In an unequal world, what can I do?

In an unequal world, what can I do?


Peter Morrall (2009) argues that as health care professionals we know about the problems of the world and the issue for health for populations, but not do anything about it is an abrogation of moral responsibility. Morrall and Goodman (2012) challenge the higher education sector to engage in critical thinking to address global issues, but thinking that leads to action.


I always think of action at various levels:


Individual, group, organisation, national and international. You decide what you can do at any level. That may flow though from your increased awareness and learning.


For the UK a good start is the Equality Trust, based on the work of Richard  Wilkinson and Kate Pickett in their book ‘The Spirit Level’.  The website has excellent resources to raise understanding and awareness:  This gives you the basic information and perhaps ideas about what might be done.



Another good source for information on a global scale is Hans Rosling’s  See also ‘Global Issues’ , Poverty Facts and Stats at

and of course the Joseph Rowntree Foundation:



So get yourself informed (consider journals and the quality press such as the Guardian) and then reflect on what you might want to do about it. There are online campaign groups through which you might voice your support such as , a political movement, or Avaaz or consider one of the main political parties to lobby and support…think which ones are focused on equality and poverty as key planks in their work.


Stay sane and keep a sense of humour, learn to laugh at yourself, base positions on facts as well as expressed values, as no one likes an intense preachy ‘right on’ leftie.




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


Morrall, P. and Goodman, B. (2012) Critical Thinking, Nurse Education and Universities: some thoughts on current issues and implications for nursing practice . Nurse Education Today (in press). 

Human health on a dying Planet?

Barton and Grant’s (2006) health map has an outer ring. In this ring sits ‘Biodiversity’, ‘global ecosystems’ and ‘climate change’. The implication here is that all of human health rests on these ultimate foundations. All human systems rely on these ecosystems remaining functionally sustainable. If we lose or degrade these three foundations for human health, then we lose our ability to survive. Modern city systems, in which 50% of humanity currently lives, would collapse. Alongside the idea of these three foundations is the idea of ‘planetary boundaries’, which map out a ‘safe operating space for humanity’ (Rockstrom et al 2009). If we transgress these boundaries, we take human civilisation into unsafe territory. We may have already done so.


The planetary boundaries are also known as biophysical thresholds and relate closely to Barton and Grant’s outer ring:


1.                     CO2 emissions for climate change (this boundary has been transgressed).

2.                     Biodiversity loss (this boundary has been transgressed).

3.                     Biochemical boundaries – the nitrogen cycle (the phosphorous cycle has not yet been transgressed).

4.                     Ocean acidification.

5.                     Stratospheric ozone depletion.

6.                     Global fresh water use.

7.                     Change in land use.

8.                     Atmospheric aerosol loading (not yet quantified).

9.                     Chemical pollution (not yet quantified).



They argue that the first three of the nine boundaries above have already been overstepped. They also argue:


In the last 200 years, humanity has transitioned into a new geological era—termed the Anthropocene—which is defined by an accelerating departure from the stable environmental conditions of the past 12,000 years into a new, unknown state of Earth”…..“In order to maintain a global environment that is conducive for human development and well-being, we must define and respect planetary boundaries that delineate a “safe operating space” for humanity. We must return to the long-term stable global environment that nurtured human development”.


The return to the long term stable environment may not now be possible.


Evidence that we have degraded these determinants of human health and which makes such a return to stable climate conditions improbable, come from ‘The Economics of Ecosystems and Biodiversity (TEEB), the OECD (2008), Millennium Ecosystem Services Assessment (2005a, 2005b, 2005c) and a series of reports in the New Scientist (2012) and even the accountancy firm PricewaterhouseCoopers (2012).


The TEEB study aims to link ecology and biodiversity to economics with a view to highlighting their importance to human wellbeing. An aim is to try and quantify the costs of inaction on the loss of biodiversity and ecosystem services. This includes assessments on water and air quality, nutrient recycling and decomposition, plant pollination and flood control. These are what are known as ‘public goods’ which do not have a market price and their loss fails to show up in the accounts of conventional economics. Thus without this accounting, companies continue to operate as if these things do not matter, as if they are provided freely. TEEB aims to provide analysis, tools and a methodological framework to assist decision makers in their quest to assess and undertake an analysis of ecosystem services and biodiversity. The 2008 Interim report sets out the many challenges facing us (food, fresh water, loss of forests, coral reefs and species extinction). The report argues “60% of the earth’s ecosystems services that have been examined have been degraded in the last 50 years” (p12). TEEB is clear that current economic approaches are just not tenable.


A series of articles in the New Scientist (2012) makes for grim reading. For arctic warming the suggestion is that summer sea ice could be gone in a decade or two and not by the end of the century and that the loss of Greenland’s ice could mean a rise of sea levels by 1 metre by 2100 and possibly by more. As for ‘planetary feedbacks’, changes (for example, the albedo affect in which white ice reflects heat, while dark seas absorb it) means that the planet’s ability to absorb CO2 will reduce accelerating the rate of heating. The PwC (2012) report suggest that we should expect not 2 degrees of heating but 4 or possible 6 degrees by the end of the century. If this figure does not mean much, Mark Lynas (2007) outlines what this could mean for humanity. It will not be a picnic.


One ray of hope (for food production only) is a farm in Australia using technology developed in the UK. Using seawater and sunlight, Sundrop farms are producing fruit and vegetables in the desert (Margolis 2012). It is this sort of technology that would have to be scaled up to feed the world as climate shifts adversely affect current food production. This development is ‘adaptation’ to climate change and thus may be an exemplar of the way we have to go in the coming decades.


It is becoming increasingly clear that the current experiment of a fossil fuel based civilization allied to extractive practices that pay little regard to the planet’s ability to renew itself or its ability to absorb often toxic wastes, means that Barton and Grant’s outer ring propping up human health is severely degraded. The climate change battle may already be lost. The IPCC target of safety, 350 ppm to keep us down to 2 degrees of warming, has been missed. We are at 391 ppm in November 2012, see The biodiversity threshold has been crossed (Rockstrom et al 2009) while ecosystem services are under severe stress (TEEB 2008). The plan now is to continue to prevent further warming (mitigation) by reducing carbon emissions, then consider the many adaptations we will have to make to a very changed world (for example changes in resource use for health care practices) and finally to build community resilience in the face of major changes. This will include work on mental health and well-being as old habits and expectations are swept away. This will not be easy. Evidence from Greece and other austerity hit countries indicate that societies faced with rapid changes often exhibit manifestations of social unrest and stress.


A dying planet? No, the earth will carry on as it always has, limited only by cosmological changes in its nearest star, the Sun. The holocene era of stable climatic conditions conducive to human development as we know it, is passing very quickly before our eyes. Welcome to the Anthropocene.




Barton, H. And Grant, M (2006) A health map for the local human habitat. Journal of the Royal Society for the Promotion of Public Health. 126 (6) pp 252-261.

Lynas, M. (2007) Six Degrees. Our future on a hotter planet. Fourth Estate. London.

Margolis, J. (2012) Growing food in the desert: is this the solution to the world’s food crisis? The Observer. 24th November. [online] accessed 26th November 2012

Millenium Ecosystem Services Assessment (2005a) Global Assessment report 1: Current state and trends Assessment. Island Press. Washington

Millenium Ecosystem Services Assessment (2005b) Living beyond our means: Natural Assets and Human well-being. Island Press. Washington

Millenium Ecosystem Services Assessment (2005c) Ecosystems and human well-being: Synthesis. Island Press. Washington.

OECD – Organisation for Economic Cooperation and Development (2008) OECD Environmental outlook to 2030.

PwC – PricewaterhouseCoopers (2012)Too late for two degrees? Low carbon economy index 2012. PwC  [online] accessed 24th November 2012

New Scientist (2012) Climate Change: its even worse than we thought. November [online] accessed November 26th 2012

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

TEEB – The Economics of Ecosystem services and Biodiversity (2008) An Interim report [online] accessed 26th November 2012