WHY PROGRAMS FAIL
[A talk given by Professor Richard Levins at the Harvard School of Public Health on May 7, 2009]
Several generations of development programs have left the gap between rich and poor countries wider than ever.
Decades of aid and foreign investment have extracted many times more wealth than they bring in.
17 years after the Earth Summit at Rio, CO2 continues to increase.
The anti-proliferation treaty has left us with more nukes, more countries possessing nukes more sophisticated nuclear weapons, more willingness to use them.
The fanfare of the green revolution has died down, and farmers are still being displaced to the cities that can’t accommodate them. The first homes of the green revolution are now importers of food.
Agricultural yields have increased, but so has hunger.
The millennial development goals will not be reached.
It is not that no programs work. There have been dramatic successes such as the eradication of smallpox, the near eradication of polio, the containment of plague. But meanwhile new diseases burst forth, old ones return, the destruction of wetlands forces migratory birds to fraternize and share their viruses with domestic fowl. Industrialized agriculture has become the petri dish for antibiotic resistance and big corporations are in a mad race to grab up the farmland of Africa. The Thames is now clean enough to allow salmon to return but the Colorado River barely trickles to the sea. Forests are protected in Japan and Europe but at the expense of forests of Indonesia and the Phillipines. There are more urban clinics, but the megacity is a historically new environment vulnerable to diseases too virulent to survive in small sparse populations. We may get a fuel efficient car, making it easier to commute longer distances, and if China achieves the automobile density of Euro-North America, the equivalent of 1/3 of the area devoted to rice production will have to be paved over. Aquaculture moves into the niche left by declining oceanic fisheries, but the ensuing salinization threatens already stressed water tables. Increases in productivity, that could give us more tranquil lives, result in longer work weeks, faster pace, and whole industries designed to compensate for the stresses of multitasking and insecurity, while the pharmaceutical industry can’t wait for new diseases to emerge and invents them, turning any variation in human physiology or behavior into a market for their products.
There is pattern of a sort: narrowly focused technical solutions reshuffle crises.
WHEN ONE PROGRAM AFTER ANOTHER FAILS AGAIN AND AGAIN, WE HAVE TO ASK, “How come?” When people just as smart as we are regularly fuck up, what are they refusing to deal with?
The problem can’t be solved. Abundance, justice, and sustainability are incompatible.
“We” are doing the right thing but have to try harder. It is not that they want people to be without health care, but they want accessible health care subject to the constraint that it is controlled by a private insurance business whose primary goal is profit.. It is not that they want to leave people without medicine, but they want them to buy medications from a private for profit pharmaceutical industry.
Explanations at three levels:
Institutional fragmentation—isolation of medical from ag schools. Department barriers help create false dichotomies: social/biological, physiological/psychological, genetic/environmental, quantitative/qualitative, individual/social, random/deterministic whereas the new creative approaches should be sought in their zones of interpenetration.
Political economy: In a capitalist economy, goods and services are commodities. Commodities are produced for sale, to make profit.
Agriculture is not about producing food but profit. Food is a side effect: there is no necessary relation between the usefulness of something and its economic value.
Health service is a commodity, health a by-product.
Development is about investment opportunities and markets, not correcting decades of plunder and exploitation.
“We”, that is, “they”, are really trying to do something quite different from the stated goals and perhaps succeeding at it all too well.
Knowledge is the product of a knowledge industry that is owned. Its owners establish the boundaries of the legitimate, determine the rules for who is recruited, who is excluded, the research agenda, the domain of acceptable theories, and provide the vocabulary for dismissing inconvenient ideas as “far out”, “not mainstream”, “unproven”, “ideological” , or other indications of tabu. They create the art of administration: the inventing of excuses to justify decisions taken for other reasons, and the conviction that this is being practical, realistic, etc.
Science prides itself on the self-correcting mechanisms to catch error which is supposed to create objectivity even when individuals may be fallible. We have become quite sophisticated about preventing idiosyncratic errors. We now know that we should wash our glassware, that experiments need a controls, that the experimenters’ expectations can influence the outcome of an experiment so that we have invented blind and double blind designs. Work might be repeated in another lab. Peer review can protect journals from careless mistakes. We can filter out random results by statistical tests, and we never, never divide by zero. These procedures work fairly well. But they are completely useless against the shared biases of the whole scientific community, the assumptions and constraints that have become part of the common sense.
The intellectual structure of our programs is still caught in the philosophy of 17th century reductionism that grew up with capitalism in Euro-North America. Note: I have no objection to reduction as a research tactic, the search for the smallest parts of a problem, but to reductionism, the belief that the small is more fundamental, and that once you know the parts the whole follows as an exercise for the reader.
The domination of science by philosophical blinders is reinforced by generic conflict of interest: In recent years the professional journals and universities have recognized individual conflict of interest, situations in which researchers have economic stake in the outcomes of their research that influences their reports and what is withheld. Disclosure statements have become part of the efforts to protect the intellectual integrity of science and scholarship. This may be working more or less well. But it does not touch generic conflict of interest, the coziness among corporations, government and international agencies, universities, think tanks and prestigious journals that has created a kind of nomenclature, the pool of people who consult each other, review each others’ grants, allocate prestige, invite each other to give prestigious lectures, give each other jobs, set the intellectual agendas, and generally show mutual appreciation while guarding the boundaries of the respectable. Professors are increasingly obliged to mobilize resources, jargon for raising money. Therefore the quality of proposals is determined by donors. And for corporations, not all knowledge is equally turned into commodities. Thus the quest for culpable genes is more fundable than the study of the industrial origins of cancer, the invention of new pesticides more fundable than studying the protective effects of mixed plantings, finding ways to supplement the nutrition of peasants on 13 cents a day is more legitimate than helping them organize for land reform. Studying the financing of “public-private partnership” is more popular than examining how universal free health care could work. But if the funding is constrained so is support for students and their potential employment. Therefore students are trained in the reductionist tradition and encouraged to focus narrowly, especially since any detours toward greater breadth and you hear the student loans ticking away.
Generic conflict of interest creates a great dilemma for students and faculty who want to face fully and broadly the problems confronting our species. We have to navigate in a terrain of a mixture of conflict and cooperation with our institutions and colleagues. We may share an excitement about the evolution of virulence or the behavior of pollutants in complex mixtures, or how traditional knowledge can be integrated with scientific knowledge. But we balk at collaboration with colonialist institutions such as the World Bank or terrorist agencies such as AID.
And we have to find ways of promoting a more holistic, complex, integral approach to scientific problems. In so doing, we can follow a series of dialectical clues:
The truth is the whole. A problem has to be posed large enough to fit a meaningful solution. No matter how small the problem you work on, always ask “where is the rest of the world?”
Things are more connected than they seem, even across disciplinary boundaries. Parts determine wholes, but wholes also determine parts.
Things are snapshots of processes, when a temporary balance of opposing forces creates a transient stability for long enough to warrant a name.
Things are the way they are because they got that way, have not always been that way everywhere, need not be that way. Always ask, “why are things the way they are instead of a little bit different?”
And “why are things the way they are instead of very different?”
Apply all these tools to ourselves and our fields of work. That way we can cope with the dual nature of science: on the one hand the millennial unfolding of human knowledge, and on the other the property of a knowledge industry, that creates the paradox of a growing rationality in the small, at the level of the laboratory, and a growing irrationality at the level of the enterprise as a whole.
In order to work toward that combination of understanding and humane commitment, we couldn’t do better than follow the advice of my grandmother when she sent me off to start first grade: study hard, learn all they can teach you, and don’t believe everything they say.