Global Health, Social Entrepreneurship and Faith Inspired Communities – 2017

by Katherine Marshall
Senior Fellow at the Berkley Center for Religion, Peace, and World Affairs,
Executive Director of the World Faiths Development Dialogue.


A sense of urgency (the notion of the Kairos moment that demands action), an appeal to the timeless “spirit of Ahimsa”: calling humanity to live together and abjure violence, and a call for solidarity set the tone for the 2017 Ahimsa Forum’s first day.
The specific topic of health care was set from the outset in the broad framework of the Sustainable Development Goals and specifically Goal 3 (health care for all), but also the large demands of contemporary global affairs, with the humanitarian, refugee problem very much on our minds. UN Director General Michael Moller stressed that “Public health is about more than healthcare”. It is about nutrition, environment, education, and spiritual well-being. And people everywhere are, as are we, interdependent, dependent on each other to survive and to thrive. We were reminded often of the call to remember the least amongst us, those in the shadows, those left behind.

Throughout the day, health issues were the anchor but the discussions, in a spirit of “breaking silos” ranged across disciplines, countries, cultures, and religious traditions, and from very global to very local and from ethereal to eminently practical.

Practically speaking, we heard a keynote speech about health workforces early in the day and concluded with wise and provocative reflections of Alain Merieux about generations of a family, company, and foundation centered on improving options for care across the world. And we left fired and saddened by the inspiration of poetry. 

Four very broad topics and panels brought many of the 130 participants here into the discussions. The discussion returned again and again to how each and all of us understand “health care for all”, the SDG mantra. Woven through were the issues of inequality and inequity, though they were rarely front and center. There was more focus on ethical challenges, that were interspersed with practical examples: for example grappling with dilemmas of partnership juxtaposed with explorations of accountability and voice. How far does context matter?  We need evidence, but what kind? How presented? What is the meaning of entrepreneurship and how does it relate to large questions about capitalist market systems, competition, and the ever present shibboleth of money and finance?

The topic of religion was central in the discussions. Many brought experience and issues explicitly tied to the practice and the inspiration of religious beliefs and communities. Others brought questions: what, after all, is religion? Does it change? Where are the boundaries with culture? What is the impact, the polarizing effect of the common effort to divide the secular (the profane) from the spiritual and religious? 

Many complex and sensitive issues were raised, in what I found a notably open, respectful, and honest way. Issues of reproductive health and rights, challenges for women’s health, and tricky boundaries between honesty about one’s beliefs and practice and proselytizing came up from various directions. And in addressing the right to health and practical issues in health services the roles and responsibilities of governments are central to the discussion. What can and should private companies, communities, NGOs, and religious bodies be doing and how? And what special, distinctive issues arise in relation to today’s humanitarian crises, notably of refugees and forced migration? What can and must be done, and by whom?

Mukesh Kapila, in an especially provocative intervention, called for an accounting: what is the balance between religion’s good and ill effects? His challenge reflected a lingering question about how well contemporary global institutions are dealing with the different facets of the “worlds of religion”. Many pragmatic questions were raised, among them the significance of coordination, leadership, evidence, partnerships, fragile and poorly governed situations, and religious literacy.  Given the Forum’s focus, serious preoccupations about partnership and a (to me) troubling discussion about addressing the topic of corruption were of special significance. Christo Greyling’s call to boldness and humility suggested an approach that would (somewhat ironically, perhaps) see religiously inspired organizations more forthright about their motivations and more open to seeing risks and the perspectives of others.

Social Media!

A current social media storm has some relevance to our discussion as it reflects some of the dilemmas around changing times in this modern world and age old institutions. Mark Zuckerburg, Facebook’s founder, recently suggested that “Facebook can be your church”, because it represents a modern day sense of community. Facebook passed the 2 billion member mark, meaning 1 in 4 people in the world, with 100 million use communities, 800 million plus “likes” and 750 million new “friends” each day. 

One observer commented that “if Facebook is like a church Twitter is a deacon’s meeting trying to decide the color of the carpet.”.

An important theme running through the day was hope. There is first Jean-Francois de Lavison’s hope that health, as a universal preoccupation that binds, can open the way to realizing a common good and a common goal, and thus open the way to creative partnerships. We heard about “Channels of Hope”, a specific methodology pioneered by World Vision that offers hope for thoughtful engagement to move difficult issues forward. Hope was linked to faith (whatever meaning one gives to the term), as its primary gift. It calls us to aspire to far more than mere survival: as Gideon Byamugisha said, to thrive and to soar. And it is tied to technical progress, observed in huge strides in fighting disease. 

So, infused and inspired by hope, on to Day 2!
 


The tone shifted in subtle but perceptible ways on the Forum’s second day, albeit with significant continuities in both agenda and preoccupations. Innovation and change, business models, impact, and entrepreneurship were the dominant focus and the “can do” energy that we associate with entrepreneurship ran through all four panel discussions (also in side conversations). One rhetorical and somewhat disdainful comment summed up an aspect of the spirit: “do you want reports or results?” The underlying assumption was that private enterprise offers paths to solutions on topics ranging from medical diagnostics to an “alimentation revolution” to mining community welfare. The power of technology and dynamics of change inspired references to revolutions and paradigm shifts. But the basic underlying theme or challenge was a clear recognition that no group: private sector, religious communities, NGOs, governments, and international organizations, can navigate contemporary challenges and change without the others.

Themes linking the two days included sustainability (a topic that came up again and again), the perils of silos, the centrality of partnerships, and challenges of working across sectors and, notably, with governments and international institutions. Faith was a word used often, though with differing significance, ranging from more classic religious faith (I reread Luke and refocused my work) to the personal drive and belief in self and goals that underpinned some of the successful cases we learned about. There were reminders of the framework of Sustainable Development Goals (SDGs) and of the miseries of refugees, child abuse, and debt bondage. But overall the tone was optimistic: with drive and discipline problems can be overcome, especially if they are tackled one by one and from the ground up. There was remarkably little reference to policy, though bad governance lurked not far under the surface, as did the specter of bad leadership.

As on the previous day, the Forum focused on people, exploring motivations and the nature and meaning of leadership. Story after story offered insight and inspiration. A recurring narrative was how successful entrepreneurs decided mid-career to shift careers, moving from a company setting to independent and socially focused activities and thus bringing a variety of skills and motivation to their missions.

We heard many stories of success that suggested models, and, if a meetings success can be measured by personal engagement and “handshakes”, exchanges of visiting cards, intense side conversations, and probing questions suggested that the Forum’s goal of spurring action was well achieved.

As examples here are some memorable themes and assertions that caught my attention:

  • CSR (corporate social responsibility), signifying, it seems, rather cosmetic “do good” efforts by companies, has little to offer today. What is sought, and what is possible, are corporate cultures and values that encourage innovation and action, in ways that are at least compatible with the SDGs if not explicitly inspired by them. Such cultures offer “win win” solutions, where employees are satisfied and good results are produced.
  • There was some exploration of philanthropy and its pluses and minuses (spilling over from the previous day). There is the promise of encouraging innovation and bridging divides but there are pitfalls including nagging questions about representation and accountability.
  • Corporate cultures often do not allow or encourage innovation. There was frustration alongside positive comments about working within private companies, large and small. The examples of Anglo American and Danone stood out on both dimensions.
  • People in private enterprises (like other institutions, it must be confessed) actually enjoy working in silos and resist efforts to break them down. Cross discipline and sector collaboration is rarely easy.
  • Partnerships again emerged as desirable, indeed critical. But many comments pointed to the real difficulties in making them work. United Nations institutions were described as remarkably, frustratingly difficult to work with. Several referred to the need for “on ramps” and for ways to work together in meaningful ways: “to whiteboard” (a new verb for my vocabulary).
  • Those left behind, at “the end of the asphalt”, the voiceless, too often invisible need special attention. Abused children and forced migrants may be the best examples but there are many others.
  • Context and community are essential. This was one theme that clearly cuts across silos. The capacity to ask unexpected, different questions is a healthy part of collaboration that marks meaningful cross disciplinary collaboration.
  • “I love making money and I love helping the poor”: one participant summed up an ideal that links a commitment to faith values, a pragmatic realization of the limits of charity, and unease at programs, policies, and actions that encourage dependence on unreliable outside sources. There need be no contradiction, it was suggested, between being and doing good and entrepreneurship.

Honest discussions highlighted some real problems. At their root money or rather lack of it was cited often as a problem. There was reflection about competition, perhaps necessary and good for the discipline and creativity it can inspire but often the bane of true cooperation, solidarity, and pursuit of common goals. “Pathological suspicions” were described: one example cited was mining companies vis a vis religious communities.

Innovation is essential to overcome problems and to realize hopes for an equitable world, but how can it be encouraged? “Planned innovation”, it was suggested, is doomed to fail, including bureaucratic efforts to structure new ideas. Innovation, rather, like poetry perhaps, emerges often where least expected. A continuing challenge is to recognize the pearls of worthy new ideas, especially those that respond to real needs of real people, and free them of artificial, unconstructive bonds.

Scale is perhaps the greatest challenge: the wide diversity of experience shows what can be done but too often initiatives and projects stay beautiful but small. The overall needs demand trillions of dollars, and though we have faith that the resources are basically “there”, mobilizing them demands new models and approaches. The scale challenge cuts across all the efforts, from the most embryonic to those with global scale.

Leaders!

The day’s diverse concluding events pulled different strands together. A remarkable panel explored both the testing demands of leadership with story after story of courage and grit, as individuals rose above circumstances, learned from adversity and failures, and took on the challenges they saw. Individually and collectively they offered examples and inspiration. An enduring theme and comment was that the fire within us must withstand and exceed the fire outside. It left us with the feeling that indeed we can seize this Kairos moment as an opportunity as well as a demanding challenge.

In concluding, Jean-Francois reiterated his hope that health can bind, open doors, and inspire. His “mantra” is ethics, broken down to include example, tolerance, humility, focus on the individual, compassion, and always planting seeds. Also part of the conclusion, a reminder of the power of art to express and inspire was integrated into the discussion of leadership, suggesting the combination of inspiration, discipline, creativity, attention to others, and innate gifts and skills..

During dinner, three of the younger participants engaged UN Director Michael Moller in a conversation about paths towards the future. And Jean-Francois de Lavison and Setsuko Klossowska de Rola revealed the meaning of the Forum’s Japanese for the Forum: it denotes smiles, explained by what they see as the disarming power of a smile. This symbol echoes the common call to love, going beyond just compassion, caring more than tolerance, and a constant anchor to a practical vision of an ethics of action and partnership.


The Forum’s third day involved mainly “satellite sessions”, but they were well attended, with lively discussions centered on United Nations roles in relation both to health systems and to religious institutions and private sector actors.

The day began (following my summary of Day 2) with a dialogue with Luiz Loures, Deputy Executive Director at UNAIDS, Geneva centered on “lessons learned” from experience with the HIV AIDS pandemic. The interview style exchange (with me) centered on the distinctive and significant role that global efforts to contend with HIV AIDS have played in shaping contemporary global health approaches. He returned repeatedly to the central importance of active involvement of affected communities – something distinctive if not unique for this disease. A vital priority is always to keep those affected at the forefront. Compassion, he stressed, is a critical element, too often sidelined. While there is remarkable progress to report, and strong sustained support that sustains HIV and AIDS programs, the large dimensions of the pandemic still keeps him awake at night. Relaxing the momentum of global and national efforts on HIV AIDS would be a grave error. As one example, 13 million people living with HIV and AIDS have not even been tested, and the vulnerability of young women and other key groups demands a sharper, continuing focus.

  • The first Satellite session focused on health system governance, led by two World Health Organization (WHO) officials, Gerard Schmets and Maryam Bigdell. Experience from different world regions highlights the diversity of challenges involved in SDG 3 (health for all): India’s enormous needs and government approaches, for example, differ markedly from those facing South Africa or Brazil. The needs of refugees stand out as needing and deserving sharper focus. The practical evidence of sharp disparities is evident in large gaps in availability of services and equipment in the world’s poorest communities, exacerbating already wide differences in the realities that people face when they need health care. We are far from anything approaching “equitable health for all”.

A lively exchange turned around two persistent Forum themes: the tendency of governments to ignore religious actors, to treat religious health systems as something apart, and questions about who belongs at “the table”, meaning the circles where policy decisions are thrashed out. One questioner noted that at a meeting this week in Kigali on health in Africa there is no religious voice in the group: “What planet are they living on?” he asked. The sense was that African ministers of health may give lip service to religious dimensions but when it comes to action they ignore them. Similar concerns emerged for Cambodia where the complex religious and private sector actors are not only ignored but often deliberately relegated to the margins. The WHO representatives reminded the group that the WHO governing body is comprises of ministers of health, so the public sector focus is hardly surprising, but also pointed hopefully to growing awareness of the challenge of bringing in a wider range of voices.

  • The second Satellite session turned explicitly to private sector roles and the SDGs. This panel included people who spoke of Danone, Vision Fund Mexico, the Handa Foundation in Cambodia, BRAC, Bangladesh, and CEPHEID. Nadia Isler, director of the UN Geneva office’s SDG lab, highlighted the goal of promoting innovation and creative communication. The panel itself spoke enthusiastically to the topic of possibilities, pointing to what is being done and to new prospects ahead. Health is seen as a pathfinder among all the SDGs, among other reasons for its obvious multisectorality. Several pointed to new generations of public private partnerships (PPPs) as evidence that points to what is possible. Less positively, in a period of turbulence there can be confusion among the roles of different sectors: notably governments, NGOs, private companies, and religious actors. Blurred responsibilities and overlapping efforts are a result.

Among hopeful comments was an assertion that common purpose is possible, rising above the normal private sector instinct to go for a competitive edge, though some healthy cautions were laced through the conversation. A “whole of government approach”, however desirable “does not just happen”. It demands more openness and effort.

Two key, large issues that need to be faced in moving forward with SDGs are risk and risk sharing and politics – not just the classic shibboleth of political will but action to encourage new forms of political collaboration and engagement. And lurking in the shadows is always the issue of money and the less attractive impulses that it can drive.

Some hopeful challenges emerged in this final Forum discussion. A first is the need to form real coalitions of players, to nurture new skills that promote collaboration across sectors, and corporate cultures that attract the modern skills that are needed for new times. The question to ask is “do we really need to do it as we have done in the past?” We are moving towards a “social century”, one speaker asserted