by HealthWrights Staff

Values Oriented Pragmatism: The article “You Can't Turn Back the Dawn.” suggests that a healthy globalization must begin with seeking a broad consensus with regard to those values most thinking and sensitive people affirm. Building on this consensus, we can then find practical ways of working toward implementing those values in the local and the global structures that are currently emerging in the world today. The philosophy of “values oriented pragmatism” that is developed in that paper suggests that many of the difficulties we face derive from our adherence to rigid ideologies that tend to divide us into mutually hostile camps and block creative problem solving.

Hope: A healthy globalization is possible. In the face of obstacles and forces that seem overwhelming, it is important that we not give up hope. True, if we project the future as a straight forward continuation of the present, the situation looks bleak indeed. It is only natural to fear that we might get to where it appears we are headed. But history is full of sudden and unexpected twists and turn-arounds. We are advocating for a rapid and intentional evolution of human consciousness and cooperation. It is reasonable to hope that the spirit of the universe is on our side. In any case, we are not alone. We have each other, and we must sustain each other in hope.

Compassion: When we think about the politics of health, we think about technological know-how and hardware, and about the politics that will make this know-how and hardware available to the people who need it. Certainly political action, medicines, sophisticated equipment and medical expertise are all important. But the ultimate springboard for creating a more healthy world is to be found neither in technology nor in political strategy, but in compassion. This is the message that is powerfully brought home by David Werner in his article, “What We Learned From Maria.”

Visualizing a Third Way: Our chances of achieving a desirable future are greatly enhanced by a clear vision of what that future might look like. Are there models that have already been implemented that will shed light on our future path? The answer is probably both no and yes. The future will look like nothing we have ever known. It will be shaped by innovations and creative events that we can’t possibly anticipate. We should be open to these creative events, and celebrate them when they occur. Even so, the future does build on the past, and it certainly makes sense to look at what has already worked well for clues as to what is worth carrying forward. In “Sweden: A Third Way” it is argued that we do, in fact have a useful model. Certainly the Swedish system suffered from flaws and errors, just as any human creation does. But Swedish society has probably come as close to providing its people with the possibility of healthy and fulfilled lives as any society on the planet. We do have something to learn from this. Perhaps the major lesson has to do with the need to globalize all the factors needed for a healthy society. At present only the market is being fully globalized. We need also to globalize the power of labor, a system of law, and a large public sector that assures the basic material, health, and educational needs of all the citizens of the Earth. And finally, as Julian Hewitt suggests in his article, `The Ubuntu' of globalization' , we need to globalize our sense of citizenship and care. In short, we need more, not less globalization.

Common Values: In broad outline, we find a lot of agreement across the political spectrum as to the values that should guide a healthy globalization. Few believe that it is OK for children to die from diseases that are easily cured or prevented. Most people do not believe that it is healthy for a hugely disproportionate amount of wealth and power to be concentrated in the hands of a very small elite, while the majority are disempowered and live in poverty. Most people believe that people should be free to pursue their own happiness in their own ways so long as they do not infringe on the rights of others. Honest differences of opinion may exist as to the best strategies for achieving the goals of health, civil liberties, opportunity, and well-being for all people, but if we can clearly articulate a set of values to which most of us can subscribe, we have a foundation upon which to build. That we can establish such a foundation is a cause for hope.

The Power of Truth: Obviously, being able to articulate a common set of values does not solve all the problems. Eloquent political rhetoric is frequently a smoke screen for a set of less noble agendas. Indeed, almost every collective atrocity one can name has been justified by appeals to righteousness, purity, patriotism and other high sounding ideals. Nevertheless, it is significant that when a government or political group chooses to deviate from those human values that people all over the world collectively affirm, the deviation can only be maintained by a deliberate miss-representation of reality. Truth is power. It needs only a forum from which to be heard. Public opinion is power. The deceit, lies and more subtle forms of dissimilation by which inhuman policies are justified and facilitated can be exposed. Our leaders can be held accountable to policies that really do further those values to which they give lip service. Aggressive and effective non-violent action in the service of human health and well-being is possible.

The Threat of Empire:

A healthy society is a democratic society. One of the great ironies of modern history is that the very country that has prided itself on its commitment to democracy, and that has often been a model for other counties, now stands in the way of a globalized democracy of nations. The United States has chosen to set itself up as the head of a world empire. This is incompatible with the values that have been central to the nation’s sense of identity from the time of its birth..

Control From the Bottom Up:

Democracy requires a balance between local, national and global levels of control, with an emphasis on bottom-up control. If we are deeply committed to the principles of democracy, we will find it necessary to insist that all the organizations and bureaucracies within which people live, work and grow be guided by democratic principles. In fact, in almost all societies, most institutions are rigidly hierarchical, and opposed to the spirit of democracy and self determination. Perhaps it might be useful to think of the various social structures within which we live as being on a continuum – from the highly authoritarian organizations Erving Goffman described as “total institutions” at the one end to highly participatory social structures at the other.

Wealth and Democracy:

All the forms of democracy may be in place, but if the reality is that only very wealthy people have a chance of being elected, then one can reasonably expect that the policies of the elected officials will favor the rich. This bias for the rich will cause state and national legislators to put health and welfare needs of the poor on the back burner, if they remain on the stove at all.

The Undermining of the Right to Universal Health Care:

In 1978 the United Nations drafted the Alma Ata Declaration, an excellent statement that affirmed access to basic health care as a universal right. In order to understand why the ideals of the Alma Ata declaration have been so poorly realized in the world today one has to look at the impact of the Bretton Woods institutions.

People Before Profits:

If we are going to make basic health services available to everybody it will be necessary to put people before profits. The Politics of Aids provides a good illustration of this important point.

Full cost accounting:

When left to their own devices, businesses will invariably attempt to avoid paying many of the costs of producing a product. Indeed, in an unregulated system they must do so in order to compete. Providing workers with a living wage, paying for the health problems created by the product, and disposing of wastes in ecologically sound ways must all be added in if one is going to assess the legitimate cost of production. When corporations are able to evade these costs, the health of individuals, societies and ecological systems suffer. One of many examples that could be highlighted to illustrate this point is found in The Politics of Tobacco.

The Right to Health Care:

The United States is the most backward of all the industrialized nations in its system for providing health care to its citizens. The web page, The Right to Health Care, examines this state of affairs and provides some important suggestions for resolving the issue.

The Trickle Down Theory:

The unseen hand of a global market that is neither regulated nor balanced by a globalized public sector will automatically guarantee that the rich get richer at the expense of the poor, and little else. Without collective arrangements to make sure it happens, the necessities of life – safe water, clean air, sufficient nutritious food, housing, education and essential health services – will not necessarily trickle down to the poor.

Globalizing the organization of labor:

Without the guarantee of a living wage and adequate working conditions, the basic physical needs of the majority of people in the world will never be met. It is very difficult to see how adequate working conditions will be achieved without the globalization of labor.

Human Rights Violation:

The protection of the civil liberties and human rights of all the citizens of the earth must become a top priority if globalization is to proceed along healthy lines. Amnesty International of necessity limits its attention to the most flagrant human rights violations. While it has proven itself to be both diligent and effective within its sphere of action, its work needs to be supplemented by other organizations, both governmental and private. Violations of the civil liberties of any group within a society destroys the health of the whole society. Precedents are established that can be extended to others in the population. Even if only a few people are killed, or subjected to extreme forms of degradation or torture by the state, such practices create an atmosphere of intimidation and terror within which the whole population must live.

The Patriot Act:

Passed as an ill-considered response to the 9/11 attack on the United States, the Patriot Act represents a major threat to the civil liberties that citizens across the full spectrum of political belief in the United States have always held dear. The American Civil Liberties Union provides a nice summary of the issues connected with the US Patriot Act. More complete information can be found on their web page.

Prisons:

Nowhere are human rights violated more regularly and flagrantly than in the prisons of the world. Prisons are breeding places for physical diseases and they generate a huge amount of psychological and social pathology as well. Concern for the human beings who are incarcerated should motivate us to look at reforms and alternatives. But self-interest, as well, suggests that those who are not incarcerated cannot afford to ignore the conditions in prisons. The pathologies that prisons create are eventually pumped back out into the general society. Finally, from the point of view of spiritual health, we must ask ourselves what are we are doing to ourselves when we tolerate or even condone the inhuman conditions frequently found in prisons.

“A popular government without popular information or the means of acquiring it, is but a prologue to a farce or a tragedy or perhaps both.” James Madison – 4th president of the United States

Freedom to Speak and Listen:

The health of any social group is largely a function of its patterns of communication. The central focus of family therapy, for example, is generally on how people give and receive messages. If people are free to speak, and capable of listening, most problems can be sorted out. The same thing is true whatever the size of the group.

The First Amendment:

If democratic forms of government are to work, the free interchange of ideas and information must be rigorously protected. People must be free to speak their minds. In the United States this right is protected by the first amendment. If freedom of speech is only the right to express opinions that are generally supported in a society, the concept is meaningless. The whole point of the concept is that we should protect the expression of unpopular and minority opinions.

Media Control:

In democratically organized societies, the opinions and perspectives of all groups must not only be permitted, but they must find expression in the mass media. On national and global levels it is in the mass media where, at least ideally, we speak and listen to each other. In his article “Media Control“ Marco Weeks highlights some of the reasons that important perspectives and information do not always get communicated by means of the media.

Facilitating Creativity:

Creativity is as important as it is hard to define. Our future depends on our finding creative ways of understanding and solving the problems that confront us. Although creativity cannot be forced, it can be facilitated and encouraged.

Law Vs. Empire:

As we emphasized in our section on democracy, dictatorships and empires are no longer acceptable forms for governing the people of the world. The powerful may continue to delude themselves that might makes right, and comfort themselves in the absurd notion that it is their manifest destiny to impose their righteous will on the rest of humanity. But people are not deceived. The rule of empire must be replaced with the rule of legitimate global law. To globalize markets without globalizing legal bodies and procedures to regulate the interactions between nations is to invite exploitation and inequity.

Law Vs. Mental Health:

Although it is not easy to make the needed changes within the current political climate, the need for effective international courts to resolve global conflicts through law rather than though violence seems pretty obvious. A more subtle threat to the rule of law and due process is often overlooked. This concerns the blurring the distinction between concepts that are appropriate to mental health and those that should guide the practice of law enforcement. Mental health procedures are appropriately focused on the well-being and self-fulfillment of the individual who has presented him or her self for assistance. The client needs to be in control of the aims of the therapy, and the process requires confidentiality. Legal processes are properly concerned with the enforcement of laws. While good law enforcement goes to some pains to avoid violating the rights of individuals, it is a public process whose “client” is society. When the appropriate functions of mental health and law enforcement are confused, it produces both poor mental health services and bad law enforcement.

Health and Equity:

Most people value fair play as a guiding principle for human interaction. In addition to the fact that fair play is to be desired in and of itself, there is a strong connection between health and equity. Even a fairly poor country is usually able to provide for the health needs of its citizens if the resources for health are equitably distributed.

Fair Trade:

The World Trade Organization has emerged as a powerful supranational organization that wields extraordinary power over nations, the environment, and health. It has been charged with being at once undemocratic, nontransparent, and unaccountable. These are strong accusations with serious ramifications for the health needs of the poorer countries and the global environment. Ironically, it has also become a rallying point for concerned people around the world who are working for fairer and more democratic international structures.

Knowledge as Power:

We value knowledge both for its own sake, and because it is a form of power. Among other things, knowledge empowers people to find solutions to their individual and collective health problems. In “Community Based Diarrhea Control in Mozambique,” David Werner shows how addressing a serious health problem in an educational setting benefits both the health and the educational processes in a community. To quote a brief passage from his article, “By introducing participatory, problem-solving methods into primary schools, and by involving both teachers and schoolchildren in practical action related to community needs, the pilot program addressed one of the major barriers to social progress in third World Countries: that of an archaic, authoritarian school system.”

Knowledge and Democracy:

Most countries that profess a strong commitment to democracy educate their children in rigid and highly authoritarian school systems. This is a serious contradiction with real consequences. Children are trained to obey, and to uncritically accept the opinions of those in power. On the other hand they receive little training in how to critically assess situations and think through problems for themselves. It has been argued by a number of educators that these practices create unhappy and oppressive environments for many children, and that they fail to provide citizens of a democracy with the tools that they need. A serious look at more progressive educational alternatives would therefore seem to be called for.

The POH Web Site:

In conformity with our emphasis on the importance of knowledge, this Web site has been designed to be a knowledge network of for those seeking to write on the various health issues. In addition to the articles linked from this introduction, we have many articles linked by topic, and well-referenced Hard Facts. The ability to search makes all of the information in our archives ready and available. Perhaps most importantly, we also provide interactive forums in which we encourage discussion and debate on health-related issues and on the articles on this site. By interacting with one another we can all become more engaged and more knowledgeable.

Modern War and Health:

The Physicians for Social Responsibility has for a long time made the point that no adequate medical plan is really possible for dealing with a nuclear attack, because the degree of devastation caused by a nuclear explosion would overwhelm any health care system that might be put into place to cope with it. Therefore the only rational policy is one of prevention. The Bush administration has shown great disdain for negotiation, treaties, and international law and has consistently rejected policies that might further the development of international cooperation and understanding. Such bellicose and unilateral approaches to global problems have increased the threat of both war and terrorist attacks and thereby reduced the level of safety in the world.

Damage to the Infrastructure:

The death, injury and mutilation caused by bombs and bullets in an armed conflict, as horrible as these realities may be, are by no means the only health issues that are connected with war. It is not uncommon that an army will deliberately target the infrastructure of the nation under attack, and that leads to a great deal of suffering and death long after the war is over. In an article entitled “U.S. Charged With War Crimes: The Evidence File,” it is pointed out that in relation to the first Gulf War “the vast majority of deaths in 1991 were caused by the destruction of the electric power grid and the ensuing collapse of the public health, water and sanitation systems, leading to outbreaks of dysentery, cholera, and other water-borne diseases.” It is estimated by some that Iraq’s inability to re-build its infrastructure during the time of the embargo, in conjunction with the problem of getting needed medical supplies and equipment, may have resulted in close to a half a million deaths.

Arms Industry:

The very existence of a huge arms industry poses major threats to health. The goods produced by this industry can be used only for purposes of destruction, so it is difficult to assert that the arms industry contributes to the real wealth of a country. Meanwhile, money that could be used to undergird the physical, interpersonal and spiritual health and well being of nations is drained off. Also, when the industrial/military complex gets big enough, it is able to dictate much of the domestic and international policy of a country. As it is almost inevitable that the industrial/military complex will advocate for policies that further its own growth, a vicious cycle is established that almost certainly increases the probability that the weapons will eventually be used.

The Circle of Acceptable Humanity:

Most societies enforce conformity and attack diversity. There seems to be a tendency in most human societies to mentally divide human beings into two groups – those who are acceptable and therefore have worth, and those who deviate too much from the norms of society, and who are therefore cast out of the circle of acceptable humanity. The little parable The Further Adventures of the Bodhisattva" does not argue simply that this or that group should not be cast out of the circle of acceptable humanity — it brings into question the notion that there should be an outside at all.

Deviance:

Attacks on diversity almost invariably begin by defining certain groups or categories of people as “deviant.” One of the great breakthroughs in our understanding of deviance was the realization that deviance was a mental and attitudinal construction of social groups rather that a objective attribute of the labeled persons or groups.

Disability:

Often a physical or mental disability has been used as an excuse to block the full participation of individuals in the life opportunities that most people take for granted. The Disability History Museum provides interesting insights into and examples of this kind of discrimination.

Scapegoating:

Perhaps the most damaging way of attacking diversity is found in the phenomenon of scapegoating. In the article, “A Tough Weed to Uproot,” Jay Edson examines some of the dynamics of this form of social pathology, and suggests that it may be more common than we usually suppose.

Sexual Deviance:

For reasons that are not entirely clear, sexual diversity has for a long time has been mis-identified as a pathology, and it is one of the most frequently and viciously attacked forms of difference. In this situation the analytic tools provided to us by labeling theory help us to see that the pathology is not within the labeled group, but within the labelers. In “Gay Apocalypse Now” Patrick Letellier wonders why the mutually desired and harmless relationship he has with his partner should be seen at a threat to the larger society.

Attacking the “Deviance” of Nations:

Not only are individuals and sub-groups within society subject to violent attack, but the same is true of nations that attempt to meet the needs of their people in original and creative ways. Counties in South and Central America have long been forced to conform to a pattern that is acceptable to the United States or pay a heavy price. Nowhere is this fact more in evidence than in the example of Nicaragua. In his article about this country, David Werner suggests that perhaps the great threat that Nicaragua was perceived to be was that if it had been allowed to succeed it would have been an example to other countries.

A Finite Ecological System:

The Gaia hypothesis suggests that we must view the earth itself as a single organism.. As has been pointed out by many people, human technology has brought us to the point where we can affect the health of this living system as a whole. We see the consequences of this fact in a number of disturbing developments such as the greenhouse effect, the loss of biodiversity, the melting of the ice caps, and the ozone holes. The specifics of each issue vary, but perhaps we can formulate one underlying principle of over-riding importance: limitless and unregulated growth cannot be imposed on a finite ecological system without disastrous consequences.

The Goals of a Sustainable Development:

In order to come to terms with the fact of a finite ecology, it will be important to give careful thought to the appropriate goals of a sustainable economic policy. In their article "Globalization Can Work; the Question is: How?" Benjamin Mkapa and Tarja Halonershed examine some of the facets of this issue.

Adjusting our view of the “enemy”

There are few if any political struggles that take place between people who think they are good and people who think they are evil. Battles always take place between people who are defending from an enemy their own convictions about what is good and true. In order to have an “enemy” in the full sense of the term, it is necessary to demonize other human beings. Without this demonization it becomes almost impossible to kill other human beings at all, or to wage war. The realization that people b on both sides of any conflict believe themselves good and honorable in defending what they perceive to be of value is of great political significance. It motivates us to understand the enemy. Once the enemy has been understood, the next logical step is dialogue and negotiation – not war.

Open Dialog

There is power in the truth. This has been intuited since the dawn of civilization. Therefore, it is logical to conclude, the truth must be defended. Unfortunately the method of defending truth has most often been some variation of the heresy model. Some doctrine is declared to be the truth, and any doctrine that contradicts it is declared to be unspeakable – literally. Those who bought into this model took their task of defending the truth quite seriously. They were willing to torture, kill, go to war, or commit incredible atrocities in the name of truth, and they believed themselves righteous in doing so. Ironically, in addition to the horror of the atrocities they committed, those who subscribed to the heresy model were in actuality betrayers of the truth they purported to defend. And they still are, for the model is alive and well today. Fortunately there is an alternative model for defending truth. This is the method of dialogue. The dialogue model is based on an understanding that truth is something that grows and changes. It emerges out of dialogue. To attempt to preserve any dogma in a fixed state – whether it be religious, ethical, or scientific – is to prevent its growth and ultimately to kill it. One important project that is based on the importance of dialogue is "Let’s Talk...America” as it is explained by Vicki Robin.

Effective non-violent political action

Many people despair because they do not really believe in violence against other human beings, but they do not have confidence that non-violent means of social and political action can be effective. History tells us that this is not so. Labor movements, the woman’s movement, the civil rights movement, the gay and lesbian liberation movement, are all social movements that have produced huge changes in society with the use of little or no violence. The excerpt from Sanderson Beck’s "Nonviolent Action Handbook" suggests some of the principles and practices that are associated with successful non-violent action. (The web site, Literary Works of Sanderson Beck, provides more information about his work for those who are interested.) An excellent example of how these principles have recently been put to effective use is described in the article Primer for a Revolution By David Ignatius.

Solidarity

When working people struggled to empower themselves by the creation of unions during the last century, with the aim of securing tolerable working conditions and a living wage, the key to success was solidarity. When they were unified, they were powerful, and their demands were met. When they allowed themselves to be divided they were stymied in their efforts. The major strategy of the economic elite to defeat the unions was always some form of “divide and conquer.” Although the specifics have changed, the underlying dynamics on a global level are now much the same as they were on a national level during the last century. Only when working people gain a sense of solidarity that transcends national boundaries will they gain the power needed to negotiate successfully with the multi-national corporations . This understanding has been slow in coming, especially among the labor communities in wealthy countries .

The same need for solidarity exists for any disadvantaged group in the world. Whether the issue is AIDS, or age – whether it is unemployment or some form of disability – people with similar concerns must band together on a global level if they are to find success in their demand that their needs be taken seriously in a global community.

Insisting on the right yardsticks

One form of power that is often overlooked concerns the issue of measuring progress. Example: a huge oil spill will produce lots of jobs for people cleaning up the mess, and will increase the demand for the equipment and supplies needed to do the job. All this will be add to the gross domestic product, which is generally considered to be the most reliable indicator of economic growth. So are we to conclude the oil spills promote progress? Another example: according to the Encyclopedia Britannica, “Nominally Namibia is a lower-middle-income economy with a per capita gross domestic product (GDP) that is significantly above average for countries in sub-Saharan Africa. But that summary is misleading. Only one-quarter of all Namibians and only one-sixth of black Namibians have adequate incomes; up to two-thirds live in abject poverty with limited access to public services.” Clearly we need to have yardsticks that are real measures of progress in human welfare and global health.

Taking Back the Media

As we have suggested elsewhere in this article, truth is power. Truth is multi-faceted. Gaining an ever-increasing grasp of the truth requires that we be exposed to a wide range of facts, and to a variety of perspectives. Therefore the policies and practices of the media must be of central concern to those who are genuinely interested in improving the health of the world and its inhabitants. It is essential that we take back the media from those who would edit the facts for their own purposes and who would exclude perspectives that do not agree with the point of view of those in power.

In a provocative article entitled “Communication as if PEOPLE Mattered,” David Werner suggested some of the reasons why globalization seems to have gotten off on the wrong foot, and he outlined some of the things that need to be done to get us back on track. Throughout this article he emphasized the need for a new kind of education – an education for liberation. The remaining paragraphs below are taken from his article.

“When, 40 years ago, Paulo Freire wrote that with critical awareness disadvantaged people can ‘transform the world,’ social scientists said he spoke metaphorically. ‘Transform the world’ meant to change and improve your local situation, your immediate surroundings. No doubt, our own back yard remains a good place to begin. In the words of E. F. Schumacher, ‘Start small!’

“But the world has changed since Freire’s time. Globalisation— with its hazardous trade agreements, structural adjustment policies, cut-backs of public services, and institutionalized neglect of those in need—has made comprehensive change at the local level harder to achieve. Disadvantaged people—even nations—have less and less voice in decisions that shape their well-being. Freire’s insistence on ‘transforming the world’ was in some ways prophetic.

“Today, for local communities to overcome the injustices and inequities that diminish quality of life, they must join the growing international grassroots struggle literally to CHANGE THE WORLD. Not until the world’s resources and power are more fairly shared, can sustainable well-being for all—or for anyone—be achieved.

“To transform the world’s power structure, we the world’s people, in all our marvelous diversity, must learn to respect our differences and embrace what we have in common. We must work together as a family: locally, nationally and internationally. To build the global solidarity we need, we must first of all find ways to communicate truthfully and directly, relying not on the mass media but on the media of the masses.”