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Healthy environment—healthy people: The links between sustainable development and health
Public Health (2005) 119, 952–953
MINI-SYMPOSIUM
Healthy environment—healthy people: The links between sustainable development and health Jonathon Porritt* The forum for the future, 9 imperial square cheltenham, Gloucestershire GL50 IQB UK Accepted 3 August 2005
I am a great believer in taking government pronouncements at face value. So let us start this exploration of the synergies between public health and sustainable development with one of the five shiny new principles in the Government’s 2005 Sustainable Development Strategy (under the heading ‘Using Sound Science Responsibly’): Ensuring policy is developed and implemented on the basis of strong scientific evidence, whilst taking into account scientific uncertainty (through the Precautionary Principle) as well as public attitudes and values. And here is some of the evidence culled from the Department of Health’s Choosing Health Activity Plans: in England, approximately one third of cancers can be attributed to poor diet and health; the treatment of ill health from poor diet costs the NHS at least £4 billion a year; since the mid-1980s, fewer miles are being done on foot or by bike—a decline of 20% in miles walked and 10% in miles cycled; only 37% of men and 24% of women meet the minimum threshold for physical activity to benefit their health; over 16% of boys and girls are now obese. If it is evidence that is needed massively to ramp up investment in public health and in reducing or eliminating health inequalities, it is there in * Corresponding author.
abundance. So, too, is an overarching ‘value for money’ rationale: Derek Wanless’s second report to the Treasury in 2004 demonstrated that failure to prevent illness would cost the taxpayer some £30 billion extra a year by 2020. The good news is that the Choosing Health white paper does indeed begin to shift the balance of both investment and influence towards the health inequalities and public health agenda. The two action plans that have come out so far (on food and health, and on physical activity) lay particular emphasis on working in partnership to make health everybody’s business. And that is where the link with sustainable development comes in. Sustainable development is all about improving the physical, social and personal quality of people’s lives (their overall wellbeing, if you like) in ways that do not mess things up for future generations. The evidence tells us that poor quality environments are bad for health (through air pollution, degraded neighbourhoods, poorly designed buildings, exposure to toxic chemicals and so on). We also know that social isolation, fear of crime, disrupted family life, poverty, powerlessness and economic insecurity are bad for health—pretty much covering all the social and economic dimensions of sustainable development. What is more, these health risks tend to pile up in the lives of the poor and dispossessed in ways that are vividly reflected in health statistics.
0033-3506/$ - see front matter Q 2005 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2005.08.004
Healthy environment—healthy people: The links between sustainable development and health By definition, therefore, a more sustainable society cannot be anything other than a healthier society. And there is no better place to start thinking of this convergence than the NHS itself. It is, after all, the largest single organisation in the UK, and one of the largest and most powerful in the world. Its annual budget is more than £60 billion a year. It employs more than one million people. It spends more than £11 billion a year on goods and services. Seen from this angle, the NHS has huge potential to do good—or harm—to the health of the nation and to the cause of sustainable development. With that in mind, the Department of Health has asked the Sustainable Development Commission to develop a ‘good corporate citizenship’ self-assessment tool for all NHS organisations. The basic model is being developed around the areas of employment and skills, procurement, community engagement and partnership, buildings, facilities management and transport. It is now being trialled with a number of organisations, and will include examples of ‘best practice’ to motivate people to get stuck in. This is going to be a voluntary initiative—so it has to be very upbeat and positive, and it has to be able to demonstrate a powerful ‘business case’ for health organisations taking on the challenge of sustainable development. So let us take one specific example. One of the scandals of the NHS is that some patients leave hospital suffering from malnutrition. The food is poor, they do not like it, or cannot eat it, and even if they do eat it, it does not do their health any good. This slows down patient recovery rates and makes them vulnerable to further ill health. This is the same point that Jamie Oliver has been making over school food—kids do better at school if they
953
eat well, and patients do better in hospital if they eat well. If the NHS used its resources more carefully— arranging its purchasing and catering policies so that it provides nutritious food in ways that encourage patients to eat and enjoy—it could do marvels not only for patients’ health, but for staff and visitors too. It could also use its power as one of the largest food purchasers in the country to encourage local and sustainable food production, and to promote organic and other environmentally sound agricultural practices. If a fraction of the political energy and leadership that is currently going into the pursuit of ‘increased choice for patients’ was directed into securing real value for taxpayers’ money through the pursuit of public health, we would all be living in a much better, healthier and more sustainable world. In the long term, there is no alternative to this anyway—as Derek Wanless pointed out in no uncertain terms. What makes us think that any health care system (however much choice it may offer people) will ever be able to cope with the consequences of people living the way we live today? Again, just look at the evidence: on levels both of drug and alcohol dependency, and of stress and mental ill-health; on the dire consequences of living in what has become a toxic world, or in today’s flabby, obesogenic environment; on patterns of environmental injustice where it is the poorest that get hit the hardest. What’s more, even though our society may be getting richer year on year, our citizens do not appear to be getting any happier—or healthier. So here is one final piece of evidence for you all to have a really good laugh about: on average, happy people live seven years longer than unhappy people. Sorted!
MINI-SYMPOSIUM
Healthy environment—healthy people: The links between sustainable development and health Jonathon Porritt* The forum for the future, 9 imperial square cheltenham, Gloucestershire GL50 IQB UK Accepted 3 August 2005
I am a great believer in taking government pronouncements at face value. So let us start this exploration of the synergies between public health and sustainable development with one of the five shiny new principles in the Government’s 2005 Sustainable Development Strategy (under the heading ‘Using Sound Science Responsibly’): Ensuring policy is developed and implemented on the basis of strong scientific evidence, whilst taking into account scientific uncertainty (through the Precautionary Principle) as well as public attitudes and values. And here is some of the evidence culled from the Department of Health’s Choosing Health Activity Plans: in England, approximately one third of cancers can be attributed to poor diet and health; the treatment of ill health from poor diet costs the NHS at least £4 billion a year; since the mid-1980s, fewer miles are being done on foot or by bike—a decline of 20% in miles walked and 10% in miles cycled; only 37% of men and 24% of women meet the minimum threshold for physical activity to benefit their health; over 16% of boys and girls are now obese. If it is evidence that is needed massively to ramp up investment in public health and in reducing or eliminating health inequalities, it is there in * Corresponding author.
abundance. So, too, is an overarching ‘value for money’ rationale: Derek Wanless’s second report to the Treasury in 2004 demonstrated that failure to prevent illness would cost the taxpayer some £30 billion extra a year by 2020. The good news is that the Choosing Health white paper does indeed begin to shift the balance of both investment and influence towards the health inequalities and public health agenda. The two action plans that have come out so far (on food and health, and on physical activity) lay particular emphasis on working in partnership to make health everybody’s business. And that is where the link with sustainable development comes in. Sustainable development is all about improving the physical, social and personal quality of people’s lives (their overall wellbeing, if you like) in ways that do not mess things up for future generations. The evidence tells us that poor quality environments are bad for health (through air pollution, degraded neighbourhoods, poorly designed buildings, exposure to toxic chemicals and so on). We also know that social isolation, fear of crime, disrupted family life, poverty, powerlessness and economic insecurity are bad for health—pretty much covering all the social and economic dimensions of sustainable development. What is more, these health risks tend to pile up in the lives of the poor and dispossessed in ways that are vividly reflected in health statistics.
0033-3506/$ - see front matter Q 2005 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2005.08.004
Healthy environment—healthy people: The links between sustainable development and health By definition, therefore, a more sustainable society cannot be anything other than a healthier society. And there is no better place to start thinking of this convergence than the NHS itself. It is, after all, the largest single organisation in the UK, and one of the largest and most powerful in the world. Its annual budget is more than £60 billion a year. It employs more than one million people. It spends more than £11 billion a year on goods and services. Seen from this angle, the NHS has huge potential to do good—or harm—to the health of the nation and to the cause of sustainable development. With that in mind, the Department of Health has asked the Sustainable Development Commission to develop a ‘good corporate citizenship’ self-assessment tool for all NHS organisations. The basic model is being developed around the areas of employment and skills, procurement, community engagement and partnership, buildings, facilities management and transport. It is now being trialled with a number of organisations, and will include examples of ‘best practice’ to motivate people to get stuck in. This is going to be a voluntary initiative—so it has to be very upbeat and positive, and it has to be able to demonstrate a powerful ‘business case’ for health organisations taking on the challenge of sustainable development. So let us take one specific example. One of the scandals of the NHS is that some patients leave hospital suffering from malnutrition. The food is poor, they do not like it, or cannot eat it, and even if they do eat it, it does not do their health any good. This slows down patient recovery rates and makes them vulnerable to further ill health. This is the same point that Jamie Oliver has been making over school food—kids do better at school if they
953
eat well, and patients do better in hospital if they eat well. If the NHS used its resources more carefully— arranging its purchasing and catering policies so that it provides nutritious food in ways that encourage patients to eat and enjoy—it could do marvels not only for patients’ health, but for staff and visitors too. It could also use its power as one of the largest food purchasers in the country to encourage local and sustainable food production, and to promote organic and other environmentally sound agricultural practices. If a fraction of the political energy and leadership that is currently going into the pursuit of ‘increased choice for patients’ was directed into securing real value for taxpayers’ money through the pursuit of public health, we would all be living in a much better, healthier and more sustainable world. In the long term, there is no alternative to this anyway—as Derek Wanless pointed out in no uncertain terms. What makes us think that any health care system (however much choice it may offer people) will ever be able to cope with the consequences of people living the way we live today? Again, just look at the evidence: on levels both of drug and alcohol dependency, and of stress and mental ill-health; on the dire consequences of living in what has become a toxic world, or in today’s flabby, obesogenic environment; on patterns of environmental injustice where it is the poorest that get hit the hardest. What’s more, even though our society may be getting richer year on year, our citizens do not appear to be getting any happier—or healthier. So here is one final piece of evidence for you all to have a really good laugh about: on average, happy people live seven years longer than unhappy people. Sorted!