Policies for Mitigation and Development (not 'or')

[The following note was written as a contribution to discussion within the People's Health Movement Climate Change Circle. It may also be of interest to visitors to this PEH blog.]

There are a lot of organisations and networks working on global warming. Many of us are members and activists in such networks. So what are the special interests of PHM in relation to global warming and what special leverage might PHM structures give to carbon pollution control?

As I see it, PHM’s core business centres around the links between global inequities with respect to the determinants of health and access to quality health care; primary health care (both as a model for health care delivery and as an approach to social change); community mobilisation; the political economy of globalisation; and the possibilities for global solidarity including the building of a global movement for progressive global change.

The People’s Charter for Health (adopted at PHA1 in 2000) provides some guidance with respect to PHM’s position on global warming. Under the heading “Environmental Challenges” the Charter commits us to:

• Hold transnational and national corporations, public institutions and the military accountable for their destructive and hazardous activities that impact on the environment and people's health.
• Demand that all development projects be evaluated against health and environmental criteria and that caution and restraint be applied whenever technologies or policies pose potential threats to health and the environment (the precautionary principle).
• Demand that governments rapidly commit themselves to reductions of greenhouse gases from their own territories far stricter than those set out in the international climate change agreement, without resorting to hazardous or inappropriate technologies and practices.
• Oppose the shifting of hazardous industries and toxic and radioactive waste to poorer countries and marginalised communities and encourage solutions that minimise waste production.
• Reduce over‐consumption and non‐sustainable lifestyles ‐ both in the North and the South. Pressure wealthy industrialised countries to reduce their consumption and pollution by 90 per cent.
• Demand measures to ensure occupational health and safety, including worker‐centred monitoring of working conditions.
• Demand measures to prevent accidents and injuries in the workplace, the community and in homes.
• Reject patents on life and oppose bio‐piracy of traditional and indigenous knowledge and resources.
• Develop people‐centred, community‐based indicators of environmental and social progress, and to press for the development and adoption of regular audits that measure environmental degradation and the health status of the population.

These commitments remain very relevant.

Given the prevailing global inequities and in particular the disease burden and barriers to health care in the Global South it is important for PHM to consider carefully the North South dimensions of the Copenhagen fiasco and to ensure that we approach the politics of global warming with full understanding of these dimensions.

As I understand it the rich countries approached Copenhagen with low ambitions and high conditions; including conditions that tied rich country action to comparable commitments from the big developing countries (ignoring the role of rich country emissions in the historical accummulation of greenhouse gases and looking for parity in policy action from hereon). As I understand it the small island states and the delta countries wanted to see action from all polluters but faced opposition from both the big rich and the big developing countries. As I understand it the big developing countries (also known as 'the emerging economies’), led by China and India, were unwilling to accept the kind of restrictions on their economic development which were being canvassed and were unwilling to slow down (what they describe as) the liberation of millions of desparately poor people from poverty.

Clearly the question of pathways to economic development links with the question of access to the necessary technologies which might support non-greenhouse economic development / poverty escape and clearly the developing countries were not happy with the offers from the rich countries on this front.

It is not possible to make sense of this impasse without recognising the role of the big transnational energy corporations (funding the global warming deniers and opposing restrictions on CO2 emissions). The big energy TNCs will oppose action on global warming to the bitter end. They have huge sunk investments in old technologies with correspondingly large profit flows. Action on global warming will require writing off these investments and choking off the profit flows and finding capital for the new energy infrastructure.

It is also necessary to contextualise both global warming and economic development within the wider regime of global economic governance. The inequities, imbalances and instabilities of the global economy, manifest in the global food crisis and the global financial crisis, are a consequence of this regime also. Neoliberal globalisation is built upon consumerism (with concomitant carbon pollution) and requires the marginalisation of a billion humans who are treated by this regime as ‘surplus to requirements’ (required neither for their labour power nor their buying power).

It is untenable that these global policy challenges should be allowed to resolve into a forced choice between economic development for the global South or mitigation of global warming (which seems to have been one of the deals on the table at Copenhagen). Rather we need to work towards a regime of global economic governance which reconciles the need for (sustainable) economic development in the global South and the need to contain global CO2 levels to 350ppm. Clearly such a regime is technically and economically possible; the main challenge is political.

So what are the core interests of the People's Health Movement in the politics of global warming? And where does the struggle for action on global warming intersect with the struggle for health?

First, we need to get our facts straight and build a robust analysis. The analysis I have set out above includes some speculation and over-simplifies some of the issues. We need to listen more carefully to the analysis of the developing country negotiators at Copenhagen, in particular, the negotiators from China and India to understand their perspectives. We need to investigate the positions being advanced by the rich countries and explore the implications of these positions. We need to contextualise these negotiations within the wider political economy of energy and of global economic governance.

We need to keep sustainable economic development at the forefront of our struggle. Not the high consumption low employment globalised model being promoted by the neo-liberals but sustainable autonomous development based in large degree on local production and supply.

We need to build pressure on the governments of the North and South to accelerate the reform of energy production and use domestically while continuing to work for binding international agreements.

We need to keep energy equity in the foreground as well as energy efficiency and renewables. This has implications for most people in the rich countries where the profligate use of carbon based energy is embedded in culture, economy and infrastructure. It also has implications for the elites and middle classes of the developing countries. Both energy equity and global economic reform require a strengthening culture of global solidarity.

So what are the implications of these policy priorities for PHM’s policy program.

Central to PHM’s policy program is comprehensive primary health care, first, as a platform for improving access to decent health care and for action on the social determinants of health; and second, as a strategy of social change, for creating healthy communities. So we need to ensure that energy reform is included in our discourse of the social determinants of health and community mobilisation for health but clearly contextualised in relation to economic globalisation and the challenge of global economic reform.

Central to PHM’s policy program is the development of global solidarity for health; building communication channels and opportunities for collaboration across various axes of difference (nation, race, gender, religion as well as class) so that the forces for progressive global change can be more coherent and effective. So we need to ensure that energy reform (including towards energy equity as well as efficiency and renewables) is part of the discourse on which such solidarity is built – and clearly contextualised in relation to economic globalisation.

Central to PHM’s policy program is the idea of intersectoral collaboration and in terms of PHM as a social movement this means working on our relationships with other social movements working in other sectors, such as global warming / environmental justice / energy reform. So we need to work towards creating and organisational relationships with organisations in other sectors whose perspective is congruent with ours.

PHM Global’s practical work program includes the Right to Health Campaign, Global Health Watch, IPHU and the People’s Health Assembly scheduled for 2011 in South Africa. There are clear implications for all of these departments from the above reflections. Particularly so for GHW, IPHU and PHA3 but also for PHM's national and local circles and other thematic circles.

Perhaps one of the first priorities for PHM in this field might be to stoke a conversation regarding these issues within the wider PHM community.

Book Review: The Spirit Level

I'm preparing a book review for InTouch and thought I'd post a draft for comment. Has anyone read it? I would love to hear your views.

The Spirit Level: Why More Equal Societies Almost Always Do Better, by Richard Wilkinson and Kate Pickett. Reviewed by Deborah Gleeson.

Since finishing my thesis a few months ago, I haven't been tempted to read many books, but this was hard to put down. I thought it would be important but dry, but I found it a good read, with surprising and interesting things on just about every page.

The main argument of the book is a simple one. Amongst rich countries, unequal societies do worse by almost every social and health measure. More unequal societies are bad for (almost) everyone - for the more well off as well as for the poor.

Using clear arguments in plain language, backed up by easy to understand charts, Wilkinson and Pickett bring together data showing associations between income inequality and many health and social problems, including poor health, violence, mental illness and drug use, obesity, teenage pregnancy, high rates of imprisonment, and poor educational performance.

What excited me most about this book, apart from the sheer weight of the evidence, was the way the authors have made it so understandable and quotable. It brings social epidemiology - and much more importantly, the damaging effects of inequality - into the public domain.

Wilkinson and Pickett challenge the myth that economic growth leads to improvements in quality of life. One of the first charts in the book shows how life expectancy increases rapidly during the early stages of economic development, but as countries get richer, the relationship between economic growth and life expectancy disappears.

One of the most important messages of this book is that reducing carbon emissions means limiting economic growth in rich countries - and that this can be done by reducing inequalities. They argue convincingly that reducing inequalities can improve quality of life without requiring further economic growth, and that greater inequality can also foster the public-spiritedness that we need to be able to develop sustainable economies.

I had two frustrations with the book. First, the authors do not have a great deal to say about the far more serious issue, in my view, of inequalities between countries, and the millions of people who live in absolute poverty. Their analysis is based only on rich countries. While their aim is to inform social movements directed to more equal societies, I think social movements must focus on, and involve, the global South as a first priority.

Second, I found the concluding section of the book vaguely dissatisfying. The authors argue that addressing inequalities requires gradual transformation rather than an overhaul of current economic systems. While it might be more realistic than revolution, I'm not sure that this approach adequately addresses the entrenched power relations that work against such transformations.

For a more thoughtful and interesting critique, see David Runciman's review in the London Review of Books.

Transition Initiatives

The emerging Transition Initiatives is one narrative for rebuilding what are called resilient communities. A resilient community is a locally focused, self reliant (not necessary self sufficient) town, region, suburb, which can survive by itself in times of need without destitution and starvation, but imports luxuries where needed, and interacts with the rest of global society.

The initiative arises from the permaculture movement, in that the principles and philosophies of this elder movement give foundation to the later. It has arisen in response to the need to prepare human society to respond to the twin challenges of climate and global environmental change and peak oil.

Since the link between the values and behaviours that lead people to trash the environment are intrinsically linked to the creation and maintenance of socioeconomic inequity, the path to solving each is shared. Both challenge the neoliberal paradigm and its values of individualism and exploitation. Further the process for creating resilient, ecologically and socially sustainable society is applicable to rebuilding community and addressing socioeconomic inequity.

See: Rob Hopkins, the Transition Handbook, Finch Publishing, Sydney 2009,
ISBN: 9781921462009 (pbk.)
See: http://transitionculture.org/; and http://www.communitysolution.org/

Another relevant stream in Australia has been the NSW Community Building / Victorian Neighbourhood projects in the context of ‘fixing’ dysfunctional communities / neighbourhoods. The Healthy Cities Programs, Healthy Urban Development programs, and others are all happening and can be built on. I am sure there are other examples.

What has been lacking to some extent has been publicising the underpinning analysis and a meta-structure for coordination and exchange.

Peter Tait

We need a road map to an alternative order to neoliberalism

Following discussion at the recent Public Health Association Conference it became clear that we need a "road map" which give a clearer alternative to the dominant neoliberal paradigm in a manner whcih can guide action at a local, national and international level.

There is a concern that there will be a return to "business as usual" in spite of the opportunities created by the global economic collapse and this is partly due to the lack of an alternative that activists have ready access to and can explain easily to each other and the community more generally. Such a road map could include things like the importance of community controlled institutions, and workers controlled coportations and businesses as suggested at the end of Wilkinson's book - the Spirit Level. It would also need to inlcude key taxation reforms in progresive income taxes, consumption taxes, carbon taxes, the Tobin tax etc. It would need to say something about publicly funded universal education and health care.

It would also need to say something about the types of global institutions that are needed and how to reform the IMF, World Bank etc. There are many more issues. I think it needs to be a type of "Standard Treatment Manual" or "Best Practice Guidelines" for the type of social, economic and political system we need to try to create. It needs to be realtively simple and easy to read and understand - perhaps such a document exists and if so could someone enlighten me? (I am not even sure if this is the right way to use a Blog as this is the first time I have done this.)

Three meanings of globalisation

The term is used in many different ways. I have three clearly separate usages.

First, I recognise globalisation as referring to the 'global village' - the various technologies which are shrinking the globe: air travel, the internet, mobile phones, Skype, automatic translation and many more. The global village has both positive and negative implications for how we live and how our world works. On one hand it enables people's movements to build solidarity across the oceans. On the other hand it threatens cultural homogeneity and the obliteration of difference. Much more to be said.

My second usage of the term is to refer to a particular configuration of economic relations and a particular set of dynamics - economic globalisation. It is a very complex 'system' which to be properly specified will require a complete accounting of the stocks and flows of a myriad of goods and services, inputs and outputs, as they move from producers to consumers in different countries, of different income levels, different genders, ethnicities.

It is important to recognise that systems (like 'models') are defined by the purpose of the describers or modellers. There are many ways of describing the global economy depending on the purpose of the describer: whether my shares will increase in value, why I cannot sell my fish, why we do not stop global warming, etc etc. If you want to know why there has been a net flow of resources from the low income countries to the rich countries over the last two decades or why one billion people are excluded from access to the global economy the babbling of the stock market commentator will not tell you very much. There are narratives which do make sense of the growth fetish and the necessity for inequality but they are not to be found in the mass media.

My third use of the term 'globalisation' centres around the governance of the global economy: globalisation as a particular regime of global economic governance. This approach frames a set of questions about control and about power. How are the current patterns of economic relations maintained? How are the dynamics of the global economic regime governed? More importantly, how might they be changed?

Understanding the relations between globalisation and population health can benefit from the insights provided by all three of these perspectives.

Welcome

Welcome to the Political Economy of Health blog.

We hope that this blog will provide a platform for a sprawling conversation about the political economy of health. In particular, we aim to explore the ways in which globalisation shapes the health chances of people globally, but particularly in low income countries.

We (the assembled bloggers) believe that the global economy, its influences on health and various strategies of change are too complex to be captured in a single narrative. Rather we need a conversation that canvasses a range of issues, analyses and possible strategies of change. We hope that out of this conversation, and the thousands of other similar linked conversations taking place at the same time, a stronger consensus might emerge which will point towards new forms of global action.

We look towards new forms of practice, new organisations and new social movements through which we may find our way to a healthier world, a more equitable and more convivial world; a progressive return to an ecologically sustainable relationship between humanity and the rest of the biosphere.

So join us. If you want to join the blog as a member (so that you can post directly and comment directly) please send your first draft blog to the current blog administrator (David G Legge) at dlegge@phmovement.org and a bit about yourself. Comments on our blogs are welcome, but may take a short while to appear because they are moderated. Comments by members are not moderated.