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My week with Kate and Tim

Linda Mans

Last week, I had the unique opportunity to meet two important thinkers of the moment, Kate Raworth and Tim Evans. In my open letter to them I explain why Doughnut Economics and the World Bank should meet.

Dear Kate and Tim,


Many thanks for your visit to the Netherlands. I hope you had a safe journey back home. I learned a lot from you, and I really think that you should meet.


Tim, I met Kate Raworth earlier last week when she, on invitation of the Dutch Party for the Animals (Partij voor de Dieren), addressed the Dutch Parliament in a public hearing about why the current economic system is unsustainable and what steps should be taken towards an economy for the 21st century. Kate is the author of Doughnut Economics – Seven Ways to Think Like a 21st-Century Economist. As a nutrition specialist you might not want to grab a doughnut in the first place, but Kate’s doughnut is actually the only healthy one: she envisions it as the economy that can guide us to a safe and just space for humanity to thrive within the social foundation and planetary boundaries.


Kate, I met Tim Evans two days after the public hearing (and your lecture in Nijmegen that I attended as well and where we briefly met). Tim holds the position of Senior Director of Health, Nutrition and Population at the World Bank. He was invited by the Joep Lange Institute to speak about the need for and path to Universal Health Coverage.


Tim started his lecture by referring to the major shift that the World Bank made back in 1993. Initially, the World Bank invested mostly in building roads and other infrastructure and considered health and education to be ‘a net drag on economy’. But then they started to reconsider that approach. In their 1993 report they make a shift towards investing in health. They show that investments in health and education, by improving health outcomes, significantly contribute to, as they call it, ‘growth, jobs and opportunity’.


Where your stories meet is the conviction that no one should fall short on life’s essentials. As Tim mentioned, those who are worst off should have priority when it comes to investing in health and education. Kate’s comparison of the Netherlands and Zambia, two countries with about 17 million inhabitants, is illustrative here. Where the Netherlands is doing well in ensuring its citizens’ life’s essentials (the inner part of the doughnut), Zambia shows a different picture. The Dutch have a healthy life expectancy of 71.2 years whereas that of Zambians does not exceed 48 years. The Dutch have an intake of 3147 kilocalories per capita per day against 1937 of the Zambians. And if we look at income levels, we see that everyone in the Netherlands but only 35.6% of Zambians earns more than $1.90 per day. These are huge contrasts and a lot needs to be done to bridge the gap.


Please allow me a warrant. I have serious doubts about framing the urgently needed catching up by the Zambians – or others, for that matter, as there are plenty of countries like Zambia in the world – as ‘good for economic growth’. Currently, the Netherlands’ CO2 emissions exceed more than eight times the per capita boundary (13.3 to 1.6), and our ecological footprint is more than 2.5 times the per capita boundary (4.5 to 1.7). This means that whereas some economies indeed require growth and an increase of fiscal space to invest in health and education, many other economies are already overshooting the planetary boundaries. This makes it necessary to redefine the goal of these investments beyond economic growth; because the goal of human well-being will remain, whereas that of economic growth should not. Framing these investments differently will hopefully lead to more sustainable pathways and solutions.


Kate, I asked you how we could frame investing in health (care) within the doughnut economics. You answered that we should indeed invest in health, education, and housing, but also in clean air. Health, according to you, depends on the inside and outside of the doughnut. We need for example clean drinking water, and whether we can satisfy that need, deeply depends on how we treat our planet. You also stressed the importance of investing in preventive health care to keep us healthier in the first place.


Tim, I would like to reflect a bit on your example of Artificial Intelligence and the robot assistant in village health care in China as one of the technological solutions that you emphasised. If I am correct, you agreed with the audience that AI involves a certain challenge to not forget the health of those most in need, that is, people who are less well-off. In the long run, investing in preventive health care and in a healthy planet should go hand in hand. It is not only unfortunate but even fatal that this has so often been disregarded (with our bias towards appreciating technological innovations as ‘concrete stuff’). Many important investments in a healthy future do not have a price tag. How can we make those count?


Kate and Tim, my guess is that if you would meet and discuss further the purpose and pathways for investments in health and education within the Doughnut model, this could lead to another paradigm shift, one where we would be able to move away from ‘health and education are a net drag to the economy’ to realizing in this 21st century that ‘health and education are an investment in people and the planet’.


Yours sincerely,


Linda Mans





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