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.

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. 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. Transforming People Transforming Structures (including Institutions)

4. The Transformation of Structures: The Powers… recapturing their meaning Karl Barth Church and State

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. 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. 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

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.” "Climate Change Impacts on and Implications for Global Health" 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. 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. 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. 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. 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. 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. 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. 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. 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 .