Undisciplinary
Undisciplinary
Exclusionary Solidarity In Global Health Justice
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We talk with Peter West-Oram about his new book - Justice, Solidarity and Global Health: From Globalisation to Collaboration - and discuss why solidarity is not automatically virtuous and how it can contribute to exclusion, coercion, and violence.
We use COVID-19, vaccine conflict, and global injustice to ask what a minimal pro-social solidarity looks like and who gets counted inside the circle of moral concern.
• solidarity as morally neutral rather than inherently good
• exclusionary solidarity and the “lone wolf” story that hides communities
• a minimal threshold for getting along in pluralist society
• fat positivity as a case of pro-social community under outside hostility
• three antisocial solidarities: hostility, mistaken, non-malicious exclusion
• vaccine hesitancy as solidarity with harmful external effects
• vaccine hoarding and partial policy choices that damage global health equity
• mandates, reactance, and why trust building is long-term work
• relational health beyond infection: infrastructure, climate change, and antimicrobial resistance
• Gaza, “who counts,” and what solidarity demands when people are denied moral standing
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Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com
Land Acknowledgment And Premise
SPEAKER_04Undisciplinary is recorded on the unceded lands of the Wadarong peoples of the Kulin Nation in Geelong and the Gadigal peoples of the Aurora Nation in Sydney. We pay our respects to elders past and present.
SPEAKER_01Medical history has been made and sound in action. New people everywhere, systemic race, the healthcare system and COVID-19.
SPEAKER_03Welcome to Undisciplinary, a podcast where we're talking across the boundaries of history, ethics, and the politics of health. Co-hosted by Chris Mays and Jane Williams.
Cold Weather Vivid And Puppy Update
SPEAKER_04Welcome to another episode of Undisciplinary. Jane, how are you going?
SPEAKER_00Pretty good. I was just thinking it's a while since I've seen your lovely face. Maybe that's been a while. I will give a oh, I was just gonna give okay, first cold day in Sydney, but I wanted to give a shout-out to Vivid.
SPEAKER_04Alright.
SPEAKER_00It's so cool. Not the lights bit, but there's so much cool stuff happening in Sydney at the moment.
SPEAKER_04I heard that drones fell out of the sky.
SPEAKER_00Oh yeah. Okay, there's lots of good music on. Let me just say that. I haven't seen the lights. But it's really nice having something cool happening when the weather's rubbish.
SPEAKER_04Yes.
SPEAKER_00That's my comment.
SPEAKER_04But it's the first cold day, did you say?
SPEAKER_00Yeah.
SPEAKER_04We've been having cold days for quite a while down here. Yeah, you guys are useless, but um all that I remember about Vivid is I used to play basketball near the Circular Key, and we could never get car parks uh on the nights when Vivid was around. So not a very festive person. Not a very um solidaristic person, as we'll come to talk about maybe a little later. Um but I will give one update uh because sometimes I say things on this podcast and I forget that I've said it, and I also forget that people listen to it, and then um someone says, Oh, you've got a puppy. And so last time I did reveal that I have a puppy, and someone came up to me and said that, and I was like, Oh, oh yeah, I do. Uh and I think I mentioned this to you, to Jane. I'm not gonna turn this into a sort of new sort of social analysis of puppy life, but it's very similar to having a newborn child in two ways. One, people got a lot of opinions, for instance, demand feeding. We were doing demand feeding and we got told off from some people both. Double get fat, mate. That's right, a lot of fat shaming, um all of that sort of stuff, developmental milestones, is the puppy reaching them? And then people also treat you a lot nicer. You walk down the street and people stop and talk to you, um which can be a good thing and a not so good thing. But uh again, not wanting to spend all the time on the puppy, the puppy has been having seizures, so then we went and saw a specialist and now the puppy's on some anti-seizure medication. But again, I'm very interested in in the uh comparisons and dissimilarities between uh sort of healthcare, sociology of health and medicine, and I guess the world of puppies. But um that's an update on Pickles.
SPEAKER_00Yeah, I hope he's alright.
SPEAKER_04Yeah, he's doing fine, um, apart from the seizures.
SPEAKER_00You have to find a season.
SPEAKER_04So I was gonna say something more about the seizures, but I think we'll move on because we don't have as much time and there's a lot to cover.
Meet Peter And The New Book
SPEAKER_04Um return visit from uh Peter Westerham, uh, who is an associate professor in bioethics at BSMS. I realised I needed to clarify what acronym uh that stands for, um, to my uh shame. Um and he's been there since uh 2017, prior to moving to Brighton. I presume Brighton means uh that one of those B's stands for Brighton.
SPEAKER_00I think Brighton and Sussex Medical School.
SPEAKER_04Yeah. Right. See, this is why you do the introductions, Joan.
SPEAKER_00Yeah.
SPEAKER_04And um he holds a PhD in philosophy from the University of Birmingham, where he wrote his dissertation on the subject of global health justice and the nature, justification, and extent of rights in healthcare. Welcome back, Pete. It's uh great to have you. Thank you so much. Thanks for having me back. It's great to be here. And you've been busy while uh you're being away. I mean, uh I also it was two years ago that you were um on the show. I know, I couldn't believe it. I thought it was last year. Um and so just this year uh you have uh published Justice, Solidarity and Global Health from Globalization to Collaboration. Um published with Taylor and Francis. And you I believe were working on this. You may have mentioned uh in early developmental stages when you were um when you were here last. Um but yeah, we're here to talk about the book. Um very excited to. Uh and I guess one thing that would be interesting just to hear first up, because we're going to focus on a particular chapter of the book um with some particular themes around uh exclusionary aspects of solidarity. But um it'd be good to sort of just hear a little bit about the process of writing the book um and a bit of uh overview of the the main argument or or what you're doing with the book.
SPEAKER_02Sure. Well uh again, thanks for having me back. It's great to be here. Um as I said, the last time we were having a conversation, I've been looking at this for quite a while. And the solidarity aspects, I've been sort of focusing on particular issues and going, okay, how how might this work in the case of refugee health or or migrant health or or in national healthcare provision, for example. Um, but prior to working on solidarity, uh as you as you mentioned um in my PhD, I'd looked at rights to healthcare more generally. Um, and I'd kind of got enough distance from my PhD to go, I think I can develop that a bit further. I think I can add some stuff from my solidarity work there. And then with the uh with in the sort of aftermath of COVID and how various people had responded to that and some of the uncertainties and controversies coming out of that of the of the COVID pandemic, I wanted to kind of solidify all of my thinking around that kind of issue. Because one of the things that was, I suppose you could say, particularly shocking is the the level of action that many people were totally unwilling to engage in. So maybe wear a face mask when you go to the supermarket seemed to be completely unacceptable to loads of people. And so that was quite shocking to me, and and also uh because I've I've I've always been interested in I I would like lots of engagement from everyone for for the protection of everyone's health, but I know that it's not going to be convincing for everyone. So, what's the kind of reasonable minimum? How do we work out what that's going to be, what that's going to be? How do we work out how to convince people of that? And then COVID happened, and what I thought would be a reasonable minimum would be what seemingly is completely unacceptable and a draconian infringement on personal liberty for lots of people in uh in in some cases in quite powerful political offices. So, what I was trying to do is find uh uh an argument and uh uh and set out what I think is appropriate and reasonable to ask of people, and also set out ways of uh working out what that might be. So I don't go through and go, right, here's a hundred thousand words explaining what we must all do in every single circumstance, because A, that's impossible, and B, that's possibly an insane task to try and attempt, but to try and go, here are the kinds of standards that we should think, here are the things that should matter. So, in one of the chapters of the book, for example, I talk about the kinds of considerations that we should look at when we're trying to work out who we should prioritize helping when we can't help everyone. So, is it the case that it's liability that we can then we we assign responsibility along those kinds of lines? We need to look at severity, but in some cases, severity might be way beyond what we as individual people can do anything about. And so I was really trying to bring all of that different thinking on different particular issues together and refine some of my earlier work so that it was more up to date and more coherent as a comprehensive argument, if that makes sense. Um, and then looking at the solidarity angle, trying to go, well, where has it worked? Because in some cases it worked really well on a more local scale, and in other cases, solidarity existed, but not necessarily for the benefit of very many people or people outside of quite narrow group boundaries, hence the exclusionary solidarity angle.
SPEAKER_04Yeah, well, let's uh get into the exclusionary solidarity angle.
Why Solidarity Is Morally Neutral
SPEAKER_04So I think, you know, as you lay out, and I think for for most, especially I would say, you know, people in the academy, people who are, you know, slightly to the left, um may well where those uh coordinates are these days, it's very hard to know. But the generally this idea that solidarity is good um is is seems to be a sort of intuitive response that a lot of people have. And I I guess I'm coming to this conversation as well. Uh having just finished um teaching a political philosophy unit on justice and equality from liberalism to decolonization, um, we actually end with fascism after decolonization. So it's a bit of a sad spoiler. But uh it has made me think about, you know, uh the students' responses, even the way that I teach it was pretty much towards this idea that, you know, solidarity, community, togetherness, these are all good things um that we don't really question too much. Um and so uh it would be interesting to hear, you know, what you do with that sort of idea that solidarity is inherently good or a virtuous force in our social life. And so why do you argue that solid solidarity is um actually morally neutral rather than a sort of implicitly or unquestioned good? And what are the risks of failing to acknowledge um that it does have this anti-social dimension to some forms of solidarity?
SPEAKER_02Well, I think it's it it's really important to retain a focus that it can be a really good thing to do. Like solidarity is enormously valuable for lots of people. I mentioned before before we sort of went on up to start dust recording that uh my university is currently looking at voluntary redundancies um and possibly compulsory redundancies, which is obviously really worrying for everyone who works there. And and in that circumstance, the solidarity between uh the people who work at the university is incredibly valuable to try and reduce the impact of uh on our community and on our students um more widely. Equally, solidarity can be hugely valuable in lots of different ways, from the kind of recreational, like it gives us a sense of identity, it gives us a sense of purpose that can be hugely protective and supportive and helpful. The other side of that, and and that it's an idea that I I first encountered in uh Barbara Prainsack and Elena Books' uh work of this idea that solidarity can be, as you say, morally neutral. And so it's it's a thing that we do, and it can be really good, and it can be really important that we encourage people to engage in it, but it can also it it's because it's a thing that we do, it's also sometimes done by people whose motives and intentions and objectives are really unpleasant and we should want to distance ourselves from. So they use the example of a of a terrorist organization that just wants to kill everyone who isn't a member of the group, and uh, but they're internally willing to carry costs for one another, they recognize similarity from what with one another, they think that their identity their shared identity is really important, and as a consequence, they are motivated to cause harm to other people in a in a kind of uh like it's us versus them rather than us and them. And and they are express concern about this possibility uh with their definition of solidarity because it might lead us to, because of that social press presupposition that solidarity is always a good thing. And I actually think that that's a real strength of the argument, of their argument, because it allows us to have a more comprehensive analysis of what is going on when people do engage in those groups. Why, why is that happening? Um, one of the examples I mentioned in the book is this like this um, I suppose you could say sort of popular narrative of lone wolf terrorism, like, oh well, this one person who was like radicalized on their own, and they're you know, we all we you hear this narrative of like this basement dweller dwelling loner who is just obsessed with this particular idea and they do this horrifying act, but they're a lone wolf. The that narrative is often used by um uh I think potentially slightly unreflectively, but in um by uh me public discourse, but I think sometimes deliberately by the people who are inspiring those individuals. Because it's like, oh no, it's if if you are a uh and the narrative usually relates to far-right fascist or neo-Nazi uh groups, like quote unquote, they're not part of us, they're a lone wolf. We they're nothing to do with us. Helps that they're doing stuff that we totally approve of and are really happy that it happened, but nothing to do with you can't prosecute us, they're sort of isolated from the the group. The thing is they're radicalized by that narrative, they're part, they identify with it, they're willing to carry the cost. So I think the if we fail to identify that these that that kind of activity falls under that solidarity paradigm, we fail, we we lose a heuristic device to analyze what's going on with their thinking, with their motivations and how they function and exist and interact in society as a whole. So recognizing there is solidarity in that community, it's seen as good by the people in it. We need to work out how to interact with them. And I am not an expert on terrorism or the far right, but from the what the research that I've done into that work, it looks like providing ways to communicate is the is is absolutely essential. So it's it's necessary that we have the the language to understand what we're talking about when we talk about those things. It's not an isolated thing, it's a community that the pe that the men are the members of which uh think is important in some way.
Pro Social Solidarity And Pluralism
SPEAKER_04Yeah, I mean it's yeah, it's interesting to think about the uh the differences in what makes a to use, I guess, the pro-social or antisocial forms of solidarity. What what does that hinge on? Is it the uh the position of the people whether they're sort of a a minority group or a majority group? Um it seems as well that uh it could be part of uh the openness or closeness of the form of solidarity. So, you know, you could have a cult that could be a minority and have very much a small group, but whether they let people in or out of that uh and shun people, if you like, once they have uh broken solidarity.
SPEAKER_02Yeah, and I think I think it's for the way I think it is not about sort of membership numbers or or anything, it's it it's a a very loose kind of can you get along with other people in in a very simple sense of like because obviously if if or maybe in some ways you could sort of say that if if you have pro-social solidarities, I think that if membership of an antisocial solidarity is almost always going to be really harmful to its members in one way or another, and and and you know, terrorism is not the only one, there are lots of other kinds, I think. But I in it the narrative at least is we as a group are doing it for our group. So they're pro-social for who the who they consider to be morally relevant society, but they're still antisocial to everyone else. It it I for a pro-social solidarity, what I've suggested in the book is that what's required is you can kind of get along with everyone else. So it's kind of a pluralist or a cosmopolitan sense of solidarity, or not, um you're you are you may have might have a different understanding of the things that identity that are your identity or your community identity, but you're also like, oh no, they're totally fine. It's just we have a different under, like we've got a you know, uh, we've got our way of doing things, they've got their way of doing things, totally fine. We can all get along together, we're all part of a kind of overarching pluralist understanding of we can get along, and and they're kind of you can think of it in more or less serious terms. So um people who support a particular football team have their kind of solidarity community, and they might have particular rivalries with other football teams, and they might not have quite heated rivalries in some cases, but they're a community about their own particular team within a wider community, and you have to have those other communities if you're going to have your team as well, um, if that if that makes sense, or you or political parties in in a diff in a democracy, for example, um, party on the left or the party on the right, like diametrically opposed on lots of different issues, but sharing an understanding of well, we have a democracy and those are the rules. And why while we might wish that we were in charge and you weren't, we're working, we have a different understanding of what's best for people, and in an ideal sense, perhaps less so with the election of certain people recently that we might think that everyone's committed to. Well, I just think this is a better way of making people in our communities' lives better, and we're both committed to democracy. So we're within that kind of meta solidarity of understanding pluralist democracy, if that makes sense. Yeah.
SPEAKER_00Do you know when I was reading Pete and I was thinking about solidarity uh in terms of some work that Chris and I have done and about fatness? And so I'm kind of interested in what happens, like I'm really like what you've just said, what happens when you have people who are solidaristically supporting each other through uh you know fat positivity. And then there are two things that I have to say, I guess, but what happens when so you've got groups who are existing, but then there will be a bunch of people who are saying that group is not a pro-social group because health or something, whatever. You know, where you've got like the the fat positivity crew are gonna get on with everyone because all they're doing is making their own lives better, but then they are still being treated horribly by other people. So does there have to be like a mutual um we can get on okay, you know?
SPEAKER_02That's a really that's a really interesting example. Because the example I use in the book is sort of vaccine refusal, where there seems to be much more of a negative externality, like a measurable negative externality to to refusal. Um I would think with and I've not thought about fat positivity in that sense. That's a really interesting idea. That's so cool. Um because I think I I think I'd be tempted to say that would you wouldn't necessarily for that example, it would there's huge value to that members of that community in terms of it, because of how hostile we society tends to be.
SPEAKER_00Um and I would argue that it's health promoting, yeah, yeah. Yeah, yeah. But then others would argue that it isn't.
SPEAKER_02Yeah, um, I think that in in that particular case, I would be I would say I think that it they would count as pro-social, they're not trying to cause harm to anyone else. I I suppose there is an argument of um trying to think how to frame it properly without um putting a foot wrong, as it were, but I think that the argument I if I've understood you correctly is the promotion of the quote unquote lifestyle is is a again, quote unquote, lifestyle that is unhealthy and that shouldn't be encouraged or something along those lines.
SPEAKER_00Is that kind of that's what some people would argue, I imagine.
SPEAKER_02Yeah, yeah. Yeah, I I yeah, I can I can I can imagine the kind of people that would make that argument. I I think I don't think that um that would be sufficient to um I I wouldn't say that that's sufficient to classify that as a as an antisocial solidarity. Like that seems too far too far to me. Um I think that um I suppose there are there are health conditions associated with beer with having much higher weight that have um but that but equally there are significant health conditions associated with how incredibly cheap. Yeah, constantly, you know, like the the fat phobia in in society.
SPEAKER_04Um this gets us to what I was going to say ask about, but I think this is a good example of um and and so with the sporting example that you used and also political parties and then this example that James brought in, it seems that part of the conditions of solidarity is that there needs to be there is some kind of uh competition or some kind of relation to another external group, but it's also how that external group or relation is framed. So, in part of reading this um chapter, uh and also part of at the end of teaching that justice and equality um unit to finish on up with the Nazi jurist um Karl Schmidt who describes the political as um friend and enemy uh distinction. That's sort of our relations are just friend or enemy, and uh we have to, if we're part of the friend group, then we want to vanquish the enemy group. And so in the sporting example, uh if you are into a sport and you support your team and you come across another person who's supporting their team, you kind of want them to have some passion for their team, but you also don't want to totally annihilate them and have them because then there's no competition. Likewise, you know, there are some politicians who think you know, the conservatives should never, you know, it'd be good if we lived in a or it would be good if the you know Labour had, you know, a total majority in the parliament. Now that would, I would think, be not a good situation. And then likewise, I think with this health, like there are some people who just would not entertain the idea that um you could have a body positive movement around bodies that are fat and and and happily label themselves as fat. Uh you have some people who struggle with that but are sort of in a position of wanting to be willing to entertain that at least because they recognise, I guess, a humanity in and and an agency in the other people. And so I guess this makes me think of not um Schmidt as the go-to person, which is always a good thing. Um, but someone like um Chantal Mouf, I don't know if you're familiar with her ideas, but you know, around agonism and or antagonism, but uh you know, this contest that we're not going for a total consensus um, you know, on the liberal side or a total vanquish of the enemy on the fascist side, but a way in which we can have an ongoing sort of acknowledgement of difference, but are working together in the context of that difference as well.
SPEAKER_02Yeah, I I think that's a really good way of putting it, actually. And I think the um your point on the the democra the parliamentary democracy, or not necessarily parliamentary, but democracy thing is that it it provides the counterbalance in a way, doesn't it? Is of different ways of living. So um the um I've I've just on a slightly different note. I've been working on a uh paper on conscience objection to contraception, the provision of contraception and abortion recently, and sort of one of the um there's a uh there's a wonderful paper, and of course, who's the author of which I can't remember, but the title is But I Could Never Have One. Um and it's kind of and it's discussing the this kind of uh and my argument is look, if you volunteered to do a job that includes gatekeeper responsibility providing these services, you I in my opinion, I don't think you should be allowed to go, but I'm I'm not gonna provide it. Like you volunteer, there's other jobs, there's other medical jobs that you could volunteer. And I think it's the kind of the the but if you it's totally reasonable, I think, to go. Oh, I don't think that's if you're a member of the public, I think that's not okay, but you that's your decision to make. And I think it's that kind of how how accessible um it is to for people to say, um, well, I'm not sure that's the way one should live, but you know, sure, whatever. Like it you might go, you probably need to have a word with yourself about your what you know internalized platphobia or or any of the other kind of prejudices. But as long as you're kind of willing to let other people get on with their lives and not interfere and not try and stop them or make life difficult, like fine. I'd I'd I'd like a better standard, but like this is a minimum threshold that I'm looking for. Um and so it's kind of the the in in the in chapter three, I do kind of try and work out what minimal minimally pro-social would look like, um, and or sort of an ideal of cosmopolitan solidarity is as long as you can kind of get along, as it were, and you might have disagreements about the uh the approach or the um the the uh what's the right word, the the moral the the value or the normativity or whatever of the principles that ground it, but it's like but that's your business, we're all still committed to this general idea that we can kind of get along, and and I think that that would be um sufficient. So I think it would I mean of course if if someone was then going, I'm going to criminalize having a body mass index of over X, then that falls short. If um but uh kind of obvious that's kind of obvious. Um, but I think going, I think it's not outside the realm of possibility. I'm not sure that's a great idea, but you do you that would would count as minimally pro-social.
SPEAKER_04Um well let's not get too down far down the pro-social path. Let's keep it negative. Um
Three Types Of Antisocial Solidarity
SPEAKER_04so you provide a taxonomy of um uh three uh types of antisocial solidarities. Um so one of them being hostility groups, misguided groups, and non-malicious exclusionary groups. Um I was wondering if you could talk us through these taxonomy or these different um types, give us a potential example, and um I guess linking it to you know how they they can help us better understand the diverse ways global health justice is undermined by some of these.
SPEAKER_02Sure. Yeah, so so I I mentioned um sort of terrorist organizations already, but I think for the for a hostility group, the the kinds of groups I'm thinking of are things like white supremacist separatist groups. So that these are organizations that are um predicated on uh uh I suppose you can call it an epistemic error about the the significance of ethnicity and skin colour. The groups that are not just, hey, we're different and we're gonna be separate, which are kind of like which you could conceive of as okay, fine, you do you, it would be great if you wanted to be involved, but you know, but a group which is not only are we separate, we're better and we're opposed to your existence and we want to dominate and what all the rest of the hideous things these groups are involved in. Um, so that's the kind of uh what I would think of as the the one end of the spectrum, as it were, like the very obvious violence, like the they are uh and the and the thing with those kinds of groups is their um their objectives and their strategies are aligned. So the the goal and the the the the telos is you know separate supremacist, um uh racist and exclusionary, the strategies that they adopt, violence towards other people, um, discrimination and all these things are aligned with that objective. They're harmful to the group members and to people outside of it, but they're the the the things they do do align with what they want to achieve. The second group is what I call the mistaken or misplaced solidarity. So this is uh, I mean, the the example I mentioned or the vaccine hesitancy. So this is where, and and this is different to the hostility group because the they're not necessarily predicated on a desire to cause harm or to um be better than or or or other people, but and and their strategies and objectives are misaligned. So they're grounded in an error of what they are aiming to do and what they do to achieve that. Uh, and this can almost be sort of grounded in something that you we might think is praiseworthy, like people who avoid vaccines, not always obviously, but have like are concerned about the welfare of their children very often. And that's a you know oversimplification. But you know, we generally think that it's a good thing to prioritize the welfare of one's children or one's community, and they have just made an error as the best way to do that. Um, so in that kind of group, and so the reason I say it's mistaken almost places, it can be um we've we're aiming for objective A, we pursue and we uh we've adopted strategy X. It's just that strategy X is not going to help us achieve objective A. It's relevant for, I mean, hostility groups are relevant for health because they are violent, exclusionary, can can motivate policy which is more active on a global level and can cause direct harm to people in their local community. Misplaced or mistaken groups, the um with vaccination, the the costs of high numbers of people refusing vaccination are felt in the spread of infection or the re-emergence of it of um vaccine-preventable diseases. So in uh Margaret Batten's um book, The Patient as Victim and Vector, she talks about this idea of resin infection. Um, so if you have large numbers of people who are unvaccinated against measles or whatever, you you might have really high coverage elsewhere, but you've got a pool of people who are potentially likely to who could potentially become uh infected and then spread it to people because you're not going to get 100% uptake everywhere. Um and we're seeing this now as the sort of the re-emergence of vaccine or the the popularization maybe of vaccine skepticism. Um what's important, and and this goes to the sort of the significance of acknowledging these as solidarity groups, is that uh there are groups in in society who have been directly harmed by the healthcare professions or who have been treated appallingly historically by the healthcare professions, and for whom going to um going to a doctor is not just something like at the level of fear that people often have, but like, why would I? Like the last time I went, they treated me appallingly, so of course I'm not going to trust them. And so we we talked about bullshit last time. Um, and so the the mistreatment of patients by clinicians contributes to that sort of fear and misinformation because it encourages people to pursue alternatives when you know the people in the white coats with the stethoscopes are dangerous, you know. So there are reasons that people seek out other kinds of communities, and and so we need to sort of understand why and understand uh a better engagement with those communities. So um there is evidence that suggests that sort of mandates for vaccination for school participation can actually drive uh vaccine hesitancy or or entrench it. So if people are already skeptical or hesitant, there's a it can encourage people to uh entrench themselves further and pull their kids out of school and make it harder to communicate with them. Whereas a sort of a more gentle approach isn't always as successful, but can be more successful than just going, right, if you're not gonna get vaccinated, you can't participate in school. Because then people just go, okay, well, my kids aren't going to go to school, and we're going to find another community which welcomes us and is supportive and helps us and that makes us feel safe. It's just not going to achieve the objective that they necessarily want. And then the the third group is again not necessarily so that so misplaced or mistaken solidarity is not necessarily predicated or focused on causing harm, but it likely to cause harm as a consequence of the erroneous pursuit of a of a mistaken strategy. For the third category, what I'm thinking of there is more the sort of political decision making. So we we saw the hoarding of vaccines by wealthy nations, um, Europe, North America, and Australia, New Zealand, uh, and the impacts that this has. So this is again not necessarily motivated by we want to keep all the vaccines because we want people outside of our borders to get sick, but we want to uh we want to keep all the vaccines just in case, which causes significant harm. Uh and earlier in the book, or in in in the second uh, I think chapter four, they talk about the different kinds of ways that harms can be caused to people or deprivations of health can be caused. Um, and so you have sort of malicious action, negligent action, and partial action. And malicious action is that which is most closely associated with hostility groups. They want to cause violent harm to people. For a nation state to hoard far more vaccines than it can possibly use, or far more vaccines than it would ever need. Um, and I the this the number has gone out of my head this morning, I'm afraid, sorry, but the UK had way more vaccines than than its entire population number, which meant that lots of other places didn't get vaccines, all got vaccines when they were nearly going, they were about to expire, and so had to carry the cost of disposing of them because wealthy countries, quote unquote, donated them to poor countries and then went, hey, they wasted all these vaccines we gave them. Like we, you know, um, so there's a whole thing going on there. So what that is is a failure to engage in sort of global health activity because of a partial or and or negligent uh emphasis or uh approach to policy, if that makes sense.
SPEAKER_00So
Mandates Reactance And Building Trust
SPEAKER_00I was interested um uh Pete in your question uh in your bringing up mandates um and the idea that dialogue and understanding um might do the trick. So I'm also working on mandates at the moment. Uh and interestingly, I am so I'm talking to people who um uh were had were uh there was a vaccine mandate in place for them during COVID for their keeping their jobs. And interestingly, um the idea of reactants, i.e., that they have then been driven as a result of those mandates into no longer vaccinating was much more prevalent in my data than I anticipated. It was something I'd heard about and I thought, oh, I wonder if that's actually a thing. When I spoke to people, it wasn't at all uncommon for them, for adults to say, I used to get my vaccines, but then when they took away my freedom in COVID, I have changed my mind and I won't get vaccines anymore. And one person said, I won't because it's um what did he say? He said it's my protest move. And I was like, that's really interesting, dude, because that's not protesting anything except yourself. Anyway, my point is that um dialogue and understanding are incredibly labor-intensive and time intensive, and they're incredibly valuable, but they're also probably uh very difficult to sustain. How do we um how do we manage that? You know, how do we how do we kind of uh come up with a thing where you've got the very blunt, very heavy instrument that is a mandate, and then you've got all of these other ideal situations that could uh uh raise vaccination rates, which is the point of a mandate. Um for different things.
SPEAKER_02I'm so glad you asked that question. Um I think it ties really nicely into the so in the UK we had an issue with limited access of personal protective equipment for healthcare workers um because the stockpiles hadn't been maintained. Um so uh nurses and doctors were providing treatment to COVID patients prior to vaccines being available when it was sort of early days. This is you know, at the most terrifying moment, and people were sort of apparent supposedly providing treatment with like bin liners over them rather than proper uh uh aprons and things like this. That is the product of a failure to adequately prepare long term, I think uh which sounds like it's completely different to dialogue and communication, but I think it's the same problem because it's a failure to it's basically okay, we fixed that now, we can move on. Whereas in reality, with things like vaccination, it if you are just going, you know, as you said, if you just have a dialogue when the crisis happens, people are immediately going to go, what on earth are you talking about? Like there's too much, there's too much information coming in, which I think is probably one of the reasons why there was so much um uh so much panic at the start of COVID, so like stockpiling and all of this, and so much kind of reticence to or refusal to wear masks, like what there's so much information. Last week they told me that a mask was no point. This week they're telling me it's and and and so I think the the issue is not necessarily how do we do it in crisis point, but how do you make sure that you've been actually communicating effectively for the 10, 15, 20 years previously so people understand that this is complicated, we have so that there is an a social understanding of um some these things matter, they're always going to matter, they're always going to be important. Now, the flip side of that is that when I uh often when I'm talk talking to sort of first-year medical students or to sort of first year undergraduates, a lot of the times, well, if people are just told if we give people the right information, and and you're you're laughing because I think you probably had very similar conversations with people. Um, and I think the like you like you have to provide the right information to people, but it can't just be here's a flyer when there's a crisis happening. It has to be like 15 years ago, we started it like, and it's not just like uh it, and I don't mean in the sense of indoctrinating people into accepting vaccines, but into it that like this is how science works, this is how like this is how we act as a community, this is why it's important to participate, so that you have uh in the same way that you're because what you're doing is you're effectively stockpiling awareness of one's place in society, one's in into one's impact on society in the same way as stockpiling PPE in an incredibly strained analogy there. Um, but I think you're right, like it's really difficult to okay, cool. Like that's a huge relief because I I thought it worked, but like I was like, maybe this is just completely absurd. But I I think it's the product of um and I think it's analogous to the to the bullshit discussion we had as well. Is it you can't just go, no, that's wrong, here's the truth, because then the response is, well, why the hell should I listen to you? Like you're no more convincing than the other guy. But if you have a uh you know, the relying on great people to communicate clearly as the the heroic individual is dangerous. But if you can if you can uh help people to understand how information works and how medicine works and how science works and how you know all of these general skills, it it kind of inoculates people against the bullshit merchant, in a way, or the by which I include you know fascists and all the rest of it. Of here's this very simple solution to the very complicated problem that you've got. If you've if you don't allow the space for that by providing people proper and and clear education and clear information and a clear understanding of how this all works, you you provide a way of going, there's no space for that nonsense in this debate, if that makes sense. And the same is true, I think, for vaccination. But but at the same time, we have to be really sympathetic and careful about people who have genuinely been really harmed by the medical profession. So I I used the example in the book of uh the infected blood scandal in the UK, um, which um, you know, was the use of it uh or entailed the use of blood products for people with bleeding disorders that were contaminated with HIV and hepatitis, and it killed about 3,000 people. And and the government and the healthcare professions knew that this was a risk, and patients were not told. There's a reason. That people in the bleeding disorder, many people in the bleeding disorders community will feel quite skeptical about the healthcare profession because they've lost people and they have it took until very recently to get a meaningful apology. So there has to be sort of ongoing and um meaningful dialogue rather than oh, we have a crisis now, so you've got to do what we tell you because that that that's not going to convince anybody.
SPEAKER_04Um is part of I guess this convincing people or um socializing them, enculturating into them uh an understanding of um I guess the collective uh good in relation to some of these programs or strategies. I I guess I think similarly, you know, something like wearing a seatbelt or wearing a helmet is something that I would do even if the laws were changed, such that because in Australia I have been uh indoctrinated into these things to deprive my freedom, where there are other people who I I do remember when I was living in parts of the US, they would just think it's strange that I put my seatbelt on or those sorts of things. Um so part of it is I guess changing this understanding of well maybe not changing, but at least um encouraging and enculturating a certain understanding of health. And and part of that is you talk about um health as uh being profoundly relational. And I I guess that works maybe somewhat clearly in the context of infectious disease, but I think you know, in a range of other areas, particularly emerging stuff around epigenetics and um the microbiome, um but also you know, just the health and well-being um has this relational dimension to it uh and requiring you talk about it, requiring collective uh cooperation to safeguard um how do the exclusionary boundaries um, whether these are sort of nationalistic in the case of I guess Kovacs and and these sorts of things um or different racial exclusions or ideologies uh endanger the health of even those within the privileged group, because I think this is uh an interesting dimension to um to not only health, but I mean health provides a little gate window into that um yeah, even the privileged groups can undermine themselves uh through some misguided solidarities.
SPEAKER_02Yeah.
Relational Health Climate And Global Risk
SPEAKER_02No, I I so that there's a lot of different ways, and I think it in in as you say, it relate the relationality of health is is most obvious when it comes to um infectious disease, because you you can go like, well, I might be a vector for COVID or malaria or whatever. Um but it's also present in lots of other ways as well. So um how we choose to regulate car emissions vehicle emissions, for example, can have an impact on uh respiratory illness. Um, so that's not necessarily a transmission, as it but it's a social environment. I there's an example in the book um where I try and illustrate how absurdly complex a lot of these kinds of assigning responsibility can be. And it's kind of so if I break my leg because I'm riding a motorcycle recklessly or even carefully, like that's not going to index, no one else around me is going to break their leg as a comp you can't catch a broken leg from someone. But if you're driving on the same roads and the roads are poorly maintained or badly lit, or they don't drain well, or there's poor visibility, you might also suffer a similar kind of injury or worse. So what so what we can do, so that that relationality comes through the the hazard rather than the hazard is the the road, the road infrastructure. Our health is therefore relational in the sense via that infrastructure in that way. So we can like if we are engaged in or recognize that relationality, we can invest in public goods together through taxation and we can you know try and improve how safe the roads are, or whatever it might be. So um, and in doing so, hopefully reduce the the threats that we are all exposed to, or we can regulate emissions, or we can improve food hygiene standards so that we are all safer in different kinds of ways. So it's there's there's relationality in a way that is not necessarily just infection, but in other kinds of ways. Equally, the the you know, solidarity groups around healthy pursuits, for example, can be really valuable for people. So um it it's it's off in my experience, like when I started at going going to a new gym when I was you know kind of much more energetic than I am nowadays. Um, I was pretty much always surprised by people like people who go, Oh, do you like this as well? Let me show you how to use this piece of equipment. Or hey, let's be friends, like like because people are in you know, if you're welcomed into a community that is like it that is doing an activity that's good for you, you're much more likely to have fun doing it and you're much more likely to keep doing it. So there's that that value of solidaristic community, even if people aren't thinking out of solidarity, I will help this new person who's trying to work out what that machine does or whatever. Uh this on the flip side of that, if we exclude people through hoarding vaccines or through um uh extractive neocolonial economic policy, or through you know failure to provide reparations for the his history of colonialism or through um failure to address climate change through our policy, we're inflicting harm on other people for a start. We're also um we're also not giving so in the case of climate policy, for example, if we are going, well, we're not gonna cut our emissions because you're not gonna cut your emissions, we're not giving anyone else an incentive to do so either. So we're gonna create additional risk for ourselves there as well. But in the case of infection, if we do not, I mean, if we do not um enable people to have access to treatment, we're creating risk for ourselves long term by allowing those pathogens to persist. So it was a wonderful thing for humanity when we eradicated polio or almost eradicated polio. Like that was a a global good for everyone. We've got real, you know, we've got really close with smallpox, for example. Measles was really under control in lots of wealthy countries until people started going, actually, measles isn't too much of a threat. I'm not going to get my kid vaccinated. And with the spread of and with international travel, the ease with which we can travel internationally, a wealthy country, people who are unvaccinated against measles, are going to poorer countries and reintroducing measles where it was previously controlled, which is uh a whole other uh thing in and of itself, but increases the likelihood of the spread of infection in both directions as well. Again, with climate change, if um the increases in temperature mean that the habitable range for various different vector organisms spreads. So richer people, richer countries, which previously didn't need to worry about malaria or dengue so much, it's now increasingly common or is going to become more common, similarly with antimicrobial resistance. So the failure to engage globally with the health of people thousands and thousands of miles away has a meaningful impact or is going to have a meaningful impact relatively soon. I I the I think it's the WHO predicted that by 2050 um there'd be an additional 10 million deaths per year as a result of antimicrobial resistance, um, because we failed globally to develop something, uh develop policy that would actually counteract the threat of antimicrobial resistance that is emerging for whatever reason. So the relationality is most obvious in infection, but it's also about how we address existing threats in our local community at an individual or domestic level, but also threats that are emerging or that have been ignored for a long time.
SPEAKER_04Yeah. I'm very tempted to take it into a more absurd direction, uh an older discussion now, uh, where Susan Jeb, your former, I don't know, she was a significant figure in public health in the UK, um, said that uh she didn't put it in terms of solidarity, but bringing cake to work was uh not uh that was sort of I guess being a vector of disease. Um so I guess in that context it is if health becomes this uh exclusionary ideology, um, and it become or the the um the organizing ideology, if you like, of all of our goods, then you can have these um uh maybe more nefarious forms of um solidaristic exclusion for those who just thought they were bringing a cake to share to work.
SPEAKER_02Yeah, I mean, I think you know I I suppose entertain like for the sake of argument, sure, okay, you're bringing an unhealthy product to work, but also you're spreading joy in your workplace. So, I mean that's pretty good for your mental health, I would argue, but uh and it's some uh only somewhat facetiously, but I think it's it is important to acknowledge that there's lots of other really important things that we need to prioritize as well. Um the difficulty is that um it's working out which ones to prioritize when and sort of the the burdens that you can place on people to fulfill the one's duties as regards to health when they've got lots of other conflicting responsibilities as well. I think I think we talked last time about sort of how to like the but it's my mum objection of like how does an individual um like make a decision when that decision might cause harm to people they care about. And it shouldn't be up to the individuals, like these are systemic problems that are matters of structural injustice that governments and and intergovernmental organizations should be helping us with and should be actually doing the majority of the the lifting so that we are enabled to care for and about other people and engage in solidarity with them.
SPEAKER_04Yeah,
Gaza Solidarity And Who Counts
SPEAKER_04um I do want to uh talk about the the way you end the book, um and uh that I mean this I think is one of the key things that we do need to talk about in terms of uh what is morally and politically serious. Um and so you and this is a spoiler, but you conclude the book with um the words free Palestine, um, and in the context of that, in leading up to that conclusion, you talk about your argument for sufficitarian standard of justice. Um and so last time we did discuss uh Israel's uh genocide um when you were on here last, and particularly in the context of bullshit and some of the the sort of um excuses and statements that were being made by various political leaders. Um and well, you know, I haven't read the entirety of your book, but I had a scan through. So it's not a sort of sustained focus throughout the book, um, but it does come up um uh at different points, and particularly in the conclusion, um you have a good uh articulation of um the uh the genocidal Israeli regime um and what they're doing in relation to Palestine. But um it's clearly, I guess, a motivator underlying your work. Um and I was just wanting to sort of finish on whether you can comment on that further. Um, and I guess like other um wide-scale horrors that the West has committed or condoned, so whether that's slavery, colonialism, the Holocaust, um, and others, um, do you think that this genocide in Gaza and the oppression of Palestinians is a test for our theories of justice, morality, and solidarity, so on? Is that part of, I guess, you know, not to put words in your mouth, but you know, this question about solidarity, what does it mean in this particular context at this particular moment?
SPEAKER_02Yeah, it it it's one of those where I and I I say in the the conclusion that that I've tried to articulate, like, okay, let's try and get an argument for something that everyone can accept and like and and with the reasons for including discussions of self-interest, but when there seems to be such enthusiasm um uh for ignoring the moral status of certain groups of people, it's really difficult to find anything that's going to motivate people, um or or or the people who are enthusiastic or who are willing to engage in that kind of genocidal violence. I suppose the the key claim there, and I think there's a um a paper that I found very moving, is what's the point of genocide studies after Gaza? Like we have these discussions around, oh well, we should do this for justice, we should engage, you know, this is how the world order should function, this is how we should ensure um that um we're all doing the right thing, or we're all avoiding uh the kind causing harm, or we're helping people the way that we should. I think that there have been there, as you say, there have been very there have been many test cases, which I I mentioned uh and you mentioned as well that this is one that has been so prominent in the public eye what whilst I was writing, and it was kind of like there's a section where I sort of have a very brief couple of lines sort of enumerating the number of people killed, and it and I ended up just having to just stop adding to that because it felt like every time I came back to that section, there wasn't there was new data that more horrifying stuff happening. This kind of test it feels in some ways uncomfortable to say as a test case because it's it's so appalling, but it sh it shows who gets to count or who is taken to count as being a member of the community of moral concern, uh which is a solidarity community, like to engage in solidarity with someone is to say you matter in some way, and it is seemingly very clear now that Palestinians and as as other as Jewish people were under the Holocaust, as as victims of colonialism, as victims of the the slave trade, were treated as people who don't count or not people, and and this is in the light of those examples, it is horrifying, and it kind of illustrates, it provides a really horrible illustration of the if you if you do not find or if we do not find ways to uh divert that hostility, solidarity, we end up with these horrifying situations, or in this case on a grand scale. But the the I suppose it the key thing is if you don't engage in solidarity with people, in in some way, it doesn't have to be sort of a massive, you know, sell your house and you know donate all your money to Medicine Sans Frontier or whatever. We're kind of acknowledging that people beyond this boundary, whatever that boundary is, don't count. And it's kind of been being made very, very clear in and it's illustrated really well by uh the the like various countries' responses to the Russian invasion of Ukraine, which is we must support Ukraine, there's absolutely got to protect people here, um, and the response to what's happening in Gaza. Um I I don't have a compelling answer to that. I I wish I did. I I sort of other than this is absolutely horrifying, and it demonstrates how wealthy country or many, many countries are failing to adequately respond and adequately acknowledge that actually Palestinians are people, which seems to be a controversial opinion in some areas.
SPEAKER_04Yeah, well, I think um it's certainly not expecting answers, and I think everyone is uh who's wrestling with this are trying to think of you know how do we think and act about um this and and particularly older concepts uh that we were once reliant on things like solidarity, things like international law. Um how how do we uh either re-fru reframe or retool those? Um and you know, someone who I've been reading a lot, Zahi Zulu, uh Palestinian uh American philosopher who interestingly his book has solidarity, his recent book has solidarity in the title, but um he doesn't spend a lot of time talking about solidarity. I wonder whether it was more an appeal to that general vibe of solidarity, and he, you know, is more looking at new kinds of universalism um uh and and different ways by philosophers like Slavol Zhuzek and um and Gilles Deleuze has an interesting thing where he talks about uh in an interview, this was in the eighties, um that the Palestinians are a people like any other. And in the sense of not trying to make their suffering or their situation exemplary to the exclusion of all others, but to sort of include them into a sort of commonality that they're like any other with their hopes, their dreams, their aspirations, and um yeah.
SPEAKER_02And I I think that's really important, it is it it is it is but apparently it seems that it doesn't matter, it's not taken to account in many places. Um and uh it it's I wish it could I could say it was astonishing to me, but after two years you know, it uh you know, more than two years, it's it almost like I don't know what to say, you know. I it it sorry I didn't mean to interrupt you there.
SPEAKER_04No, no, no. Um uh but we appreciate greatly what you've written and what you've said uh here tonight or this morning for you. Um and yeah, thanks a lot for coming back on and um we'll have you on after you've written another book.
SPEAKER_02Next year. Well, thank you for having me. Thank you for having me. It's always always great to talk to you both and yeah, lots of fun. Yeah.
SPEAKER_00Thanks, Pete.
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