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Has global health lost it?

Has global health lost it?
www.thelancet.com Vol 393 March 9, 2019
Sometimes you need a shock to wake you up. Kishore Mahbubani’s short book, Has the West Lost it? (2018), is such a shock. The sheer concentrated force of this 91-page essay, written by a former Singaporean diplomat who is now Professor in the Practice of Public Policy at the National University of Singapore, is as unrelenting as it is astonishing. Mahbubani presents a mournful lamentation for the state of the western world. His arguments have devastating implications for the future of global health.
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The world has changed irreversibly, yet “the West refuses to accept or adapt to this new historical era”. A relatively recent and short period of western domination in global affairs is approaching its end. America and Europe are in rapid decline. The rest of the world is rising. This time of “global turbulence” means that the West “has to learn to share, even abandon” its existing assumptions of dominance. “The biggest gift the West gave the Rest was the power of reasoning.” And the Rest is now using that gift to reshape power and influence in the world through three silent and largely overlooked revolutions. First, many non-western governments understand that their legitimacy depends on being accountable to their people. Second, individuals in emerging non-western nations now believe they can take control of their own futures to improve their standards of living. They no longer need to depend on the imperial benevolence of the West. Third, the importation of western reasoning into non-western societies has fostered a new era of rational good governance. Paradoxically, while many western populations are losing confidence in their political systems, Asian levels of trust in government are increasing. Since the end of the Cold War, the West has indulged itself in crude triumphalism. It has misread world events. 9/11 was a desperate moment, but it was a distraction—“the most historically consequential event in 2001…was China’s entry into the World Trade Organization”. Western elites display little humility. They do not see that by 2050 the E7 (the Emerging 7: China, India, Brazil, Mexico, Russia, Indonesia, and Turkey) will make up 50% of global GDP, while the G7’s share will have shrunk to 20%. The West is enthralled by the spectacle of events but pays too little attention to trends. The West takes a too pessimistic view about the evolution of nations—“more and more countries are enjoying functional, instead of dysfunctional, governance… Modernity is seeping into all corners of the world”. Hubris, complacency, smugness, condescension, and a sense of superiority have blinded the West to the pace of global change. Our strategic errors are legion. Underestimating the importance of Islam as a religion and mistakenly intervening in Islamic countries are special concerns for Mahbubani. The way the West has addressed 1·5 billion Muslims has left Islamic communities believing “that the loss of Muslim lives did not matter to the West”. The continued expansion of NATO and the parallel humiliation of Russia are further strategic errors. The result of these accumulated mis-steps is that “The West has lost its way significantly in the past three decades…it needs a new strategy.”
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What does Mahbubani’s analysis mean for global health? First, western global health elites must reappraise their history. They must reflect on, understand, and come to terms with their colonial legacies, the consequences of their wars, and the adverse effects of their political and economic dominance. Second, based on that historical reappraisal, western approaches to global health must be radically rethought. We should be preparing for a near future in which centres of economic, political, and people power will shift from the West to the Rest. Third, strong and effective multilateral institutions will become increasingly important for managing this new world. The West should be investing in multilateral health institutions, ensuring that their leadership and governance is truly international (which currently it is not). Fourth, the hegemony of the white Anglo-American male in global health must come to an end. Finally, global health initiatives, processes, and events must prioritise voices outside the traditionally dominant western elites. It is painful to be confronted with the truth about yourself. It is painful to give up power and privilege. But for all those working in global health, it’s time we listened to Mahbubani. Because global health has indeed truly lost it.
Richard Horton

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