The Product of Systems

Who is in charge? Part 1.

The richest 1% of the world will soon have a greater share of the world’s wealth than the other 99%. With that eye-catcher of a stat, Oxfam launched a report and a discussion on extreme global inequality. Great stuff. Do not let the quibbling distract you. This is a street child face down on a busy sidewalk in a pool of excrement. Trust your gut: imbalance on this scale is inherently and dramatically wrong. The only debate should be which is worse – what this says about wealth distribution or what this says about power.

But what if I told you that I just read about a place where the richest few control 99.8% of the wealth? Not 48%, as Oxfam’s report denounces, but the whole enchilada? Ninety-nine point eight percent represents an astounding achievement in disparity. Can you guess where? No, not mega-corrupt states like Angola or Equatorial Guinea. No, not the petrol-rich like Qatar or Bahrain. No, not even Mark Zuckerberg’s family. Give up?

The surprise winner of the award for the most inequitable distribution of wealth and control on the planet is none other than us, the ensemble of humanitarian NGOs. Congrats to the likes of MSF and Save and (of course) Oxfam. Here’s Development Initiative’s excellent financial analysis of the humanitarian system (see p. 55ff): National and local NGOs form an essential part of the humanitarian response, but in 2013 only directly received US$49 million – just 0.2% of the total international humanitarian response. That’s US$49M out of about $2.3 billion hitting NGO coffers worldwide.

You can quibble with that figure – it’s not counting indirect flows to national NGOs – but my advice is to trust your gut. Eat your heart out, Donald Trump.

Who is in charge? Part 2

Bill Gates talks solutions. Bill Gates is right. Bill Gates calling for “germ games”. Bill Gates is all over my Twitter feed.

Gates has published an Op-Ed in the New York Times, an article in the New England Medical Journal and done a lot of media work to proclaim that good old human “ingenuity and innovation” can avoid the next Ebola disaster.

Gates makes sense, of course, calling for the development of vaccines, for better surveillance, for a global logistical and medical epidemic response capacity. Gates’ central point, though, is only half correct, and therein lies the flaw in his cunning plan. Gates claims (NYT piece): The problem isn’t so much that the system didn’t work well enough. The problem is that we hardly have a system at all.

Really? Is it that the system doesn’t exist? Or is it that the non-system of epidemic response is the direct product of another system, a highly inequitable international system of interests and power that does not typically place the public good as its paramount ambition? In other words, the very same international system upon whom Gates calls to act.

On one level, Gates forgets what happens to good ideas when their basis for attention and funding is fear and insecurity. What happens when you employ scaremongering to mobilize politicians and Western publics into funding better healthcare systems for the world? My guess: skewed priorities (epidemiological surveillance trumps maternal mortality) and unforeseen consequences, like helping to justify military expansion into global health and humanitarian action. It has not exactly served the lofty goals of international development to have become an integral tool in the global war on terror.

Most importantly, though, Gates seems to be addressing symptoms, not causes. In calling for an international epidemic response system, Gates essentially advocates the same superpower and global institutional approach that helped deliver WHO’s ineffectiveness, Sierra Leone’s woefully inadequate healthcare, or an Ebola response in West Africa that was too late, too slow and too focused on staunching the Westward flow of Ebola rather than healing those who already had it.

Bill Gates outlines a system the world needs to build. Dead right. Now he needs to outline the world that will build it, because he is silent on the need for changes in the way global institutions are conceived, controlled and built in the first place.

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