Domains of ignorance

Peru is a mining country and leads the world in production of several important minerals. Mining growth is upwards of five per cent a year and makes up nearly fifteen per cent of the national GDP. Yet, mining comes with a cost, both on the environment and on the communities that live around mines. Increasing levels of heavy metal intoxication and health challenges associated with environmental pollution have increased public pressure on the recently elected Peruvian government. The competing national interests in economy and health are not straightforward, and require both a deep understanding of the local culture and experience in dealing with complex public health challenges. Patricia Garcia, the newly appointed minister of health in Peru, and a noted public health scholar, is eager to tackle these difficult challenges.

At a meeting last month in Lima, organised by the Pan American Health Organisation, that I had the pleasure of attending, Dr Garcia made it clear that all options and ideas to measure heavy metal poisoning were on the table. Yet, she was also rigorous and pushed back, demanded evidence to support every new idea, probed the presenters with thoughtful questions and was quick to get to the heart of the matter. She was both convincing in her arguments and ready to be convinced by stronger counter-arguments. She was on top of relevant literature in the field and was both strategic and detail-oriented. She had detailed knowledge of public health challenges in both urban and rural Peru that spoke of her extensive experience. I had worked with Dr Garcia in the past on new models of public health education, and was aware of her depth of knowledge, but this was the first time I saw her both as a scholar and an administrator.

The meeting in Lima was short, with experts coming from various disciplines and multiple continents. As I flew back to the US, I felt both a sense of excitement and a sense of emptiness. The sense of excitement came from the possibility of working with a minister who is a domain expert, who knew the literature in the field and was both a practitioner of the discipline and an expert in policy. The sense of loss came from looking at our own gaps in domain expertise when it comes to leadership. There is something not quite right when the provincial minister of higher education in Punjab never attended a higher education institution, or when the website describing the career of provincial minister of health in Punjab, instead of listing qualifications only lists family members who are sitting or former members of parliament. Unfortunately, the situation of expertise is hardly unique to Punjab.

Frustrated, yet again, by the governance of health and education, I talked to colleagues and friends who are aware of the situation in Pakistan. Some agreed, but others pushed back. A group of those who didn’t find our situation as a problem argued that leading the ministry does not require domain knowledge, but instead good political and administrative skills. I disagree. While good administrative skills are indeed needed, they are not the only thing required at the helm. Our problems are not just administrative problems, they are also fundamental structural problems that require technical competence, training in the discipline, experience working in the said field and being aware of recent developments that come from domain knowledge. Other colleagues pointed to the fundamental limitation in the constitution that requires ministers to be members of the assembly. While that may be true, there are several mechanisms to bring domain experts to lead important ministries. The issue is that of attitude and desire, and not of a restrictive legal code.

Finally, some others who are looking at the recent developments in the US pointed that a number of recent appointees in the US cabinet lack domain expertise as well. Point well taken, but since when did other people’s bad decisions become a valid argument to justify our mistakes?

Policy and decision-making is more than giving speeches, it requires technical expertise, training and an acute understanding of the challenges. Just belonging to an illustrious political family of politicians is not good enough.

Published in The Express Tribune, February 14^th, 2017.

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