Many societies do not generate the wealth required to be able to look
after the health of the people on a more or less fair basis. Others have the
resources but the political and social will to do so is lacking. Challengingly,
even where and when the resources are available and are deployed to
provide health care for all, that is no guarantee that our patterns of
behaviour will be healthy. For that is a matter of personal responsibility and
individual action; government can make it easier or harder, can educate
the citizens or neglect the issues, but in the end it is impossible to enforce
healthy behaviours.
Even so, people’s health is improving. There is still too much suffering from
curable and preventable conditions and, in many countries, the way that
mental and psychological disorders are handled primarily by silence and
taboo is as big a health scandal as any. But medical science is advancing,
the sequencing of the human genome has been worked out, the genetics
of cancers are being unlocked, and new treatments are being and will be
developed. The progress is encouraging but there is further to go because
many of these conditions have social causes – lifestyle diseases whether of
poverty or spreading prosperity. What is required now is to increase the
capacity to address those causes.
HEALTH OF THE PLANET
On top of all this, there is growing awareness about the unfolding crisis in
the natural environment. Compared to the other events that have shaped the
spirit of our time, changes in the natural environment are slow moving. By
the standards of 21st-century political culture, they do not deserve the name
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of crisis at all – but the timescale in which they should be understood is
much longer than a four- or five-year political cycle, which is the maximum
we are used to thinking in.
Of the five key issues that we must as a world community resolve in order
to prosper, our relationship to the natural environment is the most tangled,
the one in which knowledge is most essential to understanding, and the one
that has the highest stakes – yet the one on which we seem unable to act
on the scale that is needed. Though we cannot yet make out all the details
of the interaction between different components of this crisis – between
the different ways in which we are damaging the environment – we can
clearly see the critical moment bearing down on us. Yet generating a united
and viable response is currently beyond us. Calm reflection reveals that, on
the basis of what we currently know, there is time to act effectively as long
as we act now. But each day that passes increases the depth and scale of
change that is required.
PROBLEMS & SOLUTIONS
These five key challenges are in principle all amenable to solution. In one
sense, that is illustrated simply by there being successful approaches to
significant aspects of three of the five. Problems remain in the realms of war
and peace, rights and respect, and people’s health, but progress is visible.
There is less war, though violent conflict persists. There is more democracy
and more respect for human rights, though abuses persist and the
transition is often dangerous. Improvements in treatment for many of the
major ailments are available, though lifestyle diseases are on the increase.
Undernourishment is slowly reducing as a problem, but obesity – perhaps a
different kind of malnutrition – is now a global epidemic.
What holds us back from pressing through to greater improvements on these
three fronts and to sorting out at least some of the big issues of wealth,
poverty, and the natural environment is the condition of our politics and our
international political institutions. In Europe in the years since 2008 we have
seen signs of a breakdown in the fundamental relationship between citizens
and state – the implicit bargain that power is both real and accountable.
There is now such a deep resentment about taxpayers being forced to pay
the cost of the failings, incompetence and, in some cases, apparent crimes in
the major banks that it is building towards refusing consent to be governed.
The social and economic elite has shown a combination of incompetence
and the arrogance of impunity, and would-be political leaders continue to
cosy up to that elite so shamelessly that they are threatening the continued
viability of the contract of government.
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It is, in the end, unlikely that this will erupt into any kind of revolution
and, if it does, the odds are that it will be profoundly unpleasant for
ordinary people. But it is the kind of deep-seated problem that may make
it next to impossible to generate new policies and approaches to prevent
environmental degradation and successfully address the other major issues.
Our enemies in trying to generate new and better approaches are inequality,
unfairness and social exclusion, short termism, and blinkered allegiance to
norms and policies that used to be functional. Anything and everything
that limits the amount of knowledge that can be brought to bear on a
problem, and the number of knowledge-holders that can get engaged, is an
obstacle. Part of this problem resides in the limitations of the institutions we
have developed to regulate our affairs. We need new ones. There is energy
available that has not yet been harnessed and connected to engines of
change. The old power formats are creaking but the new ones have not yet
emerged.
KNOWING THE WORLD
Getting things more or less right on these five issues will be done by
international agreement or not at all, for no single government can handle –
or should even dream of handling – the whole set of issues alone, and much
of it will in turn be based on shared knowledge and understanding.
Of course, knowledge is not the same as wisdom. You can know all the
facts and still not be able to act wisely. But without knowledge, it is harder
to be wise – even