Celebrating Scholarship

It has been a fortnight of celebrations. Celebrations of scholarship.

University graduations are moving occasions: times of celebration of achievement and hope. There will be time for disappointment and frustration, time for cynicism and loss of ideals. But not now, not at graduation. Now is the opening up of possibilities to make a difference. Perhaps that is why the Americans call the completion of University studies: commencement. In Sweden they call it promotion – my fortnight was bookended by graduations in Yale and Lund. In both cases, the University itself put on a grand occasion to honour their graduates – to celebrate scholarship. It is wonderful and moving, and a special interlude in the rhythms of what we do the rest of the time.

When in Britain the previous government raised university fees, the arguments seemed to be that lucky university students will gain economic benefit from a degree; therefore, they should pay. And Universities are pushed to show that they contribute to the economy. They do. But universities are about much more than enhancing earning power for individuals and the nation. They are places of scholarship and commitment, of morality and reason. And graduation is a time to celebrate this higher calling.

I was at Yale on 18 May for their graduation. I come with my inequality baggage of course. Yet awareness that these Yale students, many of them, had enormous privilege just to get to Yale, and accumulate even more being a graduate, didn’t stop my enjoyment of the splendid occasion. In the School of Public Health graduation ceremony, Jordan Emont, who spoke, brilliantly, on behalf of the students said they were united in their desire to contribute to a healthier future for the population, to confront the challenge of health inequalities. He spoke not of increased earning power but of the special bond with his fellow students and their joy of learning.

I gave the commencement address to the School of Public Health graduating class.

I was slightly disoriented. The academic procession, in full academic regalia, was accompanied by Elgar’s Pomp and Circumstance March. Shades of ‘Last Night of the Proms’, the BBC’s annual patriotic flag fest. Land of Hope and Glory, a British patriotic ode, in the US? The Dean, Paul Cleary, assured me that there was no political significance; they always played Elgar at Commencement. Paul was a great host and clearly a great dean as one graduating student after another hugged him. An oxytocin surge to warm up a formal afternoon.

Yale awarded me the Centennial Winslow medal in commemoration of the Founder of Yale School of Public Health in 1915. I quoted Winslow. In 1940 he wrote: In 1890 public health was an engineering science. In 1940, it is a medical science. Tomorrow it may be a social science. We must “pay attention the social environment that man has made for himself and in which he lives and moves and has his being…” Not a bad description of social determinants of health. Thank you, Charles-Edward Amery Winslow.

Winslow understood relative inequality. He wrote: “the sense of inferiority due to living in a substandard home is a far more serious menace to the health of our children than all the in satinary plumbing in the United States.” Wish I’d said that.

Some American politicians seem to be mired in pre-enlightenment thinking. Quoting Kant, I suggest to the graduating students that each of them “have the courage to use your own understanding”; and still moved by my meeting with him, I quoted Bernard Lown: Never whisper in the presence of wrong.

Could you take someone seriously who looked like this?

"In Sweden we don't do VIP..."

But they do a lot else. Perhaps no trappings, but I have no complaints. What they showed me was gift enough. Goteborg is the third of the three Swedish cities/regions – the others are Malmo and Linkoping – that are doing reviews of social determinants of health. Or, as they put it, Swedish Marmot Reviews. It felt like we were having a conversation.

Apparently at the airport, there is a sign promoting the city:

Goteborg, growth.

One of the local hosts proposed a new sign, sadly not adopted:
 

Goteborg: reading to children.

 

Another said that they had recently been to Birmingham on a fact-finding mission, having heard me say, a few years ago, how Birmingham (England) narrowed the gap in early child development between Birmingham and the English average. They were told in Birmingham that the special programmes on Early Child Development were no longer being supported. Disappointing.

The leitmotif of this Goteborg activity is inclusion: 1100 people, mainly employees of the City of Goteborg, came to this conference on socially sustainable Goteborg. I have been to meetings of various kinds in London, but never 1100 people engaging with how to make London a more sustainable place. Per capita, to match Goteborg, such a London meeting would have to have been 11,000.  The day after my visit, 400 of these 1100 were to sit down to work together to plan a more socially sustainable Goteborg, with health equity and sustainable development at its heart.

One of the gifts they gave me was to take me on a quick trip of the city, accompanied by three expert employees of the city. Slightly uncomfortably, I was fitted with a microphone and accompanied by a cameraman. They wanted to capture my reactions (not including post prandial afternoon drowsiness, I hope.) Goteborg “boasts” a nine year gap in life expectancy between small areas. What might that look like on the ground? What I didn’t “see”, but they told me, is that 22% of the population is foreign born, with another 13% or so children of migrants. Sweden had a programme to build a million new homes in the 1960s. In Goteborg, some of these were built in outlying communities that are rather cut off from the city. They are heavily populated by immigrants. These are ‘slums’ done by the Swedes. Apparently well-built, rather neat, five or so storey-blocks of flats, landscaped, no graffiti, no broken glass, but soulless and isolated, cut off from the Central City.

 

Perhaps linked to this isolation, one of the questions I was asked at the conference was what might they be doing about the fact that the 1100 people attending, overwhelmingly, were white. My response was that I wouldn’t start from here. If immigrant communities were cut off from the main stream, geographically, it was perhaps no surprise that they were underrepresented socially.

 

Even egalitarian Sweden has inequality issues with which they must grapple. But they are, grappling. Particularly, they liked our European slogan, which we adopted from Swedes: “Do something, do more, do better.” I think it highly likely they are going to do better. I was invited to come back in three years and see.