Book review: iii "Leave No One Behind" #LNOB

Arriving at chapter 4 "No Smallholder Farmer Left Behind" by Jane Nelson,I was acutely aware of the news from India in the (N) autumn. Smallholders and family farmers protested about newly enacted farm laws. The government claimed the changes would protect the farmers from bullying middlemen, while the farmers were afraid of price instability and the rise of corporations*. Even in today's news I note this issue is ongoing. Very quickly any romantic notions of smallholder farmers are challenged reading this book and must be set aside. How can being a farmer (and agricultural laborers) equate with being among the world's poorest and most vulnerable and yet they number an estimated 500 million? There are 200 million smallholders producing food as part of formal supply chains and yet they are in extreme poverty and were circumstances are improved, there is a risk of relapse. 

Leave No One Behind

The talk of public-private partnerships, even if 'new' is disconcerting. This is the 21st C. though as  'inclusive business models' are defined. I was (slightly) shocked at the proximity of businesses and corporations, what choices do 'small-players' have? This is the value of the book, correcting parochial notions from Wigan Pier.

With an eye on the Green agenda though, and reading of the role for technology it still unsettles me thinking about bio-genetics, digital colonialisation when reading of the role of digital technology. With low and high Earth orbits filling up, there should be improved broadband access in remote locations, but I do wonder about choice. This is were the authors and organisations will no doubt push an advocacy role (p.68).

  As I mention orbits and digital technology, mapping is key and to smallholder farmers too:

🔔REMINDER: Tomorrow (Jan. 22), #YouthMappers is hosting a #mapathon in support of smallholder farmers in Mali from 17:00-19:00 UTC.

Come map with us! ReGISter for the Zoom link⬇️https://t.co/POzDO6KO4j

— YouthMappers (@youthmappers) January 21, 2021

It is good to hear of development work that is also climate-smart. Leapfrogging is a important idea in the book (to follow) but I hope that as mobile technology has jumped the communications infrastructure of some developed nations that small-holders here can also leapfrog. The book's footnotes do not leapfrog, they are fairly constant and a very rich thread of learning and sources. A key and literal platform for leapfrog is big data and AI (p.70) [ https://www.brookings.edu/research/using-big-data-and-artificial-intelligence-to-accelerate-global-development/ ]. Hopefully, this blog demonstrates my enthusiasm and interest in STEM, again with these influences I can't help recalling my review of Friel's LITTLE-big book on climate change and the people's health in which attention to the nutritional value of food is stressed. When Nelson asks of the poorest farmers "What are they eating?" (p.76) yes, you do have to ask. 

Give me a page of text and certain words standout a kilometer. 'Holistic' is one. So, holistic investment in infrastructure is needed (p.77) and a holistic approach to on- and off-farm interventions. The expertise, experience and political awareness of the development community is evident here in accounts of measures and evaluation. Rurbanomics (p.77) concerns the linkages between rural and urban economies and in policy terms there could be specific mention of the rural phenomena of 'empty villages' (in the EU too?) and the need to better manage the movement of people from rural to urban environments.

The chapter organisation is almost logical moving to refugees and migrants [Chap. 5]. I've posted before on geopsychiatry and it will be interesting to see in coming years if non-refoulement (p.79) routinely enters the news lexicon. At this time, how the majority of us wish we could travel, and p.82 had me wondering about ancient history before 'countries': no nations. Discussion of the definition and its limitations of 'refugee' 1951 is very informative, especially as it relates to the SDGs, which includes migrants. You can see how much crossover there is (and must be - sustainable determinants of health ...) between the SDGs and hence the need for all governments to address this in policy and law. 

Working in healthcare and c/o Brexit and the COVID crisis you are aware of the global nursing and social care workforce.  This is described here in terms of training (p.96) To state the obvious, politically, refugees and migration remain a charged matter. Quite rightly the gains from international refugee and migration flows have a section of their own. Since the 1990s you become ever more aware of remittances sent abroad (and until recently the cost of the same). Talk of seasonal work has an analogue in the seasonal routes that people at great risk whatever their reasons, make from Africa and Asia. I've mapped some content from chapter 5 to Hodges' model:

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

GROUP - COMMUNITY - POPULATION

mental health post-traumatic stress knowledge diffusion	access to shelter, water, health care and sanitation rural - urban border regions cities
social media social attitudes in receiving nations sexual and gender-based violence	formal labor market access informal camp employment? remittance flows 'mechanism design theory' p.93 land registration having an 'address'

I learned of What3Words quite a while ago** and the addition of 'having an address' in the POLITICAL domain is an addition. I knew an article in May (FT Magazine, 16-17 May 2020, pp.32-35.) would come in handy:

"Where the streets have no name" by Deirdre Mask - The Address Book. 

An illustration by Andy Robert Davies says it all:

Illustration for an article that highlighted the importance of street names and residential addresses when tackling outbreaks of disease. All artwork © Andy Robert Davies https://ardillustration.com/ft-magazine

Mask's book points out the obvious that if you are Stateless you are address-less too. The health - political implications here are serious and this problem is not restricted to 'developing' nations. So much is tied to this: track and trace, having a bank account, being able to vote all can depend on this specific information. Without an address, a default - whether acknowledged or not - of 'data missing' in census data gathering follows. For many nations the 'census year' has been disrupted by the pandemic. 

Referring back to migrants, refugees and the recent politicization and nationalistic rhetoric, reading made me wonder about government's ability to envision the positive potential of migration flows and refugees. The statistics are revealing in the impressions provided by social media and news reporting. The problem for (some) policy makers and resident populations given the bias and misinformation of reporting seems to me, extracting individual and family narratives from the collective.

The reader is very well served with the index, if needed, while reading and my writing here. Unless I've missed it, there is a missing reference to 'tax' on page 312, which we'll reach next time. It is an important one.

Homi Kharas, John W. McArthur and Izumi Ohno, (Eds.) 2020. Leave No One Behind: Time for Specifics on the Sustainable Development Goals, Washington D.C.: Brookings Institution Press.  

*https://www.aljazeera.com/economy/2020/12/1/why-are-thousands-of-indian-farmers-protesting

**https://hodges-model.blogspot.com/2016/04/what3words-mapping-globe-hodges-model.html

Book: Visualising Powerful Knowledge to Develop the Expert Student

A Knowledge Structures Perspective on Teaching and Learning at University

Following Professor Friel's book on Climate Change and the People's Health, I've another to review with just 33 pages left to read.

Another short book at 134 pages it has been read by-and-large whilst in casualty (3 times in 6 days), waiting and shifting between ambulance triage, X-Ray, Zones 1-3 to being warded, or not (warded now); with a family member. This probably accounts for the fact that while reading I've noticed some word errors, but not pencilled the margin. I think there are 3-4 thus far. (Usually) Proof-reader-Pete, I'll watch and record any others. This is not a major problem from a gift of book, that was brought to my attention on the Threshold Concepts Discussion list. Blogging over the years, I've probably referred to many 'gifts' granted through academia, books, journals and study in ideas and influences that can further Hodges' model. Here is another and as the book covers below reveal - what is the first book in a trilogy.

Constructionism clearly has a role to play in studying Hodges' model. Professor Kinchin from the outset prompts me to see limitations. Limitations not in Hodges' model, far from it; but the limitation and challenge of time to really focus on the model and where, how and why it 'fits' and 'sits' within theory, practice, discourse and research. I am sure it does in a way beyond the rendering of 2x2 tables on W2tQ. I've been aware of CMap and other software for many years - decades even. As my source indicates, threshold concepts figure here. I look forward to writing this review in the next few weeks, including ramifications for my study of Hodges' model and the impact upon future teaching I might pursue as a tutor.





Kinchin, I., 2016. Visualising powerful knowledge to develop the expert student. Rotterdam: Sense Publishers.

See also:

Review One

Two

Three

Four

Five

Six

Thanks to Brill for my review copy.

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

Climate Change and the People's Health

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:

1. SCIENCES -PROCESS
2. POLITICAL - POLICY
3. SOCIOLOGY - Practice
4. 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

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

Climate Change and the People's Health

Whatever your educational philosophy when a book offers new concepts that is welcome learning. Learning enhanced when the concept, as is often the case, is a hybrid of terms.

Chapter 2 It's a Consumptagenic World looks at the veritable production of climate change. Our dependence on fossil fuels not just for our transport, but the transport of food and agricultural products is explored. Perhaps there is a political irony in the former slogan of education, education, education amid relentless growth, growth, growth. At least now there is a constant message regards there being "No Planet 'B'".

If chapter 1 considered food security, this chapter attends to the industrial food system. Once again the themes are first introduced and related back. Very interesting here is the rise of urbanisation and the drivers for this. In chapter 1 I noticed the word shift. Nurses are one occupational group that recognise this word only too well. Here though it is the shifts in population that is very worrying. Especially so when many people may be putting themselves in harm's way as chapter 1 described. It is encouraging to see references going back to the 1940s. There is an evidence trail.

Current economic systems seems to reward monopolies and creates externalities (p.60). Unfortunately there is a lack of evidence in the production of pollution if remediation is to be sought. The emission of greenhouse gases where products are produced may be remote from where they are consumed. Friel argues for accountability at the origin of products not where they are consumed. Such externalities are 'out of the box' and need to be put back in the box and properly accounted for - (ecological governance). Often industrial concerns also follow the cheapest ('best value?') labour markets, relocating when needed.

Friel really annoyed me. Yes, in a positive way. Figure 2.2 compares a range of consumer goods and how their cost has changed over time; food, housing, health care, versus technology, media goods for example (p.68). The need for sustainable health care services is a constant topic it seems (Centres of research, journal special issues, conferences, twitter chats...), but when the essentials of living are so expensive does this not undermine and load - displace the disparity - the inequity no-less on to the health sector, its workforce and funding? It is as if the scientific-economic-industrial complex is saying to the health care (and social care) sector "Carry This!". There is no choice. It is a consequence of the society in which the bulk of us live. As Friel writes, processed foods lend themselves to concentrated control of supply chains which can introduce pricing volatility (p.78). The price of good quality nutritional food is a health inequality (p.76); figure 2.3  (p.77) illustrates the system.

While reading I thought of how amid the emotional, social and economic ravages of dementia we talk (well some of us ...) of organisational memory, while having forgotten what 'local' means. The rise of glocalism and the pursuit of growth - at any price it seems - in some quarters even prompts a re-evaluation of philanthropy in the 21st relative to the 19th and 20th? I found myself wondering how we would recognise a shift (the shift) in the market's thinking when watching the business TV channels CNBC, Bloomberg and similar ilk? The consumptagenic system has an effect on organisational memory, it is a behaviour known as perseveration; repetition of the word: profit. For all the thoughts provoked in me, this book is not a capitalism bashing exercise. Far from it, it deals objectively with what remains a sad and dangerous reality.

If it were not for the realist and critical perspectives that must also be present, the efforts of technologists, policy makers and researchers (urban informatics) and others to create Smart cities would seem to guarantee success. The discussion on cities (pp. 93-112), their sustainability, projected populations and the health inequities arising from them is very illuminating. In a teaching situation there is a lot to engage students, not just in the 'city' but in the text overall.


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

Chapter 3. Challenges and Future Prospects


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

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.

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

Climate Change and the People's Health

You could read this excellent little book in a couple of hours, but me being me ...

Part of a Series of 'Small Books, Big Ideas' in population health this is an important and timely text of a type that sadly will need to be a constant stream. Constant, not only to keep the message and issue in people's consciousness, but to update the research of a still new interdisciplinary field. Not only that but some sense (measure) of the socio-economic-political state must be realised to identify change (progress). This small book argues for the big change in attitudes, behaviours and systems that must follow.

The book prompts me to imagine the day (whether or not in my future) when the media can report on the gradual reverse of climate change? We have heard of positive changes in the size and behaviour of the Antarctic ozone layer for example; only for progress to be challenged once again. It is not enough to hope for our children, their children ...  and the biosphere of Earth.

The book has just three chapters in 146 pages; 188 pages including the references and index. The 'small' quality relates not only to page number but a hardback size of 18 x 15 cms, such that my copy has been on tour (petrol car and alone) over the summer. A Forward by Nancy Krieger refers to the book series as a whole and points to the political dimensions and how inevitably practitioners must be part of this 'game'. Not just what we oppose but what people stand for. The dynamism in this field is apparent in the reference to expressed opposition alone given rise to despair. This book is very current (2019) but 'eco-anxiety' did not make the index, such is the pace of events (Greta Thunberg). This is not a criticism but speaks of the dynamism and hope that action can (and must) bring as Krieger writes. The fact of this being a political struggle is acknowledged by Friel in the conclusion.

This is not just important but critical. You should never generalise and many nurses (for example) are politically very literate and Active. They seek to protect, sustain and improve the values, the health and health care systems they hold dear. Many other nurses focus on the 'job' of caring. The thought follows that while politics starts in the staff-room and rota; the Politics begins in the ward office and the various meetings and committees. They conclude that they'll leave that to others. For all healthcare workers we can no longer take this stance. Population health demands a population response.

To be continued (of course you don't have to wait to obtain your copy - this is essential reading):

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

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

Book: "Climate Change and the People's Health" i

Climate Change and the People's Health

"Chapter 3 looks forward. It begins by calling for a wider conceptual and methodological toolkit among public health researchers - one that includes systems science as well as a focus on policymaking processes." p.xxxvi

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

Review to follow ...