In many countries around the globe, the debate in the public arena has become harsh. Yes, the Internet and social media platforms have dramatically multiplied opportunities for people to share opinions, comment on social, cultural and political events, interact with like-minded and other people,… which is great. At the same time, however, this plethora of communication channels – that can be (and often are) used anonymously – boosted intensity, and in many cases brutality in tone and content when “discussing”. With, unfortunately, increasingly very polarized and sterile debates as a result. The very nature of communication on social media – going for short, crisp and often provocative messages – makes it poorly fit to address complex issues and provide proper space for nuancing. True, Global Health remains a bit of an ‘outlier’ in this respect: social media traffic on issues pertaining to Global Health has generally remained ‘civilized’. Let us cross fingers. Still, Global Health doesn’t operate in a vacuum, and faces an ever more polarizing world.
This overall trend is very much in line with, and probably played a key role in, changes in the political landscape in this country (Belgium), and in many other Western (liberal) democracies. Other parts of the world (India, Brazil, …) have also not stayed immune for this hardening of the political debate. Focusing on my country, Belgium, two trends seem to stand out: on the one hand, an increasing fragmentation in the political arena with the more ‘traditional’ political parties (i.e. social and Christian democrats, liberal parties) on the verge of an existential crisis; and on the other hand, the emergence and growth of political groups at both extremes of the spectrum. The picture at the European level isn’t that different, although perhaps less pronounced than in Belgium.
The two above mentioned trends (increasing polarization of the debate, and political fragmentation plus evaporation of the center) can of course not be isolated from the greater worldwide (and rather worrisome) picture of increasing uncertainty and instability, a crisis in multilateralism, growing social inequalities, unevenly distributed gains from globalization, the rise of populist (and often authoritarian) politics, shortsighted management of migration flows, navel- gazing identity debates, the backlash against neoliberalism and austerity which seems to lead to an increasingly neo-illiberal world … Shifts in the global distribution of power, with loss of power by a formerly hegemonic West, may also have contributed to the rise in populism according to some analysts. Meanwhile, a credible and broadly shared progressive alternative for neoliberalism is still lacking, in spite of the many interesting ideas currently raised on fairer & sustainable ways forward, by public intellectuals, scientists, grassroots movements and (some) politicians.
It is a bit in the light of all these trends that a small consortium of Flemish information media (Knack, De Standaard, Bruzz and StampMedia) launched a very interesting project earlier this year, a couple of weeks before the European, federal and regional elections (which took place in Belgium on May 26th ). The initiative was about promoting dialogue between people with different, sometimes fiercely opposed ideas and opinions on a wide range of themes, cross-cutting society. This project was part of My Country Talks , an international platform for political dialogue. It was labelled by the organizers as “Het Grote Gelijk” – which is Dutch for (forgive me the entirely free translation!) “I, myself, am of course right!”.
Citizens aged 18 or more were offered the possibility to debate with somebody (unknown to them) who had also accepted the invitation to participate, but with different ideas and opinions on a range of issues. Each interested participant was asked to respond to a small survey probing for her/his positioning on a selection of currently ‘hot’ themes in the public debate in Belgium. Side remark: The themes were not – purposely – confined to the Belgian (regional or federal) level; in many cases, they were also, at least partly, European and global issues. Put differently, if they are to be addressed, they cannot do without international collaboration and regulation.
The project staff managing “Het Grote Gelijk”, with due respect of privacy, then matched two people (who live relatively close to each other) with a different ‘profile’ in terms of social and political opinions and convictions. They then independently informed each one of the potential pair and asked whether they would agree to be put in touch with one another. If that was the case for both, the project staff shared the names and email addresses, together with a short narrative summary of the main results of the survey in which both had participated. This summary addressed the following questions: what is your profession? What do you like to do in your free time? Can you present/describe yourself in three words? What makes you happy? What are you worried about? The project organizers then listed about a half dozen of issues on which disagreement appeared rather big. These were formulated as questions and could then be taken as a basis for the forthcoming discussion. For instance: should the use of cars be discouraged?
Eventually, two people, who had never met before, thus got connected. All duos were invited to come to Brussels on Sunday 5 May to interact with each other, in a big hall, with each duo sitting face-to-face at a small table. More than 2000 people had accepted the invitation!
And so had I.
Yes, I admit, there was some suspense in the air. My “match” was a man of 54 year, with a university bachelor degree, an independent entrepreneur in the construction business, heading a small firm. To respect his privacy, I won’t share more personal details here. We could not make it to Brussels on that particular day, due to a private commitment from my side, but we agreed, after one or two email exchanges, to meet in the evening in a tranquil pub in my municipality. Over a beer (we’re both Belgians!), and later in the evening a coffee, we started our discussion on questions listed by the project staff. Is the Islam compatible with Western values? How to address the population explosion in sub-Saharan Africa and the migration to Europe? Does politics still “work” in the complex country that Belgium is? Are the (many) taxes Belgians pay properly used? Are there not too many people in our country abusing our social security system? All in all, we spent some 2 hours together but we still did not fully exhaust the discussions on the initial list of issues.
With hindsight, a few months later now, how do I look back at this experience? Not in anger, that’s for sure! All in all, I found it pleasant and interesting. I am glad I participated. My match and I had a mutually respectful interaction without major stumbling blocks. Some selection bias in the ‘population’ of people choosing to participate in this project might have something to do with this, but so be it. We exchanged ideas and views rather than opposing/confronting them (and each other). I appreciated the fact that my match’s background provided him with insights and experiences that I – as an academic with a focus on health systems in LMICs – do not have. And vice-versa. I think we learned a fair bit from each other. Or, at least, the discussion made us think things over. And see – and look for – nuances. What I definitely also experienced in this face to face exchange is that it is not sufficient to have a clear opinion, one also needs a coherent set of arguments to back it up. Not always easy. In real life, we tend all too often not to go beyond contrasting our opinions. That night, my match and I were also open enough to express our voting intentions for the (then forthcoming) elections: yes, we were going for different political parties, but they weren’t terribly different. He was more surprised than I was. We also agreed to stay in touch via mail. And my match did actually do so, he mailed me a while ago – I still have to answer. Writing this piece for the IHP Newsletter is a good reminder to do so. Perhaps I can share this editorial with him?
The political editor-in-chief of Knack magazine, one of the principal organizers of the event, nicely summarized the initiative: ‘When one looks at political debates, on tv or on social media, one would think that we live in a totally fractured society. When you look at this experience, though, you get a different picture. That is a clear win’. And the rector of the (Flemish) University of Brussels (VUB), Professor Caroline Pauwels, one of the supporters of this initiative, said that ‘If we are no longer convinced of the usefulness of a conversation with each other, then there only remains ‘an eye for an eye, and a tooth for a tooth’. Eventually, we will then end up without eyes and without teeth’.
Are there any lessons to be learned from this experience for the public (and global) health community? Being someone with a special interest for (the) front-line (providers) within the larger realm of health systems, at the intersection where health workers interact on a daily basis with people, I almost instantly think of the need to continuously search for a balance between professionally defined needs and people’s demands. The two overlap, of course, but only partially. All too often, the former tend to dominate and accordingly shape the supply of health care. Truly listening to each other, acknowledging that rationales and expectations may differ, focusing in the first place on commonalities rather than differences, would already be a major step forward. Not per se an easy endeavor because such an exercise needs to be dynamic, is naturally time-intensive, and requires self-awareness and an openness to introspection from the ‘supply-side’. But eventually it will contribute to building trust. And trust is essential in health care, as Jeremy Farrar (Wellcome Trust) argued just last week. The current Ebola outbreak in the DRC is just one of the latest examples in this respect. Lack of trust between people on the one hand and the complex web of health professionals, public authorities, institutions, donors, the international community at large may very well (at least partially) explain why the outbreak, sadly, has become a regional health crisis, one year later. We hope of course that this Ebola outbreak can be controlled, but also that when this is finally behind us, we do not simply return to ‘business as usual’, but instead, start investing in listening to each other, and from thereon, act accordingly in (re)building health systems. Put differently, as GAVI’s Seth Berkley argued a few weeks ago, “this Ebola outbreak should not be viewed in isolation, but must be seen as a symptom of a deeper public health crisis”. To address it, the conceptual framework and value basis of Primary Health Care provide an excellent way forward.
Coincidentally, when writing these words, I am on my way to Lubumbashi, DRC, for a working visit to the School of Public Health. This time, some festivities are also scheduled during my stay to celebrate our longstanding collaboration. My visit will again be an opportunity to interact with Congolese colleagues and further finetune my understanding of the complexity of managing health systems in such a very different environment. We will again try our best to listen to each other. As our Congolese academic partners largely share the same values, collectively constructed over time, this will not be too difficult, certainly when compared to the polarized debates mentioned in the opening paragraph of this editorial.
A final remark perhaps. The question remains, of course, as Richard Horton hinted in a remarkable Offline contribution from a few weeks ago, ‘The Ethical darkness of global health’, when should global health stop talking and shaking hands, at least with powerful actors? Where is the threshold, for risk of helping to legitimize unsavory regimes, when some (public/global health) ‘common ground’ no longer suffices, due to huge human rights violations in other areas, or a large-scale crack-down on opposition and civil society?
But that’s something for another contribution. And in any case, that’s more a question for ‘power’ in global health than for an academic…