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.

Transformation for health and sustainability: “consumption is killing us”

Transformation for health and sustainability: “consumption is killing us”

 

“In this century it has become clear that the fundamental social problem is now the relationship between humankind as a whole and our global environment” (Loy 1988 p 302).

 

To explain why this may be so I will be addressing nonduality/dualism (Loy 1988) and anthropocentrism in order to argue that our future health and welfare is under grave threat from our particularized thinking. This will be done within the overall argument that current lifestyles in advanced industrial societies are unsustainable in the long term because they are based on certain perspectives , economic ideology and ‘one dimensional’ thinking (Marcuse 1964, Goodman 2011). In addition, if we wish to see health and welfare continue to increase across the globe, we will need an overhaul of our philosophies that underpin current assumptions about what the ‘good life’ is, and question whether current assumptions are sustainable. ‘Consumption’ has lead the UK into an economic impasse that will have serious health and social welfare consequences. This is because it based on the manufacture of demand (Harms and Kellner 2011), planned obsolescence (Fishman et al 1993), a linear model of ‘take-make-waste’ (Stubbs 2008) and fashion which all underpin the economy’s need for the drive for buying ‘stuff’. The current focus on the public debt as a cause of our economic woes is in fact a chimera, temporary and a distraction and not the real cause of our global malaise which predates the 2008 crash. Our requiem (Hamilton 2010) was being written long before the bursting of the financial bubble. While other countries enjoy GDP growth, their consumption patterns are also implicated in the impending environmental crisis. Thus, transformation of philosophy, economic models and education is required as business as usual assumptions have served ‘us’ poorly.

 

David Loy (1988 p140) argues when contrasting Eastern traditions (nondualist) with mainly Western (Cartesian) dualism “….there is no distinction between “internal” (mental) and “external” (physical), which means that trees and rocks and clouds, if they are not juxtaposed in memory with the “I” concept, will be experienced to be as much “my” mind as thought and feelings”. This then is a non dualist viewpoint in which ‘us’ includes the biosphere, we are indivisible as human beings from all life forms and all matter.

 

In reality as experienced in advanced industrial societies especially of the West, there is a dominant mode of discourse and experience which are based on various traditions of Western thought. In Cartesian dualism, the Platonic tradition and the Judeo-Christian religious tradition, the self is understood to be the source of awareness and therefore of all meaning and value. This ontological position of our ‘being’ in the world may devalue the physical world and nature merely into domains in which the self fulfills itself. The subject is separate from object. The human subject becomes capable of confronting the objective world, a word of controllable facts. The idea of human exceptualism (Catton and Dunlap 1978) – that man is special and apart from nature – takes root in this discourse.

 

This sentiment harks back to Francis Bacon, the father of modern empiricism who argued in 1620 “The world is made for man, not man for the world” . In his essay ‘The New Atlantis’ Bacon thought that by and through the application of scientific and technological dominion over nature men would usher in a new age of abundance and comfort. Barton Perry (2011) adds in his analysis of Bacon’s views on nature“Observe nature in order that you may use nature, thus converting it into the habitation, instrument, and treasure of man. Here is the supreme maxim of our modern world, and the chief ground of its peculiar confidence and hopefulness”. This has echoes in Sigmund Freud’s (1992 p197 orig. 1927) assertion: ‘The principal task of civilization, its actual raison d’etre, is to defend us against nature’.

 

The call to have dominion over, conquer, harness, control or subjugate nature is predicated upon this idea of separateness from it, it is dualist in origin: (human) self v (nature) other. This control is thus predicated upon the self in opposition to nature which Yagelski (2011) calls ‘the problem of the self ‘: “My argument here is that the prevailing Western sense of the self as an autonomous, thinking being that exists separately from the natural or physical world is really at the heart of the life-threatening environmental problems we face”. Shabecoff (2001) suggests that concerns expressed in critiques by environmentalists of this dualist interpretation resulted in the ‘Heidelberg Appeal’ (a document signed by many scientists) which reasserted that progress by man always involved harnessing nature to man’s needs.

 

This view of a separate self supports a world view that places this self at the centre of the search for truth and the at the centre of the universe, it is anthropocentric (Foreman 1991). The anthropocentric viewpoint of ‘us’ means humanity apart from nature, we are the central and most significant entities in the universe, we assess reality through an exclusively human perspective.

 

It is arguably the case that the anthropocentric view dominates in Western thought, making us incapable of making the interconnections between the stars, the external cosmos of the myriad galaxies, the internal human physiological cosmos, the ecosphere, the biosphere, and ourselves. We then delude ourselves when we think that we are separate entities, that we are able to control for our own benefit that which we are actually a part of. Thus we have triumphed over nature controlling it for our own ends resulting in the magnificence of cities such as New York, which have become our own natural habitat. This comes at a cost. We are unable to see systemically, inter-connectedly or interdependently. The separation between humanity and ecosphere is complete within consumer capitalism in its delivery of the dreams of avarice. If however we can see nondualistically then humanity is the natural world and so what we do to it we do to ourselves. In consuming nature we consumes ourselves.

 

Consumption per se is not the issue, it is the form it takes within a particular structure of social meaning and which took on a new and very powerful form during the industrial revolution: The separation of man from nature allied to empiricism, science (Shabecoff 2001) and technical rationality (Marcuse 1964). Today, this leads to an inability to link the meaning of the use of oil as a natural and finite resource and oil as human artifact which is now embedded into our socio-political culture. Since the 1980’s a new economic creed was grafted onto this toxic stump of dualist thinking: neo-liberal economics (Shah 2010) in which free market ideology has made us servants of the economy and not its masters. The economy has become reified, as if it has a life of its own, as if we have forgotten that it is a human edifice with no concrete existence, that it can be torn down and refashioned, we have accepted a lie…that there is no alternative.

 

It took little time for the discoveries of science in partnership with extractive and manufacturing industries to raise the living standards and hence improve greatly the health of certain populations. There were genocidal casualties of colonial development, but for an increasing number of people on the planet ‘we have never had it so good’. The struggle for the pacification of existence (Marcuse 1964) has been turned into the struggle of the policing of resistance. Many no longer can resist the lures of new forms of social control that anaesthetises our critical faculties so that we are unable to posit alternatives to the current hegemony of consumer capitalism which includes it’s Chinese, Russian and Indian forms. Citizens are no longer citizens, we are primarily consumers of goods and services many of which are unnecessary, silly or just downright dangerous. Our political discourse becomes debased and is riven with debates about how best to manage consumer capitalism rather than posit any real alternative.

 

Our rapacious appetites results in the forced extraction and despoilment of the environment for oil, water, minerals and rare earth elements, and other environmental goods. The result is ocean acidification, water shortages, over fishing, oil wars and toxic chemical and nuclear dumps.

In subjugating nature, in controlling industrial processes, with the literally, earth shattering successes of nuclear technology and scientific achievements, we have created a brave new world fit for….buying stuff. Francis Fukuyama (1992) stated that we are at ‘the end of history’, free from ideological struggle, free….to buy stuff. Workers of the world may have united to lose their chains but they are now free to…buy stuff. In advanced industrial countries most of us are comfortable. Beveridge’s social evils of want, disease, ignorance squalor and idleness largely quelled, quelled so that we may…buy more stuff. The banks bring nations to their knees following a binge on cheap credit, financial sleight of hand, consumer debt and a housing bubble…and now to get out of recession we are exhorted to…buy even more stuff. Consumer confidence is the holy grail of discredited economic gurus whose pseudoscientific neo-liberal pontifications are as worthless as sex education to the whore of Babylon. The twin towers fall, so shocking the President that he exhorted Americans to ….go and buy stuff (Spiers 2003). We’ll counter the backward desert savages with shopping…..Prada versus prayer, Louis Vuitton versus Vengeance and Dior against Death.

 

Ferguson (2011) asks how western civilization came to dominate the world from humble beginnings in the 15th century. He argues that the West developed ‘6 killer apps’: competition, science, democracy, medicine and the protestant work ethic and consumerism. So there we have it the apogee of civilization includes our right to buy.

 

Spencer Wells (2010) argues that our culture has now reached a point where we must reevaluate our relationship to nature and consumption in order to survive. He argues that when we became farmers instead of hunter gathers we set in train new modes of social relationships. As populations expanded there was a need to apportion limited resources such as water, this results in social hierarchies and inequalities. Growing grain had many benefits but results now in a more crowded planet with populations that have become more sedentary and unhealthy.

 

Ben Ami (2010) tells us however that growth is good, consumption is good and we could have ‘Ferraris for all’. He argues that in advanced industrial societies we have seen decreases in infant and maternal mortality rates and increasing life expectancy coupled with control of infections. We live longer healthier lives. Hans Rosling in his online gapminder series also points out that these indicators are also rising in many developing countries, but he warns that success may literally cost the earth. So how can consumption be killing us?

 

Well, it isn’t. Goklany (2006) argues that economic growth, technological change and free trade has helped to power a “cycle of progress” that in the last two centuries enabled unprecedented improvements in every objective measurement of human well-being. Poverty, hunger, malnutrition, child labor, illiteracy and unsafe water have ceased to be global norms; infant mortality has never been lower; and we live longer and healthier lives. Further, Goklany’s research suggests that global agricultural productivity is up, food prices are down, hunger and malnutrition have dropped worldwide, public health has improved, mortality rates are down, and life expectancies are up. So that its then, we are fine.

 

Except that since he wrote that in 2006 the world saw one food crisis in 2008 and this year 2011 the UN’s Food and Agriculture Organisation are giving the global food market ‘critical’ status, again. The Millennium Development Goals have still to be met and maternal and infant mortality is still at numbers too high in many countries to enable any level of complacency.

However, if you view the world anthropocentrically within the frame of reference of consumer capitalism and you happen to live in advanced industrial nations in wealthy suburbs. You can even muster hard empirical evidence to show the beneficence of the global economic system.

 

The problem with this viewpoint is time frame. Seen from the last 200 years enormous, unprecedented progress has without doubt been made. However the time frame for a proper assessment of the current global system is much longer than that. Even in human time frames the last 200 years is a very short period of history. Depending on definition, the Roman Empire lasted over 400 years, and from the steps of the senate, Julius Ceaser may have dreamed of a millennium of Roman domination. World history is littered with the ruins of human civilizations, hubris comes before a fall. We are not Rome or Byzantium. We have controlled the natural environment (up to a point) to produce food and shelter for billions. However there is a poverty of spirit, a neglect of the ‘bottom billion’, willful ignorance of the casualties of inequalities based capitalism, a disconnect from environmental destruction and a lack of vision of alternatives that may lead to more healthy, sustainable lives on a finite planet as we bump up against limits.

 

Of course, assertions about limits needs some evidence. A key paper in this respect is that which addresses the issue of planetary boundaries – i.e. that there are limits to what we can achieve on this planet, that we need urgently to identify what these limits are and then to address what socio-economic conditions would allow all of humanity to live within the planet boundaries. If we do not do this, the argument runs, then the ecosystem services upon which all of us (the biosphere) may well collapse leading to a cull of humanity inline with the extinctions we are already exacting on the living world right now. Rockstrom et al (2009) have tried to identify what the key boundaries are and what the limits are within each. They suggest that humanity has already transgressed three of nine boundaries:

 

  1. CO2 emissions for climate change.
  2. Biodiversity loss.
  3. Biochemical boundaries – the nitrogen cycle (the phosphorous cycle has not yet been transgressed)

The other boundaries discussed include:

  1. Ocean acidification
  2. Stratospheric ozone depletion
  3. Global fresh water use
  4. Change in land use
  5. Atmospheric aerosol loading (not yet quantified).
  6. Chemical pollution (not yet quantified).

They also argue:

In the last 200 years, humanity has transitioned into a new geological era—termed the Anthropocene—which is defined by an accelerating departure from the stable environmental conditions of the past 12,000 years into a new, unknown state of Earth”.

 

In order to maintain a global environment that is conducive for human development and well-being, we must define and respect planetary boundaries that delineate a “safe operating space” for humanity. We must return to the long-term stable global environment that nurtured human development”.

 

Consumption may be killing us in more prosaic ways. The Roberts and Edwards (2010) thesis in The Energy Glut is that fossil fuels are making whole populations fat. We have replaced food with fossil fuels as our main energy source, while at the same time they argue we are eating less than we did, and certainly no more. We have become sedentary, replacing walking and cycling (active transport) with mechanical modes of transport mainly the motor car. Whole societies are using the energy oil has given us to replace physical labour. The upside is the construction of advanced civilizations and huge increases in food production, and the ability to buy stuff, the downside is that as countries develop populations get fat, more get obese and we contribute to climate change.

 

There is also the argument for a poverty of spirit leading to poor mental health fuelled by ideas such as ‘Affluenza’ (see both books of that name by Oliver James and Clive Hamilton and Richard Denniss).

 

Transformation

 

My frame of reference is that healthy lives depend on a healthy socio-economic and physical environment as outlined in the Social Determinants of Health approach (Dahlgren and whitehead) which has as its outer layer in the model ‘general socioeconomic, cultural and environmental factors’, i.e. social and environmental structures. Thus, I largely agree with Peter Morrall (2009) who argues that patterns of illness and disease are largely determined by issues of social structure and increasingly physical environments. Social structures protect some while damning others to misery and poverty as evidenced in the inequalities in health literature. The affluent even in poor countries and difficult environmental conditions live in ‘safe’ enclaves where they can ensure clean water and a ready supply of food, even in famine stricken countries, money buys food. However, even the affluent will be affected by global changes in certain key environmental limits.

 

Social structure results from a dialectic relationship between objective ‘social facts’ and subjective ‘social action’ which occur within distinct forms of power relationships. The key power relationships operating at present is the hegemonic stranglehold of advanced consumer capitalism in which a very small percentage of the world’s population own the majority of the world’s wealth and enjoy its income. Many do not understand or recognise the notions of limits, while others put undue faith on the resourcefulness of humanity to solve the problems but to do so within the frame of reference of ‘business as usual’ unaware that their selves are interconnected and interdependent within a much wider framework of meaning.

 

Thus there is a need to transform thinking. Currently education is the problem not the solution. David Orr (2004) argues that we are educating graduates to be clever not intelligent, and this applies in many if not all disciplines. Cleverness built the atomic bomb, intelligence questions our need for it. Cleverness invented credit default swaps, intelligence called for financial regulation. Cleverness develops markets for things we don’t need, spends money we have not got and distracts us with bright shiny things. Intelligence understands bread and circuses.

 

To encourage and transform thinking there is a need to engage in provocative pedagogy whereby students engage in intellectual critique through being challenged with provocative positions.   They need a sociological imagination to connect their personal troubles with public issues, to fully understand their personal biographies as related to wider social forces at this point in history.

 

Thinking in private without action is in Panton’s phrase merely ‘mental masturbation’ (Panton 2003). Marx (1848) once wrote that philosophers have sought to understand the world, the point however is to change it. So transformative education is critical, provocative and challenging leading to some form of moral action based on a deeper understanding of the human and biosphere condition. This is what Universities are for. However, Peter Morrall (2009b) suggests that Universities in many subjects are losing this vision. They are becoming ‘training warehouses’ bogged down by managerialism, bureaucracy, commodification and consumerism. Education is being increasingly defined and seen as a commodity to be bought, whose only useful purpose is to lead the purchaser into paid employment, whose worth is judged by its ability to do just that.

 

Students in this view are becoming dulled by an all encompassing ideology which narrows the focus on careers and higher pay. Universities may become ‘educational’ establishments focused on providing work skills and applied knowledge. Worthy as this is (and of course is professionally necessary) but without critical enquiry and the ‘search for truth’ there is little point to the university.

 

Medical and nursing disciplines cannot be immune from this process. It is not enough to learn how the body works and what to do when it goes wrong. This is navel gazing of the worse kind. Many doctors and nurses have for a long time been pioneers for social action, acting on behalf of the poor, weak and vulnerable. That is their ethic. That has been their historic mission, the problems of this messy little world may not mean a hill of beans to many but without a reawakening of consciousness and a reconnection of self to others, which includes the biophere, the future looks grim. Peter Morrall has argued that we as health professionals and/or academics have an ethical responsibility to take individual, collegiate, and organisational action with regard to the social ills which affect human health and happiness.

 

However, taking a stand is hard. Ethics is hard. Ethics requires thinking. We may be the only sentient being on the planet who can think and reflect on our existence and the search for ‘truth’ It may be that we have a special responsibility to think about our decisions and why we make them. Damon Horowitz has recently argued (2011) “ Not only can we think, we must. Hannah Arendt said, “The sad truth is that most evil done in this world is not done by people who choose to be evil. It arises from not thinking.” That’s what she called the “banality of evil.” And the response to that is that we demand the exercise of thinking from every sane person

 

It requires some moral framework to guide that thinking, we are required to think about the human condition and the consequences of our actions. John Kenneth Galbraith said that ‘communities are too comfortable to care’, while John Stuart Mill argued “It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied”. Affluence, satisfaction, happiness and over consumption can dull thinking and harden our sensibilities to suffering. Provoking dissatisfaction may not produce more happiness but it may encourage an exploration of eudaemonia.

 

Conclusion

Evidence is mounting that current consumption patterns are costing the earth, the result is a paradox and whether you think this is a good thing may depend on what values you hold and what indices you choose to look at. So at one level this is about values at another there is an empirical question regardless of whether you like or value consumer society or not. The question is will empirical reality overwhelm us and confer our squabbles about resources to the dustbin of history?

 

We have 4 options (Elliot 2011):

 

  1. Do nothing because advanced industrial capitalism is robust and self correcting, we have plenty of oil and climate change is a fantasy.
  2. Argue that there is an incompatibility between sustainability and current economics. However alternatives to globalization are not well worked out and would not attract popular support (yet?).
  3. Bring human ingenuity to bear on the problems, invest in green technologies, develop global governance and change our relationship to the biosphere.
  4. File it all under ‘too difficult’ and hope it is not too late to respond when the crisis breaks.

If you choose not to decide you still have made a choice, my guess is that we will do 1 and 4.

 

Benny Goodman 2011

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.

Buy Nothing New For a Year: Biophilia – Love of Life or Living Systems

Buy Nothing New For a Year: Biophilia – Love of Life or Living Systems

‘Ego or Eco’ and human health

Sustainability and Health This paper seeks to discuss the concept of sustainability and its relationship to health. It will argue that an understanding of what ‘health’ is needs to change from an individualistic (egocentric), biomedical definition to one that encompasses a more social-environmental (ecocentric) understanding. An individualistic (egocentric) understanding of health decouples the individual from society and the ecosphere and this decoupling results in inadequate preparation of some health professionals to equip them to deal with global health challenges. Sustainability, with its emphasis on the ecosphere, recouples the individual to the environment. This matters because the challenges to human health on whole population levels require a paradigm shift to enable adaptation and resilience to changing environmental circumstances (Selby 2007). Before defining sustainability there is a need to briefly address three related concepts: ecocentrism, egocentrism and the ecosphere. Ecocentrism is based on valuing ‘nature’ (or the ecosphere), and places humanity as subservient rather than as dominating and in control. Egocentrism is a system of values that puts the individual human at the centre of ethical discourse, there is a tendency to ignore society and the ecosphere. The ecosphere refers to the air (atmosphere), the oceans (hydrosphere), the land (geosphere) and all life forms (biosphere). ‘Sustainability’ as a concept is not new. Schumacher (1973) had argued that current (modernist) economic models resulted in inefficiencies and environmental pollution while the earth’s finite natural capital resources were being used without too much thought for the future. The recent increased global concern with climate change/global warming (IPCC 2007, DEFRA 2008) has brought it back into the spotlight for the general population. A problem is an egocentric paradigm which values the needs of humanity over the ecosphere. Sustainability can be defined as the ‘capacity to endure’. It is ‘the potential for long-term improvements in (human) wellbeing, which in turn depend on the wellbeing of the natural world and the responsible use of natural resources’ (definition from Wikipedia). Although this seems straightforward O’Riorden (1985) commented on the difficulty of defining sustainability, describing its definition as an: ‘Exploration into a tangled conceptual jungle where watchful eyes lurk at every bend’. Spedding (1996) argued that there is a ‘ remarkable number of books, chapters and papers, that…use ‘sustainable’ or ‘sustainability’ in the title but do not define either term. Spedding goes on to argue, in an attempt to explain sustainability, that it must be based on: 1) resources that will not be exhausted, and 2) it must not create unacceptable pollution.  One of the most oft quoted definitions and one to which we will return below is: ‘Sustainable development: ‘is development that meets the needs of the present without compromising the needs of future generations to meet their own needs.’ (WCED 1987). However, both definitions do not challenge the ‘right’ of humanity (as a separate dominant entity) to extract and exploit nature, only to do it without causing long term harm. There is therefore a great deal of thinking and discussion to be had in trying to understand and clearly communicate exactly what we mean by the term. However, we may argue that human health and wellbeing is self evidently connected to the continuance of the ecosphere as a hospitable environment and in accepting this connection we must value the ecosphere (ecocentrism). It could therefore be argued that a health care worker will be (should be?) as concerned with the socio-political and environmental issues as much as that of curing and treating individual illness. Those that work in public health, health education and health promotion may have more of an explicit concern for these concepts in their professional lives, but the fate of the ecosphere does not exclude or favour anybody. Individuals may be exhorted to change their behaviour but in the absence of environmental protection, this may be totally ineffectual in the long run for humanity. Individuals may still prosper but the species may not. There is a suggestion of a global environmental (Hamilton 2010) and health (Costello et al 2009) crisis. Despite global warming deniers (Philips 2007, The Great Global Warming Swindle 2007), the Intergovernmental Panel on Climate Change (IPCC 2007) report makes it clear (and based on conservative estimates) what our challenge is. If the global community does business as usual, the future may be bleak for humanity. Even if global warming turns out to be exaggerated and the deniers proved correct, the alleged depletion and despoiling of the environment would render the discussions around the best way to deliver health irrelevant. In ‘Climates and Change’ the UK Public Health Association (UKPHA 2007) argues that issues such as pesticide use, ozone depletion, acid rain and Cheronbyl have all highlighted the threat to the ecosphere. Sinclair’s (2009) contention that this is so, is based on reports such as the UN Conference on Environment and Development (1992), the IPCC (2007) report, the Royal Commission on Environmental Pollution and the World Wide Fund for Nature’s (2007) report (all quoted in the UKPHA’s report). If we assume the crisis to human health (if not our continuing existence) is very real, it could therefore be argued that healthcare workers need to address concepts that are otherwise alien to them. Sustainability and Global warming may not have been normally seen as health issues, but less than moment’s reflection surely establishes that they are. Further, the Department of Health (2008a, 2008b), the UKPHA (2007), International Council of Nursing (2008), British Medical Association (2008, 2011) and the World Health Organisation (2006) all have highlighted this as an issue. Therefore returning to asking the question: ‘what does sustainability mean (and what may be the links to health?)’, Fiona Sinclair and David Hall present two perspectives (among many). The Brundtland Report (WCED 1987) may have put the global economic system largely unchanged at the heart of its understanding but this approach may be seen as no more than ‘greening the consumer machine’. Sinclair is arguing for a far more radical approach. Hall, however argues that business is addressing green issues without the need to radically alter lifestyles. In ‘What is Sustainability’ Fiona Sinclair argues: ?‘Sustainability is…not earth shoes, organic eggs, hybrid cars, carbon credits, hemp clothing, a green Apple Mac book™, consumer co-ops, E85, B20, compact fluorescents, recycling bins or reusable shopping bags. All these by products of the consumer lifestyle are predicated on the natural world supplying resources. Capitalism goes shopping in the cavernous belly of mother earth seemingly blind to the fact that the store is running out.’ Thus, Sinclair points to a consumerist lifestyle at the heart of the matter and further argues that the Brundtland report is fundamentally flawed: ‘the Brundtland Report… set(s)……a precedent which links sustainability…(with) the global marketplace. As a result economics has become one of the pillars with which to define sustainable outcomes’ Brundtland, she argues, supports the idea of the People/Profit/Ecosphere triad: ? …whereby the assumptions of global markets as a foundation for human development and sustainability are not shaken. The quest which flows from this analysis is to ensure that the markets operate to provide a sustainable future. Consumerism is to become green. Sinclair argues that profit should be replaced by a global consciousness that accepts that we are interconnected, that environmental degradation is a very real and present danger to continued existence (ecocentrism). The markets in this scenario cannot provide the answer as their primary purpose is for profit and the continued exploitation of a dwindling resource. ? ‘Global consciousness enables us to see effects right in our own backyards and therefore make decisions that instigate solutions with immediate results. It’s that local/global thing granted, but it really is very important that we get it, because if we can’t see our own complicity in all the global destruction that’s going on when it’s right in our faces, we will never understand the consequences of our actions further afield. We will never understand how that early morning cup of coffee unites us with a farmer in Ecuador unless we map the route back to ourselves’. David Hall (2007) takes a different tack to say the least. He argues ‘In slashing the price of lightbulbs, we have shown how green consumerism can work’. Hall starts by quoting his challengers Mark Lynas (2007) and George Monbiot (2007): ‘Lynas argues that, as high-street chains rush to go green, the message to customers is that “all you have to do to save the ecosphere is shop”. This “green consumerism” is dangerous, he says, as it is “difficult to see how consuming more of anything can help us save the ecosphere … The point is to consume less – and no one’s going to make any money from that.” Covering an impressive range of issues, from advertising to carbon labelling, supermarkets and offsetting, Lynas quotes George Monbiot’s memorable put-down, “No political challenge can be met by shopping”, before coming to the depressing conclusion that “clearly a lot more work remains to be done”’. However he goes on to state: “By caricaturing this business response as “more shopping”, however, much positive work is misrepresented. When it joined our campaign, Tesco made a commitment to sell 10 million energy-efficient light bulbs this year (up from 2 million last year), and has slashed prices and transformed its range in order to do so. How can that be a bad thing when a single low-energy bulb saves on average 11kg of CO2 and £8 in energy bills per year? We cannot afford to stick to old divides. If defeating global warming requires us to defeat global capital too, I would suggest we all give up now and start building our arks. But if we can harness the power of a Tesco or an M&S to our cause, we may just have a chance of keeping our heads above water.” Thus, far from being the cause of the problems the global consumer is to be aided in preserving and sustaining the ecosphere by corporations. ‘Sustainable Health’ has another face. An expression of sustainable health may be seen in the flight from medicine towards alternative and complementary therapies. ‘Sustainable Health’ (a UK) based organisation (see http://www.sustainablehealth.co.uk/) uses ‘sustainable’ as a ‘hooray’ word (who is against sustainability?) to attract customers to use their products and services. Their website makes it clear what sustainability means: ‘We offer treatments in Acupuncture, Ear Acupuncture Aromatherapy, Raindrop therapy, Reiki, Herbal medicine, Indian head massage, Counselling, Shiatsu, Sound healing, Crystal healing, Breath work, Reflexology, Astrology, Self Development, Qi Gong, Meditation and Native American medicine’. Not all of these therapies have an evidence base of course, but other than that they also conceptualise health from an egocentric perspective. It may be a harsh criticism to note that the social-political and environmental dimensions are missing as these therapies are not about that. What it does illustrate is that sustainability can ‘mean all things to all (wo)men’ and can be used to rally the troops. Implications for health care. From an egocentric perspective, an individual’s health is not connected directly to other’s or the ecosphere. One person’s health may be in an optimal state regardless of the environment, therefore at the locus of the individual health can be decoupled from the environment. From an ecocentric view, the environment is coupled to the individual, they are seen as one and the same, then individuals cannot be healthy by definition if the environment is despoiled. Sinclair’s approach to sustainability would have us make the connections between our personal lifestyle choices and the impact this has on global resources, re-coupling the individual and the environment. Therefore it moves the focus on from health and healthcare based around treating individual illness and disease (biomedical egocentrism). It is a call to understand health in its widest dimensions, that individual health is inextricably linked to individual, social, political and economic and environmental decisions which accepts that the ‘State of the World’ is as important as an individual’s health (ecocentrism). The ecosphere does not need us, but we most certainly need the ecosphere. Sinclair does not explicitly argue that rejecting a consumerist lifestyle is as healthy for individuals as it is for the ecosphere but implicit in this approach may be the assumption that less than optimum health for people may actually be beneficial for the ecosphere. How may this be? On the plus side, selling one’s car and using a bicycle will have benefits (all other factors being equal) for both ecosphere and the individual. However, rejecting the products of the pharmaceutical industry and relying on ‘traditional’ herbal remedies may have serious negative health consequences for the individual. The ecosphere benefits from having less non renewable resources being used, but the individual may find life expectancy reduced. How much of our current lifestyles based on the production of goods and services need to be sacrificed before we experience a health threat? It has to be noted (McKeown 1976) that increases in life expectancy in the developed world has resulted from the benefits of a rise of general standards of living, environmental improvements and nutrition facilitated by the global markets (Ben-Ami 2010) that are criticised. We are healthier in the main than our great grandparents. The issue is whether this increase in life expectancy has been bought at the expense of the environment. The question remains whether global capitalism can continue to produce health gains for a world population of nearly 9 billion? Schumacher (1973) argued 20 years ago that it cannot. Sinclair, and many others (Orr 2004, Jackson 2009, Porritt 2009, Hamilton 2010) agree. There may be alternatives, Cuba’s health care system shows what can be achieved without applying market capitalism (Carrol 2007). However this is based on certain philosophical and political assumptions that are difficult to export. Global and environmental consciousness (ecocentrism) may be an ideal, an ideology to be achieved in some utopian future, so there is a need to show evidence that 7 billion people currently are interested in anything other than development along consumerist lines. Pielke (2010) argues that there is an iron law of climate policy: when economics comes up against emissions reductions then economics wins. This may apply to changing to sustainable lifestyles as people will not respond if the cost is too much. In ex US president Bill Clintons’s words “Its the economy stupid.” Getting individuals in western societies to change consumption habits to protect the environment may be difficult enough, it may prove an impossible challenge to persuade China and India that the path to development involves less not more (Pielke 2010), especially as the ‘brand leader’ of consumer capitalism, i.e. the USA, seems unwilling to do other than to green its products while ignoring gross inequalities which has huge impacts on a range of health and social problems (Wilkinson and Pickett 2009). Hall’s response is that business is attuned to offset the more damaging effects of its activities. The World Business Council for Sustainable Development (WBCSD 2010) agrees. Both suggest that current healthy (longer) lives can be sustained if we make adjustments to lifestyle and consumer choices rather than undertake a radical overhaul of the whole economic system. There are of course objections to this model (NEF 2010. Jackson 2009, Hamilton 2010). Those who wish for ‘business as usual’ are putting their faith in human exceptualism (and are egocentric) and technological fixes (Ben-Ami 2010) and may be downplaying the real toll of current consumer demand in terms of environmental degradation. Affluence for billions (while other billions live on less than $10 a day) and faith in technology masks very real problems. The challenge is to develop an individual and environmentally healthy lifestyle that does not draw upon more resources than can be renewed, but which harnesses the benefits of development to prevent a new dark age from descending. The decoupling of individual health from the environment makes this challenge more difficult. Healthcare professionals need to reconnect and advocate for a changed paradigm and for lifestyles that are sustainable and healthy. Benny Goodman. November 2010.

Natural environments — healthy environments? An exploratory analysis of the relationship between greenspace and health

Natural environments — healthy environments? An exploratory analysis of the relationship between greenspace and health