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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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Why the elites always rule

Since an Italian sociologist coined the word “elite” in 1902, it has become a term of abuse. But history is the story of one elite replacing another – as the votes for Trump and Brexit have shown.

Donald Trump’s successful presidential campaign was based on the rejection of the “establishment”. Theresa May condemned the rootless “international elites” in her leader’s speech at last October’s Conservative party conference. On the European continent, increasingly popular right-wing parties such as Marine Le Pen’s Front National and the German Alternative für Deutschland, as well as Poland’s ruling Law and Justice party, delight in denouncing the “Eurocratic” elites. But where does the term “elite” come from, and what does it mean?

It was Vilfredo Pareto who, in 1902, gave the term the meaning that it has today. We mostly think of Pareto as the economist who came up with ideas such as “Pareto efficiency” and the “Pareto principle”. The latter – sometimes known as the “power law”, or the “80/20 rule” – stipulates that 80 per cent of the land always ends up belonging to 20 per cent of the population. Pareto deduced this by studying land distribution in Italy at the turn of the 20th century. He also found that 20 per cent of the pea pods in his garden produced 80 per cent of the peas. Pareto, however, was not only an economist. In later life, he turned his hand to sociology, and it was in this field that he developed his theory of the “circulation of elites”.

The term élite, used in its current socio­logical sense, first appeared in his 1902 book Les systèmes socialistes (“socialist systems”). Its aim was to analyse Marxism as a new form of “secular” religion. And it was the French word élite that he used: naturally, one might say, for a book written in French. Pareto, who was bilingual, wrote in French and Italian. He was born in Paris in 1848 to a French mother and an Italian father; his father was a Genoese marquis who had accompanied the political activist Giuseppe Mazzini into exile. In honour of the revolution that was taking place in Germany at the time, Pareto was at first named Fritz Wilfried. This was latinised into Vilfredo Federico on the family’s return to Italy in 1858.

When Pareto wrote his masterpiece – the 3,000-page Trattato di sociologia ­generale (“treatise on general sociology”) – in 1916, he retained the French word élite even though the work was in Italian. Previously, he had used “aristocracy”, but that didn’t seem to fit the democratic regime that had come into existence after Italian unification. Nor did he want to use his rival Gaetano Mosca’s term “ruling class”; the two had bitter arguments about who first came up with the idea of a ruling minority.

Pareto wanted to capture the idea that a minority will always rule without recourse to outdated notions of heredity or Marxist concepts of class. So he settled on élite, an old French word that has its origins in the Latin eligere, meaning “to select” (the best).

In the Trattato, he offered his definition of an elite. His idea was to rank everyone on a scale of one to ten and that those with the highest marks in their field would be considered the elite. Pareto was willing to judge lawyers, politicians, swindlers, courtesans or chess players. This ranking was to be morally neutral: beyond “good and evil”, to use the language of the time. So one could identify the best thief, whether that was considered a worthy profession or not.

Napoleon was his prime example: whether he was a good or a bad man was irrelevant, as were the policies he might have pursued. Napoleon had undeniable political qualities that, according to Pareto, marked him out as one of the elite. Napoleon is important
because Pareto made a distinction within the elite – everyone with the highest indices within their branch of activity was a member of an elite – separating out the governing from the non-governing elite. The former was what interested him most.

This is not to suggest that the non-governing elite and the non-elite were of no interest to him, but they had a specific and limited role to play, which was the replenishment of the governing elite. For Pareto, this group was the key to understanding society as a whole – for whatever values this elite incarnated would be reflected in society. But he believed that there was an inevitable “physiological” law that stipulated the continuous decline of the elite, thereby making way for a new elite. As he put it in one of his most memorable phrases, “History is the graveyard of elites.”

***

Pareto’s thesis was that elites always rule. There is always the domination of the minority over the majority. And history is just the story of one elite replacing another. This is what he called the “circulation of elites”. When the current elite starts to decline, it is challenged and makes way for another. Pareto thought that this came about in two ways: either through assimilation, the new elite merging with elements of the old, or through revolution, the new elite wiping out the old. He used the metaphor of a river to make his point. Most of the time, the river flows continuously, smoothly incorporating its tributaries, but sometimes, after a storm, it floods and breaks its banks.

Drawing on his Italian predecessor Machiavelli, Pareto identified two types of elite rulers. The first, whom he called the “foxes”, are those who dominate mainly through combinazioni (“combination”): deceit, cunning, manipulation and co-optation. Their rule is characterised by decentralisation, plurality and scepticism, and they are uneasy with the use of force. “Lions”, on the other hand, are more conservative. They emphasise unity, homogeneity, established ways, the established faith, and rule through small, centralised and hierarchical bureaucracies, and they are far more at ease with the use of force than the devious foxes. History is the slow swing of the pendulum from one type of elite to the other, from foxes to lions and back again.

The relevance of Pareto’s theories to the world today is clear. After a period of foxes in power, the lions are back with renewed vigour. Donald Trump, as his behaviour during the US presidential campaign confirmed, is perfectly at ease with the use of intimidation and violence. He claimed that he wants to have a wall built between the United States and Mexico. His mooted economic policies are largely based on protectionism and tariffs. Regardless of his dubious personal ethics – a classic separation between the elite and the people – he stands for the traditional (white) American way of life and religion.

This is in stark contrast to the Obama administration and the Cameron government, both of which, compared to what has come since the votes for Trump and Brexit, were relatively open and liberal. Pareto’s schema goes beyond the left/right divide; the whole point of his Systèmes socialistes was to demonstrate that Marxism, as a secular religion, signalled a return to faith, and thus the return of the lions in politics.

In today’s context, the foxes are the forces of globalisation and liberalism – in the positive sense of developing an open, inter­connected and tolerant world; and in the negative sense of neoliberalism and the dehumanising extension of an economic calculus to all aspects of human life. The lions represent the reaction, centring themselves in the community, to which they may be more attentive, but bringing increased xenophobia, intolerance and conservatism. For Pareto, the lions and foxes are two different types of rule, both with strengths and weaknesses. Yet the elite is always composed of the two elements. The question is: which one dominates at any given time?

What we know of Theresa May’s government suggests that she runs a tight ship. She has a close – and closed – group of confidants, and she keeps a firm grip on the people under her. She is willing to dispense with parliament in her negotiation of Brexit, deeming it within the royal prerogative. Nobody yet knows her plan.

The European Union is a quintessentially foxlike project, based on negotiation, compromise and combination. Its rejection is a victory of the lions over the foxes. The lions are gaining prominence across the Western world, not just in Trumpland and Brexit Britain. Far-right movements have risen by rejecting the EU. It should come as no surprise that many of these movements (including Trump in the US) admire Vladimir Putin, at least for his strongman style.

Asia hasn’t been spared this movement, either. After years of tentative openness in China, at least with the economy, Xi Jinping has declared himself the “core” leader, in the mould of the previous strongmen Mao Zedong and Deng Xiaoping. Japan’s prime minister, Shinzo Abe, has also hardened his stance, and he was the first world leader to meet with President-Elect Donald Trump. Narendra Modi in India and Rodrigo Duterte in the Philippines are in the same mould, the latter coming to power on the back of promising to kill criminals and drug dealers. After the failed coup against him in July, Recep Tayyip Erdogan has also been cracking down on Turkey.

***


In Les systèmes socialistes, Pareto elaborated on how a new elite replaces the old. A, the old elite, would be challenged by B, the new, in alliance with C, the people. B would win the support of C by making promises that, once in power, it wouldn’t keep. If that sounds like the behaviour of most politicians, that is because it probably is. But what Pareto was pointing out was how, in its struggle for power, the new elite politicised groups that were not political before.

What we know of Trump supporters and Brexiteers is that many feel disenfranchised: the turnout in the EU referendum could not have been greater than in the 2015 general election otherwise, and significant numbers of those who voted for Trump had never voted before. There is no reason to think that they, too, won’t be betrayed by the new leaders they helped to bring to power.

In the last years of his life, Pareto offered a commentary on Italy in the 1920s. He denounced the state’s inability to enforce its decisions and the way that Italians spent their time flaunting their ability to break the law and get away with it. He coined the phrase “demagogic plutocracy” to characterise the period, in which the rich ruled behind a façade of democratic politics. He thought this particularly insidious for two reasons: those in power were more interested in siphoning off wealth for their personal ends than encouraging the production of new wealth, and consequently undermined national prosperity (remember Pareto’s training as an economist); and, as the demagogic elites govern through deceit and cunning, they are able to mask their rule for longer periods.

Much has been made of Trump’s “populism”, but the term “demagogic plutocrat” seems particularly apt for him, too: he is a wealthy man who will advance the interests of his small clique to the detriment of the well-being of the nation, all behind the smokescreen of democratic politics.

There are other ways in which Pareto can help us understand our predicament. After all, he coined the 80/20 rule, of which we hear an intensified echo in the idea of “the One Per Cent”. Trump is a fully paid-up member of the One Per Cent, a group that he claims to be defending the 99 Per Cent from (or, perhaps, he is an unpaid-up member, given that what unites the One Per Cent is its reluctance to pay taxes). When we perceive the natural inequality of the distribution of resources as expressed through Pareto’s “power law”, we are intellectually empowered to try to do something about it.

Those writings on 1920s Italy landed Pareto in trouble, as his theory of the circulation of elites predicted that a “demagogic plutocracy”, dominated by foxes, would necessarily make way for a “military plutocracy”, this time led by lions willing to restore the power of the state. In this, he was often considered a defender of Mussolini, and Il Duce certainly tried to make the best of that possibility by making Pareto a senator. Yet there is a difference between prediction and endorsement, and Pareto, who died in 1923, had already been living as a recluse in Céligny in Switzerland for some time – earning him the nickname “the hermit of Céligny” – with only his cats for company, far removed from day-to-day Italian politics. He remained a liberal to his death, content to stay above the fray.

Like all good liberals, Pareto admired Britain above all. As an economist, he had vehemently defended its system of free trade in the face of outraged opposition in Italy. He also advocated British pluralism and tolerance. Liberalism is important here: in proposing to set up new trade barriers and restrict freedom of movement, exacerbated by their more or less blatant xenophobia, Trump and Brexit challenge the values at the heart of the liberal world.

***


What was crucial for Pareto was that new elites would rise and challenge the old. It was through the “circulation of elites” that history moved. Yet the fear today is that history has come to a standstill, that elites have ­become fossilised. Electors are fed up with choosing between the same old candidates, who seem to be proposing the same old thing. No wonder people are willing to try something new.

This fear of the immobility of elites has been expressed before. In 1956, the American sociologist C Wright Mills published The Power Elite. The book has not been out of print since. It is thanks to him that the term was anglicised and took on the pejorative sense it has today. For Mills, Cold War America had come to be dominated by a unified political, commercial and military elite. With the 20th century came the growth of nationwide US corporations, replacing the older, more self-sufficient farmers of the 19th century.

This made it increasingly difficult to ­distinguish between the interests of large US companies and those of the nation as a whole. “What’s good for General Motors,” as the phrase went, “is good for America.” As a result, political and commercial interests were becoming ever more intertwined. One had only to add the Cold War to the mix to see how the military would join such a nexus.

Mills theorised what President Dwight D Eisenhower denounced in his January 1961 farewell speech as the “military-industrial complex” (Eisenhower had wanted to add the word “congressional”, but that was thought to be too risky and was struck out of the speech). For Mills, the circulation of elites – a new elite rising to challenge the old – had come to an end. If there was any circulation at all, it was the ease with which this new power elite moved from one part of the elite to the other: the “revolving door”.

The Cold War is over but there is a similar sense of immobility at present concerning the political elite. Must one be the child or wife of a past US president to run for that office? After Hillary Clinton, will Chelsea run, too? Must one have gone to Eton, or at least Oxford or Cambridge, to reach the cabinet? In France is it Sciences Po and Éna?

The vote for Brexit, Trump and the rise of the far right are, beyond doubt, reactions to this sentiment. And they bear out Pareto’s theses: the new elites have aligned themselves with the people to challenge the old elites. The lions are challenging the foxes. Needless to say, the lions, too, are prototypically elites. Trump is a plutocrat. Boris Johnson, the co-leader of the Leave campaign, is as “establishment” as they come (he is an Old Etonian and an Oxford graduate). Nigel Farage is a public-school-educated, multimillionaire ex-stockbroker. Marine Le Pen is the daughter of Jean-Marie Le Pen. Putin is ex-KGB.

Pareto placed his hopes for the continuing circulation of elites in technological, economic and social developments. He believed that these transformations would give rise to new elites that would challenge the old political ruling class.

We are now living through one of the biggest ever technological revolutions, brought about by the internet. Some have argued that social media tipped the vote in favour of Brexit. Arron Banks’s Leave.EU website relentlessly targeted disgruntled blue-collar workers through social media, using simple, sometimes grotesque anti-immigration messages (as a recent profile of Banks in the New Statesman made clear) that mimicked the strategies of the US hard right.

Trump’s most vocal supporters include the conspiracy theorist Alex Jones, who has found the internet a valuable tool for propagating his ideas. In Poland, Jarosław Kaczynski, the leader of the Law and Justice party, claims that the Russian plane crash in 2010 that killed his twin brother (then the country’s president) was a political assassination, and has accused the Polish prime minister of the time, Donald Tusk, now the president of the European Council, of being “at least morally” responsible. (The official explanation is that the poorly trained pilots crashed the plane in heavy fog.)

It need not be like this. Silicon Valley is a world unto itself, but when some of its members – a new technological elite – start to play a more active role in politics, that might become a catalyst for change. In the UK, it has been the legal, financial and technological sectors that so far have led the pushback against a “hard” Brexit. And we should not forget how the social movements that grew out of Occupy have already been changing the nature of politics in many southern European countries.

The pendulum is swinging back to the lions. In some respects, this might be welcome, because globalisation has left too many behind and they need to be helped. However, Pareto’s lesson was one of moderation. Both lions and foxes have their strengths and weaknesses, and political elites are a combination of the two, with one element dominating temporarily. Pareto, as he did in Italy in the 1920s, would have predicted a return of the lions. But as a liberal, he would have cautioned against xenophobia, protectionism and violence.

If the lions can serve as correctives to the excesses of globalisation, their return is salutary. Yet the circulation of elites is a process more often of amalgamation than replacement. The challenge to liberal politics is to articulate a balance between the values of an open, welcoming society and of one that takes care of its most vulnerable members. Now, as ever, the task is to find the balance between the lions and the foxes. l

Hugo Drochon is the author of “Nietzsche’s Great Politics” (Princeton University Press)

This article first appeared in the 12 January 2017 issue of the New Statesman, Putin's revenge