A quiet revolution is underway

Posted by healthyeurope on 08/04/13

The start of a new order of economic development?

There is a new economic kid on the block. Some of us have been following the ‘post-GDP’ agenda for a while or more recently the Rio+ 20 debate which is looking at new models for development and most famously, a Commission of the great and good (Professor Joseph Stiglitz, Professor Amartya Sen  Professor Jean-Paul Fitoussi et al) set up by former French President Sarkozy in response to concerns that we are not measuring our economic success in a way that is meaningful in reality. Last week, the Organisation for Economic Cooperation and Development (OECD) and the Ford Foundation raised the bar with their  workshop on inclusive growth. The workshop marked the start of a new project to develop a strategic policy agenda for sustainable, inclusive growth and I wanted to put down some of the ideas there because as a quiet and rather under-reported event, it marks a watershed in economic thinking and leadership that (hopefully) will lead to, frankly, better lives for all of us.

Why is this of interest to people working in public health, or non-economic fields?

Ultimately this is about moving away from standard gross domestic product (GDP) as a single measure of socio-economic success. This is important as GDP is not a very sensitive tool, and in fact in health policies is actually unhelpful. For example, preventing fatal traffic accidents is essential public health policy, however fatal traffic accidents generate a lot of economic activity (expensive health services, funeral services, catering, flowers even the clothing sector) and therefore increase GDP. In many cases, promoting public health means reducing GDP – prevention of smoking, reducing alcohol harm, junk food consumption etc., all take economic activity (therefore the ‘bit’ we measure) away. Therefore we have a paradox where our current economic policies value economic activities that many in the public health field wish to prevent, and dismiss positive public health improvements as less value than the harmful behaviours which drive GDP. This concept is traditionally not well addressed by health actors, but more so by those working in the environment sector and even the European Parliament adopted a non-binding resolution in 2011 as well as an agreement on environmental ‘measures’ additional to GDP.

So what is inclusive growth?

In part, this is the point of the new OECD project in which this workshop was part: to define, measure and identify how to implement inclusive growth:  a term for the next model of economic development. Ultimately the question is not only how to continue with economic – and therefore material – development, given that many of our global population live in poverty, but also how to do so in a way that would allow a more even, and fair, distribution of the wealth and benefits.[i] Our current model for growth is neither fair, nor sustainable and the rise of inequality is now considered to be at the centre of the current global economic crisis, with conditions unseen since before the second world war and in particular an explosion of wealth amongst the so-called ‘1%’

So how to move forward?

There are many questions that remain – mostly in how to define, measure and implement inclusive growth – however there were three additional outstanding points which were only touched upon in the meeting organised by the OECD. Others are perhaps better placed than I to answer questions on definition, indicators/measures and implementation tools, and as these issues move on I will comment on them. However what struck me from the discussions at the meeting – despite an awareness of the fact – was the hegemony of economics in steering the direction of our societies. Discussants were still largely in agreement that it is Finance Ministers (and above in the political leadership) who are the most important actors in the implementation of a new model. In most economies this is a truism, however it is somewhat thinking ‘in the box’ if we do not question this economic hegemony in terms of our societal governance. Discussants frequently reminded us that economics and monetary policy were ‘tools’ to a better ‘end’, and yet until we put the ‘end’ at the top of our governance processes, then the ‘tools’ are bound to become ends in themselves. Do we need to address parallel questions of governance (and therefore power) in order to answer questions regarding implementation of change?

Secondly, how do we manage change? The current model has those who benefit substantially from the system as is. In any process of change, we enter a period of instability which needs careful management (and leadership), and within this we must recognise and address that there will be resistance and that this resistance will come from pockets of the most powerful and wealthy (by very definition of the problem) parts of our system. Someone will have something to lose. Again, this moves us into governance and the rule of law – and ultimately we must admit that this process will not be smooth, in all places, at all times. How to address countries where the rule of law is weak, corruption is high and transparency or accountability difficult to achieve? To what extent is intervention (through the support of bottom-up, civil society, or democratic movements for example) possible or politically palatable?

Finally, how to undertake effective outreach or communication on what this is really about? What was stressed was the need for ‘inclusivity’ in the discussions and framing of the model, in order for the outcome of inclusive growth to be achieved. This inclusivity is absolutely essential and yet in order to create buy-in, understanding and support from those who will benefit, as well as those who need to shuffle aside to make room, we have a complex concept to communicate. Here is where concrete policy measures can help; whether this is Youth Guarantee schemes as called for by Peter Matjašič, President of the European Youth Forum, which have kept youth unemployment down in those countries that have them, or policies that support, empower and include women, or indeed policies that strengthen public institutions and governance, implement fair taxation and bring social returns, these are concepts that can be communicated. The media will have an incredibly important role to ensure that these are communicated effectively, and civil society also in order to help build the political and social support necessary for change. We should  not underestimate the need for good communication and leadership – these will be paramount to successful take-up and implementation, and go some way to mitigate the disruptive nature of change towards what is in effect a new economic and social doctrine.

[i] Inclusive growth is described as a solution to the current unequal and unsustainable growth of our global economy. Inclusive growth in theory therefore would combine both prosperity and equity – an emerging model for growth (currently attempted by the Europe 2020 Strategy as well as other policy strategies such as India’s 12th Five Year Plan. The European Public Health Alliance published a critique of the Europe 2020 Strategy in relation to post-GDP in 2011.


Corporate lobbying in Brussels – plus ça change, plus c’est la même chose?

Posted by healthyeurope on 26/06/12

For the last 10 years or so, we have seen Brussels lobbists becoming increasingly professional, campaigns becoming cleverer and more intricate and ‘EU lobbying’ developing a flavour of its own separate from its Washington cousin, increasingly apparent when US colleagues descend upon us, demanding alien activities to enrage and excite the masses, and their European colleagues try to gently explain that a) we are more difficult to enrage and excite on this side of the Atlantic and b) we speak more than just English. Corporate lobbying has become increasingly organised, effective and pervasive.

So I, in all honesty, am as surprised as most to what appears to be winds of change about (albeit very gently ones, more a breeze really). The Chair of the European Food Safety Authority has just resigned (although rumours abound that she was very firmly pushed) with cries of conflict of interest , and the European Parliament has stretched its budgetary muscle and refused to sign off the accounts of three agencies – the European Food Safety Authority, the European Medicines Agency and the European Environment Agency amid concerns that they were too close to industry. Notably all those agencies work in fields where public health violently collides with industry interests. NGOs and others have been increasingly vocal about the relationship between industry and institutions, amid a flood of empowerment and concern following the financial sector scandals and lack of regulation.

So it is not surprising perhaps, that one Brussels-based organisation is following a very traditional path. The European Policy Centre disseminated a verbatim report of a meeting on nutrition. Ostensibly this should have been really interesting, for me and others interested in public health certainly as the topic covered was the role of education, regulation and personal choice in promoting better nutrition and health. However reading through the text, I was surprised – and then angry – to see the poorly veiled agenda running through (which made much more sense when I checked the EPC membership and saw the powerful business and industry interests that make up its membership: http://www.epc.eu/members_list.php).

First of all, the American academic speaking at the event seems to have focussed on blurring the relationship between sugar and obesity. Really, really? Even the British Telegraph – not the most well-known for its public health pieces – published a great article by Damian Thompson on refined sugar:http://www.telegraph.co.uk/foodanddrink/healthyeating/9275056/Why-cupcakes-are-the-new-cocaine.html. The public health science is firm and decided on this issue, so for the EPC, a respected Think Tank, to be giving voice to this nonsense is downright dangerous. No EU ‘experts’ available to peddle this line? Unsurprising, given that this amounts to the public health equivalent of  climate change scepticism.

Secondly, it appears that a representative of the European Federation of Bakers and Confectionary Organizations was given opportunity to wax lyrical on his thoughts on how to tackle obesity. Again, really, really? No one would dream of asking me how to make the perfect croissant (for good reason), so how is this valid public policy debate? Opinion, surely – and worth less than the man in the street, in that the man in the street does not stand to make his fortune by peddling delicious sticky treats.

In times when obesity is still on a par with climate change as one of the biggest challenges of our generation, when the cost of ‘added value’ goods is cheaper than the raw ingredients that make them, when we are seeing unprecedented rises in childhood obesity in countries – such as France, Italy, Greece and Spain – where good diets and good health were traditionally taken for granted, this opinion laden, public affairs exercise masking as serious policy debate is irresponsible, does not do justice to the hard work that many of its members and certainly many within the public health community are undertaking to change this disasterous trend, and I, for one, would have expected a more nuanced and hard-hitting debate from a heavy-weight like the EPC.

What is particularly interesting here is this unscientific positioning is actually far from what appears to be a public-interest trend: Member States appear to have suddenly rediscovered that they have a powerful behavioural tool at their disposal in the name of taxes – and proposals for so-called ‘sin’ taxes are popping up from Denmark (not surprising) to the Netherlands (simply astounding). Although the Netherlands seem to have forgotten (unlike most of their European compatriots) to include tobacco – nothing to do with the alleged links between the government and the tobacco industry surely… Not to mention Ireland, the Celtic Tiger is roaring once more but this time in protection of its population health! But still, these proposals – baby steps though they are – would have been unthinkable only a few years ago. Are the independent Brussels Think Tanks are finding themselves two steps behind the political wind, or does that ‘independence’ seem a little murky now that the policymakers are reminding themselves that they are as accountable to their human citizens as their corporate ones?


This is not just the time for better policies, this is a time for better politics.

Posted by healthyeurope on 22/06/12

I have experienced something of a revelation. My eureka moment was somewhat unexpected – coming as it did in the middle of a conference. Rarely do you expect to be moved, inspired and experience a moment of clarity on a topic that you think you know well.

Two weeks ago we held a conference on the impact of austerity on health and well-being. We heard powerful testimonies from doctors and nurses working to give essential care. We heard from Greece and Spain,  from epidemiologists and patients about the rise in suicides, HIV and the threat of diseases we thought had long left Europe, and also from the Ministry of Health in Germany on how they are working with colleagues in Greece to help cope. Many in the audience urged decision makers to remember why we fought hard for many years to build the welfare states that support human dignity, human development and act as a basis for a strong, stable society and economy. The International Monetary Fund patiently explained that they only provide recommendations on what to cut, looking at the overall numbers. How DG Economic and Monetary Affairs clearly spelled out that their own policies recommend maintaining support to essential services and investing in prevention to stave off long-term costs.

And how throughout the day the problem became glaring in two directions: the first is that this is being used as an ideological opportunity to bring in cuts to health and social spending from those who don’t understand that this is a false and dangerous game. And second, most important, that as the IMF does not see itself as leading policy decisions here, neither DG Ecfin neither, nor Germany or in fact any health ministries – then the question is who now is leading one of the most important moments of our generation…?

Then I became angry. The answer is glaringly obvious. 100 billion euros has been poured into Spain. Within hours the markets spooked. Today, talk is of yet more money needing to be found – paid out of the pockets of normal taxpayers, some of whom are in places like Poland, Estonia, Hungary which is absurd and wrong when you think about it. Who are these ‘markets’? Who has the right to take the power from legitimate, accountable governments? Who are these people leading our public policy spending decisions, in the most powerful block in the world? Overexcited detached and hedonistic men and women, driving fast cars and pocketing fat bonuses in London, Frankfurt and New York, whilst they gamble with lives, livelihoods and the hope and future of billions? Honestly? What. On. Earth. Are. We. Doing.

When our economies are based on speculation, and consumption, we are gambling with our societies and our futures. When our only strategy is to return to the unsustainable growth-driven, inequality-enducing policies of the last two decades, we are delusional and irresponsible. When there is growing evidence that inequality was a driver of our crisis, as with many crises before, the answer is glaring obvious: Equality and equity are our only way out. This is tough – a fairer tax base for both people and corporate citizens, policies that redistribute including education, support for children in poverty and those who cannot support themselves, more equality between men and women, including paying decent salaries to those parts of our economies such as the care sector that are fundamental to creating decent societies, parts of the economy that are dominated by women.

A society that pays young gamblers in the City more than those who choose to dedicate their life to serving and caring for others seems to me to be quite absurd. A society where 1 billion of us go to bed hungry, and another 1.4 billion are overweight and obese is immoral. A society where we look for the next big industrial bubble to fuel our unsustainable lifestyles and aspirations is just stupid. The economists were wrong. You do not need inequalities in order to develop. You need to get rid of them. Look to Sweden and those economies who are proving robust, resilient and still high on places where people are happy and well.

Stand up Mrs. Merkel, we are applaud your nerves of steel and unwavering sense of the urgent need to reform. Stand up Mr. Hollande and take the floor to show us that people are at the centre of political vision. Stand up Mr. Cameron and find your way back to the leadership role that the UK deserves. Stand up Mr. Van Rompuy, Mr. Barroso, and serve the people who hold you to account. Stand up editors and journalists, stop spreading fear and take up your role as challengers of power structures and failed policies. Hold your head high Ms. Beres, keep us focussed with your calm and compelling vision. We hear you Mr. Cercas, continue to inspire us with your powerful sense of justice.  We must stand up, those of us who serve others, and who believe that the value of our societies is those values that make life worth living – equity, solidarity, universality and justice. Let us create policies that defend and thrive on those values. Let us value those policies that in times of crisis allow the strong to support the weak, the rich to reach out to the poor and let us put hope, vision and leadership back into our political debates.

I was truly humbled by the sense of solidarity in the room on 6 June, the reinforcement and the manifestation of those values which makes European society great. Equity, solidarity, universality – the underpinning of welfare systems, to bring hope to people at times when life deals them a shoddy card, to keep the heads above water of people who work hard to support their families and give the children of our societies the best possible future. This is not just the time for better policies, this is a time for better politics. Leaders of Europe, give us the leadership that we deserve.

In memory of Sir Alexander Macara who died yesterday morning on 21 June 2012. Sandy you inspired, you led and you will be sorely missed.


Why I believe in Europe

Posted by healthyeurope on 28/03/12

Right now we are in the middle of what my political science Professors would have called a shift in the “world order”, a “change in paradigm” perhaps. A subject that is exciting from the sleepy hazy afternoons of a lecture theatre, where ambitious overgrown teenagers planned to change the world, but gets pretty destabilising when you are in the middle of one, as we are now.

Certainly in Europe, it feels a little bumpy. Job certainty: out the window. Food, energy and housing prices creeping up and a general sense of urgency, austerity and increased hardship. But in Syria, or many other places going through the “Arab Spring”, that dramatic, painful, tortured birth that is the process of  moving from autocracy to democracy, is far from “a little bumpy”.

But you see, I have been here before. For many of us Europeans, this seismic shift is not unfamiliar. Not as bloody as Syria, but equally as devasting for some, was the transition from communism to capitalism. It is easy to be complacent about the freedoms and the privilege that we experience and take for granted – we in the Western hemisphere in the 21 century.

Life in 1980s Poland was pretty good too. If you didn’t mind sanctions, food queues, the threat of military police, the fear that your neighbors were spying, the bureaucracy, monetary, and state control, and then things became terrifying with a new world, with new rules and without the familiar, ever-present state support. For many of us Europeans, the Second World War did not finish in 1945. It finished in 2004 when Europe was united once more.

Don’t get me wrong, ten years in Brussels and I can give you a list the length of my arm of things that I would like to work better in the “EU”, but my commitment to the project is unshaking.

60 years of peacetime in a land that had seen millennia of war. For the first time in history, we have had three generations born in peace, who have never experienced famine, who have been free to be educated, to own property, to enterprise, to control their fertility, to choose their partner, to have confidence in their children’s future. 500 million people, crossing languages, cultures, religions, coming together successfully to solve these basic human needs that we have struggled with since time began.

Together, we are stronger, in our diversity are united. War no longer threatens our continent and it is the European Union, its foibles, bureaucracy and stability that binds us in our security and human success. The challenges we face today are no less important, but I refuse to believe that our best days are behind us. This vision in worth fighting for, many millions lost their lives, many more worked hard to bring peace and prosperity to future generations.

Maybe our ails are the sign of age, but with age comes wisdom and perspective. And right now, Europe needs to get back up of her knees, hold her head high and remember that she is standing on the shoulders of men who dreamed of the end of war, famine and discrimination, and she carries is her arms the future. A future that is vulnerable, uncertain and absolutely worth fighting for.

The Master and the Machine

Posted by healthyeurope on 29/11/11

I was privileged to be able to attend the TEDxBrussels event last week in Brussels’ Bozar, where the speakers were thinking about the deep future. Putting aside the lack of Europeans and lack of women amongst the presenters, I was interested in how I found myself responding to them.

There was a brilliant presentation from someone who cares a lot about how cars function and how a self-driving car (which exists) operates using cameras etc, etc. My use of ‘etc etc’ shows just how much attention I paid to this part of his presentation. What interested me is how a self-driving car can change the way our societies are organised and function. You wouldn’t need to drive your children to school – just pop them in, set the programme and let the car go and come back. You wouldn’t need driving licenses; children could become more independent and with a greater range much earlier, for better and worse. Traffic accidents would be almost eliminated – therefore so would the vast demand on emergency services, health services. The leading cause of children’s death would be wiped out. The separation between ‘travel’ and ‘living’ could become wider  - special new roads – or narrower – a caravan-like existence where the car travels and you live inside. Public transport, public health and social behaviour would change forever.

What about the presumption that we will still need cars? Are we being conditioned into thinking about self-driving cars, rather than removing cars altogether? Is the world of tomorrow simply a tweaked version of the world of today, or can we really control our future? Are we merely the evolutionary tool that facilities a bio-techno-electro- future for life on our planet…?
That is what I would have been interested in hearing about. This made me think about how some of our priorities and ‘vision’ for Europe and whether we are putting the problem or the solution at the front of our thinking. How often do we put the technology (albeit IT, medicines, novel foods, consumer goods) before we put the problem that policy is supposed to be trying to address? How should we shape policy to make sure that the people are at the centre – before we end up with cities and landscapes dominated by self-driving infrastructure projects to allow our new cars on which to operate.
(By the way, all the presentations including a brilliant Paddy Ashdown on the future of Europe, the rise of China and other high politics – Churchillian and moving can be found online here: http://www.tedxbrussels.eu/2011/)
One final thing that struck me: the car still looked like a car. We need a Steve Jobs of the motoring world. Maybe we can find a female European one?