Can we create a health system and a society where doing things is easier, more fulfilling and more fun than just complaining?
“IF you are not part of the solution, consider that you may be part of the problem.”
This sign was prominently displayed in the Kathmandu headquarters of the Nepal Red Cross Society when I was there for post-earthquake relief efforts in 2015.
It reminded me that the only certainties in life are death, taxes … and people complaining.
But what if we are not condemned to this fate? What if we can move, however slightly, towards a world with more people doing rather than just talking?
What if we can have 32 million Malaysians all participating in improving, and not simply criticising, our health system?
We must not be overly-idealistic or naïve though; even a 1% shift will be difficult.
To get there, let’s examine the importance of rhetoric, the dangers of talk, and three ways to make ideas great again.
Rhetoric is important. Aspirational ideas conveyed through beautiful language carry us towards a common lofty cause.
Imagine Abraham Lincoln’s war on the injustice of slavery in 1860s United States, Otto von Bismarck’s solidarity case for a modern welfare state in 1880s Germany, William Beveridge’s moral case for the National Health Service in 1940s United Kingdom, and the Medicare for All proposals in 2019 United States.
Rhetoric can appeal to the better angels of our nature, and help us articulate and aspire for justice and equality.
Talk is different from rhetoric, because it’s too fun, too easy and too casual.
When talk takes the form of unconstructive complaints, criticisms or grumblings, it even provides an emotional and psychological bonus – we feel morally righteous that we are “doing something”.
These feelings are so powerful and pleasurable, they easily trap us into a state of Nato (“no action, talk only”).
Complaints are very seductive, because opposing is easier and safer than proposing (which exposes you to potential attacks). This is anti-solutionism, a very destructive force.
Some public complaints take the moral high ground with convenient sweeping statements like “urgent reforms in X, Y and Z are needed to save the dying health system”.
This approach of governing-by-declaration omits reality and crucial details of implementation.
It’s too easy to proclaim “End world hunger now!”, and because you’ve already fulfilled your duty to raise awareness, you can delegate the details to someone else.
Tell me how
Former British prime minister Margaret Thatcher once said: “Don’t tell me what. I know what. Tell me how.”
The Malaysian social contract for health provides rights, but also assigns duties.
Let me propose two duties for now: to raise valid concerns (“what”), and to constructively suggest specific improvements (“how”).
Both duties are important. While plenty of people will meet the first duty, one cannot simply outsource the second one.
For more positive public discourse, we can make three shifts together.
The first is the toughest: All citizens must accept that we all have a public duty to suggest and to implement solutions.
It is tough for a few reasons. We live in an increasingly self-entitled world and must especially consider Malaysians’ quickness to complain.
In our current fetish for convenience, we think that we only have to state the problem, and someone else will fix it for us.
When apps exist for us to outsource something as fundamental to life as grocery-shopping, outsourcing our civic duties only seems natural.
As joint owners of our society and health system, we can and must do better. Malaysia’s middle class and elites have the exposure, experience, time and public space to contribute constructive and meaningful ideas.
In practical terms, this means that we should consciously create a more positive, ideas-rich and solutions-oriented public discourse, instead of merely complaining unhelpfully.
The second shift is to enrich the “science of delivery”. This beautiful term was first used in 2013 by Dr Kim Jim Yong when he was World Bank president.
The science of delivery aims to organise the knowledge around how to effectively implement an idea, not just what the idea should be.
The bad news is, there is no science, guidebook, recipe or instruction manual on how to implement a government policy. That is why governments struggle with the “delivery gaps” between strategy, policy and implementation.
There are more struggles in Malaysia. Our health system is a gargantuan hyperobject, with its own bureaucratic inertia, vested interests and silos.
Competence and capacity could be lacking. Leaders are torn between announcing reforms that play well in the headlines and making slow, but steady, changes.
Election cycles and the demands of democracy mean choosing between what’s right and what’s popular can be paralysing.
The good news is that human beings can solve any problems we can name. To improve our health system, the question becomes: “We know the ‘what’, what is the ‘how’?”
Changing the question’s wording will encourage 32 million Malaysians to think of implementable solutions, then implement them together as we build our “science of delivery”.
No magic answer
The first two shifts will minimise complaints. The final shift is to create space for more solutions to be heard from more people.
It calls on those in leadership or decision-making roles and those with hard or soft power to accept that they do not have a monopoly on good ideas and to reduce some paternalism.
It asks for their intellectual statesmanship and generosity in sharing platforms, resources, and some decision privileges with new partners-in-health.
It also requires all of us to accept that there is no single magic answer, only a basket-of-solutions.
Crowd-sourcing ideas is already in Malaysia, in the emerging field of speculative-participatory design.
Sunway University ran a workshop in 2018 where senior citizens were co-designers for “policies on ageing well in the city”.
In a citizen-centred policy-setting approach and a patient-centric health system, good ideas can come from anywhere, and perhaps will come best from the actual recipients of public services.
Public moral outrage is the hallmark of our times, but it must cede space to practical solutions and constructive discourse.
As this is our health system, we are all part of the solution and must build the health system that we want. No one else will build it for us.
Dr Khor Swee Kheng has postgraduate degrees in internal medicine and public health, and has worked in five health sectors across three continents. He is currently specialising in health systems and policy in a public university and a local think tank. The views expressed here are entirely the writer’s own.