A revolution in mindsets: How not to critique the World Health Organisation leadership contest

One of my most treasured possessions is a four volume set of Orwell’s collected essays, journalism and letters. It is a Penguin 1984 reprint and I remember collecting each of the volumes separately over the course of two years from second hand book shops. Volume four (the cover of which you can see above) includes Orwell’s famous essay ‘Politics and the English Language‘, perhaps the single most influential piece of writing I’ve ever read. I really wish Mukesh Kapila, Professor of Global Health and Humanitarian Affairs at the University of Manchester had read it too. His recent comment in the Guardian ‘We need a revolution in mindsets at the top of the World Health Organisation‘ might never have been written if he had.

In his essay, Orwell describes a number of “swindles and perversions” that plague the English language, including what he calls “dying metaphors”. I’m being kind when I describe “a revolution in mindsets” a dying metaphor: it is much worse than that. The phrase sounds like it has meaning, but it doesn’t. What is a mindset? A mind set, fixed, a fixed idea, a category of mind? No, I’m stumped. Wonder what my Mac dictionary has to say on the matter – hmmm, no entry. Ok, let’s search google Chambers. Ah, there we have it, mindset. The metaphor is, literally, a strikethrough.

Whatever mindsets are, according to Kapila we need a revolution in them. What, all of them? All of the mindsets? Yes, and a revolution at the top, the very top, of the World Health Organisation. You mean the Director General? You’re talking about a revolution in the mindset of the DG?

Look Kapila, you already know who the candidates for the next DG are. Do they have the requisite mental acuity or not? Look at their CVs, listen to their speeches, read their text. Then decide whether they have that revolution of mindsets or not. But that’s not what you’re actually saying, is it Kapila? What you really want to say is, we need the mindsets at the top of the WHO to listen to me, Professor Kupesh Kapila. That’s fine, of course, but have the courage to come out and say that instead of hiding behind the collective pronoun “we” – who is we?

But enough of the title of the article, what of the substance? Kabila writes:

“The irony is that never has medical science been so productive and yet health inequalities so wide. That is why continuing to do more of the same is not an option. While extra funding is always welcome, much more necessary is a revolution in mind-sets and attitudes. This means organisational innovation to drive universal health coverage, foster collaboration, strengthen national health capacities, and forge partnerships that respect health as a fundamental human right”.

I always find it helps to begin an argument with a fallacy. So does Kapila: “Medical science has never been so productive and yet health inequalities have never been wider”. Outrageous! Well, not really: scientific productivity is no guarantor of equality. Consider, for example, how much R&D is devoted to male pattern baldness or erectile dysfunction. No, don’t Google it! You’ll get distracted with erect…see!

Furthermore, this inability to channel the fruits of medical science productivity to resolve health inequality has festered under the leadership of the current WHO DG. Whatever Chan’s been doing, it’s done nothing to reduce the health inequality gap even when science has been so productive! Which is why “continuing to do more of the same is not an option”. It remains unstated precisely what needs to stop in order to re-align scientific productivity and health equality, but there’s no doubt about what needs to start: innovation, collaboration, partnership. In other words, more of the same!

And what was Kapila saying about the money?  Oh yes, “while extra funding is always welcome…” After all, the WHO’s annual budget (approx $2bn) is less than many U.S hospitals, so a few extra swiss francs really wouldn’t go amiss. If only member states hadn’t “financially starved WHO because they don’t trust it, or…bypassed it by creating other international organisations that do higher quality health work”. Presumably because those organisations are adequately funded? Contrast the light, playful tone of the “always welcome” with the brutality of starvation. If x had actually been starved, would one press for more food quite so matter-of-factly? X starved: extra bread would have been welcome.

Some WHO experts downplay the significance of additional funding: “The WHO’s problem is not inadequate income. Rather, it is the imbalance between what member states, through the governing bodies, and voluntary contributors (including member states), through separate agreements, ask the WHO to do” (Charles Clift 2014, p. x). Personally, I would replace Clift’s “rather” with “and”. So would clever people like Larry Gostin – more eloquently of course: “Whatever the formula, there is little doubt that the WHO will never reach its potential unless members ensure that financing is predictable, sustainable, and scalable to global health needs” (Gostin, 2014, p125).

Its not my intention to traduce Kapila. Look him up – he’s quite eminent. But it does frustrate me when people at the top of my profession write so poorly. Orwell wrote Politics and the English Language in 1946. His sample of writing identified two common traits “quite apart from avoidable ugliness”: “staleness of imagery” and “lack of precision”. He continues:

“The writer either has a meaning and cannot express it, or he inadvertently says something else, or he is almost indifferent as to whether his words mean anything or not. This mixture of vagueness and sheer incompetence is the most marked characteristic of modern English prose, and especially of any kind of political writing” (Orwell, 1984, p159).

That was true seventy years ago. What would Orwell make of the political writing today?



Published by andrew

Categories: WHO

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