Category: Climate Change

Climate change is an unsolvable wicked social problem?

Climate change is an unsolvable wicked social problem?



The following outline of climate change as a wicked problem (Rittel and Weber 1973) is based on a reading of Reinar Grundmann’s (2016) ‘Focus on Climate change and the social sciences’. The work of Jurgen Habermas (1984, 1987) and Wolfgang Streeck (2016) contextualises the exposition of climate change as a wicked social problem and this paper agrees with Grundmann’s analysis that there are no easy answers for the short or medium term, here defined as within 50 years, and adds that perhaps there might not ever be. Thus we are adopting Gramscian ‘pessimism of the intellect’ which requires urgent work on adaptation for a very different and perhaps dystopian world by the end of the century.


Regardless of its genesis, whether that be human induced or natural cycles, climate change requires human responses. Mitigation is now probably too late, as we’ve in all likelihood passed 400 ppm of carbon dioxide permanently. This means we are locked into temperature rises above the 2 degree ‘safe’ level. This is taking us into a new era, the Anthropocene, beyond a ‘safe operating space for humanity (Rockstrom et al 2009). Therefore we will have to plan for, and more urgently talk about, adaptation, disaster management and conflict resolution. However and in what manner we come together, or not, to address the fact of climate change and all of the other ecological challenges, this a ‘wicked social problem’ exacerbated by contemporary changes in the geopolitical, social and technological order (Streeck 2016, Harari 2016). The Anthropocene may well be characterised as a period of insecurity, indeterminancy and dissipation of the social order into a miasma of dystopia. Human societies are experiencing the dialectic between risks arising from modernity and the solutions put forward to manage those risks (Beck 1986).


A wicked problem is the sort of problem that is inherently different from the sort of ‘tame’ problems that natural scientists and engineers grapple with.


First of all, ‘wicked social problems’ are never solved once and for all. They can only be better managed. Each ‘solution’ invokes another problem to address. Take, for example, crime. To achieve a society with a 0% crime rate involves either redefining what crime is, leaving unsolved the social problems certain activities previously defined as ‘crime’ invokes, or it requires an enormous and deep level of surveillance and loss of liberty that would have unintended consequences for human relationships and politics. Like a game of ‘whack a mole’ other social, political and philosophical problems would arise from such an answer.


A ‘tame’ problem would be an equation to solve, analysing a chemical compound, designing a bridge or checkmate in 5 moves (Grundmann 2016). Tame problems allow us to know what the measure of success is when they are solved, and success criteria are known beforehand. They have a ‘stopping rule’. The success criteria of wicked problems like crime are inherently political and often underpinned by cultural values within a power matrix of vested interests.


‘Wicked’ here means resistance to solution rather than evil. The problem is difficult to solve because of incomplete, contradictory and changing elements to them that are also difficult to recognise. The elements making up a wicked problem may be interdependent within a complex system and thus solving one element may exacerbate another aspect of the system and/or reveal another problem.


For climate change what are the ‘success criteria’? What indicators, metrics, outcomes or empirical observations can we make that allows us to claim success? This may depend on how we define climate change. Do we use the United Nations Framework Convention on Climate Change (UNFCCC) or the Intergovernmental Panel on Climate Change (IPCC) definitions (Grundmann 2016)?


The UNFCCC define it as “a change of climate that is attributed directly or indirectly to human activity, that alters the composition of the global atmosphere, and that is in addition to natural climate variability over comparable time periods”.


The IPCC define it as “any change in climate over time whether due to natural variability or as a result of human activity”.


The UNFCCC focuses on human activity driving climate change, while leaving to one side natural variability. The IPCC encompasses both. Therefore climate policy would address anthropogenesis (UNFCCC) or everything (IPCC). In each case we would still need to construct measures of ‘success’.


If we could agree and state that the measure is ppm of C02 in the atmosphere then action would naturally be channelled towards addressing that figure. It is by no means clear that this would or could ‘solve’ the social problem of climate change such actions might entail. Climate change does not have a ‘stopping rule’ characteristic of tame problems. Atmospheric Carbon Dioxide might look like one but there are other measures such as carbon budgets, global average warming temperatures or heat content in the oceans. There is also fierce resistance to curbing carbon emissions and environmental regulation in some quarters based on free market and libertarian arguments (e.g. Cato Institute 2016), despite the agreement signed at COP21 in Paris in 2015.



The wider context in which climate change solutions operate.


The expression of climate change as a problem, and climate change solutions, interact with the social, cultural and political power context in which they operate. They are not ontologically separate from the social or the material and they operate within complex adaptive systems. Knowledge/power discourses frame their expression, their feasibility and their acceptability within often hegemonic, though not unchallenged, frames of reference.


That context is variously called late modernity, post modernity, post industrial, disorganised, financial, rentier, or neoliberal capitalism. Wolfgang Streeck (2016) pace Antonio Gramsci, suggests this context is actually a post-capitalist interregnum in which the old system is dying but a new social order cannot yet be born. Streeck calls the current order one of multi-morbidity, climate change being one of many frailties as we head towards social entropy, radical uncertainty and indeterminancy. Streeck argues that the current context is anchored in a variety of interconnected developments:


  1. Intensification of distributional (capital v labour) conflict due to declining growth
  2. Rising social inequality
  3. Vanishing macroeconomic manageability
  4. Steadily increasing indebtedness (private and sovereign)
  5. Pumped up money supply (from quantitative easing)
  6. Possibility of another financial crisis as per 2008
  7. The suspension of democracy
  8. Slowdown of social progress
  9. Rising Oligarchy and Plutocracy
  10. Governments’ inability to limit the commodification of labour, money or nature
  11. Omnipresence of corruption
  12. Intensified competition in winner takes all markets
  13. Unlimited opportunities for self enrichment (for the 1%)
  14. Erosion of public goods and infrastructure
  15. The failure of the US to establish a stable global order
  16. Public cynicism towards economics and politics.
  17. Rising populist nationalism and the spectre of fascism and isolationism in the US
  18. Fracturing political blocs and alliances
  19. Erosion of Democratic legitimacy ad thus a democratic deficit



To that:


  1. Health Inequalities.
  2. Potential Ecosystem collapse.
  3. Disruptive technologies: Automation, Artificial Intelligence and digitalisation.



There are countervailing voices. There are those who see a better future for humanity, placing belief in progress (Norberg 2016), reducing global violence (Pinker 2011), the ability of growth based capitalism to solve problems (Ben-Ami 2010, Goklany 2007, 2009) and the citing of improvements in key indicators such as reductions in infant mortality (see Hans Rosling’s ‘gapminder’ 2016). Added to this are of course the voices of politicians who promise to either “make America great again” , “A country that works for everyone” or “Russia as a Normal Great Power”. Extrapolating from the past into the future is of course inductive logic and is thus open to its critique. This also applies to the negative descriptions of the current state of affairs. The task remains to consider which view will prove correct? Not an easy question partly due to many issues being wicked problems.


These latter political narratives may be examples of ‘systematic distorted communication’, i.e. voices and discourses aimed at achieving very particular political ends inimicable to that aimed towards mutual understanding and social integration. This form of communication, according to Habermas (1984, 1987), involves one party being self deceived, it is a form of communication in which power differentials operate and are invisible.


For example, the Cato Institute argues on environmental regulation:


“Science can inform individual preferences but cannot resolve environmental conflicts. Environmental goods and services, to the greatest extent possible, should be treated like other goods and services in the marketplace. People should be free to secure their preferences about the consumption of environmental goods such as clean air or clean water regardless of whether some scientists think such preferences are legitimate or not. Likewise, people should be free, to the greatest extent possible, to make decisions consistent with their own risk tolerances regardless of scientific or even public opinion”.


On the face of it who would argue against freedom to decide one’s own risk tolerance? ‘Freedom’ is a public good is it not? What this statement ignores is the fact that some very powerful and well resourced ‘others’ are more ‘free’ to exercise risk tolerance, they are also more ‘free’ to engage in activities that involve ‘externalities’ – pushing the cost of one’s exercise of freedom onto others. How free were the victims of Union Carbide’s Bhopal ‘death by negligence’ of 1984 where at least 2000 died as a result of the plant’s gas leak? Union Carbide’s freedom to operate involved a power imbalance that denied the citizens from exercising their ‘risk tolerance’. How free are Londoners in exercising their ‘risk tolerance’ to nitrous oxide pollution from vehicle exhausts responsible for 9,500 deaths per year (Vaughan 2015)?


The Cato Institute argues it is a research organisation conducting independent non partisan research on a range of policy issues. It clearly states however that principles of individual liberty, limited government, free markets and peace underpin its work. Apart from the nebulous ‘peace’ (who is not for peace?), those principles are very clearly part of the neoliberal imaginary and are thus as ideological and partisan as many other organisations. On funding, Cato states on its home page that it receives ‘no government funding’. What it fails to clarify is who exactly funds it. On page 41 of its 2016 annual report there are only numbers of $ donated while preferring to refer to individuals, corporate and foundations as funding streams. However, Cato was founded by the Koch brothers, billionaire owners of Koch industries, who reportedly believe in lowering corporate and personal taxes, minimal social security and less oversight of industry (Mayer 2010). Hardly a non partisan viewpoint.



Habermas’ theory suggests that communicative action serves to transmit and renew cultural knowledge, in a process of achieving mutual understandings. It then coordinates action towards social integration and solidarity. Communicative action is also the process through which people form their identities. The current context suggests that communicative action, orientated towards the requirement for social integration for action on climate change, is extremely fragile.


Gross (2010) gave three examples of systematic distorted communication:


  1. The pervasive employment of Nazi language in Europe in the 1930’s in Europe.
  2. The everyday, routine use of sexist language.
  3. The prescription languages and practices of Physicians influenced by drug company promotions.


We may consider also:


  1. The narrative on individual responsibility for health
  2. The absolute requirement for deficit and debt reduction as a goal of policy
  3. Free market liberalism in the US and the UK
  4. An unaffordable NHS in the UK
  5. Immigration, asylum and refugee control
  6. Fossil fuel subsidies and continued extraction.
  7. The hegemonic Nuclear Deterrence Theory
  8. Koch brothers support for the Cato Institute on liberty, small government and free markets.



Climate change solutions arise and operate within this context. Today we have no easy solutions or even signposts that indicate success on progress to either mitigation or adaptation. It may even be the case that we are actually chasing rainbows. If we are entering a period where social institutions are breaking down, where system integration disappears leaving a mass of individuals to find individual solutions to the myriad problems they face, without grand integrative narratives to provide guidance, then social cohesion breaks down and Habermasian ‘communicative action’ dissipates in the face of the onslaught from the systematic distorted communication of power interests.



Beck U (1986) Risk Society. Towards a new Modernity. London Sage. (1992 edition)


Ben-Ami, D. (2010) Ferrari’s for All – In defence of economic progress. University of Bristol. Policy Press.


Cato Institute (2016) Environmental Regulation (online) accessed 13th October 2016


Goklany I (2007) The Improving State of the World: Why we are living longer, healthier, more comfortable lives on a cleaner Planet. Washington. Cato Institute


Goklany I. (2009) Is climate change the “defining challenge of our age”? Energy Environment, 20:279-302.


Gross A (2010) Systematically Distorted Communication: An Impediment to Social and Political Change. Informal Logic 30 (4): 335-360


Grundmann R (2016) ‘Focus on Climate change and the social sciences’ .


Habermas J (1984) Theory of Communicative Action. Vol 1. Reason and the Rationality of Society. Cambridge. Polity Press


Habermas J (1987) Theory of Communicative Action Vol 2. Lifeworld and System. A critique of Functionalist Reason. Cambridge. Polity Press.


Harari Y (2016) Homo Deus. A brief History of Tomorrow. London Vintage.


Mayer J (2010) Covert Operations. The billionaire brothers waging a war against Obama. New Yorker. August 30th. Online accessed 13th October 2016


Norberg J (2016) Progress. Ten reasons to look forward to the future. London Oneworld.


Pinker S (2011) The better angels of our nature. A history of violence and humanity. London. Penguin.


Rittell,H. and Weber, M. (1973) Dilemmas in a General Theory of Planning, pp. 155–169, Policy Sciences, Vol. 4, Elsevier Scientific Publishing Company, Amsterdam


Rockstrom, J., Steffen, W., Noone, K., Persson, A., Chapin, F. S., III, Lambin, E. F., Lenton, T. M., Scheffer, M., Folke, C., Schellnhuber, H. J., Nykvist, B., de Wit, C. A., Hughes, T., van der Leeuw, S., Rodhe, H., Sorlin, S., Snyder, P. K., Costanza, R., Svedin, U., Falkenmark, M., Karlberg, L., Corell, R. W., Fabry, V. J., Hansen, J., Walker, B., Liverman, D., Richardson, K., Crutzen, P. & Foley, J. A. (2009) ‘A safe operating space for humanity’. Nature, 461 (7263). pp 472.

Rosling H (2016) MDG 4 Reducing Child Mortality available at accessed 13th October 2016


Streeck W (2016) The post-capitalist interregnum: the old system is dying, but a new social order cannot yet be born. Juncture 23 (2): 68-77


Vaughan A (2015) Nearly 9,500 people die each year in London because of air pollution. The Guardian (online) 15th July accessed 13th october 2016

The concept of a ‘sustainability lens’.

The concept of a ‘sustainability lens’.

This is based on an understanding that we construct our social worlds and create a reality based upon what Gadamer called ‘prejudices’. The social world of nurse education, for example, has its own prejudices, referred to by Scrimshaw as ‘ideologies’. These form,  often taken for granted, assumptions and values about what education is and what it is for. An ideology, a prejudice, can act like a lens through which a particular image of the world comes into view. In healthcare a ‘biomedical lens’ constructs a certain view of what health, illness and the body actually is. Michel Foucault argues the body itself is a site for bio political power/knowledge to play out and in so doing challenges notions of the possibility of the existence of an objective truth about the body.

In common parlance, we talk of ‘rose tinted spectacles’ or the view point of ‘pollyanna’ or Dr Pangloss, for seeing only the positive.

Another common story is that of blindfolded men feeling different parts of an elephant and then describing what an elephant is only on the basis of what they have actually felt. Pity the poor chap who stumbles only into the elephant’s dung. Another story is that of Plato’s cave in which only shadows can be seen on cave walls and the people trapped within the cave consider that the shadows cast by the fire is the only reality.

In response to a wider education for sustainability agenda, nurse educators could develop their own ‘sustainability lens’ and bring it to bear to interpret professional standards. As we know ‘sustainability’ as a concept is contested and has many meanings. A simplistic binary is sustainability solutions as technical rationality or radical political change. Another binary is dualism and nondualism, or systems and linearity.

There is a need for us to engage in critical reflexivity to reveal our own world views, the ‘lens’ through which we see the world, especially urgent as we are entering the Anthropocene in the context of an increasingly heating world, one in which we have now probably permanently passed 400 ppm.  Critical reflexivity is not enough, it has to be allied to action if we wish to adapt to a heating world.



A positive lens and a negative lens:


Do you still see progress? What do you see? Strictly Come Dancing? Reports on the FTSE index? Labour party division or Labour party debate? Do you see a world in which science and technology will solve the ecological crisis? Do you even see an ecological crisis?


Crisis? What crisis?


Antonio Gramsci wrote:

“The crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear” (Selections from the Prison Notebooks“Wave of Materialism” and “Crisis of Authority” (NY: International Publishers), (1971), pp. 275-276.

He also wrote in 1921 “I’m a pessimist because of intelligence, but an optimist because of will” (Letter from Prison 19 December 1929).

I also see very little positivity.

However, Simon Jenkins is far more upbeat and quotes Johan Norberg and Stephen Pinker:

Johan Norberg’s Progress. It looks not at what “could” happen but at what “has” happened. Norberg is a prophet of anti-pessimism. He is shocked by a 2015 YouGov poll that found 71% of Britons convinced “the world is getting worse”, against just 5% who said it was getting better. More than half thought world poverty was rising, against 10% who thought it falling. It was the same in the US.  Norberg points out that every index of global improvement – measuring starvation, poverty, child mortality, literacy, women’s education, democracy, violence, death in war – shows a steady upward graph. By far the most positive sign of humanity’s advance is the decline in global violence, on a state and personal level. The cognitive scientist Steven Pinker attributes this to historical evolutions. These include nations becoming inherently more “pacifist”, the “feminising” of politics, the growing power of reason and “the expanding circle of sympathy”. He, like Norberg, is puzzled by the potency of pessimism”.

Hans Rosling’s ‘gapminder’ also provides statistical evidence of a healthier, richer world.

Yet look at the indices used, not one of them is ecological. Human societies and material conditions are improving (if not evenly spread).  Ecological indices however are not.

Thought experiment. Imagine a world in which redistribution has taken place and global gdp was spread equally across and within countries so that indices such as infant mortality and literacy resembled that enjoyed by the middle classes in, oh, Italy. Imagine that social and health inequalities as outlined in ‘The Spirit Level’ have all but disappeared.

At the same time the oceans are increasingly acidic and CO2 is heading towards 450ppm (lets assume fish stocks have recovered, deforestation halted and reversed, soil erosion halted). Would that level of prosperity be sustainable in such a heating world?

So, yes on some key and important indices the world is getting better…but……the interregnum could see any number of devastating issues, not the least is populist fascism in Europe and America.

Developing the Concept of Sustainability in Nursing

“NOTICE: this is the author’s version of a work that has been submitted for publication in Nursing Philopsohy. If accepted, 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.


Developing the concept of sustainability in nursing.




Sustainability, and the related concept of climate change, is an emerging domain within nursing and nurse education.  Climate change has been posited as a serious global health threat requiring action by health professionals and action at international level. Anåker & Elf undertook a concept analysis of sustainability in nursing based on Walker and Avant’s framework. Their main conclusions seem to be that while defining attributes and cases can be established, there is not enough research into sustainability in the nursing literature. This paper seeks to develop their argument to argue that sustainability in nursing can be better understood by accessing non nursing and grey literature and, for example, the literature in the developing web based ‘paraversity’. Without this understanding, and application in nursing scholarship, nurses will have a rather narrow understanding of sustainability and its suggested links with social and health inequalities and the dynamics underpinning unsustainable neoliberalist political economy. This understanding is based on the social and political determinants of health approach  and the emerging domain of planetary health.  However, this is a major challenge as it requires a critical reflection on what counts as nursing knowledge, a reflection which might reject this as irrelevant to much of nursing practice.




Sustainability, and the related concept climate change, is an emerging domain within nursing (Adlong & Dietsch, 2015; Allen, 2015; Aronsson, 2013; Goodman, 2011; Hunt, 2006; Polivka, Chaudry & Mac Crawford, 2012; Sattler, 2011) and nursing education (Goodman, 2008; Goodman, 2011; Goodman & East, 2013; Goodman & Richardson, 2009; Johnston et al., 2005; Richardson et al., 2013). Climate change has been posited as a serious health threat (Costello, Grant & Horton, 2008; IPCC, 2014; McMichael, Montgomery & Costello, 2012)  requiring action by health professionals (Costello et al., 2011; Gulland, 2008; Harding, 2014; Patton, 2008; Reale, 2009; Thomas, 2014) and action at international level (Durban Declaration on Climate and Health, 2011; WHO (2016) . The status of climate change as health threat has however been contested (Goklany, 2009a; Goklany, 2009b; Goklany, 2012; Goodman, 2014), but it remains an important determinant of health (Barton & Grant, 2006; Griffiths, 2009). In this context, Anåker & Elf (2014) undertook a concept analysis (Walker & Avant, 1982)  of sustainability in nursing. This paper seeks to develop their argument to argue that sustainability in nursing can be better understood by accessing non nursing literature, to address the socio-political context in more depth. This should include going beyond accepted peer reviewed nursing journals and include literature such as that written by Wendell Berry (Berry, 1995) who writes eloquently on human health and our relationship to the natural environment.  There is also a growing body of work online and of an academic standard to qualify for what might be called the ‘Paraversity’ (Goodman, 2015a; Rolfe, 2013). Without this understanding, and application in nursing scholarship, nurses will have a rather narrow understanding of sustainability. There is a need to link social and health inequalities (Dorling, 2013; Marmot, 2015) and the dynamics underpinning unsustainable neoliberalist political economy (Harvey, 2005; Harvey, 2014; Sayer, 2015) with the concept of sustainability. Climate change is just one aspect, albeit a very important aspect, of that linkage. This understanding is based on the social (Davidson, 2015; Raphael, 2004; WHO, 2013) political (Ottersen, Frenk & Horton, 2011) and ecological (Goodman, 2014; Goodman, 2015b; Lang & Rayner, 2012; Lang & Rayner, 2015; Rayner & Lang, 2012) determinants of health (Barton & Grant, 2006).  However, this is a major challenge as it requires a critical reflection on what counts as nursing knowledge, a reflection which might reject this as irrelevant to much of nursing practice. Before addressing the definition of sustainability in nursing, the socio-political ‘pattern of knowing’ will be outlined to form the justification for the ensuing discussion.


The fifth ‘Pattern of knowing’ in Nursing

Jill White (White, 1995) added a fifth pattern of knowing in nursing to Barbara Carper’s four (Carper, 1978): the ‘Socio-Political’. White argued the other four patterns provided answers to the ‘who, how and the what’ of nursing practice but not the ‘wherein’, the context. This, White argued, is the pattern of knowing essential to an understanding of all the other four. Socio-political knowing that is gained from a fuller understanding of the ‘sustainability literature’, might lift the ‘gaze’ from introspective nurse patient relationships at the bedside and requires the situating of that relationship within the wider socio-political context. This may result in challenging the taken for granted assumptions about practice, health, the profession and wider health policy. To that could be added the raising of questions about political economy and engaging in philosophical enquiry about such concepts such as ‘non duality’ (Loy, 1988), a concept Wendell Berry implies in his essay ‘health is membership’ (Berry, 1995).

White quoted Chopoorian who suggested:  “nursing ideas lack an archaeology of the social, political and economic worlds that influence both client states and nursing roles’ (White 1995 p84). This ‘archaeology of ideas’ still seems relatively poorly uncovered. Davies argued that ‘some of our concepts are missing’ in a critique of the Sociology of Health and Illness (Davies, 2003).  By that is meant that there had been a lack of a ‘sociology’ of organizations in the sociology of health and illness, a sociology which is able to reveal concepts such as discourses of managerialism (Gilbert, 2005; Traynor, 1996; Traynor, 1999; Traynor, Boland & Buus, 2010), or to reveal patterns of power and accountability for policy and its consequences (Freudenberg, 2014; Scambler, 2012; Schrecker & Bambra, 2015). Davies argued that

“sociology needed to take seriously the politics of NHS modernisation” (p183)

It is suggested here that many nurses also don’t have such a set of critical concepts to give them a more critical discourse upon which to base critical action or ‘praxis’ (Cox & Nilsen, 2014). There are a few papers addressing political activism in nursing, providing critical theories and concepts (Antrobus, Masterson & Bailey, 2004; Hewison, 1994; Phillips, 2012; Racine, 2009; Shariff, 2014) and other papers which discuss politics and nursing (Davies, 2004; Masterson & Maslin-Prothero, 1999; Salmon, 2012; Traynor, 2013).  These works suggest an interest in the interplay of the socio-political context and nursing practice and provide some evidence of relevance of this ‘pattern of knowing’.  White argued that nurses must “explore and expose alternative constructions of health and health care, find means of enabling all concerned to have a voice in care provision and develop processes of shared governance for the future” (p85). Exploring sustainability, climate change and health assists in that work. Indeed a focus on global governance for health in the context of climate change and environmental challenges is a key theme of recent reports  (Ottersen, Dasgupta & Blouin, 2014; Ottersen, Frenk & Horton, 2011) in non-nursing literature. This leads us onto consider how nurses are to understand what sustainability means.


Defining Sustainability in Nursing


Anåker & Elf (2014) argue that the “term is not clearly defined and is poorly researched in nursing” (p382). This applies not only in nursing.  Sustainability has diverse and contested meanings in many disciplines (Thompson, 2011; Williams & Millington, 2004). The quest to tie down the concept is possibly futile, as Anåker and Elf themselves suggest that: “a concept analysis is never a finished product” (p388). They provide a definition which is a helpful contribution to the discussion, and their model and contrary case illustrate for clinical nurses the value of trying to understand sustainability in practice. Throughout the paper they provide attributes and definitions from various sources and refer to, but do not foreground, social and health inequalities arising from wider determinants of health including political economy, which also underpins understandings of sustainability and climate change (Goodman & Richardson, 2009; Sayer, 2015).

The defining attributes identified in Anaker and Elf’s concept analysis were:  ecology, environment, the future, globalism, holism and maintenance. The attribute ‘globalism’ indicates that they are getting close to discussing and emphasising political economy underpinning such issues as climate change, ocean acidification and soil erosion which are three of the nine planetary boundaries which, it is argued, delineate a ‘safe operating space for humanity’ (Rockstrom et al., 2009; Steffen et al., 2015) . Nonetheless, the analysis misses something important, i.e. the neoliberal (Freudenberg, 2014; Harvey, 2005) and environmental, socio-political context of health (Barton & Grant, 2006; Ottersen, Frenk & Horton, 2011; Sayer, 2015; Scambler, 2012; WHO 2015) characterised by social and health inequalities (Dorling, 2013). This is the link between capitalism, climate change and sustainability (Goodman, 2014; Griffiths, 2009; Klein, 2014; Sayer, 2015). Various writers (Hamilton, 2010; Jackson, 2009; Marshall, 2014; Sayer, 2015; Urry, 2011) suggest or imply, that it is our political orientations (Douglas & Wildavsky, 1992), moral intuitions (Haidt, 2012) and our social and economic relationship with carbon which are foundations upon which we as communities and individuals assess environmental issues and our reactions to them.

Urry particularly on this point, (2011) coins the term, ‘high carbon economy-society’ to describe capitalism. He argues that 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. Thus, community behaviours are implicitly locked into high carbon systems that are taken for granted aspects of our lifeworld. Urry suggests 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. It is these social practices that provide the structure within which our agency operates.

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).


These social practices arise out of our ‘lifeworld’ (Husserl 1936, Habermas 1981), i.e. our internal subjective viewpoints as well as the external viewpoints of the social and political ‘system’.  A high carbon economy society thus provides the backdrop for values, assumptions and social practices that are taken for granted in everyday life. Defining sustainability therefore requires acknowledgment of such lifeworlds and the socio-political systems in which they ‘operate’.


Nursing, sustainability and acontextual Concept Analysis?


The wider body of literature, including that in the social and political sciences and philosophy, may give nurses tools and concepts to further develop their understanding of sustainability and its relationship to human health. Importantly this could include an understanding of the political economy of capitalism (Harvey, 2011) and its link with growth, climate change and sustainability (Hamilton, 2003; Jackson, 2009; Johnson, Simms & Chowla, 2010; Sayer, 2015). Without this understanding, and application in nursing scholarship, nurses may miss the arguments linking the growth dynamics underpinning the neoliberalist capitalist political economy (Chomsky, 1997; Harvey, 2005; Sayer, 2015), climate change (Klein, 2014; Sayer, 2015) and unsustainable lifestyles (Hamilton, 2010). This sits within the social and political determinants of health approach (Barton & Grant, 2006; Davidson, 2015; Ottersen, Frenk & Horton, 2011; Scambler, 2012) and the emerging domain of planetary health (Lang & Rayner, 2012; Lang & Rayner, 2015).  This paper argues that to fully develop the concept in nursing, an analysis or at the least an understanding, of the political economy of neoliberal capitalism could be a component of nurses’ understanding of sustainability and health. This is because political economy relates to both health and social inequalities (Dorling, 2013; Dorling, 2014; Marmot, 2015; Schrecker & Bambra, 2015; Stiglitz, 2012; Wilkinson, 2005; Wilkinson & Pickett, 2009)  and to issues around sustainability and climate change. However, this is a major challenge as it requires a critical reflection on what counts as nursing knowledge (White, 1995), a reflection which might reject this as irrelevant to much of nursing practice.


Anåker & Elf’s (2014) inference that nursing misses foregrounding political economy and society might be a result of the method employed to search the literature, as well as their acknowledged lack of discussion in the nursing literature of political economy. Of course there might be very little reason currently for nursing literature to discuss political economy, based as it is on knowledge (biosciences, biomedicine) that may well be largely antithetical to critical social and political science. Adult nurses in particular might face a real challenge in accepting this idea in practice as Ion and Lauder argue:


“For very good reason, adult nursing remains committed to a biomedical vision of illness which, while cognisant of the importance of a holism, is tied to a physical approach to care” (Ion & Lauder, 2015).


In addition, Walker and Avant’s method was originally published (1982) before the development of academic blogs and websites such as and therefore may not be explicit in its direction to search beyond accepted channels. This emerging literature, which may contribute to the construction of the ‘paraversity’ (Goodman 2014, Rolfe 2014), will therefore be missed as source of information and discussion on topics such as linking sustainability, health, climate change and capitalism.


There are several key papers discussing the link between human health, political economy and the environment. Goodman and Richardson (2009) explicitly link Sustainability, Climate Change and Health conceptualizing them as three sides of a triad. To fully understand one requires an understanding of the other two. The three, in this conception, are indivisible. Further, the link involves political economy and socio-economic behavior as crucial underpinnings for climate change and sustainability issues. Barton and Grant’s (2006) health map discusses key determinants for health including Biodiversity, Global Ecosystems and Climate change. Each one of those of course involves human activity and disruption to create what some are calling a new geological era, the ‘Anthropocene’ (Zalasiewicz et al., 2010). Lang and Rayner (2012) discuss the concept of ‘Ecological Public Health’, while the Canadian Public Health Association (2015) has just published its own report on ‘Global Change and Public Health: Addressing the ecological determinants of health’ which on page 1 argues:

“…changes in the earth’s ecological systems are driven principally by our social and economic systems, and by the collective values and institutions that support them”.

This echoes the World Health Organisation’s definition of the social determinants of health which explicitly mentions distributions of resources, money and power (WHO 2015). The report does not name, or analyses, in any more depth what that economic system is, as it seems to take for granted that it is capitalism. Ottersen et al emphasize the political determinants of health (Ottersen, Dasgupta & Blouin, 2014) which, alongside the WHO’s (2008) social determinants of health approach, acknowledges the role of powerful global actors and the lack of global governance for health. Health equity and social determinants are now a crucial component of the post 2015 sustainable development goals (WHO 2015).

For example, powerful global actors, i.e. the Fossil Fuel Industry, may be acting in a way to either downplay the risks to human health from rising atmospheric carbon dioxide, or engaged in protecting their assets’ (coal oil and gas) value for the short term over and above longer term risks to climate. Exxon Mobil have argued that world climate policies are highly unlikely to stop the production and selling of fossil fuels (Exxon Mobil shrugs off climate change risk to profit – BBC News, 2014) while Shell have been accused (Macalister, 2015) of accepting a 4 degree rise in global mean temperatures. This is in the context of a reported $5 trillion annual subsidy in fossil fuel subsidies (Coady et al., 2015)  while the Bank of England considers a ‘carbon bubble’ (Carrington, 2014)  i.e. the drop in value of assets if fossil fuels are kept in the ground through the imposition of any global governance regimes to curb carbon emissions. This is an aspect of the political economy of capitalism that must be understood as a driver underpinning human health. At the time of writing, world leaders and delegates are meeting in Paris for COP 21. At this meeting there will be another meeting of the The Sustainable Innovation Forum (SIF15) which is a business focused event held during the annual Conference of Parties (COP). The two day Forum will convene  participants from business, Government, finance, the United nations, Non-governmental organisations, and civil society to “create an unparalleled opportunity to bolster business innovation and bring scale to the emerging green economy” (COP21 Paris 2015). This forum operates within the paradigm of capitalism rather than seeking radical reform. However, it illustrates the complexity of players dealing with sustainability issues.


Scambler (2012) outlines ‘The Greedy Bastards Hypothesis’ to describe how the Capitalist Class Executive can ‘command’ the Political Power Elite to enact policies in their favour, with the unintended consequences of exacerbating health inequalities. Evidence that corporate activities impacts on political decision making is provided by the delays to air pollution standards, Euro 6 (Archer, 2015; Neslen, 2015).  Volkswagen’s use of software to cheat emissions testing in the United States (Topham, 2015) indicates the lengths corporates will go (Freudenberg, 2014; Oreskes & Conway, 2011) to avoid externality costs resulting in the externality of for example, increased air pollution. Therefore any concept of sustainability in nursing that does not understand political economy misses something important in understanding both the concept of sustainability and of health.


Anaker and Elf’s definition of sustainability:

“…a core of knowledge in which ecology, global and holistic comprise the foundation. The use of the concept of sustainability includes environmental considerations at all levels. The implementation of sustainability will contribute to a development that maintains an environment that does not harm current and future generation’s opportunities for good health”. In this it echoes the Brundtland commission’s definition of sustainable development (WCED1987) which has been critiqued for being uncritical of business and growth based capitalism (Sinclair 2009).


This definition is a good start but requires development. Nurses, particular nursing scholars interested in health and public health, need to consider the argument already suggested around the dynamics of capitalism as a major driver for both carbon emissions and unsustainable practices. It is perfectly possible to begin the study of sustainability and environmental health within taken for granted paradigms, but what is required is a cultural critique of the values and systems that support environmental damage (Martusewicz 2014) and a better understanding how the economy and sustainability issues such as climate change, interact (Better Growth, Better Climate, 2015). Nurses, if they stick to nursing journals and literature, will not find a large amount of material that discusses this. For example the Royal Society of Arts has a wealth of papers, presentations and works streams addressing climate change (Hahnel, 2015; Rowson, 2015)  which address causes, behaviour changes, political economy and culture change.




Anåker & Elf (2014) argue that there is a need for theoretical and empirical studies of sustainability in Nursing. This could include accessing literature unknown to most nurses.  Writers such as Aldo Leopold, Wendell Berry, Paul Hawken, Mike Hulme, John Urry all provide insights into human wellbeing, health and the social context. Related concepts include ecojustice education, education for sustainability, dualism, anthropocentrism, anthropocene, neoliberalism, modernity and capitalism. A problem for nursing scholars is that these related concepts are not readily seen as relevant to nursing and thus there may be a reticence of nursing journals to publish them, and a reticence in nurse education to discuss them. There may be a need to resort to both non nursing peer reviewed journals but also to web based materials open to all. Anaker and Elf acknowledge in their limitations (p387) ‘the lack of research literature available for review in which sustainability was the major topic and in which sustainability was not linked to other concepts’. This paper goes further in trying to make those wider links for nurses. A problem however for nurses, is the sheer scale of literature and concepts that are involved. The task for nursing scholars is to consider just what is feasible, useful and relevant as part of their scholarly development and curriculum work.



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Sustainability – what can a nurse do?

Sustainability – what can a nurse do?


This appears to be a common question, perhaps indicating that the debate has moved on from questioning the scientific basis for both climate change and the data around environmental damage caused by human activities such as ocean acidification. These are of course global issues which can make one feel powerless. This need not be so.


In June 2015, The Lancet argued:


“tackling climate change could be the greatest health opportunity of the 21st century”


If this is so, then nurses could play an important role in both climate change and health.


This report followed on from Pope Francis’s encyclical ‘Laudato Si  – care for our common home’.

The National Health Service Sustainable Development Unit (NHS SDU) welcomed the Lancet’s publication and argued that:


“The health sector can play a real role in making sure that its activities promote lower carbon and a more resilient infrastructure. This holds true in relation to every part of the sector including travel and transport systems, in relation to building infrastructure and through the procurement of products and services”.


Stefi Barna et al (2012) set out what nurses need to know about climate change and elsewhere I (Goodman 2013) challenge nurses in the NHS to act on climate change and suggests ways of thinking to do so. The NHS SDU is a great resource to support clinicians in their attempts to make the NHS responsive to sustainability and climate change issues.


This sets the context for nurses, but what can the nurse actually do. First of all we could consider those sectors of the health service in which that the SDU outline action can take place and ask what roles nurses can play, if at all in each.


A start for the nurse would be to consider what level they can work at:




  1. On a personal level:


  • Understand the facts: for example, learn what ‘carbon footprint’ means and what your personal footprint is. Access the resources published by The Lancet and the National Health Service Sustainable Development Unit. Access the literature on the subject. Understand the social political and ecological determinants of health.
  • Reflect on your values and assumptions about what the good life means on this planet. Consider the effects of consumerism, materialism and individualism on the quality of human relationships and our relationship to nature. Consider if modern culture is sustainable in its current form.
  • Eat better: e.g. reduce your intake of red meats; perhaps try to cut out/down on processed/packaged foods; shop for locally and seasonally produced foods.
  • Drink better: Consider your use of bottled water. See the ‘Story of Stuff’
  • Move better: g. use public transport walk more, reduce your use of the car, buy a bicycle (called ‘active transport’).
  • Communicate better: make full use of digital technologies.


  1. On an organisational level:
  • Consider the core aspects of energy, travel, food, gases and drugs, waste, and medical devices .


  • Energy: Between 2007/08 and 2013/14the NHS carbon footprint in relation to building energy use dropped by 3.5% despite increases in activity of 13%. The decrease represents around £50m of energy costs for the NHS in England in 2013/14. Nurse action: is there a plan for your clinical area to address energy consumption? Are you involved in innovations to reduce carbon emissions and increase renewables?   Work with your organisation’s carbon reduction team (if it has one) or consider getting a carbon reduction team developed if it does not.


  • NHS Derbyshire Community Health Services saved more than 3,000 hours of staff travel time, 20 tonnes of carbon, and over £100,000 by using teleconferencing services. Nurse action: consider how patients and staff travel to and from services and whether it is always necessary.


  • Nottingham University Hospitals NHS Trust shows how part of the health system can lead sustainable food systems.  It serves fresh, healthy meals made with local, seasonal and organic ingredients.  Nurse Action: find out where your food comes from and what it is? Discuss nutrition and food choices with your patients.


  • Gases and medicines. The use of anaesthetic gases represents 5% of acute hospital CO2e emissions. These could be reduced with lower flow rates or substituted for instance moving away from nitrous oxide. Inhalers which represent 4.3% of the English health and care sector’s footprint could be replaced by a pulverised form as in Scandinavian countries. New meter dose inhalers without high environmental impact propellants could save nearly 7 million tCO2e over five years. Medicines are often a cornerstone of our health response be this through immunisations, diagnostics or therapeutic drugs. It is however sometimes more effective to prescribe physical activity, dietary changes or talking therapies.  The pharmaceutical industry is similarly keen to help reduce environmental impacts involved in the production, use and disposal of medicines so are already important partners in this journey. Nurse action: Find out about these practices if they apply to you, work with colleagues to address these issues.


  • Contaminated waste. The health sector produces waste in vast quantities, some of which is contaminated and needs to be separated and disposed of effectively. We hold the key to doing this effectively and  safely as well as reducing environmental impacts. Nurse action: review waste management practices in your clinical area, search the literature for new approaches to waste. Find out what the waste process is and what it costs and how it is segregated.


  • Medical devices. The use of multi-use or single use items, balancing the ethical sourcing and material use with decontamination and/or recycling approaches needs to be fully understood and effectively implemented to minimise both visible and hidden costs and environmental impacts.  Work with organisations such as the Infection Prevention Society on issues such as single use.


  • The SDU argues “The very nature of our business which is now considered unsustainable economically, environmentally and socially means that we need to focus on improving health and reduce our reliance on acute settings. The NHS Five Year Forward View is addressing some of these through the development of Vanguard sites and it would be exemplary to be able to demonstrate the benefits in environmental and social terms too”.

  1. On a national/international level:

Nurses may wish to see this as a menu of choices for tackling climate and health, but remembering always climate change and carbon emissions are only one aspect of sustainable healthcare. We have to consider the economic, social and other environmental aspects of sustainability as well. This is because social and political inequalities adversely affect the health of individuals, communities and populations.

We need to consider whether the global economic system is fair, just, equitable and is not a cause of environmental damage. There are concerns over social inequalities leading to health inequalities adversely affecting those lower down on the socio-economic scale. This takes nurses away from clinical considerations and into socio-political debates about how global governance affects human health and well being. Another Lancet commission report questions whether the current system is fit for that purpose.


Selby’s 10 propositions.


David Selby, in 2007, produced 10 propositions for education that might be useful as another framework for action:


  1. Confront denial (of climate change, health crises) by challenging our own base assumptions, knowledge and responses. We need to feel unease at the current situation. Nurses should reflect on the potential a very different world in which current cultural assumptions will not hold up to be true. For example, a belief in progress, that our children will have a better standard of living may not happen.


  1. Given the threat to human health, nurses need to address personal issues of despair, grief, loss. Once some of the facts are known, we may have to make a personal journey through challenging long cherished world views, hopes and dreams. Our perspectives may have to shift to embrace wider loss and grief issues that flow from climate change.


  • Shift to a holistic dynamic understanding of the relationship between humans and nature is an end in itself not a means to an end. Nurses may already have a holistic understanding of human health and approaches to care, but this goes beyond the individual to embrace the social and the natural. Health is too often reductive, i.e. it is reduced to body parts and systems existing as separate entities from other bodies and the physical environment. It is also thus individualistic, being located within a single individual’s body. Within this reductive individualised view of health people can still view themselves as healthy in a


 “disintegrating family, community or a destroyed or poisoned ecosystem” (Wendell Berry p89).


  1. Cultivate a poetic understanding alongside a rational understanding – we need to develop awe, celebration, enchantment, reverence as well as classification, prediction, evaluation and exploitation of nature. This mirrors the ongoing debate within nursing education concerning the art/science dichotomy and would provide another useful lens to address the need for scientific competence and artistic appreciation and application in nursing praxis. There needs to be space to allow this and perhaps even academic credit?


  1. Marginalised ‘educations’ will be important, e.g. the field of non –violence. Rather more challenging for some fields of health care such as acute hospital care but may well be core to therapeutic approaches within mental health.


  1. Given the heating – sustainable and emergency education need to come together. Social dislocation, hunger, environmental disaster, tribalism necessitates nursing action that can respond, e.g. global citizenship, peace education, conflict resolution, anti-discriminatory education. Health care staff may well be key professionals in dealing with emergencies and disaster management and thus education and training that explicitly addresses these skills may well be valued and developed.


  1. Alternative ideas of what ‘the good life’ means need exploring: Again this could be core to philosophy especially within the contexts of mental health and palliative care and living with long term or life limiting conditions.


  1. Rethinking notions of democracy, citizenship and sustainability could be part of the professional responsibilities of health care staff. ‘Global citizenship’ could be a core feature.


  1. Shift from atomistic/reductionist thinking to holistic ways of mediating reality. This means that nurses change their paradigms, their world views away from focusing on the individual as the core unit of being, to understanding that the individual cannot exist with community and nature. They are indivisible.


  1. Finally Selby asks: “Everyone has to understand and come to terms with the fact that we are threatening our own existence. To confront this requires a Copernican revolution in aims, structures, processes of education and perhaps in the loci of learning ... as the heating happens, education and educational institutions ... will be deeply disrupted and if unresponsive to the need for transformation, will disintegrate as people find other more relevant loci for learning what they have to learn”. Although this is written for education in general it is a challenge to nurse education. If nurse education is too focused on developing professional competencies based in a biomedical paradigm, then it is an education that will have failed the future nursing workforce, who will be passive recipients of policies and climate change rather than active in prevention and adaptation to the changes.



So what can a nurse do?

Nursing is an ethical practice and nurses are asked to address the health not just of individuals but of communities and populations. Health education, promotion and public health are core to nursing practice. Nursing organisations have accepted both environmental issues and climate change as a health threat. All health services need to save money and use resources better. Population health would improve through adopting low carbon lifestyles. Clinical leaders can assist in the transition from unsustainable health care delivery and lifestyles towards sustainable health care as they are on the ground  and would be able to see where innovations and changes could be made.


  • Read – widely, inform yourself.
  • Reflect – on your personal values, assumptions and beliefs.
  • Revise – current ways of working.
  • Renew – yourself, your workplace, your community.
  • Reconnect – to your family, community, your social and political networks.
  • Remember- this will not be easy.




Suggested reading


Barna, S, Goodman, B. and Mortimer, F. (2012) The health effects of climate change; what does a nurse need to know? Nurse Education Today. 32(7) pp 765-71

Goodman, B. (2013) The Role of the nurse in addressing the health effects of climate change. Nursing Standard. 27 (35) pp 49-56


Griffiths, J. et al (2009) The Health Practitioner’s Guide to Climate Change. Earthscan. London.


Lang T and Rayner G (2012) Ecological public health: the 21st century’s big idea? British Medical Journal 345:e5466 doi 10.1136/bmj.e5466

Politics, Climate Change – Impacts and the IPCC

Climate Change – Impacts and the apolitical nature of reports.


The IPCC on the 2nd November 2014 issued a press release: ‘Concluding instalment of the Fifth Assessment Report: Climate change threatens irreversible and dangerous impacts, but options exist to limit its effects’.



Their first statement is:
“Human influence on the climate system is clear and growing, with impacts observed on all continents. If left unchecked, climate change will increase the likelihood of severe, pervasive and irreversible impacts for people and ecosystems. However, options are available to adapt to climate change and implementing stringent mitigations activities can ensure that the impacts of climate change remain within a manageable range, creating a brighter and more sustainable future” (p1).


This much we know from the 5th assessment report, but this release is not about bringing anything new to the table, it is a synthesis of the 3 working group reports published earlier in 2014.


The IPCC feel that progress for human development can still be made if there is the will to do it based on the knowledge brought forward by the thousands of scientists. In this they are placing faith in the ‘Translational model’ of science and policy (Wynne 2010). The ‘Translational’ model assumes that what all policy makers need, and by inference the public, is an understanding of the science to enact change.


However this does not work because as Mike Hulme points out, climate change is an ‘idea’ and not a scientific ‘fact’ for many people. Hulme (2009) and Wynne (2010) argue that what is at issue is not the propositional claims of climate science, but the conditional and epistemic nature of all science which then relates to the complex and often politicised relationship between science and policy; see also Carlisle (2001) in health inequalities and Pielke’s ‘iron law’ of climate policy (2010). Science ‘produces’ knowledge but it is conditional, i.e. always open to be refuted and it uses propositions, not certainty, in its statements. In reality, we accept as fact science’s propositions as the evidence stacks up and refutations achieve less success – who doubts the laws of gravity, a heliocentric cosmos, or aerodynamics?


Politicised uncertainty applies especially to environmental science, which Douglas discussed as far back as 1970. Goldenburg (2010), Ward (2012), Klein (2014) and Marshall (2014) outline the work of the Heartland Institute, the Cato institute, influential politicians and Tea Party members in regard to attempts to refute climate science.


The IPCC point out current impacts on the least developed countries and argue for adaption through cooperative responses. They also argue that adaptation is not enough and that reduction in emissions is still required. However, the report is written within the frame of reference of growth based capitalism, the language of adaption and mitigation is used within this growth paradigm. In other words, the argument is that capitalism requires collective action to change what it does, but not a root and branch reform of the process itself.


The time scale for capitalism to correct its market failures is now measured in decades:


“We have little time before the window of opportunity to stay within 2 degrees C of warming closes. To keep a good chance of staying below 2C, and at manageable costs, our emissions should drop by 40 to 70 percent globally between 2010 and 2050, falling to zero or below by 2100. We have that opportunity, and the choice is in our hands.” (p2).


A counter to this is the fossil fuel lobby and industries which continue to get billions of dollars in subsidies to extract fossil fuels. One measure has this subsidy at between $544 billion and $2 trillion. So while we have scientists telling us we must reduce emissions on one side, we have a very powerful vested interests and billions of dollars invested in continuing that extraction. Populations however must expect rises in energy prices if these subsidies are cut. This pertains if we do not also address wealth and income redistribution. For example In June 2014 Indonesia increased petrol prices by 44% to cut its annual subsidy bill of $20 billion. These sorts of increases hit the poor disproportionally while it is the rich who use cars more and thus benefit from subsidies. This could be addressed using tax transfers and other redistributive measures but redistribution is not on the agenda in many countries.


It perhaps is not the role of the IPCC to delve into politics, however we must make those links because the science can only take us so far. The broader arguments are cultural, moral and political and we must decide which to go.


















Carlisle, S. (2001) Inequalities in Health: contested explanations, shifting discourses and ambiguous polices. Critical Public Health 11 (3)


Douglas, M. (1970) Environments at Risk. Times Literary Supplement. 23 (4th June): 124-7


Goldenburg, S. (2012) Climate Scientist Peter Gleick admits he leaked Heartland Institute documents. The Guardian. 21st February. [online]


Hulme, M. (2009) Why we disagree about Climate Change. Cambridge. Cambridge University Press.


Pielke, R. (2010) The Climate Fix in Borofsky , Y. (2010) YaleE360: Pielke’s “Iron law” of Climate Policy [online]


Ward, B. (2012) Heartland Institute leak exposes strategies of climate attack machine. The Guardian. 21st February. [online]


Wynne, B. (2010) Strange Weather, Again: Climate Science as Political Art. Theory Culture and Society. 27 (2-13): 289-305


Communicating in contemporary culture: Climate Change and Health

Communicating in contemporary culture.


Jon Snow, the channel 4 journalist, chaired the morning’s panel discussions at the BMJ’s ‘Health and security perspectives of Climate Change’ conference held at the BMA in London on Monday 17th October 2011. In addition to his skills and experience based on years of writing and presenting, he brought interesting insights into how the media works, insights which healthcare professionals could learn from.

One message was that the media had lost interest in climate change, partly due to the hard lobbying by climate sceptics, partly due the East Anglia ‘climategate’ emails but also due to the financial crash of 2008. This illustrates Roger Pielke’s ‘iron law of climate policy’:

when policies to curb emissions come up against policies for economic growth, economic growth wins every time”.

The lesson? Messages compete on an ideological stage for their performance time.

The medium of communication is important. The panel of 9 on the stage at the conference were asked whether they use twitter. One person affirmed this to be the case. Snow pointed out that those working in the media use twitter and other social networks as core tools in their armoury. Snow argued that he gets a great deal of useful information from twitter and suggested that the doctors and by implication other health professionals, ought to seriously consider it as a medium of communication.

This illustrates another issue. Healthcare professionals work in a particular communication bubble, as do academics. Those who we need to communicate with (the public, journalists) live in another communication bubble. There is some crossover between the two but the implication is that healthcare professionals, clinicians and academics, are out of the communication loop, that the overlap between the two worlds is not large enough.

At root is a misunderstanding of the link between knowledge and policy decisions/public understanding. Healthcare knowledge is often science based and rooted in medical understanding. There were suggestions from the floor that the science needs to be simplified and clarified in order to transmit the correct messages.

This will not work in the way we think it ought to.

Firstly, policy and understanding is not based on medicine and science, it is based on what the popular culture tells us, which in turn is shaped by various vested interests, ideology, misconceptions, advertising, public relations and dominant cultural paradigms, e.g. the ‘economic growth’ paradigm, the tenets of consumer capitalism, anthropocentrism and philosophical ‘dualism’ i.e. the ‘objective-subjective’ ‘nature-man’ divide.

Secondly we are using the wrong tools. Those who need the messages do not attend conferences, read academic journals or are linked into professional networks. They use facebook, twitter, radio, television and popular magazines. These media are not often used enough by academics, doctors and nurses.

Therefore the worlds are apart, divided by the understanding how the world works and by different tools of communication. The growing interest in ehealth and web based methods is an attempt to bridge that divide, but to date is still in its infancy. This is not to say these attempts are entirely absent, see for example the facebook group ‘Nursing Sustainability and Climate Change’, or the ‘Climate and Health Council’ website, but that there is a long way to go to understand what our story is and how to best connect with a wider audience. Healthcare professionals need to learn from media studies, social marketing and cognitive psychology on how to reach those who matter if we are interested in promulgating our messages.

A word of warning though. George Lakoff (2008), George Marshall (2014) and Noami Klein (2014) all describe in slightly different ways that this is almost a ‘culture war’ in that there are powerful vested interests who so far have dominated public discourse with a pro growth, small state, anti climate change message.




Klein N (2014) This changes everything. Climate vs Capitalism. Allen lane London.

Lakoff G (2008) The Political Mind. A cognitive scientists guide to your brain and its politics. Penguin. London.

Marshall G (2014) Don’t even think about it. Why our brains are hard wired to ignore climate change. Bloomsbury. New York.

Pielke, R. (2010) The Climate Fix. Basic Books. New York.

On Climate Change

On Climate change

The health effects of climate change

The role of the nurse in addressing the health effects of climate change

“To mobilise people this has to be an emotional issue. It has to have the immediacy and salience. A distant, abstract, and disputed threat just doesn’t have the necessary characteristics for seriously mobilising public opinion.” Daniel Kahneman in Marshall (2014 p57). He stated “I am deeply pessimistic. I really see no path to success on climate change”.


Climate change needs:


  • Salience – qualities that mark it out as prominent and demanding attention, something concrete, immediate and indisputable. Climate change is none of these things for the mass of the population.
  • Acceptance of short term costs to mitigate uncertain long term losses. This is something we are not prone to do.
  • Certain and uncontested information. As long as billions of $ in the US and the UK support denial and the vested interests of the fossil fuel lobby in media this remains at the level of popular culture, and in politics, uncertain and disputed. Those with the power and finances to affect change do not want to do so as it is perceived to threaten their base values.


People, however:

  • Are more averse to losses than gains. If changing to a low carbon lifestyle means giving up the car, air travel, eating red meat, buying fewer consumer goods then the longer term gains of the health co-benefits will not be able to compensate for their immediate short term losses.
  • Are more sensitive to short term costs than long term costs, so again giving up the car is a more sensitive issue, and more salient, than flood damage 30 years from now.
  • Will privilege certainty over uncertainty. Scientists do not talk the language of certainty, and this is ruthlessly exploited by those with a vested interest in the status quo.

However, George Marshall argues that people will willingly shoulder a burden  – even one that requires short term sacrifice against uncertain long term threats – provided they share a common purpose and are rewarded with a greater sense of social belonging.

This provides a glimmer of hope especially for the  nursing commitment to climate change. Nurses often come into the profession with a purpose, a ‘shared humanitarian ethos of care’ rather than an extrinsic motivation based on money and consumer durables. How we create a greater sense of social belonging requires that we overty combat the atomistic, fragmented and individualistic culture based on the idea that “there is no such thing as society“.


Marshall G (2014) Don’t even think about it: Why our brains are wired to ignore climate change. Bloosmbury. New York

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?


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.

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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

The BBC and The IPCC working group 2 report on Climate Change

The BBC and The IPCC working group 2 report on Climate Change.  30th March 2014.


As part of its periodical Assessment Reports, the Intergovernmental Panel on Climate Change (IPCC) has just published working group 2’s (WGII): Climate Change 2014: Impacts, Adaptation and Vulnerability’. Before I get onto the content, the spin, has inevitably begun but sadly on the BBC radio 4 today programme. The chair of WGII was interviewed by Justin Webb who is gaining a reputation as a climate change sceptic. As part of the interview Webb focused on the economist Dr. Richard Tol’s withdrawal of his name from the report on the grounds that the report was not positive enough on the benefits of extra carbon dioxide. The report, Tol said, was too alarmist. His disagreement is how science actually works, but Webb’s focus on this point supports those who think the science is not settled enough.  The report itself was a result of a team of 70 scientists working on revisions so it is not surprising that at least one will disagree with the final report and will wish to remove their own name.

Tol’s argument appears to centre on farmer’s ability to adapt to new circumstances and that carbon dioxide is actually good for plants, a point accepted by WGII. The IPCC, in their video,  state that yields would not have improved without climate change which is neither alarmist or underplayed. It is a fact.  Adaptation is now clearly on the stage as well as mitigation, they are complimentary according to WGII. Adaption will bring benefits to some sectors and populations, but clearly mitigation (reducing emissions) has to run alongside adaptive responses. If we don’t try to mitigate, we run the risk of the climate overpowering adaptive systems. Low probability but high impacts events like the melting of the Greenland Ice sheets should lead us to consider insuring against that risk and trying to prevent it.

We might ask if the media is responsible for supporting scepticism on climate science; Does the media, in the interests of ‘balance’ give too much time to climate change sceptics?

Alistair Burnett , editor of the World tonight argued in 2009 “From the BBC’s perspective, the answer to this question is that our journalistic role is not to campaign for anything. Impartiality means not taking sides in a debate, while accurately representing the balance of argument. So, in the case of climate change we need proportionately to reflect the sceptical view but also, for example, reflect the debate among climate scientists about the most effective way of dealing with global warming”.

The word here is ‘proportionate’.  So 1 scientist in 70 wants his name removed from the final report. Perhaps Webb could have mentioned this and moved on the explore the more substantial discussion regarding adaption and mitigation.

More recently, February 2014, the BBC responded to complaints regarding the inclusion of Lord Lawson on the Today programme: “We believe there has to be space in the BBC’s coverage where scientific consensus meets reasonable argument about the policy implications of that consensus view. That said we do accept that we could have offered a clearer description of the sceptical position taken by Lord Lawson and the Global Warming Policy Foundation in the introduction. That would have clarified in the audience’s minds the ideological background to the arguments”.


There are very real debates to be had on this issue and the adaptation and mitigation angle is very pertinent. The good news is that, at last apart from a very few,  most accept the fact of climate change. It is what we do about it that is causing the heat. The BBC can help by reflecting the science, and ensuring we know what the ideological positions of prominent, and financially supported, sceptics are.

Planetary and Public Health – its in our hands ?

From public to planetary health: a manifesto.

The Lancet (Horton et al, 2014) has just published  a manifesto for transforming public health.

You can read the full one page easy to read manifesto here.

This is a call for a social movement at all levels, from individual to the global, to support collective action for public health. Public Health has been widely defined in this manifesto and draws upon the ideas of Barton and Grant’s health map which has climate change, biodiversity and global ecosystems as the outer ring of the determinants of health.

The current definitions of public health, for example from the Faculty of Public Health,  draw upon Acheson’s 1998 definition “The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society”.  However this definition may now be outdated as there is no mention of environmental or ecological determinants of health and no express action on planetary health at all.

Therefore this manifesto is an implicit call to redefine what public health means. Currently you can read the FPH’s approach to public health and fail to consider issues around climate change, biodiversity loss or the crossing of planetary boundaries which delineate a ‘safe operating space for humanity‘. This needs changing.

The main points within this manifesto  include a definition of ‘planetary’ , rather than ‘public’ health which they argue is an “attitude towards life and a philosophy for living… emphasising people not diseases, and equity not the creation of unjust societies”.  There is a strong focus in the manifesto on the unsustainability of current consumption patterns of living, based on the harms this has on planetary systems. They argue “overconsumption…will cause the collapse of civilisation”. Jared Diamond is worth a read on the collapse of civilisations,  and this argument is in line with his analysis.

Interestingly, an overt political statement is introduced: “We have created an unjust global economic system that favours a small wealthy elite over the many who have so little”. They attack the idea of progress, and of neoliberalism  including ‘transnational forces”, for deepening this ecological crisis and for being socially unjust. There is also a hint of the ‘democratic deficit‘ in which trust between the public and political leaders is breaking down.

The call is for an urgent transformation in values and practices based on recognizing our interdependence and interconnectedness, 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.

So far so good, and in a one page document the detail is necessarily missing.  The principles outlined in this manifesto and the analysis focusing on neoliberalism and ‘entrenched interests’ point us in a direction. However, there is now a need for a map.

I am not convinced that public health, medicine and certainly not nursing, is sufficiently politically aware of the scale of the issue and the sheer force and dynamic of capitalism to even begin constructing the map. That may be an unfair criticism because the education of health care professionals is ‘ahistoric’ and ‘apolitical’ by nature,  they simply lack a sociological or political imagination underpinned by a critical theory of capitalism. And for good reasons.

However, if doctors and nurses are to engage with this manifesto and to debate and argue for an alternative world view, then there is an urgent need to understand the forces railed against them. This manifesto rightly points out the political nature of the issue and the authors no doubt have a clear idea what they mean, however I doubt very much if the majority of healthcare professionals really understand, or even perhaps care about,  the concept of neoliberalism.

In the UK we will be having an election in 2015, in which we will be offered similar versions of the system that is causing the mess. There will be little in the way of mainstream reporting or argument on radical alternatives to consumption or finance capitalism. Indeed parties will be arguing over who can best manage the system.  The only exception will be the Green party who are a fringe party, in terms of votes.

As an example of the scale of the problem, consider Bill McKibbens’  ‘three numbers‘ argument: 2 for two degrees, the threshold beyond which we should fear to tread; 565 gigatons of CO2 we might be able to put into the atmosphere and have some hope of staying below or around 2 degrees; 2795 gigatons which is the amount of carbon in current reserves, but is the the amount of carbon we are planning to burn!  Further, the wealth of investors is tied up in this number and would evaporate like petrol in a hot day should we globally decide that this reserve should stay in the ground. This is an example of an entrenched interest backed by neoliberal politics which is antithetical to global and governmental regulations. The current TTIP negotiations which is trying to establish a free trade area between the US and the EU,  possibly exemplifies the powerlessness of states in the face of lawsuits by corporations if George Monbiot is correct. TTIP is a public health issue and forms part of the backdrop to this manifesto.

I welcome this manifesto, and would urge public health bodies to become overtly political in their statements about public health, perhaps revisiting Acheson and redefining public health to include planetary health.

Following that observation, a new publication published in February 2014, appears to address the politics in an overt way. The Lancet – University of Oslo Commission on Global Governance for Health argues in a document called ‘The political origins of health inequity: prospects for change’ : “Although the health sector has a crucial role in addressing health inequalities, its efforts often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.”

This then sets up political determinants of health which sit alongside the social determinants of health. Whether it goes as far as critiquing the underlying dynamic of various forms of capitalism remains to be seen.

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