Predatory Leadership: Are Nations Getting the Governments They Deserve?

By Chris Simms

How Weak Leadership Brought Crises to the Global Community

How did we ever reach the point of nearly 900,000 COVID-19 deaths in the US, 5.5 million worldwide and a climate crisis that now affec

• Language: English
• Publisher: University
• Release date: Dec 1, 2020
• ISBN: 9781777255435

Chris Simms

Dr. Simms teaches at Dalhousie University, Faculty of Health, School of Health Administrations. He has lived and worked in many countries including the Philippines, Indonesia, Sri Lanka, Senegal, Tanzania, Zambia, Kenya, South Africa, Madagascar, and Peru He has studied at Dalhousie University, the Johns Hopkins School of Public Health, Harvard School of Public Health and the University of Sussex. He has contributed to international health on various boards including the International Journal of Clinical Practice. He has two teenage children and lives in Halifax, Nova Scotia.

Book preview

Front cover of Predatory Leadership: Are Nations Getting the Governments They Deserve?Title Page for Predatory Leadership: Are Nations Getting the Governments They Deserve? by Chris Simms, PhD

Predatory Leadership: Are Nations Getting the Governments They Deserve?

3rd edition, September 2022

© 2020, 2021, 2022 Christopher Simms.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permissions of the publisher.

Mill Cove Publishing

Halifax, NS Canada B3H 3V2

Cover design by Rick Smith, Halifax Idea Co.

Cover illustration: Samantha Simms, 2020

Author photo: Valerie Bellamy

Ebook formatting by Dog-ear Book Design.

ISBN: 978-1-7772554-7-3

Also available in print format, ISBN: 978-1-7772554-5-9

Table of Contents

Acknowledgements

Preface

Introduction

Part One: Global Crises: where we are today

Pandemic Response: Fear Is Inevitable, Panic Is Optional

A Rising Tide: The Case Against Canada as World Citizen

Russian Dolls: Revealing Trump Diminution of the Common Good

Deregulation Amid Fires and Hurricanes

The Rise of Walls and the Decline of Values: From Trump to Calais

Biocitizenship and Forced Removals

Asian Development Bank Failing in Its Mission to Protect the Poor

Canada’s Murdered and Missing Aboriginals

Confederates and Canadian Colonialists: Imprisoned by the Past

The Precarity of Being Indigenous: The Case of Canada

Global Health and Altruism: The Case of Canada and Its Treatment of Refugees

World Bank Reforms Must Embrace Racial Equality and Accountability

The World Bank in Kagame’s Rwanda

Brexit and the Vengeance of Unintended Consequences

The Iraq War, Chilcot, and Cherry Picking Data: How to Find a Way Forward

Iraqi War: Civilian Deaths, March 2003-June 2006

Part Two: A Generation Earlier: austerity, deregulation, and privatization

The Reasons for the Rise in Childhood Mortality During the 1980s in Zambia

Health Reformer’s Response to Zambia’s Childhood Mortality

The Bitterest Pill of All: The Collapse of Africa’s Health Systems

Reassessment of Health Effects of the Indonesian Economic Crisis: Donors Versus the Data

Economic Crisis and Mortality

Part Three: Pandemics Ignored

The World Bank and Sub-Saharan Africa’s HIV/AIDS Crisis

The HIV Pandemic: Senegal

Pandemic: A Biography

The HIV/AIDS Crisis and the Right to Health

Part Four: Inequalities and Human Rights

Global Health and Local Poverty: Rich Countries’ Response to Vulnerable Populations

Health and Human Rights in Canada: A Global Concern

Indigenous Health and the Rise of Racism in Canada

Deracination: Canada’s Indigenous Suicides

Canada at 150: The Racialization of Healthcare

The Global Risk Report 2016: Who Listened?

The Measure of America: American Human Development Report 2008-2009

Inequalities in the American Healthcare System

Trump Versus Obamacare: 100 Days in

Explaining Trumpcare: The Appalling Appeal

Voice: The Importance of Diversity in Healthcare

Human Rights at the World Bank: Inside Out

Part Five: Finding a Way Forward

Global Health and Brexit: Choosing When Anxious

The British and Canadian Health Systems at 70 and 60

We Need to Prioritize Cyber Security in this Age of Global Risks

International Health to Global Health: How Africa’s HIV/AIDS Crisis Influenced the Rise of Global Health

Canada Needs a Global Health Strategy

Global Risks and Consilience: Mapping a Way Forward

What Can Senegal Teach the West about Dealing with Ebola?

An Overlooked WWI Legacy: Maternal and Child Health in Sub-Saharan Africa

CDC’S Word Ban: The Placement of Politics Over Science Is Part of a Larger Pattern

Brexit: Acknowledging Error

Trump and the Role of Data Driven Resistance in Global Health

Undoing the Undoing of Canada as a Global Health Citizen

Canada’s First Nations: The Social and Political Determinants of Health

Afterword

About The Author

Acknowledgements

The author wishes to acknowledge the input of Rebecca Visser, Mary Myketyn-Driscoll and Cameron Yetman in the preparation of this reader. Without the contributions of Ms. Myketyn-Driscoll over the past several months, or of Mr. Yetman whose editorial eye helped tighten both the style and structure of the text, it is uncertain whether this work would have seen the light of day. Any errors or omissions remain the responsibility of the author.

If they can get you asking the wrong questions, they don't have to worry about answers.

—Thomas Pynchon, Gravity's Rainbow

Preface

My teenage daughter caught her first glimpse into what Joe Biden called the soulless Mr. Putin in 2016. At the time she was in middle-school and graphic videos ¹ of Russian bombings of civilian targets in Aleppo inundated the media. She was also hearing horrifying stories from her classmate whose family had escaped Syria’s Bashar al-Assad’s regime but left relatives behind. I can see her now preparing the cover of the book in which we now find ourselves; she removes the eyes of Putin and Trump from her sketches, assesses the results, removes the entire face and then she draws them back in with a Staedtler 2B. I imagine she was trying to capture what wasn’t there by removing what was. All that was before January 6th, before Ukraine, before 18 million COVID-19 deaths and the shock at the unthinkable becoming the unimaginable. But let me stop before other conversations jostle in and set out my rationale for publishing this book.

I was raised in a household imbued with public health values, having what Paul Farmer called a good Catholic social justice vibe. I recall in 1957 a neighbor telling me she had seen my dad on CBC television the night before. He had been explaining what free hospital and physician care would mean for Nova Scotians. A dozen years later, I recall his return from Chicago (1969) where he had again been explaining the benefits of Medicare, this time at the invitation of the American Public Health Association in support of Edward Kennedy’s Medicare Bill. Although warmly welcomed by his hosts, his presentation on the finance and delivery of healthcare was rejected as socialized medicine.² He said at the time that the US Medicare Bill had no chance – they’re too selfish. The they I took to mean the American Medical Association, the hospital industry, pharma, insurance companies and the lobbyists and politicians who acted on their behalf. In retrospect, the they might have also been those who did not want to share with others with whom they could not identify.

In the end of course, the US retained its market-based model of healthcare and, through agents such as the World Bank and the IMF, imposed it and a slate of neoliberal policies on poor countries starting in the late 1970s. I spent most of the period 1985-2002 living in Latin America, Asia, and Africa, where I witnessed the suffering caused by the inequity of these policies. They conflicted with the basic values and aims of public health. In the 20 years since, my research has continued to focus on the impact of neoliberal policies on ordinary people, mainly in rich countries, especially Canada, the United States, and the United Kingdom.

These days as I wind up, time seems compressed. I note a desk photo of myself with my grandfather (b 1864) and another with my children (b 2001 and 2004). Together their lifespans will likely extend over two and a quarter centuries, from pre-Confederation Canada, before the end of US slavery and decades before the scramble for Africa, to our current world of environmental desecration, profound social and state instability, and forward to an unknown future.

This reader is dedicated to my parents, brothers and sisters and extended family. It is especially dedicated to my children, James and Samantha, my source. I also wish to acknowledge the counsel of many including Reginald H. Green³ (who witnessed much of Africa’s pestilence, war, famine, and death) and David E Bell⁴ (whose first boss ended a war by dropping the atomic bomb and whose second started another in Vietnam). What would they surmise of many of our leaders better known for their military and economic aggression and sowing distrust and discord than working towards the health of the planet and its inhabitants?

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1 https://www.theguardian.com/world/2016/sep/23/aleppo-residents-syria-russia-airstrikes

2 G. Graham Simms, A critical review of administrative and fiscal controls on cost and use in Canada from the perspective of provincial hospital authority, Medical Care, Volume 7, No. 6 Supplement, Dec 1969, pp 59-74

3 https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/4256

4 https://news.harvard.edu/gazette/story/2000/09/economist-david-bell-dies-at-81/

Introduction

As 2022 draws to an end, the world community finds itself exhausted by powerful, immanent, at-home, real-time, anxiety producing events – hyperinflation, the reversal of Roe v Wade, the invasion of Ukraine, COVID-19, the Ottawa truck convoy, extreme climate events, involuntary immigration, domestic terrorism, gun violence, racial and ethnic tensions, and endless culture wars. A subtext of this anxiety is a mounting public awareness of conspicuous inequalities, plummeting social cohesion, and of our failure to respond effectively to global risks, the climate crisis being the most worrisome.

World-wide levels of anxiety have risen exponentially since 2020. A survey undertaken for the American Psychological Association (APA) in March 2022¹, found that 87% of respondents acknowledged that it feels like there has been a constant stream of crises without a break over the last two years; 84% say the Russian invasion of Ukraine is terrifying to watch, and nearly 70% worry that it could lead to nuclear war or World War III. Of the nearly 1,000 scientists and world leaders who contributed to the Global Risk Report 2022, only 10% were optimistic about the future; they warned that since March 2020, the most important societal risks to emerge have been the erosion of social cohesion and widespread deterioration of mental health.

Research repeatedly shows that anxiety seriously hinders our decision-making capacity, such that the anxious mind seems exquisitely designed to make bad choices. These findings deserve our particular attention as many electors prepare to go to the polls in November 2022 and national leaders make momentous decisions both domestic and geopolitical.

In this reader I attempt to conceptualize our crises. Instead of the world community being challenged by a stream of crises (as referenced by the APA survey) I see us caught in a tangle of interconnected, multi-layered crises. The World Economic Forum (WEF) depicts this network of networks as a quasi-structured entity (see Figure 1) composed of social, economic, political, and environmental risks intertwining with one another spawning new crises of new types. In the absence of effective and timely responses and left to its own devices, the network seems to have a life of its own; it shifts and gravitates to where it will flourish unimpeded, along routes where inequalities are deepest and leadership is weakest – two factors I explore throughout this reader.²

To mark one million COVID-19 deaths, the New York Times evoked the image of a starling murmuration³ with a frontpage infographic, a conceptualization resembling how I imagine the spread of the HIV pandemic across Sub-Saharan Africa (SSA) beginning in the 1930s. However, in the villages of Tanzania, I saw the pandemic spreading in a wheel – or branching-like fashion. The small mission hospital in the Mbeya region where I was stationed sat adjacent to a truck-stop on the Malawi-Zambia highway. The hospital and its clinics pursued an aggressive HIV testing program; ELISA test⁴ results that came back positive were marked with an asterisk on map of our region. The mapped patterns of spread were consistent with those I describe in these paragraphs.

At the risk of alienating readers so early on, I have extracted three paragraphs from one of the articles in this reader, one which employs a fanciful device to described how I visualized the pandemic as it swept across Africa –

He imagines it meandering from Equatorial West Africa eastwards along the Trans-African Highway, along water and trade routes through Congo and Rwanda until reaching the Great Lakes region during Idi Amin’s war. Here, it erupts, spreading swiftly into East Africa as if it found its true home – Uganda, Kenya, Tanzania and then Zambia and southwards as nascent epidemics become ‘concentrated’ and then ‘generalized’ and countries tumble ….

And in the following paragraph I am addressing scientists’ repeated descriptions of the pandemic and virus as smart, opportunistic, clever, and sly. In fact, of course, neither the virus nor the pandemic are sentient; they do not have agency. However, they seem self-directed, as they seek out the path of least resistance that helps guide them to where they will thrive and avoid where they will not.

And he imagines the pandemic mimicking the very virus that flows inside, that is, its ability to invade and destroy the systems that are meant to protect. He imagines its tentacles reaching into communities, moving undetected past public and global health systems intended to safeguard at-risk populations, confounding, and disarming those very systems. First, use trial and error until you find prey that don’t matter, whose hard death will go ignored – those who live at the periphery, the social margins, far from the centers of power, out-groups. Go to where there is a tumult, a fray, a dust-up; where there is war, forced migration, sexual violence, to where the advantaged and disadvantaged have just met. Go to where power clusters and rests undistributed, where another agenda predominates. Look up into the eyes of the gatekeepers as you slip past for any signs of reproach. Go safely now; you will know your success by their responses – fear, anger, abhorrence, denial, stigmatization, and ostracism. These are useful, they will resonate, they have the ring of truth. Now trade on your strength, your omnipotence; you are invincible, you easily dissuade the dissuadable, the half-hearted, and even the final holdouts; you give them what they crave, an excuse for their docility.

In the following paragraph I am again referencing where I lived for several years, in the southern rural highlands of Tanzania, adjacent to the Kiwira truck-stop, a significant source HIV. I wanted to draw attention to the fractal or branching patterns I witnessed as HIV spread from one family compound to another, from one village to the next, the spread of the contagion almost mapping onto the network of pathways and lanes that connected these rural communities together.

A place of arresting beauty, with undulating rolling hills and valleys over which is cast a net of tiny roads and footpaths connecting one family compound with another, one village with the next; along the nodes and threads of this network, the Wanyakusa and Wasafwa peoples stop to greet in repetitive fashion as if to affirm and secure the ties that connect. At a distance it looks like an enchanted mathematical ‘fitness landscape’.

These descriptions are relevant since I visualize most of the crises I examine in this reader as mimicking the opportunistic, fractal branching spread of HIV including floods, fires, the spread of terrorism, tribalism, populism, and anti-immigration sentiments. These are typically enabled by weak leadership and deep inequalities.

Weak leadership and inequalities By weak leadership, I mean predatory, selfish, biased leadership, that which panders to its base, leadership which is uniformed and irrational. COVID-19 has shed new light on leadership and has allowed us to make international comparisons of the quality of leaders with some accuracy. It has also brought home the depth of social and economic inequalities that proliferate within and between countries. For example, the World Economic Forum’s Global Risk Report⁵ showing that COVID-19 vaccination rates in poorer countries were at 6% while in rich countries demand was satiated, reveals something about global inequalities as well as leadership. These inequalities are formed in part by a culture where meaning is private and acquisitive and turned inward towards self. Prime Minister Margaret Thatcher captured the essence of this hyper-individualism in the 1980s, declaring that There [is] no such thing as society. British Prime Minister Boris Johnson added clarity when he observed that some measure of inequality is essential for the spirit of envy … that is, like greed, a valuable spur to economic activity.⁶ The rise of authoritarian regimes is the most recent example of this greed-driven predation.

Fig. 1. Global Risk Interconnections.

Global Risk Interconnections are shown in this diagram from Global Risk Report 2022.

World Economic Forum, Global Risk Report 2020⁷ ; See Global Risk Report 2022 (after onset of COVID-19).

The values underlying these statements are in sharp contrast to the stated values of liberal democracies, global health and world citizenship, including equality, human rights, cooperation, and support for the common good. They are, however, consistent with much of the discourse associated with neoliberalism, the economic ideology that has shaped our world over the past 50 years. It emphasizes free-markets and small government, competition, individualism, deregulation, austerity measures and privatization. Since these policies favour the most powerful and influential sectors of society, they spread easily and quickly across the globe, eclipsing all other competing frameworks by the mid-1980s.

Neoliberal policies have increased global trade and technology transfer and lifted many out of poverty worldwide. However, they have greatly increased inequalities. In poor countries, policies such as austerity, deregulation and cost recovery had an immediate and detrimental impact on populations starting in the 1980s.

In rich countries, the negative effects were gradual, indirect, and largely hidden until the 2000s, when it became clear that for a large swath of less educated and working-class populations, real incomes had stagnated or declined while the wealthiest 10% grew wealthier and benefitted from increasingly lower taxes.⁸ Many jobs were lost to automation, outsourcing, and globalization. This led to anger, frustration, a sense of disenfranchisement, of being invisible which was compounded by a cultural backlash⁹ felt by many who perceived their traditional values being usurped by a host of self-expression values related to gender (LGBTQ), racial, religious, and cultural tolerance. Together, they contributed to the rise of populism and the fortunes of Trump.

An important drawback of neoliberalism is its short-termism; it does not take into account global risk and therefore nations are ill-prepared to cope when crisis hits. Examples described in this reader include the 2008 financial crisis, COVID-19, the election of Donald Trump, cyber-attacks, geopolitical fragility, and the climate crisis. Instead of planning for the long-term, markets opt for efficiency and unwisely accept the risks. For example, this short-sightedness led to Europe’s dependence on Russian oil. Joseph Stiglitz¹⁰ asked 15 years ago –

Does each country simply accept (security) risks as part of the price we face for a more efficient economy? Does Europe simply say that if Russia is the cheapest provider of gas, then we should buy from Russia regardless of the implications for its security …

Trump’s nationalism and isolationism, state interventions to fight COVID-19, and deglobalization have altered definitions of neoliberalism yet the essentials remain – the accumulation of wealth through free-markets and small governments.

This reader aims to increase our understanding of today’s multiple global crises, their genesis and evolution. It consists of articles drawn from publications that I produced over a two decades. About half of these have appeared in the Lancet or the BMJ in various forms but mainly as opinion pieces. Others are drawn from publications supported by NGOs such as Christian Aid, Action Aid, Save the Children while others have been published in the Guardian newspaper, Institute of Development Studies (UK), and journals such as the International Journal of Clinical Practice, the Canadian Medical Association Journal (CMAJ), Canadian Journal of Public Health, New England Journal of Medicine, and the American Psychologist.

It is divided into Five parts. The first, Global Crises: Where We Are Today, consists of articles representing a cross-section of crises facing the world community. They depict the consequences of policies driven by self-interest, weak and biased decision-making often leading to the abrogation of human rights and worsening of existing inequalities or creation of new ones.

Part Two, A Generation Earlier, examines the influence of neoliberal policies such as downsizing government, deregulation, and privatization on vulnerable populations, mainly in SSA in the 1980s and 1990s. It draws on my experiences of working and researching in Africa at a time when three realities converged: economic crisis and structural adjustment (that contributed to the collapse of health systems in many countries), the HIV/AIDS crisis and health sector reform.

Part Three, Pandemic Ignored: HIV and the World Bank, examines the HIV pandemic in SSA (1980s and 1990s), a crisis dramatically worsened by neoliberal policies. The World Bank became a particular target of my research in the 1990s since it was the lead donor in Africa’s health sector as well as in the fight against HIV. Its own internal documents show that it explicitly sought to prioritize health reform over the pandemic and that, even as infection rates soared in the 1990s, it failed to respond in any meaningful way. By the end of the decade, about 33 million Africans were dead or dying. These events seem to exemplify the exercise of raw power by the rich over the vulnerable. I investigate the parallels between COVID-19 and the HIV pandemic.

Parts Four and Five cover the period 2000 to 2022, in high-income countries. Part Four pursues and expands upon ideas introduced in previous sections – this time looking mainly at Canada, the US, and Britain. In particular, it explores the relationship between inequalities and human rights. It examines the influence of government policies on the rise of populist and nativist sentiments and their failure to confront the climate crisis. A persistent theme throughout is the apparent willingness of individuals, groups, and nations to act against their own best interests – often prompted by fear and anger.

Part Five, Finding a Way Forward, seeks to underscore lessons learned and to identify fresh approaches that we might take to address challenges. This section makes two foundational recommendations. First, it prescribes using a systems approach to tackle global risk, that is, using a holistic framework for understanding the dynamic interactions among complex economic, environmental and social systems.¹¹ Second, it recommends taking