‘Combatte Kudasai!’

Last week a friend and long-time supporter sent us a significant donation from the Netherlands. We came across it in the Moxafrica bank statement with this curious tag ‘combatte kudasai’ which took us a day or two to figure out. (We’ll explain how we interpret this a little further on).

WHO’s 13 Urgent Health Challenges

But last week another significant thing happened: The WHO published the thirteen most urgent health challenges that it sees the world facing in the next decade.

We list them below, at the same time stressing that the WHO offered them in no particular order. They’re of immense significance because this is the start of the decade that leads up to the culmination of the 2030 Sustainable Development Targets (SDG’s) and we’ve just entered a ten year period which the UN has already identified as a ‘Decade of Action’.[i]

So here’s the list of major health challenges currently facing humanity (as we say, in no particular order – and the notes in italics are the WHO’s):

- Climate change: “The climate crisis is a health crisis”.

- Delivering Health in conflict and crisis: “most disease outbreaks requiring the highest level of WHO response occurred in countries with protracted conflict”.

- Healthcare equality: socioeconomic gaps result in major discrepancies in the quality of people's health and their life expectancies.

- Expanding access to medicines: about one third of the world's people lack access to essential medicines.

- Infectious diseases: infectious diseases currently take the lives of an estimated four million people annually (nearly half of them succumbing to TB).

- Preparing for epidemics: “a pandemic of a new, highly infectious, airborne virus to which most people lack immunity is inevitable”.

- Protection from dangerous products: “Lack of food, unsafe food and unhealthy diets are responsible for almost one-third of today’s global disease burden”.

- Investing in the people who protect our health: “The world will need 18 million additional health workers by 2030, primarily in low- and middle-income countries”.

- Keeping teens safe: “More than one million adolescents aged 10 to 19 years die every year”.

- Earning public trust: public health is compromised by misinformation in social media, as well as through an erosion of trust in public institutions.

- Harnessing new technologies: “new technologies … raise new questions and challenges for monitoring and regulation”.

- Antimicrobial resistance: “the rise of antimicrobial resistance (AMR) is a persistent and urgent challenge that threatens to send modern medicine back decades to the pre-antibiotic era”.

- Clean water, sanitation and hygiene: “one in four health facilities globally lack basic water, sanitation, and hygiene (WASH) services that are critical to a functioning health system”.

Our first observation is that at least ten of them have direct connection to tuberculosis. In fact Dr Tedros, the WHO Director General, identifies that “many are interlinked” - which does reinforce the fact that eradicating TB is a complex and multi-facetted challenge and doesn’t just depend on the roll out of new drugs. Equally, it tells us that we are living in a very complex interlinked world in which we ignore our inter-dependence at our peril.

Our second observation, however, is that many of these challenges are geopolitical in nature and have less to do with the actual human-to-human act of delivering health care than we might expect and this is surely worth thinking about.

Dr Tedros encourages us to think about it this way: “We face shared threats”, he says, and because of this “we have a shared responsibility to act”.

So how should we act exactly?

Dr Tedros helps us here as well: “There are no shortcuts to a healthier world,” he says. “2030 is fast approaching, and we must hold our leaders accountable for their commitments.”

Sustainable Development Goals for 2030

So what commitments are they? In respect of TB, they’re a set of targets that were set at the UN by all member states for 2022. In respect of the wider global issues, they’re the SDGs, the commitments that the leaders of all UN member states signed up to in relation to “reducing poverty, rescuing the world and building a peaceful planet” (which is how the UN itself neatly summarises the totality of these SDGs).

The UN Secretary General’s been vocal on this theme as well. In September he called on ‘all sectors of society’ to mobilize for a decade of action[ii], demanding that this should be done on three levels:

1. Global action to secure greater leadership, more resources and smarter solutions for the Sustainable Development Goals;

2. Local action embedding the needed transitions in the policies, budgets, institutions and regulatory frameworks of governments, cities and local authorities; and

3. People action, including by youth, civil society, the media, the private sector, unions, for the required transformations.

It can quickly be seen that the first two levels of action are solely the responsibility of world leaders and national politicians to implement – the problem being that their actions are so far amounting to nothing that will avert humanitarian disaster. The reason for this is that they too readily respond to pressure from the wrong lobbies – not from the third level (by whom they were elected in most cases), but rather from the rich and powerful and from multinational corporations.

Which brings us to this third level – to today’s ‘third estate’ that is actually the only one that looks like it will make any real difference. Dr Tedros was right, it would appear, and tells it like it is – it is our shared responsibility to act because if we don’t then poverty won’t reduce, the world won’t be rescued, a peaceful planet will never be built (and TB will never be ended).

Combatte Kudasai…

So back for a minute to ‘combatte kudasai’ – and what this means.

We realised that it was a clever pun on the well-known Japanese phrase ganbatte kudasai (頑張ってください). Roughly translated this phrase means: ‘Let’s get down to work please, and let’s do our best while doing so!’.

We’re deliberately translating it rather clumsily to emphasise two things: firstly that it’s a polite and respectful request; but secondly because it emphasises that the final results will only relate to our best efforts (i.e. not due to luck, nor to the generosity of the universe or any tooth fairy).

So why did our donor substitute ‘combatte’ for ganbatte? Well the word doesn’t exist in Japanese (at least as far as we know!) – which is where the pun comes in. Our long-time supporter is deliberately pointing out that she knows that we continue to face an ongoing struggle pushing for moxa to be further tested by the world of biomedicine, and is politely encouraging us to stick at it.

But of course the same applies to all of us in the business of protecting our world.

‘People action’ (the third level of the Secretary General’s call-to-arms) is unquestionably going to involve a huge struggle, the results of which (as the Japanese phrase tells us) will not depend on luck or the denouement of a feel-good Hollywood film, but on sheer persistent determination. It’s not a Hollywood film where the good guys always win in the end; this is real life, and it's not a battle that we can afford to lose.

Martin Luther King Day 2020

January 20th (today) is MLK Day in the U.S.. One of his many inspirational quotes was that the arc of the moral universe is long but that it bends towards justice. He was unquestionably a man of faith but even so - would he be saying the same thing today, we wonder, given the existing timescales for change? That beautiful arc of human morality no longer has much time to touch ground in his promised land, and we can no longer depend on the long downward curve of centuries. In fact we only have ten years at best to bend the curve (as we know only too well). Meanwhile those first two levels of response (of global and local action) are led by people whose motives we cannot depend on, and it’s our struggle whether we like it or not to act at the third level.

So welcome, friends, to the new decade of action – and Happy New Year!

Combatte kudasai – because whether you want to end TB, reduce poverty, rescue the world or build a peaceful planet, like it or not, we are all in this together.

[i] https://www.un.org/sustainabledevelopment/decade-of-action/

[ii] https://www.un.org/sg/en/content/sg/speeches/2019-09-24/remarks-high-level-political-sustainable-development-forum