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Why Programs Fail

Richard Levins (humaneco@hsph.harvard.edu) is a third generation subversive, an ex-farmer, ecologist, and veteran of the Puerto Rican independence movement, Science for the People, anti-war, Marxist education, and other good causes. He teaches Human Ecology at the Harvard School of Public Health and is an adjunct foreign researcher at the Cuban Institute of Ecology and Systematics. This article is based on a lecture to the South Asian Student Association at the Harvard School of Public Health, May 7, 2009.

Several generations of development programs have left the gap between rich and poor countries wider than ever. Decades of aid and foreign investment have extracted many times more wealth than they bring in. Seventeen years after the Earth Summit at Rio, carbon dioxide continues to increase. The non-proliferation treaty has left us with more nukes, more countries possessing nukes, more sophisticated nuclear weapons, more willingness to use them. The fanfare of the Green Revolution has died down, and farmers are still being displaced to cities that can’t accommodate them. The first homes of the Green Revolution are now importers of food. Agricultural yields have increased, but so has hunger. Millennial development goals will not be reached.

It is not that no programs work. There have been dramatic successes such as the eradication of smallpox, the near eradication of polio, the containment of plague. But meanwhile, new diseases have burst forth, old ones have returned, malaria, tuberculosis, and diarrheal disease remain the big killers in much of the world. The destruction of wetlands forces migratory birds to fraternize and share their viruses with domestic fowl. Industrialized agriculture has become the petri dish for antibiotic resistance, and big corporations are in a mad race to grab up the farmland of Africa. The Thames is now clean enough to allow salmon to return, but the Colorado River barely trickles to the sea. Forests are protected in Japan and Europe, but at the expense of forests of Indonesia and the Philippines. There are more urban clinics, but the megacity is a historically new environment, vulnerable to diseases too virulent to survive in small, sparse populations. We may get a fuel-efficient car, making it easier to commute longer distances, and if China achieves the automobile density of Euro-North America, the equivalent of one third of the area devoted to rice production will have to be paved over. Aquaculture moves into the niche left by declining oceanic fisheries, but the ensuing salinization threatens already stressed water tables. Increases in productivity, which could give us more tranquil lives, result in longer workweeks, faster pace, and industries designed to compensate for the stresses of multitasking and insecurity, while the pharmaceutical industry, which can’t wait for new diseases to emerge, invents them, turning any variation in human physiology or behavior into a market for its products.

Most of these problems are well known to you, reported in technical and popular journals and the more literate television and radio programs. The missing step is to put them all together, to focus on the system that makes all of our crises profitable.

There is a pattern of a sort: narrowly focused technical solutions reshuffle crises.

When one program after another fails again and again, and when the failures are not random but somehow always benefit the owning class, we have to ask, “How come?” When people, just as smart as we are, regularly design programs that fail to achieve their stated goals, what are they refusing to deal with?

There are several possible answers.

First, the problem cannot be solved. Abundance, justice, and sustainability are incompatible. This answer is a dead end, like special creation, and carries with it just a whiff of self-serving. If it is true that we are doomed, then what remains is to speculate as to what might be a successful successor species for us. But it is also commonly observed that those who see their own way of privilege threatened also see this as universal disaster.

Second, “we” are doing the right thing but have to try harder, with more investment, more aid, more free trade. In support of this is the observation that most international pledges of aid remain unfulfilled. But more important, the neglected places have fared better ecologically than where “development” programs have been most vigorously pursued, and economic recession seems to provide the only respite that capitalism grants to the forests and waters.

It is not that they (not “we”) want people to be without health care, but that they want accessible health care, subject to the constraint that it is controlled by a private insurance business whose primary goal is profit. It is not that they want to leave people without medicine, but that they want them to buy medications from a private, for-profit pharmaceutical industry. It is not that they want medical costs to rise, but that costs should be contained only to the extent that profit is not harmed. It is not that they deplore medical research, but that they want the fruits of intellectual labor registered as intellectual property, and prefer research that is at least potentially marketable.

The third type of explanation is systemic and operates on at least three levels: the political economy, the institutional organization of the knowledge industry, and the intellectual biases and constraints that can turn small-scale ingenuity into large-scale disaster.

Political economy: In a capitalist economy, goods and services are commodities. Commodities are produced for sale, to make profit. The important thing about commodity production for us is that there is no necessary relation between the usefulness of something and its economic value or profitability.

Agriculture is not about producing food but about profit. Food is a side effect. While the majority of the world’s farmers are subsistence farmers, the bulk of the world’s food is produced as commodities by a small fraction of farm operators.

Health service is a commodity, health a by-product.

Development is about investment opportunities and markets, not correcting decades of plunder and exploitation.

“We,” that is, “they,” are really trying to do something quite different from the goals stated at numerous conferences, and perhaps succeeding at it all too well.

We must consider institutional fragmentation and the enclosure of the intellectual commons. Medical schools are isolated from agricultural schools, usually the former in large cities and the latter in rural areas. Departmental barriers help freeze the false dichotomies that disrupt our understanding of the world: social/biological, physiological/psychological, genetic/environmental, quantitative/qualitative, individual/social, random/deterministic, whereas the new creative approaches should be sought in their zones of interpenetration. Then the rules for recognition, academic promotion, standards for funding under discrete “programs,” time limits for degrees, definitions of the domains of journals, all conspire to reinforce the boundaries between fragments. The hierarchical arrangement of the disciplines promotes the reductionism that satisfies the economic needs of the corporations. A clarification is needed here: there is nothing wrong with reduction as a research tactic, the search for the internal parts of something, its smallest units. What is wrong is reductionism, the illusions that the smallest parts are in some way more fundamental, that once we know what something is made of, we understand it, that oxidation is more real than exploitation.

Knowledge is the product of a knowledge industry that is owned. Its owners establish the boundaries of the legitimate, determine the rules for who is recruited, who is excluded, the research agenda, the domain of acceptable theories, and provide the vocabulary for dismissing inconvenient ideas as “far out,” “not mainstream,” “unproven,” “ideological,” or other indications of taboo. They create the art of administration: the inventing of excuses to justify decisions taken for other reasons, and the conviction that this is being practical, realistic, etc.

Science prides itself on self-correcting mechanisms to catch error, which is supposed to create objectivity even when individuals may be fallible. We have become quite sophisticated about preventing idiosyncratic errors. We now know that we should wash our glassware, that experiments need controls for comparison, that the experimenters’ expectations can influence the outcome of an experiment, and so we have invented blind and double-blind designs. Work might be repeated in another lab. Peer review can protect journals from careless mistakes. We can filter out random results by statistical tests, and we never, never divide by zero. These procedures work fairly well. But they are completely useless against the shared biases of the whole scientific community, the assumptions and constraints that have become part of the common sense of our colleagues, our teachers, our funders.

The intellectual structure of our programs is still caught in the philosophy of seventeenth century reductionism that grew up with capitalism in Euro-North America.

Science is always flawed, all theories are limited and each has a finite life span before being replaced by a better theory. Science boasts of being self-correcting.

But the correction of the inevitable errors, an essential part of the development of knowledge, is prevented or retarded by generic conflict of interest. In recent years, the professional journals and universities have recognized generic conflict of interest: situations in which researchers have economic stakes in the outcomes of their research that influences their reports and determine what to include and what to withhold. Scientists might be shareholders in corporations whose products they defend, or receive fees for testimony in court against claims that a chemical or physical exposure is harmful, or win grants for sponsored research, or they may be courted with invitations to lecture in delightful places and paid with generous honoraria, or they may prescribe treatment at their own private clinics.

Disclosure statements detailing possible conflict of interest have become part of the effort to protect the intellectual integrity of science and scholarship. They encourage our skepticism about claimed benefits of patented drugs. This may be working more or less well. But it does not touch on generic conflict of interest, the coziness and overlapping outlooks among corporations, government and international agencies, universities, major foundations, honorary societies, think tanks, and prestigious journals that has created a kind of Nomenclatura,generic conflict of interesta kind of informal Social Register. This is the pool of people who consult each other, review each others’ grants, allocate awards, invite each other to give prestigious lectures, give each other jobs and prizes, set the intellectual agendas, teach each other when to raise eyebrows, and generally show mutual appreciation while guarding the boundaries of the respectable.

Professors are increasingly obliged to “mobilize resources”—jargon for raising money. The money can be raised from government agencies, corporations, foundations, NGOs, and private individuals. Among the government agencies for public health and policy professionals, the “Defense” Department, the National Institutes of Health, the Agency for International Development are especially prominent. Among international agencies, the World Bank is preeminent for any development studies. Therefore, the “quality” of proposals is determined by donors. And for corporations, not all knowledge is equally convertible into commodities. Thus the quest for culpable genes is more fundable than the study of the industrial origins of cancer, the invention of new pesticides more fundable than studying the protective effects of mixed plantings, finding ways to supplement the nutrition of peasants on thirteen cents a day is more legitimate than helping them organize for land reform. Studying the financing of “public-private partnership” is more popular than examining how universal free health care could work. And, for those who are uncomfortable with the obvious and deliberate blindness of the organs of “progress,” there are articulate scholars working at the outer, most humane, fringes of respectability who catalog the faults and petty idiocies of the system but reject fundamental questioning of the grand idiocy of investing our hopes in more rational greed.

But if the funding is constrained, so is support for students and their potential employment. Therefore, students are trained in the reductionist tradition and encouraged to focus narrowly, especially since any detours toward greater breadth take time, and you hear those student loans ticking away. The available courses are in the fields of the professors, the more expensive kinds of research are subcontracts of the major professors’ grants, preparing students for similar kinds of research. And there is always the possibility of a job in one or another organ of the network.

There is nothing underhanded about any of this. Within this world, they may sincerely like and admire each other. It was “natural,” some years ago, for the American Academy of Arts and Sciences to establish a membership section for “business” but not for labor. It is not necessary to be a grantee or a shareholder in a company to know that you are potentially a consultant or guest. C. Wright Mills described the workings of this Nomenclatura in generic conflict of interest. Each separate act makes sense within a shared common sense; it is practical, “proven,” etc. Of course universities need donors. Of course students have to be prepared for the kinds of jobs they might get. Of course bankers are experts in finance, and generals are the knowledgeable guests to invite as commentators on matters of war. When the sum of all the rationalities is irrational, the whole system has to be examined.

Generic conflict of interest creates a great dilemma for students and faculty who want to face fully and broadly the problems confronting our species. We have to navigate in a terrain of a mixture of conflict and cooperation with our institutions and colleagues. We may share an excitement about the evolution of the virulence of bacteria or the interactions of pollutants in complex mixtures, or how traditional knowledge can be integrated with scientific knowledge. But we balk at collaboration with colonialist institutions such as the World Bank or terrorist agencies such as USAID.

And we have to find ways of promoting a more holistic, complex, integral approach to scientific problems. In so doing, we can follow a series of dialectical clues:

The truth is the whole. A problem has to be posed large enough to fit a meaningful solution. No matter how small the problem you work on, always ask, “Where is the rest of the world?” even within courses with restricted vision.

Things are more connected than they seem, even across disciplinary boundaries. Parts determine wholes, but wholes also determine parts.

Things are snapshots of processes when a temporary balance of opposing forces creates a transient stability for long enough to warrant a name.

Things are the way they are because they got that way, have not always been that way everywhere, need not be that way. Always ask, “Why are things the way they are instead of a little bit different?” And “Why are things the way they are instead of very different?”

Apply all these tools also to ourselves and our own fields of work. That way, we can cope with the dual nature of science: on the one hand, the millennial unfolding of human knowledge, and on the other, the property of a knowledge industry that creates the paradox of a growing rationality in the small, at the level of the laboratory, and a growing irrationality at the level of the enterprise as a whole.

In order to work toward that combination of understanding and humane commitment, of cooperation and challenge, we couldn’t do better than follow the advice of my grandmother when she sent me off to start first grade: study hard, learn all they can teach you, and don’t believe everything they say.

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