Tuesday, April 28, 2009

To Promote the General Welfare

Or Why Utilitarianism works better than Kantianism in Government [4]

The classic story goes like this. Jim is in Venezuela on vacation. He come to a village where there are twenty villagers tied up and standing against a wall. An armed man in camouflage approaches him and introduces himself as Pedro. He tells Jim that the villagers are being rebellious and these twenty would be executed to punish the town for its political leanings (for the sake of argument, they’re pro-Democratic). But, he’d let nineteen of them go if Jim would himself do one execution (to prove that even America doesn’t support this ‘rebellion’). What should Jim do?

The Kantian answer is that he should not kill the one and let the twenty die. Jim should follow a universal maxim like “You ought not murder innocent people,” regardless of the circumstances. The Utilitarian reasons that 1 dead < style="font-style: italic;">because of the circumstances. The Kantian’s concern is the soul; the Utilitarian’s concern is the body.

Kantian morality is very appealing when absolute rules are available. This is usually when it’s a matter of individual decision. For example, I believe that the following is universal maxim: “A man ought not sleep with a woman he is not married to.” I obey this and, if I violate this maxim, I believe I have done wrong. But the question gets much harder when it goes from a question of conduct (relating to oneself) to a question of governance (relating to others). Even if it is absolutely morally wrong for me to have sex with my (theoretical) girlfriend, it does not follow that the best thing is for such an act to be illegal in a free society. Moral maxims don’t translate well to governments. “Governments ought to pass laws forbidding men to sleep with women not their wives,” isn’t a self evident universal maxim.

Part of the problem is that governments are not themselves the same kind of moral entity that men are. Another serious problem is the inefficacy of such a proposal. It’s very difficult to compromise about Kantian morality (a thing very important in government). Also it’s nearly impossible to, in political discourse, change another’s worldview upon which these moral laws are founded.

For questions of governance (where moral absolutes are elusive), Utilitarianism makes more sense. How do we maximize the good? Should we pass Law A or not? Principles of justice and equity certainly shouldn’t be violated, but it’s dangerous to put a political discussion in moral terms when there are two good ends. Certainly there are things which governments do which are truly evils (e.g. genocide, taxation without representation); but most governmental decisions aren’t so clear. Entitlement programs have the good ambition to give to the poor, but they also unfairly (in the strictest sense of the word) take from the rich. “Is Kindness more important than Justice?” is not practically answerable. However, “How do we optimize real GDP growth and provision for the poor?” is. We may disagree on the relative importance of the two, but at least we’re having a meaningful discussion. We can compromise on real GDP growth; we can’t compromise on Justice.

But we (particularly in medicine) have drifted back to Kantian, moral language in politics and policy. We say, “Do no harm” as a Kantian and Universal good. We repeat it as a mantra, as if to ward off the spectres of labor in thinking. When asked, “Is it just?” we reply, “Do no harm!”; when questioned, “Isn’t that harming someone?” we just shout “Do no harm!” louder[6]. We assert things like “Nothing but the highest quality,” and “Healthcare is a Right,” and we insist on “Evidence Based Medicine” and trust that (without even evaluating them) they are unquestionable, objective and universal truths. These things do indeed sound great, but we skip right over their cost. [5] [Ironic and Very Tangential Note]

When we say “Nothing but the highest quality” we also mandate “Nothing but the highest cost” and thus violate our second universal law by depriving the poor of healthcare (as a side note, Kant said these things were actually supposed to work together; direct contradictions are a bad sign). We insist on billion-dollar experiments (this is literally the cost of some of the bigger ones) to prove that our medicine works (we call it “evidence based medicine”; we want “highest quality,” after all). But when we get the bill for these (those of us who can afford them, that is) we’re outraged by the abuses of Big Pharma which we, by our demands for “evidence based medicine,” have created. We hop on our “Healthcare is a Right” soapbox and accuse the drug companies of greed (which is probably true) and oppressing the poor (which is probably true), forgetting that it was actually our own greed for perfect drugs which actually deprived the poor of their use.

Instead of trying to guess at universal truths of governance[2], we ought to come up with practical, goals. We cannot all agree that “Healthcare is a human right”; we can agree on “It’s good for everyone to have healthcare.” Instead of asking “How do we guarantee healthcare for all?” we can rally around the question “How do we optimize the distribution of healthcare?”
It is very important to note that the two questions usually have different answers. According to one of my professors, settling for nothing less than “Primary healthcare for all” is leading to “Primary healthcare for none.” Instead of focusing on what could practically be done with available resources (my professor’s goal was to “eradicate Polio,” a goal we are approaching), some people’s zealous attachment to an ideal has actually led to more human suffering. Instead of spending limited money on vaccines to help a million children, they build clinics for a lucky hundreds while thousands die of polio which could have been prevented. And if you really believe that it’s a universal truth that “All people ought to be provided primary healthcare,” you should praise those people. Those people, whose actions ended in the deaths of children by Polio, were Good with a capital ‘G’. They did what was Right. The consequences (dead children) should be irrelevant.

But we don’t really believe that. Kantian ideals and absolutes are wonderful for a podium, but not for real governance. “We ought to fight the Axis of Evil!” as a moral imperative is a lot more motivating than, “It would be in the world’s best interest, including our own and that of the Iraqi people, to war with Saddam Hussein.” And if the Iraq War cost $1,000 and the only casualty was a hangnail, nobody would complain. When it really comes down to it, we’re political utilitarians deep down; we all compare costs and benefits. Internationally, we praise a government that saves children much more than one that nobly tries and fails to provide universal healthcare.

Centuries ago, the wisest of men once assembled to answer this very question: What should a government do? They did not put it in moral terms [3], but practical ones:
…form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity…[1]
Let us follow their example. So let’s drop the moral language and get to work. The ends we are seeking are common. Rather than fighting over what is the moral thing for a government to do, let us seek to do things like “promote the general Welfare.” Let us agree on a set of things that we can all strive together for: Humanists, Christians, Buddhists, Hindus, Jews, Muslims; Democrats, Republicans, Independents; Atheists, Deists and Theists alike. Let us set out for ourselves what things we would like to accomplish tangibly and find ways to do. Let us together war against suffering; let us not each die defending an ideological hill from the other.

Now if only we in the US had a set of things we agreed to strive for…

[1] Preamble to the Constitution of the United States.

[2] By the way, it’s really hard to come up with Universal Truths without actually thinking about it… guessing usually doesn’t work. Crafters of Universal Truths should at least try to visit the philosophy department every now and again.

[3] These men were certainly extremely Kantian when it came to personal duty. But this did not seem to translate to the Government itself, at least not in the Constitution. In the Declaration they make it clear that, regarding oppressed men, “it is their right, it is their duty, to throw off such Government” and in the process they were, “appealing to the Supreme Judge of the world for the rectitude of our intentions.” They, as men, believed they had clear and strong moral obligations. In contrast, a government has pragmatic aims. I have not developed this theory fully; it may be worth another post.

[4] How did I end up on this side of the argument?

[5] Ironic and Very Tangential Note: I cannot miss the chance to point out a great irony. These arguments for universal truths on what government ought to do are being made by people who are almost universally self described “Moral Relativists.” The same people who bemoan the close-minded Christians who ‘impose their views’ about sexuality or abortion on others are imposing their own views on healthcare. When I’ve pointed this out to people, they tell me that the great difference between “Everyone a right to life” and “Everyone has a right to healthcare” is that the latter is not based on religion. In other words, the only valid arguments are ones made from the Humanist perspective; the Christian one is invalid for governance (Christianity should only apply to Christians; Humanism should apply to Humanists and Christians). So the difference is that “Everyone has a right to healthcare” is actually True (so should be imposed, though the word ‘imposed’ is always heavily euphemized) and “Everyone has a right to life” is a religiously motivated opinion which should be disregarded. I've even talked to multiple educated people who believe it should be illegal and have said, "Any law motivated by religion should be ruled unconstitutional as a violation of the separation of church and state."

[6] Not-defining ‘harm’ is a hard enough problem to avoid; our brains might explode if we actually had to answer “Why is ‘Do no harm’ the only and overriding thing a doctor ought not do? On what basis ought you 'Do no harm'? And why define your profession on not doing something? Wouldn't it be better to say 'Do heal' instead?”

P.S. I can lie about the post time. But, being a Kantian in my personal ethics, I won't. The time is 1:50am and staying up late is a birthday present to myself.

Sunday, April 19, 2009

Post # 100 - Memories

This is my hundredth post! In November of 2006 I started this blog because, "I enjoy writing. It may be therapeutic for me, and it may help me organize my thoughts." This has proved true.

Thank you, my reader, for supporting me with the occasional comment or email; you have no idea how encouraging it is to know that my writing is having an impact on more people than just me.

For this post, I've gone back and looked at some of my old posts and collected some of the best of them here including an excerpt from each.

The Man in the Arena

Through a long series of events, I have decided to blog. And what better time to make a first blog post than at 4:03AM….

Christmas Sweater and the Gospel


With the kitten sweater, I was popular.

Perhaps Christians ought to re-learn the language of those around them to win them for Christ. We continue evangelizing with the outdated language of reason to a culture that no longer understands or cares.

Life, Death and God’s Sovereignty


God is good. He's been teaching me a lot about His sovereignty recently. That's always a scary topic, and a good one if you're ever feeling prideful.



The adventure to understand and know Woman is great; it is a noble quest that demands the best of Man. With so little of manliness left today, it is no wonder why so few undertake it with the courage and dignity that it deserves.


The Body and Cell Biology of Christ


The Body of Christ is an analogy which may be far deeper than I originally gave it credit for. I have now studied basic cell biology a second time and have realized that this metaphor could be extended a bit. There is a hint here of something deeper.

Scientific Faith


Faith is very much like science. You may be shocked by this, but look at how similar they are. Both study truth. Both use methods involving the formation and testing of theories. Both are self-critical, challenging the theories to strengthen them. Those who make a discovery in each attempt to communicate it to others.

[also see the flurry of replies on the Facebook note here; this is my most inflammatory article to date]

The Next Step


We have heard of the epic struggle of life, up from a single organism that struggled and strove to survive. We have heard of the grand battle of this organism and its children to overcome the odds and live and reproduce and change. This great odyssey through the eons has become the narrative of our age, the modern story of our creation.

Spiritual and Philosophical

Photography as Prophecy


Photography, like all art, is a portal to eternity. As the prophets who shared their glimpses of heaven causing us to yearn for its glory, I aim to make visible that which is invisible to most.

Living and Life


Life is loving our neighbor, and true life sometimes requires that a person not live as long. Life is not a beating heart. It is a thriving soul. Making life all about prolonging the functioning of a pump is foolish.

On Evangelism and Coercion


We consider it an obligation and an honor for a scientist to make his findings known. We look at respect on the evangelical scientist, he who tries to better the world by his revelation of truth. And this is what I aim to do: to share what I believe I understand.

What is the Gospel?


There are explicit definitions for the “good news” or “the Gospel” in I Chronicles, Isaiah, Romans and I Corinthians. In my reading of the scriptures, these four definitions contain seven common elements:

Jesus the Paradox


He is violent and benevolent. Loving and hating. he blesses the children and curses the pharisees. He accuses Peter for using a sword and himself wields a whip. He blesses the peacemakers, but then declares He has not come to bring peace but a sword. He condemns separation through divorce, and then promises it through faith.


The Song of Twilight (True Story)


The trees sang their praises to God, and my smile would have grown if it were possible. My joy, ever filling, spilled over into my eyes which upturned, but even they would not be able to contain it.

A Good Time for Thinking (Fiction)


The Doctor was pensive. Normally The Doctor never had time to think. Work was too busy, not a good place for thinking. And home was far too relaxing a place; also not a good place for thinking. So today was special, for he thought.

The Audacity of Hope (True Story)


I ran out of my interview at 3:50PM, tie and blazer flapping in the wind. The girl who offered me a ride to the airport (who just happened to have as perfect a face and as enchanting eyes as ever I have seen) texted me to say she would be late.

Abundant Life (Short Fiction)


“Welcome to the Abundant Life ALC!” the voice of the attendant was perfect. His voice was as confident and clear as an actor of old. “My name is Dante. How may I help you?” asked Dante with such a sincerity as it almost tempted Jim to feel something.

Saturday, April 18, 2009

Philosophy (post script)

Philosophy (Part 3 of 3)

#3 Philosophy is Good in itself
[Note: this turned out to be a Biblical argument when I didn’t originally intend for it to be; I eventually want to make a non-Biblical one, too. My apologies to non-Christian readers.]
Philosophy, the love of wisdom, is good for its own sake. Wisdom can indeed be a means to an end (Pro 24:3 “Through wisdom is an house builded”), but this is not the main reason to pursue it.

Wisdom is valuable in herself (for wisdom is often personified). Solomon, in speaking of wisdom, says, “She [is] more precious than rubies: and all the things thou canst desire are not to be compared unto her” (Pro 3:15).

And, if you happen to be Jewish or Christian, you are commanded to be a lover of wisdom (or in Greek, a “philosopher”): “Get wisdom … love her, and she shall keep thee” (Pro 4:5-6). The Biblical definition, though slightly different, is not that far off from what Socrates possessed. I’ve read only one chapter of The Republic, so I don’t have much to go off of. But let’s compare the wisdom of Solomon to the wisdom of Socrates and see if there’s overlap:

Solomon: The mouth of the just bringeth forth wisdom (Pro 10:31)
Socrates: …the just man is like the wise and the good...justice is indeed both wisdom and virtue (350c, 351a)

Solomon: Happy [is] the man [that] findeth wisdom (Pro 3:13)
Socrates: …the just man is happy (345a)

Solomon: Only by pride cometh contention: but with the well advised [is] wisdom. (Pro 13:10)
Socrates: it’s injustice that produces factions, hatreds, and quarrels among themselves, and justice that produces unanimity and friendship. (351d)
I think there’s quite a bit of overlap. The point is that Wisdom is the same to Socrates and Solomon. They were describing the same thing (the latter with the help of God directly). Both were concerned with how a person should live his or her life. Both thought deeply about these matters. They both sought wisdom before wealth or production. In the case of Solomon, he sought wisdom first, and all the ‘pragmatic’ things (wealth and fame) were added to him because of it. We should aspire to be the same way.

Part 1; Part 2; Part 3

Philosophy (Part 2 of 3)

#2 Philosophy is needed for good living
What is the meaning of life? This is often posed as an unanswerable question, one that philosophers waste their time discussing. But the reality is that we all have an answer. When we get out of bed and go to school or work, it’s because we’ve answered that question in some way. But did we ever really think about it? For most, the answer is ‘no’. Most people accept the answers given to them by others who have thought about it. This is often unconscious; it diffuses into a person’s mind slowly over years. Hearing a thousand times in a thousand ways, in lecture halls, textbooks, and conversations that “God is dead,” and “Life has only the meaning you give it” you will slowly drift in that direction if unhindered. Of course, you don’t have to choose, but, in the words of Rush, “If you choose not to decide, you still have made a choice.”

We are fiercely individualistic in almost every other way. We like to believe that our thoughts are our own. We dress uniquely. We listen to unique music. And we are our own person. But we all think the same. And we resist any conversation or thought in ourselves that might expose and thus endanger this homogeneity. I often hear, “I don’t spend time talking about philosophy. I’m a practical person.” If that is you, you are an efficient slave to a master not of your choosing. Indeed, we are all slaves to some worldview or other, but why anyone would take pride in his blind obedience is baffling. We value ‘practicality,’ but fail to see that the same trench can be dug for Hitler or for the Allies; the goodness of the digger is not in his speed but in his master. If we asked a Nazi soldier, “Is Fascism a good form of government?” he could respond, “I don’t spend time talking about philosophy. I’m a practical person” as he continues digging. Should we leave our goodness in the hands of the society into which we happened to be born? We can transcend our present time and place with an ancient and mystical art: reading. If every German had challenged the assumptions of their society and read even the first chapter of The Republic, they might have realized that “…it is not the work of the just man to harm either a friend or anyone else…” (335d).

Philosophy deals strongly with living a good life. Of all the time we spend, don’t you think we should figure out what exactly a good life is? If we get that one wrong, then pretty much everything else is in vain. There are things that I would take on authority: unimportant things upon which there is much agreement. The functioning of physics. The existence of a city called Boston. I trust that I’m not being lied to. Even if I was, it wouldn’t matter that much to me (sorry Harvard). But some things are important and there is little agreement on. These are the things I don’t want to have to trust anybody about. What is Justice? What is the Good? Does God exist? How do we think about pirating music? Is the present system of education well-founded? I don’t want to entrust these answers to a social lottery of influences; I want to have reasons that I myself understand.

It is often true that being able to think about the basic elements of a thing help with planning. If one truly understands what a community is, or what a human is, or what education is, then the plans to bring about changes in those things come more easily. For easy things, knowledge of physics helps with building a bridge. But knowledge of what helps with building a government? And what is the process by which such complex things are developed? Philosophy is essential for these questions.

One more thing. If you actually think you have a good answers for important questions, share them. In the Republic, Socrates’ says of a man who wants to leave the discussion without fully sharing his opinion, “…you have no care for us and aren’t a bit concerned whether we shall live worse or better as a result of our ignorance of what you say you know” (344e).

So getting stuff done isn’t good enough to be Good. It’s what you’re doing it for that matters (a good Worldview or bad one). And that decision should be one you make, not one you are assigned. And to make a decision on these matters requires study and discussion.

Part 1; Part 2; Part 3

Philosophy (Part 1 of 3)

I just finished book I of “The Republic” after having a very stimulating conversation on politics over dinner. (Before I go on, and before you go on, read “The Republic.” I know it sounds scary. That’s why I waited. But I was stupid and don’t want you to make the same mistake. It’s a really great book.)

Anyways, the thought I had was on how deep conversation is perceived. I am often asked after I’ve had a particularly good discussion with another person, “So, did you get anywhere?” I’ve always been annoyed by this question, but kept it to myself because I assumed my questioner was right: philosophy doesn’t ‘progress’ in a straight line like most other fields. Often the conclusions of an hour of discussion land the discussants very close to where they started. I was usually embarrassed that we had not made much ‘progress’ towards solving the Problem of Governance in an hour as we would have if we were discussing a crossword puzzle (we might have even finished it).

But I do not think that way anymore. Because, as I have seen them, there are at least three good reasons why studying and discussing philosophy is a good idea. And don’t get tripped up on the word “philosophy” (“phileo” = love; “sophy” = wisdom); I mean discussing hard questions that don’t have easy answers. This covers everything from God’s existence to the wrongness of pirating music. Ultimately, what is the Good that we should pursue and the True that we should believe? These aren’t dry academic discussions about nothing for no end; they’re the essence and motivation of all our decisions. When I say ‘philosophy’ I don’t mean the class you took as a gen-ed requirement.

#1 Philosophy is good exercise
Imagine a race run in a circuit. The gun goes off, and the race begins. The fastest racers stay together, neck and neck, running hard for mile after grueling mile. Two pull ahead of the rest, sweating hard. Finally one of them, in a final exertion, gets ahead and wins the race. And then from the bleachers an onlooker, empty popcorn bag in hand, snipes to the winner, “So, did you get anywhere?” Such a question should be answered by something like, “No, ***hole, I didn’t. I just ran a ****ing race.” [1] This is sometimes how I feel when that question is posed to me after a good discussion. Someone who didn’t do any work presumes that the point of the exertion was to ‘get somewhere,’ and, seeing no ‘progress,’ mocks the waste of time and sweat.

Having a philosophical discussion makes you a stronger person. I got this idea from Francis Bacon who said, “So every defect of the mind, may have a special receipt”[2]. He doesn’t see the mind as a muscle; it’s more like a body. There are multiple muscles that need exercising, and so different exercises for each. There is a part of our mind which reasons philosophically, and by exercising it, it gets stronger. Philosophical discussion about topics so big they won’t get solved are like dumbbells: not directly useful (though valuable, see #3), but weights which when lifted repeatedly, make a person strong for other, more useful endeavors (see #2).

[1] *** = ‘ant’ and **** = ‘frak’ above
[2] Francis Bacon's essay "On Studies": “Bowling is good for the stone and reins; shooting for the lungs and breast… So if a man's wit be wandering, let him study the mathematics; for in demonstrations, if his wit be called away never so little, he must begin again … So every defect of the mind, may have a special receipt.” [As a side note, I love being able to remember three words in an essay I read two years ago that was written five centuries ago, typing them into Google, and then being presented with the entire essay in a matter of seconds.]

Part 1; Part 2; Part 3

Thursday, April 16, 2009

Professional Development

I sat on a panel today for premeds for the first time. They asked questions about (see if you can guess) getting into medical school. Would it look bad if I ____? Would doing ____ help me get in?

After about an hour, I got frustrated. They had become slaves; they were living their lives for admissions committees. Every decision they made was made with a committee's opinion in mind. In considering a volunteer opportunity at a hospital, the only end for one of the students was medical school. No thought was put into the impact he could make or the virtue in humble service. The decision was entirely based on how it would look. Eventually my frustration boiled over and I said to them, "Who cares if you get into medical school? Do what is right and what is good. If you get into medical school, great."

I strive to live by my own words, to do things for the goodness of them rather than how it would make me look. But I am a fallen man. I have not consistently maintained this attitude. But I recognize it as sin. I don't think these students see their attitude towards medical school as a problem. And that is frightening.

Though their end is a theoretical good ("Helping people"), it seems that it is achieved by four years of disregard for goodness, efficacy and excellence. Though the best applicants are those who do pursue goodness (it has been my experience that Stanford, being incredibly selective, includes mostly this sort of student), many (perhaps most) who go to medical school are those who were best able to please admissions committees. And these are the men and women who become doctors. Are we surprised that doctors, when they become doctors, are not passionate about the good, are not ruthlessly efficient and cost-controlling, and are not always role models of excellent human beings? Perhaps our selection process is filtering out those who would are Good in favor of those who are good at pleasing others.

Why are so many striving for this end? I think a part of it is power. Doctors command a power and a respect in our society that is rivaled by few. Those who care about 'medical service' rarely even consider DO school (which arguably give better clinical training), because we'd only get DO behind our name and not the coveted MD. MD's have more power than DO's. And Harvard MD's have more social power than UCLA MD's. Even I am guilty of desiring this power. You might ask, "But isn't it power for a good end?" It is. At least at first. The trick is keeping one's focus on the Good; good intentions can quickly devolve. Even if the start is noble, the Good can get lost in the pursuit of power.

There is a great danger in living one's life to please men. This is a warning I need to remember myself. Though my career is a valid consideration, the Good is ever what I ought to strive for. Too often I do not think, "What is the best thing I can do here? What is Right?" and instead think, "How do I make myself look good to those who will evaluate me?" My decisions are too often made with respect to the opinions of others disregarding God. Too often I fear man rather than God. And then I euphemize my sin and call it, "Professional Development."

Pro 29:25 The fear of man bringeth a snare: but whoso putteth his trust in the LORD shall be safe.

Friday, April 3, 2009

What is International Health?

Before I answer the question, I’ll answer "How did we come to call our work International Health?" I imagine it’s because it was doctors who were the first ones to go abroad and serve the poor. As its field diffused, the people working for the poor abroad probably found that all their colleagues self described their field as “International Health,” so by force of peer pressure, it spread.

Believing “International Health” to be a field, undergraduates with this ambition all change their majors to conform to it. Lacking a particular major, they choose the closest approximation. And so the result is every college now has a major full of bright-eyed global service-minded freshmen leaving other departments drained of such people.

But what is it? Despite high enrollment in Hum Bio, International Health is not a unified by field. It includes people from most disciplines who have very different approaches and roles to play. It’s certainly not just doctors (as much as we, in medicine, like to think of ourselves as it’s lynchpin).

Even in its philosophy it is not unified. Some are involved because they believe that human rights are being violated. These view the matter as a sort of legal violation of people by corrupt governments or corporations. Others are quite moralistic about it; they believe they are morally obligated to work abroad. Still others hold that service to the poor is primarily an opportunity to do good; they focus more on the virtue of the service than on the evil in the situation. Some haven’t even thought through their own motivations.

International Health’s real unification is not in philosophy, skill set, or even field (despite the implications of the phrase “International Health”); we are unified by our common desire to improve the condition of the poor (who happen to mostly live abroad). We have a common and united heart. Humanist Moralists and Christian Virtue-Ethicists can work together for the cause of their poorer brothers. So too can anthropologists and artists join with doctors and dentists in bringing help to those in need. International health is not about externals of career or field, nor is it about a unified way of thinking. International Health is a movement of those who have a common heart to improve the condition of the poor abroad.

It seems that the clunky six-syllable name we have inherited is both imprecise and inaccurate. Other alternatives have been suggested like Social Justice (which is definitely snappy but implies a particular philosophy) and International Development (which can get confused with building tract houses in Saudi Arabia), but none have quite captured what it is that unifies us.

I propose the phrase “Global Compassion.” The focus here is on the heart of those engaged in it, not on the field (this may release people from the implied obligation to major in it). It’s specific enough to talk about the focus being abroad, and ‘compassion’ is broad enough to include work in any field motivated by a good heart. Additionally, compassion demands a relationship; it may help us to remember that, though we may transform corrupt governments and implement stellar public health efforts, our goal in the end is to help individual people.

How would I like to define International Health? “A phrase used in the late twentieth and early twenty-first centuries to describe work in what is now called ‘Global Compassion.’” And I would define Global Compassion as: “A movement characterized by a heart to improve the wellbeing of the poor in all dimensions through the application of various disciplines.”

Wednesday, April 1, 2009

A Far Cry From Communities

We have forgotten the community. We think of problems as either being solvable by governments (through public policy and politics) or by the individual (microfinance, ‘grassroots’). We don’t think much about the community, but it is the location and society where most of humanity has its existence. What is a community? Many a debate can be had on this, but I’ll give a practical definition. I mean the people you will reasonably run into at the grocery store or pass on a sidewalk. This is your community. Sure you live in Los Angeles, but the 10,000 or so people in your immediate vicinity have a bigger impact on your life than the 3.8 million others.

Sure you’re an American, but there’s vastly more variation from West LA to East LA than there is between “America” and “Britain.” Your community, not your country and not even your race, is more predictive as to whether you’ll get diabetes, graduate from high school, or get killed by gang violence.

In light of that, how many of us vote in our local elections? We think about changing America or the world, but how many have thought changing the community a valid ambition?

When we think about Global problems, we think of it in terms of governments and individuals. I can’t name you a single village or town in Africa. But I know that Zimbabwe is suffering from Cholera, and that Malawi is dealing with HIV. I know that DRC has unstable governance and that Sudan has a refugee problem. We pass laws and give aid to governments and countries. We don’t care about communities.

Also, I’ve seen pictures of a starving child, or an AIDS patient, but I can’t tell you a thing about the community from which they came. We give microloans to individuals and sponsor individual children. But what about their communities?

But what has been shown to be effective? In banking, much expert opinion is suggesting locally administered financial institutions (not the huge mega-global banks). Centralized administration in education, government and even taxation has been shown to be far less effective than local administration, closer to the community. Why have we ignored so crucial a part of our human experience? Why do we think solutions lie in a single individual (the Republican ideal) or in governments (the Democratic ideal), when we live and work in communities?

I propose we bring back the community. We, as a community, work with others in communities to change the world. Let us remember how we, humans, operate. Let us hear the call of our community, far away and faint, and let think rightly about what kind of creatures we are.