Tuesday, 4 March 2014

Healthy Planet conference 2014: Global Health and Justice in a Changing Environment

The climate crisis is a crisis of consumption. This (pace the perhaps too-frequent interventions of one ardent neo-Malthusian) was one of the overriding themes throughout the two days of ‘Global Health and Justice in a Changing Environment’ (henceforth GHJCE – it’s a mouthful), a conference looking at the intersection of environmental change, health and social justice, organised by the UCL branch of Healthy Planet. The speakers at GHJCE highlighted how intensifying patterns of unsustainable, resource-intensive consumption are driving environmental change; however, they also demonstrated that fact that the crisis is one of consumption does not, contra dominant paradigms of behaviour change, make it a crisis of and for individual consumers. Consumption is a function of densely-interwoven patterns of social, political and economic norms, and the transition to a more sustainable society demands collective action to restructure these norms.

This observation should be familiar to any health worker who has looked at the evidence surrounding behaviour change in health promotion. In many nations in the global North, individualism dominates in health promotion; but individualistic interventions haven’t had the greatest of successes. Their benefits are frequently modest and often short-lived, they exacerbate already-severe health inequalities, and can serve to enhance stigmatisation of already-marginalised groups. This approach is neatly satirised in the Townsend Centre’s alternative to the UK Chief Medical Officer’s ‘Ten Tips for Better Health’:

The Chief Medical Officer’s Ten Tips for Better Health
Alternative tips

1.       Don’t smoke. If you can, stop.
If you can’t, cut down.
Don’t be poor. If you are poor, try not to be poor for too long.
2.       Follow a balanced diet with plenty of fruit and vegetables.
Don’t live in a deprived area. If you do, move.
3.       Keep physically active
Don’t be disabled or have a disabled child.
4.       Manage stress by, for example, talking things through and making time to relax.
Don’t work in a stressful low-paid manual job.
5.       If you drink alcohol, do so in moderation.
Don’t live in damp, low quality housing or be homeless.

6.       Cover up in the sun, and protect children from sunburn.
Be able to afford to pay for social activities and annual holidays.
7.       Practise safer sex.
Don’t be a lone parent.
8.       Take up cancer screening opportunities.
Claim all benefits to which you are entitled.
9.       Be safe on the roads: follow the Highway Code.
Be able to afford to own a car.
10.   Learn the First Aid ABC: airways, breathing and circulation.
Use education as an opportunity to improve your socio-economic position.

The Townsend Centre’s Alternative Tips bring to the fore the absurdity of prescriptions for individual behaviour change that ignore the social context that shapes individuals’ capabilities to act upon such advice, and the direct influence that social environment has on their health. But despite these shortcomings, governments have embraced the CMO’s approach in looking at the changes required to combat climate change. DEFRA’s Pro-Environmental Behaviours Framework, for example, provides a set of 12 “headline behaviour goals”. Following the Townsend Centre’s example, the contributions of those present at GHJCE provide us with ample resources to revise this framework in a way that better understands the social context of behaviour change.

Sunday, 17 November 2013

Industry and denial: climate change denialism via social epistemology of science

At Medsin's 2013 National Health Conference in Leeds, Ruth Laurence-King and I ran Healthy Planet's stream session on climate change, health and the fossil fuel industry's role in fuelling the climate change denial machine. This is the text of part of the stream, on the meaning of good and bad science in the context of the IPCC and NIPCC reports.

A few weeks ago, as most of you are probably aware, the UN’s Intergovernmental Panel on Climate Change released part I of its 5th Assessment Report on climate change. The IPCC is a democratic body with participants from over 150 nations, which invites hundreds of scientists from across the globe to participate in constructing systematic reviews of the best evidence on issues of climate change in their area of expertise. The process by which these reports are constructed is laid bare for all to see on the IPCC’s websites, and the peer review process is entirely open – anyone can register to participate in the peer review process. The AR5 WGI report concluded that warming of the atmosphere and oceans was unequivocal, with it being more than 95% likely that human influence had been the dominant cause of observed warming since 1950.

With any luck, fewer of you will be aware of another report of climate change that was released in the past few months. Calling itself the second report of the Non-governmental International Panel on Climate Change (NIPCC), it details a list of grievances with the scientific consensus embodied in the IPCC reports, attempting to review evidence that weighs against the extent of anthropogenic climate change. This report was compiled by 47 authors (35 of them scientists from a variety of fields) working for the Heartland Institute, a libertarian think-tank bankrolled by tobacco, fossil fuel and pharmaceutical companies with a fine tradition of mounting ‘scientific’ resistance to evidence of the dangers of second-hand smoke, the existence of acid rain, and the growing depletion of the ozone layer  - ably assisted in many of these enterprises by Lead Author of the NIPCC report, former rocket physicist S Fred Singer. The NIPCC report finds, in contrast, that CO2 is a mild greenhouse gas that may at most produce a fraction of a degree of global temperature increase, which in any case would probably be beneficial for the world overall.

Tuesday, 22 October 2013

On corporate and aggregate public goods

In a previous post, I toyed with taxonomies of resources to explore the health impacts of different models of ownership. The category of 'public goods', however, went unanalysed beyond the basic definition of a non-excludable and non-rivalrous resource. It's a category, however, that could bear with a rather more fine-grained analysis. It also invites looking beyond the realm of material resources, to less tangible but equally important forms of 'good' (the kinds of thing economists might label 'social', 'cultural' or 'human' capital).

One important distinction between kinds of public good is that raised by an excellent paper I recently encountered by Heather Widdows and Sean Cordell. Some goods enjoyed by a community are such that the total benefit is simply the sum of the benefits enjoyed by all individual members of that community; if one is inclined to believe that costs and benefits may accrue only to individuals, then such is the only kind of sense that can be made of public goods. However, a more expansive conception of the kinds of thing that might be bearers of value opens the floor to another kind of good - where the benefits attach, not to community members, but to the community itself.

Tuesday, 1 October 2013

On relevance, and defending the NHS

So I said I'd write something about the NHS 299 march at the Tory conference on Sunday to go on Sheffield Medsin's blog; this is the result.

Sheffield Medsin and Sheffield Save Our NHS joined over 50,000 people in Manchester on Sunday – including a zombie flashmob, a brass band, and a seven-year old girl with disproportionately large lungs who delivered the most rousing rendition of ‘When they say cut back…’ I’ve ever shouted reply to – to defend a universal health care system owned by the public and run for its health, and to stand in solidarity with health workers across the country facing job losses, and deteriorating working conditions. Those behind the compound perimeter of police and private G4S mercenaries could be left in little doubt that, as the thousands of voices raised in song outside reminded them, they were the 1%; and the 99% outside weren’t going to be ignored.

Not that they weren’t going to try their best to maintain such wilful ignorance. The lack of mainstream media coverage of recent changes to the NHS has been so predictable as to become a running joke amongst those aware of the impacts of cuts and privatisation on the nation’s health, so it’s hardly a surprise that Sunday’s demonstration was widely ignored in many venues – all the more so, since the tory-police-G4S triumvirate conspired to do their level best to prevent coverage. Where there was coverage, some worried that the diversity of people and issues on display served to ‘muddy the message’ of a march ostensibly publicised as campaigning to ‘save the NHS’. The idea, so the argument runs, is that campaigning against fracking, punitive welfare policies, or generally voicing opposition to austerity turns an actionable list of discrete demands into an inchoate expression of general discontent to which it is difficult to formulate a concrete response; these ‘non-NHS’-related demands then distract from the main opposition to the alterations to the organisational structure of the health system.

Saturday, 21 September 2013

An exercise in applications of the salience and representativeness heuristics at CleanMed Europe 2013. II: Ownership

Second of the reflections on CleanMed themes, this time on commodification, production, and alternative models of ownership. 

I’m fortunate enough not only to live in Sheffield, but to have grown up here. With the highest ratio of trees to people of any city in Europe, 61% of my home is what would currently be described as ‘urban green space’. Despite the cultural penetration of this vogueish terminology, the tree-scattered knoll near where I used to live still goes by another, rather older, name; the Common.

It is unsurprising in an era of enclosure that the language of the commons is no longer fashionable. But much of the discussion at the CleanMed Europe conference served to reinforce the principle that central to creating a sustainable health system (and political economy) lies the reinterpretation – or at least a pluralism of interpretations – of the relationship between individuals, society, and the material resources of land and labour.

Friday, 20 September 2013

An exercise in applications of the salience and representativeness heuristics at CleanMed Europe 2013. I: Responsibility

A few reflections on themes in the CleanMed Europe 2013 conference rendered salient by the heuristics and biases that cut the lens through which I viewed it. Some covered in depth, some conspicuous by their absence; many found regularly hanging around the margins of the presentations and debates, never quite daring to step into the limelight.  

The first of these: responsibility. Responsibility – whether being seized or shirked, assigned or misplaced, was always being talked about. Blair Sadler in the Tuesday evening plenary raised the question of employers’ responsibilities for their workers’ health; on Wednesday morning Dr Hugh Rayner regaled us of being in the bizarre situation of having reduced rates of renal failure in his community – and it being ‘his fault’; a rather pessimistic view reported from focus groups suggested that health professionals confronted with the reality of catastrophic climate changed “desperately wanted someone to handle it” – but assumed it would be someone else; rather more hopeful stories throughout told us of the many ways in which groups of health professionals had taken it upon themselves to act. 

One might rather call this two – albeit interrelated – themes; those of backward responsibility (or, whose fault is it that things are the way they are?) and forward responsibility (whose job is it to sort said things out?). Backward responsibility is predominantly a descriptive notion – let’s say that someone is historically responsible for some state of affairs just in case their actions were causally implicated in bringing about that state of affairs (there’s a lot of unpacking to be done there, but leave it there for now). Forward responsibility, meanwhile, is largely normative, both in the sense that is teleological – it describes a desired end to be achieved (‘sorting things out’) – and deontological – in that it makes achieving that end the particular duty of some agent(s). The two, however, are clearly interwoven; but not, I’d maintain, in the ways the dominant model of responsibility suggests. Rethinking that model is an implicit dimension of the radical transformation needed to achieve a more sustainable future.

The centre and the periphery: patient-centred care and the concrete individual

Note: This post was written a few weeks ago, in part intended to advertise the CleanMed Europe 2013 conference that took place over the past few days. Through an abject failure on my part to do anything about posting it anywhere, that never happened. But I thought I might post it here anyway.

Thanks to Izzy Braithwaite for her probably-in-vain attempts to make it slightly more readable; that it's still incomprehensible
is solely my fault.

Would anyone dispute that healthcare systems ought to put their patients first?  The mantra has a near-unassailable status in discussions of the best foundations for healthcare.  The UK’s General Medical Council makes it first amongst the Duties of a Doctor; it provides the title of the Department of Health’s response to the findings of the Francis Report; and it lies (in its more-theorised form, ‘patient-centred care’) at the core of Don Berwick’s recent report into safety in the NHS.  No politician, of any political stripe, would see fit to enter into a debate on health without it taking pride of place in their rhetoric.  I’ve used it myself, campaigning for the priority of “patients before profits”.  Nonetheless, I’ve long had qualms about it.  It took a work of fantasy to figure out exactly why.
During a recent and all-too-brief summer break, I decided to read China MiĆ©ville’s Perdido Street Station. I had harboured the vague intent of doing so for several years,  but a fortuitous alignment of stars and an inability to access any of the books I was supposed to read  in the university library meant I finally did.  As a (somewhat lapsed) devotee of speculative fiction, I’d always expected to find more than simple escapism between its covers; however, I did not expect it to form the nucleus around which those nagging worries about patient-centred care would crystallise.