In global health, some from the northern hemisphere are lucky enough to escape the peak of winter by joining a special gathering in Bangkok. The Prince Mahidol Award Conference, affectionately called “PMAC,” is hosted annually at the end of January by the Royal Thai Government in Bangkok. It’s invitation-only, with invites highly coveted but hard to come by, although the public is welcome to submit abstracts. No conference is perfect, but I want to comment on how PMAC is possibly my favorite global health conference.
The four seasons of global health
At the beginning of each year, workplans are reset. The annual cycle of policy outreach begins in four seasons. The global health community, in some sense, kicks off the new year with PMAC.
Come spring, the World Bank/IMF Spring Meetings buzz in Washington, D.C. in early April, followed by official G7 meetings and the World Health Assembly held in Geneva each May.
Summer rolls around with the G20 meetings in July and August.
In the fall, the UN General Assembly in New York bustles at the end of September, followed by the World Bank Annual Meetings and, more recently, the World Health Summit in Berlin in October.
Don’t forget to sprinkle in the board meetings of various organizations including Gavi and the Global Fund, and of course the World Health Organization.
And thus the annual cycle and seasons of global health go round.
The bigger the group, the harder it is
This list is not exhaustive. I’ve probably offended those whose events are missing, but it’s arguably impossible to be comprehensive of all possible convenings in global health. The United Nations (UN) gathering of 190+ member countries is arguably the policy forum of last resort because its size guarantees compromise. Newer fora such as G7+, G20+, or the BRICS+, bring together some coalition of the willing around bolder and more innovative ideas.
The problem of size is not only true of the UN. Let me regurgitate Mancur Olson in noting that the bigger the group, the harder to have a conversation, let alone make any meaningful decisions. Dialogue and group decision-making are easier and less compromising with the (G)7 or 20 people than with 190 people.
Multiply the number of countries participating by however many sectors, e.g., the 20 Sustainable Development Goals, and the fragmentation becomes an unenviable, if not inviable, mess. Is it any surprise that as the development community “grows,” fragmentation also grows?
Fragmentation happens on many dimensions
Fragmentation is not only in the number of countries (190 vs 20 countries) or sectors (e.g., finance vs health), but also by communities of practice (e.g., government, civil society, academia, or private sector) as well as sub-sectors, which are particularly rife in health.
If you drill down to separate sub-sectors in health, you’ll uncover the fragmentation that comes not only with sub-sector but also separate streams of government funding, interest, and advocacy groups, and ways of thinking about the world: universal health coverage (or health systems or primary health care), health security (or pandemics or resilience), nutrition, maternal and child health, and of course HIV, TB, and malaria, etc.
While health is technically in everything, when zooming out to development writ large, health is arguably at the margins of the climate community, the humanitarian sphere, water, agriculture, social protection, etc. It’s easy to hide in one’s siloed community—and so hard to reach out to a new community of practice, however defined.
Meanwhile, bilateral governments seeking to demonstrate “global leadership” have to squeeze an event into this packed schedule. Take, for example, the South Koreans, who hosted the First World Health City Forum at the end of November. The conference was a laudable attempt to bring three siloed sectors—health, climate, and city planning—that don’t normally talk to each other.
What’s worse is that the fragmentation of convenings perpetuates the existing inequality of who has the resources to attend multiple meetings, as my colleague Jubilee Ahazie commented. The end result, as my colleagues Rachael Calleja and others insightfully noted, is the lack of a shared space for meaningful dialogue.
How PMAC works through these problems
Enter PMAC each January. PMAC is highly curated by a broad planning committee. While PMAC is mostly the health community, it has made concerted effort to reach out beyond health, to climate and foreign affairs (this year’s theme was geopolitics and decolonization).
PMAC limits participation by invitation only, thereby potentially improving the quality of conversation. PMAC also makes a concerted effort to bridge the intergenerational divide between the senior and junior professionals, not to mention organizational, regional, ethnic, and gender diversity.
Annual themes are chosen to meet a particular moment or zeitgeist. Discussions are not in the rigid academic presentation format but are candid and lively conversations among policymakers, civil society, and academics.
One of many highlights is the PMAC field trips, grounding the pie-in-the-sky policy discussions, so common in Washington or Geneva. Can you imagine a policy conference held in Washington with “local field trips”? The Thais have credibility and trust by those in the “Global South” that comes from humility. There is inevitable and necessary suspicion about the colonial air of someone from a rich country telling a poor country what to do, when the same rich country lacks an ability to examine its own problems. What more need be said about the gatherings held in Washington and Geneva itself?
In this regard, it is refreshing that PMAC is held outside the usual high-income venues to discuss global health policy. It is not yet the norm that “global” discussions about “global health and development” happen in a developing country, but perhaps it should be (putting aside the activities of the regional entities such as ASEAN, African Union, and so on). Why must Washington or Geneva be the center of the universe when it comes to any “global” discussion?
Some other perks: There’s the pomp and circumstance of impeccable Royal Thai hosts and its national prestige, on top of superb Thai hospitality. Importantly, PMAC is not your typical sterile policy conference. Right outside conference discussions are stalls to expose conference attendees to different aspects of Thai culture (this year it was traditional Thai medicine including Thai massage and Thai’s health promotion efforts). (Somehow, the Thais are managing to preserve traditional culture, juxtaposing indigenous knowledge amidst rapid economic development and massive urbanization.)
Heated debates are a good thing
I haven’t written much about the actual discussions of PMAC 2024, partly because it’s hard to summarize a rich week of discussions into a single blog and also because I’m still processing what was discussed.
There were some heated debates and even some tense or awkward conversations about geopolitics and decolonization. But on whole, PMAC represents an important global health forum that does not regularly happen in the open.
The only way to have these awkward conversations is to have them, even if we vehemently disagree. Indeed, the merits of each side’s arguments become apparent in a debate. If we lose the two-way conversation and default to one-way lectures, we will have lost the essence of true dialogue.
What’s a researcher doing thinking about physical policy spaces?
You may also ask: Why am I, a health economist and researcher, thinking about policy cycles and physical spaces for dialogue? I should first acknowledge my biases: I sit in a think tank based in Washington, D.C., funded by philanthropy, known for criticizing development policies of high-income countries but also for spearheading new ideas to action.
As the story goes (regaled to me by Michael Clemens), founding president Nancy Birdsall established CGD as a place to bridge the gap between policy and evidence, not just in a physical space, but specifically in a given person. That is, an academic should be versed in policy, and a policymaker should be versed in rigor and evidence.
It’s hard to bridge both worlds, and there is nobody who can perfectly straddle both. But here I am, a lifelong learner of both policy and evidence, sharing what (little) I’ve learned while attempting to traverse both evidence and policy worlds.
To imperfectly quote Michael Clemens again, such adventures have the real risk of becoming an outsider in both communities, but we have to try. My big thanks to PMAC and all those conferences that try to bridge disparate communities together for dialogue.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.
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