Tag: Political Economy

Neoliberalism: Rhetoric and Reality.

This paper was prepared as background to the 4th edition of ‘Communication and Interpersonal skills in nursing (Grant, A. and Goodman, B. forthcoming). In that book discourses of neoliberalism and their effects on health and health service delivery as well as the interpersonal communications nurses have with people will be explored and critiqued. An example is the discourse on ‘individual responsibility for health’ and ‘lifestyle drift’ responses to public health which draw upon the concept of ‘sovereign individual’ of neoliberal philosophy. This paper explores what neoliberalism might be to argue that it is more a discursive practice than a political action.

 

Neoliberalism is at once everywhere and nowhere. There is ‘appearance’ and ‘reality’, there is reification and fetishisation. Its name is spoken in certain circles and vilified (Springer 2016), it is an ‘imprecise exhortation’ (Thorsen and Lie 2007, Thorsen 2009), in others there is denial that it even exists (Talbot 2016). It might be best to understand neoliberalism as a ‘discourse’ (Foucault 1969) rather than an actuality of political practice, as a “rather radical set of ideas which nevertheless have had a certain influence on society and politics in recent times” (Thorsen 2009 p20).  It is a word used by the progressive and critical left, e.g. Saad-Filho and Johnson (2005), to counter what the right call the ‘free market’ in the context of the breakdown of the post war consensus around the social welfare democratic state.

 

I suggest that the discourse of the ‘Free Market’ was, and is, used to reshape the State, and civil relationships, away from ownership and control of the means of production, away from Keynesian state intervention in the economy and away from providing all social security (including housing, health, education, and transport). Free market rhetoric is used to mask the reshaping of State apparatus towards State intervention for wealthy landowners and corporates (financial and industrial). This is a bid by a capitalist class to (re)capture the State’s support for capital and property accumulation in their favour. This ‘support’ is referred to as a ‘framework’ in which ‘free’ markets are to operate. I also argue that there is nothing ‘neo’ or ‘new’ about the practical reality of this form of liberalism, tied as it is to the capitalist State.

 

The term ‘Free market’ is often preferred to ‘neoliberal’ by its supporters according to Talbot (2016) and Thorsen (2009) who argues that the term neoliberal is now most often used in a pejorative way by the left. We say ‘Neoliberal’ you say ‘Free Market’. ‘Free market’ or ‘neoliberal discourse’ is used as part of the Ideological State apparatus backed up by the Repressive State apparatus of the judicial system, police and ultimately, if needs be, the military.

 

An important idea of ‘Free Market/Neoliberalism’ is the espoused theory of a minimalist State. The theory in action is a State becoming minimal for social security but otherwise continuing the facilitation of capital accumulation and the ownership of wealth especially by the 0.01%. The ‘Nightwatchman’ minimal state of the 19th century is a goal of free market (or liberal) ideology, but this has not been achieved for all of the talk of the Reagan/Thatcher years of the 1980’s. This is possibly because the reduction of State spending down to 10% of GDP from the current 40% of GDP (per year, see figure 1 in the appendix) would be as disruptive for the capitalist class and the political power elites as it would for everyone else. This is also because key sectors of the economy such as agriculture, the military-industrial complex, and the nuclear power and fossil fuel industries, rely on government funds and subsidies without which their business models would have to be radically altered. Capitalism’s ‘creative destruction’ is a lauded dynamic feature, as long as its not your industry or business model that goes bust or, in the jargon; is ‘disrupted’.  It is also because in theory, liberalism is not a monolithic philosophy, ‘classic’ and ‘modern’ Liberalism (Ryan 1993) have different views of the State’s role.

 

The minimalist state (‘Nightwatchman’) ‘classic liberal’ solution to questions of political economy might still be the goal of some current thinking. This may include the Tea Party in the US, kicked into life by Rick Santelli’s comments on President Obama’s mortgage bail out plan (Pallasch 2010),  and perhaps in the UK by the Adam Smith Institute. Yet in current practice many of the Conservative capitalist class, and their political voices in the Tory party, seem as wedded to state intervention as they claim socialists to be.

 

Neoliberalism as a discursive practice, embedded and supported by an ideologically driven, highly funded ‘intellectual’ infrastructure, can also be linked to around 1,000 self conscious neoliberal intellectuals organised in the Mont Pelerin Society (Plewhe et al 2007). Its proponents fight for hegemony in research and development, and engage in political and communication efforts with well funded, well coordinated and highly effective new types of knowledge organisations: partisan think tanks such as the Cato Institute and the Heritage Foundation in the US, the Institute for Economic Affairs (IEA) and the Centre for Policy Studies (CPS) in the UK and the Institute of Public Affairs in Australia (IPA) (Beder 2001).

 

A Discursive Project.

 

This is an ongoing rhetorical project in the UK because as Desai (2007) argues, the values and principles of Thatcherism, which did not call itself neoliberal but did emphasis similar ‘free market, small state’ principles mixed with ‘Victorian values’,  were not wholly accepted by the British public. This is evidenced in surveys of public opinion in the 1980’s and 90’s and arguably even today if support for the socialist inspired NHS is an indicator.

 

Support in elections since 1979 have not won over majorities of the electorate, and it is only thanks to first past the post that Tories and clause 4 ditching ‘Tory lite’ New Labour, were able to win. See figure 1 (appendix) which shows what % of the electorate actually voted for the government of the day.

 

These figures show that at its peak only 33% of voters could be bothered to put an x next to free market rhetoric. This was down to 24% by 2015. Neoliberals/Thatcherites/ Conservatives have not won the hearts and minds of the British Electorate and neither has the goal of a small state in terms of GDP spend been achieved. Their success in the US and the UK, is to be measured not by the popular vote, but by their assaults on Trade Unions, by Privatisations, Tax breaks and Labour market and Financial deregulations.  And by the increasing share of wealth and high pay going to the 1% and 0.01% (Saez and Zucman 2014, Dorling 2014, Moshinsky 2016).

 

I argue here in accordance with Desai (2007) that:

 

“Market dogma may well be entrenched in capitals around the world, but its intellectual vacuity and practical failures have been documented in a vast literature. It would be truer to say that neoliberalism’s intellectual pretensions are designed to provide a fig leaf of intellectual respectability to the most naked pursuit of the interests of capital and property (my emphasis) than that neoliberalism has motivated this pursuit by intellectual force and political influence” (Desai 2007 p220).

 

In other words, powerful and rich individuals have used talk of free markets (and neoliberalism) to justify their ongoing grab of global wealth through using the levers of State power, rather than it being the case that the intellectual case motivates their actions.

 

Graham Scambler (2012) also points in this direction in his exposition of the ‘Greedy Bastards Hypothesis’ which is underpinned by the strategic actions of ‘focused autonomous reflexives’ in the capitalist class executive and the political power elite.

 

 

 

 

Discourse

 

 

In common understanding a ‘discourse’ is an exchange, perhaps of ideas, between two people involving language as the medium of transmission. This can be seen as a neutral exercise between two people of equal power and status using certain phrases, words, jargon and syntax to share understanding or to question the other’s statements. Consider the situation when two Tory MPs are talking to each other about a ‘flexible labour market’  or the need for people to be ‘taking responsibility for one’s health’. The first is an example of the neoliberal/free market discourse that favours weak labour regulations to make it easy to hire and fire staff making them ‘flexible’. The second brings in and joins the ‘Moral Underclass discourse’ (Carlisle 2001) to the free market’s central idea of ‘free sovereign individuals’ in charge of their own destiny in order to shift responsibility fully onto the shoulders of individuals. This discourse can then blame individuals for being obese, for smoking or for any other ‘moral failing’ such as catching an STI or binge drinking.

 

Discourse as a critical concept is associated with Michel Foucault. For Foucault (1969) discourses are institutionalised patterns of speech and knowledge seen and felt in ‘disciplinary’ structures, e.g. in the medical clinic or in the prison (Foucault 1963, 1975). Discourses connect knowledge to power. Knowledge is power. To oversimplify, the concept refers to the idea that a discourse shapes, or constructs what we know, what we can say and also reflects differences in power between people. Becoming a Tory MP introduces one to the institutionalised patterns of speech which might be very familiar to that experienced in public schools (e.g. Eton) and certain Oxbridge clubs (e.g. Bullingdon).

 

 

 

 

Discourses are more than mere words.  A discourse, Foucault (1969) suggested, actually brings into being that of which they speak.

 

“…discourses…are nota mere intersection of things and words….

 

The task of analysing discourses is to show that they are not just:

 

groups of signsbut as practices that systematically form the objects of which they speak.discourses are composed of signs; but what they do is more than use signs to designate things. It is this more that renders them irreducible to language and to speech. It is this morethat we must reveal and describe (1969 p 54)” (my emphasis).

 

By continually repeating the discourse, and getting it accepted by enough people, that “There is no money” or “There is no Alternative” or “Labour caused the public debt” or “Banks are too big to fail” or “Top cornflakes rise to the top” or “high pay rewards hard work and intelligence” or “Inequality is good for competition” or “Skivers v Strivers” or “In this together” or “we must balance the books and bring down the deficit” these things are brought into being. They are part of a larger, taken for granted, understanding of the ‘proper’ role of the state, the individual and the corporation.

 

 

What then is ‘Neoliberalism’ and what is formed by that of which it speaks?

 

 

Traditional Enlightenment ‘classical liberalism’ (Ryan 1993) emphasises:

 

  1. Individual Freedom (liberty) through limiting government and maximising capitalist market forces.
  2. Civil liberties under the rule of law and laissez faire economics.
  3. Free markets, utilitarianism, natural law (inherent rights which are universal, uncovered by reason) and progress.

 

Key thinkers: Adam Smith, John Locke, Thomas Hobbes, David Ricardo. Alexis de Tocqueville

 

Modern liberalism accepts a greater role for the State in the economy, manifested in regulation and the State supplying of goods and services (Ryan 1993). Laissez faire economics cannot in this interpretation meet the goals and purposes of liberalism. Thorsen (2009) argues that liberalism has many facets and has become in effect a contested concept particularly over the role of the State.

 

 

Neoliberalism is associated with ‘Austrian’ economists Ludwig Von Mises (1881-1973), Friedrich Hayek (1899-1992) and the American economist Milton Friedman (1912-2006). Around 1950, the classic liberal state had grown into, for some, a social democratic monster driven by Keynesian economic theory and the growth of Welfare States. In both the US and the UK, governments were beginning to spend more and more of GDP and intervening in many areas of the economy including social security programmes. Von Mises, Hayek and Friedman would have noted that the share of GDP spent by the State on welfare and public services had grown from about 10% in the middle of the 19th Century (figure 2 in the appendix) to around 40% by the 1970’s.  Today the share of GDP spent by the government in the UK is about 41% (figure 3 in the appendix).

 

In the context of the centrally planned Soviet Union and Hitler’s Germany, Hayek (1944) argued that any government control of economic decision making through central planning leads to tyranny and that civilisation requires liberty as a prerequisite for wealth and growth (1960). Hayek and Freidman (in the 1950’s) referred back to classical liberalism rather than ‘neoliberalism’ in their reaction to the amount of state intervention in the economy.  Yet, they accepted some aspects of welfare provision by the State although this provision in their view should be greatly reduced. Their status as fringe economists  in the 50’s was altered when their economic theory and political philosophy was then taken up by Reagan in the US and Thatcher in the UK around the late 1970’s. At this point there had been a sort of post WW2 consensus between Conservatives and Labour regarding the level of state intervention in the economy.

 

 

 

Margaret Thatcher was to change that cosy relationship.

 

At a Conservative Party policy meeting in the late 1970’s, Thatcher made it clear upon what her approach to the economy was based:

 

Another colleague had also prepared a paper arguing that the middle way was the pragmatic path for the Conservative party to take…the new Party Leader [Margaret Thatcher] reached into her briefcase and took out a book.  It was Friedrich von Hayek’s The Constitution of Liberty…..she held the book up for all of us to see.  ‘This’, she said sternly, ‘is what we believe’, and banged Hayek down on the table.” (Ranelagh 1991).

 

Neo simply means ‘new’ and refers us back to the earlier liberal small state. The ‘Nightwatchman’ state in the 19th century provided for property rights, contracts, markets and personal/national security. That was about it. No provision for schools, health, transport or subsidies for industries. Hence the relatively small % of GDP being spent by the government. Talbot (2016) argues that the 1950’s Neoliberalism was new in that it also embraced social as well as economic and political rights. Social protection, workers rights and public health would actually help the capitalist society, however following the Chilean coup of 1972 a theoretical inversion took place in which it now meant a reversion to 19th century free market liberalism.

 

Four Definitions

 

Stuart Hall (2011) argued that:

 

The term ‘neo-liberalism’ is not a satisfactory one. Intellectual critics say the term lumps together too many things to merit a single identity; it is reductive, sacrificing attention to internal complexities and geo-historical specificity. However, I think there are enough common features to warrant giving it a provisional conceptual identity, provided this is understood as a first approximation…..What, then, are the leading ideas of the neo-liberal model? ….neo-liberalism is grounded in the idea of the free, possessive individual. It sees the state as tyrannical and oppressive. The state must never govern society, dictate to free individuals how to dispose of their property, regulate a free-market economy or interfere with the God-given right to make profits and amass personal wealth”.

 

A ‘tyrannical and oppressive’ State was of course Hayek’s view.

 

George Monbiot (2016) outlined its main principles in this way:

 

“Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency. It maintains that the marketdelivers benefits that could never be achieved by planning. Attempts to limit competition are treated as inimical to liberty. Tax and regulation should be minimised, public services should be privatised. The organisation of labour and collective bargaining by trade unions are portrayed as market distortions, that impede the formation of a natural hierarchy of winners and losers. Inequality is recast as virtuous: a reward for utility and a generator of wealth, which trickles down to enrich everyone. Efforts to create a more equal society are both counter-productive and morally corrosive. The market ensures that everyone gets what they deserve”.

 

David Harvey (2005) defines it thus:

 

Neoliberalism is in the first instance a theory of political economic practices that proposes that human well-being can best be advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterized by strong private property rights, free markets, and free trade. The role of the state is to create and preserve an institutional framework appropriate to such practices. The state has to guarantee, for example, the quality and integrity of money. It must also set up those military, defence, police, and legal structures and function required to secure private property rights and to guarantee, by force if need be, the proper functioning of markets. Furthermore, if markets do not exist (in areas such as land, water, education, health care, social security, or environmental pollution) then they must be created, by state action if necessary. But beyond these tasks the state should not venture. State interventions in markets (once created) must be kept to a bare minimum because, according to the theory, the state cannot possibly possess enough information to second-guess market signals (prices) and because powerful interest groups will inevitably distort and bias state interventions (particularly in democracies) for their own benefit.

 

 

Thorsen (2009) after an examination of literature on liberalism including the critical literature argues:

 

“Neoliberalism is…a loosely demarcated set of political beliefs which most prominently and prototypically include the conviction that the only legitimate purpose of the state is to safeguard individual liberty, understood as a sort of mercantile liberty for individuals and corporations. This conviction usually issues, in turn, in a belief that the state ought to be minimal or at least drastically reduced in strength and size, and that any transgression by the state beyond its sole legitimate raison d’etre is unacceptable (cf, especially Mises 1962; Nozick 1974; Hayek 1979).

 

This latter two descriptions  are that of the ‘Nightwatchman State’. Remember at this time in the 19th century less than 10% of GDP was spent by the government on public activities. Is this the goal of current Conservatives? Or is neoliberal/free market discourse an ideological mask for something else?

 

A minimal state safeguarding individual mercantile liberty and that is it?

 

We have to question whether in action Tory ministers believe this and wish to cut public spending from around 40% to 10%. To see what that would mean, we would need to look at the current 2017 budget (approximately £800 billion which is 40% of GDP) and note that to get down to 10% of GDP the budget would have to be £200 billion. See the appendix figure 4 for the 2017 budget. This is not 10% of GDP. Social Protection (pensions in the main) is over 10% on its own.

 

This is not a ‘Nightwatchman’. Is it a socialist utopia? The State is spending a lot of money still. However, what is actually happening is that in each sector, privatisation means that more and more government money (taxpayer’s money) is subsiding private provision. This is an explicit aim of the Adam Smith Institute who explicitly call for private provision but public funding for health. In Rail the government is subsiding private train operating companies and in housing the government is subsidising landlords through housing benefit.  In employment the government is subsidising employers through tax credits.  Figure 5 in the appendix shows where the revenue comes from.

 

The UK government spending accounts for about 40% of GDP, leaving 60% going elsewhere. Spending on health, social care and social protection (pensions) accounts for £426 billion, that is over 50% of the total spend. Add £102 billion for education (total now is £528 Billion).

 

Who pays for that? Well, whoever pays Income Tax, National Insurance, VAT, Council Tax and excise duties. All of this accounts for £628 billion.

 

What we have is redistribution from the 99.9% to the 99%.

 

‘Neoliberalism’ as rhetoric actually works for 0.01% – the plutocrats, the global capitalist executive. Henry (2012) argues that anything between $21 to £31 trillion as of 2010, has been invested tax free in about 80 ‘offshore’ secrecy jurisdictions. That is trillion not billion.

 

What we don’t have is a minimal state focused solely on safeguarding liberties for markets.

 

This idea of a small state free market economy is of course patent nonsense as it has just not happened. The reduction of public spending and deficit reduction are two current policy goals (i.e. Austerity) but this is hardly neoliberalism.  Neoliberal purists have failed to get the Tory party to reduce spending to these ‘classic liberal state’ levels. So what was all that Thatcherite talk for?

 

The reduction of state spending down to 10%, I suggest is either a complete failure of the neoliberal project or it is deliberate policy failure in that this is not the neoliberal goal at all.

 

It could be the case that the free market discursive practice is a cover for capital and property accumulation through curbing what is seen as labour power but more importantly by capturing the levers of the State. Cutting state spending to 10% would be seen by the capitalist executive and the political power elite to be socially and politically dangerous to capital accumulation.

 

Marx once remarked in the Communist Manifesto:

 

the executive of the modern state is but a committee for managing the common affairs of the whole bourgeoisie”.

 

One does not have to be a communist to begin to see how executive power is being used to the advantage of Capital (deregulations, subsidies and offshore tax breaks) while at the same time weakening labour through strict union laws, wage freezes and labour market ‘flexibility’.

 

Prior to 1900, no state spent more than 3% of GDP on ‘social programmes’. Around 1870 the average public spending level of ‘advanced economies’ was 10% (Talbot 2016). The 1914-1918 war saw an increase to 20%, followed by a steady growth to the 40% of today. This leads Talbot to argue that the neoliberal state of the 1970’s with 40% spending is actually little different from liberal market/social democratic states. Therefore it is all talk and no action since that level of spending has not been reigned back to 19th century levels.

 

Does this mean that Thatcherism was not neoliberal in action? Yes, if by that we define a neoliberal state as that in which only 10% of GDP is spent. Was Thatcherism even ‘free market’ in action given the continuing level of state intervention in many sectors of society and economy? Both Thatcher and Reagan promised to ‘roll back the frontiers of the state’ or that ‘government was not the answer, it was the problem’. This was ‘New Right’ talk to distinguish it from post WW2 Conservatives who accepted the post war social democratic consensus based on around 40% GDP spending and intervention.

 

Talbot (2016) argues that neoliberalism exists only as a ‘bogeyman’ created on the left to oppose various conservative attempts to ‘rebalance’ government-market relations. Bruff (2017) however argues that ‘neoliberalism’ is not about a return to free markets and 10% spending levels but is an ideology to mask a coercive, non-democratic and unequal reorganisation of society. There is seeming agreement that this is not about cutting government spending per se down to 10% but about reshaping democratic social and political relationships in favour of Capital. To repeat Desai (2007):

 

neoliberalism’s intellectual pretensions are designed to provide a fig leaf of intellectual respectability to the most naked pursuit of the interests of capital and property”.

 

Bruff (2017) points out that many current governments are not neoliberal in that they actually oppose free markets in practice and instead are engaged in protectionist rhetoric and practice. A 40% GDP spend does not indicate much in the way of ‘cutting back the state’ except for the working classes as a result of austerity politics and social security spending decisions.

 

This results in socialism for the rich (state spending) and neoliberalism for the poor (welfare cuts).

 

If neoliberalism is narrowly defined as a political programme valorising free markets then indeed leaders such as Trump, Modi, Erdogan and Abi are not neoliberal. Instead ‘free market’ rhetoric is just that: rhetoric. Bruff goes on to suggest that actually Hayek et al constantly invoke ‘free markets’ as an abstract principle but then they have a preference for certain types of markets to prevail in actuality. Neoliberalism in this definition is the use of the State in a central role to maintain a certain kind of market:

 

“neoliberalism has nothing to do with markets as commonly conceived, and everything to do with the orchestration of social relations in the name of markets…it is about the coercive, non democratic and unequal reorganisation of society along particular lines…intensification and extensification of the differences, inequalities, hierarchies and divisions that pervade capitalist society as delivered by authoritarian states and global corporations…neoliberalism is a way of seeing the world that is carved from the empty words ‘free’ and ‘markets’ ”. Bruff calls this ‘Authoritarian Neoliberalism’

 


 

Some Free Market advocates get this too.

 

Jamie Whyte is a free market advocate and in the BBC radio programme Analysis ‘Keeping the Free Market faith’ (8th October 2012) thinks Conservatives are now losing that faith in the free market, implying neoliberalism has lost its grip. Of course, as figure 1 to 5 show, it never had one.

 

Three Conservatives said this about the state of politics in 2012:

 

An Unholy alliance between a free market ideology which took over a government and a process of social change in which fair dealing and trust were ditched in favour of get rich quick economic libertarianism”

 

“We have to challenge the assumptions of laissez faire economics…”

 

“…the left wing account (of a conspiracy of the rich against poor people) is much more believable (since the credit crunch) than in 1990, although I don’t believe it”.

 

(Jessie Norman, Matthew Hancock (Tory MPs) and journalist Charles Moore).

 

In the ‘Free Enterprise Group’ in the Tory party, Andrea Leadsom argued deregulation in the banking sector had caused major problems. Ferdinand Mount also queried deregulation and the big bang which ‘had its downside’. Matthew Hancock (Tory Minister for Skills) also of the Free Enterprise Group, argued free markets need strong frameworks. He argued we should not muddle up laissez faire economics with free markets, and that the banking sector is special, it is an exception where free market principles should not hold! The State also should have a view of what are sustainable business models for many industries.

 

Jamie Whyte interviewed Ferdinand Mount, who helped write Thatcher’s manifesto in 1983, argued in the radio programme that ‘bankers are the worse kind of oligarchs, immune to old standards of corporate governance, paying themselves whatever they like. Shareholders are sleeping and are not taking them to account’. Qualms about high pay, argued Mount, is about social justice and economic efficiency (rewards gained despite performance). He argues against total deregulation and against withdrawal of state support for the ‘too big to fail’ banks.

 

Whyte interviewed Lord Griffiths (advisor to Thatcher in 1986) who dents Thatcher’s image as a neoliberal or free market ideologue. He argues that Thatcher believed in a ‘moral market’ and the value of enterprise but was never a total free marketeer. Free markets yes, but within a boundary of social justice, including consumer protection. Thatcher he suggests was not a purist Hayekian. Despite the earlier Hayekian gesture in the 197o’s, Griffiths argued that Thatcher believed that the market economy had a moral basis in a Judeo-Christian ethic; a ‘moral market’ and this was the underpinning of the economy. Thatcher was free market enough to let the UK coal mines close and railed against support for ‘lame duck’ industries. She also began the wave of privatisation of nationalised industries.

 

What then now of Theresa May’s reintroduction of industrial policy, of explicit talk of government involvement in various sectors of the economy? Since 2010, there has been the  setting up of a British Business bank and the rebalancing of the economy as policy goals. Government should now have a view over the structure of the economy (Matthew Hancock MP), and support for successful business is a legitimate role. ‘Active and thoughtful’ government should support successful companies, and not be neutral between sectors. Hancock argued that there needs to be a strong framework around a market supporting successful industries, i.e. those that work well. An industry strategy must allow new challengers, but there must not be a planned economy. This must be done through looking at regulation and providing industry with the skills it needs.

 

Pro-Business rather than Free markets?

 

However, businesses are good at lobbying government (Zingales 2012), they ask for and get support rather than just asking for arm’s length regulation.  Zingales (2012) also argues that the US risks deteriorating into a pro-business rather than pro-market system. Jamie Whyte calls the relationship between business and government  ‘cosy and corrupt’.

 

Trump’s election and his appointees and advisors might indicate or vindicate Zingales’ point. His first big meeting in January 2017 (Feloni 2017) was with 12 CEO’s of the United States’ largest companies and he told them that he would ‘prioritize corporate tax cuts and decrease regulation’ (free market talk) and impose a ‘border tax’ on companies that move production outside the US (state interventionist).

 

Key appointments include:

 

Rex Tillerson (ex CEO of ExxonMobil), Steven Mnuchin (Goldman Sachs, Hedge Funder), Robert Lighthizer (Corporate and Trade Lawyer), Andrew Puzder (CEO of restaurant chains) and Wilbur Ross (Billionaire Investor). Well, who else would you want to run the capitalist executive but capitalist executives?  Smith (2016) suggests that ‘Trump’s billionaire cabinet could be the wealthiest administration ever’:

 

Todd Ricketts ($5.3 bn), Betsy DeVos ($5.1 bn), Wilbur Ross ($2.9 bn), and Steve Mnuchin ($46 m).

 

In the UK, May’s cabinet are pretty rich but look like paupers compared to Trump’s (Saner 2017).

 

As for business connections, in the UK, there are 50 official ministerial ‘business buddies’ for large firms in the Business Council. Glaxo Smith Kline had David Willetts while Vince Cable worked with Oil and Gas. Hancock in the Whyte radio programme argued they ‘listen’ to their companies and the government then does what they would like. This is not only a UK phenomenon. Angresano (2016) argues there is a ‘Corporate Welfare Economy’ in which the US government has increasingly been influenced by corporate lobbyists with regulation skewed in order to suit the interests of the privileged.

 

Other examples include the United States Department of Agriculture’s plan to buy 11 million pounds of cheese worth $20 million (USDA 2016) to support US dairy farmers. The Overseas Development Institute (ODI) and Oil Change International found that as a whole, G20 nations are responsible for $452bn (£297bn) a year in subsidies for fossil fuel production. Bergin (2016) reported that compensating carmakers in Britain for any post-Brexit tariffs on exports to Europe could see the government hand the companies more money than they need to pay the salaries of all their British workers. For decades British farmers have received subsidies under the EU’s Common Agricultural Policy (CAP). Full Fact (2016) report that the average farmer made £28,300 in subsidies in 2015 and £2,100 from agriculture. Wealthy land owners, such as the Daily Mail’s Paul Dacre, the Queen, a Saudi Prince, the Dukes of Westminster and Northumberland, the Earl of Moray also received subsidies from the CAP (Press Association 2016). Hinkley nuclear power station will have a subsidy worth £30 billion (Ward 2016). George Monbiot (2011) wrote:

 

the Guardian revealed that the government’s subsidy system for gas-burning power stations is being designed by an executive from the Dublin-based company ESB International, who has been seconded into the Department of Energy. What does ESB do? Oh, it builds gas-burning power stations. On the same day we learned that a government minister, Nick Boles, has privately assured the gambling company Ladbrokes that it needn’t worry about attempts by local authorities to stop the spread of betting shops. His new law will prevent councils from taking action”.

 

The Economist (2012), a free market paper, also reports on the US Chamber of Commerce and its lobbying and influence in US politics:

 

“Small firms can get a lot out of the Chamber—its annual small-business summit is well-regarded, for instance. But some feel under-represented: most of the firms represented on the board are large. Others worry that they are being used as pawns. In a letter to a Philip Morris executive just after he took over, Mr Donohue said that small firms provide the foot soldiers, and often the political cover, for issues big companies want pursued, because Congress listens more to them than to big business”.

 

Traynor et al (2014) similarly reported on corporate lobbying in the EU, claiming that there are over 30,000 lobbyists operating in Brussels while Drutman (2015) argues US lobbying is ‘America’s Business’ leading to ‘politics becoming more corporate’.

 

Jamie Whyte argues for a genuine free market, unregulated and free from government, even in the banking sector whereas Ferdinand Mount argued that it would be a ‘brave thing to do’, and it is  “rather terrifying”. Whyte argues however that the market is a mechanism for experiment and trial and thus there is no place for state regulation and subsidy. Banks should be allowed to fail. However, not bailing out the banks in 2008 would have been a brave thing to do, argued Mount, but he thinks ‘free market’ ideology will return.  Luigi Zingales (2012) supports Whyte in arguing that too much intervention creates perverse incentives. The State’s involvement in protecting money lent by the banks, means we have socialised the losses and privatised the gains. Free markets should apply to banks, they should not be bailed out, and government protection of their lending, subsidises the bank’s risks.

 

Neoliberalism, if defined as ‘small state’ and free markets, does not exist. If however ‘neoliberalism’ is understood as a discourse including ideas around individual liberty within free markets with minimal state intervention including cutting welfare programmes  aimed at the ordinary people, then it does. Its function is to reshape society by using the rhetoric of free markets while at the same time controlling certain markets though state intervention. Neoliberalism for the poor, socialism for the rich.

 

We have the data on wealth and income distribution, land ownership, offshore tax wealth, derivative values, corporate subsidies and the connections between the capitalist class executive and the political power elites which includes the military-industrial complex.  We know what money is, that it is not a physical commodity or has material existence in any form whatsoever (Harvey 2008, Pettifor 2017) and is therefore not in short supply. We know that it is now nothing more than a set of social relationships, ‘promises’, and thus is in infinite supply, but it is backed by judicial and ultimately military power. One reason we perhaps do not join the dots is too many of us have swallowed neoliberal ideology that argues ‘free markets and individual effort brings success’ while ignorant of its real effect to cover the actions of Capital which operate in rigged markets.

 

 

What should current neoliberalism look like?

 

The Adam Smith Institute (ASI) (https://www.adamsmith.org) is a free market think tank. It calls itself, “independent, non-profit and non-partisan…(to) promote neoliberal and free market ideas through research, publishing, media commentary and educational programmes”. Their priorities:

 

…are driven by a desire to rid the system of rent-seeking and inefficiencies that destroy wealth, and to create public services that are both innovative and in the hands of the people who use them, not the people who run them”.

 

The use of the word ‘neoliberal’ is interesting because it is not easily clear at first from the website that the ASI wants actually to be as neoliberal as Talbot’s ‘Nightwatchman’ state. It is not immediately obvious at first glance that they would wish to reduce public spending from 40% to 10% of GDP. However, the ASI published a blog on the level of public spending (as a % of GDP) that states that we are stuck with current levels “much as we ourselves would prefer the Hong Kong option”. Hong Kong’s spending ranges from 5.7% in 1960 to 10.9% and in 2015 was 9.15%. Therefore, buried in a blog an aim would be levels of spending equal to the ‘Nightwatchman’. The ASI believes in ‘market efficiency’:

 

  1. Low, simple, flat taxes that encourage investment and innovation, and hence economic growth (OK, need to read upon on that).

 

  1. A voucher-based education system that gives parents and schools complete freedom over how and where children are educated. (Hang on, vouchers, who is paying for that?)

 

  1. A privately-provided, publicly-funded healthcare system where patient outcomes, not NHS wages, are the focus. (what, publicly funded?)

 

  1. Freedom of trade with the world, and a liberal immigration system that is designed to work for migrants and natives alike.(open borders and requires ‘flexible’ labour markets?)

 

  1. A liberalised planning system that lets many more houses be built, so everyone can afford to own their own home. (so, environmental protection to go?)

 

  1. A simple welfare system based around a Negative Income Tax or Basic Income that tops up the wages of the poor and guarantees that work always pays. (basic Income…that’s more like it…something Marx would approve of)

 

  1. Free market money and an end to bailouts of private banks, in all their forms (Yes, nothing for a Marxist to disagree with).

 

 

 

 

The need to ‘rid the system of rent seeking’ echoes Thomas Picketty’s (2014) analysis of current capitalism and Marxist critiques of rentier forms of capitalism. The importance of wealth in attracting rent, is once again asserting itself as wealth grows faster than economic output. The ASI is sounding a bit marxist here.

 

Conclusion

 

If it is serious about a minimalist state and protection only for market transactions then free market/neoliberal ideology ought to be seeking to get private corporate and wealthy landowning snouts out of the State trough. In that, Marxists would agree. A free market should be just that. No bank bail outs, no subsidies for private schools in the form of charitable status; Oil, Gas and Nuclear power to stand on their own two feet; Farmers to earn from agriculture not government handouts; Aristocratic grouse moor owners likewise; Employers should pay what the market bears and not rely on working tax credits; Private health care companies should rely on what private individuals are willing to pay; Train operating companies should pay the full price of running the network and keep all of the profits from passengers while receiving no state funding; social care to be provided by charity, families or private individuals buying from care companies; private citizens should insure themselves for ill health and old age; Schools and Universities should compete in a market for students paid for by their parents or themselves with no state funding or through loans at market rates of interest; the road network sold off and motorists to pay to access; no housing benefit, no unemployment benefit, no sickness benefit, no pension unless paid for by private schemes, no business rates, no corporation tax; Free trade across borders with no tariffs, free movement of people, capital and services.  With the state off your back: “no income tax, no VAT, no money back, no guarantee…Good Bless Hooky Street” in a ‘Del Boy’ economy.  Libertarianism for all. Freedom from the State! Let the market decide!

 

A bit much?

 

The problem with neoliberalism and free market ideology is indeed a Hobbesian one: life could be ‘nasty, brutish and short’ as we compete one with another in a dog eat dog ‘ubermensch take the hindmost’ world.  And there’s the rub. Do they really mean it, or have they not only accepted a role for the state but embraced it for their own ends under the guise of ‘market efficiency’?

Appendix

 

  winning % Turn Out Total who did not vote

at all

Total Electorate

Who voted for

Thatcher 1979 44% 76% 24% 33%
1983 42% 72% 28% 30%
1987 42% 75% 25% 31%
Major 1992 42% 77% 23% 32%
Blair 1997 43% 71% 29% 30%
2001 41% 60% 40% 25%
2005 35% 61% 39% 21%
Cameron 2010 36% 65% 35% 23%
2015 37% 66% 34% 24%

 

 
Figure 1. Voter support for free market discourse. Increasingly it is the case that nearly a third (range 23% to 40%) or more of voters were either apathetic, disillusioned, disengaged or too distracted to bother to give their support for any political party.

 

 

Figure 2.     1900-2010 spending  as % of GDP

http://www.ukpublicspending.co.uk/past_spending

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3. 1996-2017 spending as % of GDP.

 

 

The following two figures illustrates the degree of State involvement in the economy. The spending accounts for about 40% of GDP, leaving 60% going elsewhere. Spending on health, social care and social protection (pensions) accounts for £426 billion, that is over 50% of the total spend. Add £102 billion for education (total now is £528 Billion).

 

Who pays for that? Well, whoever pays Income tax, National Insurance, VAT, Council Tax and excise duties, accounts for £628 billion. What we have is redistribution from the 99.9% to the 99%.

 

‘Neoliberalism’ as rhetoric actually works for 0.01% – the plutocrats, the global capitalist executive, as Henry (2012) argues that anything between $21 to £31 trillion as of 2010 has been invested tax free in about 80 ‘offshore’ secrecy jurisdictions.

 

 

 

 

Figure 4. 2017 UK budget. Spending £802 billion

 

 

 

Figure 5 Revenues. £744 billion.

 

UK Budget:  https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/597467/spring_budget_2017_web.pdf accessed 22 march 2017

 

 

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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.

 

Abstract

 

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.


 

Introduction

 

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 academia.edu 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.

 

Conclusion

 

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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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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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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] http://thebreakthrough.org/blog/2010/10/yalee360_pielkes_iron_law_of_c.shtml

 

Ward, B. (2012) Heartland Institute leak exposes strategies of climate attack machine. The Guardian. 21st February. [online] http://www.guardian.co.uk/environment/2012/feb/21/heartland-institute-leak-climate-attack?intcmp=239

 

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

 

Health and Capitalism again.

Health and Capitalism.

 

Resistance is futile” and if you heard those words uttered by the Borg, it often was. However, that did not deter the crew of the starship ‘Enterprise’ from carrying on resisting. And so it is with our current predicament on his planet. The Borg, for the global population, is the capitalist class executive supported by their political power elite. We could just call them the capitalist class or what Graham Scambler refers to as the “Greedy Bastards”.

 

One issue is the globalised ‘capital surplus absorption problem’ (Harvey 2010) which drives capital across the globe looking for profit and cheap labour. If capital cannot make a decent return it moves on, as it did in Cornwall’s mining regions in the 20th century.

The resistance to the current global capitalist system is legion (Hawken 2009), but it is disorganised, fragmented, unfocused, without a clear plan and often unsure of who or what the real threat actually is. Some of the resistance movement of course would misguidedly seek to replace one form of exploitation and crisis generation with another, but with a kinder social democratic or green face. But, while capitalism exists it never resolves its crises, it merely moves then around the globe.

 

I seek in to cut through the mess of analysis as to why we are heading for continued economic disaster which is in tandem with the ecological one, a disaster in which we are lied to by a feral elite as being ‘all in it together’, while the distribution of wealth remains in very few hands and is then turned to exploiting the planet’s natural and social capital with often deadly results.

 

This analysis has emotional elements to it, given what the science is telling us about the crossing of planetary boundaries, how could it not? It is not however based on an emotional analysis but an attempt to understand how social worlds change and upon what basis current societies are organised. It is a complex interdependence of economy and ideology shaping social relationships, which in turn shape who we are. In the coming together as individuals to trade, work, exchange, distribute, sell, buy, advertise we bring our hopes, values and ideals to that process and in turn that process shapes our hopes, values and ideals.

 

This is an agenda that brings together  ‘inequalities in health’ (Marmot 2010), the social determinants of health, Ecological Public health (Lang and Rayner 2014) and critiques of political economy. It is a realisation that education has failed us on a grand scale. It is a realisation that a few powerful men, and it is usually men, have been bought by men of wealth and have commandeered the levers of power for their own benefit, arguing as they do that it is for our own good. It is a realisation that only when populations wake up to the fact of this old fashioned class war and demand a better way of social organization that we will we have a hope of bequeathing to our children a better world. It is a realisation that well meaning individual action that does not challenge the fundamental driver is at best useless and at worse a distraction from the real battle.

It is a realisation that the war is very possibly already lost and the best we can hope for is managed decline in human welfare before restructuring of the social economy is forced upon us. There remains optimism of the will but pessismism of the intellect.

Some are more optimistic about our ability to use technology and our transformation of economic models. The Global Commission on the Economy and Climate suggest that economic growth and combating climate change can be done together. In their “Better Growth, Better Climate “ Report (2014), the starting point for this “New Climate Economy” has been to see the issue from the perspective of economic decision-makers. By this they mean government ministers, particularly ministers of finance, economy, energy and agriculture; business leaders and financial investors; state governors and city mayors. None of these decision makers will be anti capitalist and probably have been schooled in either neoclassical economics or economic orthodoxy. I suspect few have read deeply or understood Tim Jackson, David Harvey, Steve Keen or Thomas Picketty, let alone volume’s 1 and 2 of Capital. I suggest that capital accumulation and the contradictions within capitalism is the base issue upon which climate change rests. Naomi Klein has recently (2014) linked these two and brought them into the public sphere in her book “This Changes everything. Capitalism vs Climate”.

Health

Upon what is human health based? It is largely social in nature, determined by the social relationships in a material world. No one lives alone and so it is in the coming together in communities and societies that we fashion the determinants of health. There is a biological basis for some individuals, and this may account for 30% of premature deaths. However genetic determinants (e.g. in cystic fibrosis) operate at this individual level and are manifest in a relatively minor way. This is not to deny that for the individual the medical condition is anything but minor, but health on population levels are not determined thus. Even genetic manifestations are at times made worse or better by the social conditions in which the individual finds themselves. Poverty has a knack of making underlying biological problems much worse.

 

Social Conditions and Relations

Marx (1859) wrote “In the social production of their existence, men inevitably enter into definite relations, which are independent of their will, namely relations of production appropriate to a given stage in the development of their material forces of production. The totality of these relations of production constitutes the economic structure of society, the real foundation, on which arises a legal and political superstructure and to which correspond definite forms of social consciousness. The mode of production of material life conditions the general process of social, political and intellectual life. It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness”.

 

In other words, capitalism as an economic system is formed by particular social relationships which give rise to our laws such as private property, our political system and our ideas about how society should be. The current ‘mode of production of material life’ is capitalism in its various forms and is the basis for our social life and our social relationships. Simplistically, this means economic factors – the way people produce the necessities of life (mode of production) – determine the kind of politics and ideology a society can have.

If health is socially determined by social relationships, what are the current forms of social relationships that give rise to certain patterns of health, illness and disease? We know from studying inequalities in health that socio-economic conditions and relative social status determine populations’ health status including measurable outcomes such as life expectancy and the under 5 mortality rate. Other social relationships such as gender and ethnicity also affect health status. However, these are subservient social conditions to the socio-economic in the last instance. Thus material conditions and poverty are prepotent conditions for health. That is not to deny that affluent women and affluent BME’s may also experience ill health disproportionately in certain medical categories. However, the major driver for global health are the socio-economic relationships which are based on a certain forms of capitalist political economy.

Graham Scambler argues that a way to understand health is to see ‘asset flows’ operating throughout the life course:

“The noun ‘flows’ is significant here. People do not either have or not have assets positive for health and longevity, rather the strength of flow of these assets varies through the life- course”. So it is not about the static acquisition of wealth or material deprivation that is at work. It is about what assets flow in and out of people’s lives over the course of their life, and this is particularly important in childhood and older age.

The ‘assets’ are:

biological: your ‘genetic inheritance’, sex, your disabilities, your long term conditions. A healthy child born in Redruth in 1960 starts with good biological assets.

psychological: e.g. your self-efficacy, locus of control, learned helplessness. This same child grows up in social world in which she learns that female roles are pretty much limited, her belief regarding her ability to achive anything she wants is limited by the role models and messages around her. Her ‘self efficacy’ is thus reduced to acting within strict and socially moulded goals. Her self belief does not stretch to being Prime Minister. Her psychological asset is not weak but it is certainly not as strong as a young boy at Eton.

social:  family network, community networks, friendships. All her friends do not pass the 11 plus and so her network ‘learns’ a factory fodder secondary school education hell bent on training the local girls for the local textiles factory. Father drives a bus, mother works part time at the local electronics factory. No one goes to university out of the county. This girls position on the social gradient is not the worse but it is not the best either. Her social asset is low to medium.

cultural, your lifestyle choices such as smoking. Cigarette smoking is very common, all the adults around smoke, it is a rite of passage at school and fags are relatively cheap. A 20 a day habit is soon formed. This is a very weak cultural asset.

spatial: where you live, leafy Surrey or inner city Glasgow? Thankfully Camborne is a rural small town lacking the street and environemental dangers of a Toxteth or Lewisham.

symbolic: status as a ‘chav’ or as member of the elite. Thankfully growing up in rural Cornwall in the 60’s, the word ‘chav’ is not known, the demonisation of the working class has not started and there is no talk of benefit cheats and scroungers as the girl grows, she is spared this symbolic humiliation, but the ‘gippoes’ at Carn Brea are not.

material: income and wealth. As an adult, the girl ‘marries well’, her husband has a decent job and they live in a nice part of town. The house is not damp, they can afford to heat it and provide adequate food for the children.

In addition, Scambler suggests that we need to understand that:

  1. The strength of flow of material assets (i.e. standard of living via personal and household income) is paramount. This links with the material deprivation thesis explaining the link between health inequalities and socioeconomic status.
  2. Flows of assets tend to vary together (i.e. mostly strong or weak ‘across the board’);
  3. Weak asset flows across the board tend at critical junctures of the life-course (e.g. during infancy and childhood) to have especially deleterious effects on life-time health and longevity: a child born with a chronic illness, into the lowest decile of income distribution, in an abusive psychological and social environment, living in damp squalid housing in which both parents smoke, in an area of high unemployment and poor access to health care and a proliferation of fast food outlets, in a culture that demonises ‘chavs and benefits cheats’…….
  4. Weak asset flows across the board, and I daresay strong asset flows across the board, tend to exercise a cumulative effect over the life-course (negatively and positively respectively);
  5. The ‘subjective’ evaluation of the strength of an asset flow can exert an effect over and above any ‘objective’ measure of that flow (e.g. a symbolic asset flow perceived as weak relative to that enjoyed by an individual’s reference group can be injurious in its own right). That is, how we perceive how good or poor our ‘asset’ is, affects us even if that asset is not in itself injurious. This is the social comparison thesis or psychosocial hypothesis.

Scambler regards the material asset flow as vital or ‘prepotent’. Of all assets it is the material conditions of life that underpin much of our health outcomes. In this, Scambler is adopting a Marxist take on health inequalities. To argue that material conditions underpin all other asset flows is not to diminish their importance for health inequalities. This is only highlighting the key point of Wilkinson and Pickett’s The Spirit Level, in that that action on the reduction in income inequality is a precondition for tackling health inequalities.

Danny Dorling (2014) points to the rising levels of inequality and argues that being born outside the 1% has a dramatic effect on a person’s potential – their asset flows – reducing life expectancy, limiting educational and work prospects and adversely affecting mental health. The ‘greedy bastards’ are of course not the 1%, they are part of it, but their wealth puts them more into the 0.01% of income earners.

What are the current dominant socio economic conditions therefore that give rise to the health and illness patterns we note, are affect the asset flows in people’s lives?

 

Political Economy.

A feature of modern capitalism, which in its neoliberal form especially has now gone global, is that it determines in the last instance forms of social relationships that are exploitative and unequal. The material conditions of life are shaped by these unequal and damaging social relationships. Thus, how much land you have to feed your family and where that land is, is determined by systems of private property, commodity prices and the rules of the state. The same goes for water and shelter. The fundamental building blocks of life, including eco systems services, e.g. fresh water, waste recycling, are subsumed within capitalist social relationships. Nature, the air, water, livestock et, upon which we depend has been fashioned into a mere instrument for human survival and development. There is very little ‘nature’ left untouched by human hand. All of nature has been turned into natural capital and is being used up as if it is limitless.

Capitalism has to continue to do what it does because of the ‘surplus capital absorption problem’ (SCAP). As surplus value accrues to the ruling class, those who own and control the means of production, it has to be reinvested or it is lost. Thus capital continually seeks new markets and new profits. It cannot stand still and so it looks to exploit more and more natural capital in the process. The drive for capital accumulation is the engine of this whole process.

When capital comes up against a barrier to this process e.g. strong labour organisations who demand living wages and pensions, it either designs a solution, e.g. strict labour laws that outlaw strikes and unions, or finds other investment opportunities. It takes manufacturing to countries where there is weak, cheap or surplus labour. This is one of the foundational contradictions of capitalism – the capital and labour conflict. An economy that is not returning 3% growth is seen as sluggish and, as we are experiencing in the UK, recessions which result from lack of aggregate demand and lack of surplus capital investment result in unemployment and social unrest.

Capitalism has proved to be dynamic and inventive. It has taken on many forms – mercantile, industrial and recently financial and consumer based. Apologists for capital accumulation argue it is good for societies, pointing to the jobs and wealth created while ignoring the social misery that often follows in its wake and various waves of ‘creative destruction’ as it comes up against barriers to accumulation and then seeks new forms. In this manner whole cities, e.g. Detroit, are nearly laid to waste as old forms of capital accumulation, e.g. car manufacturing, becomes unprofitable and shifts across the globe. In Cornwall, capital fled following its inability to make a profit from mining and engineering leaving a service and tourism sector characterised by low wages and precarious seasonal contracts. Camborne and Redruth are hollowed out towns still trying to recover from the creative destruction unleashed by the forces of globalisation that resulted in tin being cheaper in South East Asia.

Meanwhile whole populations have been ‘bribed‘ by the baubles and cheap credit that capitalism produces which, as the recent credit and consumer led boom and bust has proved, are merely will o’ the wisps. The phrase ‘wage slave’ resonates with many in so called ‘advanced’ societies who are trapped in alienating forms of work ameliorated only by the lures of consumer products and services. The promises of ‘you’ve never had it so good’ turning sour on sovereign and private debt while the ruling class run away with the spoils in ‘Richistan’.

 Wealth

We have heard the mantra “we are all in this together” which is supposed to reassure us that everyone in society is shouldering some of the burden of the consequences of the financial crash of 2008. We also hear that the UK’s debt has to be reduced quickly and that means cuts in public spending. This is an international phenomenon affecting the United States as well as Europe. Many other countries are not quite so indebted. Global capitalism is still working very well in certain localities and everywhere for the capitalist class.

Forbes has been reporting global wealth for 25 years and states that 2011 was a year to remember. For positive reasons. The 2011 Billionaires List breaks two records: total number of listees (1,210) and combined wealth ($4.5 trillion). This amount of money is bigger than the gross domestic product of Germany, one of only six nations to have fewer billionaires that year. BRICs led the way: Brazil, Russia, India and China produced 108 of the 214 new names. These four nations are home to one-in-four members, up from one-in-ten in 2006. Before 2011, only the U.S. had ever produced more than 100 billionaires. China in 2011 has 115 and Russia 101. While nearly all emerging markets showed solid gains, wealth creation is moving at an especially breakneck speed in Asia-Pacific. The region now has a record 332 billionaires, up from 234 in 2010 and 130 at the depth of the financial crisis in 2009. High performing stock markets are behind the surge. Three-fourths of Asia’s 105 newcomers get the bulk of their fortunes from stakes in publicly traded companies, 25 of which have been public only since the start of 2010.

Forbes argues that the reason they track this wealth is because these billionaires have the power to change the world. For example, Telecom billionaire and prime minister Najib Mikati supports the Lebanese government. Ernesto Bertarelli, is now focusing on saving the oceans from eco disaster. Bill Gates and Warren Buffett have already traveled to three continents working to change giving practices among the ultra-rich. This is feudal ‘noblesse oblige’, the power of the divine right of kings by dint of wealth with little democratic control. Meanhwile the UK’s Candy brothers like to boast of their wealth and how little tax they pay in the context where “only the little people pay taxes” and in which the rich are winning the class war.

Meanwhile nearly half of the world – 3 billion people – live on less than $2.50 a day and 80% of humanity live on less than $10 a day (2008 figures from the World Bank Development Indicators).

In the UK, the inequality briefings report that  the richest 1% of the population have as much wealth as the poorest 55% combined; Oxfam report the 5 richest families are wealthier that the poorest 20% combined.

“We are all in this together”. Right.

Green thinking

One way to confront this machine is to get off the consumerist treadmill and hope that through collective consumer choices, i.e. not to buy stuff, that the ruling class will mend their accumulative ways, invest in health, education, the conditions of social life and design products that are ‘green‘ and ‘environmentally friendly’. This is already occurring. The plethora of products from hybrid cars to organic and locally sourced food products indicate that some companies are basing their business models with sustainability in mind. What this does not do however is change the underlying dynamic of the surplus capital absorption problem which demands growth in the economy and the overuse of natural resources.

This means there is a race on between developing goods and services that are carbon neutral and environmentally friendly and the supply of goods that are killing ecosystem services and wreck social relationships through alienating labour and growing inequality. This race occurs within the context of the SCAP which will seek to overcome any barriers to the investment of that surplus value and will not wait until all goods and services become eco friendly. If investment in eco friendly products can be found, and is profitable, capitalism will do so, but it is not fussy in this regard. Canadian tar sands exploitation is an example in which demand for oil and the chance for investing surplus capital to turn a profit cannot be overlooked.

Thus, living the good life runs up against globalised capital accumulation, especially in the form of the subsidized Fossil Fuel industry.

Green thinking is also a minority sport as it is up against other forces as well. The idea of human progress and technological advances to solve our problems runs in tandem with those who have the capital to invest. This also includes some forms of religious ideology, which affirms man’s right to dominate nature and an anthropocentric and dualist world view.

Greens need a critique of political economy or risk being sidelined in the Shire as Mordor advances its deathly grip.

So what?

It is unlikely that human populations under globalised capitalism will stop the SCAP dynamic. They don’t understand it. What they do understand is that there are winners and losers in the current system. If you win, you win big. Many also feel impotent to prevent the investment decisions being made by suits in the financial districts of first world countries. Politicians have let their electorates down or more likely could not deliver as they are merely apologists for the ruling class. Democracy is under challenge, more than ironic given that many are currently dying for a democratic ideal.

Many shrug and say ‘nothing can be done’. They may be right. The ruling class may have too powerful a grip and ‘enjoy’ too much of the spoils to change. Meanwhile the political economy of SCAP produces social relationships that determine our current unequal patterns of health.

To date, not enough people are discussing the underlying dynamic of capitalism that produces periodic crises and which may eventually allow Gaia to take revenge. We are locked into a cluster of high carbon systems underpinned by this capitalist dynamic and we don’t have a key. There is an urgent need to design one but our so called elite Universities are currently so wrapped up in producing technologies for capitalist production and equipping people with skills fit for capitalist purpose that they are ill placed to produce radical thinking, challenges and alternative plans. Education is not the solution, it is the problem. Politics is not the solution it is the problem. Ecology is not the solution it is the problem.

And as for a voice? In the UK it takes a comedian to rattle cages in tandem with a few commentattors such as Owen Jones.

“Philosophers have hitherto interpreted the world in many ways, the point however is to change it”.

That means confronting Capital. Changing the light bulbs ain’t enough and may give a false sense of ‘doing something’.

The ruins of Cornwall’s mines stand in silent testament to the destructive forces of globalisation, mirroring the ruins of people’s lives in the sunken inland towns of Cornwall’s backbone, connected together by a road that fails to take them to the golden reaches of England’s South Eastern metropolis 300 miles way.

So:

  • Join/start an anti capitalist social movement.
  • Use social media to connect for example 38 degrees.
  • Confront your elected representatives in writing.
  • Identify and contact the ‘suits’.
  • Find someone who knows what campaigning is all about and share skills.
  • Focus on your core skills, attributes and role and fashion a response that suits them.
  • Identify a sphere of influence and work within that.
  • Consider direct civic action, e.g. ‘Occupy’.
  • Read and understand the issues.

…or realise that no one gives a toss about any of this, go home and get pissed or pregnant.

 

Climate Change, Health and Capitalism

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

Abstract

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

 

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

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

The Climate change ‘debate’

 

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

 

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

 

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

 

Health Impacts of climate change and the policy response.

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

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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

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.

How to save the NHS?

How to save the NHS?

 

 

In the context of rising demand, and an increasing gap in the budget to meet that demand starting with the £20 billion Nicholson Challenge, the NHS requires some radical changes. One report from the parliamentary Public Accounts Committee, suggested that 1 in 5  NHS Trusts were in financial trouble and bankruptcy was a real option, this despite the NHS having an overall surplus of £2.1 billion in 2012-13. This current surplus may not last, and the seemingly disorganised, costly management and inspection schemes alongside the disintegration of the providers into an ‘any willing provider’ mix of public and private do not bode well for the financial future of the service. The Private Finance Initiative (PFI) schemes have also locked some NHS organisations into costly long term contractual agreements.

 

So, what is the answer? Roy Lilley puts foward some radical solutions but it amounts to his oft quoted phrase “fund the front line, protect it fiercely, make it fun to work there”  and the problems go away.

 

Roy’s answer for Trust Boards:

 

  1. Cull the boards – too many people staffing Trust boards are locked into organisational thinking and theory that has got the NHS where it is. That is to say that although shared or distributed leadership is often discussed in the NHS Leadership Framework, it is often not practiced. Leadership should not be restricted to those who hold designated management roles – success comes from leadership based on shared responsibility recognising that anyone in an organisation can contribute. In Roy’s words, “staff always know best”.
  2. Get staff re positioned as co-owners and partners and have then on key committees and boards.
  3. Get as many women into management as possible.
  4. Change the organisational culture so that pointing out error is fine.

I would add:

  1. Focus on patient safety.
  2. Ensure minumum staffing levels.
  3. Ensure teams work in such a way that every voice matters.

For the NHS as a whole Roy suggests:

  1. Get rid of Monitor totally, it is expensive and has failed.
  2. Get rid of the CQC, it is expensive and it has failed.
  3. Stop financing any NHS initiative that is not front line, that includes things such as the NHS Leadership Academy, even if they are doing a good job.
  4. Scrap the market: health does not pay and the private sector knows it. This means repeal of the Health and Social Care Act 2012.
  5. Consolidate PFI debt, spread it across the NHS.
  6. Insist on a year on year 5% cut in all supplies and pharmaceuticals.
  7. A blanket pay freeze for 12 months.
  8. Scrap the CCGs.
  9. Give capitated population based budgets to Foundation Trustss and vertically integrate primary, community and social care. Let FT’s configure boards of their own choosing.
  10. Invest in doubling the bandwidth and make everything you can web based.

 

Some of these are radical changes, some Trusts are making progress through focusing on staffing levels, listening to front line staff and relentlessly focusing on patient safety. Salford NHS trust engaged staff very early on in their ‘Safely Reducing Costs’ programme. As a result staff came up with the ‘Smart health = Smart savings’ scheme. This involved on a monthly basis ideas being considered, with the best selected for development. Salford also has a ‘Quality Improvement Strategy’ aimed at patient safety. Staff initiated tests of change and senior leaders engaged in weekly ‘safety walkarounds’ . Salford also addressed staffing levels with the BBC reporting the ‘one nurse to 8 patients’ ratio, a level that under no circumstances should staffing levels fall (Safe and Sound – the safe staffing alliance).

 

The question for others in the NHS, seems to be around a lack of leadership at the right levels and ossified organisational cultures and thinking based on ideological commitments to competitive markets in health care provision. Leadership and management too divorced from the real issues front line staff face and a political leadership hide bound to political dogma and the private sector lobby who will benefit from cherry picking health contracts.

 

Making our own histories – we can change things if we want to and are free to.

Musing on the freedom to act in society, and on the nature of capitalism and its pernicious effects upon us, it might do to consider that we are free to change and we are not free to change. Capitalism at once exists and acts and feels like a cage while at the same time does not exist and is also only a product of our own imaginations and our social relationships that we have chosen to engage in. This matters because real lives are affected by the decisions that others in positions of power take, and they take these decisions as if capitalism is immutable, all pervading, inevitable…as a fact of life. This then justifies the use of batons, tear gas and surveillance drones in civil society and in putting down protest, and it justifies fixing the legal, financial and political framework so that big money fulfills big money’s needs.

In response to a recent email exchange I engaged in, a suggestion was made to me that there is a tendency to ‘objectify’ capitalism in many discussions – to make it seem indeed like a cage – a thing that has its own almost material existence and ‘essence’. This means that we may talk about capitalism as if it has objective existence and also a fixed nature. Capitalism is, in Emile Durkheim’s phrase, ‘sui generis’ – ‘of its own kind’. This derives from thinking that capitalist society over time replaces individuals with others, yet the ‘essence’ of society will not necessarily change. Over the course of a few decades, many individuals die and are replaced, however, the society retains its distinctive character. It is a thing of itself existing independently of individuals. An entire society that is built in this manner has its own ‘essence’. It has this ‘essence’ before any individual currently living in it is born, and is therefore “independent of any individual” existing almost as an ‘objective fact.’ We acknowledge this objective existence when we use such phrases as “Society today is worse/better than it was back in the day when…”

Some commentators might use different labels for capitalism. For example ‘casino capitalism‘ or ‘responsible capitalism‘ which reflects thier differing understandings of what capitalist society might be like. This tendency to label and to treat it as an objective fact, however, may overlook the fact that capitalism, like any ism, is dynamic and on the move. Historically that has been true: we have seen mercantile capitalism, industrial capitalism, post industrial or financial capitalism. Nonetheless and however it has been labelled, we must remember that capitalism is not an ‘objective fact’, although it can certainly feel that way especially to those who feel the full force of economic decisions made in far away board rooms.

Capitalism is a dynamic ever changing social system which finds expression and manifestation in human social relationships. The ‘objectivity’ of capitalism is a chimera; we may reify it and miss the essential nature of human decision making and social relationships that underpins it. Susan Strange argued “economists simply do not understand how the global economy works” due to a poor understanding of power and an over-reliance on abstract economic models. In other words, economist are apt to treat capitalism and the working of markets based on a false premise: that there is a objective system that can be understood theoretically using mathematics and a theory of self interested utility maximising rational actors, the ‘homo economicus’ of JS Mill and Adam Smith. To be fair to Smith he tempered this view in his Theory of Moral Sentiments.

What economists often miss is that what we are talking about here is a set of human relationships characterised by an imbalance of power.

“Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past” (Marx). What have ‘we’ been given and transmitted from the past? Anti capitalist sentiment such as some of us in the sustainability or others in the Transition Towns movements express, are confronting Big Oil, and a cluster of high carbon social systems (John Urry) which are based on certain capitalist relations of production. ‘We’ ignore capitalist class relations at our peril. ‘We’ may confront power elites who have made, and are trying to continue to make, history in their own image: how that history will pan out depends on our collective and individual responses to Power, e.g. the Military-Industrial-Security complex, the World Bank, IMF, OECD, G8, Davos, Bilderberg (?), EU and other Regional blocs, the Trioka, the Corporate Class Executive and the Political Power Elite. We, e.g. ‘anti-capitalists’ or the Transition Towns or Environmentalists, are trying to remake history; history as we please, but within a certain socio-political context and power play not of our choosing. We do not have ‘self selected circumstances’ and that is what makes capitalism feel like a cage. Ask yourself: who has the guns?

For an example of circumstances being shaped by the powerful, note how successful the right wing press has been in sowing the seeds of doubt in the population about climate change,  and also for blaming the poor for their position while supporting austerity in the midst of one the greatest transfers of wealth from poor to uber rich (the 0.01%) we have seen, and the movement of private bank debt to sovereign public debt. There is ample evidence that the neoliberal agenda, which unites many of groups mentioned above, are antithetical to a ‘no growth economy’ and to social democracy.  In the West, there is only one game in town: growth based on neoliberal economics.

There are countervailing voices, e.g. Paul Hawken’s ‘Blessed Unrest’,  but some are increasingly despairing, Will Hutton articulates this well.

The post financial crash shifts of 2008 are playing out, but we don’t know in 10 years what this will look like. So far however, report after report shows the wealthy elite entrenching their power and wealth* while the occupy ‘movement’, the indignados, the precariat, come under increasing demonisation, e.g. skivers v strivers, surveillance and crack downs, using para militiary type tactics. The monolith of Capitalism stands while we crash against it.

Capitalist social relationships are backed by ideology and often force. Some argue it is the best of a bad lot, and that like democracy it is the worse system we have except for all the others, that it is the only game in town. Marx himself marvelled at its ability to produce abundance. However, is this really the best we can do? Is this really the best world in the best of all possible worlds? Growth capitalism, and there is no other sort, is leading us towards ecological disaster, while the social determinants of health result in inequalities in health whereby millions die prematurely and needlessly because of our socio-political arrangements.  Many of us bluster and blog and rage and rant and protest, some of us quietly get on with living differently, remaking our social relationships as best we can.

We are free but everywhere we are in chains.

 

*the richest 1,000 persons, just 0.003% of the adult population, increased their wealth over the last three years by £155bn. That is enough for themselves alone to pay off the entire current UK budget deficit and still leave them with £30bn to spare.

An unachievable utopia in nursing practice? Utopia will not be paid for by the ‘Greedy Bastards’

The Politics of Nursing: Care is expensive: get used to it.  

Introduction

By now many nurses will be feeling a mixture of despair and insult they have received following the many reports into poor quality care. These feelings can lead to disenchantment, disengagement and disillusionment with both politics and health care delivery. Jane Salvage (1985) suggested that nurses ‘wake up and get out from under’ and while recognising that for some this past entreaty to engage politically may further entrench those feelings, the need for nurses and nursing to do so has not diminished. As Stuckler and Basu (2010) argue, government policy becomes a matter of life and death as ‘Austerity is killing people’. Nurses are part of the front line in promoting health and caring for those who are ill or living with chronic conditions. Their work is therefore framed by politics and political decisions. The bottom line is that there is a ‘bottom line’ to care, societies prioritise resources depending on their values, however there is not a level playing field in this regard. Care is under resourced, undervalued and often invisible. As millions of people in the UK, and billions across the globe, experience a daily struggle to both give and receive care Nursing must ally itself with the progressive forces which seek to redress the balance forces of power which currently results in gross inequalities in health and poorly funded care provision. In this article I wish to remove the ‘flowers from the chains’ so that we more clearly see what holds us back from progress in care giving.

The Politics of care

This summary of a recent article by Curtis (2013) is worth reading as it sets up what some are experiencing as they struggle to reconcile care and the cultures that surround it:

“Nursing faculty are facing challenges in facilitating student learning of complex concepts such as compassionate practice. There is currently an international concern that student nurses are not being adequately prepared for compassion to flourish and for compassionate practice to be sustained upon professional qualification…..nurse teachers recognise the importance of the professional ideal of compassionate practice alongside specific challenges this expectation presents. They have concerns about how the economically constrained and target driven (my emphasis) practice reality faced by RNs promotes compassionate practice, and that students are left feeling vulnerable to dissonance between learned professional ideals and the RNs’ practice reality they witness”.

A key point made in the article is that of the requirement for strong nurse leadership in clinical practice to deal with those factors that make care and compassion difficult to practice fully. That being said, no amount of good leadership will address the basic problem of the cost of caring: ‘who pays?’ Poor quality care is the fault of the person giving it, personal accountability for neglect and abuse cannot be sidestepped. However, we need to bring our sociological imaginations to bear so that we can more fully understand the antecedents to abusive institutional care. These include poorly funded care provision for a low status Cinderella service.

Too much of the discussion of the failings in care do not take into account the political economy of care in societies and the historical antecedents that have brought us to where we are. Instead, we get discussions around changing ‘cultures’. Reconciling professional ideals to actual practice is very difficult given the organisational cultures many nurses work in, and the almost grudging support given to nurses by the political system set up by what Graham Scambler (2012) calls the Corporate Class Executive (CCE) and the Political Power Elite (PPE). The bottom line, and that is a phrase the CCE recognise, is that care costs money. One of the critiques of the Mid Staffs tragedy was that corporate self-interest was put ahead of patients’ safety (Francis (2013).

There have been many reports regarding the health and social care of elderly people and it seems to be that their needs are outstripping both private and public provision for them. J K Galbraith coined the phrase ‘private affluence-public squalor’ to describe the mismatch between what is resourced in the private sector and the public:

There’s no question that in my lifetime, the contrast between what I called private affluence and public squalor has become very much greater. What do we worry about? We worry about our schools. We worry about our public recreational facilities. We worry about our law enforcement and our public housing. All of the things that bear upon our standard of living are in the public sector. We don’t worry about the supply of automobiles. We don’t even worry about the supply of foods. Things that come from the private sector are in abundant supply; things that depend on the public sector are widely a problem. We’re a world, as I said in The Affluent Society, of filthy streets and clean houses, poor schools and expensive television. I consider that contrast to be one of my most successful arguments”. (interviewed in 2000).

Galbraith first wrote about this process in 1958.

As governments embrace austerity policies, this tendency for capitalism to funnel resources, research and development into goods and services that make a return while ignoring public provision for those things that do not have immediate impacts on improving shareholder value or the price of stocks, increases. Care is seen as a cost and not a benefit to those who decide where the investments should be made. Private care companies will provide care with an eye to the balance sheet. This results in hiring under educated and poorly trained staff who too often lack supervision and development in high patient to staff ratios (Salvage 2012). The NHS is no different, but is also now handicapped by various factors making its provision seemingly expensive for society. While the current (2013) Chancellor states that NHS spending will be ringfenced, the true position is that care straddles both health and social care sector provision and is thus characterised by means testing.  It is accepted fact that our population is ageing with forecast increases in dementia and diabetes, health and social care services will experience increased pressures as demands and frailties rise. The argument is about who is going to pay for the provision of care?

Frail elderly people need a lot of care and that care is expensive. Let us not forget our history – why the NHS was set up (Abel Smith 2007), who struggled to get it in into place and why, and the functions women especially played in the private sphere (Elshtain 1981) of care both for children and the elderly. Modern Industrial society was both capitalist and patriarchal with care firmly in the private domain. No state funding as we would recognise it was provided because this was expensive. Patriarchal attitudes would not define it as ‘proper’ work and so could be left to women. The Parish, Poor laws and workhouses were the backstop for those unable to fend for themselves, for those without the family, and that often meant women, looking after them. The working class had to struggle to get health and education properly funded. Enlightened Victorian philanthropists and entrepreneurs realised that if they wanted workers to keep working then recreation and education had to be provided. This provision was despite the capitalist dynamic for profit, not because of it.

We have come a long way as social democratic pressures finally provided the NHS and Education, as the elites also were won over to the need to provide care. The ‘One nation’ Tories at least understood that a prosperous society had to take care of all of its members, of course there was some self interest in this – we needed soldiers who were fit for the battlefield, and we needed healthy workers for the factories. This is a simplistic history as it is more nuanced than this. However, over the last 30 years or so we have seen reversal of this enlightened social democratic outlook on care and public health and care. The need for care is increasing but this is occurring just when the elites are pulling back from their responsibilities. They look at what state provision will cost for high quality elder care and are frightened.  They also have a visceral loathing of state provision…because it costs them money through taxes they do not want to pay. They say it is because the state is inefficient and anti-democratic, that state provision is the road to serfdom. Suffice to say that the current involvement of the CCE with the PPE is extremely antidemocratic but their right wing press cheerleaders have not spotted it or prefer to ignore it.   Seamus Milne  has eloquently exposed how corporate power is corrupting politics.

The neoliberal capitalist agenda (Crouch 2011) requires the state to pull back from earlier involvement on education and health. The CCE and the current PPE have swallowed an ideology that simply accepts private provision = good, public provision = bad. This is why we are seeing the conditions of an affluent society being characterised by a hugely increasing wealth gap. This agenda also allies itself with patriarchal views on the proper role for women – get back in the kitchen girls and look after the kids…and now, of course, Gran as well.

Austerity is now the smokescreen for dismantling of the state provision for care. Does this mean that lack of compassion is directly related to neoliberal policies?  To accept that is to think in an overly simplistic cause effect relationship. Societies are more complex than that.  Of course poor quality care pre dates capitalism and the NHS, however capitalism (and its often hidden twin patriarchy) sets the agenda and the organisational forms and institutional arrangements in which care takes place. This now means as budgets get cut and savings asked for, nurses will be asked to provide more for less. This has been always the case; nursing work as womens’ work (Hagell 1989) has largely been invisible emotional labour (Smith) which has been poorly paid and supported, instead their rewards have been patronising labels such as ‘Angels’. Nurses know what they need to provide care and they can do it if given supportive organisational cultures and the power to actually direct, organise and manage care properly.

As Roy Lilley argued on nhs.managers.net:

(The Francis report 2013) talks about ‘culture change’. Effectively making the people we have make the services we’ve got, work better. On that basis Francis fails. What we’ve got doesn’t work. Never will.  Think about it; nearly all the quality problems the NHS faces are around the care of the frail elderly. Why? Because the NHS was never set up to deal with the numbers of porcelain-boned, tissue paper skinned elderly it is trying to cope with. The NHS’ customer-base has changed but the organisations serving them have stood still.

and…

“Fund the front-line fully, protect it fiercely, make it fun to work there, that way you’ll make Francis history.”

And there you have it. Do the austerity addicts think it is the proper role of the state to fund the front line. No, they hanker after a US style private provision with the family, the big society volunteers and women to take up the slack. That will not wash in a hospital ward or a care home full with frail elderly patients.

Nurse educators and their students do not work in a socio-political vacuum. However, one would think that they do if the content of curricula and the learning experiences planned are anything to go by. Indeed any discussion around political economy, patriarchy and capitalism is liable to be met with surprise, apathy, disdain apart from those engaged in teaching the social sciences in nursing. I would argue that nursing cannot shy away from addressing these questions. Nurses as women, who experience the requirements to care in both their domestic and public lives, bear the brunt of the demands of a society which needs that care to be done but is unwilling to fully fund it. It might be fair to suggest that since about the 1980’s both feminism and social democratic politics took their eyes off the ball or felt that because progress had been made the struggle was nearly over.  It is not. We need to argue for the social value of care and against privatised individualised provision which falls unfairly on the shoulders of those who often do not have the resources to provide it.

Caring is not sexy – it is not fancy infrastructure projects, it does not make millions at the click of a mouse;  hedge funds and private equity firms don’t crack champagne bottles over the needs of the frail elderly. Care is unglamorous emotional labour, involves often dirty body work, offering little in the way of recognition and prizes – there are no Golden Globes, Oscars or Baftas. There is no end point, no project that is completed and shown off, no bonuses to be earned. ‘Top’ Universities show off their ‘top’ professions: law, medicine, business and science whose courses are oversubscribed due to professional closure and the high salaries they attract. The children of the elite are groomed and public schooled to ensure they attend the ‘right University’ and study the ‘right’ subject while eschewing nursing, which struggles to gain academic credibility and value among society and Russell group elites, while its core concept is seen to require no education at all.

Nurses are in a political struggle whether they realise it or not. For the sake of all us who will require care, don’t let the greedy bastards grind us down

 

 

 

 

 

References:

Abel Smith, B. (1992) The Beveridge Report: its origins and outcomes. International Social Security Review 45 (1-2) pp5-16

Curtis, K. (2013) 21st Century challenges faced by nursing faculty in educating for compassionate practice: Embodied interpretation of phenomenological data.   Nurse Education Today, http://www.nurseeducationtoday.com/article/S0260-6917%2813%2900170-6/abstract

Elshtain, J. (1981) Public Man, Private Woman: Women in Social and Political Thought. Princeton, NJ: Princeton University Press

Scambler, G. (2012) Elements towards a Sociology of the Present. December 6th http://grahamscambler.wordpress.com/2012/12/06/elements-towards-a-sociology-of-the-present/

health and capitalism – a marxist view

Health and Capitalism. 

“Resistance is futile” and if you heard those words uttered by the Borg, it often was. However, that did not deter the crew of the starship ‘Enterprise’ from carrying on resisting. And so it is with our current ‘predicament’ on his planet. The Borg for us is the globalised ‘surplus capital accumulation problem’.  The resistance to it is legion, but it is disorganised, fragmented, unfocused, without a clear plan and often unsure of who the real threat actually is. Some of the resistance movement of course would misguidedly seek to replace  one form of exploitation and crisis generation with another, but with a kinder social democratic or green face. 

I seek in this paper to cut through the mess of analysis as to why we are heading for continued economic disaster which underpins the ecological one, a disaster in which we are lied to as being ‘all in it together’, while the distribution of wealth remains in very few hands and is then turned to exploiting the planet’s natural and social capital with often deadly results.

This analysis has emotional elements to it, given what the science is telling us about the crossing of planetary boundaries, how could it not? It is not however based on an emotional analysis but an attempt to understand how social worlds change and upon what basis current societies are organised. It is a complex interdependence of economy and ideology shaping social relationships which in turn shape who we are. In the coming together as individuals to trade, work, exchange, distribute, sell, buy, advertise we bring our hopes, values and ideals to that process and in turn that process shapes our hopes, values and ideals. 

This is an agenda that brings together the inequalities in health, the social determinants of health and critiques of political economy. It is a realisation that education has failed us on a grand scale. It is a realisation that a few powerful men (and it is usually men) have commandeered the levers of power and wealth for their own benefit, arguing as they do that it is for our own good. It is a realisation that only when populations wake up to the fact of this (old fashioned) class war and demand a better way of social organization that we will we have a hope of bequeathing to our children a better world. It is a realisation that well meaning individual action that does not challenge the fundamental driver is at best useless and at worse a distraction from the real battle. 

It is a realisation that the war is already lost and the best we can hope for is managed decline in human welfare before restructuring of the social economy is forced upon us.  

Health

Upon what is human health based? It is largely social in nature,  determined by the social relationships in a material world. No one lives alone and so it is in the coming together in communities and societies that we fashion the determinants of health. There is a biological basis for some individuals, however genetic determinants (e.g. in cystic fibrosis) operate at this individual level and are manifest in a relatively minor way. This is not to deny that for the individual the medical condition is anything but minor, but health on population levels are not determined thus. Even genetic manifestations are at times made worse or better by the social conditions in which the individual finds themselves. Poverty has a knack of making underlying biological problems much worse. 

Social Conditions

If health is socially determined by social relationships, what are the current forms of social relationships that give rise to certain patterns of health, illness and disease? We know from studying inequalities in health that socio-economic conditions and relative social status determine populations’ health status including measurable outcomes such as life expectancy and the under 5 mortality rate. Other social relationships such as gender and ethnicity also affect health status. However, these are subservient social conditions to the socio-economic in the last instance. That is not to deny that affluent women and affluent BME’s may also experience ill health disproportionately in certain medical catagories. However, the major driver for global health are the socio-economic relationships which are based on a certain forms of political economy.  What are the dominant socio economic conditions therefore that give rise to the patterns we note?

Political Economy.

A feature of modern capitalism, which in its neoliberal form especially has now gone global, is that it determines in the last instance forms of social relationships that are exploitative and unequal. The material conditions of life are shaped by these unequal and damaging social relationships. Thus, how much land you have to feed your family and where that land is, is determined by systems of private property, commodity prices and the rules of the state. The same goes for water and shelter. The fundamental building blocks of life, including eco systems services (e.g. fresh water, waste recycling) are subsumed within capitalist social relationships. Nature (the air, water, livestock etc) upon which we depend has been fashioned into a mere instrument for human survival and development. There is very little ‘nature’ left untouched by human hand. All of nature has been turned into natural capital and is being used up as if it is limitless. 

Capitalism has to continue to do what it does because of surplus capital accumulation problem (SCAP). Because only labour produces value, capitalism involves the expropriation of labour’s surplus value. As surplus value accrues to the ruling class (those who own and control the means of production) it has to be reinvested or it is lost. Thus capital continually seeks new markets and new profits. It cannot stand still and so it looks to exploit more and more natural capital in the process. When it comes up against a barrier to this process (e.g. strong labour organisations who demand living wages and pensions) it either designs a solution (e.g. strict labour laws that outlaw strikes and labour organisations) or finds other investment opportunities (takes manufacturing to countries where there is weak, cheap or surplus labour). An economy that is not returning 3% growth is seen as sluggish and, as we are experiencing in the UK, recessions (which result from lack of aggregate demand and lack of surplus capital investment) result in unemployment and social unrest. 

Capitalism has proved to be dynamic and inventive. It has taken on many forms – mercantile, industrial and recently financial and consumer based. Apologists for capital accumulation argue it is good for societies, pointing to the jobs and wealth created while ignoring the social misery that often follows in its wake. Whole populations have been ‘bribed‘ by the baubles that capitalism produces which, as the recent credit and consumer led boom and bust has proved, are merely will o’ the wisps. The phrase ‘wage slave’ resonates with many in so called ‘advanced’ societies who are trapped in alienating forms of work ameliorated only by the lures of consumer products and services. The promises of ‘you’ve never had it so good’ turning sour on sovereign and private debt while the ruling class run away with the spoils in ‘Richistan’.

Green thinking

One way to confront this machine is to get off the consumerist treadmill and hope that through collective consumer choices (i.e. not to buy stuff), that the ruling class will mend their accumulative ways, invest in health, education, the conditions of social life and design products that are ‘green‘ and ‘environmentally friendly’. This is already occurring. The plethora of products from hybrid cars to organic and locally sourced food products indicate that some companies are basing their business models with sustainability in mind. What this does not do however is change the underlying dynamic of the surplus capital accumulation problem which demands growth in the economy and the overuse of natural resources. 

This means there is a race on between developing goods and services that are carbon neutral and environmentally friendly and the supply of goods that are killing ecosystem services and wreck social relationships.  This race occurs within the context of the SCAP which will seek to overcome any barriers to the investment of that surplus value and will not wait until all goods and services become eco friendly. If investment in eco friendly products can be found, and is profitable, capitalism will do so, but it is not fussy in this regard. Canadian tar sands exploitation is an example in which demand for oil and the chance for investing surplus capital to turn a profit cannot be overlooked.

Thus, living the good life runs up against globalised capital surplus accumulation.  

Green thinking is also a minority sport as it is up against other forces as well. The idea of human progress and technological advances to solve our problems runs in tandem with those who have the capital to invest. This also includes some forms of religious ideology which affirms man’s right to dominate nature and an anthropocentric world view. 

Greens need a critique of political economy or risk being sidelined in the Shire as Mordor advances its deathly grip.

So what?

It is unlikely that human populations under globalised capitalism will stop the SCAP dynamic. They don’t understand it. What they do understand is that there are winners and losers in the current system. If you win, you win big. Many also feel impotent to prevent the investment decisions being made by suits in the financial districts of first world countries. Politicians have let their electorates down or more likely could not deliver as they are merely apologists for the ruling class. Democracy is under challenge (ironic given that many are currently dying for a democratic ideal). Many shrug and say ‘nothing can be done’. They may be right. The ruling class may have too powerful a grip and ‘enjoy’ too much of the spoils to change. Meanwhile the political economy of SCAP produces social relationships that determine our current unequal patterns of health. 

To date, not enough people are discussing the underlying dynamic of capitalism that produces periodic crises and which may eventually allow Gaia to take revenge. We are locked into a cluster of high carbon systems underpinned by this capitalist dynamic and we  don’t have a key. There is an urgent need to design one but our (elite?) Universities are currently so wrapped up in producing technologies for capitalist production and equipping people with skills fit for capitalist purpose that they are ill placed to produce radical thinking, challenges and alternative plans. Education is not the solution, it is the problem. Politics is not the solution it is the problem. Ecology is not the solution it is the problem. 

“Philosophers have hitherto interpreted the world in many ways, the point however is to change it”.  That means confronting Capital. Changing the light bulbs ain’t enough and may give a false sense of ‘doing something’.

  1. Join/start an anti capitalist social movement.
  2. Use social media to connect.
  3. Confront your elected representatives in writing. 
  4. Identify and contact the ‘suits’ 
  5. Find someone who knows what campaigning is all about and share skills.
  6. Focus on your core skills, attributes and role and fashion a response that suits them.
  7. Identify a sphere of influence and work within that.
  8. Read and understand the issues.

…or realise that no one gives a toss about any of this, go home and get pissed. 

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