Limits to Growth, the Rohingya, and Planetary Health

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"

**

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