Originally published on www.wrenchinthegears.com
“It is vitally important that people of the world recognize how public health policy in many nations has been harnessed to global markets. Instead of serving those at risk of sickness and death, these policies of financialization are constructed to benefit social impact investors. Transnational global capital demands the creation of new investment products to circulate the holdings of billionaires and further concentrate their wealth. This program continues to advance even as poverty rates skyrocket under conditions of economic lockdown. Social impact finance is the centerpiece of this new era of “stakeholder capitalism,” which was launched with great fanfare in Davos this January.
Data-driven “pay for success” deals are structured around the United Nations Sustainable Development Goals (UN SDGs). “Health” is goal number three. The World Bank has played a role in creating new investment products aligned to the UN SDGs. You can read more about the UN SDG financial apparatus here.
“Pay for success” finance is a performance-based contracting system that has been applied to a wide range of social issues ranging from pre-k, mental health and elder-care services to workforce training and supportive housing. It is clear to me that “pandemic preparedness” is being fitted out for pay for success profit-taking, too.
The “pay for success” finance model works as follows:
1. Identify a social problem. In this case the possibility of a pandemic.
2. Get an academic institution or think tank to cost out the problem as a negative externality. Remember, the more expensive the problem, the bigger the potential profit from preemptively “fixing” it.
3. Establish an equation that fixes a rate of return for “evidence-based” “solutions.”
4. Select the type of data, the parameters, that determine “success” for the deal.
5. Set up infrastructure to track the data and provide “evidence” of success.
6. Identify partners – service provider, investors, and project oversight.
7. Deliver the services and collect the data.
8. After a third party determines if success metrics were met, performance payments are issued to investors (or not).
If you want a more extensive overview, see this post.
In 2018, the World Bank and the World Health Organization partnered on an initiative called the Global Preparedness Monitoring Board. Its task is to oversee member nations and identify pandemic preparedness “gaps.” Gaps is a red flag for technocracy. Once a social problem is turned into data, it can be put onto a dashboard and twisted to serve the needs of global markets. The “gap” between the data as it currently is and that which is desirable allows public services and resources to be placed under the control of systems engineers, technocrats. The following excerpt is taken from a paper prepared by the Johns Hopkins Center for Health Security in 2019. It speaks to the desire for data to “motivate” and “measure.”
Source: Preparedness for a High-Impact Respiratory Pathogen Pademic, Johns Hopkins Center for Health Security, September 2019
Narrowing the “gap” justifies private profit taking. Dashboard managers are incentivized to modulate the “gaps, but never close them. The pay for success model is based on tightening gaps, but just a little.
Problems that have wide gaps and can be tightened up pretty easily are more attractive investments than intractable problems where the gap is narrow. In the case of pay for success, the worse the problem, the better your chances are to show “improvement.” Start from a terrible baseline and demonstrating growth is easier.
The terrible reality of this market is that it is built and sustained on misery. Thus, if profit is made, more misery is needed in order to grow returns. There is no profit for investors in addressing the structural nature of social problems. Plus, real solutions can’t be shoe-horned onto a dashboard anyway. Those in power set up the deals, and the deals are structured to favor those in power. Imagine that.
Interactive model of map above can be accessed here.
In 2017, through the Pandemic Emergency Financing Committee, the World Bank issued the first pandemic bonds in response to the 2014 Ebola epidemic. While at first glance that may seem like a humane gesture, the truth is that the bonds were structured in such a way that it is almost impossible to trigger the payouts public health systems need to respond to disease outbreaks.
Neither the Ebola nor the Covid-19 pandemic bonds have disbursed ANY proceeds to governments; meanwhile, these instruments of “innovative finance” have generated $100+ million in returns for private investors.
If you want to take a deeper dive, I recommend Susan Erikson’s paper, “Faking Global Health” published last June in Critical Public Health Journal. Her exploration of how “health innovation” and “health finance” advance superficial techno-solutions that generate profit for some but never structurally address public health problems matches up perfectly with my own experience regarding the privatization of public education.
Erikson speaks directly to the ways in which data can be manipulated to preference certain outcomes and how harmful consequences can arise when “success” becomes tied to narrow impact metrics.”