Orienting our economies toward wellbeing requires that while we work hard toward accessible health care, we work even harder toward health creation by transforming the systems driving up the need for healthcare.
We are living through a disruptive time in history as a result of the coronavirus. The pandemic has amplified pre-existing societal fractures ranging from unequal access to health, to socio-economic vulnerability, to racism and gender-based violence. It has also forced us to be more insular than we could have imagined in our globalized world given the closure of borders. Everywhere, it fuels the question—how do we build a reset that lays a stronger foundation for the future?
As Africans, this question is pertinent for four reasons. First, we are navigating some of the fastest rates of urbanization globally. Close to half of the continent (41 per cent) already lives in urban centres and in countries like Botswana, Equatorial Guinea and São Tomé and Príncipe, over 70 per cent of the population is estimated to be urban. Secondly, the median age on the continent is 19 years. This rapidly urbanizing and young population could be enviable if it could be harnessed for good. Thirdly, the history of extractive and colonial efforts on the continent, also amplified by the recent global Black Lives Matter protests, demonstrate that a radically different, more equal and pan-African future is needed. Finally, we live in the Anthropocene, a planetary age where human-driven developments have pushed the earth beyond its reasonable limits, putting us at more risk for disasters and pandemics such as the coronavirus.
With these considerations in mind, it is certainly time for us to discuss a vision of growth for the continent, whose success metric is improved human and planetary wellbeing. The continent is also placed well to do this, as while high-income countries, such as the Netherlands, are needing to pivot their already established growth pillars to get it right, the large gaps in infrastructure and capital yet to be harnessed means that we can get development right from the get-go.
Wellbeing-Oriented Growth: Key Pillars
Directing Innovation toward Health Creation, and Not Just Healthcare
We cannot sustainably reverse rates of road traffic injuries, mental illnesses, cardiovascular diseases, diabetes and cancers by care alone, no matter how good. This is because the drivers of these issues range from poor infrastructure, unsafe and polluted neighbourhoods, to a diet landscape dominated by highly processed imported foods, and more. We ultimately need investments in green and blue spaces, road infrastructure that is safe to walk and cycle on, inclusive, safe and thriving neighbourhoods, and supply chains that make healthy food ubiquitous. This is what it looks like to orient our lens away from a care-centric focus to one of health and wellbeing.
Orienting our economies toward wellbeing requires that while we work hard toward accessible health care, we work even harder toward health creation by transforming the systems driving up the need for healthcare. This is no small undertaking, but it is also doable. A move towards wellbeing requires transformation in our venture capital and impact investing models. Such transformation would need to accommodate system-wide experimentation as against incremental innovation, include population segments that are usually missed, and capture value to human and planetary health beyond short-term profits. Likewise, this transformation requires governance models that use more holistic measures to capture development so that rather than using narrow GDP-centric measures, we measure the impact of our development endeavours on human and planetary wellbeing. An example of Rwanda’s green villages shows us the positive rebound of investments targeting holistic growth measures, and other case studies show the positive impact of people-centred and healthy place-making on local economies, social cohesion, human wellbeing and the climate.
In addition to directing capital toward opportunities that create health, we need to curtail endeavours that damage health. There are many sectors that produce short-term growth, but then create negative externalities that lead to long-term losses to human capital. An example of this is the supply chain for tobacco products. The tobacco industry often contributes to large-scale deforestation, limiting the ability of the agriculture sector to feed the nation and driving unnecessary imports. This industry also capitalizes on weak policy infrastructure to advertise its products to young people, driving cancer rates high. Lack of policy coherence across sectors means that such a gamble of lives is justified in the name of economic growth. Growth is not enough. We must be strategic and coherent about the nature and direction of our growth. If we do it right, we will need less, not more, healthcare.
Building Inclusive Economies
Over a decade ago, in my earliest forays into public health, I worked to roll out a government-led medical waste management scheme in Lagos State. The frontline nature of this work involved interacting with healthcare providers and waste collectors. I noticed that while clinicians admitted to needing this service, there was a high level of cynicism—which I often found myself on the receiving end of—because they did not know if the government could maintain it. In these gaps of trust, there was always bricolage for better or for worse—in this case, informal waste collectors who could be counted on, even if they did not dispose wastes properly.
Informal practices, economies and means of service delivery are a consistent characteristic of service provision in many African countries. There are, however, ways to turn such practices into opportunities for value creation and improved access to services. In Ghana, a government partnership at the community level with informal maternal health workers produced outstanding results for universal health coverage. Similar examples exist for partnerships with informal waste collectors. Creating opportunities to engage informal economies can create a more inclusive economy given the opportunities for access to capital, certification, and credit, it provides. It also yields wider benefits for the economy in making essential services accessible and in drawing upon home-grown knowledge to ensure that solutions are fit for purpose.
In addition to the exclusion of the informal sector, many groups are left out of decision making in African countries. Women actively participated in every African liberation struggle, from the Eastern Nigerian women’s war of 1929, to the Kom women’s revolt from 1958-1961. Consider also Congo’s Andree Blouin and Angola’s Deolinda Rodrigues both of whom were active in the 1960s, just as Winnie Mandela was active in South Africa in the 90s. Still, men continue to dominate the political climate across numerous African countries. Regardless, different religions, ethnic groups, sexes, and classes navigate our countries differently. Without economies explicitly aiming to be inclusive, along with data systems to do so, we cannot create policies and solutions that are relevant or representative. However, if we are strategic and direct efforts to include them in health-creating sectors, we will not only drive inclusive economic growth, we will also protect the planet, and secure health and wellbeing.
Enriching the Knowledge Landscape
While African cities are often defined by the overwhelming number of citizens living in poverty, there are forms of capital simply being undervalued because they do not fit into the legitimized architecture of capital. The legitimized knowledge economy with its ‘Global North’ power centres privileges a framing of reality in dichotomies—the metropole versus the colony, the ‘self’ versus the ‘other’, culture versus nature, modernity versus tradition, man versus woman, rationality versus irrationality, ‘primitive’ versus ‘modern’, local knowledge versus ‘academic’ knowledge and so forth.
The challenge with this framing is that it is not sufficient for today’s challenges. On the one hand, it makes global health almost entirely an effort to improve health for recipients ‘out there’, typically low- and middle-income countries, whereas as coronavirus shows us, health challenges across the globe are intertwined, and expertise does not come solely from the ‘Global North’. Additionally, it suggests we view health through a biomedical, individual, and reductive lens. Therefore, while the SDGs prioritize health and wellbeing, in practice efforts to attain universal health continue to be dominated by care-centric solutions that are not linked to the place-based drivers of disease. It is virtually impossible to stay healthy in a polluted, poorly planned, unsafe, food-insecure and historically marginalized community. In contrast, an Igbo or indeed any African indigenous worldview understands health ecologically—as a function of inter-relationships between individuals, their communities, past and future generations, and the planet. Given that only about 10-20 per cent of our health is linked to healthcare, it is certain that the latter is a much more accurate lens.
A Necessary Reorientation
Indigenous forms of knowledge usually have a more intuitive grasp of the ecological approaches sorely needed today. Valuing them requires an ontological reorientation from GDP-centric to wellbeing-oriented conceptions of growth as the anthropologist, Jason Hickel, notes. It also requires a reorientation from reductive to ecological problem-solving. The anthropologist, Sabine Behl Jahsen, in her research on women’s spirituality, practices and power in Eastern Nigeria, draws attention to spiritual and cultural practices that were linked to improved child, maternal and community health. However, she also notes that the etic— their utility in protecting human and planetary health is intertwined with the emic—the underlying ecological worldview behind them.
Finally, it requires a shift in the knowledge we produce in our quest for solutions. Trevor Hancock, a champion of health in the Anthropocene notes the need to have meaningful contact with nature to imbibe a more embodied perspective on planetary health. Likewise, the feminist writer, Minna Salami, writes of sensuous knowledge—of the aliveness and full-bodied nature of knowledge production when it moves away from a Euro-patriarchal status quo to one that is centred in a pan-African, feminist sensibility. This reorientation ultimately provides us with a richer landscape of knowledge, innovation and practices for solving today’s complex problems.
Africans are creative, innovative and resilient and so many of our countries have led in creating solutions in this pandemic: from automated washing stations in Ghana, to comprehensive testing and contact tracing in South Sudan, to culturally appropriate public service announcements in Uganda, to drive-through testing stations in Nigeria and affordable testing kits in Senegal, to mention but a few. Such examples remind us that development will be a communal effort that is driven by policies, communal agency, and transformation of norms across our society. Now the work will be to orient the compass of our ingenuity, so it pays off for our wellbeing long term⎈
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