By Kristof Decoster and Radhika Arora from the Emerging Voices for Global Health Thematic Working Group of Health Systems Global
Young people see the ample opportunities of a world without borders. They are, by and large, in favour of globalisation, but not, by and large, of the way globalisation has taken shape in recent decades, aka ‘the neoliberal blueprint for globalisation’. What Brexit has brought to the fore, beyond anything else, is the need for radical and transformative change.
One thing that Brexit made very clear is that young people do not want to shy away from being part of a global community. This is no truer than with our young health policy and health systems academics navigating the very complex world we live in.
Challenging the neoliberal status quo
Mainstream global health tends to focus on ‘global health security’ and building ‘resilient’ health systems, especially in the wake of Ebola and other ongoing infectious diseases crises. One significant factor, amongst many, are the legacies of policies and practices of the 80s and 90s, including adjustments and reforms pushed as conditions of aid, inspired by leaders like Ronald Reagan and Margaret Thatcher. They have resulted in the decimation of public services in the most affected countries, including health systems. Yet, as we face the ramifications of Brexit, the focus remains to be less about challenging of the structure of inequity that allows these crises to flourish, but just to maintain the status quo within the existing structure than daring to dream about a better world. These young health researchers are challenging the hegemonic language and discourse, and pushing for change of the very structure of the world we live in.
Young people all over the world want real change, whether we’re talking about Greece or Spain where youth unemployment has been skyrocketing due to austerity policies (and plenty of young people wanted ‘real’ change of the EU, but so far with little luck), or the US and UK where young people also call for ‘change’, by supporting leaders in the form of Bernie Sanders and Jeremy Corbyn, respectively, in spite of their grey hair!
Understanding that health is political
These are tricky times, we live in a world where events and crises will often have huge ripple effects and ramifications. For young health policy and systems researchers in particular, it will be key to not only understand the intertwined and complex challenges that come with these, but also to navigate an environment where much global, regional and national health policy is increasingly connected, and coordinated by global organisations, as well as thoroughly political.
Health has always been political. But there are some key global health issues of the twenty first century like the increasing resistance to antibiotics; the growing burden of non-communicable diseases which are well and truly exacerbated by the exploitation by global food, tobacco, soft drink and alcohol industries, or climate change which has an impact on our ‘planetary health’. These challenges are inherently political, as the capacity of addressing these challenges is based on a system of inequality, both in developing countries, and in developed countries. The challenge for our young health researchers is not only to understand, but to find a way to challenge and overcome the vested interests involved.
Misinformation at the crossroads
Much of the action around the Brexit referendum pointed in the direction that people are increasingly going beyond facts and evidence to paint a picture of supposed reality. In fact, this approach of misinformation is gaining more and more currency. The rise of populists like Trump, Le Pen and many others shows this is a trend in former democratic strongholds. To quote, Martin McKee, professor of European Public Health at the London School of Hygiene and Tropical Medicine “Evidence and understanding of the issues are clearly not enough in what is being described as a ‘post-fact society’ where the ‘the very idea of objective reality is under attack.’ This is a profound challenge to the very idea of science. The research community needs to come up with a response, and quickly.”
The world finds itself at a dangerous crossroads, and it will take time to arrive at a new equilibrium. There’s a danger this could become downright ugly, with rising xenophobia, endless walls, and a new ‘security’ rhetoric where ‘development’ is code for ‘stopping migration at all cost’. This could be instead of global solidarity and multilateralism which are urgently needed to tackle the many global challenges which can no longer be dealt with in isolation.
You don’t need to convince most young health policy and systems researchers of the importance of this moment in time. What do we do now? Do we need to tactically retreat, for some years, to first let populists push the self-destruct button, showcasing their (often complete) lack of a plan and insane ‘policies’, and then come back with a vengeance?
These very discussions will shape the conversations in Vancouver at the Health Systems Research Symposium in November. The Emerging Voices for Global Health Thematic Working Group, as part of Health Systems Global, very much represent these young health researchers, and there is no doubt that they are impatient. They don’t want to wait and bide their time. Brexit shows us that despite the overwhelming call from young people to stay within Europe, it was not enough. We need to face the challenges here and now and many young people, more than others perhaps know that time is running out.