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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]
From our friend Kurt Cobb over at Resource Insights
This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.
–T.S. Eliot, “The Hollow Men”
The modern end-of-the-world imagination often seeks out great Hollywood-style cataclysms: an asteroid collision, all-out nuclear war, a solar flare that wipes out the electrical grid, even a worldwide epidemic that leaves few alive. Less compelling is the possibility of relentlessly rising death rates that finally overwhelm birth rates and quietly set worldwide population on a downward path.
While such a development would (gruesomely) address population pressures over time, it would be both highly disruptive–the costs of coping would be very high compared to family planning–and also morally repugnant if allowed to occur through intentional neglect.
The idea that a decline could unfold in this manner, however, is so far from any policymaker’s mind that it doesn’t even seem to register. And, yet the seeds for it are being sown right now. As the world economy continues to sputter, government revenues fall. More and more nations are embracing fiscal austerity and public health budgets are being cut. The situation has become exceedingly dire for Greek citizens whose health care system is being slashed to meet austerity targets demanded by Eurozone lenders as the price for keeping the government financially afloat. Because many pharmacies have not received government payments for drugs they dispense in such a long time, these pharmacies are now demanding cash up front. And, impoverished Greeks are finding it difficult and often impossible to pay.
Haiti is the poorest and most densely populated country in the Western Hemisphere, with a (pre-earthquake) population of around 10 million persons and a population density of 335 persons per sq km (10 times the density of the U.S.).[i] With a long history of colonial and political oppression, shortened life spans, massive poverty, energy shortages, poor health care, a raging HIV/AIDs/TB epidemic, and numerous other deep-seated social, political and economic problems, Haiti also represents a vivid and tragic example of Catton’s “Overshoot” concept of when a population exceeds the long term carrying capacity of its natural environment.[ii]
As Amiel Blajchman and many others have pointed out, a major cause of Haiti’s environmental degradation has been the population’s need for cheap energy.[iii] Its growing and impoverished populace is perched on a small shared island landmass with almost no domestically available fossil fuel energy resources and few hydroelectric power supplies.[iv] The cause and effect has been a massive deforestation as wood became the primary but diminishing energy source for heating, cooking and lighting for much of its population. This dramatic deforestation[v] is even visible from NASA satellite imagery.[vi] The numerous ramifications of this environmental degradation are well described with adverse impacts on agriculture, hurricanes, transportation infrastructure and several ecosystems.[vii]
Now, with the worst earthquake shaking the Caribbean in 200 years, we must sadly add another chapter to the Haitian book chronicling the linkage between its human and ecological disasters. Without significant domestic lumber sources or the resources to import replacements, much of the Haitian housing consists (or “consisted” in the areas hardest hit) of unreinforced or poorly reinforced concrete and concrete blocks of varyng quality.
As can be seen by the utter devastation in the numerous aerial surveys and neighbourhood panoramas posted over the Internet, those type of structures fare much worse than that of wood frame housing known to perform well in earthquakes from a human safety perspective. Thus, the Haitians share all too much in common with the experience of the Easter Islanders ecocidal slide into oblivion discussed by Jared Diamond.[viii] Had the Haitian forest environment been managed differently they might have been able to build their homes out of wood and the human suffering from this rare but predictable earthquake would arguably not have been as great.
With the help of massive embodied energy in the food and disaster response resources imported from generous international humanitarian efforts, some of the longer term devastation and loss of life from this event will be averted or postponed. But one can’t help but shudder at the possibility of an entire world so constrained by energy/economic decline induced transport constraints where no help will arrive in time, if at all, in inevitable future earthquake and other natural and man-made disasters. Collapse may be slow and sometimes imperceptible by the current generation, as both Diamond and Greer[ix] eloquently discuss, but sometimes nature’s fury, compounded by mankind’s short-sightedness and foibles, wreaks havoc and death in a heartbeat.
Editors Note: The following book review appeared in Public Health Reports / January-February 2009 / Volume 124. It appears here through the kind permission of the Journal. A PDF version can be downloaded here.
“Having heard all of this you may choose to look the other way… But you can never say again you did not know.”
William Wilberforce, British Parliamentarian, 17891
I recently finished reading a critically important book by Professor William R. Catton, Jr., entitled, Overshoot: The Ecological Basis of Revolutionary Change.”2 I not only consider it one of the most influential books I have ever read, but I believe it ranks as one of the most important books ever written, period. I wished I had read it 27 years ago, but at that time I had already left my undergraduate ecological roots behind me while engaged in the excitement and challenges of the start of my public health career at the Wisconsin State Health Department. Well, better late than never!
Despite its maturity, Overshoot remains a vividly fresh and visionary work of brilliance and foresight. The ecological foundations of Catton’s thinking are strong and enduring due to his careful research and interpretive power. His treatise explains much about the human condition that we find ourselves in now, early in the 21st century. In a breathtaking yet concise sweep of history and biology through the eyes of a human ecologist, Catton reveals how we got here and where we are in all probability headed. He summarizes this view as follows: