When then Chinese leader, Zhou Enlai, was asked in 1972 by an American delegate in the visiting Nixon’s team what he thought the significance of the French Revolution – of 1789, 200 years earlier – was, he famously replied: “It’s too soon to say.” This quote is often used to show how far-sighted Chinese politicians can be and how much they are wedded to a long view of history.

Whereas there is something of a racial stereotype at play here, there is also an element of truth.

History is like this…. We often have to wait many decades before we can begin to appreciate the impact of events. And always there is no consensus, but a number of contesting views about what those impacts may be.

Which brings us to what is now being punted by the founder of the World Economic Forum (WEF), Klaus Schwab, as The Fourth Industrial Revolution. The WEF is, of course, the annual meeting of billionaires, bankers, CEOs and elite politicians (and, now, pop stars) at Davos, which has earned Schwab the status of a cult figure. He claims that current technological innovations such as Artificial Intelligence, nanotechnology, the “Internet of Things” etc. amount to the merging between biology and technology and therefore a new “Industrial Revolution” to go with the First (the shift from water to steam energy), the Second (the shift from steam to electrical energy) and the Third (from analogue machines to the ICT Information age).

In and of itself Schwab’s characterisation can be considered an interesting theory that can help us to understand the modern world and the key challenges facing humanity. There have been many such attempts at periodising human development and the development of the natural world. One thinks of the Anthropocene dating of human impact on the natural world; to those theories that look at the changes in human settlement and dietary changes – from animal-based to grain-based (which gave rise to the Banting diet).

Health scientists have, in turn, written about long waves of pathogens over 100s of years, which impact on human development – the deaths wrought by the bubonic plague in Europe on the growth of an urban working class, the introduction of small-pox into what became colonial conquest. And, more recently – 1918 – the mutation of the Spanish Flu, which killed more people than World War 1, and prompted the changes which led to new city lay-outs and public health as a political policy of governments.

But what lifts Schwab’s intervention out of the realms of pure intellectual interest is its capacity to shape the public policies of governments. This is because of his status as the founder of the WEF and its evolution from a billionaires’ jamboree (Davos-Man as it used to be pejoratively called) to a necessary stop-off point of governments. This is both because governments are in hock to the billionaires and because of the seductive power of bringing together economic rationality with (apparent) scientific rationality.

Since Schwab’s declarations at Davos and his book there has been a huge take-up of the concept and a debate about whether the collection of innovations at the heart of this declaration – Artificial Intelligence (AI), nanotechnology – are liberating or threatening for human well-being and liberty and possibly even over-hyped. Many politicians across the world have found the notion of being “ahead of the game” a powerful campaign tool. Trade unions have debated whether Intelligent machines will further increase unemployment and some futurists have even speculated that such machines can be adapted to improve things by taking on caring activities such as education and domestic labour. Consultants, marketing executives, IT specialists and the like have also eagerly embrace Schwab’s view as it is in the nature of their calling to have the winning formula of “knowing the future”.

It is indisputable that many technological innovations are taking place, which can appear to be quite dazzling and that the rate of new developments – such as in robotics and nano-technologies – can be breath-taking. With democratic accountability over the direction of technological innovation – here the inspirational case of the inventor of the World-Wide Web, Tim Berners-Lee, comes to mind who has precisely this approach – innovations can improve the quality of all humanity and also save and enhance the natural world. Some of these – one thinks of Artificial Intelligence – can raise important new questions about what it Is to be human and what is “intelligence”. Others – such as stem-cell research and genomics raise important ethical debates about “designer babies” and the dark history of eugenics. But we cannot even begin to have these kinds of discussions if we do not see that it is important that we build public understanding of the sciences and not fall prey to technological determinism and to futurology.

This is above all important because of the huge challenges we face as a species – from global warming to inequality, disease and violence. All the scientific evidence points to the need to reduce global warming by cutting back on industrial output … yet the current balance of political power in the world acts as an obstacle to this necessity. So the claims of a new “industrial revolution” need to be measured against this and the claims by Schwab to his elite audience that there are new technological solutions at hand. We need to shape the content and direction of technological innovation towards overcoming these crises rather than exacerbating them – as is now the topic today, even in the USA with talk of a “Green New Deal”.

But much of the readiness to uncritically embrace the notion of the Fourth Industrial Revolution is based on a shoddy understanding of human history and a conflation of three very different things:

• Technological innovation
• Scientific change
• Social change

Whereas technological innovations occur all the time, not all are “high tech” and not all are outcomes of new scientific paradigms nor are they necessarily associated with the kind of social changes to earn the title “revolution”.

The original Industrial Revolution of the late 18^th century England – the conversion of water and human energy use to steam and pedal power – did not occur because of significant scientific changes. The developments in physical sciences of mechanics and dynamics at the time were still variations of Newton’s classic Philosophiae Naturalis Principia Mathematica, a work of some 100 years preceding their application to steam, mechanics and the textile industry.

But the social changes were far-reaching in England and later North Western Europe – literally the change from feudalism to capitalism – which is why historians, in retrospect, dubbed the applications of the spinning jenny and the steam engine an Industrial Revolution.

What became better known as the Second Industrial Revolution did not have the same qualitative social change as the original Industrial Revolution, but it is so-called because the technological changes were profound – in electricity, communications, railroads and steamships – which laid the basis for global human movement on a scale never seen before. And these technological innovations were associated with new scientific paradigms – new understandings of the nature of light and energy and opening the door to the revolutions in physics from Newtonian absolutism of space and time to Relativity and then the Quantum Theory.

So technological innovation, scientific change and qualitative social change are not necessarily a continuum.

It would be well worth noting that the inventions such as the spinning jenny, the steam engine and water to coal and steam as the source of energy in production occurred in 1770s England but no-one used the term “Industrial Revolution” until almost 100 years later. It was first used in France, which had known a revolution (hats off to Zhou Enlai again), and then in England by economic historian, Arnold Toynbee, who found connections between the technological changes applied to production and the much broader social changes which ensued – no less than rise of towns, the enclosure of the rural commons, new gendered divisions of labour and the consequent rise of capitalism itself.

Of course no one could call this the “First” Industrial Revolution until economic historians after World War 2 (1939-1945) started reflecting on the significance of the innovations, 50 years earlier at the end of the 19^th century – the developments in electricity and chemistry which made possible the extension of “daylight”, the inventions of new forms of energy such as the generator and the electrochemical cell and the expansion of the railway and the steamship and the proliferation of international travel. So these historians coined the term Second Industrial Revolution, thus making the 17^th century process, retrospectively, the “First Industrial Revolution”.

The point about all this is that it is always a reflection in retrospect – once we’re able to see the extent of the social changes that technological innovations have produced.

But even here there was no consensus. Many historians inverted the relation between technology and social change and argued that it was the social changes that made technological innovations likely. A more recent economic history school in France, grouped around the journal Annales d’Histoire economique et sociale, argues that it was not the “high-tech” innovations of the steam engine and the spinning jenny that brought about the change to capitalism but a longer history of “low-tech” shifts – the stirrup for horse-riding, the hoe for harvesting etc.

Then in the 1980s a number of soothsayers: including Manuel Castells, a political scientist who wrote the seminal The Rise of the Network Society, James Womack, Daniel Jones and Daniel Roos, who produced the car industry classic The Machine that Changed the World, amongst others, coined the notions of the “Information Age”, “Globalisation” and The Third Industrial Revolution. Unlike Schwab’s singular claim, this was at least a summation of a number of different publications straddling different fields.

Their collective claim was that developments in Information and Communications Technology (ICT) had prompted social changes of such proportions that borders were becoming extinct, that information would become the new source of comparative advantage in global competition and that human beings were shifting from national, racial and class identities to global networks.

It seemed as if these revolutions were happening faster and faster.

But, while we debate the Fourth, let us ask ourselves: what have been the outcomes of the so-called “Third Industrial Revolution”?

Despite the promises of the “information age” almost a third of the world’s population do not have access to electricity, let alone internet access and are deemed information backwaters. Instead of globalisation we now have new rounds of trade wars between the two biggest economic powers – the USA and China. Instead of a borderless world, we have Trump’s “America first” and the EU reviving borders and doing its damnedest to keep refugees out.

No-one now remembers Blair’s hype about the “knowledge economy” which has gone the way of other shibboleths in the wake of the 2008 financial crisis and the necessity of state bail-outs to save companies too big to fall. Now we have Trump’s “fake news” and right-wing populists attacking what they call “the globalisers”.

And the promise of crypto-currencies such as Bitcoin and global transactions taking place through Blockchain, thus doing away with government regulation and tedious analogue and paperwork?

Well, the reality is that this has been a case of technological innovation meeting the real world of political power. Blockchain undeniably has the innovative capacity to replace conventional money in recording international exchange. But money is not just a means of exchange. It is also a measure and a store of value. And control over these functions by the state – in a very “old technology” kind of way – is as important as a military and economic power.

For instance, in the current spat between Trump’s USA and the EU over the Iran nuclear deal, Trump is able to intimidate European companies seeking to trade with Iran – even through the EU’s proposed Special Purpose Vehicles – because global trade takes place in US dollars, via the Bank for International Settlements (BIS), and the US state can use this power over the BIS and SWIFT codes to block all transactions it chooses to block. It is not about to give up this power, Blockchain and Bitcoin or not.

So the hype about the Fourth Industrial Revolution – as was the case of the Third – is that it replaces what was seen as a retrospective review of the sum-total of social changes over the past with a prescription for the present – the stuff of politicians, soothsayers and consultants seeking to be “ahead of the game”. We’d better embrace the 4.0 IR or we will fall behind.

The South African Medical Research Council (SAMRC) is this year marking its 50^th anniversary. The SAMRC is at the cutting edge of research which can lead to innovation which allows for greater public access to medical technologies and new life-saving drugs. The SAMRC is also a partner in mapping the human genome – thus opening spaces for genomic medicine and pre-empting pathologies. But we are wary of the rush to subsume vital questions of public health and universal access to health care under what appears to be an exhortation which may skew national priorities. In the case of genomic medicine, for instance, we are aware of the tension between public good and the veritable gold rush to realise the commercial benefits here.

SAMRC research also reveals that South Africa today is threatened by four intersecting epidemics – HIV and TB, maternal and neonatal mortality, non-communicable diseases (such as diabetes) and interpersonal violence (including violence against women).

In each of these categories, South Africa’s statistics are amongst the highest per capita in the world. Mothers and new-born babies in South Africa die at two to three times more than the average for comparable countries and we have almost 1% of the global burden. We have the highest HIV and TB deaths in the world.

Non-communicable diseases (such as strokes, diabetes and heart disease) as a group, now account for the highest number of deaths in South Africa. The leading risk factors for non-communicable diseases are smoking and alcohol use, the absence of physical activity and poor diet and the lack of primary health care. Our non-communicable deaths are two to three times more than the average for developing countries.

We suffer 1.3% of the global burden of violence and injury deaths.

We also have children dying of environmental health conditions that are directly attributable to basic things like housing, the location of settlements and the quality of air and potable water.

In 2007 more than 61,000 South African children died before they had reached their fifth birthday. Nearly 40% of those deaths were from just two conditions that are strongly rooted in housing conditions: diarrhoea and pneumonia. Diarrhoea and pneumonia are also among the main reasons for the use of South African public healthcare services. In poor settings, about one in five children with diarrhoea will return to hospital time and again for treatment of that disease. Recurrent bouts of diarrhoea may lead to malnutrition and lowered resistance to a range of other diseases, such as measles or pneumonia.

The cost to families of repeated hospital admission of their children (or themselves) is significant, and includes transport outlays and loss of income from having to take time from work to seek treatment and to care for sick children. Many other child deaths, such as from poisoning, drowning, burns and falls, are also often attributable to conditions in or around their homes. With proper action, the majority of these child deaths are avoidable.

Even though we are at the cutting edge of medical research and innovations in the health sciences, this is the message coming out of the researched reports compiled annually at the South African Medical Research Council.

All of these are about political choices, about public policy and relations of power and about lifestyle changes. None of these are about high-tech solutions.

We can chase the intellectual herd of the “Fourth Industrial Revolution” as it disappears over the horizon, instead of reflecting on what our priorities are today and what the scientific evidence actually tells us.

In 2014 and 2018 two children, Michael Komape and Lumka Mkhetwa, drowned in their schools’ pit toilets. Justifiably, their deaths were followed by widespread public outrage and calls for preventive action, with the State President himself committing to introducing flush toilets!

Water flush toilets were part of the inventions of what became known as the “First” Industrial Revolution at the end of the 18^th century. Then an Englishman, John Crapper, patented an advance on this, which was used by the military, in the Second Industrial Revolution of the late 19^th century. The Annales school of economic historians even argues that toilets were more important than gunpowder in shaping military battle victories.

We need to spread the benefits of the First and the Second before we divert resources into the hype associated with the “Fourth Industrial Revolution”.

Zhou Enlai was right …it’s too soon to say. DM

Leonard Gentle advises the South African Medical Research Council on research translation.