maandag 19 november 2018

On making the switch to the planetary health era


In a previous blog I wrote the global health community should make the switch to the ‘planetary health’ era sooner rather than later.

I should probably qualify this statement a bit. Nobody should ever listen to me, I just make humble suggestions : )

More importantly, though, with that statement, I referred to  ‘planetary health’ the way Horton described it earlier this year in an Offline contribution, after attending the annual Planetary Health conference in Edinburgh ( see  Offline: Planetary health—worth everything )

As a reminder, it’s worth to provide here Horton’s related paragraph in full:

“…Planetary health—the health of human civilisations and the ecosystems on which they depend—has evolved into a capacious interdisciplinary inquiry. Yet it is neither capacious nor interdisciplinary enough. 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…. 
Defined in this way, i.e. ‘in its original conception’, ‘planetary health’ has the right feel for the challenges we face in this century.

(1) It certainly has the right sense of urgency – cfr Horton:  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.”  

And (2) the paradigm aims to connect all the dots, going beyond silos, the way the SDG agenda is trying to do (while obviously, not going far enough, as it makes too many compromises with the current (growth focused) economic system). This is why I sometimes consider the ‘planetary health’ paradigm as an “SDG agenda on speed”: it involves a strong plea for a fair economic system, that works for all, within planetary health boundaries. Only such a system will have truly ‘global citizens’, as compared to the (few) ‘winners’ and (too many) ‘losers’ in this economic system.

I admit it sounds utopian, certainly given the way things are going currently on the planet, but in my opinion, planetary health defined like this, is the right (global) framing of the (interconnected) challenges we face now. (3) Planetary health along these lines would dare to ask the questions for a radically different economic system. Deep down, for me, planetary health is about finding the right balance between equity & a sustainable planet. With both emphasized to the same extent. That requires daring to think beyond capitalism, I think. Planetary health could ask these sorts of questions more than the related environmental health, EcoHealth, GeoHealth, OneHealth, .. in my opinion.

(4) Last but not least, ‘planetary health’ also best captures the sense ‘that we’re all in this together’  (California, as much as Delhi, the Sahel, …).  It conveys this, in my opinion, also better than “EcoHealth” et al. You could argue that 'global health' already does so, however there's a certain 'Northern dominated' feel about the latter term that is hard to get rid of.

The truth is, however, for the moment, Planetary health doesn’t really do all of this, or at least not nearly enough, even if it has the potential do so, as Horton rightly emphasizes.

When I look at the Planetary Health Alliance website, for example, there’s very little on asking for a radically different economic system, based on different (post-capitalist) values.  Very little on how neoliberal globalization has led to the current situation, on political determinants of the current global ‘perfect storm’,…. Maybe it’s because ‘Planetary Health’ (as conceived by Horton) feels too broad and encompassing for scientists – I agree it sounds a bit like a ‘Theory of Everything’ -, maybe because it smacks too much of attacking the status quo? The same goes for the website of the next Planetary Health meeting in Stanford. It’s hard to imagine that post-growth thinkers (like Tim Jackson, Jason Hickel, … and others) who dare to think of a truly different economic system, will get a prominent place there. I hope I’m wrong, though. For the time being, the ‘Planetary Health ‘community & the post-growth community are still fairly separate communities; the ‘green growth’ paradigm still seems much stronger within the Planetary Health community, than more radical proposals.

By way of a more concrete example of this claim, ask yourself the question: why is it that planetary health “champions” like Macron and Bloomberg are not trusted by many ordinary citizens (even if many very well understand that the planet is indeed in dire shape)? Because, like the ‘yellow jackets’ (gilets jaunes) in France now, they feel that it’ll always be common citizens having to cough up the most for green measures  (with some mitigating measures for the very poor, the standard recipe of Macron and other “structural reformers” like him), whereas the 1 % can continue to fly around the world, without being taxed much. 

Macron & Bloomberg want to ‘green’ the current economic system, instead of trying to think of a new system based on post-capitalist values. They admit equity is important, but Macron & Bloomberg will never find the right balance, I’m afraid. Chances are their ‘planetary health agenda’ will thus not be politically sustainable. From my point of view, it is thus a problem that they are currently seen as ‘planetary health champions’.

Planetary health, at least the way Horton conceives it, is not a “rebranding” of global health. It’s acknowledging that ‘global health’ can only have partial answers for the challenges the world currently faces, and that the values that (implicitly & explicitly) ruled much of global health for the past few decades will not lead to ‘Health for All’ in the 21st century. In fact, quite the opposite seems true.     See some of the words Horton uses: ‘failure of technocratic liberalism; elites; …’     and then ask yourself whether many of our current global health leaders feel more confident talking to (and taking more into account) leaders of states (Macron), billionaires (Bloomberg, Gates), people from the financial industry, or instead to grassroots movements and people in the street.  

If Horton’s definition of ‘planetary health’ doesn’t become mainstream (and he’s certainly not winning for the moment, unfortunately…), then ‘planetary health’ will indeed turn out just another buzzword. And we might as well just forget about it.    

So the challenge seems clear: ‘planetary health’, if it is to have a future, should become ( a lot) more like what Horton had in mind. And then, once we agree on this, comes the even more difficult part: how do we get to a ‘planetary health(y)’ world?

Something in me says that we will need to look more at the likes of Ocasio-Cortez than to Macron & Bloomberg for this.

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