"Health service reform will have little relevance in the face of the systemic problems arising form our profligate use of fossil fuel energy and the associated overconsumption which underlies the chronic diseases epidemic. Who believes that any health service, however configured, will be able to cope with a population with an obesity prevalence of 40%?
Another folly of our age is the present obsession with motivational nudges as the main tool for behaviour change. It's wonderful to hear how painting a fly in the centre of the Schipol pissoir has encouraged men to aim accurately, so minimising the splash of urine onto the surrounding floor. But nudging toward drinking less alcohol, buying better food, using less carbon? Haven’t seen much evidence of success there. Regulations, taking the handle off the broad street pump, banning smoking in public spaces, having to wear seat belts , pricing alcohol effectively, giving women the vote , recognising the legitimacy of same sex relationships have, on the other hand, well established track records as effective agents for changing behaviour.
Nudging and exhorting may help some to change our behaviours, but will certainly not be effective across the whole. Systemic problems demand systemic solutions.
So with a truly alarming burden of disease coming our way, and a woefully ineffectual response to the causes , what can we do? Are there any systemic solutions? Yes there are. These emerge from our understanding of the determinants of health. Good health is a product of a society in which access to resources and services is more rather than less fair, where income distribution is narrow, where there are numerous networks between people , and where all these are developed within the limits of natures bounty. A shorthand for this happy state is a fair shares society. The systemic response is to insist that every initiative , whether personal, community, workplace , regional, national or international is framed to deliver environmental benefit, and at the same time to narrowing the resource gap, and enhance networks and community. Good examples of these synergistic , virtuous cycle initiatives, can be found at all levels. Bicycling improves personal and societal health, saves money and saves carbon. Eating less meat saves money, lives, carbon and the forests which absorb our carbon. Both of these help tackle the systemic problem of obesity. Insulating houses, preferably using locally trained labour and natural resources such as wool, regional investment in the manufacture , production and location of renewable energy facilities ,and a global framework to reduce carbon and transfer resources to the poor, so kickstarting the move to a low carbon fair shares global economy, are all examples of the systemic solutions we need.
Moving to this low carbon fair shares societies, in which using human energy for every day acts becomes the norm, not the exception, provides a solution to both our public health and climate change problems. Do we really believe we can nudge ourselves into this low carbon state? Without a financial budgetary constraint, would we be nudged into living within our means? Even if we don’t always succeed in complying , all accept the imposed discipline of living within our financial means as necessary to the smooth running of our lives. We similarly need a carbon discipline, a defined annual entitlement of carbon available to all, reducing to a sustainable level over time, to succeed in averting the interrelated problems of deteriorating health and a deteriorating climate. The regulatory framework is essential, and will enable the flowering of many virtuous cycles of activity. Within the framework we can nudge as much as we like.
Chains constrain us, (carbon entitlements), link us and liberate us (bicycling and local production and consumption cycles)- - Give us back our chains."