- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Thursday, October 17, 2019

Review: iii "Climate Change and the People's Health"

So to the book proper ...

When a book's Forward has 19 references you are primed for many more. The Introduction reinforces this expectation and also defines concepts, specifically health inequality and health inequity. I'm also bound to be drawn-in by a text that:

"... calls for interdisciplinary responses that employ knowledge and analytical tools from across the sciences, social sciences, and even the humanities". p.xxii.
That 'even' is priceless, in terms of the relationship between social sciences and the humanities and the prospective role (that is already being applied?) they will play in solutions, vis-à-vis the communication of climate change and public (mental) health themes using the arts, media, creativity, history and communities.

The Introduction provides a brief primer on global action on the Social Determinants of Health [SDoH] and climate change. A critique of key policies, programmes and reports is provided leading to the arrival of the Sustainable Development Goals. The politics of the above is discussed, with shortcomings and avenues of progress noted. The three chapters to follow are described and as befits a 'small' book we are informed of what the book does not address. The book's focus is climate change. For a text on population growth and transition to alternate energy sources readers should look elsewhere.

Chapter 1. Climate Change, Global Justice, and Health Inequities

The book uses 'Boxes' asides to elaborate on certain points, e.g. Box 1.1 The Earth System. There are tables and figures too. Many make for troubled 'reading' and not for reasons of size or legibility. The text is dense in terms of the information delivered, but that is to be expected. This is serious stuff. "Climate Change - (really) Is a Global Justice Issue" p.16.

While in the open source and open access movements we celebrate the Commons, Friel points to the way that climate change has the characteristics of a "global commons" problem. p.16. Politics permeates the book as noted in post ii.

 individual
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- MECHANISTIC
SOCIOLOGY : POLITICAL
|
group - population







"Together, the least-developed and developing economies contributed, since the mid-eighteenth century, less than 25% of global cumulative CO2 emissions (Lykkeboe and Johansen, 1975)". p.16.

The problem of having all states adopt the same transformative behaviour is described mechanistically.
There is presently no mechanism. 

Ethics is brought up as it must be in the years, decades to follow. (I was minded to think of Maslow's hierarchy applied to the whole of humanity: now that would be a great levelling. p.20.) Now, there is a new measure beyond the perverse capitalism debate. Why should people be able to live in luxury at the expense of even the basic needs of other peoples being met? Intergenerational inequity has a small section of its own (p.22). Those with the means will be able to move, to mitigate the impacts of climate change. Millions of others are effectively trapped by geography, health inequities and life chances. So many are without political and economic power to make for positive change.

As I was working on a paper on h2cm, SDoH and the SDGs the update on health inequity within and between countries was very welcome (p.24). On "food consumption gaps" I wondered about the plethora of 'gaps' that must exist and (sadly) operate in climate change and people's health (p.28). Globally foodborne disease is not uncommon, but to this degree (p.29)? With an estimated 3,037 deaths annually in the United States. Key health issues are discussed, malnutrition, non-communicable diseases, air pollution - ambient and indoor. A point about Bourdieu (1989) and an individual's life choices, is bound to remind me of 'life chances' within Hodges' model. This is what lies behind the idea of the "Health Career". This is not the professional's career, but the varying status of a person's health and wellbeing through their life (and even before birth and approaching end of life). Friel's discussion of Michael Marmot et al. (1991) and the "Whitehall studies demonstrated that, in addition to maternal security, a  range of psychosocial factors are important for health and are contributors to health inequities, including social support, social capital and social cohesion". p.33.

There are conceptual models for SDoH, the Eco-Social Model of Health, which obviously keeps me turning the pages (p.34).  Friel notes historically how environmental epidemiology has tended towards being reductive and mechanistic in approach, rarely taking onboard the influence of social, economics and political contexts. I scribbled the following as a review quote:
"Appreciation of this global scale and of the range of influences on human health required a significant conceptual as well as a methodological shift". p.35.
New epistemologies are needed: enter eco-epidemiology. Time is a factor in integrating our view of disease and disease prevention. I visualise this as a series of frames for an individual, the same for a community. Many of the figures are Creative Commons Attribution 4.0 license. I have not read the book "The Uninhabitable Earth - Life After Warming, By David Wallace-Wells, but a review declared a depressing quality in the scenarios rendered. I had this in mind noting the statistics and reporting that Friel provides. This is worrying too - future rates of mortality - the overall increase; those attributable to specific effects - diarrhea, childhood undernutrition, heat exposure and more... (p.38). There's a small Box on the Disability-Adjusted Life Year. The effect on sea level rise, food production, heat stress, the movement of disease vectors are the subject of the remainder of chapter 1. This is a sobering read, but necessary. Bizarrely - a contribution to global ecoliteracy: medicine for eco-anxiety?

To be continued ...

Chapter 2. It's a Consumptagenic World: Producing Climate Change, Exacerbating Health Inequities

Chapter 3. Challenges and Future Prospects


Friel, S. (2019) Climate Change and the People's Health, Oxford University Press, New York.