How is radical change in global health policy possible?
I’m not one of these people who thinks that money talks – at least not always. Sure, it gets you a seat at the table; it opens doors; and it will get you that front row seat at the Olympics next year. But, but, but, fundamentally I don’t believe that the state of the world’s health is determined by the interests and priorities of the richest foundations, the wealthiest countries or the most economically powerful corporations. This is an overly pessimistic conclusion and would, if true, make activism pointless. At heart, I’m an ideas man not an economic determinist and that, to coin a phrase from the title of a book now sadly out of print, we live in a world of our making.
To try to understand how it is possible for you and I to make a healthier world I wrote down a few ideas which, happily, were picked up by the journal Global Public Health. In the article, I used the example of global health public-private partnerships to show how a radical new idea – partnership between public and private actors – was possible, and how it prevailed against both hostile but powerful economic interests and the strategic self-interests of competing international health organisations.
The short answer lies with discourse – i.e. oral or written communication about a health issue. Discourse is something we all do, all the time, and if a particular discourse is justified and legitimised in the right way, amazing things can happen – like the access to essential medicines campaign, for example. But discourse does more than justify and legitimise action, it coordinates and communicates a particular idea too.
Take the example of global health public-private partnerships – like the the GAVI Alliance or Stop TB. It’s pretty clear that a network of public health policy makers communicated the idea of partnership very effectively in the early days when the partnership paradigm was just getting started – have a look at the funky Venn diagram in my paper to see who these ‘partnership pioneers were’.
But the really neat trick was how discourse communicated the idea of partnership to the world. Look back at the literature, the conferences, the debates, etc, and one thing will strike you – partnerships were communicated to us using the ‘necessity’ or TINA (there-is-no-alternative) technique infamously exploited by Margaret Thatcher in her defence of capitalism.
There is a bitter-sweet point to make here. On the one hand, you could say that we were duped into adopting a model of cooperation that is beginning to crack a little at the seams. But let’s remain upbeat and put a positive spin on the argument. We – you, me, all of us – are part of global health discourse. The access to essential medicines campaign started in South Africa and quickly went viral, taking on the economic might and powerful self-interest of pharma giants. Through manipulation of discourse, global health public-private partnerships were also taken up and packaged in a way that made them seem irresistible. In both cases ideas trumped economic and strategic interests. We all have (if we wish) a role to play in shaping those ideas: it’s our world to make. And that’s an optimistic thought.