Environmental Engineering Reference
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seriously. If this is not enforced in small organisations, then there is little hope in
managing any national or global undertaking.
Second, my position as minister responsible for the Public Health agency of
canada (PHac) provided an exceptional opportunity to take those activities that had
been conducted within a government department and move them to an arm's-length
agency, with independent thinking and an opportunity to work with the provinces
and territories in order to transform public health in canada. this agency relies
on real, scientifically based evidence, with a declaration to support what works to
produce that evidence.
third, tied closely to Franklin's observations on governance, is meaningful
citizen engagement. It is important to be connected to human responses and to know
what people are frightened of—because that is what actually changes behaviour. the
public must be put back into public health.
In the interest of transparency, it is important to declare that global health
governance is relatively new to me. My ideology is primarily bottom up and,
consequently, the task of describing what governance should look like has not come
naturally in the past. However, the complexity theory, distributive models, and the
adaptive principles explored in a discussion paper by Sholom Glouberman and brenda
Zimmerman (2002) for the commission on the Future of Health care in canada is
reminiscent of—and well complemented by—the oft-repeated H.l. Mencken quote:
'there is always an easy solution to every human problem—neat, plausible, and
wrong.' It is imperative for both health authorities and engaged citizens to keep this
in mind while conceiving the health goals for canada's future.
Glouberman and Zimmermann (2002) highlight the differences between
the responses of Brazil and african countries to HIV/AIDS. They identify Brazil's
response to a prediction by the World Bank that the country did not have sufficient
resources to resist HIV infection. The events that took place in Brazil were
unprecedented and, certainly, unpredictable. In spite of the harsh statements from
the World Bank, the Brazilian people organised themselves in a way that no one
decided not to do as they were told. Doctors and civilians managed to attain drugs
and drew circles on pieces of paper to explain to people what time of day to take
them; nuns and priests handed out condoms. From the bottom up, Brazilians were
able to organise in a way that meant the incidence of HIv/aIDS in their country
declined, while in much of africa it went through the roof.
The Brazilian experience is an impressive display of the capacity of self-
motivated citizens on the ground. In light of this type of bottom-up approach,
the exploration of health governance herein is framed by the fact that one cannot
impede or underestimate what communities are capable of if they are just asked.
the familiar Hollywood portrayal of scientists wandering around in white lab coats
and fixing everything for people is neither realistic nor feasible as a public health
strategy. In this respect, the medical myth is getting in the way of what it will take
for communities to find out what they need and for them to be able to ask for help
