Interview: The New Silk Road—Health as soft power
Prof. Vural Özdemir (Editor-in-Chief, OMICS: A Journal of Integrative Biology): Thank you all for the interview with OMICS. The journal offers a multidisciplinary forum on integration of biological and social determinants of health, with a view to system sciences and systems thinking in health. Among the latter, there has been renewed interest in the Silk Road lately, especially after the 2008 global financial crisis. China proposed in 2013 the “Belt and Road Initiative,” a major infrastructure investment envisioned to promote trade, energy, and commercial associations between China and >60 countries in Asia, Africa, and Europe. The initiative has the potential to engage almost two-thirds of the world's population and a third of its gross domestic product. According to The Economist, China is estimated to invest a cumulative $4 trillion along the Belt and Road countries.
In contrast, the “Health Silk Road” has been overlooked despite the coconstitutive nature of health, trade, foreign policy, and economic development. It is my hope that the present interview article will inform our readers on the new Health Silk Road.
I would like to ask the first question to Professor Ilona Kickbusch who has pioneered the field of global health diplomacy. Prof. Kickbusch has recently been awarded the Cross of the Order of Merit of the Federal Republic of Germany (Bundesverdienstkreuz).
Could you share your thoughts on (1) why inclusion of the health dimension is important for the revival of the Silk Road and (2) in what configurations the “Health Silk Road” might materialize in the future?
Prof. Ilona Kickbusch: The Silk Road has the potential to be a truly visionary concept if its focus is on the well-being of all the people, if it becomes a Health Silk Road. Health can be positioned as a diplomatic vehicle and catalyst for connecting and engaging countries along this road to ensure that the enhanced economic development also benefits health and that the great gaps in social and environmental factors across the Silk Road countries are addressed.
The increased intersections of trade, economic and transport policies in the region, and the strong focus on investment in infrastructures will require countries along the Silk Road to work together to ensure that negative health impacts are kept to a minimum. Using health as soft power, though, cross-border engagement and connectivity will provide extraordinary opportunities for international cooperation not only of governments but especially for healthcare organizations, business, and civil society.
The increased flow of people, information, goods, and services along the new Silk Road will affect health in many different ways: this includes concerns around health security, healthy lifestyles, road safety, and illegal substances. It also requires a strong awareness of communicable disease with the potential to travel along the Silk Road, such as HIV, AIDS, and tuberculosis.
Economic opportunities will also arise, for example, the increased trade in health products, services and technologies, and the potential for medical tourism if strong health organizations are established.
Prof. Özdemir: Natural and manmade conflicts across the Silk Road create challenges and new spaces for innovation in global governance for health, science, and technology. What are some of the emerging prospects for global health diplomacy, and governance innovation on the envisioned Health Silk Road?
Prof. Kickbusch: The health governance of the Silk Road could be truly innovative if it is not seen as a string of bilateral agreements among countries along the Silk Road, but as creating new ways of cooperation on the basis of connectivity between countries.
A new form of multilateralism so to say—which also expresses a new more dynamic approach to geopolitics. As people, goods, and investments flow along the road in many directions, they need to be harnessed to their greatest potential—in their physical manifestation but also making the best use of information technology. The Health Silk Road as a dynamic concept and a bridging factor would seek to reduce the health and social inequalities along its pathway by providing universal health coverage to all citizens along the road; it would also seek to provide the greatest possible health security.
Large variations exist in disease burden and access to healthcare along the Silk Road, and as it develops it provides the opportunity to study the effect of contextual factors and international collaboration on health outcomes. Investing in health would contribute to political and social stability along the Silk Road. New job markets in the health industry could be opened and training and research institutions in health could be established as joint endeavors between countries and institutions.
For example, trust could be built through a joint network of public health laboratories and joint centers of excellence in different health priority areas. First and foremost, a “Silk Road Health University” should be established as a cooperative project—it would bring students from the Silk Road countries together, specialize on the health challenges along the Silk Road, and monitor the health impact from its inception.
Prof. Özdemir: Food, nutrition, and water are central to governance for health, not to mention peace. I would like to ask the next question to Prof. Mustafa Bayram who is a food engineer with expertise in technology and innovation ecosystems in the Middle East. What are the ways in which food engineering, food, and water safety might shape the emergence of the Health Silk Road?
Prof. Mustafa Bayram: Engineering and informatics technologies impact the flows of data and knowledge across geographies and nation-state borders. It might be instructive, therefore, to recall the flows in the ancient Silk and Spice Roads that were unique. These ancient roads allowed bidirectional exchange of knowledge, trade, health, technology, and culture between the East and the West. This contrasts with the modern day wherein such exchange is patchy and unidirectional, often from the West to the East. But the times are changing with new investments on the Silk Road, particularly by China and other countries and geographies, including the Middle East.
I envision the 21st century New Silk Road to be a highly finessed bridge that is also as strong as the silk. Silk is an apt metaphor for innovation in governance. Silk is flexible to allow and stretch multilayered governance across countries and diverse value systems on the Silk Road across the Eurasian continent and yet, resilient enough to introduce normative measures on governance for health that are actionable, transparent, accountable, and trustworthy.
The strength of the new Silk Road will, in part, depend on our ability to innovate the existing governance frameworks for health. For many decades, governance and health intersected along the lines of a medical model and traditional healthcare stakeholders. Yet, health is more than presence or absence of disease. Health and preventive medicine, in particular, depend on input from broad segments of society. Engineering or the “bio”-related engineering sciences such as food engineering are more than a satellite knowledge domain for health. The materiality, safety, and benefits of food and water, not to mention governance of food and nutrients on the path from “farm to kitchen” rely on food engineering. These knowledge domains are directly within the training and scholarship of food engineering. Food engineers ought to work together with health actors in an ideal world.
Food and water are codependent and directly impact on human and ecosystem health. If we recall the history of human kinds and early migrations encompassing Africa, Middle East, Asia, and Europe, these movements were triggered or shaped by food and water essential to sustain life. Large swaths of water cover our planet but only a small amount of freshwater is well suited for human consumption at home or industry.
Interestingly, food engineering and medical field did not have extensive practical overlaps or collaboration in the past. It is useful to bear in mind that food and water are common denominators for safety and prosperity of populations, not to mention as levers for health and science diplomacy along the new Silk Road. I believe gastronomy, food engineering, and water safety-related science and technology would be important pillars for the Health Silk Road.
Prof. Özdemir: Mustafa, you have worked on the emerging concepts of Industry 4.0 and digital connectivity by the Internet of Things (IoT). Do you envision digital connectivity will prove to have unprecedented roles for technology innovation, and bringing food engineering and health in proximity on the new Health Silk Road?
Prof. Bayram: The concept of Industry 4.0 relates to the current pervasive distributed computing environment brought about by the IoT, artificial intelligence, and embedded sensors. For global health diplomacy and practical aspects of collaboration across the vast geographical landscape of the Silk Road, such virtual and computing capacities by Industry 4.0 are indispensible and timely. By harnessing Industry 4.0, one could work and collaborate across national borders, time zones, and institutional barriers. This should bode well for the revival of the Silk Road in the early 21st century, as well as in responding in real time to epidemics or long-term healthcare issues such as noncommunicable diseases such as cancer that have been impacting both developed and developing countries.
In sum, the Health Silk Road could build on such capacities in computing, Big Data, and the ability across borders and barriers.
Prof. Özdemir: An important issue is gender parity on the Silk Road and the Health Silk Road initiatives. Women are the only minority group who are not a minority in numbers (www.hurriyetdailynews.com/opinion/vural-ozdemir/the-top-five-ideas-for-raising-a-feminist-son-in-the-middle-east-122669). Lack of equal rights, of power and autonomy, not a deficit in numbers, is what make certain groups of people a minority, excluding them from the dominant mainstream. Silk Road is not an exception in this regard.
I would like to ask Özgür Bayram on empowerment of women on the Silk Road broadly, and the Health Silk Road in particular. In your experience as a professional in the finance and commodity exchange markets on a Silk Road city (Gaziantep, Turkey), are there certain actionable examples, or constructive intervention points for governance innovation toward gender parity?
Özgür Bayram: It is interesting to note that the hunter–gatherer tribes and the earliest human societies have been founded on generally enlightened egalitarian principles wherein women had equal influence in social networks and choices made. In other words, gender equality is not necessarily a recent idea. Current gender inequalities emerged in parallel to the agrarian age and the emergence of agriculture when people began to accumulate resources (https://www.theguardian.com/science/2015/may/14/early-men-women-equal-scientists).
Moreover, women are strong with equal numbers as with men on the planet but remain (women) as the only minority group who are not a minority in numbers, an unsettling concern in contemporary societies where the decision-making and political power mostly reside in men.
In the current century, women began to regain economic and political power but gender parity is still far from reach in many geographies and contexts. The new Silk Road and the Health Silk Road, in particular, are veritable opportunities to achieve gender parity in health, an indispensible aspect of society, and a common denominator for all. The Health Silk Road could serve for exchange of expertise in health sciences as well as governance for health for shared, accessible, and inclusive health solutions across the Silk Road. Gender parity in all health policies would be a concrete step in this regard.
We also need to bear in mind that all aspects of life in society, including economy and trade, impact health as these are not simply externalities but important levers for health. Gender parity should thus be a crosscutting concept and practice for health and society.
Prof. Özdemir: I would like to return to digital connectivity, the IoT, and their corollaries such as the Industry 4.0 knowledge platforms that have been extensively supported by the German Federal Government since the Hannover Fair in 2011. Prof. Nezih Hekim has worked with the development agencies in the Middle East and central Asian states on the Silk Road for many decades. He has also been involved in the development of the concept and theory of the “Science Peace Corps” and the “Industry 5.0.”
Do you envision, Nezih, that the Science Peace Corps might play a future game-changing role for connectivity and medical innovation across the Silk Road, in concert with digital connectivity? Some analysts on the Industry 4.0 suggest that extreme connectivity and digital automation could eliminate, or at least significantly reduce, the need for people for certain tasks. How might that affect governance for health on the Silk Road?
Prof. Nezih Hekim: The Health Silk Road will depend on building the crucial capacity for human resources, quality education, independent thinking skills, and a new generation of scholars who are well invested in science, technology, and innovation, not to mention governance innovation. Circulation of scholars and scientists across the Silk Road countries and geographies would, no doubt, be important for such transformative capacity building. Science Peace Corps would effectively combine science capacity building with peace building through the human and knowledge flows generated in the course of such a remarkable initiative. The twin concepts of the Health Silk Road and the Science Peace Corps remain to be implemented as governance instruments to allow exchange of scholars along the Silk Road.
Industry 4.0 builds on digital connectivity but at the same time, I must say, face-to-face human interactions cannot be put aside or replaced by two-dimensional e-mails or digital connectivity. Actual flows of scholars in health, science, and technology will always be important despite the facilitation of collaboration by online or virtual knowledge exchange platforms. We also need to move the physical bodies of scholars across the new Health Silk Road for real-life innovation and meaningful collaborations.
Scholarship is everywhere, but like tending a garden it needs to be cultivated. Science and technology need to be linked to societal development that is inclusive and forward looking. The new Health Silk Road would need to place safety checks and balances, so certain universal governance instruments for inclusive, transparent, and accountable production of knowledge are ensured. For this, competency in technology as well as political science and philosophy of science is important.
I would like to conclude my answer with the metaphor of a “snowdrop,” which is a flower that can blossom in the most difficult of the circumstances. Scholarship is akin to snowdrops in that it is inextinguishable and needs innovation in the ways in which we govern production and harnessing of knowledge and scholarship.
Ideally, I would like to see think tanks flourishing along the Silk Road tackling the challenges of health and societal development together with governance innovation. The legacy of Scholars such as Rhazes (860–932 AD) and Avicenna (Ibn Sīnā) (980–1037 AD) remains with us along the Silk Road, among many other countless scholars and public intellectuals.
The new Health Silk Road belongs to all on the planet, as health is interdependent across geographies, nation-states, and societies.
Prof. Özdemir: The envisioned Health Silk Road will include a broad range of innovation actors. Bülent Kayalı is the Branch Manager at the Southeast Anatolia Exporters' Association located on the Silk Road. His organization interacts with various exporters' communities worldwide.
Bülent, could you share your thoughts, and specific examples from your professional practice, on the ways in which trade, export, and health might intersect on the Silk Road in the Middle East?
Bülent Kayalı: Gaziantep has heretofore been a city and landscape that has played a game-changing role in terms of commercial regional division of labor. Starting with weaving, this role has scaled up and spread into various fields of trade, health, and scientific innovation. Healthcare industry within the context of “service exports” is one of these emergent fields. Healthcare infrastructure, which has been growing rapidly, paved the way for flow of scholars, patients, and health professionals across the Silk Road including Gaziantep.
Medical tourism and its transformative role for global health diplomacy cannot be emphasized sufficiently. Visual health, in particular, has become one of the cornerstones of medical tourism in the Middle East after the Syrian civil war. Medical tourism has been attracting patients, doctors, and nurses to the Silk Road countries such as Gaziantep, both from the Middle East and beyond such as the Central Asian countries, Russia, and Africa. From this aspect, medical tourism bodes well within the context of the Belt and Road Initiative.
However, what is tragically happening with the Syrian conflict requires us to deal with innovation in global health governance urgently. The new Health Silk Road cannot wait for implementation and the time is ripe to move from concept to practice.
Conflicts are also new spaces for intervention and opening up minds to rethink health as a soft power, as with innovation in health governance.
Prof. Özdemir: Thank you for your thoughts and analyses on the Health Silk Road. I trust that this interview and the ideas shared herein will contribute to the emergence of the Health Silk Road and innovation in governance for global health.
I wish to chime in by saying that there is a need for transdisciplinary and, importantly, value-aligned sustainable collaborations across the Silk Road countries. Collaboration, as an activity for knowledge generation and instrument for innovation governance, often involves politics (constitution and contestation of power) as with all human activities are, and thus, requires political scientists' involvement in the new Health Silk Road to be sure, beyond a technical vision in health.
The architects of the Health Silk Road will be women and courageous scholars who strive for gender parity and democratic governance in health and beyond across the Silk Road countries.