PHM-Exch> Food for an overlooked thought (2)

[Claudio Schuftan]

From: Paulhamel6318 at gmail.com University of Toronto.

Re: SOME REACTIONS TO WHAT WE HEAR (AND DO NOT HEAR) IN MANY A PUBLIC HEALTH
CONFERENCE THESE DAYS.



>  I would like here to discuss another dimension on this topic. I will
> focus on the role of academics and universities.
>
> I see universities/academia as preventing discussion of changes in the
> systems that cause disparities in the burden of disease.  This stems from
> the observation that academics are very often (mostly?) involved in
> delivering papers at these conferences and that they typically play a
> dominant role in their organization. Clearly, there are alternatives to this
> approach since other agencies often participate in these
> academicly-organized conferences.
> I concur there is quite a remarkable lack of discussion concerning "the
> elephant in the room", (i.e., the nature and drastic changes required in the
> global social-economic hierarchy that produces the disparities in the burden
> of disease) at conferences that supposedly address the nature of this
> problem. Indeed, I wonder whether there are conferences on health
> disparities or global/international health that actually have specific
> sessions that deal with the restructuring of the economic system, it's
> specific relationship to health outcomes and the specific strategies for
> promoting these changes. These issues are often mentioned in a variety of
> contexts within talks. However, it is very curious that, while we are able
> to discuss and strategize solutions for overcoming the *consequences* of
> these systems on health outcomes, there is a profound reluctance and lack of
> space to discuss solutions or resistance to the basic socio-economic and
> political causes of the unequal burden of disease.
>
> I believe that this stems from two specific phenomena that have permeated
> universities, in particular, and global society, in general. In the
> university setting, two convergent strands continue to support this lack of
> discussion: On the one hand, there has been a very strong attack on academic
> freedom in a "peculiar" way. This attack is more overt in the US, but also
> affects other academic institutions.  It comes in the form of criticism
> mounted against the inclusion of the socio-economic and, more importantly,
> the political context of the material being presented.  The second strand is
> the quite direct subversion of the university as a locus for critical
> thought.
>
> Universities ought to be centres of critical thought rather than merely the
> purveyors of current dogma and be seen as 'trade schools" (the latter may
> be important, but is not the role of universities). This problem has arisen
> due to the profound specialization of many disciplines. As Eduardo Galeano
> has elegantly pointed out, this specialization tends to prevent
> cross-disciplinary interactions and is reinforced through the generation of
> specialized discourses that inhibit these interactions. One important
> consequence to this structure is that attempts to bridge these barriers is
> met with institutional, personal and external resistance.  In the case of
> institutional resistance, this arises through condemnation of the inclusion
> of "peripheral" issues (e.g., politics, economics) by an academic corps
> whose principle area of expertise is not politics. Thus, the hierarchical
> nature of "specialty" within academy forms the basis for
> suppressing attempts to bridge the various fields. These attempts are
> further suppressed in cases where public controversy arises; there, the
> immediate point of attack is the credentials of a professor attempting to
> provide such a bridge between areas of study. This I have experienced
> first-hand in discussions, for example, concerning the health and human
> rights of Palestinians.  Also interesting is the structure of the university
> where students attend as consumers of "knowledge". Again, my personal,
> experience is that many expect to be provided with a body of information
> that will allow them to make use of it at some post-graduate point rather
> than the information "arming them" with a critical and analytical
> disposition.
> The second point concerns the subversion of the university itself. At the
> University of Toronto, for example, there has been a specific effort to
> build capacity for "global health".  This attempt, in my opinion, arises due
> to the presence of external funding that supports university activities
> --the Gates Foundation as a particular example. However, this is driven
> within the university by individuals with a profound stake in promoting the
> neoliberal agenda. These efforts have been tied further to the establishment
> of schools of neoliberal economics and management that form the "crown
> jewels" of the university itself.  Furthermore, the funding of the
> global/international health initiatives are specifically dedicated to
> studying how the current manifestation of the capitalist system can be used
> to penetrate less-privileged societies in the name of enhancing health and
> the capacity of health care systems. Specifically underlying these efforts
> is the role of generating profits for the commercial entities involved in
> these university-affiliated institutes, as well as the financial support for
> the university itself (which has been chronically underfunded for decades).
>
>
> Why does this matter? In the case of conferences, any that are associated
> with these academic institutions will never (be able to) program into a
> conference specific sessions dealing with discussions as to how to implement
> fundamental changes in the worldwide economic system. Even the work of
> someone like Thomas Pogge tends to remain rooted in consideration of the
> problems and possibilities that are open within the current structure.
> Despite his criticisms of WB/IMF policies, his work and interesting (but
> important?) solutions remain embedded in "the reality" of the neo-liberal
> paradigm. Furthermore, by praising the work of Amartya Sen, Muhammad
> Yunus and Jeffery Sachs in the global health/poverty fields, it crowds out
> any academic consideration of alternatives to the neo-liberal capitalist
> framework. For example, I am unaware of a serious academic treatment (and
> prominent discussion) of the possibilities that are arising due to the
> fundamental challenges proposed by the systems being developed in Bolivia or
> Venezuela. This lack of discussion at the university level arises due to the
> lack of interest and/or knowledge in both the health fields and economic
> fields about Latin America, as well as due to the the lack of expertise,
> language barrier and, in particular, funding for such studies.
>
> The calling and funding mechanisms for these conferences also negate the
> possibility for the discussion of alternative economic systems. As
> alluded-to above, mention of issues outside of one's specialty field
> generates  considerable resistance.  Furthermore, when political issues
> become the central aspect of such "biomedical/global health" conferences,
> there tends to be general condemnation of the political advocacy work of
> NGOs. Advocacy of alternative political and economic systems are typically
> met with aggressive audits by donors, with a risk of losing charitable
> status or funding altogether. Likewise, funding of conferences typically
> requires close adherence to the proposed agenda that must meet the mandate
> of the respective funding agencies (given their power, they are able to
> "define" what is or is not "political").
>
> There is also a curious phenomenon seen in conferences that
> maintains this lack of discussion of these alternative approaches.
> Typically, a conference attempts to attract some "star" plenary speaker such
> as Sachs, Sen, etc.  The illusion, therefore, is that the conference is
> important since these big names will give a talk and, indeed, always a talk
> in the most prominent portion of the schedule.  Thus, the ideas of these
> individuals set the tone of the conference by i)  the prominence of the talk
> in the program and ii) the sorts of people who end up being attracted to the
> conference due to these "global health/poverty stars". It is likely that the
> press, should they actually show up, will cover only these talks and the
> messages in them rather than the "alternative" stuff that might eventually
> find its way into such conferences (too much work for a journalist with
> their very short deadlines, biased editors urged to name the "star" in order
> to attract even a passing coverage).  This further reduces the space for a
> serious discussion of the alternative economic/political possibilities.
>
> These ideas are just some initial "observations"  It would be interesting
> to hear what others may have to say on this topic.
>
>
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