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[Comment] Offline: Facts are not enough

Tags: General

We are in the midst of a struggle. A struggle for the soul of global health. On one side, the intelligent idealists. Those who sincerely believe that by describing the world in ever more refined and precise ways we will advance closer to an elusive truth. A truth that will unlock the extraordinary potential that is global health. The Global Burden of Disease is the divine apotheosis of intelligent idealists. And universal health coverage their Garden of Eden. On the other side of this struggle, the innocent cynics. Those who anticipate the worst, cast scorn on the idealism of their rivals, and are contemptuous of the complacency of much of global health today. The innocent cynics are convinced that people must change their lives utterly. They are moral preachers who live by moral example. They long for a life more attuned to the natural systems of the world. As advocates and activists, intelligent idealists see disease, disability, and risk as a trinity of danger to be controlled and defeated. Innocent cynics, by contrast, see their task as reimagining the meaning of health. Removing the idea of health from the clinic and resituating it in society, in Nature. It's unclear who will win this struggle. But, make no mistake, it is a struggle whose resolution—and reconciliation—will define the trajectory for the survival of our species.

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In resolving this struggle, we must ask questions usually considered outside the scope of international health. A Public Health Emergency of International Concern gives us a unique opportunity. First, what are the supreme guiding values of global health? Hitherto, the answer has been equity. But, as we have seen from China's efforts to contain COVID-19, perhaps we should consider liberty an equally fundamental value. Without liberty of expression—for health workers, policy makers, the public, and media—there is no means to forge a common view about the future (including the future health) of a society. Second, how important is the political system for health? Global health is typically agnostic about the kind of political system a country chooses to adopt. Global health and its institutions see health systems as separate—technically, socially, economically—from the political ideologies of nations. This view is not sustainable. We cannot say that the terms of political engagement within a country are irrelevant to our hopes for health. Third, what is prosperity? Conventionally, prosperity means monetary wealth. But could we redefine prosperity to mean something else, something more? Prosperity as the wellbeing of the community in synchrony with its environment. Fourth, how should we consider the place of the human body in society? How do we better connect the social to the biological? How do we incorporate the world in which we live into our biological selves? Our bodies and the illnesses they express tell stories about our lives. Our task is to uncover those stories and to link them back to our bodies and our health. Fifth, what do we mean by health anyway? Whatever we say about the absence of disease or a state of complete wellbeing, the idea of health is also related to our sense of what our lives have been and what they might be in the future. Isn't health contingent on the purpose we envision for our life, and the possibilities we have for enacting that purpose? In other words, isn't health also about our capacity to achieve meaning in our lives?

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The next 30 years will bring dramatic changes to the conditions for health. In the Anthropocene, increasingly dysfunctional Earth systems—land, water, climate. A broken food system that is driving a double burden of malnutrition. Progressive erosion of health from predatory commercial practices. Population shifts—extraordinary increases and declines, urbanisation, and accelerating migration. Gathering recognition of the intersection between an array of inequalities—from gender to class, ethnicity to education, mental to physical health. An appreciation of the linkages between animal and human health. And a new word: infodemics. Epidemics of misinformation that limit, inhibit, and retard responses to health threats. These forces are among the complex coordinates that frame the struggle between intelligent idealists and innocent cynics. If we are to protect the gains we have made, we will have to look at health and the meaning of health from a different perspective. The courage to make that radical positional shift is our greatest challenge of all.

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