Are calls to action global health nonsense?

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Leah Richardson is a Senior Technical Associate at Emergency Nutrition Network (ENN)

Tanya Khara is a Technical Director at ENN

ENN’s mission for 2023 should be nonsense-busting – thus began our internal email thread as we shared Stein and colleagues’ recent feature in The British Medical Journal (2022). Their declaration that “Global health nonsense must be called out, because it stifles collective efforts to understand, critically assess, and improve global health governance” both resonated with us and challenged us to look inwardly. Stein and colleagues state that meaningless buzzwords and technocratic jargon have proliferated, “leading to obfuscation, misrepresentation and omission of relevant information”. They note that we are all complicit in using terms that tend to be pointless or unnecessary. There are terms that reinforce existing power hierarchies, terms that muddle reality and terms that leave you wondering what is actually being said – see Box 1 for some of our favourites. They suggest that, by using them, we disguise reality and prevent informed action for global health equity.

Box 1: Jargon that drives some of us mad at ENN

Nexus	This feels like a very complicated way of saying something simple. And where is the limit? We went from ‘nexus’ to ‘triple nexus’ to ‘quadruple nexus’…
Transformation	A word that can probably only be used retrospectively and with evidence to back it up. Highly aspirational – and what is actually supposed to happen?
Nutrition-sensitive	A term that makes no sense to anyone in the non-nutrition space. Sensitive to whom or what? And why do we need to subdivide efforts to create a healthier and better-nourished world?
Shift the narrative	Pretty intangible. Don’t we all have our own story to tell? It implies that we should value varying viewpoints differently, rather than embracing all different perspectives and focusing on finding common ground.
Call to action	This requires that time and effort is spent on talking instead of doing; often vague, based on values of how things should be, without detailing how we can do better.
Localisation	This implies that a superior, global power will make something happen ‘locally’; it is a top-down approach, often with limited meaning and action, that continues the ‘we’ and ‘them’ divide.
Scale up	Often used flippantly, presented as something that will just happen and is simple, without considering what is involved. Also usually seen as a scale-up in numbers, promoting the idea that more is better.
Maximising accountability	This implies that sometimes you do not actually have to take full responsibility – that there are gradations of accountability that can be turned up and down like a dial.
Increase the efficiency	The definition of ‘efficiency’ is “achieving maximum productivity with minimum wasted effort or expense” (Oxford Languages). How can you increase that?

In the same issue of the journal, a wry editorial by Ryan Essex (2022) about potential ‘slacktivism’¹ in a call to action made us reflect on whether, at ENN, we are contributing to improving global health governance or creating more global health nonsense.

We thought of our recent role in facilitating the development of the Wasting Reset: A Call to Action (2021), where ENN facilitated 50 governments and organisations to come together to discuss and reach consensus on the actions required to accelerate progress in six areas related to the prevention, early detection and treatment of wasting (advocacy; financing; prevention; treatment scale-up; nutrition products for tackling wasting; and policies and guidelines) in order to achieve global targets. The process aimed to align with, and build upon, the priorities identified through existing global initiatives such as the Global Action Plan for Child Wasting.² Eleven recommendations were prioritised and formed the basis of a high-level round table consisting of several ministers/representatives from low- and middle-income countries, United Nations directors and donors tasked with turning these agreed recommendations into successful actions and commitments. A consolidated Call to Action was developed³ as a result, which was launched at Nutrition for Growth in 2021.

Achieving a succinct list of actions as agreed priorities for achieving progress – and bringing these to the agenda at global level – seemed like an achievement, especially considering how many actors are involved in different elements of wasting treatment and prevention. However, the question we (and surely all those who were involved) have been asking ourselves is: “What next?” Behind the Call to Action itself were more detailed action plans, which were collectively developed for each of the six areas with an attempt to identify who was responsible for action in each area. Who is implementing these plans?

These questions sit rather uncomfortably with Essex’s assertion that a call to action “has several obvious advantages over actually acting. Making that call allows you to salve your conscience, to ‘do something’ without the hard work of actually doing something”. By facilitating this Call to Action, have we at ENN been complicit in Stein and colleagues’ claim that technocratic global health nonsense prevents informed action?

From our experience with the Wasting Reset process, we have seen the value of coming together so that diverse actors, voices and perspectives can be heard or discussed. We feel that there are some positive aspects of a call to action, and that these are as much about the process as they are about the actual output. Collaboration fosters compromise, and compromise was indeed needed when working groups were required to strictly prioritise actions in their areas of focus. An inclusive process, if it can be facilitated to reach consensus on the required actions, can prevent different agendas and messages competing on the global stage: they can be a tool to lift an issue up the global health agenda and give it a profile it did not have before. If there is a need to find harmony in diverse perspectives to rally around a common cause, we feel a call to action is not just “global health nonsense” and that it has an intrinsic value in itself.

As Essex states, “What is unknown of course, is what follows the call to action.” It is hard for us to say whether the Wasting Reset did raise the profile of the issue on the global agenda. Did we actually achieve anything? There remains no agreed ownership over the detailed action plans, although various actors and initiatives were undoubtedly already working on components before the Call to Action was issued and are continuing to make progress. Although our intention was to accelerate that progress through the Call to Action, it paid no attention to how these plans would be taken further. Little more than a year after the Wasting Reset Call to Action was made, there has been a perceived need by UN agencies to release another call to action on the same topic, which does seem to call its utility into question. Interestingly, an operational non-governmental organisation got in touch with us very recently saying they had just come across the Wasting Reset Call to Action, that they felt it aligned well with their agenda and that they wanted to know the next steps to put those agreed actions into practice – a reminder to us and, we hope, to all those involved that a call to action needs to be followed by action. As Ryan Essex states: “Calls to action are arguably most problematic when they divert well-meaning people away from acting, and care should be taken to mitigate this risk.” Would the ultimate nonsense-busting be to make our Call to Action redundant by the success of our collective action? We think so.

References

Emergency Nutrition Network (2021) Wasting reset – Call to action. https://www.ennonline.net/wasting-reset-fss-n4g

Essex R (2022) A call to action. The British Medical Journal, 379, e072288. https://www.bmj.com/content/379/bmj-2022-072288.long

Stein F, Storeng K & de Bengy Puyvallée A (2022) Global health nonsense. The British Medical Journal, 379, o2932. https://www.bmj.com/content/379/bmj.o2932