History and language: keywords for health and accountability

4 August 2017

Jonathan Fox, Director of the new, Accountability Research Center at the School of International Service, American University, shares notes from his presentation at the recent IDS-hosted event on strengthening accountability for health equity. He argues that we need to be aware of how accountability terms can and have been politically constructed, and encourages us to search for terms that do a better job of communicating the key steps on the path to accountability-building.

Totonicapán-Defensores del Derecho a la Salud - health rights defenders Guatemala. Credit: Centro de Estudios para la Equidad y Gobernanza en los Sistemas De Salud (CEGSS)

I was invited to discuss issues of language and began by contrasting two different approaches to the concept of accountability:

  1. Is it either a fundamentally trans-ideological idea, so malleable that it can be appropriated by a diverse array of actors, basically contested and up for grabs?
  2. Or is the term inherently technocratic and foreign, alienated from most cultures and pro-people social and civic actors?

During the workshop on history and language, our group discussed issues around translating the term “accountability”, but I would argue that the first problem is with the discourse in English: accountability clearly refers to exercise of power, but its directionality remains profoundly ambiguous. Who is supposed to be accountable to whom?

Upwards or downwards accountability?

This question is especially relevant in the field of global health, where an upwards notion of accountability is especially strong because a strong association with donor compliance. So it pulls upwards and inwards rather than downward and outwards.

This poses a challenge: how can our language communicate the democratic dimensions of accountability more effectively to diverse publics?

My basic proposition is that we need more engaging terms that are grounded in national and popular cultures.

To make this point, here are seven examples of the political construction of keywords related to accountability. 

Seven illustrations of the political construction of accountability key words

1) Transparency

There are some powerful constraints inherent in this term, with its implied boundedness to access to information that is already in the hands of the state.

This is a problem, especially in health, because lots of important information is not actually collected by the state. For example, governments rarely document the degree to which medicines are actually available to citizens, or, the toxicity of numerous chemical substances in everyday use, such as pesticides.

Here's an example of an effort to give the term new political content.

In Latin America, the term transparency is now fashionable and commonly used if still seen as fairly technocratic.

Twenty years ago, however, before the term took off, colleagues in Mexico deliberately tweaked the term to make it more amenable to grassroots organizing. They chose a little-used but still legitimate alternative spelling of the Spanish word for transparency - trasparencia - which omits the first N present in the more commonly used spelling, transparencia.

One reason was that organizers were concerned that the more commonly used transparencia sounded too close to a popular expression for fraud: transa. A second reason was that it allowed the organizers to unpack the words into two parts - tras las aparencias – which means "go behind appearances", and which encapsulated the goal grassroots movement. 

2) Right to know

In contrast, the concept of the “right to know” is broader, since it includes a wider notion of the types of information citizens actually need to address accountability failures.

In the US political context, the 1986 Emergency and Community Right-to-Know Act was foundational – a convergence of a grassroots anti-toxic movement and the 1984 Bhopal disaster (a massive industrial disaster in India linked to an American company) led to a law that mandated corporations to report their volumes of toxic emissions to the government and public interest groups then invested in making that data user-friendly and readily assessable at the level of postal codes.

In this case, the Spanish version of the idea – el derecho a saber – is fairly intuitive and accessible.   

3) Whistle-blower

One example of an accountability key word that is difficult to translate into other languages is whistleblower. In Spanish, translations have a negative implication – informante, denunciante – i.e. squealer, informer.

Yet at same time, whistleblower also an example of a term whose contemporary meaning even in English was politically constructed. Before the consumer rights movement and the work of Ralph Nader invented its current meaning in the late 1960s, the term referred to sports referees or the police.

Then, the growing consumer rights movement gave the term its political content, a term intended to honor those from inside powerful institutions who take the risks inherent in calling out abuse and corruption.

Another, perhaps more translatable option could be truth-teller.

4) Openwashing 

A more recent example of a politically constructed term is: openwashing.

What does this mean?

Generally, it refers to governments or corporations appearing to be open in order to actually hide persistent abuse of power and impunity. For example, when Guatemala joined Open Government Partnership, the senior government official in charge of Guatemala’s role was Vice President. Now she is in jail for corruption.

What are the origins of this term?

It is linked to earlier terms “white-washing” (denoting glossing over or covering up vices, crimes or scandals through biased or partial information) which itself was then appropriated and turned in to “green-washing” to describe organisations which claimed to have good environmental credentials through corporate responsibility initiatives whilst their core business continued to be environmentally harmful, such as mining or the production of palm oil, which is associated with deforestation, dispossession and human rights abuses.

5) Social accountability

Social accountability is an example how a term can transition from opening up new possibilities to confining them, at different historical moments.

In its origins more than a decade ago, the term created a new political space because allowed powerful mainstream development agencies such as the World Bank and larger INGOs to value and invest in promoting citizen voice, even if this was exclusively local and bounded to constructive engagement approaches.

Fast forward today, however, and I would argue that the term has become confining, insofar as the downside has been revealed with its exclusion of less depoliticized approaches to accountability, not to mention the rule of law.

6) Rule of law

That brought me to the sixth term, the rule of law – hard vs soft accountability – which is remarkably missing from most of the discussion of accountability in the field of health, even though corruption is rampant.

I'd like flag just two issues:

Reluctance to address corruption

Many of those working in the Social Accountability field are reluctant to address corruption in contexts where constructive engagement is widely understood as conflict avoidance and where tackling corruption is inherently messy. This is a problem and I wonder how we might address it.

Legal accountability is political constructed

“What counts” as legal accountability is politically constructed in a context in which behaviors and those pursuing such behaviors, are considered illegal are both contested and contingent.

For example, the US prison-industrial complex depends on hyper-upwards accountability in which certain kinds of non-violent behavior, such as recreational drug possession, are criminalized because of their ostensible health effects.

At the same time, other kinds of anti-public health activities are not criminalized, such as big pharma pushing opiod addiction or big tobacco infiltrating the process of implementing a global tobacco control treaty, not to mention contradictions such as active government support for research and health services linked diabetes and obesity whilst at the same time subsidising the production of high fructose corn syrup.

On the positive side, the progress of anti-tobacco campaigns and the decriminalization of some non-alcohol recreational drugs also shows the degree to which criminalization of behaviors based on claimed health effects can be politically contested.

7) Action strategists

For one last example of politically constructed discourse, I suggest that the dilemma of how to construct more balanced researcher-practitioner dialogue calls for a new term.

The problem is that the term “practitioner” has lots of implicit baggage. It denotes a division of labor between thinkers and doers, between those who control definitions of legitimate evidence and those whose voice and testimony are rendered to the “anecdotal” category.

To address this, I would like to propose a new term: action strategist.

This would describe civil society thinkers and policy reformers who are directly engaged with transforming governance by promoting citizen action from both above and below.

The basic proposition behind our new little startup research center, the Accountability Research Center, is that action-strategists should be at the center of informing research agendas in the emerging field of what in a few years many be recognised as accountability  studies.

To sum up...

Let’s search for terms that do a better job of communicating the key steps on the path to accountability-building.

This involves conceptual translation rather than linguistic translation of conventional terms which often come with a lot of baggage.

This suggests a two track approach:

  • Search within popular cultures to reappropriate existing terms or phrases, possibly even from private sphere that can make sense in the public sphere.
  • Unleash our creativity to invent new discourses that both communicate ideas about public accountability and have the potential to go viral because they crystallize and resonate with common sense and effectively strike a nerve.

Image: Indigenous health rights defenders in Guatemala. Credit: CEGSS

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