7.18.2006
Letters to Sam, Part II
Sam’s words next to arrows, my responses underneath. Omissions marked with ellipses.
> So, first, I think you're merging a lot of what I said with a lot of
> other arguments which I'm not making (or not trying to make,
> anyway). I'm not saying that our entire strategy should be to
> concentrate on making good arguments,or to focus on macroeconomic
> stuff. I'm saying that both of these need to be part of the
> strategy, and that it's a mistake to leave them out just because
> you're not seeing them as particularly effective. First of all,
> they're difficult to measure -- they kind of form the baseline for
> all other forms of action. I think that you'd see the world in a far
> worse place today if NOT for, especially, the huge economic
> incentives, etc. And I'm not going to be able to justify this based
> on any concrete examples; I'm at a huge disadvantage here. By
> showing failures of specific programs which try to help economically
> (rather than taking the health problem head-on), you're mentioning a
> lot of specific programs which were set up foolishly. I don't think
> that this speaks in any way to whether the approach in general is a
> good one; it's akin to "sex education is foolish because teaching
> children about abstinence has not decreased AIDS transmission." I
> never made the argument that we should be subsidising American
> farmers as a way to affect hunger in Africa, and I never asked for
> the "status quo".
You are saying that we have to maintain our credibility by making "good" arguments or no one with money is ever going to listen to us. That's what I'm responding to. I think a lot of development-as-usual projects are worse than ineffective: in the case of food aid and a lot of economic development projects (sweatshops, environmentally destructive "development" projects), they're actively detrimental. And the programs I was talking about are not "set up foolishly"; my point is that they're exactly the type of programs you will always get if you a) wait for the interests of the powerful to coincide with the needs of the poor and b) think that because people are poor, actions to promote their well-being should be held to a low standard.
Your argument is that as advocates we not make higher-order, "unreasonable" demands on the powerful because it destroys our credibility. Our strategy under your plan, therefore, would be to only advocate for the most feasible interventions and those that are most likely to line up with what the rich feel like doing. My argument is that as advocates we should work in the near-term for progressive realization of what we want but do it in the broader framework of a call for social justice which includes all the stuff that is in all those meaningless UN declarations which I already conceded should not necessarily be called rights. But, I still think we need some framework that puts those economic/social considerations, and the interests of the poor, at the forefront.
My argument was that, merely because a strategy is
> mis-used, we shouldn't necessarily scrap the strategy; not that we
> must pursue that strategy to the exclusion of others, or that we
> should blindly follow an existing, failed structure. As this whole
> practice of throwing our economic weight around to micromanage living
> crises is incredibly new (at least to me, it seems like it's only 20
> years old at most), it's natural that we haven't gotten it right.
> Even I can clearly see problems with implementation, but I feel that
> abandoning these overall strategies because they have not yet been
> effective (btw, see my other favorite argument that NO program is
> ever going to be effective unless it's subject to invasive monitoring
> and the proper incentives for performance) is almost the same as
> saying "well, Africa isn't helped much by MONEY, clearly, so let's
> try the approach of withdrawing all foreign aid." (analogies don't
> work as well when they're on the same general topic, but I hope that
> made sense) I don't know enough to state with any certainty that
> economic measures have been ineffective because they have been
> haphazardly organized and trivial in scale next to what would be
> necessary, but I strongly suspect that this is their primary failing,
> for which the measures themselves shouldn't be blamed.
I'm not arguing against the strategies, I'm arguing against the logic that underpins them and results in the bad strategies being chosen and their implementation being so lame. If we sat down and looked at it and the status quo was really the best way to help the poor _regardless of the interests of the rich and powerful_ then I would advocate for it loud and lustily. What I am saying is that we need a framework for policymaking that makes it possible to pick strategies that actually help people instead of the current framework, which I argue, doesn't.
…The status quo is the last thing I'd ever argue for in
> just about any field, except possibly in French cooking, where people
> always screw it up when they try to modernize it. My entire point is
> a baby/bathwater one. In this particular way, I _do_ think you're
> … lumping a whole series of
> arguments together because they are occasionally made together and
> then attacking one in that group based on the insufficiency of
> others. Which is kind of the point I was trying to make with re-
> defining the question. It's not that looking at a problem in a
> different way is bad, it's that it's not addressing the question
> under consideration.
>
> [re-defining] "Public health experts recommended putting all the
> focus on prevention of HIV and treatment of opportunistic
> infections. ... Partners in Health started treating people with
> antiretrovirals at their clinic in Haiti and they showed that they
> could get high adherence rates and that people got better, and they
> did it despite the 'riptide of cost-effectiveness arguments'"
>
> That's not re-defining the question, though, that's challenging an
> assumption made by 'experts'. By re-defining the question, I'm
> talking about an argumentative (does that have two meanings? I mean
> 'relating to argument') tactic. I don't think anyone is more
> skeptical of 'experts' than I am; I think every field benefits by
> challenging the idiocy of the current way of thinking of things. I
> was trying to make the point (no doubt ineffectively) that it doesn't
> really make ANY point if you fail to address the one on the table --
> someone can always re-define a point away. (I like the example of
> the second-to-last panel in the last comic strip of this link: http://
> www.doonesbury.com/strip/oldglory.html ) I'm not in any way trying
> to say "don't challenge how things are being done."
Look farther up in that paragraph. Before advocates got involved it was all about how to manage and prevent HIV in Africa--we said that that was a ridiculous way to frame the problem when treatment existed. Okay, it's not as fundamental as asking "so why is Africa so devastatingly hit?" but it's an example of how reframing the public debate made stronger action possible.
And I don’t see any reason why asking the big questions is incompatible with taking immediate action. That's why you work for progressive realization + long-term vision. Like the organization I worked for in Tanzania. We understood that the children we were serving were suffering because of a lot of huge forces—history, social breakdown, growing inequality within their country, corruption, etc. and we understood that we weren’t providing them with the services that they deserved. But we saw that it was valuable for us to do what we could to make their lives better. I don’t really plan to spend the rest of my career moping around how global inequality is so terrible and unfair; we have to do what we can, but do it within a framework that makes it possible for the poor to get out from the bottom of the pile.
>…
> "I'm really against this idea that we should set a bare minimum and
> make sure that we achieve that and then in some rational future
> moveon to the next order of business."
>
> That's exactly what I'm arguing against. I don't think you CAN move
> on later and re-define the scope of rights. But again, you're
> equating rights and things we think are good. And I grant you that,
> within the Public Health and Human Rights arenas, the word has been
> largely re-defined beyond anything I would have thought of as a right
> -- perhaps to the point that we're actually thinking of different
> meanings. I just don't see something as a right merely because I
> believe someone deserves it, or because it's owed to someone. I
> think every government has the absolute, unquestionable duty to care
> for the poor and the sick; I think these are more important functions
> than guaranteeing the free practice of religion, but I don't think
> that their importance makes them "rights".
…
> OK, here's the point I'm trying to make in everything: we have to
> have levels of principles, each of which trumps the one before it, or
> everything becomes situational and pointless. I like the metaphor of
> the laws and the constitution… Like laws which we'd
> like to make, but which conflict with higher goals (I'd like to
> outlaw the Chicken Caesar Salad, but I know that would be wrong, even
> though that specific law would undoubtedly make the world a better
> place), I believe that rights are something not to monkey with out of
> a desire for a result, and I believe that disingenuous arguments are
> bad even if they are convincing, effective, and improve people's
> lives. The ends can't justify the means in a policy sense, ever. I
> think that's just about the most important principle on earth, maybe
> even outranking "be nice to each other".
I feel you, my brother. I understand your arguments. But I don't agree. Ends matter and the people who control the means have their eyes on the ends, so we have to too.
> So, first, I think you're merging a lot of what I said with a lot of
> other arguments which I'm not making (or not trying to make,
> anyway). I'm not saying that our entire strategy should be to
> concentrate on making good arguments,or to focus on macroeconomic
> stuff. I'm saying that both of these need to be part of the
> strategy, and that it's a mistake to leave them out just because
> you're not seeing them as particularly effective. First of all,
> they're difficult to measure -- they kind of form the baseline for
> all other forms of action. I think that you'd see the world in a far
> worse place today if NOT for, especially, the huge economic
> incentives, etc. And I'm not going to be able to justify this based
> on any concrete examples; I'm at a huge disadvantage here. By
> showing failures of specific programs which try to help economically
> (rather than taking the health problem head-on), you're mentioning a
> lot of specific programs which were set up foolishly. I don't think
> that this speaks in any way to whether the approach in general is a
> good one; it's akin to "sex education is foolish because teaching
> children about abstinence has not decreased AIDS transmission." I
> never made the argument that we should be subsidising American
> farmers as a way to affect hunger in Africa, and I never asked for
> the "status quo".
You are saying that we have to maintain our credibility by making "good" arguments or no one with money is ever going to listen to us. That's what I'm responding to. I think a lot of development-as-usual projects are worse than ineffective: in the case of food aid and a lot of economic development projects (sweatshops, environmentally destructive "development" projects), they're actively detrimental. And the programs I was talking about are not "set up foolishly"; my point is that they're exactly the type of programs you will always get if you a) wait for the interests of the powerful to coincide with the needs of the poor and b) think that because people are poor, actions to promote their well-being should be held to a low standard.
Your argument is that as advocates we not make higher-order, "unreasonable" demands on the powerful because it destroys our credibility. Our strategy under your plan, therefore, would be to only advocate for the most feasible interventions and those that are most likely to line up with what the rich feel like doing. My argument is that as advocates we should work in the near-term for progressive realization of what we want but do it in the broader framework of a call for social justice which includes all the stuff that is in all those meaningless UN declarations which I already conceded should not necessarily be called rights. But, I still think we need some framework that puts those economic/social considerations, and the interests of the poor, at the forefront.
My argument was that, merely because a strategy is
> mis-used, we shouldn't necessarily scrap the strategy; not that we
> must pursue that strategy to the exclusion of others, or that we
> should blindly follow an existing, failed structure. As this whole
> practice of throwing our economic weight around to micromanage living
> crises is incredibly new (at least to me, it seems like it's only 20
> years old at most), it's natural that we haven't gotten it right.
> Even I can clearly see problems with implementation, but I feel that
> abandoning these overall strategies because they have not yet been
> effective (btw, see my other favorite argument that NO program is
> ever going to be effective unless it's subject to invasive monitoring
> and the proper incentives for performance) is almost the same as
> saying "well, Africa isn't helped much by MONEY, clearly, so let's
> try the approach of withdrawing all foreign aid." (analogies don't
> work as well when they're on the same general topic, but I hope that
> made sense) I don't know enough to state with any certainty that
> economic measures have been ineffective because they have been
> haphazardly organized and trivial in scale next to what would be
> necessary, but I strongly suspect that this is their primary failing,
> for which the measures themselves shouldn't be blamed.
I'm not arguing against the strategies, I'm arguing against the logic that underpins them and results in the bad strategies being chosen and their implementation being so lame. If we sat down and looked at it and the status quo was really the best way to help the poor _regardless of the interests of the rich and powerful_ then I would advocate for it loud and lustily. What I am saying is that we need a framework for policymaking that makes it possible to pick strategies that actually help people instead of the current framework, which I argue, doesn't.
…The status quo is the last thing I'd ever argue for in
> just about any field, except possibly in French cooking, where people
> always screw it up when they try to modernize it. My entire point is
> a baby/bathwater one. In this particular way, I _do_ think you're
> … lumping a whole series of
> arguments together because they are occasionally made together and
> then attacking one in that group based on the insufficiency of
> others. Which is kind of the point I was trying to make with re-
> defining the question. It's not that looking at a problem in a
> different way is bad, it's that it's not addressing the question
> under consideration.
>
> [re-defining] "Public health experts recommended putting all the
> focus on prevention of HIV and treatment of opportunistic
> infections. ... Partners in Health started treating people with
> antiretrovirals at their clinic in Haiti and they showed that they
> could get high adherence rates and that people got better, and they
> did it despite the 'riptide of cost-effectiveness arguments'"
>
> That's not re-defining the question, though, that's challenging an
> assumption made by 'experts'. By re-defining the question, I'm
> talking about an argumentative (does that have two meanings? I mean
> 'relating to argument') tactic. I don't think anyone is more
> skeptical of 'experts' than I am; I think every field benefits by
> challenging the idiocy of the current way of thinking of things. I
> was trying to make the point (no doubt ineffectively) that it doesn't
> really make ANY point if you fail to address the one on the table --
> someone can always re-define a point away. (I like the example of
> the second-to-last panel in the last comic strip of this link: http://
> www.doonesbury.com/strip/oldglory.html ) I'm not in any way trying
> to say "don't challenge how things are being done."
Look farther up in that paragraph. Before advocates got involved it was all about how to manage and prevent HIV in Africa--we said that that was a ridiculous way to frame the problem when treatment existed. Okay, it's not as fundamental as asking "so why is Africa so devastatingly hit?" but it's an example of how reframing the public debate made stronger action possible.
And I don’t see any reason why asking the big questions is incompatible with taking immediate action. That's why you work for progressive realization + long-term vision. Like the organization I worked for in Tanzania. We understood that the children we were serving were suffering because of a lot of huge forces—history, social breakdown, growing inequality within their country, corruption, etc. and we understood that we weren’t providing them with the services that they deserved. But we saw that it was valuable for us to do what we could to make their lives better. I don’t really plan to spend the rest of my career moping around how global inequality is so terrible and unfair; we have to do what we can, but do it within a framework that makes it possible for the poor to get out from the bottom of the pile.
>…
> "I'm really against this idea that we should set a bare minimum and
> make sure that we achieve that and then in some rational future
> moveon to the next order of business."
>
> That's exactly what I'm arguing against. I don't think you CAN move
> on later and re-define the scope of rights. But again, you're
> equating rights and things we think are good. And I grant you that,
> within the Public Health and Human Rights arenas, the word has been
> largely re-defined beyond anything I would have thought of as a right
> -- perhaps to the point that we're actually thinking of different
> meanings. I just don't see something as a right merely because I
> believe someone deserves it, or because it's owed to someone. I
> think every government has the absolute, unquestionable duty to care
> for the poor and the sick; I think these are more important functions
> than guaranteeing the free practice of religion, but I don't think
> that their importance makes them "rights".
…
> OK, here's the point I'm trying to make in everything: we have to
> have levels of principles, each of which trumps the one before it, or
> everything becomes situational and pointless. I like the metaphor of
> the laws and the constitution… Like laws which we'd
> like to make, but which conflict with higher goals (I'd like to
> outlaw the Chicken Caesar Salad, but I know that would be wrong, even
> though that specific law would undoubtedly make the world a better
> place), I believe that rights are something not to monkey with out of
> a desire for a result, and I believe that disingenuous arguments are
> bad even if they are convincing, effective, and improve people's
> lives. The ends can't justify the means in a policy sense, ever. I
> think that's just about the most important principle on earth, maybe
> even outranking "be nice to each other".
I feel you, my brother. I understand your arguments. But I don't agree. Ends matter and the people who control the means have their eyes on the ends, so we have to too.
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