketty’s analysis, but we can and will fix them in the coming decades. Even a ‘Grand Convergence’ is within sight, if we take the right mix of policy measures & market incentives, and go for innovation at all levels. The same goes for sustainable development and a green economy, in this view. Most of the ‘people who matter’ in global health side with our (democratically elected) leaders, or at least see  them (Cameron, Merkel, …) as global health leaders, asking them ‘to deliver’ or at the very least show up at important conferences (like the upcoming FfD conference in Addis). I’m afraid that’s a fundamental mistake, even if I do feel sorry for Angela Merkel – she looks extremely tired these days, beleaguered by a multitude of huge international crises (of which the looming Greek meltdown is only one). (At the micro-level I already feel sometimes very powerless, so I can only imagine what it feels like for these people in high-level political arenas in times like these, i.e. ‘perfect storms’; Cameron once called it ‘It’s like being in an asteroid shower’. (Feel no pity for him, though))

But to come back on mainstream global health, I suggest Tim Evans, Jim Kim and other Larry’s take a thorough look at the pope’s latest encyclical, and try to understand why Francis has just invited Naomi Klein to an environment conference at the Vatican. Pope Francis understands, unlike mainstream global health, that the entire economic system, based on competition, growth and efficiency gains, is sick. Fundamentally sick. You might call that naïve and think, “Hey, Francis, just leave economics to people like Larry Summers!”. But it remains a fact that no matter how much we love to talk about solidarity and overcoming injustice in global health, or the need for sustainable development in the broader development debate, the fundamental truth is that the current system encourages far more the uglier sides of being human than the better sides.

The signs of an increasingly sick system are all over the place, now also in the North. Technocrats love to mock opposition in European countries for being too ‘ideological’, ‘populist’ or both. But do not underestimate common people. If they vote increasingly for radical left or extreme right (depending on how their brains are wired), it’s because they feel that the system doesn’t work for them anymore. And that it’s fundamentally unfair.

I consider (even ugly) populism as well as so-called populism (often ‘populism’ is just a cheap way to delegitimize politicians you disagree with) in countries where there’s still, at least ostensibly, democracy, as one of the core symptom of a sick global economic system and failing governance at all levels. As for young people, many don’t even bother with politics anymore and resort to down-right escapism, during festivals etc.

Technocrats’ recipes don’t work anymore, as anybody can see. As the ship is sinking, even their analyses fundamentally differ (see in Belgium, for example, how Karel De Gucht’s analysis of the looming disaster in Greece was completely different from Herman Van Rompuy’s this weekend). Anyhow, their claims sound utterly hollow – mostly because they keep thinking ‘inside the box’.  And make no mistake, the people in the streets notice, even if they don’t understand all the high-brow details.

The horrible migration crisis (especially the pettiness of European leaders when it comes to hosting immigrants and refugees) is an even clearer sign to European citizens in the streets – both the ones on the left and the right – that their ‘emperors have no clothes anymore’. The Nobelprize of a few years ago seems incredibly dumb now.

Even if in the coming days the institutions manage once more to blackmail the Greek people into a “solution”, this will not stop.

I think the rising populism in Europe is actually – potentially- a good thing. And at least for the foreseeable future, it will only increase. Especially if the ‘powers that be’ keep insisting on taking more and more power away from electorates (via an ever closer union, as Juncker now seems to have in mind – and he’s one of the more sensible politicians in Brussels, which tells you all you need to know), or via trade and investment agreements (TPP, TTIP, TISA, …) that will hand over even more power to Big Corporate.  The message the average Joe gets from all this “high-level” manoeuvring (behind and in front of the scenes) is clear: our leaders do not trust ordinary citizens on socio-economic policies which actually matter for their lives. Just leave them the (democratic) crumbles…

The lesson for global health: as there exists no credible alternative for global capitalism for the moment, it is time to acknowledge that “populism” is playing this role now. Post-WW II, social welfare states were at least partially set up to overcome the communist danger then. Likewise, post-2015, I think populist parties, both left-wing and right-wing ones (including the nasty & truly wacko ones), can play a role in putting pressure on mainstream political parties and technocratic elites to come to their senses again, and actually do something about the ludicrous inequality, now also more and more present in our own societies. Not to mention the looming ecological disaster (but that will only be possible as a second step – as why on earth would you care about the planet if our elites do anything but, in their own behaviour?).

If elites fail to act upon this populist pressure, the system risks to become unmanageable – which is surely not what they want. Hence the numerous claims nowadays of ‘totally irrational behaviour’, ‘we need to have adults around the table’, etc.  our elites are obviously baffled, not understanding politicians who operate outside their box.  Branko Milanovic is right: this is not just an existential crisis anymore for the Eurozone, it’s also increasingly one for the entire European project.

Of course, the problem with populist parties is that they can breed something worse – as history tells us. But that’s a risk we have to take in the current circumstances. Technocrats aren’t leading us anywhere either for the time being, as far as I can tell.

Global health should thus, beyond the call for global social movements you often hear in respected global health circles (for example ‘we need a global movement for UHC’), not be afraid to capitalize on “populist” movements and parties in the North – I can only speak for countries in Europe (and perhaps the US) here – which dare to challenge the elite & technocracy.  Or at least they should try to understand what drives them and their voters.

I bet that once technocrats actually start listening again to common people, even 0.7 % ODA commitments will no longer be “toxic” anymore among a big chunk of public opinion.


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