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The WHO (World Health Organization) has released its latest in a series of reports[i] on public health in 53 European nations, and presents this assessment through a focus on the social determinants of health[ii]. Rather than sounding an alarm or considering the possibility that epochal economic decline is underway which threatens the health of the public, it serves up tepid criticism of government policies that have resulted in surging poverty[iii] and high unemployment[iv], fiscal cuts to health and other social services, increases in suicide and a host of other declining health indicators deforming people’s lives in most –possibly all- of the countries examined. Put directly, the social determinants of health are being laid to waste in several European states and endangered in others, yet the report casts this as a few dark shadows on an otherwise bright picture.
I find the report psychologically dissociative, ethically compromised, and in an intellectual malaise. Sociologically, however, it makes sense: it is self-destructive to analyze or challenge[v] the political/economic system that funds your work, even if it is destroying what your organization was founded to analyze, protect and ensure. As such, this report represents a conflict-ridden and unstable posture of ignorance and subservience to political power.
Revealingly, the report takes virtually no notice of the portents of socioeconomic and political[vi],[vii]upheaval[viii] –like UKip and Golden Dawn- spreading through Europe.[ix],[x] Naïvely[xi], the report calls for slight reforms –like giving health ministers a “seat at the table” of austerity[xii] budgeting to make the case for “proportionate to need” funding cuts[xiii]- as sufficient to ensure, maintain or in some conceded instances restore a portion of the underlying fundamentals of the health of European populations now being sacrificed in the name of balancing budgets and debt repayment. The authors give every indication of having no inkling that their flaccid calls for a realization that too much austerity endangers the public’s health is too little too late and, in any case, will have zero influence on neoliberal policymakers.
Politically, then, this WHO[xiv] report offers no recognition, let alone opposition, to the class-based austerity imposed by neoliberal governments[xv]. Accordingly, this report personifies developing turmoil[xvi] in organizational mission and collective identity for health professions as the divergence between the imposition of neoliberal austerity measures and the mission of public health deepens. This compromised stance, of offering mild warnings about austerity while accepting it as a legitimate policy response, is part of a cultural phenomenon of an inability to democratically address genuine problems while offering rhetoric to reassure and soothe a public that is losing economic ground and its faith in government.[xvii] Read the rest of this entry »
Peter Gray, MD.
I’m a small town family physician in Ontario, Canada with an unremarkable practice consisting mainly of obesity, diabetes, arthritis, hypertension, anxiety / depression and the “worried well” who want to know why they feel tired all the time. Nothing unusual, nothing particularly glamorous. One thing which is different about my practice is that I became aware of peak oil five years ago, and since then I have been struggling to integrate this knowledge into my medical practice and family life. Read the rest of this entry »
Understanding the interplay of power[i],[ii] identity, and social change is critical to those who recognize that modern societies are at the limits to growth, in ecological overshoot[iii] and undergoing a first phase reaction of economic contraction;[iv] disintegration of modern finance, as evidenced by massive corruption and wealth destruction;[v] and political upheaval[vi]. While responses to these dilemmas can take the form of involvement in community localization, disengagement from modernism, studying yoga and Zen Buddhism, shrugged shoulders, political activism, or focusing on one institution –like health care, education, transportation, public banking, or the food supply, they all contain layers of nuance involving the relationships among power, identity (personal and collective) and social change. Read the rest of this entry »
The health community in Australia is calling for strong action on climate change as the prescription for political parties looking for a winning formula in the upcoming federal election. The electorate is becoming more aware of the growing risks to the wellbeing, safety and health of communities around Australia.
The Climate and Health Alliance (CAHA), a national coalition of health groups, representing over 300,000 doctors, nurses, midwives, social workers, psychologists, physiotherapists, allied health professionals and health care consumers, has launched its policy platform this week, outlining the priorities of health groups for effective climate action to protect health.
Leading experts such as Professor Tony McMichael from Australian National University have joined the call, saying climate change should be the key health issue in this election….
…CAHA President Dr Liz Hanna said: “The health sector is already under pressure, and increasing heatwaves, fires, floods and storms will place even greater demand on frontline and community health services as people struggle with associated injuries, illnesses and trauma. The long recovery period from these events is often under estimated, as the toll upon human health and local economies linger for years.”……
…..The Climate and Health Alliance is calling for Australia to commit to the major emissions reductions now urgently required by developed nations in order to avoid the globally agreed ‘safe’ maximum of a two degrees Celsius increase.
A national strategy is a key issue, health groups say, as is the establishment of a sustainable healthcare unit within the Department of Health and Ageing to help drive the health sector’s transition to low carbon operations.
Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven said: “The health sector has an important role to play in terms of responding to changing demand patterns arising from climate change but also by improving the sector’s sustainability relating to emissions, energy production and waste management. This can not only deliver significant financial savings, but also support improvements in health status of staff and the community.”
See full press release at: http://caha.org.au/wp-content/uploads/2013/04/130805_Health-groups-put-climate-first-in-election-poll_final.pdf
For more information about the Climate and Health Alliance federal election 2013 policy platform, visit: http://caha.org.au/campaigns/federal-election-2013/ <http://caha.org.au/campaigns/federal-election-2013/>
A previous article discusses the future of health systems operating under neoliberal ideology as it comes a cropper in a world undergoing degrowth.[i] Here I consider how this thrusts public health[ii] into in a “Which side are you on?” dilemma[iii] likely to separate its institutional administration from its frontline professionals –and the public it is meant serve- as part of the larger process of political/economic conflict, cultural and environmental decline, chaos and (possibly) cultural renewal.
The effects of government-imposed austerity[iv], erroneously claimed to restore fiscal responsibility and restart economic growth, are a reflexive (or cybernetic[v]) reaction to protect the economic interests of wealthy elites at the expense of other citizens.[vi] The funding and operation of the public health system and the array of socioeconomic factors that ultimately ensure a nation’s health[vii] are damaged by austerity.
The deep-seated reasons for recent and continuing financial and economic crises (despite mountains of propaganda and self-delusion that a recovery is underway) lie in neoliberalism’s congenital rent seeking,[viii] its class-based dynamic to channel wealth to a tiny economic elite,[ix] and its inability to realize that modern economies are reaching the thermodynamic limits to growth.[x] (This third characteristic is shared by most modernist forms of political thought, from the left to the right.)
It follows that neoliberal leaders of governments and their corporate masters view the ongoing economic contraction as a temporary deviation from the “natural” pattern of wealth accumulation-to-elites-trickle down-to-the-masses economics made possible by constant growth. Therefore, economic elites see an “opportunity” to use austerity as a cover to increase upward wealth transfer.[xi] A bonus is to accomplish the long-standing atavistic goal of rolling back[xii] the gains of the New Deal and Great Society.[xiii] Hence the massive governmental and corporate propaganda assaults on Social Security, Medicare and Medicaid –and other social benefits programs- as “Entitlements” that allegedly weaken the collective moral character, fiscal integrity and work ethic of the nation. The central premise of this attack -which is arrantly false yet widely disseminated without skepticism by mainstream media- is that these entitlements[xiv] for the “Lesser People”[xv] place the United States government at high risk of debt[xvi] default[xvii] or bankruptcy.[xviii]
There are unprecedented and widely unappreciated dangers posed to public health, nursing, medicine and allied health professions by the ongoing global economic contraction. This is a multilayered and, frankly, emotionally difficult topic to digest. Before discussing how health systems are affected we first lay out the larger social-ecological context of modern society’s predicament. This includes a brief overview of the idea of degrowth,[i],[ii],[iii] which is a response to ecological overshoot and reaching the physical resources and ecological limits to growth, and why it must supplant growth as the cardinal metaphor of modern culture. Then we outline how the inability to perceive that the world has reached the end of growth –by mistakenly seeing the present as a Great Recession- threatens health systems. Read the rest of this entry »
What is sustainable healthcare?
The Alliance for Natural Health has defined sustainable healthcare in the following way.
A complex system of interacting approaches to the restoration, management and optimization of human health that have an ecological base, that are environmentally, economically and socially viable indefinitely, that work harmoniously both with the human body and the non‐human environment, and which do not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system.
Alliance for Natural Health (http://www.anh-europe.org)
Based on this definition, there is very little about our existing healthcare system that is sustainable. To achieve sustainability, it is necessary to look beyond what we have now to what we really want.
Health after Oil will occasionally offer reports from practitioners who are aware they are working in health systems that are unsustainable and in need of transformation. We begin this series with two practitioner accounts of reactions to the implementation of President Obama’s recently Supreme Court upheld health legislation. The first is by Dr. S., a psychotherapist in a rural setting. She discusses the possible implications of the Affordable Care Act (ACA). The second post is by Michael Bennett, a nurse, commenting on how the ACA has overlooked the issue of ecological sustainability. Dan Bednarz, Ed.
Obama’s Affordable Care Act as Prelude
By Dr. S.
As a solo mental health practitioner in a remote rural California community, I’d like to share my experience with what is happening along the way to the collapse of our health care system. I opened my private psychotherapy practice in this rugged and remote area of California in 2006 because it was a community where there were no locally based full-time practitioners. Residents who needed mental health care were either foregoing treatment or driving an hour each way for their 50-minute hour of talk therapy or their 10-minute “med check” with a psychiatrist.
I reasoned if I established mental health services here in this rural community when the health system/economy was still running, then as the collapse unfolded I would be able -in this localized setting- to offer my services in whatever alternative socioeconomic system of exchange emerges. While there is still no local psychiatrist here, over these past six years I have been able to establish a successful private practice. This has been made possible by 1) advertising in the local community newspaper, 2) working hard to get into as many insurance networks as possible so that people with insurance can see me and 3) offering a sliding fee scale for clients without insurance.
While I have always favored shifting health care to a single-payer system, I did not oppose President Obama’s Affordable Care Act (ACA). As this “reform” is beginning to take shape in California, however, I am seeing that it will most likely put me out of business and thus leave our rural community once again without access to local mental health services. This is not only an economic concern to me but personally and professionally frustrating because the localization of health services will be critical in the net available energy descending society we are now entering.
Today I want only to discuss why the ACA is working against my efforts to build a localized practice.
During the 20th century an indispensible yet unrecognized factor allowed the health sciences to attain dizzying levels of organizational complexity and achieve countless life saving and prolonging breakthroughs. The health professions drew upon ever-increasing amounts of human and natural resources, particularly energy. For example, energy’s significance was overlooked because –save for a few peroids of scarcity deemed anomalous or political contrivances- its main supplies –the fossil fuels natural gas, oil, coal- seemed infinite and its cost trivial. Therefore, the complexity of modern health systems and their accomplishments are an epiphenomenon of economic expansion made possible first and foremost by natural resources; only secondarily are they reflections of capital and labor expressed through human intelligence, drive and ingenuity. The era of cheap and plentiful energy is over and this has profound implications for the health sciences and modern world. Read the rest of this entry »