Economists tell us that public goods have
two important characteristics. That they are non-rival (individual consumption
does not diminish the potential for others to consume) e.g. clean air, and that they are
non-excludable (you cannot stop others from consuming of that good or service.
Because an individual or business cannot
charge for accessing these goods, very few people or businesses are interested
in providing them to the public. In deed for that reason they can become
subject to negative externalities – where inappropriate consumption imposes
risks and costs on other people. A good example is air pollution. Another good
but rarely understood example is HIV for Key Populations.
In our work on HIV for Key Populations, we
are often confronted with advocacy situations that are very difficult to deal
with. There are cultural, legal, social and policy situations that are very
unfriendly to members of Key Populations, and require review. But this is often very difficult to
communicate to members of the society.
Religious and cultural leaders have
invested heavily in maintaining the status quo, which they see as being
protective of their religious and cultural values. How do you tell them, that
in fact the situation is very harmful to public good in form of public health? How does one get them to understand that this
is a perfect case of negative externalities; where the health of the entire
society deteriorates merely because we cannot get around providing right
prevention and treatment environment?
How does one put himself or herself out
there, to do this work given the huge stigma, discrimination and sometimes
violence that accompanies the work? Why should anyone do this work,
while they cannot charge a fee on the society who benefit from it?
Indeed why put oneself in this painful
position, while the beneficiaries include the very same people loading on to
him/her the pain? After all, just like the next person, s/he too can benefit
from initiatives of others who may choose to take up his place? S/he too can
free-load – that is if someone is successful in effecting the much needed
changes.
Religious and cultural leaders – the very
people who should in fact be at the forefront of this work, but are the
vanguard against it, need to understand the impact of their opposition. If I
were a religious leader today, I would want to do what is best for the common
good. I would not want to be the bedrock for stigma and discrimination. I would
certainly not want to be the roadblock to improved quality of health for our
people.
True the moral and cultural values they
hold dear are important and need to be protected. But it is a false assumption
that cultural and religious values are mutually exclusive with a conducive policy and regulatory environment for
public health. It is a false narrative that holds; in order to protect our
morals and our culture, we must sacrifice members of the Key Populations, even
if at the cost of non-Key Population persons.
Kiambu County is honouring 12 outstanding
persons who have helped put the Kiambu on the global map. I hope they can use
the forum as a platform to honour people working on HIV and especially for the
vulnerable and marginalized populations. The only way public good can be advanced is if the societies, through their
governments pay for them; and this is an opportunity for Kiambu to do that
without incurring any financial costs.
