CCIH 2010 transformation presentation


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A presentation on the theme of "transformational development" that focuses on the need to transform fallen institutions. The presentation was done at the annual conference of Christian Connections for International Health in June 2010.

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  • Whereas the standard way of articulating and seeking to practice the concept of “transformational development”--especially as it concerns health--(Stan Rowland) is to posit that lasting change that supports poverty reduction and improved health in communities requires changes in the hearts of people.  As individual people's hearts are changed by God they learn not only to love God more deeply but to love their neighbor as themselves.  This individual change leads to broader community change that supports a healthier community as people are transformed in the same way.  LASTING change is a function of this heart change which leads to broader changes at the community level.  In the health field, this reality, combined with services and technologies, can and does lead to lasting health improvements and healthier communities. But there is another side to the story as well.  St Paul (and Jesus) also spoke about "powers", principalities and spiritual forces that influence the course of human events.  Most theologians today understand these powers to be embodied (among other things) in the institutions and structures that God has established for good in the world.  We can think of these institutions as including states, ministries of health, UN agencies, NGOs, churches--any social structure that is ordered by God for good.  The problem is, like all of creation, these institutions are fallen.  As a result, instead of accomplishing what they are ordered by God to do--bring justice, provide for health services, offer safety to residents, etc.--they tend to look after their own survival and end up dehumanizing people created in God's image. As a result they contribute to injustice.  Just as individuals need to be "transformed" in order to become what God desires them to be, there is now a strong theological consensus that institutions too can and need to be transformed to fulfill the role that God has laid out for them.   It is important to note that while all institutions are made up of individuals, they have a spiritual force--a spiritual reality--that transcends the individuals in them. Thus, in their fallenness they are capable of doing great harm as they deviate from the path that God intended them to have into other paths. It is their capacity to bring life or to dehumanize--or bring death--that makes them spiritual powers. To analyze how this happens we must first try to understand theologically in what sense they are spiritual powers, what their fallenness leads them to do and be and what our task is as followers of Jesus in relation to them. I will try to briefly outline this, provide some examples of how fallenness plays out in our world today and suggest a way of thinking about our role as Christian health development workers and agencies (as the church really) in witnessing to them--recognizing that the ultimate work of “transformation” belongs to God’s Holy Spirit.
  • We live in perhaps the first generation since the earliest church in which the full development of the meaning of the powers--a recapturing of a more complete sense of the reality of these entities has come about. Marva Dawn has a tentative explanation of why this might be in her view that major reformers shied away from the powers due to the misuse of the concept by certain groups in their time. Later, views of the powers either completely “demythologized” them--essentially denying the reality of spiritual forces or, in the broader trend of privatization of faith, relegated their understanding to ONLY that of personal devils and demons. Most of these writers in one way or another--with Dawn providing the summary--would suggest that in the earliest church the distinction between the institutional reality of the powers and the reality of personal forces arrayed against God would not have been made. Rather they would have together been seen as part of a seamless web of hostility to God. Let us explore this concept more (and I will limit my focus, as suggested in the title to the insitutional reality of the powers). In what follows I will attempt to provide a basic definition of what the powers are, how they act and what we should do with them. I will also try to provide a few (perhaps not fully satisfying) examples of how the powers, in their fallenness fail to accomplish what they are to do in the realm of health.
  • Perhaps no other writer in recent times has captured as full and complete an understanding of the powers as Walter Wink. He echoes many others in this formulation which, if it does not fully define the powers, at least places them in the context of what God wants to do in the world. This slide makes it clear that God provides the powers for the good ordering of society but that in their fallenness they fail to accomplish this ordering and, therefore need to be brought back to what God wants
  • In his Chapter on “Christ and Power” Yoder develops a similar notion and provides a useful summary of what the powers “are” (Wink does much more on this but Yoder’s is a useful summary)
  • This a quote from Willard Swartley and his analysis of evil and how power structures act… Notice here how the issue of “ends” resurfaces--powers seek to become ends in themselves rather than enabling humanity and the world to achieve the ends for which God created them… This may be a key to why we focus so little on the “big” ends--we become (as Wink states) enthralled with the powers.
  • Speaking about mammon as a power, Jacques Ellul says… Mammon acts on OTHER powers to control their drive, their course, their focus
  • As I have looked at my own work in non-profit and academic settings over the past 25 years I see these as common ways of acting. To me, these explain many of the de-humanizing and dysfunctional aspects of various organizations and also demonstrate how our institutions--even faith-based ones--mimic the fallen structures of the world. I am thinking particularly here of the institution, to corporation (see the film “The Corporation--laws that made the corporation have the rights of a human and the amorality of marketing--nagging study). Talk to about where I have seen institutions playing with the truth as part of an allegiance building process Talk about branding. I realize that I may be stepping on toes--but the point is we cannot accept non-critically the techniques of the corporation--be careful about accepting the means without asking how it directs our ends. The point here is that all of these actions have deeper implications for how we act in terms of truth telling, raising money, planning, recruiting
  • Keep the concept of losing track of the true “ends” of development in this quote. This criticism has been made by others and some refer to the failure in terms of a lack of synchronization of aid or the problem lack of coherence. Lots of resources being expended in ways that, arguably, reduces its overall effectiveness with a myriad of agencies “competing” for the funds and dispensing them without reference to achieving the ends that greater harmonization could allow for. Now I am sure that you will site examples of where harmonization IS happening but the larger picture points to a system with too many actors, too little coordination and too little honesty about how this reduces the effectiveness of aid in terms of the ostensible ends each agency is seeking. More money--lots more money--leads to more actors working on global health issues. However, with each desiring to pursue its own action autonomously, the true end of why we wanted more money is never discussed and, arguably, the needs of the most vulnerable go unmet...
  • Symptoms of institutions bent on their own survival. I know the language we use, our narratives, the stories we tell ourselves: “We can do it better”; “The government is corrupt”; “We are committed”; “We are using participatory approaches”, etc. Pushing this a step further Godal summarizes the problem this way… and I think we have all seen this--a lack of truly integrated services because of the continued stovepiping of funding and perhaps the US government with its so-called presidential “legacy” initiatives is at greatest fault.
  • Keep in mind that we have a “success” story in these slides: LOTS more money going to health--more than many of us could have imagined or at least hoped for even 15 years ago. But again, the failure of institutions of all kinds to use these resources to create systems. These are what Ron Sider might call the structural sins, the systemic failures that, again, keep us from approaching the ends we say we want. Now I know how difficult it is to arrive here but the point here is that these failures do point to structures that have forgotten the true ends and focus instead on… quick fixes? Quick impacts? Perhaps the next slide suggests even more…
  • A story of misplaced ends… The money to be made in new technologies, the organizational prestige to be gained… Rather than the messiness of figuring out how to implement what we know…
  • A demonstration of the foregoing… Who is going to make money in breastfeeding? Why the lack of attention to this? You know this story. Perhaps we cannot point at the specific institutional fallnness that leads to these outcomes--perhaps we can. Perhaps some of our organizations have participated in this by seeking after the funds rather than seeking to be faithful in delivering the services that could reduce mortality due to these causes. Am I the only one who has worked for organizations that have “chased the money” because we need to survive while neglecting the things that could make for healing?
  • Most critically with an acknowledgement of their reality and what they can and cannot do given the death and resurrection of Christ (Christus Victor). We are part of fallen organizations and structures. Can we acknowledge that and realize what it means for our work.
  • Can we see a time--even in our lifetimes when we accept that these powers can be brought into service to God?
  • Applied to the state here but could be expanded to extra-state actors as well. This merits close attention… it applies to the way we engage the US government, UN agencies or others participating in global health. Of course the work WITHIN our agencies also merits attention… What this might imply is using our experience, our learning, our research, to provide models of how to humanize health development efforts… To model other ways of being.
  • Permission to live into the the collective future of which we are a part. In this vision, transforming the powers implies reminding them of what they are to do and be--to remind them of the ends of what is to be done in global health… I hope we can use the Q/A to explore the implications of this concept more.
  • CCIH 2010 transformation presentation

    1. 1. The Transformation of Structures : A Theology and Praxis of Witness to Institutions Robb Davis Plenary 2: "Transforming People and Institutions for Lasting Change” Christian Connections for International Health June 11, 2010
    2. 2. The Transformation of Fallen Structures: A Theology and Praxis of Witness to the “ Powers ” Robb Davis Plenary 2: "Transforming People and Institutions for Lasting Change” Christian Connections for International Health June 11, 2010
    3. 3. Transforming People Transforming Structures (including Institutions)
    4. 4. The Transformation of Structures: The Powers… recapturing their meaning Karl Barth Church and State
    5. 5. The Transformation of Structures: The Powers… some definitions/concepts <ul><li>The powers are created for good </li></ul><ul><li>The powers are fallen </li></ul><ul><li>The powers must be redeemed </li></ul>
    6. 6. The Transformation of Structures: The Powers… some definitions/concepts What are the powers? … (W)e might say that we have…an inclusive vision of religious structures…intellectual structures (-ologies and -isms), moral structures (codes and customs), political structures (the tyrant, the market, the school, the courts, race, and nation)
    7. 7. How do they act? Structures that are deemed good and that provide the basis for natural or social order that enables life… are turned into ultimate values, ends in themselves , and thus are elevated to the powers over one’s life and then worshipped as gods. (emphasis mine) The Transformation of Structures: The Powers… some definitions/concepts
    8. 8. How do they act? (the specific case of “Mammon”) What Jesus reveals here (in the Sermon on the Mount) , is that money is a power. This term must be understood not in some vague way as a “force” but in the specific sense typical in the New Testament. A power acts by itself, is capable of “moving” other things, is autonomous (or claims to be), follows its own law, and acts as a “subject” (not an object)… A power has a spiritual significance… A power is never neutral, it has a direction and directs human action. In discussing Mammon Jesus is not describing the relationship of humans with an object, but with a subject. He in no way counsels us to use money well, or to earn it honestly. He speaks of a power, which wants to be comparable to God, which establishes itself as a master over humankind, and which has a specific plan. The Transformation of Structures: The Powers… some definitions/concepts
    9. 9. How do they act? <ul><li>Powers confuse means and ends (they end up being the end) </li></ul><ul><li>Powers are bent on their own survival </li></ul><ul><li>Powers seek to establish and build allegiance towards themselves </li></ul><ul><li>Powers are bent on (absolute) autonomy in seeking to liberate themselves from accountability for their acts </li></ul>The Transformation of Structures: The Powers… some definitions/concepts
    10. 10. The Transformation of Structures: The Powers… some examples … of institutions bent on autonomy Apart from poor countries’ own resources, between 2000 and 2005, international aid for health more than doubled, to more than US$12 billion annually... The sharply increased resources have brought progress, but also new challenges and costs. The number of organizations devoted to global health, including public–private partnerships, has mushroomed, each with its specific purpose, operating principles, and operational targets— challenging the overall governance of global health efforts and precipitating calls for new “architecture of global health.” &quot;Climate Change Impacts on and Implications for Global Health&quot; by Michael E. St. Louis, MD, Jeremy J. Hess, MD, MPH in The American Journal of Preventive Medicine 2008, 35(5). One of those making the call, David Fidler, puts it this way: ... states and non-State actors resist governance reforms that would restrict their freedom of action.
    11. 11. The Transformation of Structures: The Powers… some examples … of institutions seeking their survival… The success of large health initiatives such as GFATM, GAVI and PEPFAR has paved the way for many other new health initiatives in recent years. Unfortunately this crowded playing field often results in a poor match for the integrated delivery of primary care requirements at the local level... Perhaps the biggest problem is that funding from a single donor may be dispersed at the district or facility level through numerous implementing organisations (as many as 50) – mostly NGOs and development partners. (From Concept paper in relation to the development of the Global Business Plan to accelerate progress towards MDG 4 and 5 by Tore Godal)
    12. 12. The Transformation of Structures: The Powers… some examples … of money, “magic bullets” and neglect of systems… … there are now billions of dollars being made available for health spending -- and thousands of nongovernmental organizations (NGOs) and humanitarian groups vying to spend it. But much more than money is required. It takes states, health-care systems, and at least passable local infrastructure to improve public health in the developing world. And because decades of neglect there have rendered local hospitals, clinics, laboratories, medical schools, and health talent dangerously deficient, much of the cash now flooding the field is leaking away without result. (Laurie Garrett “The Challenge of Global Health” Foreign Affairs, February 2007)
    13. 13. The Transformation of Structures: The Powers… some examples … of confusion of means and ends (technique is all)… We determined the proportion of research on childhood mortality directed toward better medical technology (i.e., by improving old technology or creating new technology) compared with research on technology delivery and utilization. Ninety-seven percent of grants were for developing new technologies, which could reduce child mortality by 22%. This reduction is one third of what could be achieved if existing technologies were fully utilized. There is a serious discrepancy between current research and the research needed to save children's lives. In addition to increased research on the efficacy of treatment, there is an even greater need for increased research on delivery and use of technology. Current Priorities in Health Research Funding and Lack of Impact on the Number of Child Deaths per Year LeRoy et al, Am J Public Health. 2007; 97:219-223.
    14. 14. The Transformation of Structures: The Powers… some examples Nutrition and Breastfeeding We estimated that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2·2 million deaths… for children younger than 5 years. Suboptimum breastfeeding was estimated to be responsible for 1·4 million child deaths… In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths... Maternal and child undernutrition: global and regional exposures and health consequences. Robert E Black et al in The Lancet 2008 Prevalence of stunting in children under 5 years
    15. 15. Acknowledge the reality of the powers What is most crucial…is the failure of moral theology, in the American context, to confront the principalities--the institutions, systems, ideologies, and other political and social powers--as militant, aggressive, and immensely influential creatures in this world as it is… Americans--including professed Christians, who have biblical grounds to be wiser--remain, it seems, astonishingly obtuse about these powers. The Transformation of Structures: The Powers… our response
    16. 16. Recognize the destiny of the powers… The destiny of the rebellious angelic powers…is not that they will be annihilated, but that they will be forced into service and the glorification of Christ, and through him, God The Transformation of Structures: The Powers… our response Karl Barth Church and State
    17. 17. The Christian accepts the powers that be and speaks to them in a corrective way. The Christian speaks not of how to... create the ideal society but of how the state (or other institution) can best fulfill its responsibilities in a fallen society. The Christian witness will therefore always express itself in terms of specific criticisms, addressed to given injustices in a particular time and place, and specific suggestions for improvements to remedy the identified abuse. The witness… must be consistent with our own behavior. Only if we are demonstrably and ethically working on a given problem do we have a right to speak to others... The Transformation of Structures: The Powers… our response Witness to the powers…
    18. 18. The Transformation of Structures: The Powers… our response Keep in mind our “collective future” and what God’s Spirit desires to do… It makes an enormous difference in the way individuals and churches live if we recognize that the entire atoning work of Christ (including his life, suffering, death, resurrection and ascension) has already made the cosmos his. Then our political involvement operates not from the need to change things, but from the desire to make clear what really is the case .