by David Werner

In August, 2001, the Mulago Foundation held a meeting of leaders from different community-based health and development programs that it assists in different parts of the world. The meeting took place at the bucolic headquarters of Future Generations near Franklin, West Virginia. The purpose of the interchange was to help Mulago and the programs reexamine their overall vision and consider strategies for immediate and farreaching change, in view of the problematics of the age we live it.

In our discussions it became clear that many of these programs are doing outstanding work at the local level. Most are committed to helping marginalized people in difficult circumstances find ways to cope with their pressing needs, in ways that also enable communities to conserve the natural environment. Some of the programs have been “scaling up” their successful approaches or finding ways to have a more far-reaching impact. All share a commitment to equitable and sustainable development.

I began to feel as if we were fervently building an ecovillage a foot above sea level, knowing that the polar icecaps will melt and our dream village will be washed away.

In presenting their vision of a livable future, nearly everyone at the meeting expressed concern about what they considered to be the socially and environmentally harmful aspects of “globalization.” They bemoaned the huge and often unscrupulous power of transnational corporations, and the way the current, top heavy model of economic development is so short-sightedly pursuing economic growth (for the rich) at enormous human and environmental costs. They have witnessed how the widening gap between rich and poor, and the cutbacks of social assistance to the poor, are leading to a pandemic of social unrest, crime, violence, hunger, resurgence of the diseases of poverty, population growth, and overuse of natural resources. They are aware that sweeping deregulation and the global reach of giant industries is accelerating unprecedented ecological degradation. Many of the program leaders present have witnessed how different aspects of these global forces, ranging from trade agreements to adjustment policies, have caused increased hardships or setbacks to both local people and to ecological stability in the corners of the earth where they work.

Despite these concerns, as the participants at the meeting described their “strategies for change” in working toward a “livable future,” most conceded that they were doing relatively little to confront the overwhelming threats posed by the unbridled global economic forces. For various reasons, they had preferred to keep their focus on the development of coping strategies at the local level. Based on their wealth of experience in community mobilization for change, they talked about the need for activities that give quick, visible results. The dangers to a sustainable future that are intrinsic to a development paradigm of unlimited growth seemed too huge to get a grip on, or even to face head-on.

I began to feel as if we visionaries of a “livable future” were fervently building an ecovillage on a bucolic island a foot above sea level, knowing that in a few years the polar icecaps will melt and our dream village will be washed away.

A key participant in the Mulago meeting at Future Generations was Dr. Carl Taylor, a pioneer of Primary Health Care and an architect of the Alma Ata Declaration. Among scores of groundbreaking activities worldwide, Carl worked for several years as a UNICEF advisor in China. Now 85 years old, he has a formidably ageless mind, wisdom, and wealth of experience that lead many of us to seek his counsel. After the meeting in West Virginia, I rode back with Carl Taylor to Washington, DC. On the way we got to talking about the impact of globalization on health, and the importance of getting mainstream decision makers to reexamine their assumptions. I suggested that to begin this process, we need powerful, indisputable examples of how specific free market policies are jeopardizing the health of millions. In answer, Carl told me of his personal experience in China, and the Health Ministry’s ongoing struggle to fend off the transnational tobacco corporations.