Читать книгу Ecosystem Crises Interactions - Merrill Singer - Страница 17

Global health is not merely a constellation of diseases, a collection of national health systems, or even a set of values. It is a way of looking at our world. It seeks to observe, document, monitor, interpret, and eliminate the harms that accrue from national and transnational forces inimical to health—political, commercial, military, financial, diplomatic, legal, intersectional, and cultural. Global health is about power and poverty, violence and exploitation, oppression and silence, and collusion and exclusion.

(Horton 2014)

Planetary health, the newest of the three concepts under consideration, begins with the understanding that human health and the health of the planet are intimately connected. One might say, this is the “one health” of this approach. The origins of this line of medical thinking lie in the conclusion drawn by the Commission on Managing the Health Effects of Climate Change, organized by The Lancet, a British medical journal, and academics from many disciplines across University College London that climate change is the biggest threat to human health in the 21st century (UCL News 2009). The Commission, made up of faculty from the fields of health, anthropology, geography, engineering, economics, law, and philosophy, focused on six key areas: patterns of disease and mortality, food security, water and sanitation, shelter and human settlements, extreme events, and population migration. According to Anthony Costello, a world leader on issues affecting the health of children and the lead author of the Commission’s report: “The big message of this report is that climate change is a health issue affecting billions of people, not just an environmental issue about polar bears and deforestation … The impacts will be felt not just in the U.K., but all around the world—and not just in some distant future but in our lifetimes and those of our children” (UCL News 2009). The Commission examined the global health implications of the Intergovernmental Panel on Climate Change (IPCC) projections and considered a myriad of pathways through which climate change exerts its effects on health.

Health clearly has entered a new epoch when environmental factors, under ever mounting adverse human influence, have outpaced other threats to human well‐being. This recognition sparked the planetary health initiative, spearheaded by The Lancet and the Rockefeller Foundation, which is guided by acceptance of the fundamental need for collective achievement of a world “that nourishes and sustains the diversity of life with which we coexist and on which we depend” (Horton 2014). From the perspective of planetary health:

By unsustainably exploiting nature’s resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature’s life support systems in the future. Health effects from changes to the environment including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth.

(Rockefeller Foundation 2020)

The emergence of planetary health has been described as constituting a fifth stage in the historic evolution of the modern population health paradigm (Singer 2014). This mode of thinking about health as more than an individual‐level condition—which historically was the prevailing orientation of biomedicine—has its roots in local public health efforts, which began especially in Europe during the 19th century, transitioned to tropical medicine as a consequence of the European colonial encounter with the infectious diseases of tropical colonial environments, blossomed during the post‐World War II period into international health with the expansion of multinational health initiatives like the World Health Organization (WHO), and emerged during the 1990s as global health, a reflection of the consolidation of a global neoliberal economy and global communication systems, combined with a recognition that risks to health transcend borders and require multilateral responses. The shift to a planetary health understanding as a further advance in population health thinking was motivated by the growing awareness that not only are human communities worldwide now multiply linked together by flows of commodities, ideas, people, and health‐related influences from vectors to medicines, but that the health and well‐being of human communities are increasing linked to the environment and to other species. As stated in the planetary health manifesto: “Our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation. The harms we continue to inflict on our planetary systems are a threat to our very existence as a species” (Horton et al. 2014, p. 847). A planetary health perspective, in other words, reveals the fundamental ways in which human beings are not just agents of environmental change, but also vulnerable objects of that change.

Pivotal to the planetary health movement is a vocal commitment to equity in a world of unjust societies and unequal relations among societies. As articulated in the planetary health manifesto: “The discipline of public health is critical to this vision because of its values of social justice and fairness for all, and its focus on the collective actions of interdependent and empowered peoples and their communities” (Horton et al. 2014, p. 847). The evidence on anthropogenic climate change demonstrates the consequences of inequity. Translated into stark moral and palpably human terms, anthropogenic climate change can be assessed as a form of “social murder,” a term introduced by Frederick Engels in 1845 to characterize the impact of the corporate‐owning class on the health and survival of poor and working people. Chernomas & Hudson (2009) redeploy the term to label contemporary corporate policies designed to maximize the accumulation of private profit while socializing associated risks and costs.

To advance the perspective, The Lancet initiated a new journal called The Lancet Planetary Health in 2017. Exemplifying its content, in its second year it published a study of the adverse health effects of air pollution on diabetes in China (Yang et al. 2018). This study’s cohort included over 15 000 people aged 18–74 years from three cities in Liaoning province, in the northeastern sector of the country. Diabetes was defined according to American Diabetes Association (ADA) recommendations. Exposure to air pollutants (sulfur dioxide, nitrogen dioxide, and ozone) was measured by monitoring stations. The researchers found that all of the pollutants studied were significantly associated with increased diabetes prevalence. They were also associated with higher concentrations of fasting glucose. Stratified analyses indicated greater effects on those individuals who were younger (<50 years) or overweight or obese. The researchers concluded that long‐term exposure to air pollution is significantly associated with increased risk of diabetes, especially in some subgroups. Other articles in the journal have documented the health benefits of other kinds of environmental exposure. Crouse et al. (2017), for example, reported the findings of a study in 30 cities in Canada that showed that increased amounts of residential greenness (based on a vegetation index) were associated with reduced risks of dying from several common causes of death (e.g., cardiovascular disease, diabetes, ischemic heart disease) among Canadian urbanites. While affirming the effects of social inequalities and personal socioeconomic status on health, in terms of both exposures to greenness and mortality risks, the study found that greener cities were healthier cities.

The three somewhat different approaches to health and the environment described in this section are all products of the increasing risk of anthropogenic environmental and climatic changes on species health on the one hand, and the growing awareness of this fact and of living in the Anthropocene on the other. The objective in introducing these concepts, their histories, and their core values was not to choose the best or most useful among them but to illuminate the ways our comprehension of our role in the environment and of the fundamental role of the environment in health have been changing in the contemporary world. Collectively, the emergence of these approaches affirms the importance of accessing not simply the health–environment nexus but specifically within this initiative the role of the growing number of interacting ecocrises in health.