NHS Funding – Calls to introduce charges

The Kings Fund have been looking at the future of the NHS and how it will be funded. One of those invited to discuss the issue with Kings is the right wing think tank ‘Reform‘.
Roy Lilley stated that Professor Alan Maynard tweeted about Reform’s message to King’s:
Alan Maynard (@ProfAlanMaynard)   25/08/2014 04:35 pm
NHS funding: “can we ignore pricing any longer” in KF weekly bulletin. Answer: YES! Taxation is fairer, easier to collect & opposed by cretins!!
King’s concern is about the issue of  demand for health services outstripping the country’s ability to pay. The suggestion is that the  NHS is facing a funding crisis so big that that the only solution is co-payments, top ups and insurance. This challenges the NHS principle of ‘free at the point of delivery’. I have argued in a previous post that care costs and so we have to consider who pays, but my view is that we should socialise the risk and spread the cost across society.
Roy Lilley asks: “Are top-up or insurance based systems with their overheads, actuarial hocus-pocus, running costs, surpluses, cost of collections, regulations, appeals systems and palaver cheaper and more efficient than a tax based system?”
He goes onto make the point that insurers “have to lay-off risk, reduce exposure and break even on their book. And, ten pounds to see a GP is £10 that has to be collected, administered, audited and in extremis, debt-collected. Taxes must be cheaper to administer and easier to collect”.
Kings,  in listening to Reform , are lending credence to the neoliberal dogma that wishes to shrink the state, individualise costs and encouraging private sector involvement.
The Tories used to say that the NHS is safe in their hands. The Kings bulletin will be music to their ears. Don’t expect Miliband’s Labour to challenge this.

Climate Change, Health and Capitalism

Climate Change, Health and Capitalism The debate on climate change and health in the context of Ecological public health: A necessary corrective to Costello et al’s ‘biggest global health threat’, or co-opted apologists for the neoliberal hegemony?

Abstract

The threat posed to global health by climate change has been widely discussed internationally. The United Kingdom public health community seem to have accepted this as fact and have called for urgent action on climate change, often through state interventionist mitigation strategies and the adoption of a risk discourse. Putting aside the climate change deniers’ arguments, there are critics of this position who seem to accept climate change as a fact but argue that the market and/or economic development should address the issue. Their view is that carbon reduction (mitigation) is a distraction, may be costly and is ineffective. They argue that what is required is more economic development and progress even if that means a warmer world. Both positions however accept the fact of growth based capitalism and thus fail to critique neoliberal market driven capitalism or posit an alternative political economy that eschews growth. Ecological public health, however, appears to be a way forward in addressing not only social determinants of health but also the political and ecological determinants. This might allow us to consider not just public health but also planetary health and health threats that arise from growth based capitalism.

 

Keywords Ecological Public health, climate change; risk discourse; capitalism; neoliberalism;

The health impacts of climate change have been much discussed internationally1,2,3,4  however there is some disagreement about the magnitude of those effects, when they will occur and what the right course of action is. Underpinning those disagreements is a tacit and sometimes uncritical acceptance of the fundamental structure of the political economy of growth capitalism – neoliberalism5 , with the differences being around whether climate change requires more immediate public policy and health professionalintervention6 or whether capitalism will address the health issues though economic development. In other words, both use the frame of reference of capitalism to argue for either more market freedom or statist intervention based in a risk discourse. This paper seeks to outline the arguments over the health effects of climate change while rooting that discourse within wider often background taken for granted political economy. Two writers, Indur Goklany and Daniel Ben Ami will be used to represent the critical camp in riposte to Costello et al’s 2009 UCL-Lancet paper on climate change and health. While the focus is on climate change, other factors such as biodiversity loss, chemical pollution, ozone depletion, ocean acidification, all threaten the ecological systems we depend on7. These issues are also associated with our current growth based economic structures.  The ecological public health discourse will not be discussed at length here, but might provide a newer perspective linking global political structures, critiques of growth based capitalism and public health.

The Climate change ‘debate’

 

The Intergovernmental Panel on Climate Change 5th Assessment Report (AR5)8 argues that scientists are 95% certain that humans are the ‘dominant cause’ of global warming since the 1950’s9,10 . Despite this, there is continuing doubt, denial and a focus on uncertainty,11,12,13,14,15   that Climate Change is human induced and that it requires radical shifts in public policy.   This doubt sits in opposition to many in the medical16and public health domain17. The World Health Organisation18,19  accepts IPCC assessments and considers climate change to be a ‘significant and emerging threat’ to public healthwhile previously ranking it very low down in a table of health threats20,21. In the United Kingdom, Costello22 et al argue that climate change is a major potential public health threat that does require major changes such as action on carbon emissions. In addition, Barton and Grant’s health map23 has in its outer ring ‘Climate Stability, Biodiversity and Global Ecosystems’ as key determinants of health and supports the WHO view that alongside the social determinants of health, health threats arise from large scale environmental hazards such as climate change, stratospheric ozone depletion, biodiversity losses, changes in water systems, land degradation, urbanisation and pressures on food production. WHO24  argues:   “Appreciation of this scale and type of influence on human health requires a new perspective which focuses on ecosystems and on the recognition that the foundations of long-term good health in populations rely in great part on the continued stability and functioning of the biosphere’s life-supporting systems”.

 

It is this call for a ‘new perspective on ecosystems’ that indicates why there is a backlash, one that underpins critiques of the link between climate change, environmental issues and human health. Many of those critical are libertarian, anti-state conservatives defending the neoliberal hegemony of free market dogma which ‘new perspectives’ may threaten.  For example, Stakaityte25 argues:   “Free market proponents are quick to point out that the whole climate change issue has been used to stifle freedom and to expand the nanny state – and they are right. If the climate is changing, and if humans really are responsible, the market will adapt”.

 

The WHO call for a ‘new perspective’ however is not a radical critique of neoliberal capitalism or a call for its replacement by other political economies. It sits within an overarching acceptance that growth25 capitalism is the only economic model, and that only its particular current form requires changing, for example by investments in green technologies.   Critical discourse over such an important issue is crucial. Argument should proceed over matters of empirical facts, within discourses of risk and an understanding of scientific uncertainty27 .  Attention also should turn to philosophical positions on political economy in which the dominant neoliberal hegemony28,29 attempts to build and maintain a sceptical view30,31  in the media on climate change and on alternative, including no growth, economic models32,33,34  because neoliberalism is antithetical to ‘nanny state’ intervention implicit in public health ‘upstream’ analysis.

 

Health Impacts of climate change and the policy response.

Indur Goklany and Daniel Ben Ami respectively are noted writers on the topic and both are in the sceptical camp regarding what to do about climate change. Both however appear to accept the fact of climate change, they just don’t agree with the focus on carbon reduction targets.   For the health community that makes decisions on what the main threats to health are, there is a need to carefully weigh up the evidence for threats to population health in the short, medium and long term, or what Goklany calls the ‘foreseeable future’ defined as 2085-2100. This means addressing Goklany’s argument, especially, on the ranking of health threats and Ben Ami’s argument on progress. For Goklany the health threats this century are not from climate change, nor will they be. For Ben Ami, the answer lies in any case of more progress based on economic growth and development.   In this there is some support from the latest IPCC report 35 (p3)  which states   “the present worldwide burden of ill health from climate change is relatively small compared with other stressors and is not well quantified”.   The report also states that rapid economic development will reduce health impacts on the poorest and least healthy groups, with further falls in mortality rates.  In addition, they argue36 (p4), alongside poverty alleviation and disaster preparedness, the most effective adaptation measures are:   “basic public health measures such as the provision of clean water, sanitation and essential healthcare”.   A key point is that climate change and extreme weather events affects the poor disproportionally and that37 (p3)   “until mid century climate change will act mainly by exacerbating health problems that already exist”   So there is an emphasis on economic development and poverty alleviation by the IPCC, thereby accepting the basic tenets of growth capitalism, alongside mitigation and adaptation, to deliver them.   However, McCoy38  et al points out that by 2100,  ‘business usual’ emissions growth will see increases in levels of CO2 in the atmosphere giving a 50:50 chance that global mean temperatures will rise by more than 4 degrees, which they argue  is   “incompatible with an organised global community”.   However, they stop short of a critique of the political economy of growth capitalism that drives C02 emissions39,40,41.   Both Goklany and Ben-Ami’s faith in human progress is based on inductive reasoning, ignores the key statistical problem of exponential growth on a finite planet, and may be over confident that limits have been correctly identified or can be overcome. Goklany might turn out to be empirically correct that in the ‘foreseeable future’, climate change will not be the major threat to public health, however this line of reasoning might support the denial of climate change in particular and obscures the requirement of addressing the sustainability of current economic structures. It also sidesteps addressing the language and discourse of risk42,43 which includes considering that human action should not be based on total certainty but on the assessment of the probabilities of high and low impact events. However, the position taken by both writers is that humanity needs more capitalist economic and technological development even if that results in a warmer world.   Goklany44 argues that humanity, in developing and using fossil fuels, both freed itself from the vagaries of nature’s provision and also has saved nature from humanity’s need to turn more of it into cropland. The inference from this argument is that we ought to continue to use fossil fuels to further human progress and to save nature from ourselves. Increasing global GDP, i.e. a wealthier world, would also be better equipped to deal with future global warming issues45.   Daniel Ben-Ami46 forwards this argument. He points out that we are living longer and healthier lives than ever before thanks to economic development and growth. Therefore, inductively, we need more growth. Humanity should strive to achieve more in terms of economic development so that everyone should have access to a Ferrari if they want it.   Those who suggest climate change is a health threat do not address this economic and development argument head on.  There may be implicit acceptance of the current economic models of development. Instead there is a focus on the magnitude of climate change per se as a health threat rather than the economic structures which may drive climate change and other unsustainable practices such as deforestation.       Costello v Goklany.   In 2009 Costello et al 47(p1693)  argued that ‘climate change is the biggest global health threat of the 21st century’ . Goklany48,49 in the same year replied and argued that climate change is not the number one threat to humanity, and questioned whether it is the defining challenge of our age. Goklany50  pointed out that climate change was ranked only 21st out of 24 global health threats. Goklany’s rebuttal data comes from the World Health Organisation51 ‘World Health Report 2002’ and the Comparative Quantification of Health Risks 200452and he used results from “Fast Track Assessments” (FTAs) of the global impacts of global warming53,54 .   Costello, Maslin and Montgomery 55  in reply to Goklany argued that     “The ranking of climate change at 21st out of 24 risk factors was made at a time when global temperature rise was only 0·74°C, and when the effects of climate change on the other risk factors was unclear”   …and they claimed that there has since been substantial changes in our understanding of climate change risks. They cite two papersshowing that about 1 trillion tonnes56 is probably the cumulative limit for all carbon emissions if we wish to stay within the 2°C “safety” limit57, and that, without action, we shall exceed this limit before 2050.  They also cite a paper by Schneider58 who raised the prospect of worst case scenarios: warming at 3°C gives a 90% probability that Greenland will melt, raising sea levels by many metres, and that on present evidence and trends there is a 5—17% chance that temperatures will go up by 6·4°C by 2100. They argue that this a risk threshold, way beyond which people would buy insurance.   Goklany59  in 2012,  argued Costello et al made their claim about climate change in 2009 without a comparative analysis of the magnitude, severity and manageability of a range of health threats at that time and therefore ranking it as the No 1 threat is untenable.  His position in 2012 is that the 2 degree target is irrelevant in any case and he seems happy to accept a 4 degree rise.   The 2013 IPCC report AR560, while accepting a pause in warming over recent years, argues that climate change is a continuing very serious issue and now post dates this difference in Goklany and Costello’s arguments which are based on data from 1999 to 2009. The report makes it clear that even if greenhouse gas emissions are stopped right now climate change will persists for many centuries, much of it will be irreversible characterised by impacts such as sea level rises and argues that the last time the world was 2 degrees warmer, sea levels were 5 -10 metres higher.   On what to do, Goklany61 (p69)  argued in 2009 that   “Societal resources devoted to curb carbon dioxide and other greenhouse gas emissions will be unavailable for other…more urgent tasks including vector control, developing safer water supplies or installing sanitation facilities in developing countries….”   However this sets up a false dichotomy. The decision to spend on carbon reduction is not an either/or one. There are myriad spending decisions being made, and those choices are made from a raft of competing priorities. One could equally argue that resources devoted to nuclear armaments and other military spending is unavailable also for these other urgent tasks. So to focus on emissions reduction as the spending that diverts funds away from addressing other pressing health issues is a biased view. Goklany could argue for an end to subsidies for the fossil fuel and nuclear industries, reductions in military spending, changing the international tax regimes to access wealth deposited in offshore accounts, or the introduction of a Tobin tax on financial transactions. These are admittedly biased positions and may be seen to be too left wing, and ideologically incompatible with current growth capitalism and neoliberal hegemony62.   Whether funding spent on carbon reduction actually works in terms of human welfare and is less expensive than alternatives, is a valid question but has to be seen in a wider political discourse about spending decisions. His points regarding the need for poverty reduction via sustainable economic development and advancing our adaptive capacity would possibly bring broad agreement. In any case some63 consider that it is too late for mitigation and that adaptation to a warmer world is now needed. Goklany64  uses the term ‘focused adaptation’ meaning taking advantage of the positive benefits of warming. If sea levels are to rise by 5-10 metres this is beyond the foreseeable future and so we should focus on economic growth and development to adapt to those future scenarios rather than wasting time resources and energy on emission curbs. However, this seems somewhat an anthropocentric view taking in little regard for biodiversity loss and ocean acidification, both of which are also threats to human health.   Ben Ami and Goklany put faith instead in ‘secular technological change’. This believes that   1) Existing technologies will become cheaper or more cost effective. 2) New technologies that are even more cost effective will become available.   They may well be correct. They argue the potential health threats may be addressed through human ingenuity based on economic progress and economic progress is best served by accepting the IPCC worse case scenario which would result in greater per capita GDP and thus release capital for adaptation (figure 1).   Goklany argues that if humanity has a choice, it ought to strive for the developmental path corresponding to the richest IPCC scenario (A1FI  – 4 degrees C above 1990 by 2085), notwithstanding any associated global warming, because this increases adaptive capacity and poverty would be eliminated. Other health risks that rank higher than global warming are also associated with poverty and would thus also be eliminated. Poverty related diseases contribute to mortality and morbidity 70 to 80% more than warming. Mitigative capacity would be increased, therefore health improves with economic and technological development, and development encourages the ‘environmental transition’.   This is a very risky strategy which future generations will have to judge the merits of. There is gathering evidence beyond climate change suggesting that humanity is already transgressing other environmental limits65, transgressions which will not support a ‘safe operating space’ in the new era, the ‘anthropocene66,67 .   Risk Discourse.   Goklany68 argued in 2012   “This paper does not address hypothesized low-probability but potentially high consequence outcomes such as a shutdown of the thermohaline circulation or the melting of the Greenland and Antarctica Ice Sheets, which have been deemed unlikely to occur in the foreseeable future by both the IPCC and the US Global Change Research Program, among others”,   …although the IPCC69(p22) has since written that it is     “very unlikely that the Atlantic Meridional Overturning Circulation (part of the global thermohaline) will undergo abrupt transition or collapse…however, a collapse beyond the 21st century…cannot be excluded”.   Goklany, in not addressing these risks, appears to dismiss the need for ‘risk discourse’ to frame public debate relying on ‘kicking into the long grass’ serious future consequences of climate change.   ‘Risk’ is already an essential part of everyone’s experience, including in the world of insurance, health and investment. It is not uncommon for people to insure against low probability but high impact events, e.g. house fires, and for the long term, e.g. pensions. It is thus arguable that the thermohaline shutdown and ice sheets melts may well be just the sort of low probability but high impact events that humanity ought to be insuring against and taking measures to prevent through carbon emissions reductions. Painter70 suggests therefore that elements of risk discourse would provide a better frame for debate than disaster and uncertainty frames, which are both more prevalent in news media.   Space precludes an examination of the concept of exponential growth and the requirement to produce resources to meet the needs of potentially 9-10 billion people by 2050. Costello et al’s position seems to be that climate change will stress ecosystems before we have time to adapt and that both direct and indirect affects will adversely impact on global health. They are not so sanguine about our ability to live within our limits.         Goklany is correct to point out that currently health threats arise from poverty and underdevelopment. In this assessment he is in accord with the WHO social determinants of health approach and the IPCC AR5 WGII71.  Costello et al have not dismissed this and public health experts would probably accept a similar position. A focus on the social determinants of health and the political determinants of health72 needs to run alongside mitigation or else the good work could be undone by a low probability, according to Goklany,  but high impact event such as the melting of the Arctic Ice. They differ on when climate change will be a health threat and importantly on how to address it. Goklany and Ben Ami appear to be on the market driven economic development model as the answer whereas Costello et al argue for more immediate state and public intervention in addressing climate change. All however do not critique the fundamental neoliberal growth economic model or call for alternative economic ‘no growth’ or circular models73,74. There is little doubt that we are running an experiment with the climate, there is agreement that this will impact on global health but the dominant discourse of political economy seems to be either more or less tweaking with capitalist growth models rather than a sustained examination of alternatives.There are voices, now however, pointing public health in another direction. Horton et al75 call for a new social movement in a ‘manifesto from public to planetary health’, to support collective action on Public Health, introducing the concept of ‘planetary’, rather than just ‘public’ health.  As with Lang and Rayner’s76  discussion of Ecological public health, there is a strong focus on the unsustainability of current consumption. Interestingly,  an overt political statement is introduced in the ‘manifesto’: “We have created an unjust global economic system that favours a small wealthy elite over the many who have so little”77 p847. They attack the idea of progress, and thus implicitly growth based neoliberalism, for deepening this ecological crisis and for being socially unjust. The call is for an urgent transformation in values and practices based on recognizing our interdependence and interconnectedness, and a new vision of democratic action and cooperation.  A principle of ‘planetism’ is invoked which requires us to conserve and sustain ecosystems upon which we rely.Finally they suggest that public health and medicine can be independent voices of conscience who along with ’empowered communities’ can confront entrenched interests. In the same vein, Ottersen et al78 are explicitly political on the links between health inequity, globalisation and the current system of global governance, including the actions of ‘powerful global actors’ and while they do not use the term ‘growth based capitalism’ or ‘neoliberalism’, the tone of the report makes it quite clear that there is a need to address global governance and an analysis of power. The domains of Public Health, Medicine and Nursing may be insufficiently politically aware of the scale of the issues, and the sheer force and dynamics of capitalism79, that impacts on human health. This might be due to the (necessary?) ‘ahistoric’ and ‘apolitical’ education of health care professionals, resulting in a lack of a sociological or political imagination underpinned by a critical theory of capitalism. However, adopting the perspective of Ecological Public Health or seeing the world through a ‘sustainability lens’80 might move more health practitioners and policy makers into critique and action on current economic and political structures that result in health inequities, and indeed, if some are to be believed, that threaten western civilisation81,82.

  1. World Health Organization. Climate change and human health. (online) http://www.who.int/globalchange/en/index.html (accessed 26 March 2014)
  2. World Health Organization. Health topics. Climate Change. (online) http://www.who.int/topics/climate/en/(accessed 26 March 2014)
  3. McCoy D, Montgomery H, Arulkumuran S and Godlee, F. Climate change and human survival. British Medical Journal.  348:2351 March 26th 2014
  4. Intergovernmental Panel on Climate Change. WGII AR5 Climate Change 2014: Impacts Adaption and Vulnerability. Chapter 11. Human Health: Impacts, Adaptation and Co-benefits. 2014
  5. Crouch C. The strange non death of neoliberalism. Bristol. Polity Press.  2011.
  6. Climate and Health Council. (online)  http://www.climateandhealth.org/  (accessed 30th March 2014)
  7. Rockström J,  SteffenW, NooneK, PerssonA, ChapinF, Lambin E. et al. Planetary boundaries: Exploring the safe operating space for humanity. Ecology and Society 14, 32. 2009
  8. Intergovernmental Panel on Climate Change. Summary for policy makers. WG1 AR5 September 27th. IPCC. 2013.
  9. McGrath M. IPCC climate report: humans ‘dominant cause’ of warming. 27th September. (online)http://www.bbc.co.uk/news/science-environment-24292615(accessed 26 March 2014)
  10. Stocker. T. Climate change threatens our planet, our only home  (online) http://www.bbc.co.uk/news/science-environment-24292615 (accessed March 26th 2014)
  11. Delingpole J. Global warming believers are feeling the heat. (online) http://blogs.telegraph.co.uk/news/jamesdelingpole/100238047/global-warming-believers-are-feeling-the-heat/  (accessed March 26th 2014)
  12. Painter J. Climate change in the media. Reporting risk and uncertainty. University of Oxford. I.B. Tauris and Co. Reuters Institute for the Study of Journalism, 2013
  13. Syal R. Global warming can have a positive side, says Owen Paterson. 30th September. (online) http://www.theguardian.com/environment/2013/sep/30/owen-paterson-minister-climate-change-advantages (accessed 26 March 2014).
  14. Mason J. UK secretary of state reveals his depth of knowledge of climate change (not!). (online) Skeptical Science. http://www.skepticalscience.com/paterson-on-climate.html(accessed 26 March 2014)
  15. Cohen N. The climate change deniers have won. (online) http://www.theguardian.com/commentisfree/2014/mar/22/climate-change-deniers-have-won-global-warming (accessed 26th March 2014)
  16. McMichael T, Montgomery, H and Costello A. Health risks, present and future, from global climate change. British Medical Journal. 344  e1359. 2012
  17. Faculty of Public Health. Sustaining a Healthy future. Taking action on Climate change. (online) http://www.fph.org.uk/uploads/r_sustaining_a_healthy_future.pdf  (accessed 30th March 2014)
  18. World Health Organization. Climate change and human health. (online) http://www.who.int/globalchange/en/index.html (accessed 26 March 2014)
  19. World Health Organization. Health topics. Climate Change. (online) http://www.who.int/topics/climate/en/(accessed 26 March 2014)
  20. World Health Organization. (2004) Comparative Quantification of Health Risks (online) www.who.int/healthinfo/global_burden_disease/cra/en/index.htm    (accessed 1st April 2014)
  21. World Health Organization. Global Health Risks. (online) http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html (accessed 26 march 2014)
  22. Costello A, Abbas M, Allen A, Ball S, Bellamy R,  Friel S, Groce N, Johnson A, Kett M, Lee M, Levy C, Maslin M, McCoy D, McGuire B, Montgomery H, Napier D, Pagel C, Patel J,  de Oliveira J, Redclift N, Rees H, Rogger D, Scott J, Stephenson J, Twigg, Wolff J, Patterson C. ‘Managing the health effects of climate change’, The Lancet; 373:1693 – 1733. 2009
  23. Barton H and Grant M. A health map for the local human habitat. Journal of the Royal Society for the Promotion of Health . 126(6): 252-261. 2006
  24. World Health Organisation.  Global environmental change. (online) http://www.who.int/globalchange/environment/en/index.html  (accessed 30th march 2014)
  25. Stakaityte G. Libertarianism and (climate) science denial. (online)  http://the-libertarian.co.uk/libertarianism-and-climate-science-denial/ (accessed 30th March 2014)
  26. Jackson T. Prosperity without growth. Economics for a Finite planet.  London. Earthscan. 2009.
  27. Painter J. (2013) Climate change in the media. Reporting risk and uncertainty. University of Oxford. I.B. Tauris and Co. Reuters Institute for the Study of Journalism, 2013
  28. Crouch C. The strange non death of neoliberalism. Bristol. Polity Press.  2011.
  29. Plehwe D, Walpen B, and NeunhöfferG. Neoliberal Hegemony. A global critique.  London. Routledge. 2006.
  30. Lehmann E. Heartland Institute says more CO2 is good for the Planet.http://www.midwestenergynews.com/2014/03/31/heartland-institute-says-more-co2-is-good-for-the-planet/ (accessed 30th March 2014)
  31. Cato Institute A harsh climate for Trade: How Climate change proposals threaten Global commerce. (online)  http://www.cato.org/multimedia/events/harsh-climate-trade-how-climate-change-proposals-threaten-global-commerce (accessed 30th March 2014)
  32. Jackson T. Prosperity without growth. Economics for a Finite planet.  London. Earthscan. 2009.
  33. Johnson V, Simms A and Chowla P. Growth isn’t possible. New Economics Foundation. 2010 (online) http://www.neweconomics.org/publications/entry/growth-isnt-possible (accessed 30th March 2014)
  34. Ellen MacArthur Foundation. The circular model –brief history and schools of thought. (online) http://www.ellenmacarthurfoundation.org/circular-economy/circular-economy/the-circular-model-brief-history-and-schools-of-thought  (accessed 1st April 2014)
  35. Intergovernmental Panel on Climate Change. WGII AR5 Climate Change 2014: Impacts Adaption and Vulnerability. Chapter 11 Human Health: Impacts, Adaptation and Co-benefits.
  36. Intergovernmental Panel on Climate Change. WGII AR5 Climate Change 2014: Impacts Adaption and Vulnerability. Chapter 11 Human Health: Impacts, Adaptation and Co-benefits.
  37. Intergovernmental Panel on Climate Change. WGII AR5 Climate Change 2014: Impacts Adaption and Vulnerability. Chapter 11 Human Health: Impacts, Adaptation and Co-benefits.
  38. McCoy D, Montgomery H, Arulkumuran S and Godlee, F. Climate change and human survival. British Medical Journal.  348:2351 March 26th 2014
  39. Urry J. Sociology and Climate Change. The Sociological Review 57 Issue supplement s2:84-100.  2009
  40. Hamilton C. Growth Fetish London. Allen and Unwin. 2003
  41. Harvey, D. The enigma of capital and the crises of capitalism. Oxford. Oxford University Press. 2010
  42. Haggett C. Discourses of Risk: the construction of responsibility and blame: using discourse analysis to understand contested risks and the management of blame and accountability. Lambert Academic Publishing. 2010
  43. Painter J. (2013) Climate change in the media. Reporting risk and uncertainty. University of Oxford. I.B. Tauris and Co. Reuters Institute for the Study of Journalism, 2013
  44. Goklany I. Humanity Unbound: How Fossil Fuels Saved Humanity from Nature and Nature from Humanity. December 19th Policy Analysis, No. 715, Cato Institute, Washington, DC. 2012
  45. Goklany I. Is a Richer-but-warmer World Better than Poorer-but-cooler World? Energy & Environment, 18 (7 and 8);1023–1048. 2007.
  46. Ben-Ami, D. Ferrari’s for All – In defence of economic progress.  University of Bristol. Policy Press. 2010
  47. Costello A, Abbas M, Allen A, Ball S, Bellamy R,  Friel S, Groce N, Johnson A, Kett M, Lee M, Levy C, Maslin M, McCoy D, McGuire B, Montgomery H, Napier D, Pagel C, Patel J,  de Oliveira J, Redclift N, Rees H, Rogger D, Scott J, Stephenson J, Twigg, Wolff J, Patterson C. ‘Managing the health effects of climate change’, The Lancet, 2009; 373:1693 – 1733.
  48. Goklany I. Is climate change the “defining challenge of our age”? Energy Environment, 20:279-302.  2009
  49. Goklany, I. Climate change is not the biggest global health threat. The Lancet, 374 9694:  973 – 974. 2009
  50. Goklany I. Global Health Threats: Global Warming in Perspective. Journal of American Physicians and Surgeons 14  3:69-75.  2009
  51. World Health Organization. (2002) World Health Report 2002—Statistical Annex. (online) http://www.who.int/whr/2002/annex/en/index.html  (accessed 1st April 2014)
  52. World Health Organisation (2004) Comparative Quantification of Health Risks 2004 (online) http://www.who.int/publications/cra/chapters/volume1/0000i-xxiv.pdf  (accessed 1st April 2014)
  53. Arnell N, Cannel M,  Hulme M, Kovats R, Mitchell J, Nicholls R, Parry M, Livermore M, White A. The consequences of CO2stabilization  for the impacts of climate change. Climatic Change 53 pp 413-446. 2002
  54. Parry M (ed). Special issue: an assessment of the global effects of climate change under SRES emissions and socio-economic scenarios. Global Environmental Change. 14:1-99. 2004
  55. Costello, A., Maslin, M., and Montgomery, H. Climate change is not the biggest global health threat  – author’s reply. The Lancet. 374. 9694: 974-975.  2009
  56. Allen M, Frame D, Huntingford C, Jones C, Lowe J, Meinshausen M and Meinshausen N. Warming caused by cumulative carbon emissions towards the trillionth tonne. Nature pp 458: 1163-1166. 2009
  57. Peters G, Andrew R, Boden T, Canadell J, Ciais P, Le Quere C, Marland G, Raupach M. and Wilson C. The Challenge to keep global warming below 2 degrees C. Nature Climate Change. 3, 4-6 doi:10.1038/nclimate1783. 2013
  58. Schneider S. The worst case scenario. Nature 2009; 458: 1104-1105
  59. Goklany I. Is climate change the number one threat to humanity? October 17th  2012, http://wattsupwiththat.com/2012/10/17/is-climate-change-the-number-one-threat-to-humanity/   (accessed 30th March 2014)
  60. Intergovernmental Panel on Climate Change. WGI AR5 Climate Change 2013: The Physical Science Basis. Summary for Policy Makers. 2013
  61. Goklany I. Global Health Threats: Global Warming in Perspective. Journal of American Physicians and Surgeons 14  3:69-75.  2009
  62. Plehwe D, Walpen B, and NeunhöfferG. Neoliberal Hegemony. A global critique.  London.
  63. Parry M, Palutikof J, Hanson C, Lowe J. Squaring up to reality. (online) http://www.nature.com/climate/2008/0806/full/climate.2008.50.html(accessed 1st April 2014)
  64. Goklany I. Is climate change the “defining challenge of our age”? Energy Environment, 20:279-302. 2009
  65. Rockström J,  SteffenW, NooneK, PerssonA, ChapinF, Lambin E. et al. Planetary boundaries: Exploring the safe operating space for humanity. Ecology and Society 14, 32. 2009
  66. Crutzen, P. and Stoermer, E. The Anthropocene. IGBP newsletter 41, 12. 2000
  67. Smith, B. and Zeder, M. (2013) The Onset of the Anthropocene.  Anthropocene. (online) http://dx.doi.org/10.1016/j.ancene.2013.05.001     (accessed 1st April 2014)
  68. Goklany I. Is climate change the number one threat to humanity? October 17th  2012 (online) http://wattsupwiththat.com/2012/10/17/is-climate-change-the-number-one-threat-to-humanity/   (accessed 30th March 2014)
  69. Intergovernmental Panel on Climate Change. WGI AR5 Climate Change 2013: The Physical Science Basis. Summary for Policy Makers. 2013
  70. Painter J. Climate change in the media. Reporting risk and uncertainty. University of Oxford. I.B. Tauris and Co. Reuters Institute for the Study of Journalism, 2013
  71. Intergovernmental Panel on Climate Change. WGII AR5 Climate Change 2014: Impacts Adaption and Vulnerability. Chapter 11 Human Health: Impacts, Adaptation and Co-benefits.
  72. The Lancet-University of Oslo Commission on Global Governance for Health. The political origins of health inequity: prospects for change. The Lancet 383:630-67.  2014
  73. Ellen MacArthur Foundation. The circular model –brief history and schools of thought. (online) http://www.ellenmacarthurfoundation.org/circular-economy/circular-economy/the-circular-model-brief-history-and-schools-of-thought  (accessed 1st April 2014)
  74. Jackson T. Prosperity without growth. London Earthscan 2010
  75. Horton R,  Beaglehole R, Bonita R et al From Public health to planetary health: a manifesto. The Lancet 383:847 2014
  76. Lang T and Rayner G Ecological public health: the 21st century’s big idea? British Medical Journal 345:e5466 doi 10.1136/bmj.e5466 2012
  77. Horton R,  Beaglehole R, Bonita R et al From Public health to planetary health: a manifesto. The Lancet 383:847 2014
  78. Ottersen O,  Dasgupta J, Blouin C et al The Lancet-University of Oslo Commission on Global Governance for Health. The political origins of health inequity: prospects for change. The Lancet 383:630-667 February
  79. Harvey, D. The enigma of capital and the crises of capitalism. Oxford. Oxford University Press. 2010
  80. Goodman B  and East L  The Sustainability Lens: A framework for nurse education that is ‘fit for the future’ Nurse Education Today 34(1):100-103  2014
  81. Hamilton C Requiem for a Species: Why we resist the truth about climate change . London Earthscan 2010
  82. Oreskes N and Conway E  The Collapse of Western Civilisation: A view from the future. Columbia University Press. New York

Figure 1: net GDP per capita, 1990-2200 for 4 IPCC scenarios. The warmest is A1FI (4 degrees C) and the coolest is B1 (2.1 degrees C)       Author’s statement

Funding: none

Competing Interests: None declared

Ethical approval: Not required. This is a review paper.

 

“NOTICE: this is the author’s version of a work that was accepted for publication in Public Health. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in PUBLICATION, [VOL#, ISSUE#, (DATE)] DOI

Has anything changed? The malefactors of great wealth.

I came across a quote in Oreskes and Conway’s (2014) ‘The Collapse of Western Civilization’ from a speech made by a national leader. At this point, I will not name or date the speechmaker. I thought it interesting as a view on the relationship between a nation state and its wealthy individuals and thus on the nature of democracy. What follows are parts of the speech with some commentary in bold. I think it speaks to us today.

 

“National sovereignty is to be upheld in so far as it means the sovereignty of the people used for the real and ultimate good of the people; and state’s rights are to be upheld in so far as they mean the people’s rights. Especially is this true in dealing with the relations of the people as a whole to the great corporations which are the distinguishing feature of modern business conditions”.

The democratic deficit in both the USA and in Europe is that increasingly voters’ rights are being increasingly limited and bound by the rights of corporations and through the actions of corporate lobbying and political influence. The Transatlantic Trade and Investment Partnership  (TTIP) further threatens nation state and citizen democracy by allowing corporations to sue governments if they implement social and environmental protection legislation that the corporation deems a barrier to trade. Thus, national sovereignty is being eroded by such new legislation that does not recognise the sovereignty of people. Globalised capital flows are also eroding national sovereignty through capital mobility and a lack of a globalised governance in such issues as tax evasion and climate protection.

“Experience has shown that it is necessary to exercise a far more efficient control than at present over the business use of those vast fortunes, chiefly corporate, which are used in interstate business”.

More efficient control is now seen as anti-business and anti-democratic by the corporate class executive and the political power elites within a neoliberal idiocy that wants smaller and smaller state interference.

“But there is a growing determination that no man shall amass a great fortune by special privilege, by chicanery and wrong doing, so far that it is in the power of legislation to prevent; and that a fortune, however amassed shall not have a business use that is antisocial”.

This determination has been somewhat diluted as exemplified in Peter Mandelson’s famous quote that new labour is “Intensely relaxed about people getting filthy rich” and Boris Johnson’s eulogy to the rich as an ‘oppressed minority’. In addition we have Tax laws favouring the 1% and their offshore havens and finance capital that rewards fancy financial products while being socially useless. They argue as an article of faith that if taxes on the rich go up, job creation go down to justify their snouts in trough. Nick Hanauer debunks this idea in this short Ted talk. The rich are not job creators.

“Almost every big business is in engaged in interstate commerce and…must not be allowed…to escape thereby all responsibility either to state or to nation”.

Globalisation. If you don’t like our employment practices and wage structures then we will take our investments elsewhere; we will take advantage of the weakness of global labour and call it flexibility. You should be grateful you even have a job.

“The…people became firmly convinced of the need of control over these great aggregations of capital, especially where they had a monopolistic tendency…”

The people have become blind and disorganised, many have been persuaded to vote against their class interests. Many wish there was greater control, but are unsure of how to do it.

“There is unfortunately a certain number of our fellow countrymen who seem to accept the view that unless a man can be proved guilty of some particular crime he shall be counted a good citizen no matter how infamous a life he has led, no matter how pernicious his doctrines or his practices”.

CEO’s of certain banks, some hedge fund managers, asset strippers, CEO’s in the fossil fuel lobby and industry, climate change deniers…..many who form part of the corporate class executive who view corporate social responsibility either as marketing ploy and as a façade to mask their antisocial and anti-environmental business practices. Their rewards are knighthoods, huge salaries and bonuses, because their activities are legal and increase shareholder value.

“There is a world-wide financial disturbance, it is felt in Paris and Berlin…on the New York stock exchange the disturbance has been particularly severe…it may well be the determination of the government…to punish certain malefactors of great wealth…”

They are conspicuous by their absence in criminal courts and yet no common thief has ever cost the country so much.

“….who shall rule this country – the people through their governmental agents or a few ruthless and domineering men, whose wealth makes them particularly formidable, because they hide behind breastworks of corporate  organisation”.

We know the answer now. Government agents are discredited, lobbied or have become representatives of capital, not the people.

“I…hope that the legislation that deals with the regulation of corporations engaged in interstate business will also deal with the rights and interest of the wageworkers…it will be highly disastrous if we permit ourselves to be misled by the pleas of those who see in an unrestricted individualism the all sufficient panacea for social evils…”

Hayek, Friedman, Reagan, Thatcher, Bush, Blair, Cameron. The high priests of neoliberal individualism who first philosophised and then preside and encourage low wage, part time, zero hours economies and call this ‘labour flexibility’.

“The rich man who with hard arrogance declines to consider the rights and the needs of those who are less well off, and the poor man who excites or indulges in envy and hatred of those who are better off, are alien to the spirit of our national life. There exists no more sordid and unlovely type of social development than a plutocracy for there is a peculiar unwholesomeness on a social and governmental idea where wealth by and of itself is held up as the greatest good. The materialism of such a view finds its expression in the life of a man who accumulates a vast fortune in ways that are repugnant to every instinct of generosity and fair dealing or whether it finds expression in the vapidly useless and self-indulgent life of the inheritor of that fortune…”

We now have demonization of the working class, poverty porn on our TVs and victim blaming focusing on immigrants, welfare claimants and benefit cheats as a way of deflecting public anger on the state of public finances and the accumulation of wealth in fewer and fewer hands. The 1% now blame the poor for their fecklessness and lack of hard work resulting in the poor man increasingly turning to such ‘tools’ as jihadist ideology in reprisals. Meanwhile the middle classes in the UK bleat on about inheritance tax that is set at such a level that most of them will not pay it in any case. Turkeys voting for Christmas, Lemmings searching for cliffs, donkeys asking for whips.

 

This speech was given by President Roosevelt 1907  – the words in bold are mine. There is nothing new under the sun, the same issues regarding wealth and its influence and practices exercised Roosevelt over a hundred years ago. Between then and now various policies and legislation were put in place to deal with those worries. However, we have now reverted back to a time when we can again speak of the ‘Malefactors of Great Wealth’. This time around Obama is aware of inequality as a ‘defining challenge of our time’ but is wary of raising it for fear of being accused of class warfare. Roosevelt had no qualms about calling these people out for what they are.