Thursday, 15 June 2017

Update and interesting article on sustainable development and health

Classified as: update, evidence

(The relevance will be made clear below!)

I was due to submit my thesis on 28 June (two weeks from today!), however I've obtained an extension to 29 September. It's a shame because I'm nearly finished but I just needed some more time to tidy up loose ends and finish redrafting.

One of the 'loose ends' was a review I discussed during stage 3 consultations last year. When I began this research, way back in 2009, there was very little research literature looking at all three factors - health promotion, equity and environmental sustainability - together. It was a new field and people were mainly exploring it in practice; little had been written up in the formal academic literature.

However I mentioned during the consultations that I would try again to do a literature review before I finished the thesis, time permitting. The extension has given me time to complete that task. I will try to put the key findings up here when possible, though it will need to be published before it can be widely used.

There is one article in particular that I found interesting and encourage everyone to look at if they can:

Galvão LAC, et al (2016) ‘The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health’

Revista Panamericana De Salud Publica-Pan American Journal Of Public Health 39(3): 157-165.

(It might be difficult to obtain a copy of the the original article so please feel free to contact me if you need a copy and I will see if I can help.) 

As the title suggests, the authors conducted an overview of systematic reviews to find interventions that would be likely to promote sustainable development and health. The interventions were mainly outside the public health sector, but the findings provide useful information, including about which sectors public health could be partnering with.  

"Sustainable development" is defined as development that "meets the needs of current generations without compromising the ability of future generations to meet their own needs"*, and rests on three pillars: social, economic and environmental. So the evidence is not just about environmental sustainability, but environmental sustainability is a key component.

The focus of the study is of course on low income countries but I think it should have some relevance for health promoters working with low income groups in Australia.

The authors produced a table which I have reproduced in text form below. As can be seen, it supports some of the work currently being done in health promotion, particularly around local food production and housing sustainability. There has been some push-back by the environmental sector, particularly questioning the value of local food production, so it is useful to have some supportive evidence^.

I've highlighted those points that seem most relevant. The evidence on sustainable jobs is mainly drawn from health services so should be relevant, particularly for those who are employed in hospital or clinical settings, and particularly for low paid and casual staff.


“Interventions that facilitate sustainable development and have a positive impact on health from an overview of systematic reviews 1997-2014

Sustainable food production:

  • Agriculture interventions that aim to increase household food production (home gardens, livestock, dairy, cash cropping)
  • Reduction in meat production and consumption
  • Bio-fortification of maize, rice, or wheat
  • Agriculture policies – output prices policies and public distribution system policies
  • Taxes and subsidies
Sustainable jobs (“decent work”)

  •  Enforcement of health and safety regulations
  • Workers’ compensation feature – degree of experience rating
  • Flexible working interventions that increase worker control and choice (such as self-scheduling of shifts or gradual/partial retirement)
  • Organizational changes to shift work schedule – positive for switching to slow to fast rotation, changing from backward to forward rotation, and self-scheduling of shifts
  • Some employee participation interventions (such as employee committees and giving employees more control over their working hours) though these may not protect employees from generally poor working conditions (such as during downsizing)
Sustainable energy use
  • Introduction of electricity for lighting and other uses
  • Improved stoves for cooking and health and/or cleaner fuels for cooking
  • Household energy efficiency measures
Prevention of toxic exposure to chemicals
  • Legislation to band Endosulfan pesticide to prevent fatal poisonings”
Within these overall findings the authors noted that there were also two other interventions that were promising in terms of their potential impact on health:
  • "Drinking water tested for contamination with arsenic and results disseminated to households
  • Organic farming/diet to reduce exposure to pesticides" 
(Galvão et al 2016)
The reviews didn't find that organic diets were necessarily better from a nutritional point of view (although there is ongoing debate on this issue) but that they were promising in terms of reducing exposure to pesticides. Pesticide use in Australia is more controlled than in most low income countries, but it is still widespread in industrial scale farming. Moreover food is also imported into Australia from low income countries, so this seems to be another argument in favour of local fresh fruit and vegetable growing, where done organically.
*World Commission on Environment and Development Our common future (Brundtland Report) 1987 
^ The article mentions "home gardens" as highlighted above, but presumably community gardens would also fulfill the same criteria. It is the combination of local food production, meat reduction, and organic food production that I think both community and home gardens can help to achieve.