Liderazgo y Gestion en Enfermeria – Leadership and Management in Nursing

Liderazgo y Gestion en Enfermeria – Leadership and Management in Nursing

Growth and Doubling and the competition for resources

Growth, doubling and the competition for resources

Wednesday, January 05, 2011

Daniel Ben-Ami has written a good book challenging those of a green persuasion and those he calls ‘growth sceptics’ “Ferrari’s for all” is the title. Well worth a read. I believe there are flaws however mainly around the failure to address CO2 emissions related to growth and an almost panglossian belief in human ingenuity and progress. The key message is that economic growth and development has delivered huge advantages for humanity (let’s put aside the worlds’ poor for a moment) and is a precondition for dealing with the challenges that lie ahead.

However this is inductive logic, basing future predictions on past patterns. Whatever the historical record shows in the past, it may not be replicated in the future. In addition, growth itself may contain the seeds of its own destruction. See for example some counter arguments on growth:

To quote from the article: ‘But the key problem concerns the doubling time. Suppose an economy grows by 3%. It will double in capacity in 23 years, but it will consume as much in that time as in all previous doubling periods put together. For that reason, either there has to be a massive expansion of available resources, or the growth model becomes unsustainable.  Read more:

However the political realities are that the main parties in the UK (and the US) are wedded to the idea of capital accumulation based on market competition as an economic imperative and is the only model for economic activity: they believe that growth relieves poverty, they believe that what is good for business is good for society, free markets tend towards equilibrium and that competition leads to fairness. China and India are following their own models – not quite the same but still based on capital growth while ignoring the doubling principle.

So growth is probably here to stay until the physical realities and the ensuing struggle for resources (China uses 30% of the earth’s copper according to a BBC newsnight report) intervene.

Now why should any of this bother a healthcare professional?

The ‘sustainability literate’ nurse graduate – why do we need one?

“In a world characterised by complexity and uncertainty, our long term survival lies less in our ability to ‘apply the grammar’ (of sustainability literacy) and more in our willingness to bend the rules in unforeseen circumstances and even operate beyond our level of knowledge as we make our world view” (Paul Vare).


1. Vare’s point is that the world’s problems requires graduates to have not only an understanding and knowledge of key sustainability concepts but also to be able to act in an emancipatory fashion to engage in critical thought and action beyond merely understanding what sustainability may mean. If indeed ‘climate change is the biggest threat to public health in the 21st century’ (Costello et al 2009) then action is required.


2. We argue there is a ‘sustainability-climate change-health’ triad (Goodman and Richardson 2010) which makes it an imperative that we examine notions of sustainability and climate change in the curriculum (Goodman 2011).


3. Plymouth University itself recognises the issues, and has identified sustainability as a policy objective (a key performance indicator) at all levels of university life (campus, curriculum, culture and community).  


4. The NHS Sustainable Development Unit states on their website that it is working “to help the NHS fulfil its potential as a leading sustainable and low carbon healthcare service…by developing organisations, people, tools, policy and research which will enable the NHS to promote sustainable development and mitigate climate change”. Nursing staff in NHS organisations will be key people helping to achieve carbon reduction targets (NHS SDU 2009) and thus need to have the skills, knowledge and understanding to help their clinical settings achieve this.


5. The NMC standards for education (NMC 2010) explicitly outlines that nurses  should engage in promoting the health, not just of individuals, but also of communities and populations. Public Health is also core to the standards. We know that unsustainable lifestyles and practices lead to poorer health outcomes, and we also know that low carbon lifestyles are also healthy lifestyles, i.e. that there are health co-benefits to be had.


6. In ‘Securing the Future’ (DEFRA 2005) the UK government published a strategy for sustainable development and encouraged all education sectors to embrace SD. The HEA (2009) has taken this on, to support ESD in the HE sector across 17 subject centres. The HEA has a dedicated Education for Sustainable Development theme aiming to provide strategic leadership for ESD in the HE sector. HEFCE (2009) also support sustainability practices across the sector.


7. David Orr (1994) argues that current education practice is not the solution, it is the problem. That is to say graduates who lack an eco-perspective, or who are illiterate in sustainability matters, become part of the problem as they engage in ‘business as usual’ activities. A nurse who cannot make the links between clinical waste, resource use, carbon reduction and health inequalities will not be able to devise solutions because they are not asking the right questions.


8 Nurses are about health (in theory at least), understanding health requires understanding the social determinants of health, which includes the interdependence and interrelatedness of many factors including the physical and social environment. This is core to sustainability thinking.


9. There is increasing evidence that students themselves demand their universities encourage and develop sustainability across their programmes. Bone and Agonbar (2011) argue that first-year students believe universities should be responsible for actively incorporating and promoting sustainable development to prepare them for graduate employment.


10. The challenges to current and future global health (Rao 2009) that result from high carbon and unsustainable patterns of living require nothing short of mobilising healthcare professionals to not only understand but to act upon the various factors that result in disease and misery for billions on the planet. Not to do so is an abrogation of our ‘moral responsibility’ (Morrall 2009) as healthcare professionals to prevent suffering.





As we reflect on the challenges to earth’s natural resources and the planetary boundaries that scientists are now beginning to reveal (Rockstrom et al 2009), we realise that we are running a huge experiment on a global scale. The time scale for evaluating the success or otherwise of this experiment, based on high carbon lifestyles of industrial and post-industrial capitalism, is some time in the future. However we are having measurable adverse effects now on both the planet’s climate and upon the ecosystem services that we all depend on. Nurses, as people, are part of the problem. We need to be part of the solution.


Bone, E, and Agonbar, J. (2011)  First-year student attitudes towards, and skills in sustainable development. HEA. York.


Costello, A. et al (2009) Managing the effects of Climate change. Available online at


DEFRA (2005) Securing the Future. Delivering the UK sustainable development strategy.


Goodman B., Richardson J. Climate Change, Sustainability and Health in United Kingdom Higher Education: The Challenges for Nursing In: Jones P., Selby D., Sterling S.(2010) Sustainability Education: Perspectives and Practice Across Higher Education. London, Earthscan.


Goodman, B. (2011) The need for a ‘sustainability curriculum’ in nurse education. Nurse Education Today. Nov  31 (8):733-7


HEFCE (2009) Sustainable Development in Higher education [online] accessed 24th may 2010.


Higher Education Academy (2009) HEA Sustainability Project


Morrall, P. (2009) Sociology of Health. Routledge London.


National Health Service Sustainable Development Unit. (NHSSDU) (2009), Saving Carbon Improving Health. NHS Carbon Reduction Strategy for England. NHSSDU. Cambridge.

Nursing and Midwifery Council (2010) Standards for Pre-Registration nursing education. NMC. London.

Orr, D. (1994) Earth in Mind. On Education, Environment and The Human Prospect. Island press. Washington


Rao, M. (2009) Climate change is deadly: The Health Impacts of Climate Change. Chapter 2 in Griffiths, J. et al (2009) The Health Practitioners Guide to Climate change. Earthscan  London


Vare P. (no date) Sustainable Literacy: role or goal [online]


A sustainability-climate change-health triad

I have previously suggested (with my colleague Janet Richardson) that there is a sustainability-climate change-health triad  which needs to be addressed more explicitly in nursing.


I further suggest that health at both individual and population levels will be more and more based upon both sustainable living and mitigating and adapting to climate change as global temperatures continue to rise.


In addition to the biological basis for health, human health is based on the fundamentals of physical environment such clean air, clean water, sufficient food and safe waste disposal, and also upon good psycho- social-political environments. For example, low unemployment and absence of military conflict. A sense of aesthetics and the need ask what constitutes the ‘good life’ for human happiness cannot be ignored when assessing human health and well-being. Health is also founded upon on social and environmental factors that transcend national boundaries. Therefore, as the determinants for health are social and often global, one way of addressing the issue is through developing a sense of global citizenship. In addition, because sustainability, climate change and global health are inextricably linked, health has to have sustainability at its core.

We know, as much as we know anything, that climate change is largely resulting from increasing carbon dioxide and CO2 equivalent emissions as a result of fossil fuel energy consumption. Unsustainable economics and lifestyles based on current economic structures also contribute to this process and to ecological degradation. Thus addressing carbon emissions and climate change cannot be achieved without addressing sustainable living.


Sustainable living entails ensuring that current patterns of consumption and lifestyles do not endanger the physical and non physical resource base for coming generations. Climate change threatens health as it threatens both the physical environment and the psycho-social-political environment the latter, for example, as water becomes a scarce commodity and replaces oil as a source for conflict.


Environmental pollutants, radioactivity and toxins also affect the health of current generations and future generations by increasing the likelihood of passing on genetic defects.



Understanding that our individual lives are interconnected systems, bound up with the planetary ecosystems, is a first step to helping us heal ourselves. The planet will survive human predation upon current living systems and the geo-bio-chemical systems, when this current ‘anthropocene’ era that we have started will comes to an end.

Obesity and society

our social envionment encourages obesity

Peter Dawson, a pharmacist, discusses obesity and its ‘origins’ in society. He starts with a retired teacher’s personal account of weight gain and makes the important point that nurses would do well to remember: ‘Knowledge does not lead to behaviour change’. I suggest that knowledge might (only might) be a necessary step, but it is not a sufficient step to changes in behaviour. The Lancet has called weight gain “a normal response by a normal person in an abnormal environment” (Lancet 2011 378 (9793): p741 – the hyperlink is in the article). Obesity has ‘social determinants’, we live in social and physical envionments where the ability to make the right choice is often severly compromised: Consider the Food and Drink industry, car use, urban planning and the changing structure of employment (away from jobs requiring physical labour). A key concept: ‘Obesogenic environment’. These latter factors are what Wright Mills (1959)* refers to as ‘structural transformations’ that help to create your ‘inner life’.

The equation: ‘calories in v calories out’ is too simple an explanation (Dr Harry Rutter). the reality is far more complex than this biophysical explanation.

*see the blog on the ‘sociological imagination’.  An interesting view from two professors in the USA.  The Lancet series on obesity

Harry Rutter  ’Where next for obesity’The Lancet, Volume 378, Issue 9793, Pages 746 – 747, 27 August 2011 : “There is a seductive simplicity to the conceptualisation of obesity as a straightforward problem of energy balance—calories in versus calories out. But the physiological, behavioural, and environmental influences on this relation are asymmetrical. Therefore, although the basic arithmetic holds true, in practice it is much easier for people, and populations, to gain weight than to lose it”.

Our social environment encourages obesity

our social environment encourages obesity

How much is enough?

Robert and Edward Skidelsky, father and son, address the question ‘How much is enough’, in their recently published book (2012). Robert Skidelsky, professor of political economy, and Edward, lecturer in philosophy, wish to suggest what might the elements of a ‘good life’ accepting that this indeed can be known. Following on from this they suggest that the goals of economic policy should be directed to foster the good life, if we can know what that is, rather then directed towards encouraging mindless GDP growth for growths sake. They do this through briefly exploring the work of the renowned economist John Maynard Keynes and through examining the long traditions of philosophical thought. They critique current economic thinking, measurements of happiness and examine some weaknesses of environmentalism.


Underpinning their argument throughout is the notion that wealth is not the ends of a good life, it is merely a means, and not the only or exclusive means at that. In addition to this failure to identify what the ends of economic policy should be, current economics and culture conflates needs and wants thus failing to make the distinction between the two. Policies aimed at the relentless pursuit of money, are then counterproductive because they fail to direct is to asking when we have enough and what a good life is.  


Wealth is not what they would classify as a basic good, and is not automatically an element of ‘the good life’. This might seem counterintuitive, and goes against the grain of a euromillions lottery, celebrity obsessed, consumerist culture. However, many already know that the ‘love of money is the root of evil’ even if they often fall victim to its lures.


The argument is of course highly relevant in cultures which have elevated money making and economic growth as ends in themselves. The results of so doing are environmental damage, social division and a diminution of human flourishing, or as Skidelsky and Skidelsky say eudaimonia’.


They leave it until chapter 6 to outline what they consider are the ‘elements of the good life’, which they say could apply across cultures and across time.



So what are these elements (the basic goods) and how do they go about deciding what they should be? Accepting that the choice of these goods could be arbitrary, they argue for inclusion criteria to prevent this. There are thus 4 inclusion criteria to use to choose the ‘basic goods’.


1.    Universality. Basic goods apply across time, cultures, and not just from a localised, time bound definition of them.

2.    Finality. They are goods in themselves and not a means to an end. Keep asking the ‘what is it for’ question. Money, what is it for? To buy food. Food, what is it for? For life. Life, what is it for? Well, life is not ‘for’ anything, it is not a means to an end, it is an end.

3.    Sui Generis. That means it exists on its own and is not part of anything else. So, ‘freedom from cancer’ is part of larger whole, the good of ‘health’ generally.

4.    Indispensable. Anyone who lacks a basic good can be deemed to have suffered serious harm or loss. Another way is to to think of basic goods as needs.


In establishing these criteria of sufficiency, the task is to treat a ‘good’ as basic only if its lack constitutes serious harm or loss, for it is “…only such goods whose possession could be thought to constitute ‘enough’ ” (p153).



In choosing these basic goods they acknowledge that there is fuzziness, room for argument and overlap, but in such matters as this they argue for “honest roughness is better than spurious precision”. (p 154).


The seven basic goods:



1.    Health.

2.    Security.

3.    Respect.

4.    Personality.

5.    Harmony with nature.

6.    Friendship.

7.    Leisure.



Of course each of these need defining and argument, but maybe that is the point. However tempting it may be to descend into a hermeneutic vortex of relativist definition seeking, and as much fun as that might be in academic discourse, this list could be used as a basis for some universal agreement about how much is enough for a ‘good life’. An interesting exercise would be to gather people of faith and those of no faith to discuss the criteria and the seven basic goods. This would highlight subjective definitions of what for example ‘respect’ means. The list itself is difficult to argue with, who does not want health and security?


Herein lies a problem and that is ‘Politics’. The political class, the capitalist class, have yet to show any signs of social solidarity and thus a desire for the development of these basic goods. The marketisation of society, the commodification of all things, continues apace while the main political parties bow down to the God of growth. The Skidelskys resurrect  Keynes who thought that capitalism was a necessary if nasty route to prosperity and well being. He thought increased GDP would provide ‘enough’ and would usher in a shorter 15 hour working week. Yet despite increased national wealth we are now working longer hours. It is however the spirit of Hayek and the triumph of neoliberal free market ideology which has been unleashed upon Western economies. Hayek would want governments to go even further in their attempts to wither away the State. However without a strong civil society and a strong state, the 7 basic goods have no chance of being realized. They are just too vague and do not serve the interests of capital which requires the increase of profit driven by competitive advantage.




Skidelsky, R., and Skidelsky, E. (2012) How much is enough? The love of money, and the case for the good life. Allen Lane, London.

Sociology of sustainability

‘We are all locked in’ but can we escape the system?

“the apparently independent and autonomous system of industrialism has transgressed its logic and boundaries and has thereby begun a process of self-dissolution” Ulrich Beck.

Sociologically we can make the following observations about our current high carbon ‘economy-society’ (Urry 2011).  The starting point for an analysis of why society engages in particular practices and habits is the observation that energy is the base commodity upon which all other commodities exist (Urry 2011) and which therefore underpins behaviours, habits and practices.

Consider a society that does not have or has never had access to coal, gas or oil. All they have is the wind and water for energy. You don’t have to imagine it, those societies have been well documented and some still exist. Their habits and social practices are then based on the energy form that water and wind gives them. This is not to say that the energy commodity determines the social forms they create otherwise they would all look the same. It is to say however that energy as a base commodity has a good deal of influence.

Since the discovery of steam power based on coal, and then power based on oil and gas, our western societies were able to develop in particular ways until we designed a society that needs this form of energy. Thus, our community behaviours are implicitly locked into high carbon systems that are taken for granted. We live within a cluster of interdependent systems: 1) coal/gas electric grid power; 2) petrol, steel and automobile; 3) carbon military industrial complex; 4) suburban housing and domestic technologies; 5) airlines, leisure, foreign tourism. These are all oil/carbon based. To that add a food system: agribusiness, farm, supermarkets. Some of these have become very fashionable and then embedded into our everyday practice. We have become carbon addicts unable to go cold turkey even if we wanted to.

To date we have to accept that much of social science has been carbon blind and has analysed social practices without regard to the resource base and energy production that we now know are crucial in forming particular social practices. Economics as a discipline tries to explain human behaviour, but has limits as it has an overly ‘instrumentally orientated, rational planning, utility maximizing’ model of human behaviour (in its non Marxist form). That is to say it assumes we make our choices based on our consideration of our own needs and self interests. The Thatcher-Reagan revolution was predicated upon seeing the consumer as king and the individual as the best master of their own destinies. The market is where rational actors come together to make the best choices, so it follows that nothing should get in the way of market activity. John Urry critiques modern economics for failing to address the fundamental relationship between people and the material physical world:

most of the time people do not behave as individually rational separate economic consumers maximising their individual utility from the basket of goods and services they purchase and use given fixed unchanging preferences…(we are) creatures of social routine and habit…fashion and fad…(we are) locked into and reproduce different social practices and institutions, including families, households, social classes, genders, work groups, schools, ethnicities, generations, nations…. (Urry 2011 p4).

This really muddies the waters, it requires understanding that behaviour change results from myriad inputs raging from the ideological and analytical to the pragmatic availability of material resources at hand. It also requires us to consider issues of power over ‘rational’ actors, who has it and who exercises it and in whose interests? Therefore any new technological developments will operate in this ‘economy-society’ space.  So how do new habits form? What is fashion and what are the effects of this? Do we need ‘the fashionableimagination’ – is there a quality of mind that spots and encourages low carbon fashions which are supported by technologies and commodities that use less carbon based energy? This way of thinking may be doomed however, for even if we could spot the next low carbon fashion, the structure of the economy as it currently is run would militate against it for the reasons set out below.

So, we live in societies that are locked into high carbon systems. We are also being asked to change our behaviour to adopt low or zero carbon habits, fashions and social practices. “Deep greens” ask us to fundamentally changeeverything about how we live. This rejects all high carbon systems, and that means consumer capitalism. ‘Mainstream’ sustainability adopts a less radical approach. The focus is not on complete system overhaul but on incremental individual behaviour change while encouraging and being encouraged  by (‘nudged’) governments and corporations to do the right thing.

The emphasis on individual behaviour change through mechanisms of ‘behaviour change technologies’ (for example social marketing techniques or nudge theory) sit within a taken for granted neoliberal paradigm which sees the citizen consumer exercising their freedoms within deregulated markets. This is a technical-rational approach which assumes that there is no contradiction between greening our lifestyles and the capitalist system’s need for growth and consumption to increase.

This individual focus also obscures questions of collective social responsibility and power. Thus we have the project of the ‘carbon calculating’ consumer who may be nudged to do the right thing, to exercise choice within frameworks of governance that does not challenge the fundamentals of consumer capitalism chasing GDP growth.

A technology of behaviour change is the UK’s ‘Pro-environmental Behaviours Framework’. Social conduct can be divided up into segments (e.g. our travel behaviours) which are then amenable to intervention. We can re-engineer choices step by step. Behaviour forms under certain conditions which then can be manipulated using social marketing techniques. Concepts include: ‘Behavioural entry points’, ‘wedge behaviours’, ‘behavioural levers’, ‘choice editing’. There is a set of 12 headline behaviour goals categorised within 3 areas of consumption: 1) personal transport 2) homes and 3) Eco-products.  This is the ‘change the lighbulbs approach’ to climate change.

The paradigm within which all of this sits is that of neoliberal consumer capitalism. This requires, no, has to have, 3% capital accumulation (Harvey 2010), deregulated markets and accelerating consumption. GDP growth is the central goal of economic policy. This form of capitalism also externalises costs, has cycles of crises due to the surplus capital accumulation problem (Harvey 2010) and relies on technological solutions (Ben-Ami 2010). It also wishes to rely on individual responsibility for health, welfare and social problems (e.g. Big Society solutions). Baumann calls it “a parasitic form of social arrangement which may stop its parasitic action only when the host organism is sucked dry of its life juices” (1993:215). The contradictions between consumer capitalism and sustainability are obscured, power and collective responsibility issues are marginalised. It produces two main approaches to carbon reduction:

Macro economics cap and trade systems, e.g the EU’s Emission Trading System.

Micro economic techniques designed to encourage pro environment consumer choice.

It is also based on the idea of the ‘self governing individualised subject’ (Homo economicus) which is a model of human behaviour not born out by the evidence.

What this seems to imply is that consumer capitalist societies will not address carbon reduction other than within this paradigm. If we are locked into clusters of high carbon systems and given the limits to growth (Meadows, Randers and Meadows 2004), planetary boundaries arguments (Rockstrom et al 2009) and ecological devastation then we will need to focus more and more on disaster management. David Selby made this point in 2007 in ‘as the heating happens’.  Behaviour change technologies such as the pro-environment behaviours change framework cannot address the fundamental driver of carbon emissions in anything like the time frame required because neoliberal capitalism will always outrun sustainability due to its need for growth and consumption. Its very mechanism is antithetical to sustainable living.

Webb (2012) suggests citizen consumer knowledge on climate change is patchy at best. Short term concerns over the practicalities, convenience and cost of domestic and social life unsurprisingly dominates longer term concerns. Surveys demonstrate that we on the one hand identify with the need to adopt a low carbon future but on the other hand adopt high carbon choices. This ‘value-action gap’ is seen by government as a non reflexive fact about self interest (we don’t think about  the contradictions in our answers) which is then seen as a barrier to change. In other words, self interest is supposed to drive behaviour but from a governments point of view we are not seeing our self interest as lying towards a low carbon future. We are paradoxically acting against our self interest. We value a low carbon future but we act as if we don’t because we are not reflecting on the connections.

However, surveys do not pick up the ‘situatedness’ of our response and the meaning we give to questions about low carbon living; cultural perspectives, social institutions and political values mediate the responses to attitudinal surveys and interpretations of climate science (Leiserowitz et al 2010). Therefore survey responses cannot be taken to be any true account of our actual preferences because our actual social practices are bounded by the material life we live in (the sorts of houses we have, the cars we drive, the products we buy).

We may be already in an era of peak oil, peak US power, peak welfare states and inequality reduction, peak water and gas availability. Given the limits to growth thesis, our ‘lock in’ to high carbon systems, the resistance to change and the needs of the economy for consumption and GDP growth which fuels that resistance there may be little else to do than prepare for the catastrophes to come. Sociology’s role will be in the field of disaster studies (Nursing will be part of that). Mental Health and Adult nursing may need to emphasise disaster and trauma management during ‘Peak Everything’.

Baumann, Z. (1993) Postmodern Ethics. Oxford Blackwell..

Ben-Ami, D (2010) Ferrari’s for all. Polity Bristol

Douglas, M., Wildavsky, A.B. (1982) Risk and Culture : An Essay on the Selection of Technical and Environmental Dangers. Berkley, University of California Press.

Harvey, D. (2010) The Enigma of capital and the crises of capitalism. Polity. Cambridge

Meadows, D., Randers, J., and Meadows, D. (2004). Limits to growth: the 30 year update. Earthscan. London.

Leiserowitz, A., Maibach, E., Roser-Renouf, C., Smith, N. and Dawson, E. (2010) Climategate, public opinion and the loss of trust. Yale Project on Climate Communication. July. [online]

Urry, J. (2011) Climate Change and Society. Cambridge. Polity Press.

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Rockström, J. Steffen, W., Noone, K. et al (2009) A safe operating space for humanity. Nature. 461. Pp 472-475. 24th September. 8th January 2011

Selby, D. (2007) ‘As the heating happens: Education for sustainable development or education for sustainable contraction? Discourse, Power, Resistance Conference, Talking Truth to power’, accessed 25thMarch 2009

Webb J (2012) Climate change and society: The chimera of behaviour change technologies. Sociology. 46(1): 109-125.