Health Systems Research

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Medicine in the Transition to an Ecologically Viable Society

Ecological systems are defined by hard limits to the quantity of materials that can be extracted, energy that can be used, and pollution that can be absorbed (Odum, 2007). For many environmental systems we are either approaching these limits, or have already surpassed safe thresholds (Rockström et al., 2009). The emergence of global-scale, complex problems such as climate change, economic crises, and geopolitical conflict illustrates that the dominant socio-ecological regime of industrial modernity has become maladaptive (Beddoe et al., 2009). Globalization, which strengthens the interconnectedness of social and ecological systems throughout the world, also makes the risk of “synchronous failure,” or cascading social and environmental disasters, higher than at any other point in human history (Homer-Dixon, 2006). Navigating the transition to an alternative socio-ecological system that can maintain ecological integrity and long-term human wellbeing will require unprecedented redesign of existing cultural, economic, and political models (Westley et al., 2011).

In sustainability studies, the intrinsic connection between human and environmental wellbeing is widely accepted: human survival and quality of life depend on the clean air, fresh water, hospitable climate, and plant and animal species that only healthy ecosystems can provide (Gibson, 2005). More research is needed, however, to understand and address the “wicked problems”[1] at the confluence of human and environmental health. The crux of these wicked problems is the extent to which modern healthcare systems are premised on levels of social complexity and material and energy use that are unsustainable and cannot be taken for granted in a context of increasing ecological constraints (see Tainter, 1988; Homer-Dixon, 2006; Quilley, 2015). For instance, consider the antibiotic penicillin. While the bacteria penicillium could be cultivated at home, a daily dose of penicillin for a single individual requires processing over 2000 liters of raw mold juice (Dartnell, 2014). It would be nearly impossible to make antibiotics without mass production facilities, which in turn entail not only a high degree of role specialization, but also the presence of related industries furnishing appropriate equipment, expertise, facilities, and distribution networks (Dartnell, 2014; Quilley, 2013). Therefore, although modern medicine has vastly improved human health outcomes around the world (Schrecker, 1999; Kunitz, 2007), it has done so on the back of energy intensive, ecologically destructive, and socially corrosive industrial processes made possible by a historically singular abundance of nonrenewable fossil fuels (see Greer, 2009; Ophuls, 2011).

While modern healthcare systems are vitally important to human wellbeing, their embeddedness in the ontologies, social structures, and political economy of industrial modernity make them vulnerable to accumulating stressors on the dominant socio-ecological regime (Bednarz & Beavis, 2012). In the coming decades, ecological limits to economic growth (Meadows et al., 1972; Daly, 2005; Jackson, 2009) will place increasing pressure on healthcare systems that currently depend on perpetual growth and fiscal transfers to fund highly complex infrastructures[2] (Bednarz & Beavis, 2012; Quillley, 2013). My research will consider how modern medical systems can adapt to provide effective care during the transition to a sustainable society. I will explore potential alternative models for healthcare systems that are finding ways 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) (Quilley, 2015); and
  5. Re-frame the problem of death through culture change and re-enchantment rather than continually deferring and externalizing the costs of death anxiety (Becker, 1973; Dickinson, 2009; Seligman, 2008)

The goal of this work is to frame a prefigurative politics (identify future social arrangements and excavate a shallow, unstable but alternative basin of attraction intimating a different kind of modernity) for medicine in an ecologically viable society that can secure both human wellbeing and environmental sustainability over the long-term. To do this, I will consider the potential of existing models to build the foundation for an effective global healthcare system in a future of growing ecological constraints and economic and social instability (see Homer-Dixon, 2006). These models include, for instance, community-based care for mental illness in Geel, Belgium (Jay, 2014; Roosens, 2007), alternative healthcare systems in intentional communities (Richardson, Nichols, & Henry, 2012; Da Silva, 2009), and complexity medicine (Sutherland, 2015).

Conceptual Framework Diagram (click on the image to expand)

Conceptual Framework Paper Concept Map Final

Footnotes

[1] Wicked problems are complex, confusing, and paradoxical. Solutions require engaging diverse stakeholder groups and negotiating between inevitable trade-offs and unintended consequences (Rittel & Webber, 1973; ASPC, 2007).

[2] US healthcare industries currently contribute 8% of the country’s annual greenhouse gas emissions, employ 5.3 million people, represent 17.9% of the nations’s GDP, and use 73 billion kWh of electricity (Campion et al., 2015). Hospitals are the second-highest consumers of energy by facility type in the United States (Campion et al., 2012).

References

Australian Public Service Commission. 2007. “Tackling wicked problems: a public policy perspective.” Canberra: APSC.

Beddoe, R. Costanza, R., Farley, J., Garza, E., Kent, J., Kubiszewski, I., Martinez, L., Mccowen, T., Murphy, K., Myers, N., Ogden, Z., Stapleton, K., Woodward, J. 2009. “Overcoming systemic roadblocks to sustainability: the evolutionary redesign of worldviews, institutions and technologies.” PNAS 106(8): 2483-2489.

Bednarz, D., Beavis, A. 2012. “Neoliberalism, degrowth and the fate of health systems.” Resilience.org.

Campion, N., Thiel, C. L., DeBlois, J., Woods, N. C., Swanzy, L., Landis, A. E., Bilec, M. M. 2012. “Life cycle assessment perspectives on delivering an infant in the US.” Science of the Total Environment 425: 191–198.

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

Dartnell, L. 2014. The Knowledge: How to Rebuild Our World from Scratch. New York: The Penguin Press.

Da Silva, A. 2009. “Growing a culture of community health and well-being at Earthaven Ecovillage.” Communities 145: 16-17.

Gibson, R.B., Hassan, S. 2005. Sustainability Assessment. Sterling, VA: Earthscan.

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

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

Jackson, T. 2009. Prosperity without Growth: Economics for a Finite Planet. London: Earthscan.

Jay, M. 2014. “The Geel question.” Aeon. https://aeon.co/essays/geel-where-the- mentally-ill-are-welcomed-home

Kunitz, S. J. 2007. The Health of Populations General Theories and Particular Realities. New York, Oxford: Oxford University Press.

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.

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

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

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.

Richardson, J., Nichols, A., Henry, T. 2012. “Do transition towns have the potential to promote health and well-being? A health impact assessment of a transition town initiative.” Public Health. 126(11): 982-989.

Rittel, H., Webber, M. 1973. “Dilemmas in a general theory of planning.” Policy Sciences 4(2): 155-169.

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.

Roosens, E. 2007. Geel Revisited: After Centuries of Mental Rehabilitation. Antwerpen; Philadelphia, PA: Garant.

Schrecker, T. 1999 “Money matters: income tells a story about environmental dangers and human health.” Alternatives Journal 25(3): 12-18.

Sutherland, W. 2015. Grand Rounds: Healing medicine for a complex world. Institute of Complexity & Connection Medicine.

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

Walker, B., Salt, D. 2012. Resilience Practice: Building Capacity to Absorb Disturbance and Maintain Function. Washington: Island Press.

Westley, F., Olsson, P., Folke, C., Homer-Dixon, T., Vredenburg, H., Loorbach, D., Thompson, J., Nilsson, M., Lambin, E., Sendzimir, J., Banerjee, B., Galaz, V., van der Leeuw, S. 2011. “Tipping toward sustainability: emerging pathways of transformation.” Ambio 40: 762-780.