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If the world was run by doctors

Politicians work together to tackle political crises, so why not medical emergencies? Malaria can an

It's a strange thing to be asked by the Archbishop of Canterbury to write an article. Particularly strange for me, as I'm one of the few people who would have been confused by his original letter. It asked me to write something for the New Statesman and was signed simply "Rowan". I assumed that it was from my old friend Rowan Atkinson and, although slightly puzzled by his new, fancy headed notepaper, I ignored it, as you're allowed to do with old friends. My office then received a prompting call. I reread the letter and realised that it was from a real, clever clergyman, rather than some­one who has just acted as stupid clergymen throughout his career.

But what to write about? I've been fairly scared of archbishops, ever since my first encounter with one on a train when I was nine. He sat down opposite me - we were travelling from Ascot to London - and I looked at him a lot. When I was finally convinced that he was Michael Ramsey, the archbishop of Canterbury (the purple dress was something of a giveaway), I asked him a question about God. He couldn't have looked at me in a more bored manner. He said it was a "very interesting question", then went straight back to reading his book without giving me an answer. So I was nervous of trying to get in touch with Rowan Not Atkinson and asking him a question, in case I got a similar reply.

I hope it's OK if I just write very quickly about malaria. I know I've got quirks but, now that I'm 54, I guess I have to accept who I am. I'll never understand classical music. I'll never get a glimmer of emotion from any painting by Picasso. I'll never like fish in any kind of white sauce. And I'll never understand why malaria is still killing over three-quarters of a million people, most of them young, every year, in this modern world of ours.

My sense of confusion was brought into focus by the letter that our Prime Minister, David Cameron, President Nicolas Sarkozy of France and President Barack Obama of the US sent to the major newspapers of the world in April. It was about something very urgent: the situation in Libya. They had to get together urgently because of the gruesome and dangerous situation that had arisen there. They had to take urgent action and they did. Urgent and expensive action - billions of pounds' worth of action.

What I don't understand is this: why are the lives at risk in Libya more valuable than the lives we are losing to malaria? I don't know how many are at risk in Libya, but I doubt there are 800,000. The total population of Libya is only six and a half million - roughly the same as the number of people who die of malaria around the world every eight years. Of course, oil may have something to do with it, but all of the rhetoric has been about human suffering. So it continues to puzzle me why these three powerful and important men don't write a letter to those same papers and say, "There's this terrible situation that is killing nearly a million people a year - 600,000 innocent children; more than 2,000 people yesterday - even though we know how to prevent these deaths. We must do something about it urgently."

Opening the box

One thing is for sure: they could be much more confident of the outcome of their initiative. Winston Churchill once said that as soon as you open the box marked "War", you have no idea what will happen:

Never, never, never believe any war will be smooth and easy, or that anyone who embarks on the strange voyage can measure the tides and hurricanes he will encounter. The statesman who yields to war fever must realise that once the signal is given, he is no longer the master of policy but the slave of unforeseeable and uncontrollable events.

This seems true in Libya and the other Arab spring nations. As I write, it is a fluid and dangerous situation. And the history of western support for revolution is littered with strange and unpredictable outcomes - see Osama Bin Laden.

But open the box marked "Malaria" and you will find a complicated plan for its elimination that nobody opposes. There's a long document called the Global Malaria Action Plan, which is a pretty good blueprint for success. There are a lot of brilliant people working on it. There has been a 20 per cent decline in deaths from malaria since 2000. During that time, 11 African countries have cut their malaria deaths by 50 per cent. The world did, in fact, almost get rid of malaria in the 1960s, but a bit stayed in Africa and now it's killing all over again.

This time we could win the full victory. So why doesn't it happen? Why do politicians seem to find lives at risk because of politics so fascinating but bide their time when it comes to lives at risk because of health? One answer, I suspect, is that it seems somehow more horrific for a life to be taken by a ruthless tyrant than to be taken by a ruthless disease.

I would argue that it's not. Spend a day at a hospital in Mozambique, Uganda, Nigeria or Burundi, where malaria is bad, and there's enough panic and horror and violence against children there for anyone's taste. See the looks on the faces of the mums and dads as their children sweat, vomit and slip into comas - they are no less full of horror than if a tyrant's bullet had caused the damage.

Another reason why there is so little sense of urgency in the face of the spectacular number of deaths from disease is that politicians are very, very interested in politics. We'd have a different world if it were run by doctors. You notice it with newspapers and the media, too - newspapers and the media love stories about the media and newspapers. There is no way that the public is as interested in the phone-hacking issue and the superinjunction furore as the newspaper column inches they've been given would imply. Editors love these stories because they're about their job. It is for the same reason that most politicians are interested in politics. They're obsessed by the Middle East - the ultimate political mystery - but they're not viscerally interested in medical questions. And they are not lobbied on medical questions with such vigour. In a world run by doctors, malaria would have been wiped out years ago.

Yet the truth is, if you want huge wins with predictable outcomes, they lie in the area not of politics, but health. And perhaps universal education (see Gordon Brown, overleaf). I would plead with David Cameron to think about making one of these issues his great foreign-policy cause. I'm particularly passionate about malaria but universal vaccination would also save millions of lives - rotavirus, which kills 500,000 children a year, could be wiped out. And universal education would transform the lives of 70 million working children. In a world run by teachers, every child would go to school.

Optimist that I am, I think perhaps things are indeed changing. I strongly applaud the Tories for recommitting to the last government's impressive promise that international aid should account for 0.7 per cent of gross national income by 2013. I've heard George Osborne talk passionately about the fight against malaria and I was thrilled. And the UK is co-hosting the crucial Gavi forum this month to find extra money for immunisation.

But I strongly encourage them to go a step further, to ask: "How can British leadership leave a mighty legacy in the world, change things permanently, quickly?" And then I think Cameron should ring up Nicolas and Barack in the middle of the night and say, "Let's write a letter to the papers again. I think we can do this. By the time we're out of power, we could save a million - no, if we really focus on it, five million lives a year, for ever."

Writing on the wall

I know I've got a simple view on it. I know I'm still just the boy in shorts asking the archbishop an obvious question. Nonetheless, I'm interested to know why this is such a foolish notion. Particularly if we have a dominant Obama winning a second term and doing some­thing serious about Africa while in power, unlike some Democrats before him.

One final statistic. At a rough count, the total number of lives - such precious lives - lost in the Middle East conflict since the Six Day War in 1967, added to the number of lives lost in the Troubles in Northern Ireland since 1969, added to the number of US soldiers lost in the Korean and Vietnam wars, added to the number of civilian and military casualties in our recent engagements in Afghanistan and Iraq, still has to be multiplied by two to get the number of lives that will be lost to malaria in the next 12 months. Precious lives, also. The combined cost of those wars is almostincalculable. But recent calculations say it would cost $6bn a year to get rid of malaria once and for all. That's 12 countries putting aside just half a billion each. But someone's got to lead it. Could it be our lot?

One final quotation. I went to a Roger Waters concert performance of The Wall the other day and up on the wall at one point came a quote I assumed was from the mouth of some noisy, bearded radical. It read: "Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed." I was surprised when its attribution came up: Dwight D Eisenhower, supreme commander of Allied forces in Europe during the Second World War and Republican president of the United States. So, maybe it's me and Ike now asking the new generation of politicians: is there another way?

Richard Curtis is the writer of "Blackadder", "Four Weddings and a Funeral" and, most recently, "The Boat That Rocked"

This article first appeared in the 13 June 2011 issue of the New Statesman, Rowan Williams guest edit

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Goodbye to the Confederate flag

After the shootings in Charleston, the Republican right showed it was finally ready to reject the old symbols of the Confederacy.

On 27 June, an African-American activist named Bree Newsome woke up before dawn, put on her climbing equipment and scaled a 30-foot flagpole on the lawn of State House in Columbia, South Carolina. She then removed the Confederate battle flag that flew from it. “We can’t wait any longer,” she explained later in an online statement. “It’s time for a new chapter where we are sincere about dismantling white supremacy.”

After she was led away in handcuffs, the flag was raised again.

Newsome’s protest reflected a growing impatience within America’s black community and anger about liberal inaction. Political rallies by the Democratic presidential contenders Hillary Clinton and Bernie Sanders have been disrupted by the Black Lives Matter campaign against violence committed on young African Americans and the cultural and legal biases that justify it. While promoting his book on race in the US, the writer Ta-Nehisi Coates argued that, to African Americans, the battle flag represents a lingering attempt “to bury the fact that half this country thought it was a good idea to raise an empire rooted in slavery”.

Yet, on this matter, to everyone’s surprise, the black civil rights movement and many southern Republicans have proved to be of one mind. On 9 July the House of Representatives in South Carolina voted to lower the battle flag for good. It stood, representatives said, for racism. It had to go.

The context of this agreement was a painful one. Ten days before Newsome’s act, a 21-year-old white man named Dylann Roof shot and killed nine black worshippers at the Emanuel African Methodist Episcopal Church in Charleston, South Carolina. According to his room-mate, he wanted to start a race war. The TV screens showed a photo of him holding a gun in one hand and a Confederate battle flag in the other.

If the demands for redress made by civil rights groups didn’t come as a surprise, conservative acquiescence did. The Republican Party had built a solid base in the South by courting white voters who cherished the memory of the Confederacy. Yet the party’s presidential hopefuls from both the North and the South – including Jeb Bush, Lindsey Graham, Scott Walker and George Pataki – said that the battle flag ought to be lowered. The most striking intervention was made by the governor of South Carolina, Nikki Haley, who denounced the use of the Confederate flag and signed the bill removing it. Haley is now tipped to figure on the list of potential vice-presidential nominees.

The volte-face of the US right is in part a result of the horror of the Charleston shootings. Yet it also occurs in the context of major shifts within American society. There are still many conservatives who will defend Confederate heritage as a matter of southern pride but the culture wars are changing as the US becomes increasingly European in outlook. This is taking place across the country. It just happens to be more pronounced in the South because no other region has fought so violently and so long to resist the liberal tide.

The story of the battle flag is the story of the South. The first official Confederate flag used in the civil war of 1861-65 caused confusion during fighting – through the haze of gun smoke, its design of 13 stars and red and white bars was hard to distinguish from the Stars and Stripes. An alternative blue cross was rejected for being too sectarian; the racist Confederacy was anxious not to offend its Jewish citizens. So the cross became a diagonal X. This flag was never officially adopted by the Confederate army. In the years after the war its use was infrequent.

There was little need to visualise southern difference in a flag. It was self-evident in the physical signs of racial segregation: separate schools, pools and drinking fountains; black people confined to the back of the bus. Political displays of the battle flag of Dixie (the historical nickname for the states that seceded from the Union) only really resurfaced when that racial order was challenged by northern liberals. In 1948, the Democrats – then the party overwhelmingly in control of the South – split over modest calls for civil rights. The conservatives who refused to support that year’s presidential ticket, the “Dixiecrats”, triggered a rev­ival of flag-waving across the region.

The old battle flag suddenly appeared on private lawns, on cars and at political rallies. Supposedly ancient cultural traditions were invented overnight. For instance, the 1948 student handbook of the University of Mississippi confessed: “Many Ole Miss customs are fairly new; they lack only the savouring which time brings . . . Ole Miss has adopted the Confederate flag as a symbol of the Mississippi spirit. Each football game finds the scarlet flag frantically waving to the rhythm of the Rebel band.”

I can confirm that this “tradition” was still going as recently as in 2005. That year, I attended an American football game at Ole Miss and was surprised when the band played “Dixie” at the end. White boys and white girls stood up and belted out the folk song of the Confederacy, while black students filed out.

In 1958, South Carolina made it a crime to desecrate the battle flag. Three years later, on the 100th anniversary of the outbreak of the civil war, it was hoisted above its Capitol building in Columbia. That day, there was a struggle in the US Congress to keep federal funding going for segregated schools.

So clear is the link between the postwar white resistance to civil rights and the battle flag that many see it as the symbolic equivalent of the N-word. Jack Hunter, the editor of the conservative website Rare Politics, says: “Some people insist that it’s not about racism, not about slavery, not about segregation. But it’s about all those things.” Hunter grew up in Charleston and used to skateboard in the car park of the church that Dylann Roof attacked. When he was a young journalist, he appeared on local radio as a rabidly right-wing masked character called “the Southern Avenger”. His past was exposed in 2013 while he was working for Rand Paul, a Republican presidential candidate, and Hunter stepped down from his position. He publicly renounced his youthful association with racial conservatism. He now eschews any romanticism about the Confederate cause and its demand for states’ rights. “States’ rights to do what?” he asks: the right to discriminate against African Americans? He is glad that the State House flag is gone. He ascribes its longevity to ignorance, which was corrected by Roof’s rampage: “It was the first time that [southern Republicans] were able to see a different perspective on this symbol.”

Not everyone agrees. Richard Hines – a former South Carolina legislator, Reagan campaign state co-chair and senior activist with the Sons of Confederate Veterans – insists that the flag is “an enduring symbol of the southern fighting man”. Indeed, a poll in July found that 57 per cent of Americans think it stands for southern heritage, rather than racism. Yet that heritage has a political dimension. “Southern people are proud of who they are and there is a leftist assault to destroy the best part of America,” Hines says. “The Trotskyite elite in control of the establishment wants to root out the southern tradition” – a tradition of religious devotion, chivalry and military honour. It is possible to cast the battle flag as a pawn in a much larger cultural conflict.

In 2000, civil rights activists lobbied hard to get the battle flag removed from the top of the South Carolina Capitol and succeeded in having it shrunk in size and relocated to the grounds of State House. The issue came up in that year’s Republican presidential primaries – an unusually poisonous contest between George W Bush and John McCain. Supporters of Bush put out a false story that McCain had fathered an interracial child out of wedlock. McCain added to his woes by opining that the battle flag was “a symbol of racism and slavery”. An organisation called Keep It Flying flooded the state with 250,000 letters attacking him and he lost the crucial competition here to Bush.

The battle flag has retained a strong emotional power for a long time. This makes the Republican establishment’s abandonment of the flag all the more surprising. Then again, those who run the South are probably the people most likely to grasp how much the region has changed in just a decade.

***

In 2010 I took a trip through North Carolina. The landscape told a story. Dotted along the roadside were abandoned black buildings, the old tobacco sheds. The decline of the rural economy had rendered them obsolete. Over the fields that would once have been full of farmers were freshly tarmacked roads, stretching out to nowhere. My guide explained that these were supposed to be cul-de-sacs for new houses. North Carolina was going through a property boom. But who was going to buy all those homes, I asked? The answer: damn Yankees.

Demography is destiny. This once agri­cultural region developed fast from the 1960s onwards by keeping union membership, taxes and regulation as low as possible. Yet capitalism proved disastrous for southern conservatism. Northerners flooded in, seeking work or retirement and bringing their own values. The forecast is that North Carolina’s Research Triangle – the South’s Silicon Valley – will grow by 700,000 jobs and 1.2 million people in two decades.

White migration was accompanied by an influx of Spanish speakers as the service sector flourished. Between 2000 and 2010, the white share of the population of North Carolina fell from 70 to 65 per cent. The black proportion remained at roughly 21 per cent. The Latino proportion, however, jumped from 4.7 per cent to 8.4 per cent. Today, the proportion of people who are non-white and over 60 is about a third. But it’s approaching nearly half for those under 18. As a result, politics in the South is no longer biracial: a contest between white and black. It is increasingly multiracial and uncoupled from the region’s complex past.

The impact of these changes is reflected in voting patterns. In 2000, the South was still overwhelmingly Republican in presidential contests. Even the Democratic nominee, Al Gore, a southerner, lost his home state of Tennessee. But in 2008 and 2012, Barack Obama took those states with the fastest-changing demographics: Florida and Virginia. He won North Carolina in 2008 and lost it in 2012 – but by less than 100,000 votes. It is true that the Republicans won back control in the 2014 midterm elections, with the result that the Deep South now sends few Democrats to Congress; but the region’s political masters are not quite as traditional-minded as they once were.

The Republican relationship with the Confederate past is complex. As the party of Abraham Lincoln and the Union, the GOPs’ southern support was historically small. But in the 1960s the national Democratic Party embraced civil rights and alienated its once loyal southern following; the Republicans took the opportunity to steal some conservative white voters.

The growing southern Republican vote had a class component. Its success in local and congressional races was built more on winning over middle-class moderates than on appealing to the working-class racists who filled the ranks of the Ku Klux Klan. The southern Republican Party did enthusiastically embrace the Confederate battle flag in many quarters. But some office-holders did so only with ambiguity, while large sections of the party never identified with it at all. The period of Republican ascendancy in the South was, in reality, linked with a softening of the area’s racial politics.

Two of the Republicans’ current southern stars are Indian Americans: Bobby Jindal, the governor of Louisiana, and Nikki Haley, the anti-flag governor of South Carolina. There are just two black people in the US Senate and one of them is a Republican, the Tea Party-backed senator for South Carolina, Tim Scott. Marco Rubio, the Floridian senator and presidential candidate, is Cuban American, and the former Florida governor Jeb Bush is married to a Mexican-born woman and speaks fluent Spanish. Bush has tried to push a more moderate line on immigration, in deference to how the GOP will struggle to win the White House if it appeals only to angry white voters. The Kentucky libertarian senator Rand Paul, Jack Hunter’s former boss, has called for legal reforms to correct the trend of keeping far more black than white people in prison. And he is not the only Republican to have been moved by recent race riots sparked by police violence.

***

Violence on the streets of Ferguson, Missouri, and Baltimore, Maryland, confirmed that there still is a culture war in the US. Yet its character has changed. In the past, civil disturbances were typically leapt upon by conservative politicians as evidence of social decline. The 1992 LA riots were blamed on single parenthood and rap lyrics. In contrast, conservative leaders today are far more likely to acknowledge the problems of white racism. There is no place in their ranks for the likes of Dylann Roof. White supremacists are tiny in number.

Jack Hunter claims: “The KKK is like 12 guys in a telephone booth. Liberal groups will use their threat for fundraising but it doesn’t exist. It hasn’t properly since the 1960s.” Roof’s actions say more about gun control, mental illness and the angst of the young than they do about popular, largely liberal views on race, as polling shows.

We can see a similar liberal shift in other areas of the historic culture war. In May 2015 Gallup released the results of a “moral acceptability” survey charting changes in national attitude across all age groups, from 2001 to 2015. Approval of gay relationships jumped from 40 to 63 per cent; having a baby out of wedlock from 45 to 61 per cent; sex between unmarried men and women from 53 to 68 per cent; doctor-assisted suicide from 49 to 56 per cent; even polygamy went from 7 to 16 per cent. Abortion remained narrowly disapproved of: support for access has only crept up from 42 to 45 per cent. This is probably a result of an unusual concentration of political and religious opposition and because it involves a potential life-or-death decision. But the general trend is that young people just don’t care as much about what consenting adults get up to.

Why? It might be because old forms of identity are dying. One way of measuring that is religious affiliation. From 2007 to 2014, according to Pew Research, the proportion of Americans describing themselves as Christian fell from 78 to 71 per cent. Today, only a quarter of the population is evangelical and 21 per cent Catholic, down despite high immigration. Then there is the decline in civic or communal activity. Since 2012, the organisers of Nascar, the stock-car races, have not published attendance figures at their tracks, probably because they have fallen so sharply. The decline of this most macho and working class of sports parallels the fall in conservative forms of collective identity such as southern traditionalism.

The old culture war was, like the racial politics of the old South, binary. In the 1950s, around the same time as the South invented its tradition of flying the battle flag in colleges, the US constructed an ideal of the “normal” nuclear family unit: straight, white, patriarchal, religious. On the other side was the “abnormal”: gay, black, feminist, atheist, and the rest. The surest way to get elected in the US between 1952 and 2004 was to associate yourself with the economic needs and cultural prejudices of the majority. The approach was once summed up by a Richard Nixon strategist thus: split the country in two and the Republicans will take the larger half. But that is changing. The old normal is no longer the cultural standard but just one of many identities to choose from. The races are mixing. Women want to work more and have children later in life, possibly without marriage. Many religious people are having to rethink their theology when a child comes out as gay. And the enforcers of the old ways – the unions, churches or political parties – are far less attractive than the atomising internet.

***

Politicians are scrabbling to keep up with the diffusion of American identity. Democrats got lucky when they nominated Barack Obama and chose a presidential candidate who reflected the fractured era well: interracial, non-denominational Christian, and so on. In the 2012 presidential race the Republicans got burned when they tried to play the old culture war card on abortion. They won’t repeat that mistake. After the Supreme Court legalised gay marriage across the country in June, the right’s response was not as uniformly loud and outraged as it would have been in the past. Some protested, but serious presidential contenders such as Jeb Bush grasped the implications of the defeat. There is a cultural and political realignment going on and no one is sure where it will lead. It’s encouraging caution among the Republican top brass. It is time, they think, to abandon lost causes.

The death of southern traditionalism is part of the ebb and flow of cultural history. Identities flourish and die. As political fashions change, you find the typically American mix of triumph on one side and jeremiad on the other. Richard Hines stood vigil as the battle flag was lowered in Columbia and noted with disgust the presence of what he described as “bussed-in” activists. “They pulled out all these gay pride flags and started shouting, ‘USA, USA, USA!’ It reminded me of the Bolshevik Revolution.”

Hines reckons that more southerners will now fly the flag than ever before and says he has attended overflow rallies of ordinary folks who love their region. He may well be correct. The faithful will keep the old Confederate standard fluttering on their lawns – an act of secession from the 21st century. But in the public domain, the battle flag is on its way down and in its place will be raised the standard of the new America. The rainbow flag flutters high. For now.

Tim Stanley is a historian and a columnist for the Telegraph

This article first appeared in the 20 August 2015 issue of the New Statesman, Corbyn wars