Insights (Essays)

Insights (Essays) September 2015

Healthcare - How We Live, Environment - Where We Live, and Economy - How We Make A Living

Hugh MacLeod

In earlier society we separated human health, the economy and the environment into neat boxes, each divorced from the other with separate ways of thinking, communicating and funding their solutions.  Think of the many cycles of disease, which swept the European capitals of the last millennium.  In the wisdom of hindsight we know that cholera epidemics were a function of pollution, human effluent running in the streets.  Black death was to a degree spurred on by food waste, attracting vermin into cities and leading to the rapid spread of disease.   

These scourges were not just problems of environmental degradation however.  They were also problems of the economic realities of the time, which had many poor members of society living in squalid city conditions, in order to earn their livings.  Healthcare was also not sufficiently evolved to realize that prevention was part of their sacred trust, not just treatment of disease, after environmental conditions had created a crisis. 

Has humanity learned that an externality to economic activity has the potential to stifle economic growth?  Have we embraced the fact that the environment, the economy and human health are intertwined in complex and irrevocable ways? 

Each and every week separate conversations are happening about...climate change, economy and health. Convention dictates that there is something called healthcare, something called environmental protection and something else again called the economy. They look at different issues, use different language and depend on different types of expertise. 

Yet we will never optimize progress in any of these domains unless we begin to think of them holistically. Taken together, these core elements of society – how we live, where we live and how we make our living - are so tightly integrated that it is impossible to think of any one without necessarily involving the other two. 

If we think of healthcare in isolation, we can easily focus only on curing people of disease. But a reduction in infant mortality is of limited value if that means more children survive disease to die of poverty and starvation. If we think of the environment in isolation we can expend huge efforts to preserve the wilderness yet remain heedless of the human destitution just outside the borders of wildlife sanctuaries. If we think of the economy in isolation, we will focus on growth as the only measure of human development but ignore its effects on resource depletion, pollution, an overindulgent life-style and even mental stress. 

Science has shown us again and again that our reality consists of ecologies, systems and networks, yet our preference for compartmentalized thinking persist in breaking problems down in ways that refuse to see larger interrelationships. Looking only at the domains that we’ve arranged neatly in silos, we fall victim to the law of unintended consequences.

We pull economic levers and are surprised by their unexpected effects on health or the environment. We pull healthcare levers and are shocked to find spiralling costs the economy simply cannot sustain. The global economic situation we find ourselves in today has shown us the extent to which we live in a highly interdependent global world, where boundaries matter less than the urgency with which we can devise trans-national solutions.  

Yet despite both the immediacy and urgency of the crisis, governments and citizens alike are delaying in making the obvious but hard choices that are the only way forward. I am not talking about wind power, carbon taxes, or electrical cars. Laudable and necessary (even overdue) as such initiatives are, they address the crisis only at the margin. Our real difficulty lies in how we frame the problem, our inability to think about social challenges holistically. 

Nowhere are the effects of compartmentalization more harmful than in the economic concept of externalities. These are the items that are “off the books” and never factored into the complete costs of any economic activity. A company dumping industrial waste into a river considers its clean up as an “externality” that does not figure in its cost calculations – it is someone else’s problem. A computer manufacturer prices its products without worrying about the time and effort that will be needed to dispose of components, some of which are health threats, once the products become obsolete. Just think about the amount of industrial waste we send offshore to be out of sight and mind. We have compartmentalized our thinking about the economy so as to ignore its effects on health or the environment. 

Consider at a minimum the issue of global warming. The World Health Organization has identified climate change as one of the top three current threats to human health. We expect to see dramatic increases in temperature-related morbidity and mortality. We will likely see more severe health effects from air pollution. Finally, vector-borne and zoonotic diseases will likely spread to areas that have been relatively immune. 

What is more, the proliferation of these health challenges could have a crippling effect on our economy in terms of rising absenteeism, high turnover and low productivity.  Indeed, it is not fanciful to imagine a self-fuelling downward spiral in which climate impairs health, which impairs productivity, which reduces the resources available to mitigate the deterioration in the environment. 

The challenge is how to benefit from a systems approach without it becoming disempowering.  At a certain point, problems can seem too vast and complex to solve.  With climate change, economy and health, we have people and politicians feeling overwhelmed by the complexity and the reality that it touches on so many different parts of our lives.  Mobilizing support for discrete actions is often more effective than broader comprehensive approaches.  We are a society that loves piecemeal approaches in many respects.   Ultimately, my question is how do we reshape our thinking to benefit from a broader perspective, while still moving forward and taking action?  

Solutions to today’s problems will not be characterized by a magic bullet or a single technology. They will be framed by broadly based initiatives that secure participation from the grass roots. They will embody a holistic approach that breaks down silos, aligns motivations and associates incentives. And they will consist of thousands of small steps, all leading in the same direction. 

Is such a transformation possible? History shows us that it is. Broad social campaigns have promoted women’s equality, LGBT rights, literacy, and healthier lifestyles, and they have decried smoking, domestic violence and drunk driving.

Ultimately such examples show that it is possible for mindsets to change and for society to abandon the familiar and convenient in favour of a higher set of principles. Society does it even if it is inconvenient because we come to recognize through collective reflection and action, that it is the right thing to do.

About the Author(s)

Hugh MacLeod a concerned citizen.


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