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Global Health and the Art of Really Big Lies

In a former role I had a boss who lied a lot. The lies were pure fantasy, but massive in scope and delivered with sincerity. They were very successful. This success was based on the reluctance of most people to consider that someone in a position of authority in a humanitarian organization would completely ignore any semblance of reality. People assumed the claims must be true, as fabricating information to that extent in those circumstances seemed to defy logic.

The principle of Really Big Lies is based on their being so divorced from reality that the listener will assume their own perception must be flawed, rather than the claims of the person speaking to them. Only an insane or ridiculous person would make such outlandish claims, and a credible institution would not employ such a person.

Therefore, given that the institution was apparently credible, the statements must also be credible, and the listener’s prior perception of reality therefore flawed. Lesser lies, by contrast, are likely to be perceived as sufficiently close to known reality to be provably wrong. Inventing truth can be more effective than bending it.

Early on, my colleagues would ask me to “do something about it,” as they still thought the organization should not lie to our source of funds, to partners, or to the audience of scientific meetings. Over time many of these same colleagues learned that integrity was a poor career choice, whilst good team players supported false narratives. Though I had always been aware of the fragility of integrity, this place taught me a lot about human behavior. In the end, only a minority refused to participate. It was excellent preparation for COVID-19 and the evolving credibility crisis of global public health.

A Template For Deception

People working in the global health industry want a decent income, they want their children to have reliable healthcare and a good education. They have important holidays to attend, bosses to impress and subordinates to support. Some time ago when global health was concerned with supporting a human rights and pro-community narrative, success meant advocating loudly and sincerely for community control, informed consent and the importance of patient-centered care.


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