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.

Pro-environmental behaviours: an alternative framework

 

DEFRA’s headline behaviour goals	Alternative goals
1.       Use water more responsibly	1.       Don’t live in climate-vulnerable countries or vulnerable regions within countries. If you do, make sure it’s in the wealthy regions.

DEFRA’s first goal looks at proper stewardship of our water resources; but another dimension of water management was, unsurprisingly, more on the minds of those at GHJCE – flooding. Andrew Watkinson and Mark Maslin highlighted how flooding embodies a recurrent pattern in the consequences of climate change – those least responsible are those worst affected by the damage. This applies not only internationally – 25% of Bangladesh being under threat from sea level rise, for example – but also within the UK; as Andrew Watkinson showed, the regions of East Anglia most threatened by flooding coincide neatly with those with the highest indices of multiple deprivation. While the distribution of these risks is to some extent a fact of physical geography, our response to them is a matter of political will – and, as Watkinson further observed, we must not overlook the profound injustice that government intervention to compensate for flood damage and mitigate further flooding risks only entered the political discourse when wealthy Thames Valley land and capital was threatened; similar discourse was notable only by its absence when flooding hit Hull and Sheffield. Mala Rao and Ilan Kelman highlighted that there are more dimensions than poverty alone when considering the social justice implications of climate-driven natural disasters, looking at the impact of gender on morbidity and mortality in flooding (where, for example, women and children are up to 14 times more likely to die than men).

DEFRA’s headline behaviour goals	Alternative goals
2.       Use more efficient vehicles	2.       Don’t live in cities designed for cars
3.       Use cars less for short trips	3.       Don’t be prevented from participating in active transport by access costs, disability, or gender norms
4.       Avoid unnecessary flights	4.       Don’t live in cities with such intolerable environments that cheap flights abroad are the only viable escape

  

Rachel Aldred left the conference in no doubt that transport was an issue of social justice; if one image alone could provide sufficient argument for that point, this is it: a city designed for able-bodied, affluent car users, providing an alienating, intolerable lifestyle escapable only by cheap flights to sunnier shores.

She also examined the relationship between gender and active travel in the UK, noting that our cities, where they cater to the preferences of cyclists at all, favour men’s perspectives on what makes cities fit for cycling. The ugly situation described by Dr Aldred is in stark contrast to the potential benefits to be realised from embracing approaches to active travel that look first at the environment we create for it – Freiburg is a prominent example of what can be achieved when we look beyond the individual in trying to reduce our dependence on cars, instead creating cities that do not ensure such dependence.

DEFRA’s headline behaviour goals	Alternative goals
5.       Install insulation	5.       Ensure your government levies tax on the social costs of carbon and invests the proceeds in providing homes fit for sustainable living
6.       Manage home energy usage better	6.       Manage the political economy of energy better
7.       Install micro-generation	7.       Ensure proper support for community renewable energy projects

DEFRA’s goals properly consider the importance of approaching energy production and consumption for tackling climate change, but neglect entirely the obstacles to doing so posed by a broken energy policy. At GHJCE, Bryn Kewley of the Energy Bill Revolution spoke of the absurdity of expecting individuals to invest in the long-term returns of better home insulation when rising UK fuel poverty means fewer and fewer are able to afford to heat their homes at all. He also offered a solution: invest in social housing stock to provide people with insulation, at a single stroke reducing cold-related deaths, energy bills and energy consumption. Others looked at different aspects of energy policy, seeking alternatives to a UK market in which over two decades of liberalisation without concern for the market failures displayed have left us with a situation in which investment in renewable energy R&D has collapsed, the energy production oligopoly is dominated by those companies who profited from the initial privatisation fire sale, and major investment institutions plough their resources into the fossil fuel industry, inflating a carbon bubble whose value is reliant upon resources we know we cannot afford to use. Partial solutions to this situation discussed at the conference included divestment from fossil fuels (as represented by UCL’s Fossil Free Campaign, part of a growing international movement for university divestment from the fossil fuel industry) and learning lessons from Germany and Denmark about intelligent market regulation to support community renewable energy.

 

DEFRA’s headline behaviour goals	Alternative goals
8.       Waste less food	8.       Don’t over-produce food
9.       Eat more food that is locally in season	9.       Don’t let globalisation threaten the sustainability of your diet
10.   Adopt a lower impact diet	10.   Produce and consume as if we all have to live within the means of a single planet

“The only progressive thing Coca-Cola could do is to go out of business.” So spoke Tim Lang, warning the conference of how the public health dimensions of food policy had transitioned in his lifetime from questions of how to produce sufficient food to prevent malnutrition, to how to control its rampant overproduction. He described a supply-driven food market that produces a situation in which it would take 4 earths for all of us to eat like an American (and 2-3 of them to support the EU); and a system of international trade liberalisation policies that spread this market globally, crippling local systems of more sustainable agriculture and diet in the process.

DEFRA’s headline behaviour goals	Alternative goals
11.   Recycle more	11.   Don’t stop at recycling
12.   Buy energy-efficient products	12.   Don’t equate citizen with consumer; don’t equate moral action with responsible exercise of rights to consumption of an unending variety of positional goods

The last objectives on DEFRA’s list come to the crux of the problem; individualistic behaviour change ultimately views individuals as consumers, and the answer to all ills as being the proper exercise of consumer choice. Buy right, recycle the packaging, and you’ve ‘done your bit’. This discourse breeds complacency, a theme touched upon both by Andrew Watkinson and David Pencheon, whether in the 65% of the UK public ‘satisfied’ that they are doing enough by recycling and buying high-rated fridges, or in the doctors “too busy saving patients to save the planet.” It also neglects the systemic issues already discussed. Furthermore, the concomitant individualisation of responsibility carries much the same risks here as it did in health promotion – ineffectiveness, inequality, and stigmatisation. David McCoy of Medact provided a striking illustration of these risks – when the resultant agenda for ‘sustainable development’ will see the eradication of extreme poverty only in another 100 years, and requires a 97.5% reduction in the current carbon intensity ofproduction to stand any chance of keeping to the 2^oC warming threshold, and even then only at the cost of vastly increased inequality (with the resultant damage to health and wellbeing), we need to seek another approach. The GHJCE did not present such an approach, but at least presented some steps that could be taken towards its realisation.