Saturday, May 12, 2012

THE HEALTH OF NATIONS*


Gavin Mooney’s book launch

May 7th 2012

It is my personal and professional pleasure to launch Gavin Mooney’s new book The Health of Nations this evening. Personal, because my friendship with Gavin extends over 20 years and I have benefitted as many here this evening have from his loyalty and support and his commitment to notions of social justice, a commitment that inspires and energises and shakes us up, moves us along, and reminds us repeatedly and firmly of the higher purposes of our work. 

It is also a professional pleasure because Gavin is a leading contributor to the debate about the social significance of economic and political positions and how these contribute to, or perturb, human flourishing including health. He is especially concerned about policies that make worse the extent and effects of poverty and inequality and is a trenchant critic of political, economic and social movements and forces that overlook the serious and damaging side-effects of their pursuit of the neoliberal agenda. ‘To me,’ Gavin writes, ‘social justice is central to public health.’ That is the nub of his argument, his values and his professional life.

It is fortunate that Gavin does not hide his light under a bushel, because if he did the bushel would quickly erupt in flames. There is chutzpah in his naming his new book The Health of Nations in line with Adam Smith’s The Wealth of Nations published in 1776. Smith, of course, was also a Scot and I can imagine that conversations between Mooney and Smith would be lively, especially if lubricated by an ale or two.

For example, while Mooney and Smith may well have joined voices to attack groups – the factions as they were called – of politically aligned individuals who attempt to use their collective influence to manipulate the government into doing their bidding, including bankers and other commercial conglomerates, and today pharmaceutical companies and the AMA, they may have parted company over Smith’s distaste for guilds, forerunners of unions, that brought together workers. Smith wrote:

"People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices. It is impossible indeed to prevent such meetings, by any law which either could be executed, or would be consistent with liberty and justice. But though the law cannot hinder people of the same trade from sometimes assembling together, it ought to do nothing to facilitate such assemblies; much less to render them necessary." 

Yet this is the same Smith who wrote in The Theory of Moral Sentiments: “How selfish soever man may be supposed, there are evidently some principles in his nature which interest him in the fortune of others and render their happiness necessary to him though he derives nothing from it except the pleasure of seeing it.” Indeed, as the Concise Encyclopaedia of Economics tells us: “In fact, while chair at the University of Glasgow, Smith’s lecture subjects, in order of preference, were natural theology, ethics, jurisprudence, and economics, according to John Millar, Smith’s pupil at the time.” Indeed, Smith was painfully aware of global inequalities and looked forward to a day when an "equality of courage and force" would lead all nations into a "respect for the rights of one another."

So Smith’s statement would not have finished the debate. Mooney would have responded to Smith’s notions of capitalism with a clear and strong exposition as in his book of deliberative democracy. And so the dialectic among these two Scots would have flowed – energetic, constructive, and fierce – in pursuit of social betterment but just maybe they would not have come to blows.

There is more to the comparison of Smith’s and Mooney’s work, though. Think of the context for Smith’s book. When Smith wrote he attacked the contemporary Feudalist bureaucracy and philosophy, convinced that Feudalism’s controls over the European economies was stifling and that capitalism might offer a new path forward not only for the creation of wealth for a few but also for those many trapped in serfdom. In other words, his was a critique of a prevailing political economy that held people and nations in an exploitative thrall. This has strong parallels with Gavin’s trenchant attack on contemporary neoliberalism.

Gavin’s book concentrates its criticism of macroeconomic and global economic systems on the political economy of neoliberalism, a form of economic thinking and acting that reifies the individual and the market and “breeds inequality and individualism and discourages a sense of community and feelings of compassion.” It is the expression of neoliberalism in case studies of countries, corporations, governments and professions that is the major work of Gavin’s book. Nothing much escapes his criticism and none of us gets away – to coin a phrase – Scot free.

To balance this critique, in examining countries and states including Cuba, Kerala and especially Venezuela, Gavin explores positive alternatives to the prevailing neoliberal political economy where health and health systems thrive. I am not sure that I would have chosen Venezuela as a good example, even less claim for it as Gavin does that it is “the closest model that I can find to a working example of what my paradigm would point towards.” Its IMR of 17 or 20, depending on whose stats you read, puts it alongside Libya and Uzbekistan and interestingly has been declining smoothly since 1960 when it was 60, without the slightest ripple attributable to oil crises, coups, dictatorships, Charvez’ thumbing his nose at the US and at organised medicine or any other notable political or social event. Closer to home, examples of constructive deliberative democracy including citizens’ juries are also explored in Gavin’s book.

Fundamentally, however, this is a pathology text, indicating to us where things have gone wrong and what the nature and mechanism of disordered politics and economics really are and what distress they cause. We do not look to textbooks of pathology for therapeutic solutions, and it would be inappropriate to expect that political remedies to the problems of neoliberalism should abound in a book such as The Health of Nations. We are left needing to work out what if anything can be done.

We need greater clarity about the way in which, through political action, we can move our society more toward a communitarian future. The strategy should include what needs to be done through advocacy, what needs to be done by new institutional instruments such as new political parties, what needs to be done to garner grass roots support and where we might find the money necessary to make this all happen. All this we may hope to find in Gavin's next book. We need to know what we, as individuals, can do.

Is there a historical inevitability about neoliberalism that is beyond the capacity of international institutions, nations and individuals to solve? Do we just need to sit and wait until disaster strikes?

Perhaps not. Gavin adduces the example of the breadth and depth of community concern over climate change, another consequence of the same political economy in Gavin’s estimate, to argue that all is not necessarily lost or inevitable, that ordinary people, once energised and informed, can push for local, national and global change, even though the effort takes much energy and time. We can occupy Wall Street.

Jeffrey Sachs, from the Earth Institute at Columbia University and another economist and grand campaigner against global poverty and ill health although not of the Mooney stripe, ended his 2007 Reith Lectures that were an exposition of the crises of global poverty, inequality and unsustainability with a call to his audience to abandon cynicism in favour of engagement.

You must be the peacemakers, development specialists, ecologists, all.” He said. “Do not lose heart. Remember, as John Kennedy told us, "our problems are manmade - therefore they can be solved by men [and women]." And remember what his brother Robert Kennedy reminded us.

It is from numberless diverse acts of courage and belief that human history is shaped. Each time a person stands up for an ideal, or acts to improve the lot of others, or strikes out against an injustice, he [or she] sends forward a tiny ripple of hope, and crossing each other from a million different centres of energy and daring, those ripples build a current which can sweep down the mightiest walls of oppression and resistance.”

Grand speaking indeed, envisioning a collage of individual commitment, a new painting of community action. Gavin Mooney has urged us to return the formation and oversight of health policy to our communities and the citizens that comprise them realising that they – the communities and their citizens – are the ones we serve in health care when we do it best. That is a challenge indeed, but one that can be met, perhaps more easily and effectively in Australia than in many other countries.

Gavin, we are grateful to you for you scholarship, courage, insight, challenge and wisdom manifest in The Health of Nations and I am pleased to launch it on its journey.

*Speech from Gavin Mooney's book launch

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