We gather in the atrium of the Royal Swedish Academy of Sciences, founded in 1739, surrounded by statues of Carl Linnaeus and portraits of the great (male) heroes of science (Newton, Galileo, Brahe). Reflecting on the pride and responsibility that Swedish scientists feel for their stewardship of the Nobels, some recalled with fond nostalgia the great lost years of Swedish influence in global health. The amplification of Sweden's presence in health stemmed from the nation's distinctive values, innovative research, policy translation, and strong activism. That was back in the 1970s and 1980s. But for reasons unexplained and unexamined, Sweden slowly disengaged from the global health community. The Swedish International Development Cooperation Agency (SIDA) has continued to play an important part in promoting attention to health systems, maternal and child health, and sexual and reproductive health and rights. There are still pockets of research excellence, such as Stig Wall's international epidemiological research centre at Umeå University. We mourn and miss Hans Rosling. A rather too quiet Ambassador for Global Health goes about his business. To add insult to injury, as Sweden lost its voice, so Norway gained their's. But thanks to the vision of two individuals, Peter Friberg and Göran Tomson, this trajectory of decline is about to change. With the support of the Bill & Melinda Gates Foundation, last week saw the launch of SIGHT—the Swedish Institute for Global Health Transformation. SIGHT's vision is “to contribute to health and wellbeing globally for all, with a particular focus on vulnerable groups, including women and children”. An international faculty was assembled to offer ideas for SIGHT's future work. The list of suggestions was long: from adolescent health to pandemic preparedness, universal health coverage to the biosphere. But the challenge facing SIGHT's ambitious, and small, team is to identify a niche in global health that complements Sweden's strengths. One strength is the country's values. Sweden's concern for equity, gender, environment, and peace, together with its history of political neutrality and civil society advocacy, provides the firm foundation for a radical reframing of global health in an era of sustainable development. And the moment for radicalism is supremely urgent. During one working dinner, news broke that President Trump was withdrawing America from the Paris Climate Agreement. He was fulfilling a campaign pledge. It is easy to be angry at Trump's decision. I am. Many are. But we should be wiser. He is riding on a feeling of voter rage against elites. Global health is a classic elite. A vote for Trump, a vote for Brexit, was a vote, at least partly, against us. For here is a truth we prefer to overlook. Global health represents an uneasy paradox. It stands for two contrary ideas that exist in perpetual opposition. The idea of “health” suggests the lived experiences of a particular person at a particular time and place. The idea of “global” is, by contrast, ethereal, distant, everywhere, and at the same time nowhere. For us to protect and strengthen the notion of global health, we must constantly strive to root it in the lives of those who make up authentic and identifiable communities and societies. Abstract inquiry and advocacy will justifiably earn us contempt. Moreover, there is no single global health. Your global health is different from mine because our experiences, perceptions, and understanding of the world are different. What is Sweden's experience, perception, and understanding? It is the fourth best nation in terms of health-care access and quality. The third best in progress towards the health-related SDGs. The second best for innovation. And Sweden enjoys flourishing artistic creativity (it recently won the Palme d'Or for Ruben Östlund's film, The Square). But Swedes have fears too. They are living in the aftermath of a terrorist attack, which took place in Stockholm on April 7 with the loss of five lives. The rapid rise of the far-right Sweden Democrats—a party Prime Minister Stefan Löfven calls “neofascist”—is eroding the country's historically liberal political culture. The Green Party has seen its support collapse. One Green Party leader has pointed to feelings of hopelessness in Swedish society. The global context for Sweden's anxieties is not propitious. Democracy is in recession, and the world is a less peaceful place. But these trends and inclinations are all arguments in favour of SIGHT. To discover solutions to our most dangerous challenges demands disruptive thinking, interdisciplinary inquiry, collective action—and new institutions that will confront lazy orthodoxies.
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