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On the Limits of Doing Good

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OFFERED:  Used dog ball and toys

I found that gem on my local Hackney Freecycle, a terrific website designed to unite people needing stuff with people getting rid of stuff (see lessons learned on British plastic bags for a glimpse into the exciting world of marital bliss).

Can you imagine the dog whose owner collected on that offer?   Maybe a pug or Chihuahua accessory to an East London vintage girl; or perhaps some adoring chocolate lab at the heels of her strapping student master.  Imagine now its utter shame, entering the gate to Victoria Park, a hand-me-down dog ball for a toy. What latte drinking dog owner could be so cruelly cheap as to save the price of a dog ball?

But that’s only the start.  These are dogs, not people.   Imagine the poor dog’s pulse quickening in fear, its master blithely cocking his arm to toss the ball.  Imagine the fear of that poor dog!  It knows.  It knows from the holes in the used dog ball and it knows from the ball’s scent.  That ball belonged to a rotweiler. Or maybe a raging Doberman-pit bull mix.  That ball belonged to 50 kilos of canine killing power and there now is his owner, about to toss that ball out into the park. Imagine that poor dog scanning the horizon, scanning scanning scanning for the ball’s former owner to cock his head at the first whiff of his long lost toy and the simpering runt of a pooch running after the thing.

Now, where do I go with this?  How about the topic of fear?  We humanitarians struggle to convey what is often the most damaging element of life caught in crisis, the years of waiting for violence to leap out from behind the curtain of poverty and desolation.  It’s relatively easy to convey starvation, disease or actual violence , but for the most part, protracted, pervasive fear remains invisible to medical data and escapes capture in a photo.  Recall that time somebody appeared behind you on a dark street?  Now elongate that momentary distress over years.  Or maybe it’s the life of a Palestinian child who wets himself every time an olive branch bangs against the zinc roof of his home.

 That was a diversion, a case of indulging my solemn side. 

I’ve seen lots of oddball stuff on offer at Hackney Freecycle – pavement slabs, broken darkroom equipment, 17 assorted felt cuttings – but that used dog ball takes the proverbial cake.  It struck me as an icon for the limits of do-gooderism.  It’s a story of how the feeling of goodness surpasses actually having done some good.

My wife and I have been experiencing the sense of being good as a result of our giving.  It took me by surprise, as I’d been getting more and more miffed as time constraints killed off my plans to sell much of it.  So up onto the Freecycle website went the items we couldn’t carry over to the Salvation Army.  Often, the phone rings almost immediately, so eager are people.   

These are people with stories:  Joe, binding a stack of heavy duty moving boxes for his garden (??) and then carrying on the train to Dagenham; Enrico, starting a new business, sputtering off with a heap of ring-binders; or the fantastic Veronica, heading to the bus stop with our 180 cm tall book shelf (translation for the metric-impaired from showing-off American:  approx. six feet), the first piece of furniture for her new apartment.   A bookshelf on a London bus!  I wonder if the driver dared challenge her determination.   These are people who are grateful and seemingly thrilled with the idea of getting something useful for free. 

And there stood my wife and I, like proud parents, our furniture going out into the world, each piece a helping hand in the untold thousands of fresh starts happening right here in our little corner.  We basked in the glow of the giver, modern day Johnny Appleseeds.  Somewhere, a former dog ball owner is doing the same.

Next blog:  Part II on this topic, because that sense of doing good is what pays my rent.

Critique of Aid

Once Again, Wishing I Were George Clooney

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George Clooney just got himself arrested, protesting in front of the Sudanese embassy.  I can’t quite put my finger on it, was it his radiant smile as the cop ushered him along, but somehow his arrest didn’t quite remind me of that archetypal image, repeated over and over again in places like 1960s Mississippi, 1980s South Africa, or the Arab streets of last year, of protesters being hauled off to the certainty of beating, torture, rape or disappearance.  I suspect George will not have his face rearranged by interrogators.  I suspect our tax dollars will not pay for his water-boarding.

With a world still excited over the Invisible Children video phenomenon, the last thing the Sudanese government wanted was to become famous like Kony.  They should have paid the WDC police not to arrest the most handsome gray-bearded man on the planet.  And even if there are plenty of similarities between Kony 2012 and the oversimplification of the Save Darfur Campaign, I’m not going to complain much about the useful fact of celebrity catastrophe tourism.  Let’s give Clooney some credit, because like Angelina Jolie, Sean Penn and some others, he has consistently made an effort, not just showed up at a few cocktail parties.

Celebrity altruism is at times comical, at times pitiful, and now firmly established as part of the humanitarian landscape.  As Madonna’s publicist explained to Mother Jones:  “She’s focusing on Malawi. South Africa is Oprah’s territory.”  See MJ’s clickable map of celebrity African do-gooding.     I guess I’m used to the idea of NGOs shamelessly exploiting celebrities, trading souls for search hits.    Celebrityism is just one more stunt, a questionable and yet undoubtedly profitable response to a world where American Idol losers are more famous than Omar Bashir or Joseph Kony or the entire nation of Chad. 

Should we question one children’s agency’s lucrative use of David Beckham, by all accounts a devoted father and footballer, simply because he’s pretty much a poster child for the sort of rampant materialism that’s consuming childhood itself, not to mention the idea of spending more money on a pair of underpants than 2.7 billion people earn in a week? Yes, of course we should, but it’s not such a big deal.

The more interesting story is the celebrifrication of the humanitarian crisis itself.  It is no longer just a question of celebrities shining the light of attention on a particular cause; it has become the interpretation or “reality” of that cause.  We increasingly perceive the disaster itself, be it the suffering of Somali refugees or the war in Nuba, through the eyes of movie stars, as opposed to the eyes of academic experts, humanitarians, or journalists.  Our views still exist, but who sees them?  Now, the story is the celebrity visit itself, not the disaster, and the suffering of others reaches us through the lens of their experience.  Here’s Sex in the City’s Kristin Davis fresh off the plane from Dadaab camp in Ethiopia. 

This is only partly sour grapes.  We should give some celebrities credit, for rolling up their sleeves and getting far deeper into the issues than many NGO CEOs like myself, who drop into major mediatized crises and demonstrate little timidity around cameras and starving babies. 

So as the celebrity experience of the suffering, catastrophe and crisis overshadows our own, who do we in the disaster cartel resemble?  Why, it’s the Somali, Congolese, or Sudanese people themselves, who we academic experts, humanitarians and journalists have spent decades rendering almost completely invisible.  Hooray for justice.

P.S. If you want to see a gray-bearded humanitarian take a stab at acting, click here.

Critique of Aid

New Kids on the Block

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Most madmen love the idea of fame so Joseph Kony’s wet dream just came true. He’s trending. He’s gone viral. He’s bigger than Victoria Beckham, Tiger Woods and Newt Gingrich all together. He’s still nuts, of course, but his madness has become the social media equivalent of a cuddly polar bear cub eating an ice cream cone.

Have you seen the stir caused by the success (over 50,000,000 views!) of Invisible Children’s video; of their campaign to stop butcher extraordinaire Kony and his Lord’s Resistance Army? Check out Michael Wilkerson’s blistering critique, and then the critique of the critique (in the comments). The blogosphere is choked with aid agency pundits like me getting steamed by the sheer ego of Invisible Children.  Even the Ugandans are pissed off.  Although Obama jumped on the bandwagon.

Ok, they’re an easy target. A problematic approach to facts (oops, you mean Kony isn’t even in Uganda), a seemingly unprecedented exploitation of sentimentality (ugh, not his own oh-so-cute son again), ego so far beyond borders it becomes the ether of the message itself, a healthy dose of white-man-to-the-rescue-ism, and a “solution” that solves little . . . the critique is all spot on. Then again, what’s so new about any of that in the world of charity fundraising? Just look at some of the appeals launched around the Somalia crisis, Darfur, or, perhaps in the near future, the Sahel. Invisible Children isn’t that different. They’ve just raised the game.

So why, really, are we aid insiders so bothered? It’s the big green monster. Is there another charity whose message has captivated so many so fast? About six months ago, my niece “Lisa” in Chicago excitedly asked me to contribute to Invisible Children.  At the time, I’d never heard of it. I poked around. I can’t say I was taken by the cause, but I couldn’t help feeling envious of IC’s having so effectively reached Lisa, usually more interested in dance and boys. These young upstarts at IC are the next big thing. And we aren’t.

Why? Well, for one, they have a simple message that people grasp. For another, good looks. More importantly, Invisible Children has discovered what the entertainment industry figured out a decade ago. It’s not about us old timers. It’s not people who read the Philip Roth or contribute conscientiously to their pension fund. It’s about the under 25s, maybe even the under 15s. It’s about the kids. That’s why there are a couple dozen TV shows about teenage vampires. That’s why we have Jedward.

The aid industry has just been Biebered. IC’s hundreds of thousands of donor / activist – they were invisible to us.  Kids. That’s the target and that’s the message. If you think the aid world depends on gray haired HNWIs (High Net Worth Individuals, aka rich folk), wait and see what IC does with its pubescent legions.

My advice to the aid industry? First, get over it. Then, get on the boat. Invisible Children has more than an audience, more than loyal donors. They’ve built a repository of faithusiasm that will make change happen. As a colleague of mine lamented, too bad we can’t do for tuberculosis or Eastern Congo what they’ve done for Kony. Invisible Children might well deserve our scorn, but we’d be smarter to take notes. They are schooling us in comms, mobilization and fundraising. While we try to exploit social media to improve return on investment, IC turned social media into operations itself.

They don’t have any shame, and they don’t have doubts.  They don’t have any hang ups about dreaming.  When was the last time any of us from inside the aid cartel conveyed a dream? Oh, and because I can’t resist, what’s one more thing IC doesn’t have? A sense of irony. With image after image of saluting school kids in uniform, they’ve built a business model on the commitment to cause and enlistment of children in the service of one man’s vision. When they finally get him, I bet even a madman like Kony will appreciate that.

Critique of Aid, Politics

The Rest of the Story

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When I get nostalgic for folksy American journalism, I think of Paul Harvey’s “The Rest of the Story” broadcasts.  In his rather unique delivery, Harvey would tell some story, hiding until the end the identity of its protagonist.  That was the surprise that transformed the rest.  Like a story about a kid who was so scared of heights, he was afraid to get on a playground swing.  The poor lad would have been mercilessly teased and abused a child, crying to his mama on a daily basis.  And then (after the commercial break!) Harvey would reveal that child to have grown up to become somebody like Orville Wright or Yuri Gagarin.

Now Saturday’s Observer brings us similar broadcast.  A fading superpower rides the high and mighty humanitarian horse of generosity, compassion and moral imperative into crisis. The good nation sends heavyweight envoys to demonstrate commitment.  They make thoughtful, pained pronouncements on the terrible suffering of the innocents.  The good nation scolds other actors into stepping up the response.   The good nation even organizes a conference to help stabilize the country, because it’s a very messy place.  Then, lo and behold, it turns out there is oil to be found underneath that mess; a failed state whose failure doesn’t bode well for extraction industries based in the good nation.  The countries?  The UK and Somalia.  “And now you know the rest of the story.  Paul Harvey.  Good day.”

I doubt very much that The Rest of the Story broadcasts would have lasted over thirty years if they contained such an anti-climactic finish as that one.  Sorry, you probably saw in coming.  And I have no doubt there will never be a self-contained “rest” of the story for Somalia. 

Appearing on the BBC’s Andrew Marr Show, Andrew Mitchell, the UK’s International Development Secretary, strenuous denied the accusation, awarding the Observer’s journalist “the prize for the most cynical piece of journalism this century”. 

Unfortunately, sexy accusastions resonate a lot better than predictable denials.  (Odd, isn’t it, that the one thing retractions don’t have is traction?). Somalis will be repeating for two generations that we humanitarians were sent to their country because of the oil. Here’s Bashir Goth’s take on it:  “No politician and especially a British for that matter flaunt naked objectives. They have to be sugar coated with diplomacy and altruism.”  So billions of dollars of work is reduced to the colorful exterior of an M&M.

Apologies for repeating the message of the previous blog.  But humanitarian don’t need more nails in the coffin of our perceived integrity.  As if the good doctor were not enough.  A government like the UK working to advance its military, economic and security interests is, well, what a government like the UK is supposed to do.  

What is maybe more interesting is the rest of the story.  We humanitarians are often in search of our own oil, in search of the donations we are able to extract from our (marketing claims of an effective) presence in the Horn crisis.  Humanitarianism is increasingly constructed on this basis of extraction and exploitation.  Using misery to mine gold.  That doesn’t mean it fails to deliver good.  Ditto for the UK government in Somalia.  But we need to make sure Somalis like Goth aren’t writing the same thing about us.

Critique of Aid

Guilty

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I blogged a while ago on the response of our aid industry to the “perfect storm” of emergency appeal factors — er, I mean, the perfect storm of factors causing the crisis in Somalia. I felt rather smug about waxing ethical on the way aid agencies dumbed down this incredibly complex crisis to drought drought and more drought, with a hint of livestock mortality.

Then, about five weeks ago, Dr. Unni Karunakara (MSF’s International President) stirred the pot with an opinion piece on the Guardian website, decrying the overly simplistic messaging of us NGOs. (In a related article, one journalist even quoted him as calling it a “con”!). There was quite a diplomatic reaction within the UK aid community, muted of course by the judicious desire to avoid a public spat.

Fundraisers and comms people, along with their CEOs, expressed concerns about the effect of “truthful” messaging that highlight the complexity and difficulties of providing aid, though of course denied any suggestion of having pumped the public with overly simplistic notions of causality ( innocent victims preserved) and of aid success (innocent NGOs as well). Return fire even included the smack of moralistic bleating, allegations MSF’s message would reduce public confidence and hence reduce donations and hence reduce the number of living Somalis. Something to that effect. Bleating aside, it’s a worthwhile discussion . The aid industry is stuck on the tricky question of whether the ends justify the means, because we know that an effective response to the crisis in Somalia will require massive funding of the sort dependent upon public generosity.

It wasn’t until I read (somewhat belatedly) this blog on AlertNet, that I realized what was bothering me with the entire discussion. The pros and cons of our messages on Somalia were being squeezed through the lens of fundraising. Thank goodness for Dominic Nutt of World Vision, who said something that might have gotten him a right bollocking in many agencies: that we have censored ourselves on issues related to politics. I’d take that further. What gives us the right to say anything about Somalia that fails on so many levels to inform our publics? That fails to help people here in the safe world understand even one tenth of what the suffering is about, staring at your wasting children in that horror of a war and depredation zone? Or that fails to advocate forcefully for access or to denounce the obstruction of groups and governments alike? No, the terms of discussion reinforced the progressive subjugation of our voice to the twin masters of the fundraising appeal and our brand identity.

Funnily enough, I heard a few comments from operations people in other organizations, and they actually praised Unni’s message. Not for its own oversimplification (making it seem “impossible” to deliver aid in Somalia), but because they were sick and tired of the sanitized messages spurting from the top floor of their own offices. Seems I belong on the top floor myself. I got locked into a closed-termed debate around income, pontificating that integrity in messaging is the only way to safeguard our publics in the long term. As if that wasn’t the smallest of reasons for integrity! For that; for losing sight of what really mattered in our voice; for becoming an aid bureaucrat: Mea culpa.

Critique of Aid

The Corporate Responsibility

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I came across this blog/forum at Tales from the Hood and thought I’d contribute:

In terms of the for-profit sector – those massive corporate-states we love to demonize – how many are naïve enough to believe that CSR is primarily motivated by a desire to do good, rather than an idea that doing good is useful.  CSR is a tool to build public image, morale and maybe even business itself.  Plenty of blogs and commentary out there testify to the rather cynical regard in which CSR is held. 

That cynicism might be well-earned (and not without its parallels in the government funding to which so many NGOs are addicted).  A corporation with a fiduciary responsibility towards its shareholders to create profit should not lightly engage in activities contrary to the banker’s bottom line.  Of course, CSR can be a way for considerable resources to be placed in the service of humanitarian goals. The world would be a better place if Big Pharma, for instance, would dedicate more resources to developing unprofitable lines of drugs for neglected diseases like kala azar and chagas. 

That said, it would probably be an even better place if Big Pharma wouldn’t spend so much effort in fortifying the protective walls around their products (read: profits) when effective generic drugs could help healthcare providers reach millions more people.  Now that would be an actual exercise in CSR.  In other words, CSR should cease to be a subset of activities/projects within the larger corporate mission, and should become instead a guiding principle of the corporation in the exercise of its mission.   In current practice, then, CSR is a figleaf, providing a get-out-of-unethical-behavior-free card.  What would stop a landmine manufacturer or a torture rendition firm from having CSR?  In short, the SR of CSR should cover the entire C, not just some part of it.

But let’s not stop at the C of CSR.  Why shouldn’t NGOs, especially aid INGOs, be scrutinized with the same level of cynicism?  The big ones are as corporate (though non-profit) as BP.  Well, almost.  Doesn’t our application of CSR to “them” betray an assumption about the motives behind our actions?  That when we do good, it is for the sake of the good itself.  Hence our blindness towards any sense of social responsility as a discrete element of our action, because we equate it with all our activity; we believe the SR ethos permeates the entirety of our organizations.  Of course, within an INGO it’s not the interest in profit driving aid activities, but one cannot deny the extent to which institutional interests drive INGO behavior, in particular the survival of the organization or of the jobs and way of life of its staff.  So what about NGOSR?  To what extent can we think of field activities – the building of a school, distribution of food, vaccination campaign – as SR?  To what extent are those activities a form of SR for the institution of the NGO?  They improve public perception, build morale, and generate the income which pays for offices and salaries and SUVs and an occasional booze up on an exotic beach.

Our Western Identity, Politics

Nine-Twelve

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The day after.  The images fresh again:  that second plane arcing into the tower, or the South Tower descending into itself, as if steel and cement suddenly atomized into smoke.  We humanitarians have a peculiar relation to the events of 9/11.  We’ve all seen disasters where 2996 lives (I’ve included the 19 perpetrators) make for a shocking chunk of “excess mortality,” but it’s somewhat molecular compared to estimates such as the feared 750,000 potential victims of the famine inside Somalia, or the millions inside Eastern DRC, etc. etc.  False comparisons.  The spectacular imagery and the ease with which we can identify with the people in NYC make it all too clear why 9/11 has such a disproportionate hold on the tragic stuff that happens trophy. 

Humanitarians including me continue to blame 9/11, or perhaps more accurately the reaction of the West, particularly the USA, and then the reaction to the reaction and then the reaction to that reaction (ad nauseum), for the erosion of humanitarian space.   Seems to me the world with the Twin Towers included all of the same elements as the one without, but it’s nonetheless true that 9/11 changed the balance between these elements.  So the West’s longstanding insistence on an “us or them” polarity finally found enough traction to eradicate the idea of neutrality.  And there are unavoidable consequences on Western NGOs when the West becomes both an overt belligerent and a covert killer on large tracts of our turf, or where counter-insurgency strategy plus national security interest have so publicly embraced the delivery of aid as its chosen methodology.   But neither the West as warrior nor COIN tactics are particularly new.

Instead of blaming 9/11 and its aftermath, we should probably look a little more closely at ourselves.  As an industry we lament the GWOT-determined directionality of aid, yet we have shown little by way of independence to resist being swept up in this orphaning of impartiality’s dictates.  As the British government so vociferously defends its foreign aid budget on grounds of national interest, we half-heartedly decry the difficulties caused by the politicization of aid, and then sign the contract.  But the existential questions we blame on the “shrinking space” may in fact veil a more serious existential question:  Considering the way GWOT has managed to supersize aid budgets in the declining days of the euro-dollar-pound empire, does the industry actually owe its existence to 9/11? 

 

Critique of Aid

Another Perfect Storm

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Western aid agencies, especially those here in the UK, have spent the last two weeks fanning the media flames of a fundraising campaign for the Horn of Africa.  Merlin even went so far as to call it a “global food crisis” but seems to have recoiled to the idea of an East Africa Food Crisis.  Let’s start by stating the obvious.  The situation in parts of Somalia, Kenya, Uganda and Ethiopia seems desperate, and humanitarian aid is needed to save lives right now.  To question whether or not this is the Drought of the Century is not to deny the gravity of the situation and the need for emergency aid. 

But I don’t really want to debate whether or not aid agencies are hyping drought in order to stuff their pockets.  Of course there is hyping.  Of course agencies use weasel words, at the same time painting a picture of saving stick-legged children from starving right now while being clever enough to avoid claiming that it is already a famine or mass starvation.  Nope, those things could happen.  Writing in The Times, John Clayton makes his opinion clear:  “By hyping up a localised “drought” and playing down the real causes of the turmoil in Eastern Africa, the aid agencies are crying wolf. What happens when there’s a real emergency? Will we believe them?”

On one point, it is easy to agree with John.  It’s a sad reflection of public attitudes towards aid, but people like the idea of giving to the innocent victims of El Nino rather than to the not-as-innocent victims of clan violence, war, and greed-fueled bad governance.  It’s amazing how even somebody purporting to set forth a list of factors somehow miss out:  “High food prices, fluctuating rainfall, a rising population and ever dwindling natural resources have created the perfect storm,” said Leigh Daynes, director of communications for Plan, in the UK.   Oops.  Forgot to mention conflict in Somalia.  Oops.  Forgot to mention corruption in Kenya.  About like forgetting to mention Ghaddafy in an analysis of the situation in Libya. 

But let’s not be too hard on these agencies for omitting the ways in which locals themselves could be blamed for their own suffering.  By definition, humanitarian aid is based on need, not worthiness, because being a human being possesses inalienable worth enough.  Besides, the entire point of the media campaign is to raise money to pay for the relief effort and save lives.  So let’s not moralize about painting a picture that is skewed towards being effective rather than depressing to the average punter.

That said, let’s moralize anyway.  Let’s moralize not about the fact that the perfect storm of factors missed conflict, missed corruption (kudos to UK AID for suspending bi-lateral aid to Kenya on account of the lack of integrity), or missed the way in which drought has some very local and human causes (on this point, check out Paul Theroux during his Africa overland odyssey ten years ago, quoting a diplomat on the situation in northern Kenya: “Right, it hasn’t rained in the north for three years.  Whose fault is that?  They cut down the trees for fuel, they sold them to loggers, they destroyed the watershed.  And they’re still doing it.”).  No, let’s moralize about the fact that the aid agencies’ perfect storm of factors forgot one key factor:  aid agencies. 

Inside Somalia is a different story, because aid agencies have little access there.  But the rest of the Horn?  Kenya?  Ethiopia?  Uganda?  For decades, aid agencies (and the Kenyan government!) have been all over these places, practicing what they call development.  They collect a lot of money for this work and they have been pumping out glossy reports describing their glorious success in helping communities become sustainable, in helping to protect the environment, in building the capacity of people to cope. Etc etc.  So where is it?  Where is this development we keep hearing about?   Surely people have been helped.  But as the current disaster in the area would seem to suggest, at the big picture level all this development work didn’t amount to squat. 

What we have, then, is a perfect storm of irony.  Aid agencies are asking us to fund humanitarian relief work (and I admit this is also an assumption, because we don’t really know what sort of program will receive their money).  We should do that.  People need it.  Lift the veil, though, and what they are also asking the public to do is to fund their own failed development policies.

Critique of Aid, Our Western Identity

Let Them Eat Hippo

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“Do the local people eat hippo?  Hippo, lechwes [a kind of antelope] and the other game?” 

I was on safari with my octogenarian parents.  After all those years working in Africa, my first real safari.  We were in the Okavango Delta, which (without the two octogenarians) I would recommend visiting to any humanitarian who wants to see African wildlife other than mangy goats and one-eared dogs.  Of course, I’d also have to recommend robbing a bank first.

One of the safari guides was explaining traditional food to us over the evening meal.  That’s when Ron asked the question.  Ron was clearly an intelligent guy.  New York banker working for a venture capitalist group, articulate and engaged, owner of the newest top Nikon SLR.  In short, somebody who would place in the upper percentiles of just about any set of social indicators.  He probably laughed at Jon Stewart and would be above average (for one of us Americans) on the scale of being politically informed.  I’m sure he considered himself a responsible voter.  Oh, and he was Keanu Reeves handsome to boot, so I disliked him intensely.

Look again at that question.  Let me rephrase it:  Did the people who lived in the middle of this game-rich delta eat game?  Or rephrased again:  Were all the people practitioners of vegetarianism?   If not, does one of these densely forested islands hide the local equivalent of my local Ginger Pig butcher shop selling butterflied leg of lamb and ground pork loin burgers?  Is there a supermarket nearby?  Because if these weren’t the questions he was implying, what is it he thought traditional people ate in a place like the Okavango Delta?

Smart as he was, Ron seemed wholly unacquainted with the basic rules of human existence.  How could traditional ways have included the people here not eating the game that surrounded them? 

Now back to the aid world.  We know that our donor base, even those who keep well-informed, tends to think of people in Africa and aid workers as, respectively, more impassively victimized aid and more heroically productive than reality.  But we also believe, and must to a certain extent require, that the public has some generalized understanding of the way it is.   For our newletters and “protection” reports and situation updates to have any meaning, readers must be able to hang them onto some sort of foundation.  Otherwise, it would be like me attending a graduate school lecture on molecular biology.  The difference, of course, is that I would quickly recognize my confusion, whereas I’m concerned that our public is unwittingly getting it dead wrong.

Well, the Rons of this world are our donors.  They are our constituency.  It’s OK that they don’t get it 100 percent.  But what if it’s more like 10 percent?  Forget about meaningful engagement in the public debate on foreign politics, military incursions into unfriendly countries or the (current in the UK) discussion on aid budgets.  Forget about the idea that the people who give us money actually support – as in agree with – our work.  It all adds up to an Antoinettesque “Let them eat cake” level of comprehension.

Health

A Fat Tax on HIV+

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How many others missed this early April news gem?  Arizona Governor Janet Brewer proposed socking obese Arizonans who are enrolled in Medicaid or Medicare with a $50 surcharge unless they adopt a supervised weight-loss program prescribed by their doctor.  (Smokers will get nailed as well.). 

Congratulations to the Gov for the world’s first “Fat tax”.   

The Gov’s arguments run pretty simple along the surface:  unhealthy lifestyle choices and behavior eat up the healthcare budget, so let’s make these miscreants and self-indulgers pay.  After all, why should the public subsidize bad behavior?  Looked at differently:  If some guy like me wants to bicycle the streets of London without a helmet, running the lights, why take money away from cancer research to pay for his brain surgery? (It’s a slippery slope:  skiers and joggers are always breaking ankles, and that costs a lot of money, but taxing them would bring us right back to the obesity risk of blogging from the couch all day.).

If the Arizona governor sounds confused on the workings of blame here, as if people choose to be obese the same way our guy chooses to cycle recklessly, it’s because any debate on the merits or not of the fat tax as a public health policy is misplaced.  This is about trimming budgets, not waistlines.  Ha ha. From a health policy standpoint, blaming the sick sounds perverted, though I guiltily admit somewhat less so in light of estimates that the cost of obesity is the US range from $150 to $270 billion.  Isn’t that more than the continental budget for healthcare in Africa?  Anyway, from a financial standpoint, the fat tax is the sort of decision that will be increasingly more common as politicians and health officials scramble to save cash.

 Now flip to HIV/AIDS.  I recently visited MSF’s HIV/AIDS project based in Khayelitsha township, on the outskirts of Cape Town.  It’s an impressive programme, one that has led to a great deal of innovation on the treatment/delivery side of things and, more importantly, to a sizeable scaling up of HIV+ people receiving anti-retroviral therapy.  Depressingly, I found the decade of advances in HIV treatment have been unmatched by advances in preventing transmission.  It’s simple:  too many men refuse to wear condoms and they certainly aren’t interested in abstinence. 

During my visit I listened as young outreach and community education workers exhorted others on the need to do education in the taxi stands and drinking places, or called for opening hours in the evening, etc. etc.  Essentially, the same hopeful exhortations I heard 10 years ago.  As if a “new” or “improved” community messaging will actually produce a sufficient enough change of behavior to reign in this epidemic.  Aside from the fact that it doesn’t work well enough or fast enough in a context like South Africa, I’m still a fan of this sort of health education.  But limits need to be recognized.  The problem isn’t solvable through education because it’s not caused by ignorance.  That is a topic, though, for a later blog.

For now, back to Arizona.  How long before the logic of the fat tax will be applied to men and prostitutes in South Africa?  There, masses of people knowingly engage in high risk behaviour – becoming infected and (quite different from obesity) infecting others – and then fall ill.  They then assert a right to treatment.  So how long before the “no condom tax” or a “surcharge on unprotected sex”?  How long before money is switched out of HIV treatment into other health priorities at the ministry level, as is already happening on the global stage?  In the end, the Arizona fat tax heralds the coming day when budgetary pressure on the state forces a false distinction between “good” sick people and “bad” sick people.  After the obese, after the smokers, will come the reckless, be it the helmetless riders or rubberless fuckers.