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.

Economic rationalism in Canberra (1992)

Twenty five years on, I've been reading Michael Pusey's book above at last. Course everyone talked about it when it came out, and I picked up some of the ideas, but this is the first time I've read.

Wish I had read it then. It's still pretty topical though. Here are some of my notes:

The economic rationalists in Canberra saw "the system" as a market economy and society as its environment (p 200) "in terms that relegate society (if such a thing exists at all) to just another dimension of the biosphere"

Pusey is not making a feminist analysis (although he acknowledges this possibility on p 202: "Women will say, with some reason, that it is a patriarchal and therefore a hierarchical family ....[of] members ... engaged in their work of demoralising and depoliticising all those residues of social life ... that have yet to be absorbed into the system")

- but his description fits wellvwith the insights of ecofeminists such as Carolyn Merchant, and mirrors the attitudes of 17thC enlightenment 'men of science' who saw themselves as superior to the subordinate sphere of 'nature' and unpaid caring work, and also the lower orders who provided the labour force for emerging capitalism

Women now move back and forth between the world of unpaid caring and the world of paid work, where, like less educated or racially 'othered' men, they are more likely to provide the 'workforce' than the 'management'. This is often thought to be a recent development but in fact the idea of women as a subordinate, 'reserve' or lower paid workforce is historically quite old.

Pusey goes on to say that for the economic rationalists: "In fact, the whole of society has become a generic 'externality' ... " (p 200). He refers to Luhmann's view of systems which are closed, self-referential and " 'autopoietic' " p 201

For the economic rationalists "society per se is incoherent and it is therefore dependent on an extrinsic economic logic of coherence (formal exchange through the market)" (p 201)

... [and]

"rationality" becomes "reducing an ever broader array of 'material uncertainties' to the purely formal and self-referential logic of money" (p 201-2)

Refers to "new scientism" on p 203

Talks about "homology with the " 'military mind' " and "strategy" against the opponent,  which is society, on p 204

Though later in this section he later discusses assumptions about how society is "reproduced" on p 204, without discussing reproduction as procreation! (Not much feminist consciousness there)

It reminds me of a radio program I heard years ago when someone (I wish I could remember who it was) was psychoanalysing economic rationalism as being like the theories of a teenage boy, who is just beginning to realise how emotionally complicated and risky the adult world is, and wants to reduce it all to something simple with no emotional risk (I'm probably not doing it justice).

Well better finish it now. Very interesting analysis.

I wonder if there has been much feminist analysis of economic rationalism (or neoclassical economics, or neoliberalism, which all seem to be descriptions for the same thing, although neoliberalism is s broader term)? It seems so much like a reaction against the achievements of feminism in the 1970s and 80s (eg anti discrimination acts) but I don't think I've ever seen it analysed that way.

'Natural' or 'non-human' - problems with terminology

I'm working on a final lit review, looking at one of the underlying questions of my thesis: are there commonalities between promoting equity and promoting environmental sustainabiliy?

The answer so far in the thesis is an ethical one, around the 'ethics of care'. This has been a position in both health promotion and the environmental movement for many years: care for others, care for the earth.

However I'm also trying to look at it in terms of logic and evidence, particularly around: are there common causes for inequity and environmental degradation? Are there synergies in addressing both together?

The question for inclusion in this final lit review (using terms: 'health promotion' OR prevention AND equit* OR 'social inclus*' AND environment* OR 'climate change') is:

Does the research or intervention in the article seek to promote environmental sustainability as well as health and equity benefits?

That's proved to be the defining question. Nearly all the articles that have come up are about promoting health (or at least preventing illness - another contentious issue that I won't go into here although I think it is important) and addressing inequalities (even though inequalities and inequities are not clearly defined, but I've pointed that out throughout the thesis so don't need to explore it again here). However many of them don't appear to be promoting environmental sustainability.

I've included in the thesis a discussion about what environmental sustainability means. I looked at a range of definitions and the best one I found was this:

"meeting the resource and services needs of current and future generations without compromising the health of the ecosystems that provide them,
…and more specifically,
as a condition of balance, resilience, and interconnectedness that allows human society to satisfy its needs while neither exceeding the capacity of its supporting ecosystems to continue to regenerate the services necessary to meet those needs nor by our actions diminishing biological diversity."

(Morelli 2011)

That seemed the best one because it addressed the 'thinking like a planet' issue raised by Joni Seager in 1993. (I have just found a rather disturbing thing. As far as I know, Joni Seager should be credited as the author who used this phrase first in 1993. But if you google it, the person who comes up is a male author called J Baird Callicott, who wrote a book by that name in 2014. I will try to follow this up later)

In the lit search one of the problems was that health promoters use the term 'environment' frequently and in a broad way, including when they only seem to mean social and built environments. I tried narrowing the search by using terms such as environmental or ecological sustainability and variations, but that excluded too many, reducing lists to two or three records. So I've had to do it through reading abstracts in terms of my question above.

However that's revealed some grey areas: for example should environmental health issues (eg issues like mining or asbestos) be included when the author seems to be addressing them only in terms of the impact on human health rather than a broader concept of environmental sustainability? I've tended to include them so far, but then thought, why aren't I including tobacco smoke, or environments that restrict physical activity? Common sense says those things are not really 'environmental' issues in the sense I'm talking about, but why not?

I've come to the conclusion that this is about the questions of thinking like a planet (as part of the ecology) rather than just as a human. It could be addressed by using the term 'natural environment' but that falls into the fallacy of the nature/culture dichotomy ('man' vs 'nature' etc). Human beings are part of 'nature' or the ecology, we are not separate from it, so social and built environments are legitimately part of the 'environment' or 'ecology'. They just don't compose the whole of it.

So I've come to the conclusion that in order to meet my definition of environmental or ecological sustainability, as in Morelli's definition above, authors need to be also thinking about the 'non-human' parts of the environment or ecology as well as the human parts. So they can't just be thinking about the environment in terms of human needs (human health impacts), they also have to be thinking about the needs of 'non-humans' - other living species and other material things (like that recent case in New Zealand about the 'rights' of a river).

I don't think I'll be able to use this to exclude articles by looking at abstracts, and even when reading full texts I think if I used it as an exclusion criteria, I'd end up with very little literature, but I think I may be able to distinguish articles on this basis to some degree at least in the review. Interesting.

Pity that 'non-human' is such an inelegant term, but I can't think of a better one.

action and advocacy at all levels?

A thought while reading about a youth community empowerment study (Delp, Linda ; Brown, Marianne ; Domenzain, Alejandra ‘Fostering Youth Leadership to Address Workplace and Community Environmental Health Issues: A University-School-Community Partnership’ Health Promotion Practice, Jul 2005, Vol.6(3), pp.270-285)

- if research projects and funding guidelines for health promotion projects focus on small-scale projects (eg at local level), they don't provide evidence on how local projects can link in to broader advocacy

eg in this project, the community empowerment model involved linking high school youth to community capacity in the sense of local organisations

however issues such as environmental regulations or workplace conditions are legislated at state or federal level

where this project (above) might have such links could be eg through local union branches (since workplace conditions for youth were one of its concerns) which would in turn link to the broader union movement

but are other links being made and is anyone investigating this area (in practice or in research)?

emphasis on local may lead to fragmentation and lack of power?

Students did engage in lot of community education and were involved in action to prevent local incinerator and ensure clean up of school grounds

authors acknowledge at very end that 'community infrastructure" is needed such as "government agencies that effectively enforce workers’ rights and environmental law,"

However the potential risk from teaching people about their rights and encouraging them to engage in activism when those things don't exist are not considered.

Risks of empowerment approaches and community empowerment, community building, CBPAR