Sustainable Development SD, ecological public health, and promoting SD through community pharmacy Ge

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Sustainable Development (SD), ecological public
health, and promoting SD through community
pharmacyGeof Rayner PhDProfessor Associate in
Public Health, Brunel UniversityVisiting
Research Fellow, City Universityformer board
member, PharmacyHealthLinkContact
mail_at_rayner.uk.com
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This presentation

• Reviews the meaning of Sustainable Development
• Examines key dimensions of planetary health and
  why SD is now critically important
• Presents the case for understanding public health
  as ecological public health
• Sets out parameters of current UK SD policy
• Suggests that participants should develop an
  ecological audit of the world of the pharmacy
  in order to promote an SD pharmacy model

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The origins of sustainable development
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The old concept of SD? - Thomas Malthus

• Thomas Malthus, writing 210 years ago, warned
  that food production could not keep up with
  population growth. We were heading for trouble.
• Actually his dire predictions have not occurred
  (in Europe) -- but growing global population and
  industrialisation/urbanisation has exposed other
  limits to growth energy, water, climatic
  balance. SD is modern societys belated response
  to Malthus dire predictions.

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The meaning of SD

• Sustainable Development (SD) is development
  which meets the needs of the present without
  compromising the ability of future generations to
  meet their own needs' .
• SD first came to prominence in the 1987 Report
  Our Common Future
• The concept expanded through the Rio Earth
  Summit, and led to Agenda 21 a framework for
  development seen in social, economic and
  environmental terms, and the formation of the UN
  Commission on Sustainable Development
• In the UK Public Health Alliance published
  Sustainable Development Health (1995) but it
  gathered little interest.
• Now SD gaining widespread attention and policy
  making but the challenge is vast requiring both
  a big picture and complex detail

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What has brought SD to public and governmental
attention now?

• Answer climate change, rising energy use (peak
  oil, etc.), environmental depletion and water
  depletion and projections of rapid,
  irreversible worsening
• Growing understanding across public health of the
  societal and environmental factors underlying
  non-communicable diseases (e.g. obesity,
  diabetes) (most recently through Foresight
  obesity project) and the resurgent risks of
  infectious diseases globally
• Government focus (Euro and UK) on the economic
  consequences (Stern)

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What are these problems?And how are they
affecting planetary and human health?
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The critical problem the Earth is getting warmer.
C
Green bars show 95 confidence intervals
2005 was the hottest year on record the 13
hottest all occurred since 1990, 23 out of the 24
hottest since 1980.
J. Hansen et al., PNAS 103 14288-293 (26 Sept
2006)
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With the causal link to greenhouse gases
Source Hansen et al., Science 308, 1431, 2005.
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Harm is already occurring
Major wildfires by decade, 1950-2000
The trend has been sharply upward everywhere.
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Where were headed Heat waves
Extreme heat waves in Europe,
already 2X more frequent because of global
warming, will be normal in mid-range scenario
by 2050
Black lines are observed temps, smoothed
unsmoothed red, blue, green lines are Hadley
Centre simulations w natural anthropogenic
forcing yellow is natural only. Asterisk and
inset show 2003 heat wave that killed 35,000.
Stott et al., Nature 432 610-613 (2004)
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Harm is already occurring - cyclones Total power
released by tropical cyclones (green) has
increased along with sea surface temperatures
(blue).
Source Kerry Emanuel, MIT, http//wind.mit.edu/
emanuel/anthro2.htm. SST anomaly (deg C) with
arbitrary vertical offset. PDI scaled by
constant.


Kerry Emanuel, MIT, 2006
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Harm is already occurring rainfall patternsThe
East Asia monsoon is weakening
Qi Ye, Tsinghua University, May 2006
The change is as predicted by Chinese climate
modellers. It has produced increased flooding in
the South of China and increased drought in the
North.
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Malthuss prophesy? Temp rises and lower yields
Crop yields in tropics start dropping at ?T
1-1.5C
Easterling and Apps, 2005
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Where were headed droughts
Drought projections for IPCCs A1B scenario
Percentage change in average duration of longest
dry period, 30-year average for 2071-2100
compared to that for 1961-1990.
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.                                                
                                                  
                                                  
                                                  
                                
Sourcehttp//www.solcomhouse.com/drought.htm Acce
ssed 17 May 2004
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Water futures

• 2000-2020 water availability for humans is
  expected to drop by one-third
• Water scarcity or stress (having less than 1,700
  cubic metres of water per person per year) is
  estimated to affect 40 of humanity by 2050
• Consequences
• 1. increased food prices (happening now) and
  health threats
• 2. poor countries likely to be most heavily
  affected
• Stockholm International Water Institute (2003).
  General water statistics World Water Week
  Symposium data sheets, August 10-16. Stockholm
  Stockholm International Water Insitute
  www.siwi.org/waterweek2003
• Cosgrave W, Vice-President of the World Water
  Council, quoted in Houlder V (2003), World in
  drier straits, Financial Times, 11 August, p 16

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World population by freshwater availability 2000
2025

• Source Marie Stopes International, evidence to
  All Party Parliamentary Group on Population,
  Development and Reproductive Health (2007)
  Return of the Population Factor its impact on
  the Millennium Development Goals. London House
  of Commons. Jan. Fig 22 pg 52 http//www.appg-popd
  evrh.org.uk/Publications/Population20Hearings/APP
  G20Report20-20Return20of20the20Population20
  Factor.pdf

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Oil energy

• International Energy Agency est. oil / energy
  demand 2000-30 1.7 per yr
• equivalent to 60 on todays consumption
• 60 of demand growth will come from DCs (esp.
  China and India)
• Biofuels no solution ?land use pressure food vs
  biofuels vs amenity vs housing vs carbon sinks
  overall negative effect

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Is International action on energy making a
difference?

• On energy use, not much! Two futures suggested by
  International Energy Agency
• Reference scenario If governments around the
  world stick with current policies the worlds
  energy needs would be 55 higher in 2030 than
  today...
• Alternative Policy Scenario the worlds energy
  demand and related emissions would be reduced
  substantially. Measures to improve energy
  efficiency stand out as the cheapest and fastest
  way to curb demand and emissions growth in the
  near term. But even in this scenario, CO2
  emissions are still one-quarter above current
  levels in 2030.

IEA World Energy Outlook, 2007
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(Some) health consequences of non-sustainable
production/consumption
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WHO estimates climate change already causing
150,000 premature deaths/yr in 2000
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Motorised transport has become a global driver of
obesity
Michael P Walsh, Motor Vehicle Pollution Control,
Paper to China Fuel Economy Workshop, Hong Kong,
December 13, 2004, http//www.walshcarlines.com/c
hina/Applying20The20Lessons20To20China20-20M
OVE20.pdf
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With heavy energy users also (minus Japan) the
societies having bigger weight gains

• Source World Resources Institute (2006) climate
  analysis indicators tool version 3.0 (www.wri.org)

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Implications

• The ecological challenge to health is real and
  happening now
• Sustainable development in public health can no
  longer confined to the fringes
• Exhorting people to change individual behaviour
  ignores how living is shaped around waste of
  energy, water, resources, and how behaviour,
  belief and consumption are societally shaped
• SD thinking has to be based upon modifying supply
  chains to conserve resource use, and
• Changing behaviours, habits and patterns of
  consumption requires everyone, every business,
  every individual, through mutually-reinforcing
  actions

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Implications

• Developing policy and practice around SD is a
  real test for community pharmacies (and NHS
  generally)
• In order to do it we need
• To redefine public health as ecological public
  health
• New policies, led by government, to take SD
  forward
• New commitment and new skills, in developing and
  applying SD concepts
• Recognition of the need to think long term and
  exchange learning across the pharmacy world
  including competition to be the best!
• Fortunately, thinking and policy have been
  changing but are not yet fully joined up
  the real test.

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1. Redefining what we mean by public health
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The current formal definition of Public Health
Donald Acheson

• Public health is
• The science and art of preventing disease,
  prolonging life and promoting health through the
  organised efforts of society.
• Sir Donald Acheson, 1988

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Sir Derek Wanless refinement

• Public health is
• The science and art of preventing disease,
  prolonging life and promoting health through the
  organised efforts and informed choices of
  Society, organisations, public and private,
  communities and individuals."
• Wanless 2nd report to H.M.Treasury, 2004

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The trouble with such definitions

• Organised efforts of Society is vague -
  national local government has less power to
  tackle the determinants of health
• Appeal to choice/individual underplays societal
  determinants
• Different levels or levers of choice private,
  public, group, individual
• Drivers social, cultural, psychological,
  political, economic
• These definitions ignore the natural or material
  world the built environment living nature
• Unwise in an era of climate change!
• (And also a misreading of the history of public
  health)

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An alternative incorporating an ecological
perspective into public health

• Ecological is understood here in two ways
• Ecology as our place in nature and the
  environment (natural ecology as per the
  origination of the term (Ernst Haekel, 1880s)
• Ecology as inter-relationships in society (human
  ecology tradition borrowing from Haekel)

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The notion of ecology is already being applied to
public health

• US Institute of Medicine key body in USA
• WHO supported models of social ecology
• WHO Commission on Social Determinants of Health
• Health determinants rainbow (Dalhgren
  Whitehead)

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The US Inst of Medicine 2002
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US Institute of Medicine

• Understanding and ultimately improving a
  populations health rest not only on
  understanding (a) population perspective but also
  on understanding the ecology of health and the
  interconnectedness of the biological,
  behavioural, physical, and socio-environmental
  domains.

Institute of Medicine. The Future of the Publics
Health in the 21st Century. Washington, DC
National Academy Press 2003. p.51
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the IoM drew on Dahlgren Whitehead 1996 model
Source Dahlgren Whitehead 1996
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But

• While these layers are insightful the social or
  economic relationships are often vague
• These models locate health in society but they do
  not give equal attention to natural ecology
  (incl. built environment)
• We need to redefine what we mean by public health
  
• And we need to redefine what it does, how it
  works and who it works with.
• Public health has to be an imaginative,
  exploratory, participant enterprise, not a repeat
  of the old formulae of the recent past.

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Ecological Public Health a definition

• To comprehend the composite interactions between
  the physical, physiological, social and cognitive
  worlds that determine health outcomes in order to
  intervene, alter and ameliorate the population's
  health by shaping society and framing public and
  private choices to deliver sustainable planetary,
  economic, societal and human health.
• Source Lang and Rayner expert submission to
  Foresight obesity project (published in Obesity
  Reviews January 2007).

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2. New Policies
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UK Government SD strategy Securing the Future -
March 2005

• Natural resources are vital to our existence
  and to the development of communities throughout
  the world. The issues we face are the need for
  better understanding of environmental limits, the
  need for environmental enhancement where the
  environment is most degraded, the need to ensure
  a decent environment for everyone, and the need
  for a more integrated policy framework to deliver
  this. Examples of strategy include
• drive to improve resource efficiency and reduce
  waste and harmful emissions across business
  sectors
• long term goal of reducing carbon dioxide
  emissions by 60 per cent by 2050
• Promote sustainable communities to catalyse SD
• meeting the new national target to improve the
  local environment, focused on the most deprived
  neighbourhoods
• providing better information to people on their
  local environment

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Governments current SD policies and priorities

• Under four headings
• Sustainable Consumption and Production
• Climate Change and Energy
• Natural Resource Protection and Environmental
  Enhancement
• Sustainable Communities

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DH SD work programme (following StF)

• the NHS as a corporate citizen
• food and health in the context of sustainable
  food and farming
• transport and health
• healthy sustainable communities
• health impact in partnership in the regions
• And
• new governance structure
• new DH policy sub-group on climate change and
  some developments in relation to new biodiversity
  legislation addressing this in terms of the NHS
  estate

Delivering Sustainable Development DH Action Plan
2007/08
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3. New skills in developing and applying SD
concepts

• Its a question What is community pharmacys
  role in SD? Can we develop an SD pharmacy model?
• As a community leader, exemplar, advocate or
  resource?
• As an advice giver (recognising that advice
  starts at home)
• As an employer or employee contracted to the NHS
• As a private sector enterprise
• As individual (pharmacist) or member of trade or
  professional groups
• Other possible roles? e.g. particular
  responsibility for reducing medicines waste and
  promoting the correct disposal of medicines in
  the community

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CONCLUSION

• The SD strategy for community pharmacy
  can/should
• develop an understanding of the links between
  natural and human ecology
• encompass SD within business planning
• examine position within supply chains from
  energy use to waste (including microbial waste)
• engage with stakeholders as part of network
  engaged in local action
• aim for measurable change
• work with (and help guide) customers/patients to
  promote sustainable consumption
• focus on long term sustainable change
  starting now