Thinking Globally

It's an artificial occasion, but then again, most occasions are artificial. With about 1,000 days to go until the target date for the UN's Millennium Development goals, the organization is making a marketing push and they are getting some attention. Not in the United States, of course, where people generally don't give a rat's ass about the rest of the world. But BMJ, among other durn furriners, has marked the occasion with a couple of commentaries.

Charles Kenney of the Center for Global Development  considers what new set of goals should be established once the 2015 target has passed. Summarizing progress so far, we have already "halved the proportion of people living on less than $1.25 a day," we're basically on the way toward getting as many girls into school as boys (with exceptions, obviously), and lives of slum dwellers have been improved in accordance with the goal. We aren't doing so well in other areas. More than 15% of people in poor countries are still malnourished, gender equity aside 10% of children still don't get enrolled in primary school, mortality among children under 5 has fallen but remains at more than 6%, and maternal deaths have not fallen enough either. Results with HIV are mixed, with declining incidence but prevalence still rising and many people not being treated.

A lot of the progress, particularly on poverty, is actually attributable to strong economic growth in China and India. Sub-Saharan Africa in particular hasn't done so well. Supporting public health and health care through international aid can be effective, but it isn't sustainable. Rich country support has fallen, due to both economic and political conditions. But in the long run, countries that are now poor will have to develop sustainable, indigenous infrastructure. Done wrong, foreign aid is indeed a recipe for corruption, waste and dependency. (Viz Afghanistan, also one of the exceptions when it comes to gender equity in education.)

But, more profoundly, as David Legge and David Sanders remind us in the same issue, focusing on outcomes really misses the target. "As well as the health crisis (untreated AIDS, escalating tuberculosis, avoidable child and maternal deaths), humanity faces a more complex set of global crises, including global warming, financial instability, food insecurity, an unsustainable population, and environmental degradation." They credit the People's Health Movement with arguing that "the post-2015 development agenda will need to confront the underlying dynamics that are driving widening inequality, creating avoidable suffering, and accelerating global warming."

As I argued in my master's thesis too long ago to mention, the ideology of progress stands in the way of our honestly confronting our situation. We think that we are much wiser, and more powerful, and better off than our ancestors, and that with a few fits and starts, human history has been an upward trajectory. Not so: we have lost as much as we have gained. We invent technologies to solve problems and enrich ourselves in our current social and physical context, but  in doing so we inevitably create changed contexts that confront us with new problems for which the solutions, in turn, create their own harmful side effects and new challenges. We are like a patient who takes a drug , then another to combat its side effects, then another to combat the side effects of the second, and on and on, but without cure.

Powerful elites, of course, stand in the way of correct diagnosis because they have so much to lose. But so do we all, if we cannot see through to the heart of our problems.