Medicine in the Anthropocene at the Planetary Health Alliance Annual Meeting

This past weekend, I presented a poster of my doctoral research at the Planetary Health Alliance’s Inaugural Annual Meeting in Boston. Planetary health is a growing field[1] focused on “the health of the human civilization and the state of the natural systems on which it depends.”[2] The new paradigm draws on research from conservation medicine, ecological health, the one health movement, geo health, and studies of the Anthropocene to develop strategies for living healthily within the earth’s biophysical limits. As Samuel Myers, Senior Research Scientist at Harvard’s T.H. Chan School of Public Health and Director of the Planetary Health Alliance noted in his opening remarks, achieving planetary health will require a fundamental rethinking of the relationship between the human species and the earth’s environmental systems. This kind of change not only demands action at the level of public health policy, but must also use the power of social movements to change our culture from one that perpetuates ecological destruction to one that improves human health and ecosystem integrity in tandem. Natalie Linou, Policy Specialist at the United Nations Development Programme, captured the new field well when she described planetary health as an opportunity to connect the narratives surrounding social justice, environmental justice, and health equity.

My poster, titled “Human Health and Long-Term Social-Ecological Systems Change: Emerging Alternatives for Health in the Anthropocene”, introduced the theoretical framework that guides my doctoral research. Central to my approach is the notion that the age of economic growth is coming to an end, and that climate change, environmental destruction, and declining energy and material resources will transform the structure of health systems in the future. To deal with the mounting constraints that will limit the size and scope of formalized healthcare models, health and care activities will need to be increasingly grounded in systems of family and community reciprocity. In other words, we need to find ways to make it easier for people to look after one another, often on a voluntary, reciprocal basis. In an individualized capitalist society, the barriers to this kind of approach are high, but in a context of declining resources and energy use, the tables could turn quickly. To explore some of the alternatives that already exist in this space, my fieldwork will investigate social innovations including the Family Care System in Geel, Belgium, Care Farms in the Netherlands, and Community-Based Care in the Transition Movement.

The poster itself was a bit unusual. I recently defended my PhD dissertation proposal and finished up a pile of grading for my teaching assistantship. When it came time to prepare my poster, I felt like I needed a break from sitting in front of screens all day. I decided to make my poster out of fabric so that I could spend a few days making something with my hands. I figured out how to print onto canvas and embroidered details on all the diagrams. The crafted approach to an academic poster also reflects the kinds of social innovations that my research highlights as emerging alternatives for health in the Anthropocene. These are strategies that can operate in a context of significantly reduced materials and energy use. They are place-based and community-centric, and offer strong meaning frameworks for those who participate. Throughout the weekend, I had many conversations with researchers and practitioners affiliated with the Planetary Health Alliance who see the value in asking big anthropological questions about the future of health on our changing planet.

[1] The Planetary Health movement is supported by research institutions around the world including the Consortium for Advanced Research Training in Africa, the University of Edinburg, the London School of Hygiene and Medicine, the Oxford Martin School, the Cornell Atkinson Centre for a Sustainable Future, and the Health Network of the Future Earth initiative.

[2] The Lancet Planetary Health, 2017. “Welcome to The Lancet Planetary Health.” The Lancet Planetary Health 1 (1): p. e1.

The Problem Domain

Tracing the Problem Domain for Medicine in the Anthropocene: Trajectories of Change and Minimum Specifications for Adaptation

Problem context

Part 1: Trajectories of Change

Health systems in the Anthropocene will need to adapt to pressures at the confluence of planetary ecology, the global political economy, and cultural meaning systems. This post will draw together the socio-ecological trends that are converging to transform health and medicine, both at the institutional level and in the informal ways people in diverse local worlds perceive and pursue health in their daily lives. It is intended to capture challenges, tensions, and possibilities, tracing the edges of the problem domain surrounding medicine in an era of social and environmental instability.

I propose that the following trajectories will define the transformation of health systems in the Anthropocene:

  1. Declining resource and energy flows. We have already passed peak production of many nonrenewable resources that industrial capitalist societies rely on for continued economic and technological growth (e.g. oil, copper, and rare minerals that are essential for renewable energy and other advanced technologies). This means that if we are to avoid catastrophic climate change, the material and energetic inputs into all sectors of the economy, including healthcare, will have to be reduced.
  2. The end of economic growth. Evidence from ecological economics and natural sciences suggests that economic growth and environmental sustainability are irreconcilable. Attempts to increase efficiency or to redirect growth to the green economy have not resulted in absolute reductions of material or energy use at a global scale. Projections of potential future efficiency gains offer little hope of continuing to expand the market economy while accomplishing sustainability goals (economic activity would have to be taking carbon out of the atmosphere by 2100 to stay within safe levels). Further, addressing inequality between rich and poor countries and between the rich and poor within countries in a context of ecological constraints will inevitably require wealthy nations to reduce their levels of consumption. Work in degrowth economics shows that the end of growth opens up opportunities to reorient the economy, positioning care as a central organizing principle.
  3. Vulnerability to rapid losses of social complexity. Complex systems theories coupled with historical studies of civilizations such as the Romans and the Maya suggest that increased connectivity and social complexity require ever-expanding material and energy inputs that, when they can no longer be acquired, can precipitate societal collapse. The degree of integration of elements in a complex system has a strong effect on its rigidity and vulnerability. Highly connected systems like our current globalized society are particularly vulnerable to tipping into a phase of creative destruction (for an ecological metaphor, think forest fire in a mature forest). Creative destruction is devastating to the established order, but also releases resources that have been tied up in the existing system to be used in new ways. Health systems will be dramatically affected by any broad-scale social collapse that, for instance, curtails industrial production of medical technologies and pharmaceuticals or that limits their international distribution.
  4. Geopolitical conflict. Warfare in Syria has witnessed hospitals, medical facilities, and medical professionals becoming military targets. Doctors have been forced out of conflict zones or made to work in hospitals without basic equipment or supplies, sometimes even without electricity. In modern war zones, experiments in remote consultation and trauma surgery are emerging out of necessity in the most painful circumstances.
  5. Extinction of medicinal plant species. Climate change is pushing many medicinal plants, central to the medical care of most of the world’s population, toward extinction. The loss of local plants deprives people who lack access to biomedical treatments of their primary mode of healing. It could also limit the availability of plant compounds that are essential ingredients in common pharmaceuticals.
  6. Changing ecologies of disease. As the planet warms, disease vectors that were once confined to tropical regions are migrating into new environments, increasing the incidence of endemic diseases like Malaria and spreading new infectious diseases across a broader geography. Growing antibiotic resistance is also pushing us into a post-antibiotic period. Without antibiotics, the success of cancer therapies and surgeries, which rely on antibiotics, could be seriously reduced, while old diseases once thought to be eradicated begin to reemerge.
  7. Aging demographics. Declining birthrates and increased life expectancies in affluent regions have culminated in an aging population that will live longer and require ongoing care for chronic conditions including heart disease, respiratory health problems, cancers, and dementia. With fewer people of working age to support government provision of healthcare services in the global North, and in a context of shrinking economies and ecological constraints on resources, the demographic transition will strain healthcare services and call for new arrangements for elder care.
  8. Reimagining the welfare state. The end of economic growth creates a crisis for the welfare state, which currently depends on taxation of individuals and corporations for funding. If growth cannot be assured, social welfare will need to be provisioned in new ways. Austerity measures have already gutted healthcare services in countries like Greece that have experienced economic collapse. Options such as a universal basic income funded through global resource rents offer to relieve pressure on overstressed services, but require a radical reorientation of the state’s role in the provision of welfare and social security.
  9. The rise of diseases of modernity. Diseases of modernity like type 2 diabetes, cancer, osteoporosis, and depression emerge due to the wide gulf between the environment in which humans evolved and the behavioural patterns of industrialized nations. Depression, increasingly affecting young people, is associated with diets lacking in essential micronutrients, low levels of physical activity, a reduction in the number of hours slept each night, and intensified social inequality, competition, and isolation. In modern societies, embodied states once within the normal range of human variation are pathologized and treated. Medicalization contributes in some instances to social emancipation for people with disabilities while in others extends the scope of social control over perceived undesirable behaviour or is driven by pharmaceutical companies intent on marketing new cures for new illnesses.
  10. Individualization. Individualization pervades all aspects of modern life, manifesting in medicine as a determined focus on curing individual bodies and extending the lifespan. In societies where health is understood to be an individual responsibility, illness comes to be seen as a personal failing. Individualization masks the social aspects of illness, psychologizing social, economic, and political issues and leading to rising levels of anxiety and psychological disorders. Individualization in healthcare is currently realizing diminishing gains at the level of society and ecology. For example, the quest to extend the lifespan is rapidly expanding the ecological footprint of medical interventions while in some instances decreasing quality of life close to death and contributing to widespread isolation and loneliness among the elderly).

Part 2: Minimum Specifications for Adaptation

With these trajectories as a backdrop for the continued adaptation of human health systems, hope lies in the reinvention of social arrangements of care, the development of low-impact technologies that enable prosumption in healthcare, the growth of captivating meaning frameworks to orient the life course, and the recombination of elements from modern and traditional medicines. I will consider these possibilities in detail in future posts. For now, I will end with what I see to be the minimum specifications for health systems in the transition to an ecologically viable society. Based on the trajectories listed above, effective strategies for medicine in the Anthropocene may attempt to:

  1. Decrease the social and technological complexity of modern medicine as part of a broader project to align society’s energy and material throughput with the capacities of the biosphere.
  2. Extract the best of modern medicine from reliance on industrial production, consumption, and distribution, grounding these processes in an alternative political economy that is radically different from the one in which it developed.
  3. Re-embed aspects of healthcare in networks of family and community reciprocity.
  4. Leverage disruptive technologies (e.g. 3D printing) and ontologies (e.g. cultural understandings of health, illness, the good life).
  5. Question the unit of analysis in medicine (the individual), integrating broader recognition of social, cultural, and ecological health.
  6. Re-frame the problem of death through culture change and re-enchantment.

References:

Armelagos, G. J., Brown, P. J., Turner, B. 2005. “Evolutionary, historical and political economic perspectives on health and disease.” Social Science & Medicine 61(4):755-765.

Baer, H. A., Singer, M., Susser, I. 2003. Medical Anthropology and the World System:  Second Edition. Westport, CT:  Praeger.

Bailey, D. 2015. “The Environmental Paradox of the Welfare State: The Dynamics of Sustainability.” New Political Economy 20 (6): 793–811.

Bauman, Z. 2012. Liquid Modernity. Cambridge: Polity.

Beck, U., Beck-Gernsheim, E. 2002. Individualization: Institutionalized Individualism and Its Social and Political Consequences. London: SAGE Publications Ltd.

Bednarz, D., Beavis, A. 2012. “Neoliberalism, degrowth and the fate of health systems.” Resilience.org. http://www.resilience.org/stories/2012-09-14/neoliberalism-degrowth-and-fate-health-systems

Blakemore, E. 2016. “Will Medicine Survive the Anthropocene?” Smithsonian Magazine Online. http://www.smithsonianmag.com/science-nature/will-medicine-survive-anthropocene-180959473/?no-ist

D’Alisa, G., Demaria, F., Kallis, G. 2014. Degrowth: A Vocabulary for a New Era. New York: Routledge.

Daly, H. E. 2005. “Economics in a full world.” Scientific American 293: 100-107.

Giddens, A. 1990. The Consequences of Modernity. Stanford: Stanford University Press.

Gunderson, L. H., Holling, C. S. (Eds.) 2001. Panarchy: Understanding Transformations in Human and Natural Systems. Washington, DC: Island Press.

Harrison, M. 2004. Disease and the Modern World: 1500 to the Present Day. Cambridge: Polity Press.

Hidaka, B. C. 2012. “Depression as a disease of modernity: Explanations for increasing prevalence.” Journal of Affective Disorders 140: 205–214.

Homer-Dixon, T. 2006. The Upside of down: Catastrophe, Creativity and the Renewal of Civilization. Toronto: Vintage Canada.

Martínez-Alier, J., Pascual, U., Vivien, F.D., Zaccai, E. 2010. “Sustainable de-Growth: Mapping the Context, Criticisms and Future Prospects of an Emergent Paradigm.” Ecological Economics 69 (9): 1741–47.

Maynard, R. 2006. “Controlling Death – Compromising Life: Chronic Disease, Prognostication, and the New Biotechnologies.” Medical Anthropology Quarterly. 20 (2): 212-234.

Meadows, D. H., Meadows, D. L., Randers, J., Behrens, W.W., 1972. The Limits to Growth, (Report to the Club of Rome). New York: University Books.

Meadows, D. 2008. Thinking in Systems: A Primer. Vermont: Chelsea Green Publishing.

Missoni, E. 2015. “Degrowth and health: local action should be linked to global policies and governance for health.” Sustainability Science 10(3): 439-450.

Odum, H. T. 2007. Environment, Power, and Society for the Twenty-first Century: The Hierarchy of Energy. Columbia University Press.

Quilley, S. 2012. “System Innovation and a New ‘Great Transformation’: Re-Embedding Economic Life in the Context of ‘De-Growth.’” Journal of Social Entrepreneurship 3 (2): 206–29.

Quilley, S. 2013. “De-growth is not a liberal agenda: Relocalisation and the limits to low energy cosmopolitanism.” Environmental Values 22(2): 261-285.

Quilley, S. 2015. “Navigating the anthropocene: Environmental politics and complexity in an era of limits.” In Economics for the Anthropocene.

Rockström, J., Steffen, W., Noone, K., Persson, A., Chapin, F. S., Lambin, E. F., Lenton, T. M., Scheffer, M., Folke, C., Schellnhuber, H. J., Nykvist, B., De Wit, C. A., Hughes, T., Van Der Leeuw, S., Rodhe, H., Sörlin, S., Snyder, P.K., Costanza, R., Svedin, U., Falkenmark, M., Karlberg, L., Corell, R. W., Fabry, V. J., Hansen, J., Walker, B. Liverman, D., Richardson, K., Crutzen, P., Foley, J. A. 2009. “A safe operating space for humanity.” Nature. 461:472-475.

Singer, M. 2014. “Transcending ‘Ordinary Times Rules’ in Environmental Health: The Critical Challenge for Medical Anthropology.” Medical Anthropology 33(5): 367-372.

Solomon, S., Greenberg, J., Pysczcynski, T. 2015. The Worm at the Core: On the Role of Death in Life. New York: Random House.

Steffen, W., Broadgate, W., Deutsch, L., Gaffney, O., Ludwig, C. 2015. “The Trajectory of the Anthropocene: The Great Acceleration.” The Anthropocene Review January.

Tainter, J. A. 1988. The Collapse of Complex Societies. Cambridge: Cambridge University Press.

Tainter, J. A. 2014. “Collapse and Sustainability: Rome, the Maya, and the Modern World.” Archeological Papers of the American Anthropological Association 24 (1): 201–214.

World Health Organization. 2015. Health in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals. Geneva: World Health Organization.

Two Rivers

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My research is about how moving deeper into the Anthropocene will transform human health systems. It is also about practices (some long-standing, others newly emerging) that could offer practical alternative trajectories for health systems coming to terms with the ecological and social dynamics of a novel geological epoch. The Anthropocene is already marked by global warming, altered weather patterns, environmental decimation, energy and resource shortages, financial crises, and massive movements of populations, not only of humans, but of birds, wolves, ocean mammals, monarch butterflies, and disease vectors. Since 1950, the scale of growth in humanity’s economic sphere has burned enough fossil fuels to begin changing the patterns of the Earth’s seasons, of its landscapes, and of the less visible biophysical cycles that sustain life on this planet.

The growth of the economy has also fueled the expansion of human society. We now have more people, more cities, more roads, more electricity, more complicated technologies, more pharmaceutical drugs, and more scientific knowledge than at any other point in the long life of the Earth. We also have fewer species, less tropical rainforest, melting polar ice caps, and a smaller number of languages. The parts of the world that are not incorporated into an international division of labour are diminishing and the number of people with access to digital technologies is rising. In the Anthropocene, human economic, social, and political activities will determine the course of ecological change. It is an era of unprecedented global connectivity and social complexity. It is also a time of great fragility and vulnerability to crisis and nonlinear change. Together we each face global risks (climate change, nuclear disasters, pandemics), but lack the collective identifications and institutional mechanisms for a global-scale response.

Health systems in the Anthropocene are floating down two rivers. One is wide and rushing. It is the strong current of high technology, of novel gene therapies, nanomedicine, robotic surgical techniques, wearable tech, and pharmaceutical drugs. It is the medicine of an industrial capitalist, highly complex society; it cures individuals, extends the lifespan, and enshrines health as a human right. The other river is slow and deep. It is the age-old, innate human capacity to imbue life with meaning, to care for each other, and to heal with the pharmacopoeias of nature and human consciousness. It is the medicine of place-bound communities in a resource constrained world; it is embodied, ritualistic, invested with cultural significance, and is community-centric rather than individualized. In the Anthropocene, the two rivers meet.

Some references:

Baer, H. A., Singer, M., Susser, I. 2013. Medical Anthropology and the World System: Second Edition. Westport, CT: Praeger.

Beck, U. 2016. The Metamorphosis of the World. Cambridge: Polity Press.

Bednarz, D., Beavis, A. 2012. “Neoliberalism, degrowth and the fate of health systems.” Resilience.org. http://www.resilience.org/stories/2012-09-14/neoliberalism-degrowth-and-fate-health-systems

D’Alisa, G., Demaria, F., Kallis, G. 2014. Degrowth: A Vocabulary for a New Era. New York: Routledge.

Farmer, P.E. 1999. “Pathologies of power: Rethinking health and human rights. ” American Journal of Public Health 89(10): 1-11.

Greer, J. M. 2009. The Ecotechnic Future: Envisioning a post-peak world. Gabriola Island: New Society Publishers.

Harrison, M. 2004. Disease and the Modern World: 1500 to the Present Day. Cambridge: Polity Press.

Homer-Dixon, T. 2006. The Upside of down: Catastrophe, Creativity and the Renewal of Civilization. Toronto: Vintage Canada

Ophuls, W. 2011. Plato’s Revenge: Politics in the age of ecology. Cambridge, MA: The MIT Press.

Quilley, S. 2012. “System Innovation and a New ‘Great Transformation’: Re-Embedding Economic Life in the Context of ‘De-Growth.’” Journal of Social Entrepreneurship 3 (2): 206–29.

Quilley, S. 2015. “Navigating the anthropocene: Environmental politics and complexity in an era of limits.” In Economics for the Anthropocene.

Rockström, J., et al., 2009. “A safe operating space for humanity.” Nature. 461:472-475.

Singer, M. 2014. “Transcending ‘Ordinary Times Rules’ in Environmental Health: The Critical Challenge for Medical Anthropology.” Medical Anthropology 33(5): 367-372.

Steffen, W., Broadgate, W., Deutsch, L., Gaffney, O., Ludwig, C. 2015. “The Trajectory of the Anthropocene: The Great Acceleration.” The Anthropocene Review January.

Turner, V. 1977. The Ritual Process: Structure and Anti-Structure. New York: Cornell University Press.

Zalasiewicz, J., Williams, M., Steffen, W., Crutzen, P. 2010. “The New World of the Anthropocene.” Environmental Science & Technology 44 (7): 2228–2231.

This blog was also published on http://medicineintheanthropocene.tumblr.com

Disclaimer for an Autoethnography of Research

The purpose of this blog is to document my ongoing research while participating more fully in current conversations about medicine in the Anthropocene. For most social scientists, the early stages of the research process are kept private, with observations living in field notebooks instead of out where other people can read them. Although there are many good reasons for this, I find myself settling in to a more reflexive approach.

It has already taken me many years to begin, and before I launch into too much public writing I think it will be helpful to set out a few points about the nature of these posts. The first thing I should say is that my formally published academic work will necessarily be more painstakingly crafted, having gone through official channels of peer review and revision, than what appears here. What I am trying to capture in this context are the beginnings of ideas and the way they change over time. This blog is meant to be a record of research paths, some followed closely, others abandoned, and still others left to grow wild for a time before being returned to. In this way it represents an autoethnography of the research process which is more tentative than complete. As an autoethnography, it reflects not only changes in my thinking but also more encompassing shifts in my worldview deriving both from my personal experiences and from the inseparability of these experiences from the social, cultural, economic, and ecological positions that I occupy as a person living in this place at this time.

It may be worth being a bit more specific about this situatedness. I am thirty years old, am married to a man, and have two step-daughters that live with us part of the time. I live in an old house close to downtown in Kitchener, Ontario that my parents and my husband’s parents helped us to buy. My parents both run small businesses at a local farmers’ market, my father importing rocks and crafts from Asia and Latin America, and my mom selling coffee. I am an only child, and my parents had a relatively amicable and non-traumatic divorce when I was a teenager. On my dad’s side my grandfather was a teacher in Poland, then worked as a security guard after immigrating to Canada; my grandmother cleaned houses in Rosedale and developed early onset Alzheimer’s when I was a toddler. On my mother’s side my grandfather was a communist and an alcoholic and left when she was little, so no one knew him. My grandmother was a single mother living in Regent Park who went back to school in her forties and worked at a mental health NGO before retiring early and gardening for the rest of her life. I know almost nothing about any of my great-grandparents, am not acquainted with an extended family beyond my parents’ siblings, and have very little sense of cultural connection to my European ancestry. I was raised without religion and with few set assumptions about my future aside from the expectation that I would go to university, which I did. I have an undergraduate degree in Anthropology from Mount Allison University and an MSc in Medical Anthropology from Oxford, and am currently in a PhD program at the University of Waterloo.

Returning to the purpose of this blog, it is also relevant to mention that I have been compulsively journaling for over fifteen years. Long ago I left behind the fear of writing things that I found difficult to process intellectually or emotionally. This means that my writing can be exceedingly honest but also informed by impulses that travel only at the edge of my awareness. These impulses need to be considered thoroughly before being committed to, but can’t be properly considered without first being articulated in some (inevitably incomplete) form. Journaling has on the one hand made me very comfortable with writing about uncomfortable things, but has also made me unafraid of changing my mind and curious about the process that leads me through a tunnel from one perspective into another.

By contextualizing my work in this way I am not trying to make it immune to meaningful critique. I am instead attempting to define this blog as a place to articulate and refine ongoing research, hopefully in conversation with others, or at least in dialogue with unfolding public discussions related to health systems in the Anthropocene.

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Medicine in the Anthropocene

medanthropocene

The world has entered a new geological epoch in which society is a dominant force of ecological change. Moving deeper into the Anthropocene will accelerate the metamorphosis of human health systems.

I study how medical systems are transforming in response to profound reorientations of global socio-ecological systems. My research looks beyond incremental changes to existing health care models toward more radical health system innovations. Around the world, people are searching for ways to secure long-term human and environmental wellbeing amid ecological crises and social upheavals accompanying the end of economic growth as an organizing principle for society. This blog is a place to collect ideas, stories, and emerging practices for medicine in the Anthropocene. In sharing early iterations of my research questions, theoretical orientation, and practical ideas for positive health system transitions, it is also a form of autoethnography tracking the research process.

I also post on medicineintheanthropocene.tumblr.com and Navigators of the Anthropocene.