Tuesday, 24 February 2015

Unpredictable Behaviour and Disaster’s Consequences

Jeffrey Levett

It seems paradoxical to hear, and reasonable to ask, how a small geopolitical entity called Greece stands indicted for precipitating an international financial nightmare or economic disaster on a grand global scale. This seems something like blaming Gibraltar for global warming or Malta for planetary climate change. Certainly a humanitarian disaster is unfolding, so designated by the current and new government of Greece. It is driven by austerity measures, which have also reduced or even wiped out the resources of the average Greek. My term is a creeping health disaster, for which Greek politics carries a heavy burden of guilt. With the prevailing model of the European Union for austerity some responsibility should be attributed to it. In Greece, considerations of guilt-blame-accountability have all been brushed under the carpet of politics. It is bad enough that fascism is alive and well in Greece without some elements raking up the Nazi past. Germany painfully came to terms with its past decades ago. With poetic expression Percy Bysshe Shelley envisioned another Athens, and I would wish for a different Greece, even though I do ask whether it is at all possible.

Alexis Tsipras the incoming prime minister is conducting his own fight against austerity, heath damage to the population and economic inequality in Greek society within a European framework, cognitively, politically and ideologically. His world view is entirely different from those of his Greek predecessors while his socio-economic model for development is oppositely directed-weighted to the one currently applicable, in the EU. Its only extrapolation is towards conflict with those internal structures that agreed to everything within Europe and with its lenders as well as conflict resolution with the EU to reduce or nullify this principle, avoid a head on collision and to negotiate an agreement to bridge different worlds having two components, one of substance, the other of faith, without further social disaster.

Unlike its current dismal economic problems and in spite of the heavy clouds of the recent past there is now more joy in Greece as "social depression" ebbs and "schizophrenia" comes under control. Greece stands united, seemingly ready to move towards its future step by step in spite of many slaps received from outside. Neither paradise nor revolution is an agenda item, only newly awakened interests with optimism and expectation for the best and for the worst. Today Greeks are following the news with interest, thoughtfully and with emotion. They are peacefully demonstrating in squares in support of the government whose popularity is creeping upwards. They are worried about lists [La Guard] more so about the list of reforms that Europe will ask of from Greece. The fall guy for failure in negotiations however will be the new Prime Minister, whose role in the Greek misadventure of the past several decades is zero. Having won the support of the Greek electorate by playing his opposition role well he is making a great effort to be true to his pre-election promises and redefine Greece as an independent nation and an equal partner in Europe. Leading up to the elections, I had a dual thought that Greece would be better served if he- Tsipras, remained in the opposition with a stronger hand and if Europe had its own Tsipras. The losers on the home front are trying hard to trip him up, which will surely intensify, while Europe is trying to make him yield and sway him away from his intentions. His achievement so far: he has transposed the arena shifting the focus away from economics onto a political stage and internationalized it. The EU has been called into question with one demand for a detailed account of all past negotiations and outcome agreements between the two parties. The implications refuse to leave my mind.

When Greece first declared itself an independent state its national agenda was twofold, freedom or death and to promote a vision of Hellas, which Europe to some extent found amusing. Tsipras also has a twofold strategy for Greece to which Europe stands firmly opposes. This time around, a disastrous outcome is possible and there is no sense of amusement in Europe. On first look, Tsipras is sincerely bent and emotionally engaged to stem the tide of humanitarian disaster and to improve the lot of the average Greek. His socio-political orientation runs contrary to that of economic Europe, which means a clash of world models. What he promised was reasonable and while he tries hard to deliver realism is creeping in. You can’t fight city hall. Think what might have happened 60 years ago when Germany received a 50% debt cancellation, if political posturing had outweighed compassion and solidarity.

As a result of the social and developmental model of the EU there are grave doubts in many places whether the united Europe envisioned by Churchill, or the image in the mind of the of the founding fathers of the European Community tallies with what it has evolved into. Personally, it is quite removed from that of my dream in youth. Within the conclaves of this incredible supranational entity there are so many examples of enrichment for a few, helped by strong commercial interests and offshore mechanisms. I recall a statement of one of the EC’s founding fathers that little can be achieved without man, and he meant ethical man, but nothing is sustainable without functional autonomous institutions. Without the rule of law, ethics, rights and obligations in all spheres and the promotion of education, health and social justice, progress will be retarded in Greece and in the EU. Greek reactions to social and economic inequality have been piece meal. It has included prayer, charity and benevolent actions, lukewarm talk of rebellion and revolution with bursts of fanaticism and violence as well as political acts of reform and social policy, which have gone nowhere. The impact of the past five years on daily life is well known and well recognized by the European Union, WHO and the Council of Europe but not as yet to its full extent. The analysis of cause and effect requires a much more thorough investigation, which within a limited scientific culture and a set of dysfunctional Greek institutions is extremely difficult.

The Greek misadventure and the misfortune of its citizens is an extremely complex affair. It is based on historical and cultural factors as well as unchecked political greed and unreasonable personal enrichment within a two party political system that has enforced compromise on many players with acts of joining to belong, if you want to make it. Misfortune compounded by misadventure has precipitated uncontrolled borrowing from the European Union and the international community as well as the encouragement of poor governance with a lack of transparency in all institutions [justice, education] and services [health, social] and of all professional groups which has compromised autonomy, effective functioning, productivity and development. The wasteful public sector which constantly faces bankruptcy is continually shorn up by borrowed money as are the organizations for electricity, water and telecommunications.

Greek society has been seriously damaged by the two-party system and the predominance of party thinking with deliberate misrepresentations, distortions, and a resistance to cooperation. It has reduced institutional autonomy, cultivated a state that prefers repressive rather than measures of prevention. It has caused a running down of the bureaucracy and encouraged a principle of non-transparency and information systems have been left poorly developed. Education is a poor child, justice is a weak infant and health is now in the intensive care unit. Obstacles have been placed to the development of public health and to the operation of a unique National School of Public Health, which are critical for pulling Greece out of its current health crisis. Over-popularization versus meritocracy has lead to behavioural distortions: declared socialists acting like mini-capitalists, "marketeers" supporting a system whose infrastructure is weak, healthy competition absent and production limited as well as trade unionists mixing in with institutional management and university students manipulating procedures in which they should have no role. More serious, there has been a lack of a socio-political compass and a scientific culture. The academic community has been tri-and-dichotomised while the intelligentsia has remained a bystander to the national drama and they both have a significant share of responsibility for the current plight of Greece.

Another view shows that there are significant skills and abilities in all areas, but to get them to effectively work demands a collective approach, systems thinking in order to reduce malfunctions, bottlenecks and chaotic situations. Yet another dimension is the emergence of new political structures which have provided refuge and for those who have "manufactured" the Modern Greek drama and who have and continue to construct their own mythology. The latter is part of the problem of over popularization. In a popular like way, Greece is on the one hand a case of «assisted suicide" by politics from within, while on the other hand it represents a case of directed disappearance of democracy from without, this, as the troika started to pull the reigns of a sovereign state. The only reason for pouring money after money into Greece has also a profit motive, since contribution to development has been limited. Only one-tenth of the monies flowing towards Greece arrived, the other nine-tenths were redirected before they ever arrived. In the absence of financial stability and the steady improvement of daily life with growth and development, the Memorandum and its austerity policies are in spite of rhetoric here to stay. Only one thing is certain, the political events in Greece and its ongoing deliberations with the EU are awakening forces elsewhere that also demand change. In describing the complex problematic space or situation and more importantly in finding explanations and solutions to carry Greece forward, it is useful to keep in mind that the Social Charter of the Council of Europe, which should guarantee socio-economic rights, does not, nor is population health or human security protected through the additional competencies of the European Union, especially as a result of austerity measures that have been imposed by the Greek government and to which the EU is a major contributor. Within this health problem space the WHO has not been much more than a bystander. Public hospitals require increased personnel payroll, technological equipment, and change in management with new management tools. I know firsthand the heroic struggle made by their staffs and safety problems for: patients and staff, visiters, technology and waste. Today's hospital must meet common challenges with upgraded procedures and the right technology to be able to function: a hospital without functional radiology is meaningless.

To correct the trauma to health and to the health care system comprehensive health policy is needed together with a well developed crisis response strategy and the cancellation of all obstacles to the development of public health and the working of its related institutions, especially of its unique National School of Public Health. There is now a need for a crisis mechanism for the management of suicide. These actions are critical for pulling Greece out of its current humanitarian crisis and in preparing it for future mishap. In these matters the WHO could and should play a vigorous role.

It is commonly said that Greece never dies, but it still has to deal with debt repayment of an untenable magnitude which weighs heavy on the backs of the people and may if not well managed take away more of life’s blood. If the unsustainable debt is not erased or considerably decreased, austerity will continue, life expectancy will gradually fall, infant mortality will rise, which will cause a reversal of the quality of life.

The problematic space, in which Greece currently lives, is incredibly confused. With respect to Europe it is further complicated by embedded ambiguities and is exacerbated by contradictory evidence. Explanation of events by previous governments has been absent, much like the absence of informed consent in medicine. Consequently, it is extremely difficult for mere mortals to follow for example the meaning of an extension in the absence of memorandum or the coming again of technocrats and the rejection of the troika and even more difficult to design and propose solutions other than the ones suggested above. Within this framework ambivalence proves to be one helpful factor when the problematic field requires solutions to meet unexpected behaviors. New tools have been introduced into this arena such as the theory of systems to counteract a monopoly of party considerations and thinking and the game theory that helps dealing with conflicts. It also adds additional ambiguity in that a poker game is underway instead of a much larger game In the conceptual framework of a much larger game of destruction-creation and a doctrine of shock, Europe can take advantage of a new revolution in public health which can place a brake on austerity’s impact on the population as well as prepare for future potential shocks.

In the decade following the Asia Minor disaster Greece was plagued by the scourge of infectious diseases. Accordingly, it was said that the health of the Greek people was a danger to Europe and its status worse than in Brazil. As a result help was requested from the League of Nations. Greece was rejected in a most inelegant and insulting manner when the French representative told him “address yourself to bankers, we are not financiers”, Aid quickly came from the people of America. Coming from Syria through Lebanon a few years later a bizarre pandemic of dengue fever the most explosive and virulent dengue one ever recorded jumped borders to knock Greece off the EUROPEAN CONTINENT FOR months. It sent waves of panic throughout European capitals, but its impact was catalytic to development. With help from the League of Nations and the Rockefeller Foundation the government cleverly targeted actions to counteract health destruction with the enactment of entirely new social policy which precipitated a revolution in public health beneficial to both Greece and Europe. In Greece the revolution was short lived but it still helped to regenerate public health, promote national development and over the next four decades it contributed 20 some years to life expectancy, gains in danger of being lost today.

Perhaps the Greek role is one of a butterfly, a butterfly of hope that is trying to escape from Europe’s Pandora’s Box that may allow forces to gather and arrive at a level that might change Europe. At any time, however, Europe can trap the butterfly and crush it. Unpredictable decisions in Europe may cause destruction to the whole interlaced global system, which would be the victim. Greece is negotiating in a difficult and uneven arena of the EU, where the dominant player expects play to be conducted by its rules, procedures and dictates. The two major players are oppositely polarized and demonstrate large internal asymmetry. They maintain distance between themselves and bring two different approaches to the table in addressing the problematic situation in Greece and of Greece. Europe reflects a world view that underlines a concern mainly for economics, emphasizing debt repayment according to already established agreements leaving out social policy, population welfare and compassion while Greece stresses its concerns for the deficiencies in prosperity in the age of austerity, knowing full well that the debt created by previous governments with the complicity of Europe is so bulky that it is impossible to get out from under. It leaves no room for any improvement in health status. Neither the EU nor the Greek opposition is ready to give Greece a real break. In closing a talk on primary health care in 1981 I said that “Change” [the banner of PASOK] has come, and asked whether Greece is ready for change. In the same timeframe Richard Feynman Nobel laureate in physics made the observation that the educational system heralds to Greek children that nothing they do can ever surpass the achievements of their ancestors. A very large issue for Greece is the System of Education from bottom to top.

Insightful emails coming from distinguished friends who sincerely love Greece and who have made their own small contributions in disaster management and public health……. One a psychologist [USA] who in looking longingly at her photos in Athens reflected on the recent mandate to renegotiate the crippling austerity measures saying that fighting against the EU and the euro will be quite the task,…. hoping that Greece will not be made a scapegoat as previously, when blamed for bringing down the international stock market and causing EU monetary chaos,…. who with respect to speculations on the viability of the current coalition says you never know ….troubled with the unbelievable British Museum loan of one of the Elgin marbles to the Hermitage, finding it outrageous for Greece. The other a German and a man of public health who would love to enjoy Greece again, to be in Athens again, to be in Greece which he says is still the place of enjoyment. He was a major contributor to the Athens Memorandum and public health’s response to the Maastricht Treaty, to the Skopje Declaration on Public Health, Peace and Human Rights and the development of public health in the Gaza Strip.

Whatever the economic equation, the bottom line is that the sum total of what Greece owes and what it now needs to function is just far too big a sum for viability. No economist knows what Greece can reasonably pay without facing further social disaster and no economist knows how much more viable Portugal is than Greece or how less viable Greece is compared to Italy. It can only mean a new memorandum, new adventures with Greece having to survive on a high-strung tightrope, inside of Europe or in GREXIT mode. Is this what the EU wants? A game of great risk has been underway for considerable time.

Yesterday, the day before and today, distinctly different eras but quite similar. What will be written in the book of GREEK developments, digital and analogue, still hangs in the air as the ink dries up and the pen might be misplaced. Will the last page be completed or supplemented by scribbles or with substance? Only the quality of everyday life will give us the answer in the coming months.

There is a need for great insight to interpret unfolding reality and to tease out a balanced understanding of this reality. It might mock us and we can fool ourselves. We need a systems approach and the tools of science to dissect reality. Two vital driving forces for progress come from the wisdom of role models and charismatic leadership. Both elements have been sorely lacking in Greece’s recent past. Tsipras is charismatic and should be supported at home and abroad.

How to end? On the hand with a sense of optimism: It is not over until it is over and knowing that we cannot know now that what we will know, on the other with a sense of alarming speculation: there are many indications to indict the past agreements between Greece and the European Union, there are indications to suggest that rejection and failure will arrive.

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