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"

11 comments

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Dr. Clarke's picture

Mr. Woogy, Captain Sensible and Seenitall, are you speaking as physicians?

Seenitall's picture

@seajay23 "Ever visited a community in such a community ... " No. Never been to the South Pole either, but I know it's cold. "Feckless" may have been the wrong word to use, though among its meanings are "feeble, weak, ineffectual, incompetent" (just checked online dictionary), which is what I meant. I'm talking about people who have so little foresight that they can't stockpile enough food, or assets they could exchange for food, to survive a famine, though famine occurs frequently in their country (chicken or egg?), can't implement sensible population control measures, and can't keep the peace long enough to ensure effective governance.

Strange that you cite Africa's strong economic growth -- is it so strong that it no longer needs the crutch of international aid? Praise be. Great news about Ethiopia -- it won't be coming round with the begging bowl again in ten years' time, you reckon? But you compare Africa's growth to India's -- that'll be the India where "over 60 percent of Indian children are wasted, stunted, underweight or a combination of the above" (Global Hunger Index, 2009). African economies may be growing, but mostly from a very low base, and clearly, they still can't quite support themselves.

I don't want these people to die -- I did say as much; still less do I think "we" should "exterminate" them -- though they seem to want to do that themselves, judging by their suigenocidal behaviour. But I don't think it's kinder to help 85 million people (for example) to face starvation rather than 42 million. It's a bit like feeding the birds in your garden: more will survive to next winter, but unless you then increase your donation of bird-feed, more will die.

seajay23's picture

Dear Seenitall
I presume your reference to the poor of the South as feckless was ironic, if not you mark yourself as a complete fool. Ever visited a community in such a country/ Ever seen how hard each individual works to survive?
Compare their actual work to say a banker - i know which one could be described as feckless.
As to your basic contention that if we keep people, especially children, alive they will just keep on breeding and make things worse; it works the other way around. If children live, parents are less inclined to have more children. Remember that a child is considered an asset in a poor family - they can work (see previous feckless comment), poor people reproduce not out of stupidity but out of need. Improve education, improve nutrition, improve women's rights and fertility rates decline, regardless of religion or race, it works every time.
And you don't mention that Ethiopia, despite its rapidly increasing population (or perhaps because of it) has one of the fastest growing economies in Africa, and Africa as a whole has grown faster than India over the past decade.
Of course, the end point of your logic would be that we should just exterminate the poor, voila! problem solved! Unfortunately the good Dean Swift has beaten you to the punch by several centuries with his Modest Proposal.

Dr Peng Hui Lee's picture

Syria is run by a doctor, ophthalmologist Bashar al Assad. Serbia did quite well under child psychiatrist Dr Karadzic who maintained their territorial integrity in the face of many enemies.

dr.who's picture

give a man a fish feed him for the day, teach a man how to fish you feed him for life

Seenitall's picture

There may be unforeseen consequences to saving three-quarters of a million lives a year in dirt-poor countries. Those lives will have to be supported in some way -- can their countries afford it, if they can't afford anti-malaria treatment? Wouldn't it mean more people enduring lives of horrible poverty and giving birth to more people with similar miserable prospects? I read recently that the Germans have a saying that translates as "Better a calamitous end than an endless calamity."

To illustrate my point, consider Ethiopia, which had a population of 42 million in 1984, just before the famine that inspired Band Aid and Live Aid. Lots of lives saved. Great. But recently there was another famine in Ethiopia, which by then had a population of 85 million. One might conclude that rescue in 1985 and international support since then removed the Ethiopians' incentive to address their food-supply problem.

It's not that I want those people to die. But populations that are unable to devise or implement viable social and economic policies cannot, in the long run, be saved. All that will happen is that palliatives in the form of aid and assisted emigration (to rich countries like the UK) will perpetuate the illusion of superficial crisis, while underlying realities are ignored, and celebrity messiahs like Curtis and Geldof project guilt on to the prosperous West (which has virtually zero population growth) and peddle quick fixes.

The question a lot of people are asking themselves is: Do we want to subsidize the feckless poor of the South in perpetuity? For me, the answer is a clear no.

Gideon Polya's picture

Excellent article by Richard Curtis. The 800,000 people who die from malaria each year is just 5% of the problem of the disaster that is global Avoidable Mortality Holocaust.

Using UN Population Division data one could estimate 5 years ago that each year there were about 16 million avoidable deaths from deprivation and deprivation-exacerbated disease, with about 10 million being under-5 infant deaths (see my book "Body Count. Global avoidable mortality since 1950": http://globalbodycount.blogspot.com/ ).

Using the latest UN data one can estimate that 18 million people die avoidably each year in the developing World (minus China).

Of course none of this has to happen but it is de rigeur for Spaceship Earth with Neocon American and Zionist Imperialists (NAZIs) in charge of the flight deck.

And, of course, it will only get worse because of worsening Climate Genocide. Top climate scientists have predicted that only about 0.5 billion people will survive this century i.e. about 10 billion people will die due to unaddressed, man-made climate change - . an average annual avoidable death rate for the century of 100 million per year, about 5 times greater than at present (see "Climate Genocide": https://sites.google.com/site/climategenocide/ ).

The worsening NAZI-complicit Climate Genocide will dwarf the ongoing, NAZI-imposed Iraqi Holocaust, Iraqi Genocide (4.6 million war-related deaths, 2.0 million under-5 infant deaths, 1990-2011) and the NAZI-imposed Afghan Holocaust, Afghan Genocide (5.0 million war-related deaths, 2.7 million under-5 infant deaths, 2001-2011) (see Muslim Holocaust, Muslim Genocide: https://sites.google.com/site/muslimholocaustmuslimgenocide/ ).

Captain Sensible's picture

Peaceniks and emotional wankers shits and trots make another million from some movie. A Picasso is worth all of African the long run!

kahelelani's picture

I share the passion in eliminating malaria and other preventable diseases; but i differ in how we get there. It seems like the best bet is a competent political leader in those countries, who at least leads a clean government. It angers me when only a small portion of foreign aid ends up where it is supposed to go, while the governments and middle men are taking advantages of the kindness from foreign countries. After all, while all lives are precious, the leaders should be in charge in taking care of their own people, not to rely on others.

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