One of the things that my wife and I have enjoyed in retirement is our subscription to the Lesley University/WGBH Boston Symphony Hall Speaker Series. Once a month through the fall and winter we enjoy a great evening in Boston. We go to dinner with friends and then join about 2500 other older adults at Symphony Hall to hear an interesting speaker like James Comey, Gloria Steinem, Bill Clinton, John Cleese, Bill Bryson, Bryan Stevenson, Cokie Roberts, Robin Wright, and the list goes on and on. Sometimes I have very little prior knowledge of the speaker, but I am always expecting the best, and in retrospect some of the most informative and thought provoking presentations have come from the speakers that I did not know well. One example of a speaker for whom I had little prior knowledge was the neuroscientist, Lisa Genova. She studies dementia and wrote the 2007 book, Still Alice, about a college professor who is developing Alzheimer’s disease. In 2014 Still Alice was made into a movie starring Julianne Moore who won an Oscar for her performance. Genova presented a blend of science, literature, and enormous empathy that left me inspired and amazed.
This season kicked off with an informative, though somewhat egocentric and long winded, presentation by former Senator and Secretary of State John Kerry. The November speaker is Bob Woodward, but I had no prior knowledge of the October speaker, Zanny Minton Beddoes. The program introduced her as the first female editor in chief of The Economist, the venerable British journal of current events and business. She grew up in England and was educated at Oxford and did graduate work at Harvard in the late eighties. She worked as an economist for the Polish government and the IMF before starting a long career as a journalist at The Economist in I994. I learned a little bit about her reading the program as I waited for the evening to begin. When the evening was over, I reflected that there was no hype in the introduction. She was better than advertised, exceeding the very positive introduction that I had read:
From her post at the top covering the global economy, policy, and business enterprise, Zanny enlightens audiences on financial and economic trends with prescient analysis that is detailed yet comprehensive in scope. With charming wit and remarkable precision, her unique depth of perspective on the future of the global economy provides an unparalleled outlook that always engages and informs.
Each attendee was given a copy of the current edition of The Economist as we entered the hall. She began her presentation by pointing out that in most editions of the magazine there was a dichotomy between the bad news about the UK, European, and American politics that was reported on the front pages, and the more positive business, science, and economic discussions toward the back of each week’s magazine. It’s her opinion that the bad news up front makes us depressed and that dims the way we view the more positive information toward the back of each issue that might offer us a reason for optimism. The back pages are where we can read about industry advances, innovation, and scientific breakthroughs that may someday generate applications that improve lives and offer pathways to global progress.
She made it clear early on that she was there to look at the future, and that we all need to accept that was risky business. She asked anyone to identify themselves if they had known in 2014-2015 that in 2019 Donald Trump would be the American president and that the UK would be mired in an endless discussion of Brexit with Boris Johnson as its prime minister. After none of the 2500 in the audience wanted to claim that they had anticipated in 2014 where we might be five years later, she was ready to get down to the business of looking at the future. As she began, she offered a little bit of a “spoiler” for her talk by telling us that her objective was not to depress us, but to leave us with a little hope.
After her introductory remarks, she suggested that if we wanted to anticipate the future that we will experience, we should consider four big trends. Here is what I can remember:
- There is a worldwide problem with inequality. The rich are gaining wealth rapidly while the rest of the world is struggling for survival. This is leading to anger and political turmoil within nations, and is driving migration from poorer nations to other nations that appear to be more hopeful places. Inequality is also driving conflicts and a loss of social stability in poorer nations that creates refugees. Inequality and social unrest drives people toward Europe, the United States, and other prosperous nations, and the influx of migrants and refugees generate anxieties within the prosperous nations that make them more likely to become illiberal. These are complex spiraling problems. Within prosperous nations there are changes in demographics. Populations are aging. In America we are approaching the moment (about 25 years from now) when the entire nation will have a “minority majority.”
- China is advancing its interests. The current foriegn policies of America and Europe are not adequately responding in a coordinated fashion to the pressure that China is applying to the economic status quo.
- Artificial Intelligence and the expanding realities of social networking, communications, and online commerce offer us both challenges and opportunities. We don’t have policies to manage the global companies that have radically changed our lives even as we can’t imagine how we might live without them.
- Climate change is likely to be the biggest challenge that will define our collective future. There are business opportunities in the development of sustainable energy resources that do not add to our environmental problems, but there is a concern that we do not have a global will to abandon or manage our consumption of fossil fuels. This problem, even more than the other three problems, can’t be isolated or managed by unilateral policy changes. Time is running out, or perhaps has passed, to make much difference with a focus on “prevention” efforts. We now may be in an era when we will need to just deal with the mess that has already been created. A strategy of just hoping that global warming is not true, or just neglecting to plan for its impact may be the most significant failure of all time. The time may come sooner than we have previously thought when it will be impossible for the dullest or the most greedy among us to deny it.
After she reviewed her four realities that will be major factors in our future, she compounded my distress by describing the world wide rise of illiberal ideals and the emergence of authoritarian governments around the world. It has been a historical reality that when the going gets complicated many people are willing to give up their individual liberty to leaders who promise to protect them and their special interest group. Stressful times promote the search for scapegoats that are potential targets for the anger that uncertainty fosters.
The Economist has been promoting the upside of business opportunity and stable “liberal” values (human rights, not to be confused with socialism) in politics since it was founded in the 1840’s. Expanding markets are good for sellers and buyers. In their view of the world, individual rights are associated with economic progress.
Am I misinterpreting her message? I got the idea that Zanny Minton Beddoes’ hope, the view that she wanted to leave with us, arises from her belief that we are intelligent enough to recognize that our survival is possible through our collective ability to recognize that none of us can hide from the four evolving trends. I think that she believes that it is still possible to hope that we can control the future, if we recognize our connectedness and work for our collective benefit with the wonderful tools we have developed.
Am I twisting her ideas and advancing my own fantasies when I hear her words and imagine that she is calling us to recognize our universal vulnerability and interdependence and set aside the fantasy that there is a gated community somewhere where we will be individually safe and happy attending to our own concerns as we let the rest of the world go its way? Did you notice that the California fires forced Arnold Schwarzenegger, LeBron James and other residents of posh LA neighborhoods to leave their homes? There are some events in life from which status and wealth can’t offer protection.
Was she implying that border walls and tariffs are just expansions of the fantasy that big problems can be solved by putting our individual interests first? Was she implying that the day is over when it was possible to “have it our way” by ignoring the needs of others in our community or in the wider world? Did I misinterpret her idea when I thought she was suggesting that “zero sum” economics eventually becomes a bummer for everyone, and that the way toward the future we want is a path toward more “non zero,” or win-win thinking?
How do we apply Zanny Minton Beddoes’ thinking to the healthcare questions that face us now? I think that at least three of her four trends, inequality, technological advance, and climate issues connect to healthcare and it is easy to imagine that the tensions related to China will eventual effect everything, including healthcare. I don’t know if she has ever heard of the Triple Aim, but its principles that arise out of the foundational concept that access to effective healthcare is a right that advanced societies guarantee is in line with everything that she said or implied. It seems to me that if we ever decide to do something about economic and social inequality then establishing equity in healthcare would be a good place to start.
AI is not a threat to healthcare. AI offers us opportunities that must be developed over the resistance of the status quo. The question is not what it might do for us. The question is what we will let it do for us. It is certain that if we take full advantage of its benefits, it will change the way we provide and receive care.
It may seem like a stretch to imply that climate change will impact the future of healthcare, but it has already. People who live near power plants and refineries have higher rates of chronic disease. There are many public health challenges that are intertwined with the violent weather associated with global warming. Eventually, the relocation of people driven by climate change and the changes in agriculture driven by global warming will drive health concerns that we have not yet fully imagined.
I think the real benefit of using Zanny Minton Beddoes’ ideas to address our healthcare questions lies at a much higher level than even her four specific concerns. Her bottom line is that the world has changed in ways that can’t be reversed. We aren’t going back to a world that no longer exists. I think she was telling us that we live in an increasingly interdependent world that requires us to develop new ways of organizing solutions and delivering services. Healthcare faces the same challenges. The solutions we need must include universal access at an affordable expense. I am convinced that we must come up with inclusive solutions for the future that are as focused on giving the 80 million uninsured or underinsured Americans the care they need as a priority equal to the unrealistic guarantee we offer to the other 250 million citizens that there will be no compelling reason for them to accommodate to any change. The message that I took away from the evening was that any future solutions must be inclusive. We are facing a future where we all are part of the problem, and the solutions we seek will ask something from each of us. In the end we will have failed if those solutions do not work for everyone.
