Global Health and Justice in a Changing Environment

Alistair Wardrope

The climate crisis is, first and foremost, a crisis of over-consumption.   This was one of the overriding themes of the ‘Global Health and Justice in a Changing Environment’ conference this weekend.  This conference, organised by the UCL branch of Healthy Planet UK, looked at the intersection of environmental change, health and social justice. 

The speakers highlighted how intensifying patterns of unsustainable, resource-intensive and inequitable consumption are driving global environmental change.   They also demonstrated that although the crisis is primarily about consumption does not, despite what some dominant paradigms would leave us to believe, mean the solutions are all in the hands of individual consumers. Consumption is a function of interwoven social, political and economic norms, and the conference showed that the transition to a more sustainable society demands collective action to restructure those norms.

This observation should be familiar to anyone who has looked at the evidence on behaviour change in health promotion. In many nations in the global ‘North’, individualism dominates in health promotion - yet individualistic interventions have largely been unsuccessful.  As Daniel Goldberg has highlighted, their benefits are frequently modest and short-lived, they exacerbate already-severe health inequalities, and – through ignoring the societal factors that influence patterns of disease - can increase stigmatisation of already-marginalised groups.

This individualistic 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 

1.  Don’t smoke. If you can, stop. If you can’t, cut down.

2.  Follow a balanced diet with plenty of fruit and vegetables.
3.  Keep physically active. 
4.  Manage stress by, for example, talking things through and    making time to relax. 
5.  If you drink alcohol, do so in moderation. 

6.  Cover up in the sun, & protect children from sunburn.

7.  Practise safer sex.
8.  Take up cancer screening opportunities.
9.  Be safe on the roads: follow the Highway Code.
10. Learn the First Aid ABC: airways, breathing and circulation.    

Alternative tips 

1.  Don’t be poor. If you are poor, try not to be poor for too long. 
2.  Don’t live in a deprived area. If you do, move. 
3.  Don’t be disabled or have a disabled child.
4.  Don’t work in a stressful, low-paid manual job.

5.  Don’t live in damp, low quality housing or be homeless.
6.  Be able to afford to pay for social activities and annual holidays. 
7.  Claim all benefits to which you are entitled. 
8.  Don’t be a lone parent. 
9.  Be able to afford to own a car. 
10.  Use education as an opportunity to improve your socio-economic position.  

The Townsend Centre’s Alternative Tips highlight the absurdity of prescriptions for individual behaviour change that ignore the social context.  It is the social context which shapes people’s capacity to act upon such advice, and such prescriptions also ignore the direct influence that the social environment has on health. 

Yet our governments have embraced a similarly individualistic 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 the Healthy Planet conference this weekend provide us with ample information to revise this framework in a way that better understands the social context.

                            Pro-environmental behaviours: an alternative framework

DEFRA’s first behaviour goal looks at proper water resource stewardship, but a rather different dimension of water management was, unsurprisingly, more on the minds of those present at the conference – flooding.   Andrew Watkinson and Mark Maslin highlighted how flooding embodies a recurrent pattern in the consequences of climate change – those least responsible are often those worst affected. 

DEFRA’s headline behaviour goals

1.       Use water more responsibly

Alternative goals
 
1.  Don’t live in climate-vulnerable countries or vulnerable regions within countries. If you do, make sure it’s in the wealthy regions.

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 in a highly visual way (see images, left), 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 about physical geography, our response to them is a matter of political will – and, as Watkinson further observed, the need for government intervention to compensate for flood damage and mitigate further flooding risks only started to move up the agenda when wealthy Thames Valley land and capital was threatened; similar discourse was notable only by its absence when flooding hit Hull and Sheffield.  This is a profound injustice which we must not overlook.

As Mala Rao and Ilan Kelman highlighted, there are many 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, worldwide – although in some developed countries this pattern may be reversed, again due to gender stereotypes and different cultural expectations).

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Whose mobility, how?

DEFRA’s headline behaviour goals

2.       Use more efficient vehicles

3.       Use cars less for short trips

4.       Avoid unnecessary flights

Alternative goals

2.       Don’t live in cities designed for and dominated by cars, which make walking and cycling unpleasant and unsafe.
3.       Don’t be prevented from participating in active travel by access costs, disability, or gender norms.
4.       Don’t live in cities with such intolerable environments that cheap flights abroad seem the only means of 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, her photo of a Ryanair advert over a dangerous, unpleasant inner city highway (right) was 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 lead to such dependence.

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Energy & fuel poverty

DEFRA’s goals do consider the importance of approaching energy production and consumption for tackling climate change, but entirely neglect the obstacles to this posed by a broken energy policy. 

DEFRA’s headline behaviour goals: Energy 

5.       Install insulation 


6.       Manage home energy usage better

7.       Install micro-generation

Alternative goals: Energy

5.       Ensure your government levies tax on fossil fuels in relation to the social cost of carbon emissions, and invests the revenue in providing home insulation for people in fuel poverty
6.       Vote in a government who will manage the political economy of energy better.
7.       Call on politicians to provide meaningful support for community renewable energy projects    

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 simple and appealing solution: invest revenue from the carbon tax in social housing stock to provide people living in fuel poverty with better 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 and a lack of concern about externalities have been dominant themes.  This has resulted in investment in renewable energy R&D having collapsed, the energy production oligopoly being dominated by those companies who profited from the initial privatisation fire-sale, and most if not all major investors 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 a workshop delivered by UCL’s Fossil Free Campaign, part of a growing international movement for university divestment from the fossil fuel industry) and lessons from Germany and Denmark about intelligent market regulation to support community renewable energy.

“The only truly progressive thing Coca-Cola could do is to go out of business.”

So said Tim Lang, warning the conference how 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 planets 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:

8.       Waste less food 


9.       Eat more food that is locally in season

10.   Adopt a lower impact diet

Alternative goals:

8.       Don’t support government policies that lead to over-production of food and prevent 'waste' food from supermarkets/restaurants from going to those in need.
9.       Don’t let globalisation undermine the sustainability of your diet
10.   Produce and consume as if we all have to live on a single planet and respect planetary boundaries

Buy right, recycle the packaging, and you’ve 'done your bit’. 

The last objectives on DEFRA’s list come to the crux of the problem: a focus on behaviour change views individuals primarily as consumers, rather than citizens, and the answer to all ills as being to provide more information and then to enable the unrestricted exercise of consumer choice.  

This approach breeds complacency, a theme touched upon by both Andrew Watkinson and David Pencheon, whether in the 65% of the UK public who feel they are doing their bit for the environment, by recycling and buying energy efficient fridges, or in the doctors “too busy saving patients to save the planet”.

DEFRA’s headline behaviour goals:

11.   Recycle more 

12.   Buy energy-efficient products    

Alternative goals 

 11. Don’t stop at recycling: it's a much more transformational change that is needed,
12. Don’t equate citizens with consumers, or doing the right thing with buying more and more things - energy-efficient or otherwise.

It also neglects the many societal issues already discussed.   Furthermore, this individualisation of responsibility carries much the same risks here as it does in health promotion – ineffectiveness, rising inequality, and stigmatisation. 

David McCoy, the current chair of Medact, provided a striking illustration of these risks – showing us why an agenda for ‘sustainable development’ based on the neoliberal argument that 'a rising tide lifts all ships' would see the eradication of extreme poverty only in another 100 years.  

Moreover, tackling poverty through attempts to promote continued economic growth across the board, as opposed to a greater focus on wealth redistribution, requires a  97.5% reduction in the current carbon intensity of production to stand any chance of keeping to the 2C warming threshold.  Even then, this would be at the cost of vastly increased inequality (with immense resultant damage to health and wellbeing, and to societal cohesion).  It is clear that we need to seek another approach. 

The 2014 Healthy Planet conference did not present such an approach in its entirety, but presented some steps that could be taken towards it.  The rest of the story is up to us.



Contact: [email protected]

Alistair is a current medical student at the University of Sheffield, unable to sever ties with former life in physics and philosophy, writing his blog, Unprincipled: bioethics against individualism, which is chiefly on health care ethics with a consequentialist/communitarian/feminist-allied flavour; occasional musings on related issues in philosophy of medicine.