At just over 30 pages chapter 3 the last is also the shortest, we all hope this does not reflect the length of the future?
Chapter 3. Challenges and Future Prospects
Before beginning to review Chapter 3 I need to revisit the closing sentences of the preceding chapter's conclusion - if you 'get' Hodges' model you will understand why:
"I [Friel] pick up on these ideas of complexity in chapter 3, arguing that how we understand and characterize these phenomena depends on our standpoint and also evolves as knowledge develops and available evidence accumulates. Given those complexities, responding to climate change and health inequity requires the development of policies that transcend doctrinal boundaries and draw on insights from a range of disciplines, including those in the sciences, social sciences, and humanities". p.112.
I hope you can see and will please excuse my reference to Hodges' model, but I've another.
Friel refers to how research is primarily based upon
reductive pathologizing and needs to shift [ ;-) ] "towards research that is attentive to, and actively engaged with, policymaking
processes". (p.114).
In Hodges' model, the Sciences and Politics are
mechanistic, the sciences invariably (with some exceptions)
reductive and the 4Ps I have attributed to the model as follows:
- SCIENCES -PROCESS
- POLITICAL - POLICY
- SOCIOLOGY - Practice
- INTRA- INTERPERSONAL - Purpose
(As in a previous part of this review I have been wondering how policy can (best) permeate the other care (knowledge) domains?)
Being where this review is posted I would be remiss not to state this, picking up on Friel's thought.
OK, let us get back on track. Taking the lead from chapter 2, in Chapter 3 Friel argues the need to take research, advocacy, and policy forward to address environmental degradation, social justice and health equity by breaking down the disciplinary, sectoral and various silos that exist in the many systems that are encountered. Systems research can increase our understanding and the evidence base. Interesting to note also then solutions can be
crafted. (p.113). The evidence base on more equal societies is discussed. With the stress on systems research, systems and systems thinking are explained briefly and referenced. As will already be obvious I am all for the plurality of disciplinary approaches that is needed, but as Friel will conclude this, with systems science, and improved understanding of policy processes (hybridised: is this the Green Marshall Plan that is referred to?) to counter the resistance to change that is already being experienced
now (p.115).
Perhaps above, I have fallen into Friel's trap. I have been caught out as a
model monger (p.115)?
Scale is a concurrent consideration in Hodges' model, as with Friel's account of systems thinking. To macro- meso- and micro-levels let us add nano, there is much still unclear from the presence of plastics and other pollutants in the environment. The arrival of eco-epidemiology is to be applauded (p.116).
Any mention of 'systems' takes me to the
Health System Redesign book I reviewed over a year ago on W2tQ. This is a very useful companion to "Climate Change ..." but is not referenced here. Box 3.1 'Systems Approach to Childhood Obesity Prevention' brought home the connection and the visual representation referred to (p.120). I could readily go off again with Friel's section on Politics, Policies, and Processes (p.122). Thank goodness for this - I feel better now - as Friel "shamelessly plugs" personal involvement with a research program at the CRE (p.124).
The Centre for Research Excellence in the Social Determinants of Health Equity needs to be, not just on the 'map' (Sciences - located geographically) but affecting policies, practices and purposes (individual and organisational). Friel provides several references - very useful and timely. I will reference this, as I'll explain next time. Again the much needed call for a move from
reductionist pathologizing.
Box 3.3 Policy Principles for the World We Want is simplistic (like Hodges' model), but if delivered would be very impactful in terms of the positive change (p.128) that would ensue. Against p.134 my note is "It's a small world!" I'm not sure if this a reference to the Disney song as a perverse consumptagenic global eco-anthem, or to Schumacher? What could be noted (p.134) is the potential role of blockchain in assuring land tenure and ownership. This technology is much vaunted in health, education and the obvious application of economics. In terms of developing nations protection of land rights is critical (even as I write and you read). The chapter closes on policy from "The first 1000 days of Life" to "Health in All Policies" which I reflected upon as "Policies in All the (#h2cm) Domains"? How do we do this? There are avenues as Friel writes of macroeconomics and progressive policy development. There is much on the Social Development Goals and how cities (despite the critique on urbanization) are working together internationally to mitigate climate change effects, even as some governments fail to meet set objectives and global agreements.
The print and layout is excellent, a content listing of sections complements the index (invaluable). The next book I've to review has no index.
Small book, big ideas - correct on both counts and a very informative if rightly troubling read.
One last plea. Do buy this book, but don't leave it on your shelf; read it. There is no excuse, it's small, but your ideas on climate change and the people's health will grow!
I would like to thank OUP
CHAD ZIMMERMAN │ Senior
Editor, Medicine and Public Health
Oxford University Press │ 198 Madison Avenue │ New York, NY
and
Prof. Nancy Krieger for the review copy and
Prof. Sharon Friel for engagement on twitter and RTs.
While I appreciate I make the request to review and this places absolutely no obligation on others, it helps a lot when a publisher / author / conference organiser ... acknowledges the effort - even just a thank you. As ever, the thanks is in the learning gained, not the thanks lost. Many do - lift a hand, nod their head ... of course, making this even more worthwhile here. TY
Chapter 1. Climate Change, Global Justice, and Health Inequities
Chapter 2. It's a Consumptagenic World: Producing Climate Change, Exacerbating Health Inequities
Friel, S. (2019) Climate Change and the People's Health, Oxford University Press, New York
orcid.org/0000-0002-0192-8965