Global Health Experience
Security: global, collective, and inner
“Deep roots are not reached by the frost” [JRR Tolkien]
The past month has been an unusual one, by any account.
Early on, I finished a novel, Remainder, by Tom McCarthy, in which the protagonist is hit on the head by falling scaffolding, leading to brain injuries that necessitate months of rehabilitation. The required re-learning of life’s everyday activities make our anti-hero lose touch with reality, leading him down the most extraordinary path in an effort to re-connect with human existence. I won’t say any more, except to mention that in the week after I wistfully finished the last page a film version appeared, which was awful.
Despite the cinematic disappointment, the book made me think about the meaning of security: not in the sense of precautionary measures to avoid trouble in the streets or how to cope with kidnapping — as per the 3-day obligatory SAFE training I did in a Sussex hanger last year because of the unsafe locations of some of PHE’s global work — but security in both a broader and also a deeper sense. With a spark ignited in the mind, the notion of ‘security’ started to appear in different guises through the month, three of which I wish to share.
First, amidst Public Health England’s expanding international portfolio, much of what we are doing comes under the umbrella of ‘global health security’. This is a difficult term to unravel (global health alone means different things to different people) but in a general sense global health security refers to endeavours aimed at keeping the world safe and secure from dangerous infectious diseases, with a focus on three components: preventing and reducing the likelihood of outbreaks; detecting threats to save lives; and responding rapidly in an effective, coordinated manner. There are international initiatives to take forward the actions, underpinned by the legally binding International Health Regulations, but it is the Ebola emergency in West Africa that has brought the whole agenda into truly sharp relief. As a result, significant funds have been made available to address global health security concerns, and a number of PHE’s overseas projects in some of the world’s poorest countries are supported by such. All of this is positive, and one hopes the much-needed attention will continue, but lessons from history suggest we must keep alert to the implications and underlying causes. Beneath the surface, the conditions leading to global health insecurities include poverty, fragile States, vulnerable populations, corruption and politics. Without sustained attention to these factors, laudable health directed security efforts may have limited long-term effect.
During the month, I spent a week in Ottawa with a PHE director colleague, Kevin Fenton, visiting the Public Health Agency of Canada (PHAC). Shortly before our arrival, a large sink-hole had suddenly appeared in the main road adjacent to our hotel — giving a whole new meaning to pedestrian security. Thankfully there were no casualties, and the heightened interest in our downtown area didn’t affect an outstanding trip. A major purpose of the visit was to build relationships with our vital counterpart national agency, and invaluable talks and meetings were held on a range of important public health topics. One particular aspect of the visit that stood out, however, was the manner in which we were looked after by our PHAC hosts. Seamless binder packs were presented on arrival, with every component of the three-day schedule detailed, individual policy staff were assigned to each of us to ensure we reached the right place at the right time, and every possible effort was made throughout to maximise the utility and positive experience of our time. Now, I realise that we were being spoiled and such treatment cannot be provided to everyone, but there was something simple in the graciousness of the effort that resonated profoundly. It’s about collective security, the second notion I encountered during the month, and the feeling that is generated by making people feel really looked after. Creating such an atmosphere through genuine attention to wellbeing makes individuals feel safe, enhances performance, builds bonds and brings the best out of people. All of which is perfectly human, and can readily be achieved through the simplest of means.
As we touched down at Heathrow, after an overnight flight home, the habitual turning on the iPhone while the plane is still taxing revealed the Brexit decision, one impact of which was people articulating concerns about their security. Clearly, being supported by a collective can engender feelings of security, whether with regard to the EU or as articulated in the paragraph above, and there is no intention to diminish that significance — or the essential importance of improving global security. Yet, ultimately, substantive feelings of security come from deep within us, and are not dependent on what is happening externally and what we are not in control of — regardless of our place in the world. Inner security is about being truly in touch with the part of us inside that connects with being human: the part that knows what to do, what to say, what direction to take. If you think about an interview that went awry, a meeting in which you omitted to say what you meant or a wayward interaction with your boss, it usually boils down to losing your bearings, a disconnection with your grounding. It’s both tangible and intangible: you know you have it when it’s there, but it’s harder to sense when it’s missing.
In Remainder the protagonist loses touch in the extreme with what it is to be human, and has to work immensely hard to try and get it back. But Tolkien’s deep roots are always there, untouched by the frost of life’s challenges. And, regardless, those cold challenges are often only as real as we make them. Our imagination creates the thoughts that we then hold on to as real and, when those thoughts dominate our experience of the world, our inner core becomes increasingly obscured. Nonetheless, as the American poet Maya Angelou has put it rather poignantly: “Nothing can dim the light that comes from within”.
[There will be no August posting because of the summer holiday break]