By Anupam Saraph*
Last week I attended a webinar on “India, COVID-19 and Global Health Governance” at the National University of Singapore. It reinforced my observation that the idea of flattening the curve had exposed that almost none of the countries had hospital capacity to deal with the high incidence of the disease. They all needed time to even provide protective equipment to the medical staff in hospitals. What was hard hitting was that COVID-19 also exposed that the countries that had privatized their health had been amongst the worst hit.
Public health ceases to be a concern when individuals seek health services as an individual purpose and health professionals seek to deliver individual health for a price to maximize profit. Matters become more complex when insurance steps in to cover the growing costs of health.
In systemsspeak we would say that the actors participating in a privatized health system have not come together for a common purpose. The purpose of those afflicted is different from the health workers or from the purpose of the insurers. The system is not symbiotic. It is exploitative.
I am reminded of the mission statement that management guru, Peter Drucker, formulated for a missionary hospital in the United States. Asked to help with formulating a mission, Drucker asked the hospital trustees for time to talk to the actors in the system. After a few weeks he told the trustees he was ready to talk to them about the mission of the hospital. He requested the trustees to share their ideas about what their mission should be. The trustees came up with different responses. “We will be the largest hospital”. “We will be number 1 hospital in the region”. “We will have state of the art facilities”. “We will have the best doctors”. “We will provide 5-star service”. “We will provide cashless care”. They went on with more ideas for the hospital.
Finally, Peter Drucker got up and asked who the hospital served. There was pin drop silence. Drucker continued, “the only need of the afflicted that you can serve is to provide assurance to those afflicted”. Drucker’s insight was to find the common purpose that got the afflicted and the hospital together. By formulating the mission to serve the common purpose, he was helping create a symbiotic system, not an exploitative one.
Our health systems no longer serve any common purpose. Private hospitals, insurance companies, medical suppliers and pharmaceuticals do not serve to provide assurance to the afflicted. They serve their own private purposes. Purposes that put them in conflict with the common purpose of those afflicted and the other actors in the system. Purposes that put them in conflict with public health.
In their attempt to flatten the curve, our governance systems have exposed their failure to protect us from the mushrooming private hospitals, insurance companies, medical suppliers, pharmaceuticals that have eroded the creation of a resilient and sustainable public health system. They have exposed their failure to understand, recognize and protect common purposes and public interest.
Governance systems exist to ensure common purposes of actors participating in the various systems they participate in. Only when they do that, they can protect fairness, dignity, liberty, and equality of the actors participating in the systems. When governance systems fail to recognize the absence of common purposes in systems, or the mushrooming of private purposes that are at conflict with the common purpose of a system, they cease to serve any useful common purpose. They cease to serve the common purpose of the participating actors to provide free, fair, dignified systems to the participating actors.
Governance structures that continue to insist on protecting and recreating exploitative systems, promoting, or protecting actors who have private or exploitative purposes in public systems, have outlived their public utility.
Full or partial lockdown measures are now affecting almost 2.7 billion workers across the world, representing around 81 percent of the world’s workforce. The International Labor Organization (ILO) estimates that 1.25 billion workers, representing almost 38 percent of the global workforce, are employed in sectors that are now facing a severe decline in output and a high risk of workforce displacement. Businesses across a range of economic sectors are facing catastrophic losses, which threaten their operations and solvency.
Stock markets across the world have lost trillions of dollars causing the wealth of the worlds corporations to evaporate in days. This means the liquidity and money flows of the financial world have suddenly disappeared. Many businesses have sung their last song, folded, and vanished into history.
Most of the market driven supply chains delivering services and goods across the world suddenly failed to ensure that we have the services or goods accessible to us. Even the essential medical services, medicines, food, water, and sanitation became no longer accessible. They exposed themselves as serving purposes other than a common purpose of all the actors of their systems.
Not only have our market systems failed, so have our governance systems. If civilization must protect the Short Now, the lifetime of the child born today, it will have to reinvent governance to further our common interests, not our private profits. Our governance systems have responded with allocation of funds to restore “normalcy” instead of identifying and protecting the common purposes of people in communities.
You have the power to refuse to be part of exploitative systems. You have the power to insist on common purposes for the new systems we will be called to be part of. COVID-19 has provided civilization with a once only opportunity. An opportunity to reinvent itself based on the principles of symbiosis, not parasitism and exploitation. We are at a defining moment where history will remember us as the people who took or missed an opportunity to be worthy of the name homo sapiens, the wise one. Our choice will decide if humans will find themselves among the dinosaurs who became too large for the planet or the bacteria that continue to thrive symbiotically with other life forms.
Dr. Anupam Saraph is recognized as a global expert on complex systems. As a Professor of Sustainability and Governance of Complex Systems, Dr. Saraph, has taught System Dynamics, information systems, environmental systems and sustainable development at universities in Europe, Asia and the Americas. He has worked extensively with Donella Meadows on global modelling and systems theories. He holds a PhD in designing and exploring sustainable systems from the faculty of Mathematics and Natural Sciences of the Rijksuniversiteit Groningen, the Netherlands. He is based in Pune, India.