- Email: [email protected]
Where are all the philosophers when you need them?
Editorial
How do low-income countries improve the health of their least-advantaged citizens? Never has this question mattered more than today. In the Global Monitoring Report 2006, published recently by the World Bank, the appalling lack of progress towards the Millennium Development Goals (MDGs) is made all too starkly clear. Understanding how to put the lives of a nation’s most vulnerable citizens first—matching political with public interest—will be the key to accelerating action on health and development. But just what is the public interest? In a Demos report, The Slow Race, Melissa Leach and Ian Scoones propose a set of citizens’ commissions to find out. These groups would gather views and reflections about the kinds of policies that are needed to meet community needs. This study follows their wide-ranging analysis of what citizenship means when considering the application of knowledge to the problems of the poor. They warn of falling into the trap of glib solutions. Participation sounds good. But if it means having to submit oneself to the power, organisation, and agenda of another institution, perhaps participation is bad. Taking part can neutralise your message, dilute your advocacy, and isolate you within a process that aims to strip you of your influence. The issue of what we mean by the public interest was taken up last week in the UK at a Nuffield Trust meeting led by Iona Heath (a general practitioner), Martyn Evans (a philosopher), and Stephen Pattison (a theologian). Their premise was that the public interest is often neglected in the formulation of government policies. Policymakers are frequently poorly informed about the lives of citizens on whose behalf they are designing policies. This deficit of understanding is rarely acknowledged. Yet it leads to a desperate alienation between a population and its centre of power. To be fair, policymakers do not have an easy job. They might ask what is meant by the public interest. There is, after all, no single public, only many, often competing, publics. The views that those publics advance are not necessarily accurate or informed. The representation of ill-informed public opinion in policymaking might do harm. The notion of the public interest as a universal good can therefore easily be challenged. www.thelancet.com Vol 368 July 15, 2006
Even worse, efforts to incorporate the public interest into policymaking produce a reality that is often very different from the aspiration. In many public consultations, there is commonly little serious attempt to include public comment into policy in an explicit and methodologically robust way. Public engagement is often used as a means to legitimise a political process, to give it added credibility, and to “proof” it from criticism. Power and private interest remain far stronger governing forces in policymaking than consideration of the public interest. The assumption that citizens should be more effectively engaged in policymaking—the tyranny of participation—also deserves scrutiny. Such scepticism seems heretical in a modern age. Engagement is an inviolable mantra. But the larger question must be confronted: what are the limits of democratic decisionmaking in society? Who should decide how to spend a limited national budget? Should a government invest more in health or education? Vaccines or clean water? Anti-retrovirals or food? Should these questions be left to elected politicians, technocrats, or a sample of the public? Can the public be trusted? Or politicians? Or even technocrats? Perhaps we should turn to philosophy for answers. Sabina Alkire and Lincoln Chen have probed the moral values underpinning global health. Our decisions, our policies, are substantially determined by our moral outlook. If you lean towards equity, you will prefer to seek a fairer distribution of resources. If you are more attracted by utilitarianism, which is undergoing something of a renaissance today, you will prefer to focus on increasing total human happiness. Policymakers rarely make their values explicit. They prefer to hide them behind the asphyxiating language of management. A few philosophers might make a positive difference to all of our lives. Part of the answer may well be philosophy. But thinking needs to be supplemented by action— collective action. It is here where citizen commissions may have value. Not to talk, but to do. Human development—and hitting the MDGs—will only happen if the public-health workforce expands to include us all. We all need to take responsibility for our society, indeed our world. Q The Lancet
We do not have the rights to reproduce this image on the web.
Science and Citizens: Globalisation and the Challenge of Engagement (Zed, 2005). Edited by Melissa Leach, Ian Scoones, and Brian Wynne.
Lancet 2004; 364: 1069–74
175
Wellcome Library, London
Where are all the philosophers when you need them?
How do low-income countries improve the health of their least-advantaged citizens? Never has this question mattered more than today. In the Global Monitoring Report 2006, published recently by the World Bank, the appalling lack of progress towards the Millennium Development Goals (MDGs) is made all too starkly clear. Understanding how to put the lives of a nation’s most vulnerable citizens first—matching political with public interest—will be the key to accelerating action on health and development. But just what is the public interest? In a Demos report, The Slow Race, Melissa Leach and Ian Scoones propose a set of citizens’ commissions to find out. These groups would gather views and reflections about the kinds of policies that are needed to meet community needs. This study follows their wide-ranging analysis of what citizenship means when considering the application of knowledge to the problems of the poor. They warn of falling into the trap of glib solutions. Participation sounds good. But if it means having to submit oneself to the power, organisation, and agenda of another institution, perhaps participation is bad. Taking part can neutralise your message, dilute your advocacy, and isolate you within a process that aims to strip you of your influence. The issue of what we mean by the public interest was taken up last week in the UK at a Nuffield Trust meeting led by Iona Heath (a general practitioner), Martyn Evans (a philosopher), and Stephen Pattison (a theologian). Their premise was that the public interest is often neglected in the formulation of government policies. Policymakers are frequently poorly informed about the lives of citizens on whose behalf they are designing policies. This deficit of understanding is rarely acknowledged. Yet it leads to a desperate alienation between a population and its centre of power. To be fair, policymakers do not have an easy job. They might ask what is meant by the public interest. There is, after all, no single public, only many, often competing, publics. The views that those publics advance are not necessarily accurate or informed. The representation of ill-informed public opinion in policymaking might do harm. The notion of the public interest as a universal good can therefore easily be challenged. www.thelancet.com Vol 368 July 15, 2006
Even worse, efforts to incorporate the public interest into policymaking produce a reality that is often very different from the aspiration. In many public consultations, there is commonly little serious attempt to include public comment into policy in an explicit and methodologically robust way. Public engagement is often used as a means to legitimise a political process, to give it added credibility, and to “proof” it from criticism. Power and private interest remain far stronger governing forces in policymaking than consideration of the public interest. The assumption that citizens should be more effectively engaged in policymaking—the tyranny of participation—also deserves scrutiny. Such scepticism seems heretical in a modern age. Engagement is an inviolable mantra. But the larger question must be confronted: what are the limits of democratic decisionmaking in society? Who should decide how to spend a limited national budget? Should a government invest more in health or education? Vaccines or clean water? Anti-retrovirals or food? Should these questions be left to elected politicians, technocrats, or a sample of the public? Can the public be trusted? Or politicians? Or even technocrats? Perhaps we should turn to philosophy for answers. Sabina Alkire and Lincoln Chen have probed the moral values underpinning global health. Our decisions, our policies, are substantially determined by our moral outlook. If you lean towards equity, you will prefer to seek a fairer distribution of resources. If you are more attracted by utilitarianism, which is undergoing something of a renaissance today, you will prefer to focus on increasing total human happiness. Policymakers rarely make their values explicit. They prefer to hide them behind the asphyxiating language of management. A few philosophers might make a positive difference to all of our lives. Part of the answer may well be philosophy. But thinking needs to be supplemented by action— collective action. It is here where citizen commissions may have value. Not to talk, but to do. Human development—and hitting the MDGs—will only happen if the public-health workforce expands to include us all. We all need to take responsibility for our society, indeed our world. Q The Lancet
We do not have the rights to reproduce this image on the web.
Science and Citizens: Globalisation and the Challenge of Engagement (Zed, 2005). Edited by Melissa Leach, Ian Scoones, and Brian Wynne.
Lancet 2004; 364: 1069–74
175
Wellcome Library, London
Where are all the philosophers when you need them?