Myworld2015: The challenge of democratic global governance and prioritizing development goals

Myworld2015 asks all of us – that’s right, all of humanity — to vote for the changes that would “make the most difference to our world.” We get to vote online for the priorities that we believe to be most important – they provide us 16 options, and we are asked to select 6. And on our honor, we vote just once. Sometime between now and… 2015.

It’s a crowd-sourcing scheme for defining the “next” set of goals (presumably after we discover how many of the millennium development goals go unmet).


Good idea for participatory development? Interesting attempt at making all of us citizens in one big global democracy? It’s certainly well intentioned, but maybe not so well-thought-out.

It’s not clear from the website how the votes are going to be tallied or interpreted. At the moment, I see that there are almost 1500 votes from the U.S., and just 208 from Nigeria and 596 from India… let alone 3 from Congo.

What happens when voters from the global North click through that they want to prioritize climate change, gender relations, and freedom from discrimination; and those from the global South want jobs, clean water, and affordable food? Especially if those from the global North with exponentially greater access to the internet dominate voter turnout?

OK, maybe I’m taking this scheme too seriously, but if the UN, ODI, and others are going to make the case that they want to listen to the whole world’s views on such important matters, I hope they are prepared to deal with the messiness that much smaller democracies face. Not only are the world’s priorities likely to be highly heterogeneous, but their scheme is likely to highlight that the rich minority of citizens have quite different policy preferences than the majority poor — even if one assumes that the types who are likely to vote are going to be disproportionately cosmopolitan in outlook in the first place. And if the goal of the exercise is solidarity, one has to wonder if this all might backfire?

And of course if they take the vote and then hide the results because of turnout disparities or polarization of priorities, well, that won’t look very democratic after all.

Should an African lead the World Bank?

I don’t mean to pose the question in a rhetorical, politically correct manner. It’s not obvious that the answer should be yes.

Sure, the World Bank’s mission is to reduce poverty, and its biggest challenge remains the African continent. But there are lots of reasons to answer in the negative:

For one: Africa is not a unified political entity, and any single leader could easily be viewed as favoring one country or region over another, casting the institution into even greater institutional legitimacy crises than it currently faces. Moreover, I admit that I hate to see top-notch African talent, especially in government and the financial sector, get scooped up by international organizations. I am all for a free market for executive labor (an oxymoron?), but it does send the wrong signal when the best and the brightest leave their own countries for a job based in Washington or Europe.

And of course, to the extent that the bank depends on resources from Europe and the U.S., pragmatically speaking, it’s pretty easy to predict that these rich governments would become even tighter with their aid dollars, euros, and yen if one of “their own” were not at the helm.

Despite all this, at present, a pretty good case can be made that the answer should be yes.

First, I have been surprised to read some of the lukewarm endorsements for Obama’s candidate, Dartmouth President and Partners in Health co-Founder, Jim Kim. I would have thought that Laurie Garrett would have been a big supporter, but she writes that he is “not a shoe-in.” Her blog posting offers some praise, but sometimes in a backhanded way that makes clear that maybe Kim is not the best idea:

Kim’s possible appointment is both a blessing and a challenge for global health and development advocates. Because he is the first individual nominated to lead the Bank who lacks either economics, business or US government  experience, Kim will be watched closely for failures to comprehend or maneuver through the often Byzantine world of finance and development. Experts in the field argue financial figures in language more akin to that used on Wall Street than inside the NGOs and schools of public health that execute global health programs. Moreover, Kim is prone to speaking with moral authority, putting the weight of his experience tackling tuberculosis behind controversial calls to action. Bankers and “moral authority” don’t usually mix well together, even when the financial institution is meant to lend to the poorest of the poor.

Meanwhile, many, including Richard Dowden of the Royal Africa Society, have argued that the time may be ripe for abandoning the tradition of an American appointment.

This year there is a really good candidate: Ngozi Okonjo Iweala. She is highly competent, energetic with a real vision of what the bank should be doing. But she is African – the Nigeria Finance Minister. The World Bank will be judged on the success or failure by what it does in Africa. She has the backing of the African Union…. The Bank led the way on structural adjustment. Its reforms may have helped in the long run to bring investment, but what really turned Africa’s economies round was China’s decision to buy its raw materials from the continent. That, combined with the arrival of mobile phones, and the rise of a new African middle class, has given Africa more than 10 years of growth. In 2008 the Western free market model exploded and since then the US and Europe have demonstrated neither success in their own economies nor found a new theoretical model to impose on others through the Bank and the Fund.

So what better moment to appoint Ngozi? She has already laboured in the dull desert of the Bank’s Washington offices and twice walked unscathed through the terrifying valley of Nigerian politics. She retains a strong vision of development for people, not for ideologies or theories. It’s time for America to listen to others – especially Africa. Mr Obama, are you listening?

It would be nice to say that the appointment should be decided based on personal qualifications alone, but that would be naive. Country of citizenship matters in terms of influence and perceptions. I think there are some risks, but in the current context, I agree that Ngozi woud be a very attractive choice for the post.

Stephen Lewis needs to be a bit more cautious about how he treats scientific evidence

I really like and admire Stephen Lewis — the guy has been an enduring, committed, and vocal advocate for global HIV/AIDS for a long time. And I suppose what distinguishes an advocate who really gets things done from academic types, is the degree to which the latter feels compelled to make claims based on evidence and to explain the limitations of  arguments and conclusions. In other words, I admit that much of what has been accomplished on global AIDS would likely not have been the case if every policy decision were rooted in an arduous process of research and analysis rather than on a good measure of instinct and emotion.

But in reading Lewis’ remarks from the recent international conference on AIDS and STI’s, I found myself a bit frustrated. He seems to cherry pick ideas that looked promising and were not rapidly embraced until there was substantial scientific consensus. He writes,

I’m thrilled when I hear animated talk of male circumcision. But I know that we didn’t need to wait for the results of the three studies in Uganda, Kenya, and South Africa. Nothing would have been lost if we’d focused immediately on making circumcision safe and available for informed parents to choose for their male babies; it’s a minor procedure that has been performed for centuries. Instead, during nearly a decade as the evidence piled up that circumcision was a defense against AIDS-evidence provided by experts in the field-we waited and waited and waited, in that self-justifying paralysis of excruciating scientific precision. As we come to this thrilling moment of progress I cannot forget the numbers of lives that might have been saved had we acted sooner.


I’m thrilled with all the talk of “Treatment as Prevention” and how it has suddenly become the mantra of the international AIDS community. But back in 2006, I sat beside Dr. Julio Montaner, about to become President of the International AIDS Society, when he first expounded the proposition at a press briefing at the International AIDS Conference in Toronto. His evidence and argument were rooted in science and common sense in equal measure. But he had to endure scorn and derision, and we had to endure a five-year delay until Treatment as Prevention was definitively authenticated by the National Institutes of Health in Washington. Julio’s theory suddenly became the 96% solution five years later, and it doesn’t-I emphasize-it doesn’t apply only to discordant couples. As we come to this thrilling moment of progress, I cannot forget the numbers of lives that might have been prolonged if we hadn’t waited nearly five years to create the momentum that now propels us.

Ok, with 20/20 hindsight, ideas that seemed right, and turned out to be right, ought to have been embraced earlier. But what about something like microbicides that were the darling of the international AIDS community until the scientific community showed them to be ineffective? Imagine if those had been promoted on a wide scale without evidence? Or imagine if widespread circumcision had been promoted and the evidence showed it to be ineffective?

It’s certainly good rhetoric to blame the “international community” for going too slow on some issues, and when he complains about things like donors reneging on their commitments, he’s dead on. But when he begins to suggest that we should not impatiently wait for good scientific evidence before launching global health problems, he really loses me.

Global governance of hiv, health

The UNAIDS/IAS workshop concluded yesterday. The most interesting aspect of the day’s session was the consideration of the “global governance” of HIV, which is the configuration of international institutions and actors that try to shape policies, services, behaviors, etc. relevant to the control of the epidemic. The speakers were right to point out some concerns about the problem of large institutions not being able to react with the speed necessary for some types of problems, and for what may seem an unbalanced distribution of authority (still dominated by Northern rich countries, as population and target problems are weighted toward the global South.) To be certain, in an increasingly integrated world, we need to think more about what are the right institutions for addressing truly global problems, rather than thinking about them as problems facing an amalgamation of states.

But I still think it’s worth reflecting more on the enormous successes of global governance organizations in responding to and coordinating responses to this pandemic. Activists can, of course, claim that more should have been done. To think that the rich countries were going to support millions of people on life-saving pharmaceutical treatment in Africa and elsewhere while in many cases (well, really just the U.S.), our own domestic politics does not provide much health care to our own citizens… well, that’s a remarkable story.

Am here at the Tokyo airport, and for the most part, all seems pretty normal here — except for the closure of moving walkways, owing to power cuts associated with the fallout of last month’s natural disasters.