I submitted
the following abstract for a conference
on "planetary health". It was rejected (no feedback). I may as well
post it here. The writing is compressed, due to the word limit. I have
added a brief commentary. Comments welcome, as always. Extra refs added, with
PS, written in June 2018.
Introduction
and Background
Numerous
violent expulsions and panicked flights of the Rohingya, a minority population
mainly from Rakhine state in Myanmar, have been documented since the 18th century,
but their incidence and scale have increased since 1978. Of a population
estimated at 1-1.3 million, over 700,000 Rohingya fled Rakhine in late 2017,
joining hundreds of thousands of Rohingya already living in exile in squalid
refugee camps in Bangladesh. (1) The 2017 expulsion of and flight by Rohingya
is the largest yet. Although Rohingya-led violence is well-documented (2) many
argue that the response of the Myanmar state is grossly disproportionate. The
adverse health effects of this violence and exile are immense, profound,
diverse and multi-generational. (1,3) They may arise from social responses to
deteriorating physical ecology.
Body
Rakhine is
fertile, but growing tension over resource distribution, (4) combined with weak
institutions and population growth, have been identified as likely to
contribute to human insecurity in Myanmar. The 1994 Rwandan genocide has been
postulated as an “eco-social” phenomenon, arising from growing resource
scarcity interacting with social ecology, expressed as fear of the other,
racism, and entrenched beliefs and behaviors, expressed by both victim and
perpetrator groups. (5)
It is here
theorized that many subtle changes, as yet poorly studied, in the physical
ecology of Rakhine have contributed to the plight of the Rohingya. As in
Rwanda, a dynamic of competing social ecologies has generated violence, on a
background of real and perceived resource scarcity.
Many vested
interests inhibit resolution, and even diagnosis of this chronic health
emergency. The most obvious obstacle is the hostility of the dominant Buddhist
population in Rakhine, supported by an aggressive central government and
military. United Nations Security Council action is inhibited by China, which
shares with Myanmar anti-democratic impulses and practices. (4)
Diagnosis
and remedy of the Rohingya crisis is also inhibited by dominant neoliberal
academic discourse, which for decades has suppressed and failed to integrate
the multi-disciplinary evidence that underpin and explain the growing planetary
heath emergency. (5) Two particularly important strands are approaching limits
to growth (6) and the once widely accepted view that rapid population growth
generates and entraps impoverished populations. (7)
In response to
the most recent crisis, the United Nations High Commission for Refugees has
helped to fund Rohingya camps, supported by many aid groups, such as Médecins
Sans Frontières. (1) There has been much criticism of Myanmar authorities,
especially from Western sources. Inevitably, however, these criticisms and
attempts to assist, even if noble, can do little to solve the really deep
causes.
Conclusion
Although
aggression, fear, violence and hatred have deep evolutionary roots, a future
can still be created in which populations, even if culturally diverse, such as
in Rakhine, live in partial harmony, or at least co-exist. Implementation of
these solutions has several pre-conditions. These include a global
re-awakening, both high-level and distributed, that the scale of human
co-operation needs to be widened to the planetary level, and an evolution of
technology which allows the worst physical manifestations of adverse
environmental change to be kept within tolerable levels.
Commentary
It will be
interesting to see if the Planetary Health conference includes any papers on
the Rohingya, and for that matter, any of the many other cases of what I have
called "regional overload". I am rather doubtful. In 2016 I was
invited to submit a longer version of these arguments for the first issue of
the new journal Lancet Planetary Health - but only if accompanied by
US$5,000 (for a research paper, not a commentary). In a world of intensifying
market forces, where publishing is corrupted
by money and power, this is not surprising.
Postscript (June 9, 2018)
In June,
2018, Richard Horton(editor of the Lancet) wrote,
in part:
“Planetary
health, at least in its original conception, was not meant to be a recalibrated
version of environmental health, as important as environmental health is to
planetary health studies. Planetary health was intended as an inquiry into our
total world. The unity of life and the forces that shape those lives. Our
political systems and the headwinds those systems face. The failure of
technocratic liberalism, along with the populism, xenophobia, racism, and
nationalism left in its wake.
The
intensification of market capitalism and the state’s desire to sweep away all
obstacles to those markets. Power. The intimate and intricate effects of wealth
on the institutions of society. The failure of social mobility to compensate
for steep inequality. The decay of a tolerant, pluralistic, well informed
public discourse. The importance of taking an intersectional perspective. Rule
of law. Elites. The origins of war and the pursuit of peace. Problems of economics—and
economists. The study of nations—their histories, geographies, ideas, and
beliefs.
In his most
recent book, Global Discontents, Noam Chomsky writes that, “The efforts that go
into trying to ensure the end of humanity are impressive.” 200 years after the
birth of Karl Marx, who still teaches us the importance of critically analysing
the nature of society, and 50 years after 1968, which so clearly signalled that
the modern state was not quite as impregnable as it might seem, perhaps we
might commit to making planetary health our response. Our resistance. In Joseph
Roth’s 1932 novel, The Radetzky March, which chronicles the extinction of the
Hapsburg Empire, Roth writes, “The collapse of the world could already be seen
as clearly as one sees a thunderstorm on the edge of a city.” There is our
task: to see the thunderstorm ahead of us. Many have preferred to turn their
heads away. It falls to planetary health to insist that we face the
thunderstorm."
**
I am
currently writing an entry on planetary health for an encyclopaedia of
geography. In my draft, I had written (only this week):
"most
of the abstracts
selected for the second Planetary Health conference, held in Edinburgh,
Scotland in 2018, could have been presented at many similar conferences hosted
by Ecosystem Health, EcoHealth and One Health.
Two decades
ago these ideas were genuinely novel within health. But are these ideas truly
exciting today? Or are they principally exciting to a younger audience
unfamiliar with this history?"
**
I wasn't at
the Edinburgh conference (even if my abstract had been accepted I am not sure I
would have attended; it's a long way) but I have attended at least seven
Ecohealth (or "ecosystem health") conferences, as well as two One
Health meetings (one was a joint meeting of EcoHealth and One Health). This
experience is since 2000, in at least 5 countries, at least 3 times as an
invited, fully funded speaker.
**
I have also written
(in my draft for the encyclopaedia):
"If
Planetary Health is to flourish it needs to do more than mimic these earlier
movements (two of which still exist). It also needs to do more than simply
describe problems. One way forward might be for its practitioners to deeply
study the civilization threatening aspects of planetary health, building on its
manifesto.
Another early paper
on planetary health, co-authored by Horton, also provides a clue, reflecting
“every day we see the limits of our ability to collaborate with one
another—conflict, nationalism, competition. One active area of research that is
not obviously mainstream for global health, but which is core to the idea of
planetary health, is understanding what helps or hinders human cooperation.”
But although
issues including conflict, mass migration and population growth are discussed
in the major Lancet paper (and to an extent in the new journal), the eco-social
consequences of resource scarcity, including mass migration and conflict were
not prominent at the recent conference. The major Lancet planetary health paper
does not include the word neoliberalism, nor any obvious synonym for it. A
literature search for the terms planetary health and neoliberalism is currently
blank, apart from the Planetary Health manifesto and a handful of papers that
have made this criticism."
**
I also know
how hard it is to challenge the powerful. I tried that at the 2012 EcoHealth
conference in Kunming (China) - one of my abstracts there was also
rejected, but in that case it was blatant censorship, as I had the temerity to
speculate that self-immolation was in part a reaction to the violation of
nature. (see)
I
mention this because I think Horton shies away from use of the word
"neoliberalism" because there are limits to how directly he can
challenge the powerful.
**
I was
invited to a meeting about planetary health, held in New York, in January 2015.
I couldn't attend due to the impossibility to get a timely US visa, made
difficult for me at that time as I had recently been arrested (and charged with
property damage - even though all I "damaged" was use of the road by
coal trucks for 50 minutes).
In
re-reading a background paper for that meeting I found another essay by Richard
Horton ... I am not sure if the part I am about to quote has been published before;
I have searched but not found it verbatim.
In it,
Richard wrote:
"What
actions might be taken to strengthen planetary health? First, attack poverty.
Poverty is a cognitive tax that diminishes our capability to reach full human
intellectual potential (5).
5. Mani A, Mullainathan S, Shafir E, Zhao J. Poverty impedes cognitive function. Science 2013; 341: 976-80"
5. Mani A, Mullainathan S, Shafir E, Zhao J. Poverty impedes cognitive function. Science 2013; 341: 976-80"
**
As alluded to above, Horton's
essay does not mention the word neoliberalism, but in this and some other
sentences (including some in the most
recent commentary) he is coming very close to a criticism of it, for
example: "if civilisational collapse is imminent, wealth can mask the
gravity of threats and weaken incentives to act until it is too late. By
combining evidence from civilisational and sustainability science, we have an
opportunity to put planetary health—the health of human civilisations—at the
centre of our concern."
In summary:
1. There is
a mismatch between the rate of planetary change and the evolution of
institutions. This threatens "planetary overload".
2. This
mismatch often drives conflict, migration and famine.
3. The fate
of the Rohingya (10) is a plausible case study of "regional overload"
(as could be Yemen, South Sudan, Syria, Burundi, Venezuela, Puerto Rico,
Bodoland and - perhaps in the near future - other parts of Assam.)
4. This is
all relevant to planetary health. It is also relevant to broad interpretations
of ecohealth, ecosystem health and One Health, but you won't find much about
these topics in that literature (though there is some, eg).
5. What
potentially makes Planetary Health radical, and braver than its three main
predecessors is its apparent willingness to discuss co-operation and its
limits, and the resultant risk to civilisation.
6. My
interpretation of Richard Horton's most recent essay ("Planetary
health—worth everything") is that we have much in common.
References
1. White K.
(2017) Rohingya
in Bangladesh: an unfolding public health emergency. Lancet 390:1947.
2.
International Crisis Group. Myanmar: A new Muslim insurgency in Rakhine State
(2016) https://www.crisisgroup.org/asia/south-east-asia/myanmar/283-myanmar-new-muslim-insurgency-rakhine-state
3. Riley A,
Varner A, Ventevogel P, Hasan MMT, Welton-Mitchell C. (2017) Daily stressors, trauma
exposure, and mental health among stateless Rohingya refugees in Bangladesh. Transcult
Psychiatry 54(3).
4. Kattelus
M, Rahaman MM, Varis O. (2014) Myanmar
under reform: Emerging pressures on water, energy and food security. Nat
Resources Forum 38(2):85-98.
5. Andre,
C., Platteau, J-P. (1998) Land
relations under unbearable stress:Rwanda caught in the Malthusian trap. J
Econ Behav Organizn 34, 1-47; 75. Butler C.D. (2000): Entrapment:
global ecological and/or local demographic?Reflections upon reading the BMJ's
"six billion day" special issue. Ecosyst Hlth 6, 171-180.
6. Bolopion
P. (2017) How
long will UN Security Council be missing in actionon Burma? New resolution
opportunity for Council to address crisis. Human Rights Watch.
7. Butler
C.D. (2017) Limits
to growth, planetary boundaries and planetary health. Current Opinion Envtl
Sustainability 25: 59-65; Butler C.D. (2017) Regional overload, and the
consequences it has for health. BMJ http://blogs.bmj.com/bmj/2017/01/20/colin-d-butler-regionaloverload-and-the-consequences-it-has-on-public-health/;
Butler C.D. (2016) Planetary
Overload, Limits to Growth and Health. Curr Envtl Hlth Reports 3(4):
360-369; Butler C.D. (2016) Sounding
the alarm: Health in the Anthropocene. Int J Envtl Res Pub Hlth 13, 665
8. Butler,
C.D., Higgs, K. McFarlane, RA. Environmental health, planetary boundaries and
four futures. In Nriagu, J. (editor) Encyclopaedia of Environmental Health,
Elsevier (submitted).
9. Butler
C.D., Higgs K. (2018) Health, population, limits and the decline of nature. In:
Marsden, T (editor) The Sage Handbook of Nature; pp 1122-1149.
10. Butler,
C.D. The
Rohingya, ethnic cleansing and Buddhism