“We cannot allow our women in childbirth to die in the developing world solely because we have not decided to work together.” ~Naveen Rao, Lead, Merck for Mothers
Last week, in a country that shares a border with my ancestral home of India, 1,127 Bangladeshi garment laborers were killed due to inhumane working conditions. This social injustice revealed once again how numerous European and American clothing companies benefit from cheap, exploitative labor practices in resource-denied communities around the world. It marked the world’s worst industrial disaster since the 1984 chemical spill by Union Carbide in Bhopal, where I personally witnessed birth defects and water-borne illnesses among Indian women and children twenty-five years later. It was in Bhopal where I experienced how harmful corporate practices were embodied into the lungs, limbs, and wombs of those who lived within meters of the chemical spill, as if they were disposable commodities to the CEOs of Union Carbide. And now this week, along with a few members of my Global Health Corps (GHC) family, I will be attending the GBCHealth 2013 Conference, the world’s largest convener of Fortune 500 companies that addresses the impact of market-based strategies in the global health equity movement.
And so I stand shakily between last week and this week, a space that represents the biggest uneasiness throughout my journey in global health. It is the space where on the one hand, I critique the forces of social marketing and philanthro-capitalism among my global health colleagues, and then on the other hand, eagerly shake hands with businessmen who fund the NGOs I work for. With my global health colleagues, I often ran to the private sector in solace and in frustration, when the bureaucratic red tape of governments made it difficult for our programs to be quickly resourced. Is this an act of hypocrisy or a strategic act of survival in the competitive struggle for money and attention in global health, especially during our current economic recession? Does garnering resources and delivery models from the corporate sector lead to redistributive justice, or does it perpetuate an ineffective charity model that sustains power imbalances? Most importantly, can businesses pragmatically chip away at structural violence in the global health equity movement rather than perpetuate it?
Just as I was struggling on my own to adequately answer these unsettling questions, at our GHC quarterly retreat this past weekend, my GHC peers and I stood in solidarity and challenged each other to address some of the most critical questions that are left unanswered in the global health movement today. Can we incite more meaningful change working within the “System” or outside of it? When partnering with private companies with a corrupt legacy in health and human rights, do the legitimacy of our motives and goals change for the worse? Most importantly, are we working towards band-aid reformation or a radical revolution that seeks to demolish the structural inequalities that creates disease and poverty in the first place?
As a girl, I frequently observed multinational companies exploiting, but also investing, in my community’s “development” in northern India. And so from a young age I was exposed to profit-making from so-called social good, where Coca Cola was available more readily than clean water. As a graduate student in medical anthropology, I became deeply inspired by unapologetic global health activists; those who applauded community-borne approaches to development and redefined capitalist influences in social change efforts as the new face of imperialism. Both my childhood experiences and studies shaped a rigid perspective for me in viewing the public sector as “holy” and the private sector as inherently “corrupt.”
I was equally ashamed of the history of structural adjustment and neoliberalism that the private sector pushed onto developing countries like mine starting in the 1980s, that nurtured massive debts and the crumbling of their public social sectors. Pharmaceutical and oil companies soon became the biggest corporate players in global health, and began exploiting patients while at the same time reporting that they “saved lives.” I felt that every profit they made off the diseased bodies of my community, they were strategically debilitating the fight for free health care as a universal human right.
Corporate social responsibility programs seemed to be more of a public relations campaign, and less of a sincere commitment to stand in solidarity with resource-denied communities to transform power structures. I believed that the private sector popularized a cost-effective argument in commodifying the suffering of patients in poverty, and instead I hoped for a moral-based discourse to shape how we framed the global health value chain. And I struggled to truly understand and embrace the recent glamour of global health buzzwords such “strategic management,” “social marketing,” “delivery pipelines,” and “impact investing.”
At this current juncture of global health, where at almost every major conference and classroom public-private partnerships are praised, it seems heretic to critique the ethics of intervention by the private sector. However, my past ten months as a GHC fellow has radicalized the way I glorify the public sector and demonize businesses. GHC’s mission focuses on tackling the root social, political, and economic causes of health inequity. But GHC also embraces the idea that in order to build a sustainable movement, engagement of all sectors of society, including the private sector, is necessary in achieving health equity. Many of my colleagues in GHC have spent their entire careers in the corporate sector and are now successfully applying their technical skills and innovative solutions to health system strengthening in Malawi, Burundi, Uganda, Rwanda, Zambia, and inner-city U.S. It has now been difficult for me to ignore the impact of businesses in global health delivery efforts, whether good or bad.
As a health policy fellow, I have been working under Mayor Cory Booker’s administration, which has famously lured some of the most powerful American companies to combat poverty, violence, and unemployment in Newark. At times, I become disillusioned on my daily walks to my office, as I witness homelessness and grinding poverty adjacent to the glittering Prudential building that has been recently crowned as the central hub of downtown Newark. On the other hand, I have also experienced that the importation of businesses to the fourth most impoverished city in the nation has proven that city-wide investments in health care delivery and education reveal how Newark residents are valued in the country’s larger political economy and future progress.
I have come to the conclusion that maybe it is more effective to shift some of the energy put into critiquing the private sector towards providing solid recommendations. We can push international companies to invest in local businesses rather than in their corporate social responsibility programs. Since ninety percent of jobs in the world’s poorest economies are established by local business owners, global companies can partner with or invest in these small businesses with the capital and resources they require.
While I still challenge the ethics and legitimacy of businesses as central development players, the wise words of global health prophet, Dr. Paul Farmer, echo in my mind, “Unless we can build public-private partnerships that support public health and public education, we’re going to get a lot of energy going into NGOs, but not really being able to be sustainable over time.” Although I will strive to embrace the positive outcomes of public-private partnerships in the social justice movement, I will equally challenge us to consider PPPs of a different kind, public-people partnerships, where governments collaborate with community members to drive social change.