Sandra Dawson
We began this session with a not overoptimistic picture of the immense geopolitical forces in Europe. We then moved on to networks and governance and looking for new ways of
working. Then we went on to aspects of health and working life, and now to equivalent opportunity and diversity. I sense there’s a fair degree of agreement around the table as to what we need to do.
Ilona Kickbusch
I think that the future will not only be one of diversity in terms of the many different people;
it will be diversity in ourselves.
We need to look at how society provides the opportunity to live with two levels of diversity, and also where society forcesus to take multiple roles. These are issues of choice and freedom and of coping and developmental health. How can we prepare ourselves to live in that society, and to make use of choices where they exist and not to be frightened by them, and how can supportive policies help us manoeuvre through that new environment?
That leads me to what is happening to the old idea of a career, where you start as an
apprentice and end up as a director-general. That does not work any more. Now, at different points in your life, you will play different roles with different amounts of power, and that power is not continuously increasing. You might be very powerful at 30, much less so (but much happier) at 50, and then go back to being powerful at 70.
So with diversity there is the loss of the continuous life role in the sense of an automatic progression. What you do at what stage of life and what you do at what age is changing. At present it is changing more for women, who seem to be able to use these changes more than men. It is interesting that in the United States it is feminists who are writing books about identity crises that men are now facing, because men are much less prepared in our society for these multiple roles.
Very interesting research into health determinants is being reported from Canada, in an area referred to as developmental health. This has brought together, in a very innovative and productive way, research from the neurosciences, economics, education and health. It shows how, for the future learning society, we need to invest in young children and in developmental policies that actually support cognitive development and the intellectual capacity and potential that people will need in order to survive in the societies of the future. That also relates to the question of political expression: how one expresses political interest in this variety of networks and communication streams. We are looking at a new type of person.
Graham Lister
I recall that Ivan Illich said something to the effect that good health arises when people have the ability to improve their own health. One of the temptations of the technological society is to think that you achieve that by giving them access to the Internet or some other technology.
And yet we know this is not enough – that to be empowered, people need to be able not just to use information but to take social actions that actually enable them to improve their health and that of their community.
The challenge is to find ways of supporting civil structures that enable and empower people to improve health, while avoiding the other side of empowerment as a sort of derogation – “it’s over to you; it’s your personal responsibility”. We have to find ways of supporting all sorts of different structures such as women’s health movements, European patient organisations, and people-to-people health contacts between the first and third worlds. These can all be
supported by technology, but they need investment in social capital (organisations and people) to make them work on a community level.
Cristina Puentes-Markides
We should remember that societies are not homogeneous only because they share a language or a geographical area. People who are discriminated against may also be racist themselves.
There may be a danger in our discussion of exaggerating the “us and them” dichotomy, in part because the group here shares similar middle-class values and levels of education. None the less, it is precisely because of our concern for the future and for others that we would like to see the distinction between us and them become progressively less pronounced. The impact of globalisation on the health of the most disadvantaged is making an impression. Will a new type of health governance be able to generate enough pressure on countries that condone child labour, for example?
Laura Balbo
Governments do not do much, but every time they do something they say they have the solution and then simplify the issues. That worries me, because they cannot do things any differently, especially when they address the issues of the developing countries and the gap between “us” and “them”. Offering reassurance is a very old-fashioned way of addressing these issues. What might happen in the developing countries in the future? Suppose the majority of the young people in Africa or Latin America decide that they need to get organised and there is a big conflict. That’s one possibility I think we have to keep in mind. There is a risk of us in Europe trying to say things that have no value for the rest of the world.
But here we are talking about Europe, and Europe has privileges and advantages. What could the European population provide the rest of the world in terms of setting and contributing to a new agenda? What could the new social movements be, and what role could they play? We have NGOs, but it is not clear whether they are really social movements any more. They reflect the old models of participation, but apparently that is the only way people in our countries can participate. And now we have the Seattle model, but we do not yet know much about it.
Sandra Dawson
I always go back to my own experience, and in every piece of academic supervision I do there is always an issue about what the level of analysis should be. And today there is an issue as to what the level of policy intervention should be.
There is no doubt we need to see the big picture; we need to grasp the scale of the global issues. But in terms of working out where the levers are, that we as individuals or collectively may be able to pull, we have to think about the various different levels. We have to keep them all in mind: the global level, the transnational corporations, the multinational agencies, the national governments, the organisations directly involved in providing care, and our communities, families and individuals.
None of us can address all of those at the same time. Each of the parties has to decide where the levers are that it can pull, knowing that pulling the levers is likely to be more effective if we are aware of their interconnectedness.
Allow me one personal comment about going to Cambridge to build a business school, with great expectations and very few resources. I had endless visits in my first year from people promising resources if only I’d realise their dreams. And I used to go home feeling a complete failure, because I could not work out how to realise their dreams even though their dreams were clearly so important.
But of course one is there not to realise other people’s dreams – one is there to realise one’s own, worked out in the groups of which one is a member. And that has come through to me very strongly during this session. We have been shown the enormity of the problems, but also the enormity of the opportunities and the possibilities for action within them.