I am Co-chair of the Emerging Voices for Global Health. Many of my EV colleagues and other health system researchers think, half-jokingly perhaps but still, that my ideas are reflective of the ones of far-right populists because I support the Brexit and US election results. However, I strongly feel that this is not the case, rather they have stopped looking beyond the Trump-style-rhetoric. This myopic perspective prevents us from exploring and understanding the underlying issues that are deeply rooted in the broader political economy of this change.
Both the UK and US are considered as some of the most established democracies on the world map, having strong influence on global politics and policy discourses. Their politicians, policy makers, health practitioners and general population take great pride in their political values and longstanding democratic traditions. They present their democratic systems as role models for other nations, especially for countries governed by dictators and autocratic monarchies. Inclusiveness and respect for the popular mandate are basic corner stones of their democratic values.
Without any doubt, Brexit and the US election result are “Big Bangs” in global politics. It is increasingly becoming evident that the world was not ready for a change of such a massive scale. The global elite, including health policy and system researchers, are finding hard to grapple with the rapidly changing scenario and world. During the 14-day training period of EVs followed by participation in the ongoing 4th Global Symposium on Health System Research, here in Vancouver, I realised that most health system researchers have already made up their mind that the outcome of these elections is a disaster for international and global health. They outrightly reject this popular mandate and consider that a decision by the majority is, in these cases at least, not a right decision and such decision may resonate as ‘might is right’. As per their viewpoint, the results of Brexit and US elections are irrational and driven by forces of opportunism, racism and ethnicity.
The research evidence and related discourses for the 4th Global Symposium on HSR 2016 are organized around two major themes: resilience and responsiveness. These two themes build upon the lessons learned from the 3rd Global Symposium on HSR (in Cape Town, 2014) which was organized around the central theme of the science and practice of people-centred health systems. Resilience means absorbing shocks and sustaining gains whereas responsiveness refers to anticipating change, respecting rights and engaging politics.
People are the most important component of health systems because health systems are run by people and for people. In this context, a ‘health system for people’ or ‘people-centred health system’ has a significant meaning because it requires alignment of health system organization with the population health needs and satisfaction.
The outcomes of Brexit and US elections were driven by many factors and can be (and are being) debated at length. The packaging of arguments and supportive evidence is diverse but conflicting depending upon which side you support. However, there is one common ground, generally accepted – “a majority of the population of these two countries was clearly not satisfied with the current governance and how the world is generally being run”. Although we can find multiple excuses by shifting the blame towards increasing globalisation and further marketization in our economies, it is difficult to deny that the results were reflective of an increasing gap between what a common man (and woman) wishes to have and what he/she is actually receiving from the systems operating around him. Yes, they were only majorities, not overwhelming majorities perhaps, but you get the idea.
The health policy and system researchers are entrusted with building evidence for effective and responsive health systems that are resilient and meet the needs of the populations they serve. It is important for them to listen to the peoples’ choice. It requires an open mind and not taking sides/positions even before starting the inquiry. Under the current scenario, it is critical that we explore and understand the precise underlying factors why those who voted for supporting Brexit and Donald Trump felt unsatisfied with the current management of affairs.
In one of the plenary sessions, while presenting an exciting debate on intersectionality as a research approach to understanding and promoting resilience and responsiveness in health systems, Daniel D. Reidpath, Olena Hankivsky, Sundari Ravindran, Saira Shameem, Jean-Frederic Levesque and Asha Asha George, very rightly emphasized that health and the provision of health care are inseparable from broader considerations of social development and their other social, cultural, political and economic drivers. However, I am of the strong opinion, that even the best research methods will not reveal the real complexities driving social and political change if viewed and implemented with a myopic vision and predetermined mindsets.
This is the time to listen to the popular mandate in these countries and analyse the issues we failed to listen to before and why we did so. It is the time to look beyond the worst aspects of Trump-style-rhetoric and instead capitalize upon the opportunities offered by the ‘Big Bang’. We have the right to criticise but in a constructive manner with due respect for the popular mandate. Do we merely need cleaning our glasses to see better or do we require a fresh pair of glasses? The choice is ours. Our people are the best judges for our actions.