Morning Lecture Recaps

Nick Glunt | Staff Writer

Theodore Olson, former U.S. solicitor general, answered questions from John Q. Barrett, professor of law at St. John’s University and frequent Chautauqua speaker, on stage Thursday. Olson addressed a variety of topics, including his personal experiences with the Supreme Court, the 9/11 attacks and California’s Proposition 8.

Olson was the fourth speaker in Week Two’s topic, “Applied Ethics: Government and the Search for the Common Good.”

“There are a lot of things that one could shoehorn into ‘the common good,’” Barrett said, “but among the things we have in common is our system of law. … It creates our society. And that rule of law is in the hands of each of us, but particularly in the hands of our legal profession.”

Interpreting the Constitution

Barrett brought up the topic of constitutionality being “fixed,” as opposed to the Founding Fathers giving Americans the Constitution as a tool to work in whatever situation is required of it.

“I think that the idea that there’s one way to interpret the Constitution and that solves all your problems is just silly,” Olson said. “I also believe that the Constitution needs to be something that people attempt to interpret the way it was intended to be interpreted and to instill in our society the values that the people that passed that Constitution believed in and what they enacted.”

The problem, Olson said, lies in phrases like “due process,” “reasonable searches and seizures” and “cruel and unusual punishment.” The application of those phrases is the Supreme Court justices’ choice to make, Olson said.

In the situation of reasonable searches, the advancement in technology complicates the definition. With telephones and Internet, invasions of privacy are made more possible and therefore less understood in terms of constitutionality, Olson said.

Judges, he said, must interpret the Constitution in a way that makes sense in the context of today.

Personal experience

Olson outlined his path to practicing law, including his participation in a college debate team, his appointment to the Office of Legal Counsel under Ronald Reagan and being targeted in the Watergate investigation — after which it was discovered he was not involved.

Olson’s experience in law has given him the opportunity to represent causes and people he’s both supported and opposed.

Among his most high-profile cases, Olson represented George W. Bush in 2000’s Bush v. Gore and worked on a lawsuit against Proposition 8, a state Constitutional amendment that banned gay marriage in California.

Though he identifies himself as Republican, Olson said he doesn’t let that party line stand in his way of following the common good. As a lawyer, he said, he always has the choice to turn down cases. That doesn’t always mean he does.

Specifically, Olson is very supportive of gay marriage, despite his Republican Party affiliations. He teared up on stage, commenting on how the topic always gets him emotional.

“When you look into the eyes of the people who are affected (by Proposition 8),” Olson said, “you have to be emotional about it. (NPR’s) Nina Totenberg asked me in an interview, ‘You get emotional when you talk about this, don’t you?’ and I said, ‘What kind of person would I be if I didn’t?’”

In that way, he said, party ideologies are less important than personal beliefs.

Olson’s view of the common good is also affected by his wife’s death. His wife, Barbara Olson, was a passenger on American Airlines Flight 77, the hijacked plane that crashed into the Pentagon on 9/11.

“I felt at the time that it was important for me to appear on various television shows and to talk about Barbara, to talk about terrorism and to talk about process,” he said, “because Barbara was a public figure.”

Because Barbara was an author, Olson said, her face was one of the first to be revealed as a victim of 9/11. He saw himself and his wife as personifying Americans that day. He was able to help people cope because he, too, had faced pain that day.

The common good

Olson said he is very hopeful about the nation’s pursuit of the common good. The U.S. has survived world wars, terrorism, slavery and discrimination, he said. He’s certain it can survive the problems the U.S. is facing now.

“I’m pretty optimistic. I think it’s important to be optimistic,” he said. “I think that, by and large, I have a lot of faith in the people of this country.”

Q: I will start by asking you if there are some issues that you hope will drift your way in terms of arguments that you’d like to make.

A: Well, I like that; I’ve been very blessed because I’ve had challenging legal questions come to me that I get to argue in federal appeals courts or, in many times, in the Supreme Court. It’s a thrill for a lawyer to be in the Supreme Court; it’s a thrill for anyone to have the opportunity to deal with these things, and I don’t have a checklist. I have some cases that I hope the Supreme Court will take, and so we want those to be heard, but if there are difficult legal problems that present constitutional challenges where it’s really going to be a contest in the Supreme Court, I’d love to do it. Now, I love cases involving individual liberties — freedom of speech and freedom of the press and things like that — but I’ll take pretty much anything if it’s really an interesting case, and it doesn’t involve certain things that I wouldn’t want anything to do with. But I argued, for example, I’ve argued on the decision that the President of the United States really doesn’t like the Citizens United; that has to do with whether corporations can express their views with respect to people running for office. I argued that case and won it, but five years before, I argued the opposite side of the case on behalf of the government, and we won and upheld the federal election laws, so I’ve sort of been on both sides of these issues, and it’s really fun to have the chance to be in the arena.

Q: We have some questions about your opinions on recent Supreme Court rulings. I think you just mentioned Citizens United, but what about the Wal-Mart legislation?

A: I have to disclose a bias; my law firm represents Wal-Mart. I was on the brief; I helped my partner win that case, I think, and I’ve debated about it a little bit. I was over in Europe when the decision came down, and several people that were on the biking group with me thought that it was a terrible decision because the class of plaintiffs lost, and the big corporation won. But really it involved, and part of the case was a nine-to-zero decision on the meaning of certain provisions of the federal rules of civil procedure about when class actions can be brought, and when a class is just too big and too unmanageable and doesn’t have enough in common. I think the Supreme Court, again having disclosed my bias, got it absolutely right that this was a class of a million and a half people that included people that alleged to have been discriminated against and people that had not been discriminated against, people that had been promoted, people that were supervisors, people that had made the employment decisions because of the way the company was structured. But the real issue is: How do you handle class actions where individuals are not representing their case, but they’re representing someone else’s case, and they’re representing people that won’t be heard but will be affected, sometimes adversely, by a decision, and how far do we go with that kind of representative litigation? So I think it was the right decision.

Q: There are about three questions that I’ve seen so far about the connection between the 14th Amendment and the current budget crisis and asking for your comments about that.

A: I’m not sure what the questions relate to. I think the things that we’ve been hearing about, with respect to Obamacare, the health care issues, have to do with the commerce clause, and when how far can the government go with respect to imposing requirements that you buy insurance or pay a fine — that’s sort of a commerce clause issue. The budget crisis and the 14th Amendment, I’m not sure I have an opinion about because I’m not sure precisely what the issue is.
Barrett: I think what it’s asking about is a Section 4 argument, this public; I have my pocket Constitution —
Olson: He’s been waiting for the chance to drag that out. I thought you were going to nail me after the questions.Barrett: The only reason he didn’t bring his is because he knew I was carrying it for both of us. But there’s an argument that’s percolating about Section 4 of the 14th Amendment that’s the validity of the public debt shall not be questioned. In other words, that a debt ceiling might be unconstitutional pursuant to that declarative phrase.
Olson: You know, I haven’t studied that. I don’t know the answer to that question. This is maybe the next case. Whoever really cares about that and can afford to…

Q: Justice Jackson was a graduate of Albany Law School, asserts this questioner. Is it healthy that all the present Supreme Court justices went to Yale or Harvard?

A: That’s a really good point. There’s six, I think, Harvard and three Yale. There’s three from Princeton; there are six Catholics, not one Protestant on the Supreme Court, so we have diversity on the Supreme Court in some respects, and we don’t have diversity. There’s mostly people from the East. The ones that came from California, Justice Kennedy and Justice Breyer, actually both went to Harvard, so they all come out of the same system. There’s 36 clerks, four per justice, and virtually all of them went to Ivy League schools, maybe a couple from Chicago, a couple from Stanford, and they all clerked for the same federal circuit court judges before they went to the Supreme Court. And I’ve actually kidded justices on the Supreme Court and said, “Don’t tell me about diversity, you know, if you didn’t go to Harvard or Yale, you’re not on the Supreme Court. You’re all thinking the same,” and then they come back with, “Well, did you read that last five-to-four decision?” I think it’s an interesting question, but I don’t know where we come out on that. I will say, especially because John’s involved in this, that Justice Jackson ought to be an example for every Supreme Court justice.

Q: There are a couple of people in the audience who want to know about your partnership with David Boies and what your current relationship is with him.

A: David Boies is one of the outstanding lawyers in the United States. If you ever watch him cross-examine a witness, you’ll say, “There’s no question about who’s the best lawyer in the world.” He’s fascinating to watch; he’s wonderful to work with. When I was approached about the Proposition 8 case, I decided that it would be unhealthy if it was just about me. So what I wanted to do, and I don’t mean that it was all going to be about me, but I didn’t want our issues to get distracted by the fact that I was a Bush v. Gore guy, so I said, “We need to get a prominent, highly respected lawyer who’s been in the Supreme Court who’s identified with the other part of the political spectrum, and I thought, “What a great idea it would be if I could talk David Boies into this,” and I called him up on the phone, and everybody that was involved in the case said, “That’d be fantastic. Do you think he would do it?” and I said, “Let’s ask him,” and I called him up, and I didn’t even get the question out before he said “yes.” So, what that has allowed us to do is go to the American people and say it’s not a conservative or liberal issue; it’s not Republicans or Democrats; it’s not even gay lawyers representing gay people. It is a matter of constitutional imperative, of human rights, American rights, liberty and freedom, and then people want to put us on camera to ask us questions about what it’s like to work together, and it gives us an opportunity to talk about the issues and the people we represent because we know, we can win this case in court, but if we don’t win it also in the court of public opinion, we won’t have achieved our aims. But if at the end of the day, we win this case in court and the American people said, “Of course, that’s the right outcome,” then we will have succeeded. So, I’ll say one more thing; David Boies is an absolute delight to work with, and we’re co-chairing a task force for the ABA that is trying to publicize the plight of our judicial systems in the United States that are being affected by budget cuts, which means poor people don’t have access to the courts. But we’re also on the opposite side of this football case. We went biking in Croatia two weeks ago. Our wives are great friends and colleagues; he’s a wonderful person to work with, and the teamwork has been spectacular.

—Transcribed by Emma Morehart

Nick Glunt | Staff Writer

David Gergen, Wednesday’s morning lecturer, told a short story about Benjamin Franklin to illustrate his point that it’s up to Americans to decide the future.

As Franklin was leaving Independence Hall in Philadelphia, where the founding fathers wrote the Declaration of Independence and the Constitution, a woman approached him. She pointed to a chair, which was painted with a half-sun on the horizon.

“Is that a rising or a setting sun?” she asked.

“Madam, that will be up to all of us,” Franklin said.

Gergen presented his speech at 10:45 a.m. Wednesday in the Amphitheater. He was the third speaker in Week Two’s topic on “Applied Ethics: Government and the Search for the Common Good.”

Gergen, director of the Center for Public Leadership and professor at Harvard Kennedy School, has served as a political consultant and presidential adviser for four U.S. presidents. He also is editor-at-large for U.S. News and World Report and a senior political analyst for CNN.

‘The greatest generation’

Throughout his speech, Gergen made references to the “World War II generation,” which he said should be a model for the most recent generation if it hopes to keep America at the roundtable for worldwide politics.

“As a society of only three million people fighting for independence on these shores,” Gergen said of Revolutionary War-era America, “we produced six world-class leaders: Washington, Franklin, Adams, Jefferson, Hamilton, Madison. Today, with over 300 million people, we struggle to find and to create world-class leaders.”

He made similar references to John Quincy Adams, Abraham Lincoln, Joshua Chamberlain, Oliver Wendell Holmes Jr. and Franklin D. Roosevelt.

In addition, he mentioned the seven “World War II presidents”: John F. Kennedy, Lyndon B. Johnson, Richard Nixon, Gerald Ford, Jimmy Carter, Ronald Reagan and George H. W. Bush.

“Seven presidents in a row who drank from that cup,” Gergen said, “and learned to sacrifice (and to work for the common good) when they were young. And as a result of that, (they) came back when they were older and continued to work for the common good.”

When he arrived in Washington, D.C., in the 1970s, he found people who were strong Democrats and strong Republicans. However, Gergen said all those people were strong Americans first. They were working together to come to future that benefited everybody, he said.

‘Sex, drugs and rock ‘n’ roll’

Gergen said the generation of people who were born in, rather than raised in, the midst of World War II — his own generation — was the beginning of the demise of American power.

Though that generation brought about the civil rights movement, women’s movement and the beginning of the green and consumer movements, he said the generation was also split in half by those very same movements.

He made a distinction between the majority of that generation and those who attended universities like Yale, Harvard, Stanford or Northwestern.

“One group of people came out with the old-fashioned traditional values,” Gergen said. “The rest of us came out with sex, drugs and rock ‘n’ roll.”

He said the gap between those groups has never healed; there’s still political “polarization” and “paralysis” in that generation. Results of this gap, he said, are things like America’s economic and political decline, rising levels of mediocrity and sinking graduation rates.

He said he hopes the generation will “grow up,” but that good news lies in the newest generation.

‘The next greatest generation’

Gergen said the newest generation should emulate their grandparents’ generation — the World War II generation.

“These millennials, people in college and a little older than that, aren’t perfect,” Gergen said. “Too many of them, as my son Christopher points out, have a sense of entitlement. There are a lot of (millennials) out there who are slackers: They spend too much time on Facebook and on the iPod and not enough time getting ready for the future. But there’s a growing core at the center of this generation that is terrific.”

He said he’s seen two main groups of students in his classrooms that “knock his socks off.” First are the social entrepreneurs; young people who apply entrepreneurial principles to effect social change. Second are the young soldiers returning from overseas. These veterans, he said, have realized their patriotism and want to make a country in which they are proud to live.

Millennials, he said, have the potential to bring the U.S. back to the way it used to be.

“Now, in another time of peril for our country,” Gergen said, “we need more men and women to step forward, ready to take responsibility, ready to lead in difficult, changing times.”

Q: How do we prepare future generations to serve and lead without war?

A: First of all, that’s a very good question. But clearly, my argument in part is that we’ve had these wars now that have dragged on for 10 years. And they’ve cost us a pile of money. And they were much more expensive, and we shed much more blood than we ever should have, and one war in particular, the Iraq War, seemed to be particularly misguided in the way we executed it. I think we can all agree on that. But one of the silver linings — and we should not forget this — one of the silver linings is that it has molded and shaped the character and spirit of a lot of young men and women who’ve served, and that is a blessing for the country. So there are a lot of negative things about this, but we need to honor and respect and appreciate how much they can now do for us as they come back. Having now said that, how do we go forward? I think the president is on the right track and trying to wind these wars down as quickly as possible. We’re going to probably have to leave some kind of footprint there. There’s some talk about leaving 10,000 in Iraq before it’s over. We may have to leave something in Afghanistan. That’s partly insurance against losing all that our young men and women have fought for and we’ve spent so much money for. So I think we ought to be respectful of the hard choices that this president and his team are going to have to make here in the next couple of years about the remaining footprint. Going on, what I think is so important is to create a culture here of service in the younger generation. And this is something that’s been — I think people of goodwill on both sides of the ideological spectrum. Robert Coles can call for national service — I happen to believe in national service — but so did Bill Buckley. He wrote a book about service and how important it was. And that is not to say that they all need to go work for the Federal Government. They do not. In fact, what we really ought to do is have a lot of people out working in nonprofit organization. And I don’t believe in mandatory service. What I do believe in is the culture in which young people, when they hit the age of 40 or 50 years old, can look at each other and say, “What did you do in your year of service to the country? How did you spend your time?” And I think that’s time that could be spent often between high school and college, to really get you ready. And by the way, the theory would be, go spend one year in service as a follower, and if you’re willing, sign up for a second year and we’ll make you a leader, just as they do in the military. You’ll have a chance to learn how to follow but then learn how to lead if you want to give that second year. And we want to encourage that. But then that service ought to be honored, not only by colleges, but by graduate schools, so that business schools would look and say, “You spent two years in a classroom, and this other person spent two years at McKinsey, we’re not going to give the benefit of the doubt to McKinsey. You’re going to compete on equal playing fields.” So that we don’t have all these incentives to go off and do the financial services with a lot of our bright young people, that in fact that there is some incentive built in. And my own belief is that if people serve early, if they begin to realize there is something bigger than themselves that they need to care about,  that they begin to appreciate just how hard social change is — and it’s very hard — and they begin to understand what it’s like to live on very little. We have so many people now who are hurting in this country, and yet we have others of us who are living, in effect, in gated communities, and we don’t want to know each other. We don’t know what it’s like to be lower middle class without a job. We don’t understand how it demoralizes a male who can’t find a job year after year or whose income never goes up. The average salary for men in this country, measured in real terms, is no higher today than it was in 1975. That’s for the average. That’s tough. That’s really tough. The great American job machine has slowed down. We were creating 20 million jobs in the 1980s, and we created another 20 million jobs in the 1990s. In the last decade, you know how many net new jobs we’ve created? Zero. In the last three years, we haven’t created any net new full-time jobs. All the jobs we’ve created, despite 15 months of growing employment — all the net new jobs are part time. Mort Zuckerman had a piece the other day: part-time, average pay is $19,000 per year. People can’t live on that. And we need our sons and daughters who are coming to places like Chautauqua — where it’s so idyllic, and we all love it here — to have a chance to be and work with and understand not just what it’s like to be poor, but the beauty and the souls of many people who are poor, who need to be unleashed, who need to have a shot in life, who need to have an equal opportunity. And service will do that. One of the great things about World War II, it was said, was that a Saltonstall from Massachusetts had to salute a Polish kid from Brooklyn. And it was healthy for both. And service will help get us back to that playing field. When Franklin Roosevelt created the CCC and put 250,000 young men out in the woods, which was a wonderful organization, it really democratized them. They felt that they all belonged to the same country. And now increasingly, we don’t feel we belong to the same country, and service will help to get us back there, and it will be in the blood, and people will get committed. Yes, they may believe the way you get there is through conservative principles, and they may believe you get there through liberal principles, but most of all, they care about getting there. And that’s the culture of service I’d like to see.

Q: Would you comment on whether or not we really should believe that the concept of the common good still exists today?

A: Does the concept of the common good still exist? It does, but it’s not essential to the conversation as it once was. I there are those out there, like those of you who come to a place like Chautauqua, who need to carry on those traditions, to make sure that flame doesn’t go out, because it is not as widely discussed today. Howard Gardner, another Harvard type, he knows the difference between a sheep and a dog. Howard Gardner, who is at the School of Education at Harvard — a wonderful man — he’s been toying with this concept about ‘trustees of the country.’ We have trustees for corporations; we have trustees for universities; we have trustees for other non-profit organizations, and they’re really people who are stewards of the long-term future of that organization. They don’t do the day-to-day management; they’re supposed to be there to preserve the long term. And he argues increasingly that what we ought to be doing is looking to people to be ‘trustees of America,’ to think of themselves as that’s their role, that they have some responsibility, some stewardship — no matter what their personal belief may be, but you have some larger sense of responsibility. And John Gardner, one of my heroes, is the personification of a trustee for America. I think all of us out to see ourselves, to some degree, in that role. Just as you’re somehow a trustee of your kids, can you become a trustee for your community? For where you live? And for the nation? I think we can rebuild it as long as we remember who we are and retain a sense of heroes.

Q: Should our goal be to maintain our No. 1 status forever, or should we aim at exercising the sort of leadership that aims at helping the world transition to a new era in which we are content to be a leavening influence at the table?

A: It’s a good question. It’s a good question. I think the ‘rise of the rest’ is going to happen. China is coming to the table. India is going to be coming to the table. And we should welcome them to the table. We should not be afraid of having other nations at the table. And if anything, our responsibility is to make sure that, as China grows, we keep a decent working relationship so we don’t get in a fight. Historians tell you that one of the most dangerous times is when one nation is rising and another nation is declining. And there’s a resentment that builds up in the declining nation, and a sense of arrogance that can build up in the rising nation, and you can have a real fight on your hands. Think of the end of the 19th and early 20th century that we spoke about earlier. Britain became a declining nation, and Germany and the United States were the rising nations. Now in our case with the Brits, we got along very well — we didn’t have a war — but Germany and Britain got into it twice, and it’s in part because of this rising falling thing. We want very much to have China; it would be a good thing for us — the more China grows, the more they consume. That’s a bigger export market for us. It’s good for jobs here in this country. So we should not be afraid of China coming to the table. We shouldn’t be afraid of India coming to the table — Japan, whoever it may be — as long as we’re still at the table. What we don’t want to do is leave the table. What we don’t want to do is no longer be seen as an important influence for good, that people take us seriously. Because, believe me, if we slip and become a second-class power, we’re going to get shoved around in ways that we have no idea — we can’t predict, but I will guarantee you — anybody who knows anything about world realities and world history understands that when some nations get very big and there’s nobody out there to help keep the balance, it can get very, very tough for the other, smaller nations. We happen to have been — for the most part, not always — but we happen to have been, I think, a benevolent superpower. We’ve made a lot of mistakes, we’ve been too aggressive, we’ve tried to impose our way of life upon too many people. But by and large, if you look at international history, if you compare the United States’ record as a superpower versus others, our record is pretty darn good. And we should not apologize for that. We’ve helped the rule of law; we’ve helped to promote the rule of law; we’ve helped to promote the U.N.; we’ve helped to promote a lot of other organizations that have been very important. We’ve helped to create a world trading system that has allowed China and India and Brazil to grow as they should. We need to be very aware of that, but I’m just telling you, you let us slip into second-class status, and our children and our grandchildren are going to be in a world of hurt. They’re going to be in a world of hurt, and we’re going to get ordered around, and this will not be the same country, and we owe it to our children not to turn over a nation to them that is in decline. We owe it to them. That’s a moral responsibility on our part to turn over a nation as good as our parent left it to us. If we don’t do that, we will have failed.

Q: Please comment, if you would, on the future of balanced and fact-based journalism, and how can we be well informed in an age of ideological media.

A: Do we want to have lunch together or dinner? I know this is a question that is sensitive to a lot of you. It’s asked almost every year at Chautauqua, and frequently, about the media. I have certainly at least one leg in journalism, so I plead guilty to this. I’m as responsible as others. I do think that the modern media has contributed to the deterioration of discourse in this country. I’m old enough to know — I didn’t know Edward R. Murrow, but I’m old enough to know a lot of the Murrow boys — and to have worked with people like Jim Lehrer and Robin and Ted Koppel and Walter Cronkite, and you can go through the list, who believe very much in fact-based journalism and kept their opinions to themselves. They checked them at the door. To this day Jim Lehrer does not vote. I disagree with that, but he’s trying so hard to be non-partisan. And I admire that, and he upholds those old standards. And once again, it’s really important that there be a core of people who keep the flag, who maintain that flag and keep it up, long enough for us to get back to a better day. We’re going through a bad period in journalism. We’re going to get back to a better day one day, I think, I hope. The news organizations are businesses. They do have bottom lines, and ratings do matter. We’ve had a tendency to cater downmarket. We found we couldn’t make the profit levels that you needed upmarket. So what you find on an evening news broadcast on one of the over-the-air networks, which used to be — people like Cronkite fought to get that half hour — but now it’s about six or seven minutes of news, and another 16 minutes or so often go to froth. I think, frankly, as a nation, we’re too engaged in bread and circuses. We are. And of course, bread and circuses we associate with the decline of the Roman empire, as we should. Two other points ought to be made. If you’re going to have an education system that turns out people who don’t read, who are not interested in public affairs, if you’ve got politicians who drive people away from public affairs, as Christopher was just saying, young people don’t feel invited to the conversation; they feel irrelevant; they feel isolated. There’s a lot of evidence that people volunteer because they feel guilty, not because they feel like they’re involved. They don’t feel involved. If you’ve got politicians who chase them away and don’t make them feel involved, then it’s hard for anybody to build an audience of people who really want to pay attention and want to be informed of what’s happening in Sudan, or what’s happening in Saudi Arabia, or why women can’t drive in some of these countries, or what’s happening here in this country, what’s happening in Atlanta with this new case that’s just breaking of all the cheating that’s been going on in school tests. It’s a very upsetting story in the paper today about that. And we need people who are deeply engaged. What’s happening on these deficits? Pete Peterson has been trying very hard to get the younger generation involved, and what’s going to happen to them if we don’t cure these deficits? Because they’re going to pay the price. It’s hard to bring them in. Don’t just blame the media. We’re all in this together. We need to create a culture in which there are people who do care. In any society, there’s going to be a core of people who do care. People who come to Chautauqua generally care. Most of you are very well educated, and you can keep up. We need to build that core. We need to expand that core. We need to have people around us; we need to be in our communities building up people around us who care, and who do want to read and who do want to watch. And if you care, you can find it on the Net. If you want to be informed, you can inform yourself. There’s more than enough out there, and there are people who aggregate for you and will find articles that will present three different sides of the same question. So you can find it if you want; you just got to work at it. And it’s not necessarily going to be there when you click on the tube. You’ve got to work at it. You can be informed. You can read the Financial Times online. I think the Financial Times has become a required daily read. I don’t think you can understand the United States unless you read the Financial Times, frankly. Just as I think you need to look at The New York Times and The Wall Street Journal and The Washington Post if you can get it and look at some of these opinion pieces. But I think a well educated person today has to be reading more than just an American-written publication. You have to see us and the world through other eyes, not just our own eyes. There are multiple perspectives. We don’t have a monopoly on wisdom here in this country.

– Transcribed by Josh Cooper

Nick Glunt  | Staff Writer

Bill Purcell remembers the first debate he experienced in 1986 as a member of the Tennessee House of Representatives.

“Mr. Speaker, I rise to observe that the snack bar, which has for so long stood in the area outside this great chamber, has been removed, and I now call upon you, sir, to explain, ‘Where is our snack bar?’” a senior member of the legislature said as he stood.

“Mr. Speaker,” the chairman of the Finance, Ways and Means Committee stood and said, “as the chairman of the Historical Renovation Committee of this great house, I can report to you that we determined during our work this past year that there was no snack bar in that area during the construction of the capitol, and so, in the interest of historical preservation, we have removed the snack bar and moved it to another space. And there it is and can be found. Thank you.”

The first man stood again.

“Well in that case, Mr. Speaker,” the man said, “if that’s the rule we’re to apply, then I make a motion that we shall remove the electricities — the electric lights, the telephones and everything else that was not in this building at the time of the construction of the capitol, and that is my motion.”

And it was seconded.

“I’m not sure I’m cut out for this,” Purcell said to his wife that night.

And while his wife insists she said, “I told you so,” Purcell insists she said, “It’s OK. It’ll get better tomorrow.”

Purcell shared this story to great laughter and applause from his audience during his lecture at 10:45 a.m. Tuesday in the Amphitheater. He was the second speaker during Week Two’s theme “Government and the Search for the Common Good.” This is Purcell’s second time speaking for the Chautauqua Institution’s morning platform.

Though Purcell has spent more than two decades as a politician, he is most notable as a former mayor of the Metropolitan Government of Nashville and Davidson County. He won his second-term election with a nationally record-breaking 84.8 percent of the votes. Today, he serves as special adviser for Allston at Harvard
University.

‘Happy Days Are Here Again’

Throughout the entirety of his speech, Purcell continually referenced 1929’s “Happy Days Are Here Again,” a song written by Milton Ager and Jack Yellen but more commonly known as President Franklin Delano Roosevelt’s campaign song.

After quoting several historical figures — from Aristophanes to Davy Crockett to Harry Truman — on the matter of politics, Purcell said Americans have learned from and been uplifted by politicians.

He spoke of the ethical problems and political devastations Americans faced in decades past, most notably Watergate and the assassination of John F. Kennedy.

It was his friends and neighbors, Purcell said, that led him on the path of politics. They approached him and asked him to run for the legislature.

“And like hundreds, indeed thousands, of young men — and thankfully, increasingly, women — I set out,” Purcell said. “I thought that perhaps it would be a place where I could make a difference.”

Purcell said a common trend today is that Americans sometimes forget where politics has been or believe that today is somehow entirely different than years past. He attempted to disprove that belief — specifically using taxes as an example — by quoting Luke 18:11, in which a Pharisee thanks God that he is not like evildoers, including tax collectors.

He said politicians all over the country have stepped down from their posts for ethical or legal reasons. Americans need to understand, Purcell said, that leaders are flawed too.

“People, individuals fall from grace,” Purcell said. “They always have; they always will. The question becomes, though, what then happens?”

He said Americans must decide the answer to this question before moving on, but had no answers aside from analyzing the past.

“In difficult and baffling times, I argue it is critical to remember where we have been, how we got there and that we have ultimately always sailed the worst storms imaginable and unimaginable.”

Since the Declaration of Independence, he said, every day has been the day after Independence Day. It is up to Americans, he said, to decide the future. But looking to the past is important in deciding that future.

He said that because of that cycle, happy days are indeed here again. They’ll keep coming, he said, as long as Americans aspire to them. Belief and hope is what makes them happen.

“As always,” Purcell said, “these issues of governance and the common good remain the work of each of us, of all of us.”

Q: Do you think it’s possible to instill in young people a passion for plentiful service?

A: I absolutely do. One of the proofs of this isn’t some polling data that you can access. I talked briefly about youth participation, and I told you that the high-water mark for youth participation in America was 1972. What’s interesting about that is it falls off almost in a straight line to the year 2000. There’s a small blip in the year 1992, but it goes on down to 2000. What’s interesting is that it picks back up in the year 2000 and continues up. Many people believed that it was the 2008 elections, but actually at the 2004 elections, it had begun to turn considerably back up, and ultimately we reached the levels that we had reached in 1972. We don’t fully know what happened, but I can give you the initial observations. This research is done in a variety of places — the polling is at the Institute of Politics at the Harvard Kennedy School. What we believe is that the combination of 9/11 and (Hurricane) Katrina focused young people on the reality and the fact that they were part of a larger world, and they had to be engaged in that world. Otherwise, their lives would be changed for the worse. There is more going on in that time period, but the combination of understanding where you are in the world and your place in it, which is part of my argument. The leaders who have reached out and touched and inspired those young people in our lifetimes give me incredible hope. And I will say one more thing. Into these voids young people have always strode with our encouragement, with the encouragement of the people in this room who can help make that happen. So although there has been a decrease in interest and the most recent polling is reflective of that, young people are still very strong about community service but less convinced at the moment about their own service. That can and will change based upon the leadership and the opportunities that are provided.

Q: What’s happening in the Allston community and exactly what are you up to?

A: The Allston community, for those who are not from Boston, is one of the very special neighborhoods inside the city limits of Boston. It adjoins the city of Cambridge, where Harvard obviously was begun. In Allston, however, Harvard has had a presence now for more than a century — the business school, as well as all the athletic facilities of Harvard, the football stadium, are in the neighborhood of Allston. Over the course of the last generation, Harvard has acquired land within that area, and a number of different proposals and projects were both made and undertaken. Over the course of the last year, I’ve been part of a group of Harvard faculty deans as well as alumni and led in so many ways by the office of the executive vice president, Katie Lapp, to think about what Harvard can and should do within the area of Allston going forward. The good news is the recommendations were made two weeks ago. They are all online if you go to the website, for those of you who are interested, to the office of the executive vice president at harvard.edu. You will find a set of recommendations and there’s an opportunity to respond and provide your own suggestions and comments as well.

Q: How would you draw the line between holding to core values and beliefs and avoiding the “my way or the highway” prevalence in today’s politics?

A: I think that question is at the core of the discussions that will take place throughout this week here at this platform as well as monitoring the special programming that I understand was announced earlier. Jim Leach and others will be participating in a terrific panel, I think Thursday afternoon, involving former leaders from the region or current leaders, former elected officials, from the region as well. And the answer is that the way you avoid it is you don’t stand for it. You just don’t stand for it. You just say it’s unacceptable. When candidates and elected officials perceive that you are unhappy, you will be amazed how they move. There was an article three days ago in the Los Angeles Times that is observing that even within the current partisan primaries for president of the United States, there is a sudden change in tone, a sudden change in approach. Take a look at the article; think about it as you go forward. At the end of the day, when the people who are in control ultimately say to them, to each other and out loud, “That’s unacceptable,” then this complete inability to compromise, in my opinion, will change. Now, it doesn’t mean that there’s not matters of principle upon which we stand. Those are key and core to our own values and we stand on those, and people in this room understand for themselves what those may be. Those are not things that we give up because we’re elected in governance from a range of issues that are not within that category. They’re within this other category. And when you demand that they be resolved, oddly enough, they are.

Q: Do you think that there are too many politicians that are lawyers? America has 98 percent lawyers, China 90 percent engineers.

A: This is an easy question to answer, actually. As a lawyer, I think there are too many lawyers. There just are. It’d be better for me if there were fewer lawyers, don’t you think? Here’s the good news about elected office. Take a look at it in your own local government and in your own state government. There are many fewer lawyers than you thought. When you do the count, you will find typically that there are just enough. I would argue that whether or not you think it’s just enough, you will find many fewer. In fact, there’s a lot of growth in funeral directors in our state governments. They’re very good at it. They deal very well with difficulty, trying times; they’re able to break bad news to people, especially the cost of things. Funeral directors do very, very well; you find growth in that, retired people — retired teachers, especially — who have time. What cuts against lawyers particularly in the part-time of public service is the amount of time that it consumes. I think when you actually look at the raw numbers wherever you are from, you’ll sleep much better. There’s just not as many lawyers as you thought.

Q: We the people have always solved the problems, but the way the people are getting their information has changed. How do you see this issue?

A: As I mentioned briefly, it’s a real struggle for us. Although I think we were probably wrong in believing that everyone in the whole community read those two newspapers and were fully informed on all the issues, there was at least a chance — and in fact, among the leadership, there was shared information across the whole community. Now it’s pouring in. The arguments that are frequently made and the early research shows that among young people, they are receiving as much or more information from a variety of different sources. And there is in this, I’m told, reason for optimism. I’m frankly unsure at this moment whether optimism is warranted. But I think for the long term as we increasingly figure out how to sort what is valid and what is invalid, what is true and not true, as we figure out how to sort what is valuable to our own lives and our work that this fact of more information more easily accessed and more broadly shared is a positive for all of us.

Q: How can any one of us or any few of us or many of us support concern for the common good? How can we few influence the definition of the common good?

A: In the way that you always have. The reason this space is so special is that it’s been devoted to that from the beginning in a wide variety of different ways — matters of faith as well as matters of politics. I understand that this is a place that I think is the living embodiment of all the ways that you do it — as individuals sitting alone and thinking and receiving, as individuals in dialogue and debate with leaders and others, as people who are part of groups who on this campus gather together and further refine their own thinking, as people who go back out from here into the world and change the world in which they are. I think this place is as good an example and model of all of the different opportunities that you have and the critical piece, I think, is to not let the headlines, the disaster, the disappointment of the day make you forget how far you and the people who came here before you and the people before that — even back when the mayor of Jamestown was promoting the place, if wondering what was happening here, and indeed moved on and changed the world. That is the strength of our world and it remains so. Of that, I’m confident.

Q: You spoke in your speech about people of ability and merit. Are they in politics, and do you find them more in the city, the state governments or the national government?

A: On this I used to say we had, where I come from, a truly representative government, and that meant we had one of everything. Just about the smartest person that ever had an idea on any particular day and the person on the other end of that particular spectrum as well. And there is actually some power and strength in having one of everything within the body. You’d prefer that everybody at least remembers why they came. That would be helpful, but overall, the presence of a wide variety of people in the room is not problematic. The question though goes to whether or not we are advancing in this, much like the first question, the opportunities for all. I think about that, there is always reason to be concerned and vigilant. There’s always reason for people like the people in this room to go find people, if not like me, at least positioned as I was in 1986. Maybe I was naïve; maybe I was overly optimistic, but I was encouraged by my neighbors. That sounds so simple, and I know you doubt when you hear it sometimes from politicians who say, “Well, if my neighbors want me to run again, I will. If the people insist, I would be happy to serve a 32nd term in this position.” I can tell you if your neighbor, your friend, your family member, comes to you and says, “You should run,” it transforms your view, and you have an ability and a strength and a power in that way beyond anything that you know. I leave you with that thought, because you can in that way make greater changes than you ever know.

Q: What’s happening in Nashville today; how is it progressing?

A: Well, I just came from Nashville. Actually, I would have been here yesterday on the Fourth (of July), but we were celebrating our nation’s independence as well as the Hot Chicken Festival, which is one of my favorite things, and I recommend it to you. If you cannot for some reason be at Chautauqua on July Fourth, the Hot Chicken Festival occurs every July 4. This was our fifth, and I hope you can join us there, and going forward, I have other materials I can hand out and give you. Nashville went through a great challenge a year ago, as you know: A flood that was not just a 500-year flood, maybe 1,000-year flood, not anticipated in that way ever. Nashville has recovered from that flood and has, in all one hopes (with) such recoveries, is not just strong, but in many ways, stronger. The city itself has progressed in its educational systems; it’s continued to focus on its public safety as well as its quality of life, and I feel very good that in the four years since I’ve been there, the city’s progress has been sustained across all categories.

Q: Are you willing to comment on the actions of governors or mayors taking over failing school systems and dismissing elected officials in those systems? Is this ethical? Is it democratic? What value trumps kids’ education or the democratic process?

A: The overall question until the part about the trumping is a very critically important question that is not for every city but could be and is now for, I think the first time in American history, at least on the horizon for every mayor and elected official. Let me explain what I mean. For the longest time, there was a deliberate, conscious, some thought constitutional division between public education and general government. Let me put it another way. Most mayors worked very hard not to be dragged into, engaged and involved in matters of schools for a variety of reasons. I think there is a larger consensus now that unless, and until, everybody in the community believes that schools are the most important thing that we do and then everybody in the community is involved and all political leaders are perceived to have at least a role of some kind, and until that happens, there is a much more limited opportunity for progress in the ways that we have come to believe it should be made. So I would argue first of all that now this consensus does direct mayors and everyone else to be involved in some fashion. In my city, we did not control the school system, but we funded it. The argument is, what level of control does funding the budget of the school system provide? Actually, considerable — particularly if one understands the importance of resources to both capital and operating expenses with school systems. In the cities of Chicago, Cleveland, Boston, New York, there has been a move along the line of the question which was done through the democratic process by and large through actions in state capitals by state legislatures. Typically, that process provided control in the executive. It was done, in my opinion, after it was perceived that the existing system would not meet the needs of the children and the communities they were a part of. I don’t recommend that for everyone; I don’t suggest it as the solution for all places, and we in Nashville did not pursue that at the time that I was there, but I recognize that in the cities that I mentioned, it was perceived to be required. It was, in those cases, proceeded appropriately under the law, and I believe to the betterment of those school systems. But in the long term, the underlying issue will return. And that is governance in those places and other places, and you need to be vigilant about that as well.

Q: Will you address the appointment of a city regulator in Benton Harbor, Mich., usurping the power of the mayor and the council?

A: I’m afraid I don’t know about that particular case. I can tell you that at the core of the debate back 100 years ago, was this notion of city government being one of city managers or elected officials. And a part of the progressive movement believed that elected officials could never deliver a fair, unbiased, honest government in that context. The argument on the other side was, in fact, that was the only way that progress would be made. In this particular case, we’re talking about a regulator stepping in, and I can’t respond.

Q: How can you deal with the impasse on the entitlement issue?

A: I think that we in this area facing one of the great and large problems of our federal government and of our time do not even now have enough information about which we can agree. I don’t mean there’s not enough information in the world; I mean, there’s not enough information in front of us, before us, between us, about which we can agree or if necessary, disagree. This is the debate that is that important and should continue in as many places in as strong and clear a way. I won’t ask for a show of hands, but on an issue that important, you would think that everyone in this room would have at least an opinion. I hazard to guess that that is not the case. There ought to come a time when you do, when you’re clear, when you know. When that time comes, in my estimation, there will be a result in Washington as well.

Q: What is the deal with male politicians and sex?

A: You know, that’s just funny. When I was here four years ago, I wasn’t going to share this, but this is toward the end of the question period, and I think it’s just worth sharing. I wasn’t sure how (my speech) had gone, and I had been honored and touched to be here and to be in this space, but I needed some reassurance, and I talked to Tom Becker. Tom Becker is really an incredible combination of people all in one, I believe. He just is, Tom Becker really is. But as an aside, when I look at this week and what we’re talking about this week and the weeks that follow and remember that Tom Becker came to Harvard more than a year ago and sat down with me, and I know with others, to think about what should be in this space the year hence and once again, he hit it just directly. It’s exactly what we should be thinking and talking about at this time, and our history is incredible. I got on the phone with Tom Becker about how things had gone, and he said, “Well, it went fine,” and I said, “Well, how can you tell?” and he said, “Well, actually we rank them, the presentations, in certain ways, and you did fine.” Then I didn’t say anything, and he didn’t say anything, and he said, “Well, you know, you weren’t No.1,” And I said, “Well, OK,” and he said, “But remember, Dr. Ruth was on the program, and you know, really there was no chance for you.” That’s my answer.

Q: What are you doing now? We need you in Florida.

A: You know, it’s too hot in Florida. No, it’s not. Florida is a special place going through its own period of reflection and reconsideration and evaluation, and I know that. And it’s one more example of the way in which this process works all the time. Not in a pendulum swinging one way or another but moving, we hope, ultimately always forward. Right now, I just completed my work at Harvard. It’s been a terrific opportunity for me, especially this last effort with the work team to envision this campus in Allston and make recommendations to the president. I obviously leave that work incredibly optimistic about the future of us all. That is the way I am as I head back to Nashville, Tenn., to continue on with my career and my life, and that’s where I am.

– Transcribed by Elora Tocci

Nick Glunt | Staff Writer

Former U.S. Rep. Jim Leach said that in order for the government to strive for the common good, politicians and the country as a whole must learn to respect others enough to see through their eyes.

“If we don’t try to understand and to respect others, how can we expect them to respect us, our values and our way of life?” Leach said.

Leach said that “fear of the different” is part of the human condition. He reached this conclusion by looking at history’s injustices in events such as world wars and genocides, as well as hate crimes and the wars in which the U.S. is currently engaging.

Leach, who currently is chairman of the National Endowment for the Humanities, was the opening speaker for Week Two’s topic on “Applied Ethics: Government and the Search for the Common Good.” He spoke at 10:45 a.m. Monday in the Amphitheater.

Leach said politicians, in particular, are guilty of incivility. Be it between politicians in the U.S. or between U.S. politicians and those of other countries, Leach said, they disrespect and insult one another instead of creating proper, logical discourse.

To solve this problem, Leach said politicians must learn to see differing perspectives. Only then, he said, can we reach a common good.

To illustrate this point, he explained a set of books called “The Alexandria Quartet,” written between 1957 and 1960 by Lawrence Durrell. The four books tell the tale of a single set of events, but from the perspective of four different characters.

“To get a sense of reality, you need to get the story from more than one set of eyes,” Durrell said of the tetralogy. “That is, every single story was totally different. And with each story, you get a greater sense of what actually occurred and why it actually occurred.”

He said “The Alexandria Quartet” is a universal example of needing and respecting multiple perspectives on topics. It can be applied, he said, to law, foreign affairs, politics and more.

However, Leach said that the idea of viewing different perspectives isn’t as utilized in American politics as he would like. There’s a rift in the population today that he says should and could be repaired.

Leach’s lessons

In three decades as an educator, Leach came up with several “two-minute lessons” to explain the causes of these divisions in the U.S. population.

The first, which he calls “Political Science 101,” explains that the population is a third Democratic, a third Republican and a third unaffiliated. If one half of those unaffiliated vote for either primary party, that makes one-sixth voting for each.

However, during primary elections, only one-fourth of the population actually votes — meaning only one-twenty-fourth of the population decides the candidates for the main election.

Leach said a large portion of those who vote during primaries are either very conservative or very liberal. Thus, they vote for Congressional candidates that are either far left or far right. He said the center-right and center-left are underrepresented in Congress as a result.

For “Political Science 102,” Leach said those very same candidates who were elected tend to scoot toward the center-right and center-left in order to earn more votes. They do this, he said, because the majority of Americans are more center-left or -right. When elected, though, they rarely show that center lean.

In his lesson “Psychology 101,” Leach said a large number of issues presented in Congress are explained as issues of morality by both sides. The other side of the argument, he said, seems to always foster immoral values.

With the increase in globalization of late, Leach explained in “Psychology 102” that corporations are becoming less and less concerned with national issues and more with
international ones.

In giving his lesson “Sports 101,” Leach said politicians could learn something about athletes’ sportsmanship. Players respect and applaud one another and are punished if they do not. Leach said politicians, on the other hand, often focus on the negatives in their oppositions’ characters when the election is close.

As physicist Isaac Newton said, “For every action there is an equal and opposite reaction.” Leach focused on this idea for his “Physics 101” lesson, saying the same applies to politics. The only difference, he said, is that the reaction is often much greater.

When a politician says something negative about an opposing candidate, the opposing candidate often responds with something much worse. Instead of respecting one another, a volley of insults comes and goes.

In “Humanities 101,” Leach said that developing as a country makes that country more vulnerable to terrorist attacks. An attack on a skyscraper is much more effective than an attack on a rural hut, he said.

Finally, in explaining his lesson “Humanities 102,” he said that there’s a distinction between politeness and civility. Too often, he said, politicians blur that line.

Has American culture peaked?

Conflicts and argumentation are important in finding the common good but must be conducted civilly, Leach said.

Despite this, he said the world is now waiting for us to come out of this rut. He added the world has looked to America for the past century as a leader in education, government and the arts. American society today, though, is being challenged.

“Around the world, people are asking whether America has peaked, whether we’re on the precipice of social decay or the edge of renewed greatness,” Leach said. “That question can only be answered by our actions. Everyone is responsible. All are called upon.”

Q: One of the most divisive elements of today’s society is 24-hour cable news, whether it’s MSNBC or Fox News. What can average citizens do to counter the fear and anger that these networks perpetuate?

A: Well, freedom of speech is obviously everybody’s right. About the only thing that can be done is to vote with one’s hands — that is, to click off one approach or another. But the bigger question is in many ways, the new communications technology is changing American society, and if we think of the 19th century, often every community had two or three or four newspapers, and some of them looked pretty virulent in their views. There was a Whig paper, Democratic paper, often an immigrant paper — sometimes of a different language than English, but with the 20th century, we’ve gone through a lot of changes, and as we enter the 21st, these changes have become accentuated. At the beginning of the century, we had our first mass media with radio and television, and as people have larger audiences, the effort was to encompass everybody, and so you had an effort to make balance an important thing, and then the newspapers consolidated, so it wasn’t just a Republican paper or a Democratic paper. Balance is, for economic reasons, pressed, and then often papers get to show balance. We’ve tried to have on editorial pages a prominent conservative and a prominent liberal commentator, but what has occurred is that with new ways of advertising, newspapers have lost their revenue and so has television, and so people are looking at ways to develop audiences, and some people figured out that one way was to abandon traditional efforts of balance particularly to appeal to audiences, and so it became fashionable to appeal to conservatives, symbolized by Fox News, fashionable to appeal to liberals, symbolized by MSNBC. These shows ended up getting a bigger audience rating than the traditional networks. ABC, CBS and NBC aspired to be balanced, although that doesn’t mean everybody in the public thought they were balanced, but they truly aspire to. And this has become a very awkward circumstance for everybody. Then the news media, of course great newspapers have lost the capacity to fund deep research, often different kinds of investigations to hold local and national government accountable. Now we have some things replacing it. There are some non-profits that are doing journalism in an interesting way, and then intriguingly, even those newspapers are getting to be less comprehensive; there’s no one in this room that can’t go to a computer and with a click or two, tie in to some of the truly first-class blogs on almost an hourly or daily basis. One can get updates on what’s happening in the Middle East, in the Far East. One can get wonderful academic journals, and then one also has the choice of getting some incredibly shallow, prejudiced perspectives. I sometimes suggest to people that the great battle underway is between those who choose both to see blogs or information from different sides but also choose to see in-depth, quality things versus those who choose not to. This is becoming one of the great social cleavages in the United States today. That there are some people who choose only to go to exactly what they think is the perspective that aligns with their biases to begin with, and others who go to what might be considered deeper, more thoughtful approaches. This is something we’re going to be living with for a time. And so one of the really unanswered questions is whether the huge new communicative capacities existing in this country and increasingly around the world will be a force to bring us all together or whether it will be a force to divide us and fracture us even more. My own personal suspicion is it’s going to be a little bit of both. We’re going to have a lot of ups and downs in these curves.

Q: Can you set an example wherein a figure has effectively contended that an opposing point of view is profoundly wrong, yet the ideal of civility has been maintained?

A: We’ve seen many people from many different perspectives reflect different views. One that I thought was rather wonderful was the terrific friendship between Harry S. Truman and Herbert Hoover. And I once heard a lecture by David McCullough, the historian, and it was a lecture about Hoover, but he made this comment at one point. The reason that Hoover and Truman were so close, he said — as a historian, I have no evidence whatsoever, but I’m certain of this statement, which I love, as a historian to acknowledge. He said they were both bookends to Franklin Delano Roosevelt, who they recognized would be the heavyweight president of the century based on timing and certain calls that were made, but they each knew that they were far smarter, and they resented it.

Q: You discuss the role of corporate influence, as this questioner asks, if you distinguish between that influence and that of the unions and a variance on all of this is how does one protect the freedom of speech without corrupting campaign finance?

A: Well, those are two separate questions, and first let me say that there’s a definitional thing that’s very important. The word “corporation” is implied in the Supreme Court ruling in Citizens United about corporations can give money directly into campaigns also applies to unions, and it’s one reason why America’s unions supported, in brief, to the court, the ruling that was made. So the Chamber of Commerce and the unions had exactly the same position, and each enhanced their own power, and one of the least commented-upon implications of what one might describe as a corporatist ruling is that the Republican Party will get increasingly indebted to big corporations; the Democratic Party will become increasingly indebted to unions, and they both are to some degree to begin with, but this is a significant new increase that over time will become ironclad. And so one of the implications of the Citizens United ruling is the unionization of the Democratic Party when it comes to money and politics and the Republican Party when it becomes money and politics. But one of the aspects of Washington politics, it is truly not noted by the public if you take political action committees, which are the forerunner of all of this; unions give about 99 percent of their money to democrats, as people know. What people often don’t know is that when the Democratic Party controls the Congress, business gives about half its money to the Democratic Party and half to the Republican because business gives to power. When Republicans control the Congress, they give about 60 percent of their money to Republicans and 40 percent to Democrats, but corporations weigh in with both sides, unions with one side. And it’s a mistake to think that all sides don’t buy profunds with the same sources. As someone who chaired a committee of Congress called Banking, I’ll give you an anecdote that might surprise people: The Banking Committee has jurisdiction over commercial banks, investment banks, savings and loans. The Republican Party traditionally got its greatest support from commercial banks. The Democratic Party got much more support from investment banks and savings and loans, and the two sides then would vie for each other for both, and interest groups give not principally to parties in Congress, that is business; they give to committees with jurisdiction. So, a committee with jurisdiction over a field — both sides get lots of money. For example, the defense contractors give enormously to the Democratic and Republican parties on the Armed Services Committee. It’s a very natural thing, and so it isn’t as if there is huge division between the parties. Both sides vie for the same. It’s one reason that Ralph Nader likes to suggest that we only have one political party, not two. Now I think Ralph has exaggerated, but he has some rationale for his argument.

Q: There are lots of questions about what changes you might propose to create a more civil exchange between parties or how you might break the status quo, but there’s sort of a delicious phrasing in this question: As a congressman re-elected many times, I would consider you an elder statesman. As such, I think you might have something to teach our current lawmakers. How might an elder statesman approach, advise our current lawmakers to come to the center, increase civility and make better laws?

A: Well, first of all the only premise of that that I agree with is that I’m getting increasingly elderly. But there’s just so many human dimensions in all of this, and one I hinted at in my talk is people have to recognize what’s important to be loyal to. In all the pressures in Congress — and they just grew over the 30 years I was there — well, the party caucuses became dominant. When I was first elected, we had a caucus about every six weeks; the Republicans would get together. Then it became once a month, then every two weeks, then every week and then two or three times a week, and people come together. Republicans get together, and the words are unbelievable in describing Democrats. Democrats get together, and the words are unbelievable in describing Republicans. What you see in the public view is really much scrub compared to the private views in Congress, and what we have in the American political system is when you go at levels you have a city council, a state legislature, a federal legislature. It’s as if civility is in inverse proportion to ultimate power, and so in city councils you have relatively little incivility based upon ideology. Frankly, most city councils have one person who’s kind of a crank, at least in the view of the other members. Now the crank thinks the others are out of step, but it’s a personality thing. Then you get to the state legislatures and you get an increasing partisan dimension, but then you get to the federal level, and it’s just dramatic. To me, part of it’s attitudes, part of it’s money and where it comes and then there are aspects of politics that are kind of family oriented. When people read about old Congresses in the early part of the 20th century and frankly, members didn’t have a lot to do; most decisions were made by their leaders. There was an awful lot of socializing. And partly, the intriguing aspect of representative governance today is just how much interchange there is with peoples, and it takes a lot of time, and so the time between members is broken down, families are no longer central to the social life, and oddly when you read histories of the early part of the 20th century, there is a huge problem of alcoholism; Jack Daniels was everywhere. Today, Jack isn’t, and it could be that you need a little more presence of Jack to bring things back together. You certainly need a little more humanization. Let me throw out a sociological dimension of all of this: If you visualize a new primary process in both parties and the type of people both parties nominate, these are not types of people that would be close friends in the community, and there’s a sociological kind of awkwardness to this, and people are going to have to get together more on a level. I’ll tell you an anecdote about one of my favorite members I ever served with who’s from this area, might even have represented this area, but from near Buffalo was Jack Kemp, and I remember with my wife Deba, who is here, we went on a trip to Moscow once in which we had a Duma — that’s their legislature congressional exchange of views — and I remember a Democrat from Wisconsin named David Obey; he was a very smart Democrat, giving a pretty tough anti-communist talk, and Jack turned to me and said, “Jim, I didn’t know Democrats were anti-Communist!” And I said, “Jack, maybe it’s a good thing we have these jackets.” But we do need to just see each other in other frameworks other than stirring each other down on the house floor.

Q: To spread the responsibility for aggressive foreign policy across the entire populous, would you recommend reinstating the draft for military service?

A: I would hope we could avoid it at all costs — at most costs, I should say. The downside is terrific, because we are making a great social divide in the United States military, and that’s sad for society. When it’s coupled with no financial sacrifice either, we’re neither sacrificing financially or with our families in supporting a controversial set of wars. I think as a society, a draft should be avoided if we can, but I think it begins with quickness to go to war and the challenges we face and the judgment involved. The Iraq war is the first war — there might be an exception of the Philippine War — that we really attacked a country that had nothing to do with attacking the United States. Not that our leaders intended it that way to be, because I think our leadership thought it did, but there has been a lot of thought about intelligence failures. That is, there is a failure not to understand weapons of mass destruction or whether they existed in Iraq or not; there is a failure about this concept of “Yellow Cake,” which ended up being a made-up story, and we still don’t know the origins of the made-up, but there is a greater lack of intelligence in what is the meaning of the Muslim world and what would the meaning of intervention be. We had gone to war in the Gulf based upon aggression of Iraq towards Kuwait, and I think we had a proper cause to respond, but even though we’d been at war in the Gulf, a decade earlier than 9/11, very few decision-makers knew there was a distinction between Sunni and Shi’a, and almost nobody knew what that distinction was. Today, all educated Americans know the importance of the distinction, although most do not know exactly what that distinction is, but they know there is a distinction. That is an intelligence failure of the United States of America, and I mean very serious policymakers didn’t know these issues. If you think about history, whether we’re talking about the British or the Russians in Afghanistan, whether we’re talking about the French in Algeria and even by analogy, the United States in Vietnam. We should recognize that there is a real instinct for people not to be particularly appreciative of intervention. One of the theoretical comments that everybody talked about in the wake of Vietnam was when you’re thinking about war, what is your exit policy? That was talked about a little bit before these wars but people suddenly stopped talking about it, because there was no rational exit policy that existed. It seemed rational to policymakers that overwhelming force was sufficient to have overwhelming capacity to control events after the fact, and that didn’t prove to be the case. That is something that we’re all going to have to think through as a society. Now, the tragedy, of course, is that we’ve found that nothing is easier than terrorism, and so it’s probably something we’re going to be living with for a long time, and then the question’s going to be: If there’s another terrorist act, and let’s pretend it emanates from an obscure country that people don’t really know where it is today; how do we respond, and how do we respond constructively? We’re all going to have to be dealing with that issue for a long time to come, and every situation is going to be different, and we all hope it can be dealt with in ways involving small numbers of incredibly proficient people with incredibly great capacities, but we don’t know.

– Transcribed by Taylor Rogers

Nick Glunt | Staff Writer

On May 1, a team of highly trained Americans killed Osama bin Laden. After the United States spent 10 years hunting through the Middle East, bin Laden finally was found and struck down near the Pakistani capital.

Americans were happy. Pakistanis were not.

Wendy Chamberlin, former U.S. ambassador to Pakistan and Laos, said Friday that despite more than $5.1 billion in aid since 2002, the Pakistani people distrust Americans because of the nation’s historical pattern of unstable alliance.

This point was part of Chamberlin’s 10:45 a.m. lecture in the Amphitheater titled “U.S. Aid to Pakistan: Harmful or Helpful?” It was the fifth and final lecture in Week One’s theme on “Global Health and Development as Foreign Policy.” Chamberlin currently is president of the Middle East Institute.

Inconsistent aid to Pakistan

When bin Laden was killed, it wasn’t his death that made Pakistanis unhappy. Chamberlin said they didn’t care for him much anyway. It was that they weren’t alerted, despite the fact that he was found in their country.

“I think we are guilty as charged in giving our assistance inconsistently throughout the last 64 years,” she said.

During the Cold War, Pakistan aligned with the U.S., while India aligned with the Soviets. When Pakistan and India went to war between 1965 and 1971, the U.S. withdrew military aid from Pakistan. Chamberlin said the U.S. did it to stop the war, but Pakistan viewed it as an offense. To them, that’s not how allies act.

It happened again in the 1980s.

The U.S. needed Pakistan’s help in evicting the Soviets from Afghanistan. Money was “poured” into Pakistan, ending with a successful Soviet withdraw, Chamberlin said.

The U.S. then began developing legislation specifically designed to stop Pakistan from manufacturing a nuclear bomb. The legislation failed, ending with the U.S. stopping all aid to the country.

Once the War on Terrorism began during the Bush administration, the U.S. once again began funding Pakistan action. Today, they’re unconvinced that the U.S. will stick around once the war ends.

“(Pakistanis) look to the future and think, ‘You’ve got a pattern of this. You’re going to do it again,’” Chamberlin said.

Complex relations

Every person and place in Pakistan is “interwoven,” Chamberlin said. The U.S. can’t hope to fix any issues in the country by focusing on individual sectors. In order to fix relations with the country, she said the U.S. has to focus on the entire relationship.

“Making sense of Pakistan and our relations with Pakistan is difficult enough,” Chamberlin said. “It is one of the most complex relations we have in diplomacy. It is fraught with misconceptions and misunderstandings and confusions.”

Today, the U.S. provides more than half the assistance Pakistan receives. Chamberlin said Pakistan doesn’t just benefit from the U.S. — it needs the U.S. But the U.S. also needs Pakistan, she said.

Despite this, the relationship between the two nations suffers. A survey of the Pakistani people determined that only 12 percent of Pakistanis have a positive view of the U.S. Chamberlin said this is one of the lowest U.S. approval ratings in the world. Furthermore, 75 percent of Pakistanis view the U.S. as more of an enemy than an ally.

By comparison, China — a country that gives much less aid to Pakistan than the U.S. — has a 90 percent approval rating in Pakistan.

“Anti-Americanism is a complicated phenomenon, but it is one of the great anomalies of our relationship,” Chamberlin said. “Our military and financial assistance itself is one of the reasons why the Pakistanis distrust and dislike us.”

They see U.S. aid as a precursor to the U.S. leaving once the job is done, she said.

A second reason for anti-aid belief was that the Pakistani people believed the U.S. only wanted Pakistan for the country’s military strength. The U.S. prepared the Kerry Lugar Bill, designed to give $1.5 billion over five years to Pakistan, though the language in the bill said that none was to go to the military.

Once the bill was enacted, the military attacked the bill. Chamberlin said there is still a sense of criticism among the Pakistani people toward American economic assistance.

As a result of these rocky interactions, anti-Americanism has spread through Pakistan. Chamberlin said she knows of journalists in the country who are hired specifically to write anti-American stories. Furthermore, schools are a hotbed for anti-American lessons.

Fixing foreign relations with Pakistan

Chamberlin said she sees three ways the U.S. failed in its relationship with Pakistan.

Firstly, the U.S. failed to recognize the “essence” of Pakistan. The U.S. needed to understand Pakistan’s national identity, she said, before it took action.

Secondly, the U.S. needed to resituate the “architecture” of aid legislation.

Lastly, the U.S. needed to recognize competition between the Pakistani army and its civilian democrats in regard to aid within the country.

In order to repair the relationship between the U.S. and Pakistan, Chamberlin said, the U.S. needs to think about those three points. It needs to incorporate those points in future legislation.

“We’re in a really bad place in our relationship with Pakistan,” Chamberlin said. “It’s about the lowest point it’s ever been. The distrust is an all-time low.”

Chamberlin also posed some solutions. She said the U.S. should embrace realistic goals in foreign aid to Pakistan, should be more honest and genuine in its interactions, should be explicit in how aid can be used and should ask the Pakistanis directly what they want funded.

“None of these suggestions are meant to be a silver bullet,” Chamberlin said. “Ultimately, the Pakistani people are going to have to deal with what is happening in their own country and the extremism within. But minimally, we should not allow bad behavior.”

Q: What has China done in Pakistan to gain 90 percent public support?

A: China has built very visible infrastructure projects. They built the Karakoram Highway, from its border down the spine of Pakistan, of course, that had very immediate military and economic advantages to China, but it was a very expensive road through a lot of steep mountains. China is building another seaport in addition to Karachi for Pakistan’s navy. And of course that has implications for China’s military, but it is visible, it’s branded and the Pakistanis know about it. And China does not tell Pakistan what to do all the time. China does not feel responsible for easing tensions between Pakistan and India. China does not feel it’s its responsibility to end the War on Terrorism. China isn’t pushing military leaders to take off their uniform and run for office to build democracies. China just says their public diplomacy is: “We’ll stand by you, whatever you do; we’re your true friend.” But, when the Pakistanis test this, as they did two years ago, when their foreign exchange was just two weeks away from being completely depleted, and the IMF said that they would not replenish those foreign exchange unless Pakistan made some reforms, Pakistanis said, “We don’t need the Americans and we don’t need the IMF; we’ll go to the Chinese.” And the Chinese said, “Go to the Americans and go to IMF.” And that same thing happened a couple of times. So there’s a lot of bravado on the part of Pakistan when they say, “… We don’t need the assistance from America; we’ll go to the Chinese.” They know that’s not an option.

Q: Can you comment on the effect of the Internet, Facebook, etcetera, concerning the masses’ communications in Pakistan, and can we expect something similar to the Mid East?

A: There aren’t as many educated middle-class people in Pakistan as there were in Tunisia and Egypt where the Arab Spring has been most successful. But among the middle class, and it is growing, the social media is enormously important. It’s also been very much worked, by extremists and those that are pushing an anti-American narrative. The single place where most Pakistanis get their information, however, is television and radio. One of the reforms that President Musharraf — and he instituted a number of very useful reforms — one of the reforms he institued was to privatize the media. And in just a few years, and just recently, over 56 new television stations grew up over Pakistan. Unfortunately, it spews out a lot of misconceptions and inaccurate information. But that is what the illiterate masses hear. I was participating in a little group that was trying to support the middle class in Pakistan, and we did a study of the media. Pakistanis are voracious; even uneducated, illiterate villagers follow very closely international and global news, and they know what’s happening in the United States, and they know what they’re being told about our relationship. Americans, in contrast, don’t want to hear about the rest of the world. We have enough to do in our communities and our own lives, and Sarah Palin and Lindsay Lohan and all of these important things; we don’t want to hear it. But believe me, in inverse proportion, they care about what’s happening with us, and know about it.

Q: What would you predict would be the result in Pakistan if we ceased all money to Pakistan?

A: Well, first of all, I think the Army would and they may even still close their border routes at Quetta and the Cairo Pass, so that our logistics support, the food, the fuel, the heavy material that we are importing to support 140,000 NATO troops, American troops in Afghanistan, would stop, and that would be very, very troublesome to us. We have tried and have spent a lot of money trying to develop alternative supply routes, but their air routes and through Uzbekistan and Tajikistan and boy, I’ll tell you, they negotiated some very expensive deals for us to use those routes. And it just at most can cover about 25 percent of our needs. So we would be up a creek.

Q: This questioner wants to know if we’re fighting in the wrong country, if we should be fighting in Pakistan instead of in Afghanistan.

A: When I first met Musharraf on Sept. 13 (2001), and delivered the “are you with us or are you against us” demarche and he said, “We’re with you unstintingly,” and they were. I went back on the 15th, and this is sort of in the literature out there, with some additional instructions from Washington, not from me but from Washington, about what we would do and what we would not do, and he gave me some ideas on what they would do and what they would not do. And one of the things that was understood we would not do in order to get their support was to put American boots on the ground. They would not, under any circumstance, have an American base with American combat troops or have American combat troops go across the border based, safe-guarded in Pakistan and go across the border into Afghanistan. So they were clear they were not the battlefield. And he told me, and this has been consistent, they would take care of any insurgents or extremists or al-Qaeda inside Pakistan because they had a professional Army that would do it. As I said before, in a couple of years, they were good to that promise. It’s just been a little bit eroded over the years, and so is our promise not to place combat troops in their country. We’ve done it a couple of times, including most recently to get Osama bin Laden, and that’s what really, they went off on.

Q: Two questions about getting these ideas past the military, and I’m honestly not sure from the papers whether or not they’re talking about our military or Pakistan’s. One is the “race to the top” analogy; how would you get those ideas past the military? And the other is, how we can get more aid to women through the military?

A: My race to the top idea was really just for development aid. For the military, I think we have to be very clear and set clear benchmarks and monitor closely that money is not diverted. The race to the top was meant only for development aid. Women, there’s some really creative ideas out there for educating women in Pakistan. For example, you build a school and provide a teacher in a community on the condition that they build a separate latrine for girls at the school. Many girls don’t go to school because they don’t have a modest place, a modest loo, and their family keeps them back. Simple solution. You can educate girls that way. Another solution, you give families a quart of cooking oil every month if the girl comes to school. And believe me, they send their girls to school when that happens. There’s some very easy ways to get girls’ education. We had before the rupture in our relations in the ‘90s, with the Pressler Amendment, we had some very promising projects of training local midwives, nurses, for preventative health in the villages. And it was making an enormous impact on the health situation in Pakistan. Of course, that went by the wayside, and security issues today make it difficult to recreate that project. But there are ways.

Q: We have several questions about cultural issues in our own State Department and our AID; what are we doing to make sure that we’re doing our homework and to stop misjudging other peoples’ cultures?

A: That’s a tough one, because whatever we do, you know, it’s never enough. I’ve noticed an awful lot of Pakistani-Americans, hyphenated names, have been recruited into the Foreign Service and into AID. And that’s been helpful. We’ve paid much more attention in reaching out to the diasporas and bringing them into the government in ways that they can bring insights that may not have occurred to me in my background. We’re putting a lot more money into languages. But sometimes we, in our efforts to understand the local culture, can get it very wrong.  I understand there was a question that came up earlier in this week about Greg Mortenson and his book and his approach. I mean, if I can just give you a minute on what I think about that. I totally support what Greg Mortenson was able to do; in writing his book, he reached more Americans with information about what it’s like to live in a Pakistani village than anything any official has ever been able to do. It’s been read so widely. Sometimes the only thing many Americans know about Pakistan is from his book. But then we overdid it. It became required reading; Three Cups of Tea became required reading in the military. And then the notion that, ‘Oh well, all you have to do is go into a village, sit down, talk to the guys, ‘What do you want? You want a bridge, a school; OK. We’ll give it to you.’” And that’s how you win hearts and minds. That’s not Mortenson was saying. What he was saying is, you spend time doing it. You stay in the village for a long time; you figure out whether the first person that approached you and said, “Oh, I know what we need; we need a bridge,” he may not be that right person. He may be from the next village, he may be the least respected guy in the village, or wrong ethnic group, whatever. You have to spend time with the people to understand what’s happening. And that’s not what we’ve done. So what I’m trying to say here, is that in our effort to be culturally sensitive — and give our military credit; they really were. It’s not a bad idea. We’re just too impatient; we’re in too much of a hurry. Development is a long-term proposition. It’s not something you do for short-term victories and get out.

Q: Can we assume that when we pull out of Afghanistan, we’ll have major military cutbacks to Pakistan?

A: I think, and I’m just going to speculate here, and it’s not going to be pretty, I think when we pull out of Afghanistan, Afghanistan is going to, over time, slip into, revert, to another civil war. That the jockeying for power will be defined along ethnic bases. Every Taliban is a Pashtun; not every Pashtun is a Taliban. But they won’t have much choice when the Taliban have free reign, and that will not be accepted by the Uzbeks and the Tajiks and the other ethnic groups in the North. And we will see a repeat of the last time we pulled out of Afghanistan, because the security forces in Afghanistan are not yet able to provide a national security. And because Karzai is a very weak leader. So you’ll find that Pakistanis supporting the Pashtuns and the Taliban, because the other guys are going to be supported by India, and that will put greater strains in our relationships with Pakistan. So I don’t see a happy, an easy way out of this. So, are we going to cut back our assistance to Pakistan or increase it? I don’t know.

Q: Who represents the biggest nuclear threat to the United States: Pakistan, Afghanistan, India, China, USSR or small terrorist groups?

A: Small terrorist groups. One worries that — I mean, and it’s a long shot, and you do have to have worst case scenarios out there — you do worry that, if Pakistan were to slide into a country, maybe that a relationship with us that might look not too dissimilar to Tehran, in Iran, where our relations would break down completely, where our diplomatic community is expelled; there’s no embassy, and we’re hostile, and they’re nuclear armed. One would worry that there would be no controls over their nuclear arms, and that selling them for profit, like North Korea does, would be — we would face that. In fact, to answer that question, if I could add, what nation presents the greatest nuclear threat to us, I’d say probably North Korea, in the sense that it sells it.

Q: We’re hearing that Pakistanis themselves must affect change in their country, but if the majority of the population are illiterate, impoverished, how can we expect them to do that? How can we help them? What good would a people-to-people program do?

A: Well, only the people; I mean, not much, but you’re in it for the long haul, not the short haul, and so you start building those people-to-people relations now because you don’t want to waste time in doing it. I mean, if the questions were, what should the Pakistanis do? I could give you a clearer answer. But what we can do is very little, really. It’s got to be the Pakistanis themselves that implement tax. I’d start with a land tax; that would break up the feudal system. People would have to start to sell off their big holdings, if they couldn’t pay those taxes. I would change the curriculum, but we can’t change the curriculum; they must change that curriculum. But what we can do, we can do is to help them create jobs by lifting some of the really onerous tariffs that we place on their largest export, and that is textile and apparels. We have higher exports by multiples on Pakistan exports on textiles and apparels than we place on the French. Now you go figure. And that is something that inside government, we’ve tried to persuade the lobby, the cabal in Congress, but the textile interests in this country, it’s defending an industry that left a long time ago, is so strong that we can’t do the right thing.

Q: Any other hopes?

A: I hope you all have wonderful Fourth of July.

Nick Glunt | Staff Writer

As a pediatrician at an inner-city hospital, Dr. Helene Gayle found herself treating the same patients over and over.

These children weren’t necessarily facing a particular disease — their visits had more to do with their family situations, events they couldn’t solve on their own.

“After a while, I realized that if I really wanted to have an impact on these children,” Gayle said, “it wasn’t by practicing individual medicine.”

She started practicing medicine to help people, but said that if she wanted to have a “long-term impact,” she needed to do more. Having a say in the policies that affected large populations would make more of a difference, she said. Public health seemed to be the next step.

NPR foreign correspondent Charlayne Hunter-Gault interviewed Gayle on stage during the 10:45 a.m. lecture Thursday in the Amphitheater. While answering a variety of questions, Gayle expressed her views on poverty abroad.

Gayle is now the president and CEO of the U.S. branch of the Cooperative for Assistance and Relief Everywhere, a secular non-governmental organization dedicated to fighting global poverty. CARE USA generally focuses on the empowerment of women as a means to eliminating said poverty.

Global health and poverty

When Gayle first entered the field, the phrase wasn’t “global health” — it was “international health.” It was looked at more as a comparison between nations. Now, she said, it’s viewed as the world as a whole.

“Global health isn’t about poor people over there,” she said. “It’s about, ‘How do we all work together in a way that enhances everybody’s health around the globe?’”

She said one of the driving forces behind this shift in thought was the realization that diseases can spread between countries seemingly overnight. To improve the health of populations around the globe, she said, there needed to be global cooperation.

By aiming to develop countries out of poverty, CARE USA can increase public health.

“Poverty is a consequence of poor health,” Gayle said, “and poor health is a consequence of poverty.”

Health in developing countries is slipping in part because of a mass “exodus of medical professionals,” Gayle said.

In many of these countries, Gayle and Hunter-Gault said, doctors and nurses see opportunities for greater incomes in more developed countries. As a result, few remain inside the borders of their homes.

If these countries are developed, doctors will have more incentive to remain, she said.

Development by empowering women

CARE USA’s efforts against poverty are mainly directed at the female population in countries. This is only natural, Gayle said, after looking at the statistics.

She said 70 percent of the people who live on less than a dollar a day are women, and women make up two-thirds of the illiterate population. Furthermore, she said women work 50 percent of the world’s farmland, but only make 10 percent of the world’s farming wages.

“If you want to go and make a difference in poverty,” Gayle said, “you have to focus on girls and women, because they make up the greatest number (of those in poverty).”

She said that if women are educated, their daughters are more likely to get educated. Thus, women are more likely to have fewer children and to get married later in life. These are qualities that contribute to the development of nations, Gayle said.

Countries with more women in their parliaments have more stable governments, less corruption and higher economic growth, Gayle said.

She added that furthermore, women with extra income provide more money for their families as opposed to men, who are more “egocentric.”

Focusing on women can even help to combat AIDS, Gayle said. Safe-sex campaigns can reduce the spread of AIDS, which in turn can reduce poverty.

“When you talk about safe sex and safe behaviors,” Gayle said, “you have to remember that people have sex for all kinds of reasons.”

Women, she said, can be performing sexual acts in exchange for food, water or money. This just increases the possibility that AIDS will spread further.

U.S. donations and aid

Gayle cited a survey of the American population that asked about monetary donations to global poverty. Americans believed the nation gave 25 percent of its worth to poverty abroad, but they said they’d be willing to give about 10 percent. In reality, Gayle said, Americans give less than 1 percent.

However, America is seen as the most generous nation because the U.S. gives more money than any other. Gayle said there’s room for more generosity. One percent of incomes isn’t enough, in her opinion; she said there is more Americans can do.

“Money helps,” Gayle said, “but I think what people often don’t think about is using their voice.”

Even if Americans aren’t donating money, she said, they can pressure their politicians to distribute more to developing countries.

“It really is about coming together and realizing that to be a healthy world,” Gayle said, “we have to look at it in a global nature.”

Question and Answer for Helene Gayle and Charlayne Hunter-Gault

Q: Reproductive health continues to be a political football here in America. In terms of global health, please suggest strategies that will make everything from basic birth control to safe abortion available for women in the developing world.

A: (Gayle) Well, you’re right. Reproductive health continues to be a very delicate issue in many places. What we’ve tried to do is to talk about it less from the standpoint of a woman’s right or reproductive health, but more from the standpoint of good health. We know that a mother who is able to space her children is going to both be healthier herself as well as have healthier babies, and I think for many people that’s much less controversial than saying, “a woman’s right to choose,” or some of the other ways in which people talk about reproductive health. So I think we, and others, have taken the stance that if you talk to people about the safety of a woman and a child, you’re more able to get some common ground around those issues.

Q: Could you please give us an update on Ethiopia since 1985, in terms of the government, tourism and overall sense of progress?

A: (Gayle) I don’t know if I can do it justice. I will say, I think Ethiopia has a very, very interesting plan to accelerate its economic development, and it has a president who, some may say is controversial, but he has been incredibly innovative in his commitment to things like a clean environment. He has a plan. He’s a man with a plan. He says by 2015, I think, he wants to be a middle-income country. So Ethiopia is one of these countries that’s on the move.

A:(Hunter-Gault) Actually I do have something to say about that. All of what you’ve just said is true. Those of us involved in the free speech and freedom of expression movement would hope that the president would be a little bit more progressive in that arena. I have been to jails in Ethiopia where journalists have been kept for many, many months because of their outspoken criticism of, or an attempt to balance the political discussion in the country by giving voice to the opposition, which has landed them in prison, so we want to just help ensure that the president, while he’s being progressive on those issues, also becomes a little bit more progressive, as he promised us when we met with him, on the issue of freedom of speech.

Q: This one has the salutation of “Dear cousin.” What role has religion played in your work as you travel from one country to another? Is society guiding religion, or is religion guiding society?

A: (Gayle) Well, first of all, I want to recognize this row of all my cousins here. I looked up and saw some that I hadn’t seen in years. I’m not sure how to answer that. We are a non-affiliated NGO, so we are not affiliated with any church organization and have taken that stance partly because we work in so many different countries in which being aligned with one faith or the other can cause problems, but our background has always been non-sectirian; it’s who we are. I don’t know if I would say religion — the question was religion leading — that’s a broad question, and I think it really depends on the country.

A: (Hunter-Gault) I was having a conversation with the priest, (CLSC author Uwem) Akpen … and in the northern part of Nigeria, that’s definitely a problem and to a certain extent in Sudan and some of the other places where you have some of the more militant Muslim extremists trying to determine the direction of the society, and I think that’s a real challenge. I think that’s a real problem, and it’s very worrisome in a country like Nigeria, which has more Muslims in it than in the Middle East, which is not to say that all Muslims are militant and want to do some of the things that the extremists do, but the extremists are tending to give the religion a bad name, and I think that the more outspoken clerics, and others who condemn this kind of behavior, there needs to be more of that in order to confront this very real challenge in some of the countries, particularly in Africa, that I am aware of.

A: (Gayle) And I was reading that in a slightly different way, and maybe because I’m here in Chautauqua, and there’s so much focus on bringing different faiths together. I think ideally in a society where there is freedom of religion and people can practice whatever religion speaks to their heart or to their culture, then I think you have a society that is going to be free in a lot of different ways. So I was thinking of it more from that standpoint, and I think if you look at different societies when there’s this kind of extremism and where there isn’t freedom of religion and freedom of thought, then I think you have a very, very different kind of society, and I think it cuts across not just religion, but I think it cuts across many other things. I think a world like you’re creating here in Chautauqua, where there’s actually opportunities for people to talk across religions — I think opens up freedoms of all sorts.

Q: Would you please talk about the reaction of men in communities where CARE focuses on assistance to women?

A: (Gayle) Yes, good question. In the countries in which we work, we work very, very closely with communities, and one of my very earliest trips to Afghanistan, I think it was the very first country I went to when I first started at CARE, I would talk to men in the villages and they would say, “We like working with CARE because we know we can trust you. Because we know you listen to us and that you’re not going to try to get us to do something because it’s your way.” I remember, again in Afghanistan, during the time of the Taliban, when you were not allowed to teach girls in school. It was illegal to teach girls and women. Well, CARE’s school was able to stay open because they worked with the community to come up with a way that it was acceptable, and the men said, “Well, if you call it sewing schools, you can keep them open.” Now the teachers were teaching girls reading, arithmetic, etc., but as long as they called them sewing schools, it kind of gave them cover. So the bottom line is, whether it’s working with girls in communities, or whatever might seem controversial, it’s by working with those communities to come up with solutions that they find acceptable.

A: (Hunter-Gault) Can I just add to that? Because I saw this happening in the CARE project, micro-financing, in Tanzania, where the men were telling me how grateful they were that the women were participating and becoming economically independent, and it was actually affecting even the interpersonal relationships within families. The men were so much happier because they had income coming into the house, even when they didn’t have a job, but men were also getting involved in the micro-financing, so it has both community-wide implications but also implications for within the family. A much more stable economic situation was leading to a lot more stable relationships.

A: (Gayle) And just to add to that. The same sort of question I had when I first went to some of our micro-finance programs, and you would assume that this would be a threat, and over and over again, men would say, “No, in fact, my wife brings value to the family. I now respect her in a way that I didn’t respect her before.” So quite to the contrary, again, I think this focus on girls and women has really helped communities, and as I always say, the girl or the woman wins, but so do the men and boys, because it does change the way that they think of their sister or their mother in a way that’s positive for them as well.

Nick Glunt | Staff Writer

John Hamre, president and CEO of the Center for Strategic and International Studies, said in Wednesday’s 10:45 a.m. lecture that America’s future as a global leader depends on developing political health as foreign aid.

“There is just a profound disagreement on where we’re heading as a country with our politicians,” he said, referring to politicians on both sides of the spectrum.

Hamre, who is also a former U.S. deputy secretary of defense, presented “Charting a Development Agenda in a Time of Austerity,” the third lecture for Week One’s theme “Global Health and Development as Foreign Policy.”

Hamre offered a political angle, differing from the medical-focused lectures delivered by Paul Farmer, co-founder of Partners In Health, and Sandra Thurman, president and CEO of the International AIDS Trust, earlier this week.

Essentially, Hamre said the U.S. needs to work to earn the respect and popularity of other countries if it hopes to keep the nation secure. Foreign aid is the way to do just that, he said.

Looking into the past

Hamre’s evidence for this conjecture lies in the history of the U.S. — specifically, during the Cold War.

“At the time, we saw a long-term struggle that we had to mount against the forces of international Communism,” he said, “and we set ourselves about the task of developing a strategy to succeed. And that was not a strategy that was based on military might.”

He said the military force of the Soviets was too large for the U.S. to effectively compete. Instead, the U.S. turned to social tactics. The military was large enough to prevent “political intimidation,” he said, but the real battle lay in presenting more superior ideas than the Soviets.

“We would win the Cold War only when the rest of the world wanted us to win and saw our ideas as being worthy of support,” Hamre said. “That was the foundation of our grand strategy during the Cold War.”

These ideas that would win the Cold War included ideologies like representative government, free elections, free and uncensored press, rule of law by independent judiciary, freedom of speech and freedom of religion. This strategy, Hamre said, proved victorious.

Learning from history

After the events of Sept. 11, the U.S. developed strategies that Hamre said should be revised.

“On that day and the days that followed, America was shocked; America was frightened; America was angry,” he said. “We set about a set of policies, honestly, that may have been logical from our own emotional standpoint, but it was counterproductive to our national interests.”

Policies that formed out of emotional responses are still being followed, Hamre said.

He added that these policies, which inspired fear in the rest of the world, damaged the reputation of the U.S.

Then, a tidal wave in the Indian Ocean struck Indonesia in 2004. The U.S.-based Project HOPE provided a ship’s worth of doctors and nurses, but only if the U.S. Navy could get them there. Hamre was a part of forming this partnership.

“In the days after 9/11, America’s popularity in Indonesia was between 17 and 19 percent,” Hamre said. “After the earthquake and the tsunami, America’s popularity went up to 80 percent. It doesn’t take a rocket scientist to understand what this says: that when people see America doing what’s good for them, they have a different attitude about us.”

He said the U.S. shouldn’t be lending aid simply for popularity purposes, but it is a requirement in gathering support. If a nation believes it is not advisable to negotiate with the U.S., Hamre said, then that country is a target for a popularity boost.

Application to today’s politics

Hamre said that although foreign aid is not a popular concept among Americans, the U.S. is “hands down the most generous country in the world.” Americans donate six times more per capita than the second most generous nation in the world, he added.

Despite this, Hamre said, offering aid could boost employment in other countries. Afghanistan’s high unemployment rate should be seen as a threat to national security, he added, as it makes those people angry and vengeful. Aid could quell that unemployment.

Furthermore, a study conducted by the World Bank determined that only about 30 percent of a nation’s wealth could be attributed to natural and manmade resources. The rest is attributed to “intangible resources” like the national quality of education and the stability of currency. Hamre said these intangible resources are a direct result of good government.

“The private sector cannot build better banking systems in foreign countries. The private sector is not going to be building better courts and a rule-of-law culture,” Hamre said. “They take advantage of it, but they don’t build it — they can’t build it. These are things only the government can do.”

The government, he said, has to be involved in creating other governments. In contrast, the private sector must be involved in creating sustainable jobs.

To illustrate this point, he mentioned an anonymous food company. The company wanted better farmers for business reasons, so it hired 2,000 agronomists to teach its farmers better farming strategies. The company has now licensed more than 600,000 quality farmers.

The government, he said, would do a poor job at hiring those agronomists. He called the relationship between government and the private sector “a natural complementarity.”

Hamre’s suggestion

Military force, Hamre said, is an inefficient means. Instead, the U.S. must use social and diplomatic tools to remain on top.

In addition, the U.S. needs to “clean up its act” if it hopes to inspire other nations. Hamre met the president of Ghana, who told him the U.S. only gives him lectures, while the Chinese give him money. Hamre said simply talking about inspiration isn’t enough.

“I posit three very simple things,” Hamre said. “We’re trying to build or create healthier people, healthier communities and healthier countries. Now, that’s an agenda that either progressive left liberals or conservative Republicans can embrace.”

Q: What would you propose we do in Afghanistan?

A: I’m sorry; there’s so little time. I thought that would probably come up. Let me give a slightly longer answer to the question. I think it’s so important because it’s on everybody’s minds. My academic training is that I’m a realpolitik structuralist. I believe that there are global power structures that are in our interest that we need to manage. And for a global superpower, we should not get ourselves involved in an area or in a conflict where it takes enormous resources for us to influence the people in the region. We do not have central national interests in Afghanistan. That’s the reality. We got into Afghanistan probably for understandable reasons — the desire for revenge, a way to send a signal to the rest of the world that we won’t tolerate this sort of thing again. Those are the reasons we did this. But what happens when countries go to war is they lose track of what they’re doing, and they start to develop new agendas. The reality is that because we don’t have central interests in Afghanistan, but all of the neighboring countries around Afghanistan do, they have more capacity to manipulate us than we do to manipulate them. I mean, that’s to be very crass about it. So there is no outcome in Afghanistan that they won’t veto if it’s not in their interests. So there is no political solution. We could lose militarily in Afghanistan, but we can’t win militarily in Afghanistan. So we have to have a political solution. And no political solution will work unless it involves the neighbors. What we need to do, I personally feel, that we need to find a way to get out of Afghanistan, and as soon as we can, in a way that doesn’t look like we’re crawling out. It does matter how we get out. A friend of mine said rather brutally, “We will not kill our way to success in Afghanistan.” We will have to have a political solution, and the political solution has to reflect the interests of the neighbors. At one time we had a strategy that made that work, but then we lost track, and we need to recover that. I think we have a little bit of time to get it together, and I think it ought to be our highest priority.

Q: What is the actual percentage of our budget in foreign aid? We would like to see a return on investment; how do we measure return on investment?

A: Foreign aid is — I wish I had the right number — something like $45 billion as a percent of the overall budget. That’s maybe 1 percent, maybe 1.5 percent. I have to say, so much of this is earmarked for two countries, for Israel and Egypt. It was part of the agreement to get them to stop fighting each other. So it is not nearly as much money as people think it is. The size and the amount of the money is quite small in percentage terms. How we measure success is a big issue. And again, I think we have too much of a focus on foreign assistance in that it has to create the jobs. I don’t think that should be its role. I think foreign assistance should be to develop quality institutions where they work with a private sector to build sustainable employment. And I would substantially reshape how we spend the foreign assistance. One of the great contributions of President Bush Jr. was the creation of the Millenium Challenge Corporation. The Millenium Challenge Corporation is designed to be a critique of AID, and it was designed to ultimately replace AID. But at its core, the philosophy was that we will give larger blocks of money to countries if countries prove that they are developing quality institutions to make sure the money’s well spent. That’s not a bad agenda. That’s a good thing. The problem is they only picked the winning countries. They didn’t pick the losers, and frankly, losers need as much help as the winners. So we need both the Millenium Challenge Corporation, and we need aid. We need to reshape this so that it’s about creating quality institutions, and our government frankly has to figure out how to cooperatively work with the private sector. We’ve gotten in a bad way in Washington where our government thinks it can’t talk to the private sector because it might be a conflict of interest. Give me a break. That’s what government is supposed to do. They’re supposed to help build jobs. They’re supposed to build the economy. That’s a good thing. So we’ve got to change our thinking in the government too.

Q: Can you or can’t you give this talk to Congress?

A: Well, they won’t ask me. And I would give it to them. I have had conversations with individual members of Congress. I have absolutely no problem saying publicly what I’ve said to you here. I thought this was public. The problem with Washington right now is Washington is a giant self-licking ice cream cone. It’s just enjoying itself. And I think it’s completely decoupled from where Americans are. And I think a good example of that is the deficit discussion. There isn’t an American who doesn’t know that the only solution to this is going to have to involve both cuts in entitlements and increase in taxes. And yet we’ve got two political parties that are both playing games with their base so that they can hold the loyalty of their base when they go to the next election. Well, frankly, its not their base that will going to get them elected, it’s the center centrists that will get them elected. At some point, we’re going to have to let honest judgment trump tactical political politics.

Q: How can we justify spending so much money in other countries when we have such huge needs ourselves for health and education?

A: Well, we do have huge needs here; there’s no question about that. But if we had 11 people who undertook a clever terrorist action, it probably forced us as a nation to spend $2 trillion. I would rather find a way to spend a couple of tens of millions of dollars or a couple billion dollars over time to remove that problem, because we took ourselves over the cliff with how we reacted. And we are going to do that as a nation. So let’s find sensible ways to spend our money that helps our national security interests. I only recommend this because it’s in our national interests. While it may speak to my religious convictions, I’m here today as the former Deputy Secretary of Defense to say that this is in our national security interests.

Q: Will existing NGOs be able to fill the gap created by reduction in government aid?

A: No. NGOs play an absolutely essential role, and I should have mentioned them. I was inadequate in my presentation. I think the profit-seeking part of the private sector and the non-profit-seeking part of the private sector and the government play essential complimentary roles. They cannot replace each other. NGOs, like businesses, are not going to create rule of law. They can contribute to civil society, which becomes a foundation to sustain rule of law, but they cannot create it. NGOs play an absolutely crucial role, but they are not a substitute for government. And the profit-seeking part of the private sector is not a substitute for the government where we need the government to do its work.

Q: If you were the president of the United States, what are the first three major actions you would take?

A: Oh, gosh. I believe that American citizens are actually a lot smarter than our politicians give them credit for, and so that an honest discussion with the citizenry about what we’re facing would receive a positive response. I hate to be saying this, but I thought President Obama made a huge mistake to reject the Simpson Bowl’s commission. I thought the Simpson Bowl’s commission layed out a sensible pathway forward to start eliminating the deficits, and I thought the president failed by not embracing it. It would have been politically risky, but I think it’s something we should have done. And I think it’s still going to be required at some point. So I think an honest discussion with the American public about what we’re facing and what we need to do would actually be welcome by the public. That would be the first thing. The second thing I would try to do is to change the public sentiment we have on terrorism. We have created the image in our public’s mind that anything bad that happens is an existential threat to America, and that’s not true. Let me set aside the case of nuclear terrorism, because I think that is genuinely an existential risk to the country — maybe not to the nation, but certainly to our democracy. But for normal terrorism, it would be a bad day, but it’s not going to be the end of America. I believe we rewarded the terrorists of 9/11 over and over and over again by the way we distorted ourselves in fear. I don’t know how many of you travel and have visited the new embassies we’re building overseas. It’s so disappointing. These are giant enclaves surrounded by nine-foot-high, fortified walls. They’re often in the suburbs, so they’re isolated from the population. What does that say about America? It says we’re afraid; we’re frightened; we’re a frightened little nation. I mean, this is pathetic. We’re rewarding terrorists all over again by our behavior, and we need to change that. But unfortunately, we have the two parties each trying to look like they’re more for homeland security than the other guy. And that means no dumb idea is too dumb to propose. We’ve got to change that narrative. As long as I’m getting myself in all kinds of trouble today, the third thing I’d try to do is I would try to change our narrative about immigration. I could ask for a show of hands, but I don’t think it’s necessary. How many of you had a grandparent or a great-grandparent that came from another country? It’s everybody. That’s what we are. We are in a good country. It’s the reason why we’ve been such a successful country, because people with energy and hope and a tremendous amount of imagination wanted to come here. Tell me another country in the world that has had this benefit and this privilege. It’s the reason for our huge success, because we became a welcoming nation to people who wanted to improve their own lives. How lucky can we be? And yet what have we been doing? We’ve been sending out signals that say somehow we’re afraid of people who want to come here to work, that we’re afraid of somebody who’s different from us. We’ve got to change that story too. I think we should start the religious service.

Q: What percent of U.S. foreign aid actually goes to foreign countries and their business versus American corporations and contractors?

A: I don’t have the facts. I’m poorly prepared to answer that question. When we first started off giving foreign assistance, we were giving money away to other countries, but they could only buy stuff from us, so it was fairly a self-serving thing. There was a time when Japan foreign assistance was putting up a television tower in a country so people would buy SONY TVs. It’s that kind of a thing, and we used to do that. We’re a lot better than that now. We do spend a lot more of our resources now on organic support. We’ve learned our lesson for that. In the old days, we gave foreign assistance, but it was really kind of a subsidy to ourselves, and we’ve learned from that. By the way, I think that’s one of the most common things I hear, how ominous it is to hear about Chinese development. Well, frankly, they’re doing it wrong just like we used to do it wrong. You see what Chinese development is around Africa. It’s Chinese enclaves bringing their own food and bringing their own cooks. They don’t interact with society at all. So we shouldn’t be afraid of Chinese development in any of these countries. It’s really about them. It’s not about the recipient. We’re better than that, but we’re still not doing what we should be in my view.

Q: What position would the United States need to take that would indicate to the countries or other parts of the world that we are a worthy partner for them to achieve their goals for their people?

A: First thing I would say, I think America has become very tiresome by giving lectures all the time about how inspirational we are. And I think we would do a lot better to stop giving lectures about how wonderful we are and how inspirational we are, and I think the best thing we could do to be an inspirational power again is to clean up our own act. I mean, it’s pretty hard to be an inspiring power when we have to borrow $5 billion a day from the rest of the world to sustain an inflated lifestyle. That is not inspirational. That looks selfish. I do think getting our own house in order is an exceptionally important thing for America’s reputation in the world. That would be the No. 1 thing. Second, we’ve unfortunately allowed so much of our foreign assistance to be subject to political manipulation here at home over things we think are important so we tie strings to things. We’ve made a lot of foreign assistance kind of unpredictable and unreliable. I remember talking with the president of Ghana. He came to my think tank when we had an event that commemorated Ghana receiving the Millenium Challenge Award, and in a small conversation beforehand, he said that, “You Americans give me lectures, and the Chinese give me money.” There’s something to that.  We’re so busy giving people lectures and tying people’s hands. Let’s clean up our own act, provide ways to help them improve their quality of government and then let’s encourage our corporations to work with their corporations to build real and sustainable jobs. I think it’s pretty simple.

Q: Is the influence of industry and business in our government more than in our electorate?

A: I have a very different view of this. Are there corrupt influences in government from business? Yes. There are only three ways that societies make major decisions. One is through prices. You’re going to sell something for a product level, you’re going to buy it, and you let the marketplace decide what to do. So one way is through market pricing. The second is through administrative procedures. You agree in advance what the rules are going to be, and then you establish structures to help resolve differences, and you put them into an administrative structure. There’s only one other way to make major decisions, and that’s politics. Politics is about making decisions where there are no structures in advance that you can turn to to help you make decisions. Politics is an essential and positive dimension of society. The foundation of politics is the clear understanding and balancing of conflicting interests. You cannot insulate yourself from interests and be effective in politics. And yet we’ve approached ethics in a way that somehow we can have anybody that has an interest in something be involved with the government. I think this is crazy. The only people who are going to be allowed to consult the government in the future are the people who don’t know anything about the subject. And that can’t possibly be in our interests as a country. So how do we deal with that? Well, we deal with that in two ways. We deal with it by transparency, you know, declare your interests so that we know what your motives are, so that we know what your interests are. Then we have to create structures where we have competing interests that are at the table at the same time. When politics gets distorted is when people do things secretly, and only one small group is at the table. Now that is bad. We have to fight that. But we don’t fight that with the way we’re currently approaching ethics in government. The way we’re approaching ethics in government is that we can’t let anybody that knows anything work for the government. And that’s going to be to our long-term detriment. We’ve got to fix that problem.

Q: Can the U.S. economy accommodate the return of all the soldiers in the existing unemployment situation we have in our country?

A: First of all, we’re not that big a military anymore. We’ve got 1.4 million people in uniform active duty, about 700,000 in reserves. We’re not going to dramatically change that. We’re going to bring them home. But we’re still going to have a fair number deployed overseas. We’re not going to be able to afford quite the same size military as we currently have with the budget constraint we’re facing. I personally don’t think we ought to make defense the leading part of budget cuts, because I don’t think it can solve the answer. Defense is going to have to be a part of it. I don’t think there’s going to be any question about that. But I don’t think it ought to be the leading part, because in all honesty, we do live in a dangerous world. We ought to be very prudent and very careful on how we use force. There are times when we have to pick up arms to protect people we love and ideas we care for. We have to be prepared to do that. So finding a sensible balance between how big a military we want and how we use it is the question in front of us. If we are going to cut the size of the military, we’re talking about maybe 100,000 personnel, something like that. I don’t know big it’ll ultimately be. But that’s a small fraction, and these are exceptionally talented people. Let me give you one example of that. If you take the best corporations in America with the best talent, on average, 1 percent of their executives will have a master’s degree. You go to the United States military, 7 percent have master’s degrees or (higher degrees). It’s an exceptionally talented group of people. Our NCOs, which are really the backbone our military. It’s the core of our success. These are exceptionally talented people. It used to be rather crude individuals. That’s way in the past. I know master sergeants that have two or three master’s degrees. These are talented people. So they’re going to do well in our society. Sadly, our recession is going to hurt a generation, but it’s the lower quintile generation, a segment of American society. Our military is not in the lower quintile; they’re in the upper quartile.

Q: What is the point of giving foreign aid if we have to work through corrupt governments?

A: I think the question is, do we use our assistance program in a way that over time builds better government? And let me point in that regard to Korea. For reasons of our geopolitical competition with the Soviet Union and with China, South Korea became our ally. It was certainly not a democracy for the first 20 years. It gradually became a vibrant democracy. We were partnered with them, and we systematically helped them work through to see a better structure for their own society and their own government. And it’s been a huge success. It takes a long time. And of course it was successful because it had an overarching problem that we were willing to close our eyes to some failings, but that’s because there was a larger challenge we had to deal with, and we made it a success. I think the great challenge we have now is when we’re involved in a situation where our national interests are somewhat in conflict with our national values. And that certainly was the case when we were involved in Bahrain in the spring. We certainly can’t afford to have the current government of Bahrain unhinged. The power geometry of the Persian Gulf depends on them being solid and in place. But it’s hard to see how they remain solid over time when 65 percent of the street is in protest with their own government. We have a tension here. The problem is that you confront this dynamic, this tension, at a moment of maximum crisis, and that’s of course when you have the least degrees of freedom to solve it. So I think we have to get through the current moment, and we have to try to work with countries who we need them to be successful, and we need them to adopt more progressive policies concerning their own citizens. This is a standard problem we have, I think.

Q: How can the U.S. foster multinational funds and objectives? I’ve got several questions about the European situation and how much we need to intervene in Greece. As much as we’d like to be 50 years old and get a full retirement, can we let them make that decision with multinational support?

A: On the Greece situation in general, I mean, I understand the anger that people feel about the undisciplined nature of the Greek economy over the last 20 years. And that’s painfully now coming home. That has to get sorted out. Frankly, I think we’re very fortunate that Papandreou is currently the prime minister, because I think a socialist prime minister has a much better chance of selling bad medicine, hard medicine, than would a conservative prime minister. I think that’s working out. It’s painful. It’s very difficult. Terrible pictures in the paper this morning, you probably saw. It’s going to be hard, but gradually we’ll get through that. Let me try to address the larger question of multilateral cooperation. This is a hard thing for Americans, because it’s when I meet with Europeans and when they were most angry with us back in 2003, 2004, at some point in the conversation, they all said, “Look, we all share common values.” And I would tell them, “We do except in one very important way.” Everybody in Europe had a chance to leave and decided to stay. Everybody in America had a chance to stay in Europe and decided to leave and come to America. There’s a pretty profound difference when you think about it — really a big difference. It’s the source of the great divide between us American unilateralists and European multilateralists. In this country, the attitude is: If you don’t like your situation, get off your dead butt and do something about it. It’s up to you. We’re not going to do it for you, right? That grows out of the fact that our culture springs out of people that left their home and chose to make a new one. It’s up to you. The Europeans, they decided they wanted to stay, but after 300 years of killing each other, they said, “We’re not going to do that anymore, so we’re going to work this out.” It was a profound impulse toward multilateralism in Europe that we don’t understand. It’s kind of hard for us to figure it out. It’s like, “Get over it. Do it.” Well, it’s not quite like that, so it’s hard for America. This is what I think is one of the great tensions we have, to be the global superpower, but to be honest, we can no longer do it on a unilateral basis. We’re going to have to grow up a bit. We’re going to have to moderate some of our impulses a bit, and we’ll push others to get out there and do some things with us. I think one of the easy and great problems of multilateralism is that there is endless opportunity to look for an excuse not to do something. Multilateralism gives you so many reasons to do that, so we have to strike a balance here.

Q: Two days away: the birth of southern Sudan. What do you believe will be the United States’ role in helping secure the safety, wellbeing and independence of this new country?

A: This is a huge issue; it’s underappreciated. Looks like some modestly good news today. The news over the last two months has been very dark, very troubling. Modestly good news, as I said, in today’s paper. Very few Americans really know about the tragedy of Sudan. This is a country that was involved in a 14-year civil war. If you were to take the civilian losses in Sudan and scale them up to American population standards, it would be the equivalent of losing 15 million Americans. It’s just astounding how awful this has been. We were instrumental in helping to broker a reconciliation process between the North and the South, but then both sides, for different reasons, chose to not move the agenda forward constructively — both sides. And so now we’re on the edge of a radical new political arrangement, and the instinct is to go back to fighting, and of course, that would be a very dark and bad thing. The central dilemma is this: all the oil in Sudan is in the south, but it can’t get to the market unless it goes through the north. Our argument to them has been: You both die together or you both live together I mean, you’re going to have to chose. You know one path and it hasn’t been very good. So you have to find a path where both of you can prosper together. Yeah, you have all the oil in the south, but you can’t get it to market unless you go through the north. You’re going to have to find a way to work together. We have a more active engagement strategy now than we’ve had in the last six years. It’s very last in coming. As I said, I think the news today is somewhat more optimistic, but it could break down easily. The south new government is incredibly immature … It just doesn’t have life experience to be a government, so running a government is very hard for them. Fortunately, several of the Nordic countries are being quite helpful in mentoring them. This could become a bad thing, and again, isn’t central to our interests; it’s really more to our humanitarian impulse that we really try to help here. But you could also say it is in our interests not to let portions of Sudan — and the Trans-Sahel region is increasingly like this; it’s becoming the new Afghanistan — where it becomes the lawless area where radical terrorists elements can operate freely, and that’s not in our interests, so we do want to try to help solve the problem.

Q: Please comment on the role of culture in foreign aid — both by how to decide what we need to provide to a country, and also what limits to place on exporting American cultural norms.

A: This is where I said, rather elliptically, we have a bad habit where we tend to let our domestic politics infect our approach to foreign aid, and we tend to do it in this area more than others. I think we do a reasonably good job of keeping it in check, but I think the efficiency of our expenditures is significantly diminished because of it. I would, again, like to argue we would be a lot better off if we spent the bulk of our foreign assistance on the government helping other governments develop quality institutions. That doesn’t mean we have to embrace our form of democracy, but they need to have some form of representative government, some rule of law. They can decide what are the norms they want to put into their laws, but there needs to be a rule of law. We could do that, and I think we could free ourselves from a lot of the battles that are waged on, kind of, the cultural attributes of foreign assistance, which tends to become an increasing problem, but again, it’s part of our domestic politics; it’s what it takes to get a consensus in Washington in order to get a bill passed, and that’s part of our problem now.

Q: What kind of a moment might we need to assert our global leadership again? We don’t want to have another attack like 9/11. What could we do? What could we create? What’s our possibility of global leadership?

A: Well, I think America still has an enormously popular image in average people’s minds around the world. If you were to get any citizen in another country say, “I can guarantee you a free Visa to the United States if you want one,” the line would be endless. People still see this as a land of personal opportunity. I dread the idea that it would be some security crisis again, because I’m afraid our domestic politics would push us more towards the angry response we had after 9/11 than it would towards a large and generous spirit. I would hope it wouldn’t be that. It’s one of the reasons why I do think we should have a homeland security program, is just to try and moderate our own impulse. If we were to tidy up our own house — it’s not unlike our own personal lives. We all know we need to lose 15 pounds… We all need to get our finances in better shape. We all need to have more modest expectations for what it takes to be a quality life. I mean, who the hell needs 30 suits in the closet? I only wear one at a time. If we were just more measured, I think we would easily restore our own sense of confidence. I think America is best when it is confident, but not overconfident. I think we need to work on that at home. I think we could do that. I’m weary of grand episodes that will create it for us.

Q: This last question actually starts with your question. You came here to talk to thoughtful people; we think we are. How do we make an impact other than “losing that 15 pounds?”

A: Well, let’s be honest. We’ve got the politicians we deserve, because we are not positively engaged in politics the way we should be. We should be demanding more of our politicians. We expect them to be quality people, and yet, we treat them poorly. We get disgusted with what we find; we walk away from it. I’m completely optimistic about America in every dimension except our politics, and so I think that starts with all of us. We have to be more engaged; we have to be more demanding of quality people. Don’t just be disgusted when your representative says something dumb; tell them. This has got to be more of an interactive process, because right now, too much of the politics in Washington is shaped by highly engineered interest groups that have turned Washington into a fishbowl that’s just isolated from America. I think it means ultimately that we have to be far more engaged. You need to tell them if you think they’re doing the wrong thing, and you need to tell them thank you when they’ve done the right thing. I think it would be helpful to all of you if you find people that are like you — sensible, thoughtful people that want a better America and a more positive American role in the world, to let that be criteria that you say you’re going to value your politicians by. This is a long-term recovery effort. But we can do it. That’s what this country is about. We’ve had episodes like this before, and we’ll get through this one too.

Nick Glunt | Staff Writer

Tuesday’s lecturer Sandra Thurman, president and CEO of the International AIDS Trust, quoted Martin Luther King Jr. to convey her views on global health diplomacy: “We must learn to live together as brothers or perish together as fools.”

The International AIDS Trust is a non-governmental organization that focuses resources to aid the worldwide battle against AIDS. The organization must overcome cultural and religious barriers abroad to take preventative action.

Thurman served as the director of the Office of National AIDS Policy under former President Bill Clinton and has been a leading advocate in the struggle against AIDS for two decades. She was the second speaker for Week One’s topic on “Global Health and Development as Foreign Policy.”

The U.S. Global AIDS program started forming in 1997 under the Clinton administration, Thurman said. The main problem at the beginning was that therapies to combat AIDS were very expensive and complicated
in use.

“There was a lot of doubt whether, No. 1, we could afford to treat people in the developing world,” Thurman said, “and No. 2, whether we could actually do it.”

She credited people like Monday’s speaker Paul Farmer, one of the founders of Partners In Health, in proving that treating underdeveloped countries is entirely possible. She said that oftentimes, people in those less fortunate countries are more willing to accept treatment than those in the developed world.

Though the phrase “health diplomacy” has only recently taken hold, Thurman said people like Farmer have been practicing it for decades. It is now an emerging field of practice in today’s world.

“Health diplomacy,” Thurman said, “provides an opportunity to both proactively and systematically provide interdisciplinary training of health and development professionals and diplomats to dramatically improve the delivery of health care services, development assistance and scientific research.”

Global health as diplomacy

Thurman said that in addition to simply lending aid to those countries, such treatment has created peace in situations of war or unrest.

“The fundamental importance and power of the provision of health services has stabilized situations where politics, frankly, has failed miserably,” she said.

Assistance to health and development can act as the initial steps to “building bridges” between nations, quelling human suffering and creating peace, Thurman said. She posed the worldwide eradication of smallpox in the 1960s, when it was believed that between 80 and 100 percent of the global population needed to be immunized, as an example of such diplomatic action.

Thurman mentioned innovations made by Jim Grant, head of UNICEF from 1980 to 1995, as inspiration for the coming years. Grant sparked a “revolution” to increase child immunizations in developing countries to 80 percent, resulting in 100 million immunizations in China in two day’s time in 1993.

Under former President Jimmy Carter, Grant also discovered that the U.S. could negotiate ceasefires in warring nations like Sudan to provide health care
to children.

“Those people in those countries actually care about their children and families just like all the rest of us do,” Thurman said. “They were willing to find a way to lay down their guns and arms for a number of weeks so that teams from all over the world could come in and actually care for their children.”

Thurman said this is an important lesson. Children are, as she calls them, “the Trojan horse of public health.”

By focusing efforts on the children of the world, people are much more willing to comply with health care efforts.

Facing roadblocks

Thurman said religious and cultural barriers can be detrimental to the development of proper health care practices in these countries.

Sexual behavior is perhaps the most prevalent of these barriers, she said. Misusing or disusing condoms, having multiple sex partners and not being circumcised are some specific practices that increase the spread of AIDS.

To encourage preventative measures, speaking with religious leaders is key, Thurman said; however, she fears it will never fly in some places like Kenya, Tanzania and Uganda, where openly gay men have been murdered by conservative religious sects.

Even in America, there are situations where religion has blocked preventative actions against AIDS. Thurman recalled one particular event at which she bought condoms for the Atlanta-based Sisters of Mercy because they couldn’t let condoms show up in the records. They bought her office supplies in exchange.

She said this is an excellent example of diplomacy “finding ways over
and under.”

To solve issues in developing countries, Thurman said undergraduate and graduate degrees are now regularly combining public health with diplomacy, theology, law, business and development. To influence change, professionals need to have the tools to understand the religion and culture in the places they will work.

“The new cadre of students entering health science training institutions today are going to be the leaders of this work tomorrow,” she said. “We need to make sure we’re giving them the knowledge, support and training that they need to be effective.”

Looking to the future

Thurman said it is necessary to utilize clear, deliberate and thoughtful engagement to solve the grip of AIDS and other infectious diseases.

“All of these kinds of activities require leadership, creativity, maybe a little bit of deceit and investment at the highest levels of politics, academia and the private sector,” Thurman said, “to maximize our efforts on the ground and the fight against diseases all around the world.”

Q: Can you talk a little bit about the coordination among all of the players in this realm? When you think about now, when you have major foundations coming into the game, a number of different countries and agencies that have been doing this work for a long time, how do you all pull together, understand what everybody is up to, and be most effective as a coordinated group?

A: I think it would probably be easier to describe ways that we don’t get along than we do get along. But the fact of the matter is that this is a place where, I think, UN structures actually work. It provides a framework for us to share information as nations and individual agencies in a way that no other framework actually gives us the capacity to do. I think we’re doing better. There’s a current initiative inside the State Department, which has been championed by Secretary of State Hillary Clinton, called the Global Health Initiative, that is making an effort to pull together all of the global health programs inside the U.S. government. This includes the Department of Defense, obviously USAID, CDC, the President’s Emergency Plan for AIDS Relief and others. Although it’s a real challenge to do that, Secretary Clinton has hired a very strong-willed woman — who was from the private sector in health care — who is doing a really good job of cracking the whip and carrying a chair. She might need some other weapon before it’s all over, but she’s doing an extraordinary job of beginning to find ways that we can pull together our U.S. government partners. The wonderful thing that has happened with the growth of the Gates Foundation, as others, is that they have a convening power that almost no one else does. They’re seen as objective, for the most part, partners in this work. They’re funders outside government, so they actually do fund a lot of the same programs that these government agencies fund. They’ve played an important role, and I think almost a moral authority, for those agencies and seem to be doing a good job of calling them to task. We still have a lot of work to do, but I think we’re doing better. UN seems to be the best structure for that to happen.

Q: Is there an inverse relationship between private philanthropy, global health care dollars and government responsibility? Are we simply shifting responsibility from the government to the private sector?

A: I think that, and my hope would be, is that we’re not trying to shift responsibility from the government sector to the private sector. Although in these fiscal times, it’s going to be very difficult for us to maintain our current levels of spending in global health and certainly to get increases in certain areas in global health, what I think is happening is that with the commitment of the Gates Foundation — and again, many others — what we’re seeing is increased pressure on government to actually continue to invest and shift some of their investments to global health from other programs. I think that’s very important, because these donors — both in the non-governmental organizations and in the big foundations — have a tremendous amount of political clout. They’re using that to keep pressure on the government to invest in global health and not so much in defense and other activities. I think they’re playing an important part.

Q: I have two questions in the few I’ve seen so far that go to the issue of the anti-vaccine, anti-immunization movement and what effect it is having.

A: It has had a tremendous effect. Part of our challenge in Nigeria, around polio immunization, was related to the myths that have evolved in this country about vaccination: That vaccination was going to make their children sick, or poison them, or all of these kinds of myths that are floating around. It hasn’t had a huge effect yet in global health, but I’m really concerned about the impact that it’s having domestically, where we see dramatically declining rates of immunization in our children. Of course, the good news is that in most school systems, you can’t put your kids in public school — and I would imagine most private schools; our kids went to public school— without having a certificate of immunization. I think there’s a push back against that, but it’s a place where we need a tremendous amount of education. You’ve seen this happen in AIDS. We forget that we have to continue to educate people, over and over again, as new generations marry and have families and children. We need to make sure that we’re continuing to educate people, even if we make the assumption that people have information already. I think it’s, a tad bit, our own failure in that regard. Aside from some of the myths that we saw around polio immunization, I think that we are doing better, but it is an issue.

Q: Let me follow up with this question that goes to religious and cultural barriers that you encounter. How do you solve them without offending or making enemies of the people you’re trying to help?

A: Well, that’s hard, and I’m not sure that we’re always successful in doing that, but I think it’s part of the reason that it’s so critical that we educate our practitioners, either in diplomacy or public health, in the cultures and religions in which they’re working. We’ve seen this in Kenya; we’ve seen it all over Africa: issues relative to sexual behavior, the use of condoms, multiple partners, sexual practices that put people more at risk. Circumcision is a big issue, more tribal than religious in Africa, but there is a big push to circumcise men in some areas because it reduces the rate of infection in those populations by as much as 30 percent. But adult circumcision is no easy matter, so we’ve had to do a lot of work in educating people. I think we’re making some progress. Engaging religious leaders upfront in conversations about these issues is really important. But, there are some places where I think we’re never going to make headway. We’ve seen that, of late, in Uganda, Kenya and Tanzania, where openly gay men have been murdered as sort of a religious act. Both Muslims and Christians in those communities — very conservative Muslims and Christians — have been a part of that violence. I think there are some places we’re going to have to understand that we aren’t going to make great inroads, but those are the fringes on either side. I think we have a good chance — in conversation, dialog and partnership — of finding ways around these issues. One case in point that I experienced early in my career was working with the Sisters of Mercy in Atlanta. We have Sisters of Mercy doing the same thing in other parts of the world, and I won’t name it because I’m sure their bishops will be cranky. I found a way to help the Sisters of Mercy buy condoms when I was Executive Director of AID Atlanta. They obviously couldn’t put that on the books, but they were serving the homeless and the poor. I bought all the condoms, and they purchased all of my “office supplies.” Again, it’s all about the diplomacy: You have to find ways over and under; that’s what diplomacy is. They would come down in their little white van, with their little red cross on the side, and offload all of their pencils. I’m sure that people who were running the Mercy health care must have wondered what in the world they were doing with all of those tablets, pens and erasers. Nonetheless, they were getting their condoms. They still may be doing that to this day — I’ve been gone awhile. Anyway, I think there are ways we can find common ground.

Q: Let me ask these two questions together. Should we be attacking one disease at a time? The questioner said, “I’m hopeful we can provide comprehensive care.” And where do you see the U.S. playing a role in combating chronic disease abroad, infectious diseases and everything?

A: It’s absolutely true. A couple of things: I think that we can, absolutely, look at treating diseases and preventing diseases across the board. We’ve actually now used our platform of the President’s Emergency Plan for AIDS Relief to expand to reproductive health services, to maternal and child’s health, to immunizations, to other service prevention of mother-to-child transmission of AIDS, from mothers to babies. We’ve used the platform we have built to combat AIDS to now expand to provide other health services. We actually did some of that back in old immunization days, too — built some health care capacity on top of that. But this is the biggest effort we’ve ever had. We are now building out those programs to address other diseases, and that’s part of what the global health initiative, inside of the State Department, is trying to actually do. I think that’s important. The other thing is that we really do have to look at chronic disease. At the end of the day, chronic disease is killing more people than other diseases are. Both here and abroad, we need to be building on existing platforms to address diseases like heart disease, diabetes, cervical cancer, which we’re actually now doing in conjunction with some of our AIDS programs. We’re moving in that direction. But until we slow down these killers that we know we can actually stop, or at least reduce dramatically with relatively few dollars, we need to do that. The fact of the matter is that chronic diseases are a lot more complicated and expensive to treat than engaging in prevention, if we know we can actually stop a disease from happening. Dr. Foege used to say, “No one ever comes up to you and thanks you for preventing the disease that they never got.” It’s a difficult challenge.

Q: What role are the drug and medical supply industries playing in your work?

A: Actually, they have played a major role in this work. We’re actually at a point where drug companies have dramatically reduced the cost of drugs to people in this country, and more importantly, to people in the developing world. We had negotiations with drug companies, through the World Trade Organization and others, about a decade ago, to actually allow us to buy drugs for delivery in Africa that were generic, made in other countries, and not off-patent. That was a huge success. You know, they don’t like to budge on those issues. Medical manufacturers of test kits and other devices have dramatically reduced their cost. Many of them are making very large donations of their goods to clinics, both U.S.-funded clinics and non-profit clinics all over Africa. It took them awhile to step up to the plate, in my personal opinion. I apologize to any drug executives who are in the audience. My personal opinion is we can still do more. We’re looking at the bottom line of those companies and they’re still functioning, making great profits in the billions. I think it would be nice if they would share a little bit of that, but they’ve been very good in recent years in stepping up to the plate.

Q: A couple of questions go to economic equalities and the relationship between the work and the benefit of improving peoples’ health when their economic situation remains less than satisfactory.

A: It’s interesting. It’s a challenge. People’s health becomes a chicken-and-egg situation. If people are suffering from chronic disease or infectious diseases, they can’t work, the children can’t go to school, the parents can’t work on the farm, they can’t send the children to school if they have no income, the children end up falling farther behind, girls wind up engaging in transitional sex, being sold or being abused because they don’t have any income. It’s a very vicious cycle. So at some point in time, I think we have to take a dual strategy. We have to look at providing economic development, support as part of a public health strategy, but that’s long-term, because the majority of the people in the world, as we know, are very poor. It’s a dual strategy; it’s not an either-or proposition. We have to do this hand-in-hand. But if people are sick — or if they have AIDS, or if children’s parents have died of AIDS and they’re caring for four siblings of their own when they’re 12 years old — if we can’t do something to at least keep them healthy, we won’t be able to get very far. If we can keep them healthy, we can at least give them hope. We may not be able to stop poverty at that moment, but if we can keep them healthy, we can at least give them hope that there is a better future. That’s what we’re trying to do, but it’s a delicate balance.

Q: A returning Peace Corps volunteer asks, “Have you involved the Peace Corps in your common-goal efforts?”

A: Absolutely. The Peace Corps is a primary partner of the President’s Emergency Plan for AIDS Relief. We’re now actually educating and training the majority of Peace Corps volunteers, who are working in places hardest hit by the epidemic, in HIV and AIDS activities. Almost every Peace Corps volunteer I’ve meet in Africa is engaged in some kind of HIV and AIDS and other health-related activity, whether it’s mother and child health, neo-natal care, taking care of infants or clean water. They are a major, major player and a very important player because these are folks that are actually living on the ground in community, where those wonderful relationships are developed. These are not people who parachute in — in a suit with goggles or a bag or with this and that — and then, 24 hours later, they’re gone. These are people who live, work and become part of the community. So they are really our best advocates and our best educators.

Q: How have Middle Eastern countries, including Israel, responded to the global health care crisis?

A: It’s interesting; it’s a much more difficult place to work. Obviously, there are resources in many of those countries that are being spent internally on global health issues. Around HIV and AIDS, it’s been very difficult to work in most of those countries because talking about sex, talking with women about reproductive health, even maternal and child health, is a particular challenge in many ways.
But we do see some countries that have done enormously well, like Jordan, which has made maternal and child health and reduction of maternal mortality a priority. That country is really focused on women’s health, which is interesting. But of course, Jordan is not necessarily reflective of some of the other countries in the region. That continues to be a challenge, although many of those countries now have state-of-the-art health care delivery systems. Universities all across the U.S. are partnering with those institutions to expand that delivery capacity. We’re hoping that the situation there will be better.

Q: Can we hear an example of partnership work in a particular country? The questioner suggests AIDS in Uganda.

A: AIDS in Uganda has had some interesting partners. A number of them are actually private partners. Nike has been very involved in girls’ education and girls’ health resource delivery in Uganda. The Nike Foundation is entirely focused on girls’ education and empowerment of girls. They’ve been a wonderful partner.
We have other non-profit organizations like World Vision — a faith-based organization, the largest one in the United States, about a billion dollars a year in services provided overseas. They have been extraordinary partners up in the hardest hit regions in Uganda, where all the child soldiers have been such an issue. They’ve been working up there where many other partners have not been willing to go. And of course, CARE is also in Uganda and in Kenya, doing extraordinary work in partnership there. I haven’t worked in Uganda in the last 10 years as much as Kenya. We have a number of really wonderful private partnerships in Kenya — actually in Uganda, too — with Rotary International. They are doing health clinics and HIV testing days in the same format that we used for national immunization days to get people in, get them tested with volunteers from the community, Rotarians in the community, and then get them connected to some kind of treatment. There are a lot of examples out there of really wonderful partnerships and some real creative ones.

Q: Do you see global health initiatives as including the non-served in this country?

A: Absolutely. I always wonder how we talk about global health and we leave “us” out. That’s probably not a great strategy. The fact of the matter is that we have enormous needs in this country. People in the South, for instance, who are still standing in line and on waiting lists to get AIDS drugs when we’re able to provide them for free in other places in the world. We have to really focus on our own health in the context of global health. These days, it’s a lot easier to do both. The diseases that affect us — again, H1N1, other kinds of influenza that are erupting all over the globe, issues of chronic disease like obesity, heart disease and cancers — affect us all in a very similar way. The way that we invest in research is having global impact. The way that we look at providing comprehensive care, engaging communities in care, looking at faith-based organizations to deliver care — a variety of creative options ought to, more and more, include us in the conversation of global health. I’m tired of “them and us.” We talk about working together and then we immediately engage in a conversation that’s polarized, and we do it over and over again. Doing the same thing over and over again and expecting a different result was, I believe, Einstein’s definition of insanity. I think we might be slightly insane. We’ve got to get with the program.

Q: This is a rather lengthy question, but I think that it is well-framed and very appropriate for our theme this week. Can you comment on the potential pitfalls of framing health assistance as a tool of foreign policy, health diplomacy, particularly the shift in funding for HIV, AIDS and other health assistance programming out of HHS, CDC and USAID, to the State Department, over the last decade or more? Does this shift increase the risk of politics trumping scientific knowledge, and evidence from evaluation, of what works in health and developmental assistance programs?

A: That’s a very good question. I do think that we have to be very careful — and again, that’s sort of my caveat around the language of winning hearts and minds — to focus on some sort of servant leadership, as opposed to other kinds of almost colonialist engagement, in the way that we work with other countries and nations. I do think that there is a risk if we do that, that we have to make really sure that other, outside organizations and entities, certainly universities and other non-profits, are really vigilant in watching what happens in our foreign policy. We need the same kind of advocacy around that that we’ve had in advocacy around HIV and AIDS, generally speaking. I can sort of understand, and of course you know there was a lot of pushback when USAID was merged into the State Department, that they were not happy about it and a lot of people in the development world were not happy about it. But I do think that, at some point in time, we have to have some kind of strategy for engagement that’s comprehensive. If we’re going to move away from this work in silos that we’ve done historically, where you have the Department of Defense working over here, and then four miles down the road you’ve got a big HHS program, and DOD has a clinic over here, and HHS or CDC or somebody has a clinic over here, and then USAID has programs over there — it just creates mass chaos. These poor people really do feel like they’re being invaded. If you’re staying in a country where you have 18 U.S. government agencies working in your country and have no clue to how to get them to coordinate and collaborate, it’s a challenge for them, but it’s an even bigger challenge for us. We can’t articulate what our own people are doing very much. It’s one of the beauties of the President’s Emergency Plan for AIDS Relief. What it’s forced us to do — at least around AIDS at the moment and hopefully, in the long-run, our whole global health response — is to actually sit down and coordinate at the table, not only our own efforts, but the efforts of host countries at the same time. We’re taking their plans, merging them with our plans, and coming up with some sort of common plan that lets us understand and map, with some certainty, the kind of investments and priorities that they have with our own investment and priorities so we’re not falling all over each other.

Transcribed by Lauren Hutchinson

Nick Glunt | Staff Writer

The screen behind Dr. Paul Farmer depicted a Rwandan man with a short gray beard on his chin, his lips curved into a vague smile. He wore blue cloth pants held up with a loose belt that dangled from his fragile hips. He had no shirt, drawing immediate attention to his frail body. His ribs protruded from underneath his skin, his arms nothing but bone covered with a thin layer of skin. In his right hand, he gripped a wooden walking stick.

“I said upon meeting this man, whose name is John, ‘We have all the medications that we need to get you better,’” Farmer said.

The man didn’t entirely believe him, and neither did the Rwandan doctors — Farmer’s colleagues. This man was suffering from both AIDS and tuberculosis; surely there was no way to keep him healthy. But Farmer’s Haitian colleagues believed it. With Farmer, they had seen something like this so many times.

“This is the same fellow afterwards,” he said, revealing a second photo to gasps and applause from the Amphitheater audience Monday.

This photo depicted a much weightier and visibly happier man. A wide smile spread across his face, and a round belly lobbed over the strap of his gray cloth shorts. Only the man’s beard was similar between the two photos.

Farmer, the first lecturer of the season, is a founder of Partners In Health, an international organization focused on providing medical care to less fortunate patients in the world.

His speech, titled “Partnering with the Poor: One Physician’s Perspective on Global Health,” was the first in Week One’s theme “Global Health and Development as Foreign Policy.”

Partners In Health has centers in Haiti, Peru, the United States, Rwanda, Lesotho, Malawi and Russia, with supported projects in Mexico, Guatemala and Burundi.

Most of Farmer’s lecture, though, focused on the problems facing Haiti today. These problems — like the 2010 earthquake and recent outbreak of cholera — can be fixed, Farmer said, by strengthening world health systems. These issues, as well as his personal narrative, are dissected in his book, Haiti After the Earthquake.

Farmer arrived in Haiti within three days of the earthquake, which he calls an “unnatural disaster.” Haiti was not prepared, he said, for such a disaster, and is still facing the aftermath, almost a year and a half later.

“This is an acute-on-chronic disaster,” Farmer said. “Anybody in this room with a chronic ailment — asthma, diabetes, hypertension — knows that, and you don’t have to be a doctor or a nurse to know that, when you have an acute event like pneumonia, if you already have a chronic illness, it’s more complicated.”

The earthquake, he said, is an acute event worsened by Haiti’s chronic problems. The Haitian government released an estimation of 316,000 deaths as a result of the quake. Approximately 1.3 million people were left homeless. What hospitals that were left standing were filled with people suffering from spinal and brain injuries, crush injuries and multiple fracture wounds. Others faced mental trauma from the events.

In the U.S., there are many “nerve centers” in New York City, San Francisco, Chicago and others. In Haiti, Farmer said, there’s only one — in Port-au-Prince — and it, too, was struck by the quake. Partners HealthCare, a Harvard medical group that employs Farmer, sent more than 100 caregivers into the earthquake zone within one month.

However, many people were displaced because of the earthquake. Haitians left the earthquake zone to find refuge in rural areas, where family lived. The burdens of food and water shortages, which these families were already facing, were exacerbated, Farmer said. Within Port-au-Prince, people moved into open areas like parks and runway strips, living under tarps for shelter.

Furthermore, collapsing buildings killed medical workers as well as the general population. For example, the main nursing school in Port-au-Prince collapsed, crushing those in ongoing classes as well as faculty members.

Partners In Health opened up about 10 clinics in these various areas. And just as the refugees are still there, these clinics are still open today.

“A lot of the emergency response and relief workers have already left Haiti,” Farmer said. “I’m not exactly sure how.”

And then, on Oct. 22, cholera was confirmed in Haiti. There have been more than 331,000 cases, and it’s killed more than 5,000 people as of June 4. Farmer compared the outbreak to a bomb because of how quickly it spread.

In Haiti and the rest of the world, it is imperative to prepare for problems facing global health, he said.

“We’ll never be ready for these problems without thinking about strengthening health systems,” Farmer said. “The same systems that one would build to respond to one health care problem should be, of course, robust enough to respond to others.”

Q: I wonder if you would comment on, not just in the context of the disaster in Haiti and the concentration that has occurred since then, but in the long history you have of working in that country which including some time, frankly, when you were expelled and went back in anyway, so as you think about that and think about the sense of global health in its potential to inform foreign policy, throughout that history, have you had a positive interaction with the State Department or other policymakers and, if so, what is their focus of interest in hearing from you?

A: I’ll just be very personal about this and say that in the first 15 years or so, I actually rarely went to Port-au-Prince and rarely went to Washington. The first time that I gave testimony, some time in the ‘90s, in Congress, at the behest of a radical nun friend of mine, I got convinced by a social justice group to do this; I didn’t really know the scene back then. There weren’t a lot of people interested in what I had to say, which turned out to be right, actually. As the years went by, I learned more and, again, not to embarrass Mark Dybul, but when we started talking about a grand plan around AIDS, it was really to influence the White House, the State Department, to take up these goals. This current administration, in my opinion, is focusing a lot on what some in the State Department, including the secretary, are calling ‘human security,’ and it’s not a novel idea. It’s the idea that if we want to have security, we have to think about things like poverty, inequality; and one of the leading causes of poverty in the world, if not the leading cause of destitution, turns out to be catastrophic illness. So, in my experience, if people I meet take the time to engage the leadership, then you will be rewarded, if you’re patient, diplomatic, courtly, honest, persistent — that has, in my view, yielded a great deal for those of us working in the field on delivering these services I’m calling basic. So, yes, it’s a golden era, in my view, for global health, but also, it’s an era when people are really listening to these old arguments but true about human security as a key to security in general. That’s also one of the reasons why Rwanda is making such strides. They seem to embrace that notion of security as well.

Q: You mentioned working closely with the public-sector institutions. What techniques have you used to minimize the impact of corruption?

A: Well, the public sector does not have the corner market on corruption. Not to be just polemic, if you look at the problem of corruption, and I don’t want to take potshots at the financial sector. Clearly the transnational financial sector was rife with corruption, yet had the bookkeeping seal of approval from the leading houses in the world. So, corruption is a very slippery term, and one thing that I’ve learned over the years is to try to at least struggle to avoid conflating corruption with institutional poverty. So, for example, so that this doesn’t sound arcane, to be transparent requires an infrastructure of transparency — bookkeepers, computers, electricity, water, salaries for the public sector. Rwanda, which has been lifted up, I think, rightly as an example for real struggle for transparency, really pushed this zealously in the public sector. So, in other words, it’s kind of inconvenient when someone you’re working with in the public sector gets thrown into jail. That really was meant to be a joke, so thank you for laughing. But I really think it’s part of our job to struggle, to help deal with lack of transparency, help our partners to become transparent and not be corrupt. So that’s a sort of philosophical answer, but I wanted to say that we had actually tried to do these things inside the public sector — electricity, bookkeepers, the kind of technical assistance that we’ve taken to calling ‘accompaniment’ in our work. Accompaniment means you’re actually going to walk with your partners. That could be a patient or a city government, or a national government, a ministry of health. That’s what Mark (Dybul) and Helene (Gayle) have done with a lot of their careers is accompany at that level. You can also do it at the district or local level, and it requires resources and commitment and patience, and that’s a very difficulty project, but one that’s well worth pursuing over the years.

Q: Does your partnership also include engineers, landscape architects, architects to rebuild, plan and design the community and infrastructure to support your long-term goals?

A: The answer is yes, but I’m smiling because I’m kind of a tree hugger. Looking around and seeing all these trees, I love trees. It’s kind of my hobby, landscaping. Some of my coworkers, who are doctors, thought, Well, Paul’s not going to want to have landscaper volunteers, and I said, ‘Well, that’s not true.’ Actually, in northern Rwanda, we built this beautiful hospital. I wish I put a picture of it in here, but one of the reasons it’s so beautiful is because of engineers, architects and a landscaper — the woman who helped designed The High Line in New York — she lives in Rwanda and she was a volunteer, and I can tell you as proud as I am of things like the hospital I just showed you, it’s much better to have professionals. So, the answer is yes, we have volunteers from management. The day after tomorrow, on my way back to Rwanda; I’m going to be meeting with volunteers in advertising who are trying to help us convey what a really complex message is in a much more concise matter. Let’s just say concision is not my strong suit. So, we have volunteers from every walk of life, not just doctors and nurses.

Q: There are a number of questions that go to your personal experience with all this. This questioner participated in relief efforts in the field hospital set up by Harvard Medical Initiative on the ground of the Love A Child orphanage and continues medical work in poor Haitian neighborhoods. The question is: How do you do the work you do without internalizing the grief you see every day and the suffering?

A: I think doctors do internalize the grief and the suffering, and nurses, looking at my colleague. That is not a bad thing to do. Being cognizant of someone’s pain is obviously what empathy is all about. The question is how to be effective and focus on good outcomes for patients, for families, for areas, for systems, when you’re exposed to a lot of grief. I think one of the best ways to do that, and I’ll say this in an avuncular manner to any young people, or not young people, is with partnership. None of this work is done effectively with small groups. It’s really about bringing lots of people together. I don’t know what we would do in Haiti without our Haitian partners, who I regard as some of the toughest people I know in terms of helping all of us who are ‘transnational bilaterals.’ So, my coworkers who are American or European who are working in very difficult circumstances, all of us need to be spelled, including our Haitian colleagues. We’re really trying to think more about this in the future. Should we have a sabbatical system? Should we have shorter stints of engagement in the field? And the answer to all those questions is almost surely yes. So the main advice I’m giving you is you’re always going to work with a team; remember that it’s all about partnership, and everybody needs to be spelled.

Q: One of the things that is talked about in terms of responses to disasters are unintended consequences. You send in a lot of foodstuffs and you end up destroying a local marketplace; the farmers are driven right out of business. This questioner asks if there is a similar affect on the indigenous medical care — hospitals, clinics, doctors — that are trying to make it with a huge influx.

A: Well, that was the claim of the private sector providers in Haiti. They were being ruined by all of this free care. I think that they Haitian poor would be quick to point out that those people were not providing services for the poor before the earthquake. Very sharp critics, the Haitians. So, the claim was made many times, and very publically, and picked up by the international press, including the American press, was that the unintended consequence of all this free medical assistance and free water was damaging the local economy. I don’t find that a very compelling argument. What I would say is that sector, the private sector, was not providing adequate water, shelter, primary care or primary education before the quake, so we need a third answer. The unintended consequences, however, are after years, decade after decade, and I think we’re starting to learn more about predicting the consequences of engagement. It’s just that we need a big-picture analysis. You’re not going to understand food and security in Haiti by looking in Haiti. You have to look at the transnational economy. You have to look at U.S. agricultural arrangements to understand agriculture in Haiti, and that’s important to do.

Q: Do you think that the model, which Partners in Health has developed for developing under-resourced countries, has any relevance or value for the health care debate in the United States?

A: I do. I do think it does. I think you could even call this a technical part of this and, again, I hope that Helene (Gayle) will talk about this and others who are thinking about lessons learned in global health that could be applied here. One of the main ones, the technical ones, is community-based care for chronic disease. As someone who spends most of his clinical time outside the United States, listening to the debate about medical homes in the United States, they’re really still not talking about homes. It’s almost like we can’t get quite get to the point in the United States where we talk about home-based care, community health workers, really community-based care for chronic disease. That’s going to be absolutely critical to improving quality, and, I believe, lowering relative costs, although there’s a kind of fetishization of dropping cost. If we focus on quality, we’ll end up doing what we did in Haiti, which is to provide community-based care for chronic disease. That’s what our Boston project is all about. The patients who we’re serving there have fallen through the cracks of the most fantastic teaching hospitals you can imagine, and they’re still doing poorly with the people we started with in the Boston area had HIV disease, but we’ve extended that to major mental illness and diabetes, and most of the people we’re caring for in Boston with community-based care, with community health workers, have more than one diagnosis. I know this is adding a little bit onto the answer, but I was in a (neurologic disorder) conference in Uganda, and I was making a plea for community-based care, and I said, ‘We really need to have community health workers to train and involve them.’ I gave an example, unwisely, from Kenya because we had a neurologist visiting us at Harvard, in the ‘90s, and he did a study of the blood levels of seizure medicine somewhere in Nairobi. This isn’t even rural Kenya; it’s the capital city, and zero percent of the patients with seizure disorder who were being followed in a seizure clinic, had the correct blood level. They all had under treatment. Those are the people who actually made it in there. So, I was saying, ‘Look, we need community health workers,’ and a colleague who didn’t say where he was from in Africa, but I guarantee it was a capital city, got up and said, ‘Well, you wouldn’t say this, in the United States, that we should have community health workers.’ I was very happy to say, ‘That’s not true at all.’ I say this everywhere I go. I’m not changing the message from Boston to Kampala. It’s because I believe this is the best way to respond to these chronic illnesses: community-based care.

Q: This is from a group of students from the University of Pittsburgh, Student Leaders in International Medicine. We’ve met with Dr. Joseph in Malawi. Can you comment on your involvement in Malawi and its success? Also, do you need another personal assistant?

A: That’s very nice of you. Thank you guys. As long as it can be indentured labor, but they’re against that at Chautauqua. Dr. Joseph, who’s from Upstate New York, was a student of mine. He’s been working for Partners in Health for 15 years in Peru, in Haiti, in Boston, and then he went to direct PIH’s program in rural Malawi. It’s very much like all of our efforts in rural and urban areas, too. We’re doing three things at once: rebuilding infrastructure (in this case, there was no hospital in this district, as you may know), training local people to do this work and also putting resources into the system. So, that’s what happening in Malawi. The impact of those interventions, which have been fairly modest, again in partnership with the Clinton Foundation and the Ministry of Health, have been just enormous in terms of maternal mortality. In other words, the health system strengthening approach has led to massive reduction in infant mortality, maternal mortality, juvenile mortality and great outcomes among the patients we’ve been taking care of. So, to me, Malawi is just another conformation that many parts of this model are perhaps distinct from place to place, but most of them are actually general and applicable from the urban United States to the mountains of Lesotho. That’s what I believe the Malawi experience teaches us, too. Thank you for asking.

Q: In my view, you have all the characteristics of a modern-day visionary. Do you credit your commitment to the world of public health to a particular person in your life? Who inspired your great work — a parent, a grandparent, a religious leader? If none of the above, what about you drives your incredible mission to help others answering the question: How to make things better?

A: I’ve got to say that I think that is very common in public health, and I’m not trying to embarrass my friends who are here, including Helene (Gayle), who’s the reason I’m here today, but the people I know in public health really share that vision. I don’t know who asked the question, but I don’t think it’s rare in public health or public education. I believe it’s very common. Another thing that struck me, and it’s not just the Pittsburgh students who are making me say this, is that it’s also very common on the university campuses in the United States. I don’t have much experience in Europe or Asia; my experience is United States, Latin America and Africa. It’s just not rare, so people should not exceptionalize and, above all, I hope they won’t pathologize commitment to social justice. It’s common, and we need it. I will say that my oldest daughter, who read me, out loud, an essay, ‘Who’s her hero?’ and she said, ‘Martin Luther King.’ There are people in the world who we all know who are embodiments of real commitment to struggle to make things better. Of course, there are the Dorothy Days and the Martin Luther Kings, figures from Upstate New York in the 19th century. I gave the graduation speech at Wesleyan, and I said, ‘This is the coolest institution ever founded by white people in the 19th century.’ That was my opening line. But what I really want to say is there are these heroes, but there are everyday heroes — people who are struggling, women in rural Haiti who are struggling to keep their families safe and their kids in school — and I think it’s better for all of us to understand to not exceptionalize commitment, not just to one’s own family but to making things better. I think it’s a very under-recognized value in our species, and it’s much more common than avarice that we hear so much about, including in 2008 with the financial whatever it was, I’ve met a lot of people in that sector who are big supporters of Partners in Health who are upstanding, good people, too, so I don’t want to say that this commitment to make things better is just in public health, although I think it’s very common in public health. I think Helene (Gayle) and Mark (Dybul) would agree with me.

Transcribed by Patrick Hosken