SOME REACTIONS TO WHAT WE HEAR (AND DO NOT HEAR) IN MANY A PUBLIC HEALTH CONFERENCE THESE DAYS.
Human Rights Reader 237
SOME REACTIONS TO WHAT WE HEAR (AND DO NOT HEAR) IN MANY A PUBLIC HEALTH CONFERENCE THESE DAYS.
1. Am I tired of going to such conferences? Sort of.
2. It is just that, in them, we hear about so many things that need doing and have so long been overdue (…achieving the health MDGs, strengthening health delivery systems, organizing and empowering beneficiaries to demand changes ….and on-and-on…). One gets the impression that it is in times of crisis that we finally will bring to the fore what really needs doing and has long been overdue… But not even in such circumstance does the needed happen in our meetings of the learned; almost nothing substantial, beyond a passing comment, is heard about taking actions to address the ‘condition of poverty’, about disparity reduction, about addressing the widespread and numerous violations of the human right to health and to nutrition; nothing substantial and really deep-felt is heard about empowering claim holders –or worse: the concept of empowerment is repeatedly hijacked by making it mean giving women greater self-esteem, providing them with health education and nutritional knowledge and skills and/or ‘empowering’ them to better take care of their children.
3. Empowering claim holders a) to exert growing social counter-power to the power that keeps them in poverty; b) to fight the often flagrant health and nutrition rights violations they are subjected to; and c) to fight for greater equity and access to the services they need, all still seems to be a taboo topic at the conferences I attend. A shame.
4. One gets the feeling that, after so many years of struggle to combat preventable ill-health and preventable malnutrition, we are, over and again, back to square one. Presenters in time-scarce crammed parallel sessions* do not seem to be aware at all of (or decide to overlook) the fact that there has been significant criticism of, for instance, World Bank-funded projects and the recommendations they make to ministries of health –a criticism rooted in objecting to the fact that these ignore the social, economic, political and human rights dimension and determinants of the problems at hand –beyond a window-dressing/passing-by mention.**
*: In these sessions, questions and discussions are quelled when the chairperson says: “Sorry we have run out of time” and all of us in the audience are left boiling when some of what was said from the podium is sheer nonsense –as many others attending feel these are the take-home-messages from the gurus up there.
**: Also lately ignored are the objections many of us have voiced over and over about the ‘ten top solutions’ proposed by the Copenhagen Consensus of Eminent Economists.
5. In these conferences, we are further repeatedly asked to believe the dogma that pointedly investing-in and improving health and nutrition per-se improves equity. Well, by themselves, they do not! Rebalancing the power equation does!… In the spirit of the interrelated and interdependent right to health and to nutrition, that calls for mobilizing claim holders to actively demand changes, and making duty bearers accountable. [The prescriptions we hear in the conference rooms (maybe not in the corridors --the better part of these conferences) do not heed this call; the presentations we hear in the closing session, not as a surprise, only pay lip service to the processes really needed for the realization of these inalienable human rights.
6. We do not need more ‘pro-poor interventions’ that target and victimize poor people’s groups. We may target poor geographical areas, but at the same time --and never missing-- we need to proactively move to sustainably reduce disparities beyond mere poverty alleviation; only that will take care of the violations we see in both health and nutrition (and will actually make mainly technical interventions ultimately irrelevant once and for all).
7. I am personally tired of our colleagues alluding to ‘the need for structural changes’ with impunity, i.e., without really meaning (or understanding) what they say.
8. The ‘window of opportunity’ for disparity reduction has been open for 3,000 years… And what do we get at these meetings? More of the same, i.e., ultimately not taking advantage of the window of opportunity…
9. What we get is not necessarily unimportant, but it is INSUFFICIENT. Is now the time to act? Yes! But with more than what we usually hear at these gatherings of, so often, scientists that sadly seem to still not having climbed down from their ivory towers.
10. Only some lonely and committed souls mention the need of using the human right framework as a basis for action, as the basis for plans to tackle the major right to health and to nutrition violations --as the People’s Health Movement is doing (www.phmovement.org). The message of applying the human rights-based approach as an avenue to empower claim holders, to work with duty bearers to help them comply with their human rights obligations is hardly ever heard.
11. The power to act is different from the ability to act; thinking we can achieve quicker results, we have often given the role to individuals and institutions with the ability to (and not the ones with the power to) act. This has led to the status-quo so many of us refuse to live with.
12. Am I too harsh in my analysis? I do not think so; I just call a spade a spade. We have to stop the infamous practice of speaking about these things in whispers.
Claudio Schuftan, Ho Chi Minh City
[ I have here unfairly omitted denouncing the exhibitions that accompany many of these conferences where the big pharma houses and the food industry are scandalously offered a booth to advertise their wares in order for the conference organizers to get some shameful funding --which these companies use to whitewash their consciousness anyway].
yes, Claudio, powers of co-optation… diplomacy masquerading as social science, unwillingness to confront power configurations, even to push the limits, research-as-a-delaying-tactic in technocratic guise (dot the ‘i’s and cross the ‘t’s; evidence-based policies and program’), feeding off the conceit and willful naivety (disingenuity) of policy researchers and analysts…
You allude to the fact that the changes that are needed are not just structural, but also cultural. Cultural changes take a long time. Nevertheless, we need to look at the very ingrained way in which we assign value..
Many of us are part of a very wide spread culture that values achievement, and measures success relative to others with various markers. These markers are representative of the importance that we assign to given structures; such as conferences or peer reviewed journals. There are reasons for giving these things high value – they have been approved by a number of people. As Ron Labonte notes, though, there are many good ideas out there that haven’t been approved and the peer-reviewed ideas aren’t necessarily the best, and certainly won’t always be the best.
Our culture also values certain ways of gathering, recording and holding information, e.g. the “hierarchy of evidence” (meta-analysis is better than RCT is better than expert opinion). As a result it is difficult to developing indepth analysis of systems and situations that are constantly in flux.
Whilst “star speakers” have valuable ideas, it is the ideas, not the speakers that we should be hanging on to. There is increasing recognition of the need for more participative methods in conferences, such as smaller groups sessions. It’s very difficult on very large scale and under time pressures.
Things could be better through
- ensuring effective structures for meetings – representative individuals present, working on a local scale wherever possible and sharing ideas/information/outcomes with other groups by email/other communication channels (benefits in terms of time, sustainability and involvement)
- learning and disseminating good facilitation techniques to enable small groups to work effectively
- trying to break away from our engrained leaning towards “achievement” and value only in recognised channels (many of which are inaccessible to people with great ideas) – recognising good ideas from the “non-star” speakers, and the ones who don’t even get to attend the conference
- trying not to promote ourselves through these channels (very difficult, as we still need to use them to get the message out, and because we can’t help but assign value to ourselves through them!)
A different style of writing (!), but some cross-over messages..
http://www.crimethinc.com/texts/atoz/nomasters.php
http://www.crimethinc.com/texts/atoz/product.php
I certainly share a lot of Claudio’s frustrations. While I realize that even those of us in the public health and health education fields do not want to bite the hand that feeds us, otherwise known as the sources of funding, could we not see some research that is directed towards change? How do we get into the boardrooms of those who manufacture weapons rather than how we help the maimed? How do we access the mining companies that take the land (and pollute) rather than deal with the loss of livelihood and food sources of the peasants?
Need I say more?