Of Places, Faces, and Stories: What can the Environment and Health movement learn from Global Health?


“Humanism, I strongly believe, must excavate the silences, the world of memory, of itinerant, barely surviving groups, the places of exclusion and invisibility, the kind of testimony that doesn't make it onto the reports but which more and more is about whether an overexploited environment, sustainable small economies and small nations, and marginalised peoples outside as well as inside the maw of the metropolitan centre can survive the grinding down and flattening out and displacement that are such prominent features of globalisation." Edward W Said

Said was not known as an environmentalist. Yet these words could well have been describing the challenges to planetary health in excavating the stories and data born from natural disasters, urban crowding, lost species as well as the populations displaced by disaster, conflict, and lost livelihoods.  Born to Palestinian parents, with American citizenship, growing up in Jerusalem with the most English of first names, the author of the seminal text Orientalism challenged the history of the Middle East documented in the language of the West. Said became in his lifetime one of the most notable voices in human rights, on comparative literature, with the uncanny ability to put a fresh examined angle on old positions and stories. 

It is beholden on each sector to tell the stories of our era well. Using in medicine’s case, the language of science, human contact, and medical ethics. But also using lessons learnt from successes in recent global health challenges. Global health as a discipline is a definition or construct of the last decade and half - although its origins derive from the established practices of international and public health. Its focus is on health for all – globally and equally.   Among collective global health successes are the increases in worldwide child survival, the ongoing fight against tobacco, and for HIV AIDS treatment. Ongoing struggles but with significant gains, are in addressing LGBTIQ rights to health, maternal mortality, and universal health coverage. In modern health history the global HIV AIDS crisis is considered a global health success story in the sense that collective societal action on a global scale around the challenges of a disease with a death sentence – became written into a history of lives saved through access to anti-retroviral treatment. The lessons of HIV AIDS are well documented. Community activism as a global public good. Human rights at the centre. Science driven research agenda. Partnerships across business, government, communities, schools, and media. (See AIDs and Global Health: the path to sustainable development: Lo and Horton 2015). 

In comparison, climate change, environment and health, and planetary health campaigns are sometimes accused of being devoid of a strong human face. They are also sectors where passionate good people and organisations have too often failed to find their common launch pad. Part of the reason for delayed societal action often has sometimes been attributed to the lack of immediate regard of personal risk. Furthermore, the urgent impetus to act very locally is sometimes disconnected from global support or learning networks.  While not disregarding the obvious differences to the HIV crisis in detail, there are some pertinent lessons in global health for the health and environment community to consider. 

  1. Community activism is a global public good.
    Activism or action covers all activities from the universally enshrined right to demonstrate peacefully, to testimonies about the health of your local communities, to technical working guidelines participation as part of professional work. HIV AIDS programmatic success is largely because of community involvement and peer support and counselling. Community including people affected and living with HIV AIDS were and still are the face of the AIDS movement. Are we the health and environment community working at scale with our affected communities? Putting their voices together with ours on scientific and policy panels where we have the power to do so? Are we prepared to walk with (not above) all of them particularly those perceived as less empowered including indigenous, migrant, and refugee and youth  communities as partner advocates in health?

  2. Human rights front and centre.
    While Australia does not have a Bill of Rights, the country is party to several global legal agreements. Assisting international legal instruments to full realisation of their potential to protect health and the environment needs to be prioritised where the chance arises.  A DEA core activity is contributing to submissions and where we can further extrapolate from international legal agreements in an absence of national legislation can be useful.  Intergenerational equity, indigenous health and community, are only two examples of climate justice in need of action. Another is the challenge as to how to sustain and feed our growing populations while protecting the environment. The language of human rights and specifically women’s’ health and reproductive rights holds the critical key to addressing this challenge -- in addition to reducing consumption overall. 

  3. Science driven research and policy agenda. 
    While there is an element of clear science denial in some regions, there are other areas of evidence building in language that policy makers understand that has largely gone unexamined. For example, costs at all levels regarding environmental impacts on health. Future scenario mapping of which interventions on air pollution would bring would overall health or economic benefits have already been extensively conducted and continue to be, in countries such as China. Other potential areas to examine more systematically are in describing and communicating mental and physical health effects of living close to nature and protecting for human health the medicinal riches in the plant and animal life. Can we collate and clearly stake a new and transparent common research agenda as part of ‘national progress’?

  4. Partnerships.
    These are happening at all levels but the one partnership that the entire health community can continue to build and invest in sooner rather than later is with investors and businesses open to listening to the health risks and able to design health impact risk assessments of their own portfolio of products or investments. At the same time public health challenges must not be subject ever again to the argument of profit dominance. That argument has killed many undocumented people from cancer, infectious diseases such as MDR TB, HCV, HIV AIDS, and chronic diseases such as obesity and diabetes. The Doha declaration of Public Health and TRIPS placing public health above profits ensured this in accessing ARVS for HIV AIDS treatment. What is the equivalent future planet and health over profit global forum?

As always, the solutions lie with all ‘ordinary’ people in health -- able to take on global health lessons, not repeat the same mistakes, and apply them in extraordinary fashion to the challenges we are facing in advancing health for people and planet.


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