Put Power Where It Belongs

By Karl Hofmann, PSI President and CEO  

We live in a fascinating time. For all of us working in global health, we can thank President Trump—yes, thank him—for opening our eyes to some harsh realities, and giving us every reason to urgently change course.

Does anyone feel we need a fresh example of the old adage, “Power Corrupts?” Seems like we get a new reminder every day.

In reality, power dynamics have always existed. They explain so many of our frustrated ambitions, and our most shameful moments. And they’ve been laid bare anew these past few months, in ways we couldn’t imagine even a few short years ago.

The #MeToo movement exposed something we knew but rarely openly addressed—that the power differential between men and women, between old and young, between the privileged and the poor translates effortlessly into abuse and exploitation.

For too many, it’s been a daily, lived experience. For others, it’s only now visible. (And, naturally, it took people with power and privilege to make this reality loud enough to hear, and clear enough for all to see.)

If we’re honest, power and privilege have a similar effect on global health. Too many of today’s health challenges exist not because medicines don’t work, but because power, money, and race do.

And wealthy countries have decided what’s best for poorer countries for far too long.

Even how we talk about aid is skewed. Take the widespread use of the word “empower,” which, if we think about it, reinforces the notion that power is something for me to give to you. Even in empowering you, I win. #banthewordempower.

As WHO Director-General Dr. Tedros Adhanom Ghebreyesus says, “The people we serve are not the people with power; they are the people with no power.”

How has the power dynamic held global health back?

Take specially formulated kid-friendly dosages of TB medications. How is it that they haven’t existed for over a century until now? Because kids don’t have power.

Why is the all-in-one injectable contraceptive Sayana® Press so revolutionary? Because not only is it useful for a woman who doesn’t want her partner to know she is using contraception, but because she can also administer it herself. No need even for a provider, with (his) built-in biases.

And medication abortion—what is it that generates so much fear and concern among anti-abortion activists about this particular therapy, which is highly effective and safe within the first trimester of pregnancy? Because it’s loose in the hands of women, with no intermediary, no physician, no man to exercise control.

It’s high time we put more power and control directly into consumers’ hands. For PSI, this begins with a paradigm shift.

We see a future where the health consumer we serve isn’t impacted by the political whims of a country far away, where the market that provides products and services is robust and actually works for her, where the funding for the health systems she relies on comes increasingly from her home country, and where she has far greater control over her health decisions—and we have far less.

Today, we rededicate ourselves to keep the health consumer at the center of our thinking, we listen closely to understand her actual needs and barriers—we take inspiration from the giants of consumer insights that every day mold our consumer behavior—and we begin to chip away at the imbalance that has frustrated faster global health progress and too often served the wrong people.

 

 

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