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This blog seeks to discuss the concept of sustainability and its relationship to health. I argue that an understanding of what ‘health’ is needs to change from an individualistic (egocentric), biomedical definition to one that encompasses a more social-environmental (ecocentric) understanding. An individualistic (egocentric) understanding of health decouples the individual from society and the ecosphere and this decoupling results in inadequate preparation of some of us to deal with global health challenges.

Sustainability, with its emphasis on the ecosphere, recouples the individual to the environment. This matters because the challenges to human health on whole population levels require a paradigm shift to enable adaptation and resilience to changing environmental circumstances.

Before defining sustainability there is a need to briefly address three related concepts: ecocentrism, the ecosphere and egocentrism.

 

Ecocentrism is based on valuing ‘nature’, the ecosphere, and places humanity as subservient rather than as dominant and in control.

The Ecosphere refers to the air (atmosphere), the oceans (hydrosphere), the land (geosphere) and all life forms (biosphere).

Egocentrism is a system of values that puts the individual human at the centre of ethical discourse, there is a tendency to ignore society and the ecosphere.

 

‘Sustainability’ as a concept is not new. Eric Schumacher in 1973 had argued that current economic models resulted in inefficiencies and environmental pollution while the earth’s finite natural capital resources were being used without too much thought for the future. The increased global concern with climate change/global warming has brought it back into the spotlight for the general population.

A problem is an egocentric paradigm which values the needs of humanity over the ecosphere while not understanding that the two are indivisible.

We cannot have healthy lives without a healthy planet.

 

The fact that many of the global elite, and the global middle class, do experience a healthy life despite environmental degradation does not negate that statement.

 

Sustainability can be defined as the ‘capacity to endure’. It is ‘the potential for long-term improvements in human well-being, which in turn depend on the wellbeing of the natural world and the responsible use of natural resources’ (definition from Wikipedia). Although this seems straightforward O’Riorden (1985) commented on the difficulty of defining sustainability, describing its definition as an:

Exploration into a tangled conceptual jungle where watchful eyes lurk at every bend”.

Spedding (1996) argued that there is a

remarkable number of books, chapters and papers, that…use ‘sustainable’ or ‘sustainability’ in the title but do not define either term”.

Spedding goes on to argue, in an attempt to explain sustainability, that it must be based on: 1) resources that will not be exhausted, and 2) it must not create unacceptable pollution.

One of the most oft-quoted definitions and one to which we will return below is: ‘Sustainable Development: ‘is development that meets the needs of the present without compromising the needs of future generations to meet their own needs.’ (WCED 1987). However, definitions do not challenge the ‘right’ of humanity as a separate dominant entity to extract and exploit nature, only to do it without causing long term harm. There is therefore a great deal of thinking and discussion to be had in trying to understand and clearly communicate exactly what we mean by the term. However, we may argue that human health and wellbeing is self-evidently connected to the continuance of the ecosphere as a hospitable environment and in accepting this connection we must value the ecosphere (ecocentrism).

There is a suggestion of a global environmental (Hamilton 2010) and health (Costello et al 2009) crisis. Despite global warming deniers (Philips 2007, The Great Global Warming Swindle 2007), the Intergovernmental Panel on Climate Change (IPCC 2007) report makes it clear and based on conservative estimates what our challenge is. If the global community does business as usual, the future may be bleak for humanity. Even if global warming turns out to be exaggerated and the deniers proved correct, the alleged depletion and despoiling of the environment would render the discussions around the best way to deliver health irrelevant.

In ‘Climates and Change’ the UK Public Health Association (UKPHA 2007) argues that issues such as pesticide use, ozone depletion, acid rain and Chernobyl have all highlighted the threat to the ecosphere. Sinclair’s (2009) contention that this is so, is based on reports such as the UN Conference on Environment and Development (1992), the IPCC (2007) report, the Royal Commission on Environmental Pollution and the World Wide Fund for Nature’s (2007) report (all quoted in the UKPHA’s report). If we assume the crisis to human health (if not our continuing existence) is very real, it could therefore be argued that healthcare workers need to address concepts that are otherwise alien to them.

Sustainability and Global warming may not have been normally seen as health issues, but less than moment’s reflection surely establishes that they are. Further, the Department of Health (2008a, 2008b), the UKPHA (2007), International Council of Nursing (2008), British Medical Association (2008, 2011) and the World Health Organisation (2006) all have highlighted this as an issue. Therefore returning to asking the question: ‘what does sustainability mean (and what may be the links to health?)’, Fiona Sinclair and David Hall present two perspectives (among many). The Brundtland Report (WCED 1987) may have put the global economic system largely unchanged at the heart of its understanding but this approach may be seen as no more than ‘greening the consumer machine’. Sinclair is arguing for a far more radical approach. Hall, however argues that business is addressing green issues without the need to radically alter lifestyles.

In ‘What is Sustainability’ Fiona Sinclair argues:

Sustainability is…not earth shoes, organic eggs, hybrid cars, carbon credits, hemp clothing, a green Apple Mac book™, consumer co-ops, E85, B20, compact fluorescents, recycling bins or reusable shopping bags. All these by products of the consumer lifestyle are predicated on the natural world supplying resources. Capitalism goes shopping in the cavernous belly of mother earth seemingly blind to the fact that the store is running out.”

Thus, Sinclair points to a consumerist lifestyle at the heart of the matter and further argues that the Brundtland report is fundamentally flawed:

“…the Brundtland Report… set(s)……a precedent which links sustainability…(with) the global marketplace. As a result economics has become one of the pillars with which to define sustainable outcomes

Brundtland, she argues, supports the idea of the People/Profit/Ecosphere triad whereby the assumptions of global markets as a foundation for human development and sustainability are not shaken. The quest which flows from this analysis is to ensure that the markets operate to provide a sustainable future. Consumerism is to become green.

Sinclair argues that profit should be replaced by a global consciousness that accepts that we are interconnected, that environmental degradation is a very real and present danger to continued existence (ecocentrism). The markets in this scenario cannot provide the answer as their primary purpose is for profit and the continued exploitation of a dwindling resource.

Global consciousness enables us to see effects right in our own backyards and therefore make decisions that instigate solutions with immediate results. It’s that local/global thing granted, but it really is very important that we get it, because if we can’t see our own complicity in all the global destruction that’s going on when it’s right in our faces, we will never understand the consequences of our actions further afield. We will never understand how that early morning cup of coffee unites us with a farmer in Ecuador unless we map the route back to ourselves”.

David Hall (2007) takes a different tack to say the least. He argues:

In slashing the price of light bulbs, we have shown how green consumerism can work”.

Hall starts by quoting his challengers Mark Lynas (2007) and George Monbiot (2007): ‘Lynas argues that, as high-street chains rush to go green, the message to customers is that “all you have to do to save the ecosphere is shop”. This “green consumerism” is dangerous, he says, as it is “difficult to see how consuming more of anything can help us save the ecosphere … The point is to consume less – and no one’s going to make any money from that.” Covering an impressive range of issues, from advertising to carbon labelling, supermarkets and offsetting, Lynas quotes George Monbiot’s memorable put-down, “No political challenge can be met by shopping”, before coming to the depressing conclusion that “clearly a lot more work remains to be done”’. However he goes on to state:

By caricaturing this business response as “more shopping”, however, much positive work is misrepresented. When it joined our campaign, Tesco made a commitment to sell 10 million energy-efficient light bulbs this year (up from 2 million last year), and has slashed prices and transformed its range in order to do so. How can that be a bad thing when a single low-energy bulb saves on average 11kg of CO2 and £8 in energy bills per year? We cannot afford to stick to old divides. If defeating global warming requires us to defeat global capital too, I would suggest we all give up now and start building our arks. But if we can harness the power of a Tesco or an M&S to our cause, we may just have a chance of keeping our heads above water.”

Thus, far from being the cause of the problems the global consumer is to be aided in preserving and sustaining the ecosphere by corporations.

Sustainable health has another face. An expression of sustainable health may be seen in the flight from medicine towards alternative and complementary therapies. ‘Sustainable Health’ a UK based organisation (see http://www.sustainablehealth.co.uk/) uses ‘sustainable’ as a ‘hooray’ word (who is against sustainability?) to attract customers to use their products and services. Their website makes it clear what sustainability means:

We offer treatments in Acupuncture, Ear Acupuncture Aromatherapy, Raindrop therapy, Reiki, Herbal medicine, Indian head massage, Counselling, Shiatsu, Sound healing, Crystal healing, Breathwork, Reflexology, Astrology, Self-Development, Qi Gong, Meditation and Native American medicine”.

 

Not all of these therapies have an evidence base of course, but other than that they also conceptualise health from an egocentric perspective. It may be a harsh criticism to note that the social-political and environmental dimensions are missing as these therapies are not about that. What it does illustrate is that sustainability can ‘mean all things to all (wo)men’ and can be used to rally the troops.

Implications for health care. From an egocentric perspective, an individual’s health is not connected directly to others or the ecosphere. One person’s health may be in an optimal state regardless of the environment, therefore at the locus of the individual, health can be decoupled from the environment. From an ecocentric view, the environment is coupled to the individual, they are seen as one and the same, then individuals cannot be healthy by definition if the environment is despoiled. Sinclair’s approach to sustainability would have us make the connections between our personal lifestyle choices and the impact this has on global resources, re-coupling the individual and the environment. Therefore it moves the focus on from health and healthcare based around treating individual illness and disease (biomedical egocentrism). It is a call to understand health in its widest dimensions, that individual health is inextricably linked to individual, social, political and economic and environmental decisions which accepts that the ‘State of the World’ is as important as an individual’s health (ecocentrism). The ecosphere does not need us, but we most certainly need the ecosphere. Sinclair does not explicitly argue that rejecting a consumerist lifestyle is as healthy for individuals as it is for the ecosphere but implicit in this approach may be the assumption that less than optimum health for people may actually be beneficial for the ecosphere. How may this be? On the plus side, selling one’s car and using a bicycle will have benefits (all other factors being equal) for both ecosphere and the individual. However, rejecting the products of the pharmaceutical industry and relying on ‘traditional’ herbal remedies may have serious negative health consequences for the individual. The ecosphere benefits from having less non-renewable resources being used, but the individual may find life expectancy reduced.

How much of our current lifestyles based on the production of goods and services need to be sacrificed before we experience a health threat? It has to be noted (McKeown 1976) that increases in life expectancy in the developed world has resulted from the benefits of a rise of general standards of living, environmental improvements and nutrition facilitated by the global markets (Ben-Ami 2010) that are criticised. We are healthier in the main than our great-grandparents. The issue is whether this increase in life expectancy has been bought at the expense of the environment. The question remains whether global capitalism can continue to produce health gains for a world population of nearly 9 billion? Schumacher (1973) argued 20 years ago that it cannot. Sinclair, and many others (Orr 2004, Jackson 2009, Porritt 2009, Hamilton 2010) agree.

There may be alternatives, Cuba’s health care system shows what can be achieved without applying market capitalism (Carrol 2007). However this is based on certain philosophical and political assumptions that are difficult to export. Global and environmental consciousness (ecocentrism) may be an ideal, an ideology to be achieved in some utopian future, so there is a need to show evidence that 7 billion people currently are interested in anything other than development along consumerist lines. Pielke (2010) argues that there is an iron law of climate policy: when economics comes up against emissions reductions then economics wins. This may apply to changing to sustainable lifestyles as people will not respond if the cost is too much. In ex US president Bill Clintons’s words “Its the economy stupid.” Getting individuals in western societies to change consumption habits to protect the environment may be difficult enough, it may prove an impossible challenge to persuade China and India that the path to development involves less not more (Pielke 2010), especially as the ‘brand leader’ of consumer capitalism, i.e. the USA, seems unwilling to do other than to green its products while ignoring gross inequalities which has huge impacts on a range of health and social problems (Wilkinson and Pickett 2009). Hall’s response is that business is attuned to offset the more damaging effects of its activities. The World Business Council for Sustainable Development (WBCSD 2010) agrees. Both suggest that current healthy (longer) lives can be sustained if we make adjustments to lifestyle and consumer choices rather than undertake a radical overhaul of the whole economic system.

There are of course objections to this model (NEF 2010. Jackson 2009, Hamilton 2010). Those who wish for ‘business as usual’ are putting their faith in human exceptualism (and are egocentric) and technological fixes (Ben-Ami 2010) and may be downplaying the real toll of current consumer demand in terms of environmental degradation. Affluence for billions while other billions live on less than $10 a day and faith in technology masks very real problems. The challenge is to develop an individual and environmentally healthy lifestyle that does not draw upon more resources than can be renewed, but which harnesses the benefits of development to prevent a new dark age from descending. The decoupling of individual health from the environment makes this challenge more difficult. Healthcare professionals need to reconnect and advocate for a changed paradigm and for lifestyles that are sustainable and healthy.