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.

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.

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.