Sunday, January 14, 2018

“Regional overload” as an indicator of profound risk: a plea for the public health community to awaken

Comments welcome. First draft of an abstract for a chapter in a forthcoming book to which I have been asked to contribute called: "Health in the Anthropocene: Living Well on on a Finite Planet" My slides are here, for a talk at the University of Waterloo, Canada on April 5, 2018.

Public health is the field of medicine charged with protecting human well-being, via the identification of health risks and the development and implementation of effective strategies to lower such dangers. Public health workers have a long history of promoting new paradigms and tackling vested interests, often with great difficulty and against immense opposition. Their campaigns often take decades to be successful, even at a regional scale.

Today, the greatest threat to global public health is barely visible within public health circles, although, like blind men palpating an elephant, some of its many manifestations are recognized. These identified protuberances have several names. Ecological public health, climate change and health, and even planetary health have arisen, in recent decades, as sub-disciplines of public health. The risk of nuclear war to health has seen the awarding of two Nobel Peace prizes to health-related lobby groups. Tropical medicine has evolved to international health and global health.

Yet, none of these emerging sub-disciplines or fields, as yet, fully integrate the health risks arising from what McMichael called “planetary overload”. Central to this (Malthusian) conceptualization is the risk of large-scale conflict, famine and infectious diseases, acting, increasingly, in combination, in ways that reduce human well-being, as a consequence of linked “eco-social” phenomena. 

Crucially, ecological and environmental contributors to these crises must be recognized not just as living elements of the biosphere, such as crops, coral reefs and forests, but inert resources, particularly of fossil fuels and the rare elements needed to drive the accelerating energy transition. Although the health community is belatedly awakening to the public health harm that climate change constitutes, there is scarcely any recognition, within public health, that the growing scarcity of these inert resources risks the triggering of social consequences with profound adverse health consequences, many of which are already apparent, in examples of what Butler has termed “regional overload”.

There is a growing number of recent examples of this; from Syria to Yemen, South Sudan, north-east Nigeria and Myanmar. However, very little analysis exists, within public health, of the shared causal pathways which underpin these localized public health catastrophes. 

There are many reason for this scarcity of analysis. One is the bias, within most public health fields, to problems in high-income settings. Publications on (for example) public health in South Sudan are rare, and data-rich papers are almost non-existent, due to the difficulties of safely obtaining such data. This leads to a reinforcing cycle, a positive feedback loop, where there is little market or appetite for analysis, and where such papers, if submitted are unlikely to be accepted due to their likely deficiencies. 

Another important impediment is of disciplinary boundaries and suspicion of the “academic other”. These factors contribute to the failure of academic institutions and health funders, who are overwhelmingly embedded in a milieu of neoliberal signals and incentives, to recognize the need for a new paradigm to emerge, if humanity is to thrive in this and coming centuries.

PS regional overload is long-standing, and is different to what really concerns me; which is regional overload in the context of tightening global limits to growth. That really warrants a new term, or phrase, but it is too premature to attempt that.