It’s not often you come across a truly visionary op-ed but in my opinion last week’s viewpoint from Guy Standing in The Guardian, ‘Cheer up – a renewed left is coming’, fits the bill. In the piece, Standing says the precariat is today’s (emerging) mass class, and like the proletariat in the 19th and part of the 20th century, it will define a new progressive agenda for this age. Not all the examples he gives of “precariat uprisings” in countries around the globe are convincing, and not everybody shares his analysis, obviously, but the man has a point. If the 21st century is to have a progressive agenda, it will need to come through a social and political mass movement with a vital role for this precariat.

Granted, the precariat is not yet a “global” class, and our individualized and fragmented societies don’t exactly facilitate its emergence, but nevertheless, as Standing mentions, “a growing part of the precariat perceives a common predicament, realising that this is a collective experience due to structural features of the economic and political system.” People belonging to this precariat lead very insecure/precarious lives, and “increasingly resemble denizens rather than citizens: people with restricted rights, largely living towards the bottom of a “tiered membership” model of society, in which a plutocratic elite takes the single biggest share, while other classes – the salariat, free-ranging “proficians”, and what remains of the old working class – divide up most of what remains.”

If you share this analysis, and French economist Piketty has provided some more evidence for it lately, the conclusion for the global health community seems obvious.

Especially since 2000, the focus of the main global health stakeholders and donors has been largely on the many poor, marginalized, downtrodden, … in fragile, low and middle income countries. Inspired by a donor-recipient logic, the idea was to do something about the huge health inequities that characterize our world. A great cause, no doubt, and one that isn’t finished yet, far from it. Global health embraced public-private partnerships, with their trademark mix of business spirit, skills and philanthropy, to make progress towards the eradication of extreme poverty and the softening of health inequities, and some (big) successes have indeed been achieved.  For the ‘Grand Convergence in Health’, an even greater effort along these lines is planned, although more domestic revenue will be used too, if all goes well.

Yet, if the global health community really wants to contribute to a more just world in the 21st century, it will also need to embrace the cause of this growing precariat – and frame some of the key global health battles in these terms. As Standing mentions, the size of the precariat is increasing as we speak, in many countries. You have people in LMICs who just escaped extreme poverty and are aspiring for the middle class lifestyle but could fall back any time, people in formerly developed countries who are no longer middle class but living very precarious lives, due to the forces of globalization & technology, austerity policies imposed by financial markets and technocratic institutions, the shrinking of traditional welfare states, … and the global trend towards more insecurity and inequality, within countries, doesn’t seem to stop any time soon.

If global health is about more than just ensuring security for the North, contributing to economic growth and/or  charity,  the global health community should help raise the political awareness of this already emerging class by framing issues as the right of all human beings, regardless of the role people play in the economy. UHC can be a great tool in this fight for more global social justice, although then it would need to be – more than now – framed as a global agenda (and not just a national agenda), as a human right for all, uniting Brazilian rioters with Israeli protesters and desperate Greeks and Portuguese. To some extent, this is happening, if only because UHC has the word ‘universal’ in it, but the political momentum and the framing still seem to be nation-based, mostly. Let’s face it: apart from people like us, in the global health community, who knows the World Bank, WHO and the Rockefeller foundation are leading a global campaign for UHC? Most people talk about UHC for the US, or for Indonesia or for Ghana, not really about UHC as a right for all, around the world, including the marginalized & the very poor, obviously, but also the global precariat. In a way, although it’s a bit of a stretch, what the informal sector is for LMICs, the precariat is for formerly developed countries. So it shouldn’t be too hard to start framing the agenda as such and pointing out similarities.

But UHC is just one example. It’s clear that in other global health struggles too, like  for example in the fight for decent work, the global health community shouldn’t be aligning with the likes of Walmart and co. Equally, in the fight for fair taxation, it’s time to discard the “very respectful language” towards JP Morgan and Goldman Sachs top employees, in fora like Davos, hoping for an innovative ‘partnership’ with them for a global health cause.

If global health is indeed (also) about social justice, as it claims to be, it should embrace the precariat’s cause, wholeheartedly. To put it differently: Bill Gates shouldn’t be the face of global health (anymore), in spite of all the good he does. His global health commitment feels too much like benevolent charity by the winners of globalization. His efforts are still much appreciated, but instead, Guy Standing and others like him should be the faces of a truly progressive agenda for the 21st century. We can think of a number of good global health examples to embody such a “pro-precariat” agenda.

Last but not least, there’s one more reason why global health should pay much more attention to the precariat’s predicament. The ranks of the global precariat are not just swelling due to social and economic trends. From an ecological perspective, increasingly, we are all “the precariat”…

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