I’d love to be an impatient optimist who believes in linear progress. But I’m not. In 2023, it’s time to wake up and stop stating that “more, faster, better” will be the solution to the dire challenges our world faces.
In the middle of the 20th century, the second World War had shown a barbaric side to humankind. In 1947, a seminal book, The Dialectic of Enlightenment, was published to explain how, after constant progress expected following enlightenment (the age of reason and science), a track of regress had occurred in parallel – and had made the holocaust possible.
I read this book in my early 20s, and was at the time also hugely influenced by the work of Nietzsche, who also explores the concept of dialectic (good and evil, progress and regress, etc., coexisting).
In the 21st century, my generation and that of my parents, who never experienced World War II, has been influenced by a narrative of linear progress, the same way as enlightenment influenced people centuries before. We experienced the fall of the iron curtain and Berlin wall, and Fukuyama’s book End of History gave us hope that everything would only get more peaceful and prosperous.
Then 9/11 happened. And wars in Syria, Yemen, Ukraine, and many more. Climate disasters began occurring more frequently. Famines. Refugee crises. Mass shootings. A rapid widening of inequality.
Yet especially in the sector I work in (global health), the impatient optimist narrative continued. We should focus on long-term progress, and take a look at the state of the world as if we’d be looking at long-term bonds, and not short-term share prices. Ignore the fluctuation. Ignore the crises. Focus on the silver-bullet products that will save the day. If we invest more, produce and create markets faster, if we innovate even better, the line of progress will continue to rise.
Yet that line of regress, running in parallel – with inequities, restrictions in civic space, abolishment of women’s rights and bodily autonomy, climate change, conflicts – has become increasingly evident to many people. They’re no longer buying the narrative of linear progress, because it never reaches them, or if it does, it is overshadowed by multiple crises. In global health, by the Covid-19 pandemic the latest, millions of people realised that the model we’ve set up has never been designed to serve all people. It has been designed to create markets for products. And products require profits.
Accelerate!
I’d love to accelerate progress, so that progress reaches every human being on the planet. I’d love to continue raising billions of dollars, and to continue advocating that products and services that I personally have access to – vaccines, doctors, midwives, any medicine or medical equipment I will ever need – would be accessible to every person on this planet. If I only look at the data and lines of progress that are being presented to me on many platforms and portals, I could still sing with the chorus of “more, better, faster”.
But I see the lines of regress, and I am unable to see them. I see the rising inequality, and I know for a fact that there is increased conflict around me. I see what is happening to women’s rights and LGBQTI+ and especially transgender rights. I have for three years during the pandemic, together with many others, looked at the inequality in access to vaccines, tests and medicines – and felt embarrassed, depressed, disgusted.
Yet every global health press release I read, every annual report I see, calls for acceleration. And I have to use this term too in my work, because this is what is expected, mid-point to the 2030 SDG goals.
Wake up! And don’t forget to decelerate regress!
As with the enlightenment, global health is a technocratic world that believes in medicalised science. The calls to consider and take into account a socio-political context in which science and medicine operate in – some would say are integrally intwined in – have been ignored for many decades.
“But science is always right.” “We can innovate and leap-frog to overcome challenges.” “Market-shape-market-create-product-innovate.” The rest is not our work. It’s not our problem? It doesn’t affect the impact we’re trying achieve?!? Wake up!
There are many people, and many great advocacy movements, who are focused on decelerating regress. It’s a tough battle, because it’s inherently political, it’s a battle against those who have power and money, and it’s a battle against the status quo (on climate and energy policy, on production and consumption, on patriarchy). Some of these people and movements are trying to shape what we do in global health, and how we do things, e.g. focusing on addressing inequality and its drivers, rather than just focusing on a single disease and innovating new vaccines. But they are the exception rather than the norm, and the funding is nearly all elsewhere (with the technocrats).
It’s time for global health to break out of its technocratic bubble, and stop believing the impatient optimist narrative.
Just speak to young people – as I do with my three teen kids – about the world they see around them. They are growing up in this world where regress is more than evident than ever. It directly affects their current lives, that of their friends and peers, and their future. If I tell them my solution and contribution is to do “more, better, faster”, they will ask me in frustration whether I’m kidding, whether I don’t see what’s happening around us, to them, to millions of people, and to the planet.
2023, at crossroads
For those of us who still believe in the value of achieving the SDG targets (things like having a healthy planet, and healthy people), 2023 is indeed literally a mid-point to 2030. The calls to accelerate action, and to do “more, faster, better” are growing louder with each day that we get closer to September’s UN General Assembly, and SDG Summit, where heads of state will take stock of (lack of) progress, and recommit to doing better and more (of the same).
I’m not saying that I don’t value science, evidence, or innovation. Scientific discoveries such as vaccines have saved millions of lives, and continue to do so. Evidence drives decisions I make for myself and for my children.
But there’s more out there, and there’s more affecting our lives and health. Women’s rights. Gender rights. Civic space. Inequality. A sick economic system that places profits above people. We can’t ignore these issues, if we seriously try to claim all lives matter. Because all lives should matter now too, not just in the long-term legacy run. And these issues require highly political approaches and solutions.
As after World War II, it’s time to wake up to the fact that we live in a world and time where progress is not just linear. Stop telling me to celebrate our model because maternal mortality has decreased globally since 1990, when it’s shockingly unequal and rising even in countries such as the US and UK due to racism and inequality as well as health systems that have been reformed to focus on profitability and private financing.
Let’s not simplify or blatantly oversell just one part of a model, when we know that reality is complex and not a pretty upward arrow. We may not be able to fundraise as easily, and we can’t constantly post on LinkedIn how proud we are to be part of this life-saving legacy model, but at least we are looking at facts, being honest, and can address the real drivers of life-and-death and health.
Katri Bertram 