I recently read Amitav Ghosh’s book, The Great Derangement: Climate Change and the Unthinkable, where he says that contemporary literature has simply failed to acknowledge the new reality of climate change outside of the realms of fantasy and science fiction. There are few books in which climate change and its impact are simply embedded in the narrative as part of the twenty first century world we live in.
The more I thought about it, I realised that there seemed, at least superficially, to be a parallel with the health crisis. A variety of health-related messages abound in our lives — warnings, articles, advertisements. And we are aware of the changes that have occurred in our own lifetimes. More of our friends and family, including young people, now have cancer compared to when we grew up. Just two decades ago, we reacted with shock and horror when someone was diagnosed with cancer. Today we take a deep breath and say we hope it was diagnosed at an early stage. If it was, we nod and say, that’s tough but he or she should be fine. Indeed, many of them get treated and survive (sometimes without too much trauma). Others, sadly, don’t. But this simply doesn’t make the casual appearance in novels that we would expect based on their real-world occurrence. However, I would argue that the parallels go beyond the fact that our imagination has failed to cope with the not-so-brave new world.
Ecology and health
The most straightforward nexus is that environmental problems cause health problems. Air pollution has caused a range of respiratory problems, and has been implicated both directly and indirectly in rates of increase in cancer. Water scarcity, water-borne diseases and pollution lead to considerable loss of lives, but also high health-care costs and loss of work days and school hours for children. Climate change itself has led to changes in distribution of both pathogens and their vectors, leading to epidemics and spread of a variety of infections.
This much is obvious. But there are more insidious similarities. The most fundamental of these is the belief — both individually and collectively — that the current models of development and lifestyle cannot be compromised or changed. In fact, as Ghosh argues, our very notion of freedom (and therefore happiness) is tied up irrevocably with it. The idea that substantial changes in lifestyle can reduce environmental or health problems exists but appears almost impossible to adopt. This is particularly peculiar in the case of the latter. With environmental problems, individual efforts can be perceived as having a negligible effect and therefore lead to inertia. With health, on the other hand, individual choices can make the difference between life and death, literally. And yet, barring a few, there seems to be the same collective lethargy towards making those choices.
This resistance to change leads to an interesting conundrum — we are likely to spend far more money on cure than on prevention. This is more obvious in the medical world. Millions of dollars are spent on cancer, but little on changed lifestyles that would prevent it. Even in less crisis-ridden fields such as dental care, the onus is entirely on post-hoc filling than on preventing. Given that this makes little sense even economically, why then does this persist across the globe?
The answer to this lies perhaps in the nature of modern neo-liberal economics, which is held captive by the state-industry-science nexus that is responsible for creating a world where technological solutions are given primacy. This drives both industrial and economic growth (both are normative within this paradigm) which keeps governments in power. So, in fact, there is nothing to be gained in people not falling sick or the Earth being ill.
The Cuba model
One of the few counter examples to this global paradigm comes from Cuba, a country much reviled across its Bay. But Cuba has a lower infant mortality rate than the U.S., and its life expectancy is nearly as high. Moreover, Cuba spends 4 per cent per capita of what the U.S. does on healthcare. While some of this difference may come from low wages, it is still a significant difference. While there are numerous factors that drive Cuba’s success, two stand out. First, there is a great emphasis on preventive medicine — as its model shows, this is both more effective and cheaper. Second, there is an interlinked emphasis on social rather than technological solutions. Much has been written about how doctors and nurses are embedded within communities, thus understanding their patients and improving their ability to treat. This is a model not just for poor countries but for the world. Yet, only a few Latin American countries have started to adopt it.
What is the lesson for the environmental movement which has to deal with the cancer of climate change, apart from a host of equally debilitating environmental ills? The first is that supply-side economics is not the solution. There have to be changes in lifestyle at a societal level that are preventive in nature. While it has been widely argued that one cannot expect a return to a Gandhian lifestyle, my argument here is more about collectivising the focus on prevention. Simultaneously, one has to recognise that social solutions are as important as technological ones. Certainly, the right buttons must be pressed and the right switches flipped, but in society, not on a machine.
Finally, and most importantly, none of this is possible unless we understand the politics of change. One can ask, how did Cuba successfully achieve as good a health-care system as the richest, most technologically advanced country in the world? Certainly, one is not advocating ‘communism’ — democracy remains paramount. However, as long as the current forms of democracy also allow complete ‘freedom’ to the modern state-industry capitalist enterprise, no meaningful change is possible.
The parallels between human health and environmental health are not absolute. Nevertheless, they do provide insights that I believe could help in addressing both challenges and provide new paths (rather than pills) to a healthier future.
Published in The Hindu, August 15, 2016