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75th Annual Summer Conference, August 10–13, 2006

Left to right: Gwen Burrows, Sheela Basrur, Elizabeth May, Madonna Larbi

The Paradox of Progress

Summary by Brianna Goldberg

On Thursday evening of Couchiching’s 75th anniversary, conference co-chair Gwen Burrows moderated a discussion that questioned “The Paradox of Progress: Unintended Consequences.” To attack the problem from three key areas, Sheela Basrur, Elizabeth May, and Madonna Larbi brought their kudos and their criticisms of progress to the table.


Basrur began by placing the paradox of progress in context of Public Health, bringing her more than twenty years of experience to bear on the topic. Basrur is currently the Chief Medical Officer of Health, and Assistant Deputy Minister to the Ontario Minister of Health. However, as she joked, she is more frequently recognized as the former Medical Officer of Health for the City of Toronto during the SARS crisis.

Even so, she began by suggesting that there is more to Public Health than just infectious diseases (such as SARS) and their control: her discussion instead focused on the more fundamental causes and consequences of health and illness, which are “the stuff of Public Health” from her perspective.

Public Health, she explained, focuses on prevention rather than treatment. It is anticipatory, and takes the long view of illness. So, for all our progress, have we gotten the fundamentals for good health, and priorities regarding good health, right?

The definition of progress, she said, may be debatable, but its one key quality is that it is never always good and it is never always bad. She argued that there are three main paradoxes inherent to this problem.

The first paradox is our modern assumption that better health is directly due to better technology, but that it has in fact been non-clinical interventions that have had the most material effect on infectious disease rates. The real reason for the dramatic reduction in infectious disease pandemics and other problems, she said, has in fact been an improvement in sanitation, sewage and animal control, and an improvement in quality of housing.

The second paradox is the tyranny of the acute: our approach to Public Health, which has focused on treating individuals after health consequences have occurred, rather than dealing with our health in a preventative manner. Basrur cited on the omnipresent pharmaceutical advertisements, which reflect a push of cures for what ail us, “even if we didn’t feel that sick to begin with.”

The third paradox is the “bigger is better” ideology of our society, which drives us to acquire bigger, faster, sexier cars, even though we know the environmental consequences.

Basrur put these paradoxes in context by using the problem of urban sprawl as a model. She outlined the overwhelmingly negative effects of suburban life and commuter-living, which include increased pollution from air traffic, obesity, stress, and an erosion of social life. However, she argued that with the creation of walkable and mixed-use urban design, local citizens can again be engaged.


Elizabeth May, Executive Director of the Sierra Club of Canada and current nominee for leadership of Canada’s Green Party, then provided her take on the paradox of progress from an environmental perspective. May framed her talk as a discussion of the environmental impacts of human technology and progress, which would contrast the unintended and unforeseeable consequences of the same.

Some environmental consequences are unintended and unforeseen: acid rain, for example, arose in earnest. However, some environmental consequences, May suggested, are unintended, but not unforeseen. The very first debates of the U.S. congress in the 1920s, which discussed General Motors’ plan for a new car that ran on leaded gasoline, in fact included a complaint that a neurotoxin such as lead should not be distributed in the environment. The plan for the new car, however, went ahead. It was thought at the time that progress would trump the health concern. It took 70 years to ban lead in gasoline in the U.S., and it is still sold in developing countries.

May also argued that climate change was also foreseeable, and was in fact predicted as early as the end of the 19th century. She suggested that humanity is but a blip in earth history, but in its short time has put life support systems into reverse.

May concluded by suggesting that humanity is capable of learning from mistakes. After all, Al Gore’s film on climate change has been a box-office success! However, to truly put this learning to use we must redefine what progress is about by asking ourselves, “if we want to treat this planet as though we are planning to stay.”


Madonna Larbi rounded out the discussion by putting the paradox of progress in terms of the gender divide. Larbi is a consultant on international and social development, and a former Executive Director of MATCH International Centre. Her discussion used her first-hand work in Ghana and Nepal as case studies to express the disadvantages of women in those countries, despite a perception of progress in motion.

Larbi discussed the obstacles faced by women entrepreneurs in Ghana as an example. She cited the inability of women entrepreneurs to access capital from commercial banks, because unrealistic collateral is demanded. Instead, women are forced to turn to family and friends, or loan sharks, as a last resort. Consequently, women-owned businesses remain at a micro level, and 70% of womens’ employment is restricted to the micro and meso levels. Despite the significant role played by women in the informal sector, economic aid policy remains geared to private sector.

Larbi also provided a snapshot of the obstacles of women in Nepal, where poverty, political instability and insecurity have all created rife opportunities for the trafficking of women, especially to India, so that they may extricate their families from poverty. She argued that donors must work within the Nepalese government to stem the flow of human capital, and institute severe punishment for related offences to protect the women of Nepal.

The global community makes it easier for links to be formed, added Larbi, as she concluded that policy-making must become an inclusive process for all citizens to enjoy their human rights.

Questions from the audience

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