This week DGMT CEO, Dr. David Harrison, presented the keynote address at the Africa Regional Symposium on Character Building in Nairobi (24-25 October 2018) organised by the Aga Khan University and the Templeton World Charity Foundation. In this rather wide-ranging philosophical and personal address, he reflects on how we can activate human nature, for good.
I love tasting the fusion foods of inter-disciplinary research. I am fascinated by stories of life concocted from the ingredients of primordial soup and its emergent phenomena. Like Blaise Pascal, I stand in awe and horror on the edge of two abysses – one, the world of smaller and smaller things, and the other, the planets and galaxies swirling beyond us.
Sixty orders of magnitude between the lightest and heaviest structures of the universe, and plenty of uncertainty in-between! Somewhere in there is us, and we really want to know who we are and why we are here.
These questions have excited collaboration across mathematics and physics and biology and psychology and theology and cosmology to give us tantalizing glimpses of how it all holds together. But our interest goes further than curiosity. It involves ambition. For some reason, our species is wired to want to change the natural world – either through technology or behavioural change. We call it innovation. Strangely though, that same drive has a destructive edge – the hubris of power that will ultimately be our undoing if we don’t learn to live gently with each other and with the rest of nature. In his book, The Big Picture, the cosmologist Sean Carroll ultimately concurs with folk wisdom that the meaning of life is what we make of it.[i] Ironically, whether we endure as a species depends on what we make of ourselves; how we nurture our nature as homo sapiens continues to evolve.
Motivation and goodness – these are the attributes that will sustain humanity. Together they create the agency to make the world a better place. Just as oxygen and glucose combine in mitochondria to release energy, so goodness and motivation unite to free the vitality of the soul. Of course, I am saying nothing new. If we fudge the terms for a bit – goodness as ‘virtue’ and ‘hope’ as the source of motivation, we can trace them back over 2½ thousand years. The ancient Greeks saw nature as both the essence of an animate object and its continual growth towards perfection. In fact, the core of the Greek word for nature, physis, is growth.[ii]
Plato viewed emergent knowledge as the blossoming of the soul, which needed to be protected against the distortions of ideology, no matter how noble the intent. On the other hand, the teacher and rhetorician Isocrates, saw virtue as the main goal of education[iii]. He argued that human nature would be perfected by honing the power of speech and finessing one’s ‘political’ faculties, which he saw as the interplay of society, religion and government. He believed that character is always shaped in a particular socio-political context, and that its growth must be intended toward the common good.[iv] In Isocrates’ view, individual virtue and social justice go together, and hope gives those who are just advantage over the unjust in forging a new society.[v] I will return to his ideas later, but for the moment, let me hasten on to the Common Era.
The apostle Paul saw hope as a virtue in itself, part of the classic trinity of Christian values: faith, hope and love.[vi] According to the epistle of James, these virtues converge in human agency to do good works.[vii] But three hundred years later, Bishop Augustine of Hippo pulled the rug from under James’ feet by foregrounding ‘divine grace’ as the ultimate source of hope for humanity. While the good bishop would flatly deny it, the net effect was to downgrade the role of humans – or at least that of Christians – in shaping their own destiny. Much later, on this side of the Renaissance, the German philosopher Emmanuel Kant tried to mediate a fairer balance of power, arguing that sound reasoning of the mind was the basis of a moral world order, underpinned by a hope that divine principles of justice shaped human logic.[viii]
Towards the end of the 19th Century, Leo Tolstoy overturned the doctrinal tables by locating divine agency squarely in the heart and hands of human beings – “the Kingdom of God is within you”.[ix] Actually, Tolstoy was just echoing words ascribed to Jesus himself, when responding to the Pharisees’ quest for a liberation hero.[x] The radical shift here was away from a concentrated source of goodness to a distributed one. The Pharisees were looking for a strongman; instead, Jesus offered them the common man and woman as liberators. This struck a chord with German theologians such as Dorothee Sölle who, emerging from the horrors of the Holocaust, were appalled by the consequences of blind faith in one man. Sölle was influenced by the Marxist philosopher, Ernst Bloch, whose Principle of Hope anticipated a new society free from alienation and class division, and the reconciliation of humans with nature. To both Marxist and theologian, human agency and not divine intervention was the means to liberation. “God”, said Sölle, “has no hands except from our hands”.[xi] Fast forward to 2009, and Barack Obama’s first inaugural address: “With hope and virtue, let us brave once more the icy currents, and endure what storms may come.” The rhetoric would have made Isocrates proud!
Throughout documented history, ‘virtue’ is largely uncontested as a goal to which humanity should strive. While we may have different preferential values, we seem to share an intuition for goodness. The neuroscientist Antonio Damasio thinks that this probably reflects the evolutionary basis of our social emotions – disgust and indignation on one hand, and compassion, awe and elevation on the other.[xii]
But there has been far more scope for dispute in the characterization of ‘hope’, which is essentially about the ownership of power. Who is in control of human nature? Who determines our future? What is the hope in hope?
The problem with hope is that it swings both ways. Hope can be hollow when it is an empty promise – when, to quote the prophet Isaiah, it “returns void”.[xiii] Then dogma may be the refuge from unrequited hope. Hence the ambivalence of Plato, Aristotle and later Thomas of Aquinas to the notion of hope as a virtue. On the other hand, hope can be the driver of progress, the centre-forward on the playing field of life.[xiv] When hope teams up with love in the form of caritas – a deep empathy for others – it drives humanity towards the common goal of universal goodness. When hope is substituted by blind faith, love is too often the loser.
Not that faith is always the villain of the piece. It becomes a rogue player when it leads to the fatalism and exclusivism of unshakeable conviction; but when faith is a respectful trust both of what we know and what we still don’t know, then it is a thoughtful defender of the best of human nature – embracing diverse peoples and unseen possibilities.
Indeed, Plato’s trust of knowledge as the pure wellspring of the soul has merit when one considers the distortions of science wrought in the name of religion or politics. But there can be blindness in scientific purity too, precisely because we don’t know what we don’t know. Rational optimism is essentially a faith in perpetual human inventiveness.[xv] Whether emerging knowledge contributes to universal goodness depends on how it is used, which in turn depends on human nature. Taking Isocrates to his logical conclusion, even if the condition of perfect information were met, the politics of planet Earth would still play out.
My biases shine through this historical reflection. Like Isocrates, I am persuaded that, at a societal level, the strengthening of human character cannot be separated from universal justice. This implies that there is political edge to character development and that the continuing evolution of human nature rests in our hands.
The key to justice that we hold is hope; not just any old hope, but a sense of real and imminent possibility in life. Hope is the means of redistributing human virtue. Without it, the mundane vices of humanity are concentrated in the lives of the marginalised, who are then punished for their hopelessness. As Anatole France ironically remarked in his book, Le Lys Rouge: “In its majestic equality, the law forbids rich and poor alike to sleep under bridges, beg in the streets and steal loaves of bread.[xvi]
I must hasten to add that possibility in life stems not only from material satisfaction, but from other freedoms as well: the space to grow physically and intellectually; to think differently and be different; to feel equal regardless of gender, race or sexual orientation. These are the spaces in which the human character may develop fully.[xvii]
Enough philosophising about areas of human existence that I know precious little about! This stuff fascinates me, but I am not a researcher. I impulsively bite off and chew on the bits of knowledge that come my way, and try to make sense of them in the light of my own experience and the people around me. So let me tell you bits and pieces of my story, which lead me to these conclusions.
Professionally, I am a medical doctor with a specific interest in public policy. In 1988, I was a fifth year medical student at Groote Schuur in Cape Town, the hospital in which Professor Chris Barnard did the first human heart transplant a mere twenty years earlier. I was invited to examine a patient presenting with a new disease, one of the very first cases seen at that hospital. All I remember of that day was the thrill and novelty of scientific discovery. Usually, I connect with sick people by touching them and reading their faces, but to my shame, this time I didn’t really see the person in the bed. I was too busy looking at my first case of AIDS.
A decade later, I was given the opportunity to study public policy at the University of California at Berkeley, and spent a wonderful two years there with my wife, Claudine and our new baby Andrea. It was a time of renewal and relief from the many difficult challenges of post-apartheid South Africa. But we returned home into the howling gale of the AIDS epidemic, then responsible for over 300 deaths a day. I was invited to head up loveLife, newly established as a national HIV prevention campaign for young people.
It was a controversial campaign, both because it coincided with the president’s refusal to acknowledge AIDS as a national crisis, and because it dealt with sex. Sex – so much part of who we are, yet so often associated with sinfulness and the worst side of human nature. Fortunately, the designers of loveLife made the right call. The life-loving nature of young people was placed at its centre – and not the transmission dynamics of the virus nor the morals of its human hosts! We celebrated healthy sexuality as an integral part of human nature and nurtured teenagers to be future-focused, resilient and more in control of the choices they made. Through young people, we came to realise that behaviour change is mediated by a sense of identity, purpose and belonging – and designed our communication and face-to-face programmes accordingly.
The first few years of the new millennium were a crazy time – AIDS denialism at the highest levels of government, public health types who kept asking why we don’t just tell young people to stop having sex, religious fundamentalists who accused us of fostering permissiveness. One prominent cleric concluded my meeting with him – not in prayer – but with a punch on my jaw!
From the loveLife experience, I gained three insights I would like to share with you.
The first is that the spread of HIV in hyper-endemic countries is determined by where people live. In South Africa, rates of HIV are twice as high in informal settlements as in other living spaces, and mining communities form intense hot spots of infection.[xviii] Obviously, it is easier for HIV to race through denser populations, but that doesn’t explain why people in shacks are more susceptible to HIV than those in equally dense high-rise buildings.[xix]
These observations reminded me of a study from UC Berkeley, which asked the question: “Why do the poor behave poorly?” referring to health-related behaviours like smoking, binge-drinking and poor diet.[xx] Patterns of poor health behaviour follow socio-economic differentials.
Similarly, crime is both spatially clustered and associated with lower socio-economic status. [xxi] Even within poorer communities, it tends to be crammed into specific “hot spots”. [xxii] Areas with lower rates of crime seem to be protected by community processes that facilitate social cohesion and trust and act to limit criminal activity.[xxiii]
Harvard researchers have mapped the childhood roots of upward social mobility in the United States, and show that the strongest predictors are neighbourhood factors that create opportunity for children.[xxiv] Pathways to social mobility are weakest in fractured communities where income poverty and hopelessness seem to feed off one another, making the misery worse. To my rather literal way of thinking, this means that there must be a psychological trigger for risk-taking – the endpoint in the titration of individual preference against socio-economic reality; a specific moment when a young woman from a shack-land decides, at least subliminally, that the risk of HIV is worth taking.[xxv]
Some of the factors she may weigh up include the risk of physical violence if she gives up the protection of her older boyfriend; the risk of hunger when that man is her only source of income; the fear of loneliness where, with little prospect of employment, personal affirmation may be found most meaningfully in motherhood[xxvi].
For behaviour change analysts, the list of interlinking factors is daunting. How do you begin to calibrate all the variables influencing sexual decision-making, especially as they seem to emanate from several different parts of the brain?
The Platonic approach, implicit in classical rational choice theory, is to simply ignore the limbic brain and assume that people make decisions based on their knowledge of the probability and consequences of a specific hazard.[xxvii] We now know that this is not the case. A sense of dread or immense pleasure can swing the choices we make, discounting risk in the heat of the moment.[xxviii] This is obviously very relevant to HIV, as sex can be pretty orgasmic! Antonio Damasio has gone so far as to theorise the parts of the brain that release ‘somatic markers’ in decision-making.[xxix] His work is helpful in understanding the viscerality of human nature, but it doesn’t explain how multiple risks can be processed at the same time.
Here, psychometrists have shed some light. Slovic and Weber conclude that we all subconsciously weigh up the risks of one option over another.[xxx] Critics say that they fall prey to ecological fallacy – when you take the central measure of a sample and smear it across the population as if everyone reacted identically.[xxxi] But these researchers have shown that all individuals and groups do calibrate risk in the same way, even as perceptions of particular risks are influenced by gender, ethnicity and worldview.[xxxii] The question then is: what is it about a specific culture – the way a society structures its thinking and actions – that determines its perceptions of risk?
Given the sensitivities of language, perhaps it is necessary to define what I mean by culture in this context. The anthropologist Mary Douglas, argued that “culture is a dynamically interactive and developing socio-psychic system” – interacting not least with the economic circumstances in which people find themselves[xxxiii]. She, together with Aaron Wildavsky proposed the Cultural Theory of Risk, which states that risk perception across societies is essentially shaped by just two factors, namely the degree to which individual choices are constrained and the level of social solidarity.[xxxiv] Atomized, low-choice societies tend to fatalism, tolerating greater risk, whereas more egalitarian societies avoid risk to health and well-being.
Some have questioned the worth of Cultural Theory in real life, although its proponents counter that the scales used to gauge its explanatory power are simply inadequate.[xxxv] I cannot comment on its predictive value, but I found Cultural Theory a very useful heuristic in the design of HIV prevention. Far from being a distal determinant, as most causal models suggest,[xxxvi] a pervasive sense of constraint and exclusion may directly impinge on sexual decision-making. If that is the case, behaviour is the result of a trade-off between risk and opportunity, and we can tip the scales by giving young people a greater sense of possibility.
Not just optimism, mind you – but a real and imminent possibility, and that’s the final piece of the risk puzzle that I want to share with you. In the early days of loveLife, we were perplexed as to why surveys found that young people were generally happy and optimistic.[xxxvii] This seemed to refute our thesis that hope was a critical motivator of safer sexual behaviour. Enter the behavioural economists. Turns out that most of the motivational approaches to health behaviour change were premised on the notion of exponential utility decay i.e. the further away the benefits of any present action, the less value placed on it. However, the economists Lowenstein and Prelec realised that this pattern of inter-temporal choice was not consistent with human nature. People continue to value their health and their lives over the long-term.[xxxviii] They proposed that the utility curve over time is hyperbolic – U-shaped – rather than exponential. It’s a bit like seeing an ice cream parlour on the other side of a ravine. You would very much like to have an ice cream, but your willingness to act on that impulse depends on the steepness of the down and up! What influences decision-making is not a generic hope in the future, but reasonable expectation that tomorrow will be better than today.
Hope – expressed as a sense of real and imminent possibility in life – seems to be both the catalyst for character-building and the means of distributing it more fairly across society. We should, therefore, nurture that which the anthropologist Alvin Appadurai describes as the ‘capacity to aspire’.[xxxix]
Now you could argue that such a conclusion contradicts the gist of this entire paper, which is that character building must be supported by political and economic change. Agreed, but if we accept that material poverty and human dispiritedness reinforce each other – that the causal arrows point both ways – then we must consider the possibility that prosocial interventions can have economic outcomes. Which brings me to the second insight from loveLife, which is that a new moral leadership can emerge to act both as normative role-models and as agents for political and economic change.
The most powerful morality is a lived reality. Our experience was that young people change because they want to be like other young people who are connected, who know who they are and where they’re headed. loveLife’s agents of change were called groundBREAKERS, vibrant young leaders who exuded an aura of possibility. They certainly weren’t saints. One of the tensions in the loveLife team was whether pregnant groundBREAKERS should be allowed to continue their work. Personally, I couldn’t think of anyone better to talk about the joys and pressures of sexual relationships than a pregnant teenager! We wanted to nurture goodness, not piety.
Over the time that I headed loveLife – just short of a decade – ten thousand groundBREAKERS and the fifty thousand younger peer motivators called mpintshis reached more than five million young people face-to-face, in intensive and sustained programmes of behaviour change. That’s was about 40% of teenagers in South Africa at the time.
So, after all that effort, did loveLife work? Certainly. The rate of new infection among 15-24-year-olds nearly halved between 2002 and 2012[xl]. But mid-way through this time period, anti-retroviral treatment (ART) became widely accessible in South Africa. How much of the decline in incidence was due to behavioural change and how much due to viral suppression through ART, we will never know. We have some evidence from a nationally representative household survey that participation in loveLife was independently associated with lower rates of HIV.[xli] And, as I was to discover from panel series data published just this year in the Journal of Health Economics, access to loveLife’s youth-friendly clinical services was associated with more young people completing school and earning higher wages as adults.[xlii]
Even if loveLife was having an effect, it was a difficult case to make. I remember a particularly sardonic columnist lampooning me for arguing that we had slowed down the rate of an explosion! In any event, the dramatic effect of antiretrovirals eclipsed our cautious claim that the character of young people had changed for the better.
We did, however, have one constituency firmly behind us, and that was young people themselves. In their view, loveLife was about them and for them.[xliii] On the few occasions that they told us we’d let them down, we listened. Most groundBREAKERS benefited hugely from their year as stipended volunteers and went on to study further or find jobs.[xliv]
But not all of them did. One of my most sobering moments was listening to a former groundBREAKER in a rural part of South Africa, who felt angry and used by us. She had committed a year of her life to the campaign but had nothing to show for it. She was still hungry and unemployed. It was a sad interaction for both of us, but it got me thinking. She was right. We had invested in young people, trained them, used them to motivate others – and then dropped them just as we should have been capitalizing on them to reshape society.
Even groundBREAKERS felt the divides of space and gender, with rural young women least likely to find new opportunities. These young leaders were powerful role-models, but clearly, building character and self-efficacy was not always enough to break through the structural ramparts that excluded them. Which raised the question: what would it take for young people to move beyond normative role-modelling and start to redesign the socio-economic circumstances in which they lived?
I was intrigued by the work of Anirudh Krishna in India, who had shown that young entrepreneurs could activate social capital by connecting people who would otherwise never interact. These connections sparked innovation and created new economic value.[xlv] The power rested in the network – and as I would later learn – one of the most appealing properties of social networks is their increasing returns to scale. The bigger they are, the more energy they have – because they draw on a growing diversity of ideas and expertise.[xlvi]
Amartya Sen speaks of humans as “diversely different.[xlvii] He argues that people are diminished – “miniaturized” – when they are labelled with just one identity when in fact we all have multiple descriptions of self. Apartheid’s legacy is that most South Africans see themselves in monochrome – black or white. The notion of race is so imprinted in the distribution of wealth, health, education and living spaces that we can’t get rid of it merely by appealing to a common nationhood. We must continue to confront the physical and psychological diminution of black South Africans and dismantle whiteness as the proxy for power and privilege. But we must also start seeing each other as diversely different – as parents, professionals, community activists, innovators.
Imagine if – in the language of Isocrates – we could create a new political constituency of young leaders whose only common identity was a commitment to the public good. That would entail building the most unlikely network of young people South Africa had ever seen, across ethnic group, class and party political lines. Difference, and not similarity, would be its key to success. In this dynamic 3D network, the position of individuals would not be fixed by their belief in a single idea, and network intensity would ebb and flow as participants found areas of common cause or even disagreement.
The obvious pool of participants in such a network were ex-groundBREAKERS and alumni of other youth initiatives. Today, the Activate! Leadership Network comprises some 3,500 innovators in their twenties and early thirties[xlviii]. They all go through training aimed at blowing their minds – exposing them to ideas and experiences that grow their skills and connectedness as social innovators. But that is only the start. Activators then plunge into a variety of network activities, some facilitated, some spontaneous. In last year’s survey, over 80% reported regular active engagement with other young people through campaigns and community projects.[xlix]
We soon realised how the collective power of the network could be applied to local issues. Where a municipality diverted its stream of sewage through an informal settlement, several Activators had dealt with same issue and knew how to tackle it. When unemployment and wildlife protection collided in wilderness areas bordering local communities, it sparked the idea of night-sky tourism. I could go on with story after story.
As a melting pot of South African society, Activate is not without its challenges. Hot issues, often related to gender or race, sometimes flare up and unsettle the network. But this is the forum where honesty and trust can find new ways forward. After six years, I am persuaded that Activate! will contribute powerfully to the character and politics of South Africa over the next few decades.
The challenge, of course, is in providing an objective basis for such confidence. To do so, we have to answer two questions: First, have we strengthened the character of Activators? Are they more entrepreneurial, patient, trustworthy and civically engaged? And second, has all this character building had a tangible impact on others? Let me start with the second question, and admit that we have found no other way to document the ripple effect except through stories and network analysis.[l] It makes for a great narrative, but we can predict nothing of its long-term contribution to national transformation.
Which leaves us with the narrower question of whether Activators themselves have changed. Our research interest was not only whether they had become “better people” but whether network engagement fundamentally changed their individual preferences that shape economic behaviour.
We commissioned the University of Cape Town to conduct a randomised controlled trial using behavioural markers of trust, risk and time preferences, among others.[li] I must admit to raised-eyebrows when the actual research instruments were revealed. How could all the large-scale thinking, all the careful design and planning, be reduced to a few experimental games that behavioural economists play? Admittedly, these games were combined with in-depth survey measures of mental health, risk perception, social capital and income dynamics. The researchers did a good job of proving the validity of these tools – although I wonder whether these measures are sensitive enough to capture the full extent of inner change.
Some measures of solidarity – cooperation and building fairness norms – showed no significant effect. But Activators became more trusting when their beliefs about the trustworthiness of their peers changed. Perceptions matter. The suite of measures related to individual choice showed that participants were more willing to take on entrepreneurial risk, more patient and less tolerant of personal hazard.
The trial confirmed heightened civic engagement, but it did not find that network participation created new access to the labour market. However, the number of hours that female Activators engaged in paid work increased by almost 60%, suggesting that the network has gender-empowering effects for women.
So the economic preferences of Activators have generally been nudged in the right direction, even if we don’t have truly definitive results to share. We can however see a dynamic interplay of perception, reality and imminent possibility – which seems to be driving both individual agency and collective action for good.
In retrospect, I think we conducted the randomised controlled trial too early, and the results are more a reflection of the training component than the network, which has matured significantly over the past few years. It may be that economic outcomes take longer to manifest. There are also many other identities of Activators that we did not consider in the evaluation, not least that about half of them are parents. Which opens up another frontier for character development, as they nurture that sense of possibility in their own children.
This brings me to the third insight from loveLife, namely the power of family and its potential to create cycles of inter-generational goodness that could even become imprinted on our DNA.
In South Africa, a twisted knot of migrant labour and ethnic tradition keeps fathers away from their children. Young men are accustomed to work away from home, and many are not welcome in their in-laws’ house until lobola (bride price) is fully paid. Fewer than 40% of children live with their biological fathers.[lii]
I confess that in my fervent desire to save lives, to counter the most terrifying pandemic the world has seen since the Spanish Flu, I too spent little time with our young family. It is a lasting regret that I worked through most weekends just as our youngest child’s brain was at its most sensitive to love and stories and game-playing. Fortunately, their mom is a star, reading to them from their first day at home, and I am delighted to say that all three of our children are loving, wise and creative.
I started with reference to the ingredients of the primordial soup, and conclude with the same. The human genome is an eclectic scavenger of genetic material from other organisms. It has four times as much specifically viral DNA as uniquely human nucleic acid[liii], and all our mitochondrial DNA is likely derived from a particularly entrepreneurial bacterium.[liv] This reminds us of our primal connectedness with all other organic things. Retroviruses like HIV are a humbling reminder that microbes still have the passwords to our genetic codes. Perhaps we’re as much the product of hacking as we are scavenger of DNA!
Fortunately, we are not entirely at the mercy of rogue genes. We are mostly wired for goodness; and the relatively new field of epigenetics offers up the possibility that biological imprints of human nature will continue to evolve. Love and empathy, passed down from generation to generation, could become increasingly part of normal homeostasis.[lv]
Nor are we helpless in the face of extrinsic viruses. That peculiarly human trait – ambition – has resulted in medical advances that can detect and neutralise many of them. Some only remain endemic to specific places and populations because we have not confronted the social and economic conditions that allow them to continue to thrive. The HIV pandemic reminds us just how politically determined human behaviour is – shaped by the structure and power differentials of society.
Societal influences shape learning, thought and behaviour – brokered by our very visceral emotions.[lvi] As a result, we cannot leave human nature entirely to its own devices or even to a greater god. In the deep recesses of the brain, prosocial emotions like compassion contend with antisocial ones like pride and greed that would seek to capture new knowledge for personal gain alone – often at the expense of the environment as well.
This is where our higher cognitive functions come in. Our imagination and willed action stem from a consciousness of mind that, even if entirely biological in origin, is both shaped by and able to shape our world.[lvii]
We live at a time when the financial returns to innovation are increasingly concentrated; while millions of young people feel angry and left out. This country, Kenya, has direct experience of the radicalization of young people who feel that they have little to lose. It is particularly poignant that the mind-blowing training of Activate! was designed by a team led by James Thomas, who died at the Westgate Mall just over five years ago; killed by militants of al-Shabaab, the full name of which translates as ‘The Striving Youth’.
Faith in the innate goodness of human nature is not misplaced, but we must still work at it. Together, the ‘behavioural trinity’ of the body, brain and the world define who we are and how we act.[lviii] We can imagine a better world and cherish the power of human ambition to improve on it. At the same time, we must foster hope – in the sense of real and imminent possibility for all – to ensure that this ambition is firmly harnessed for the universal good.
Thanks to Sebabatso Manoeli, Janet Jobson and Claudine Bill for their helpful comments in reviewing this paper. Thanks also to Robert Steiner for inspiring thinking.
 Incidence among 15-24 year olds in 2002: 2.8 , 95%CI, 1.7-4.2; in 2012: 1.5 2.8 , 95%CI, 0.8-2.3
 Adjusted odds ratio for HIV infection among participants in loveLife programmes, for males and females respectively: 0.60; 95% CI, 0.40-0.89; 0.61; 95% CI, 0.43-0.85, respectively.
 Analysis of panel data from the National Income Dynamics Study found that living near a loveLife youth-friendly clinic during adolescence delayed childbearing by 1.2 years
 Successful applicants were randomised into two successive cohorts in 2014 and 2015, to reduce selection biases
 The researchers ran a number of economic models, which cannot be fully represented here. Please see actual report (Keswell & Burns 2016) for specifics. In summary, Activators whose belief in the trustworthiness of other Activators was positively influenced by the network, were 5% more trusting. Those whose belief did not change were 6.7% less trusting.
 Risk coefficient increased from 0.58 to 0.67, p<0.1. (Risk coefficient < 1 = relatively risk averse)
 Discount rates applied to future benefits declined from 75% to roughly half (Regression coeff. ~-0.5, p <0.05)
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[v] Isocrates, to Demonicus 1:39
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[vii] James 2: 1-26
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[x] Luke 17: 20-21
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[xiii] Isaiah 55: 11
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