Three areas of progress towards ecological thinking in healthcare

Reframing ecocrisis as a healthcare opportunity

When considering the implications of climate change and the despoliation of the natural world, it can be difficult to avoid a feeling or tone of apprehension, with recent reports from the IPCC, for instance, suggesting there may only be 12 years for humankind to undertake the significant societal transformations necessary to forestall the worst effects (including health effects) of runaway climate change.14

But terrifying people with predictions of dire ecological catastrophe may not be the most effective strategy available to us for motivating people to adopt more ‘pro-environmental’ behaviours. According to Solitaire Townsend, for example, medics and psychotherapists have long known that helping people to ‘imagine a better future is more effective than scare tactics’. Townsend is among those who point to the plethora of evidence which indicates simply giving people the ‘facts’ or ‘disaster narrative’ about environmental problems does not work—if by ‘work’ we mean persuading people to adopt more environmentally sustainable lifestyles and behaviours. Townsend: ‘It should work that telling ‘facts’ about climate change would change behaviour, but it doesn’t. We need to tell a different story’.15 Consequently, it may now be a matter of some urgency that we develop narratives which can help people ‘imagine a better future’, one that is more ecologically wholesome.

Partly in a bid to offer people just such a positive vision—of the health and well-being benefits of tackling environmental problems such as climate change—the Lancet, in their climate change report of 2015 sought to narrativise the more immediate health co-benefits that can emerge from policies which seek to address environmental problems. As Anthony Costello, co-chair of the 2015 Lancet Commission on Health and Climate Change put it,

All the things we want to do to combat climate change will also protect us against ill health … We want to shift the balance from talk of catastrophes to a ‘we-can-fix-this’ mentality.16

Thus, whereas the earlier 2009 Lancet report on climate change found climate change to be ‘the biggest global health threat of the 21^st century’, the central finding of the 2015 report is that

tackling climate change could be the greatest global health opportunity of the 21^st century … [g]iven the potential of climate change to reverse the health gains from economic development, and the health co-benefits that accrue from actions for a sustainable economy…17

Some of these health co-benefits include: improved diet (eg, reducing red meat consumption reduces CO₂ emissions and is better for health), improved air quality from reduced burning of fossil fuels and driving less (can reduce CO₂ emissions while increasing physical exercise).

But as David Pencheon indicates in discussion with Transition movement founder Rob Hopkins, environmental sustainability may have even more radical—and positive—implications for the ways we conceive of health, care, human flourishing and our visions for what constitutes the ‘good society’:

We need to think and talk and conceptualise health in a different way than we’ve normally done. Not just living without mental illness or physical illness but living truly fulfilling, meaningful, connected lives, depends on roughly four things if you put things like genes aside:

• Do you have a house, do you have somewhere to live?

• Do you have a job, are you in education or do you have a fulfilling role in your community?

• Are you connected socially, do you have friends, do you have a community you’re part of?

• Do you have access to services, which are the icing on the cake for health which deliver things which none of the first three can do?

That’s about social care, it’s about healthcare, it’s about welfare. It includes culture and libraries and all those other things that make life worth living. If you take that as your concept of public health or community health or holistic health or health in the broader sense, then it’s absolutely clear that public health is by far the best investment we could make in local, meaningful, resilient, sustainable communities where it is just a much better place to live.18

What sustainable healthcare thinkers such as Pencheon are suggesting, in other words, is that an ecologically viable future and a ‘greening’ of healthcare need not be conceived as a privation, as a lessening of health opportunities. Instead, a ‘greening’ of healthcare might be conceived more properly as a positive vision: of an ecologically viable future, that is more humane and convivial as well.

To what extent might an ecologically dimensioned medical humanities challenge commonplace assumptions of modernity?

If environmental problems are an urgent threat to global health, and ecological thinking a potential source of health co-benefits, why do healthcare issues so often continue to be compartmentalised and conceptualised apart from and away from their ecological contexts? According to Pencheon, one of the central challenges confronting a more ecological approach to healthcare is that

we’re so addicted to what we currently know, that we don’t have the vision to see that it could be much better. It could be so much better for the present and for the future. Sometimes we do lack vision and we do lack courage. Things do not have to be this way and to live sustainable lives we don’t have to resort to living in caves.19

According to many ecological thinkers, the task of unpicking that burden of ‘what we currently know’ is a profound one, which may require challenges to some of modernity’s most cherished assumptions. Indeed, once we pay serious attention to what ecological cultural theorist Tim Morton terms ‘the ecological thought’ we may find few aspects of our lives remain untouched.20

For example, while historians of medicine have traced the role of the mechanical philosophy in leading to a mechanical or biomechanical understanding of the body and self, ‘green’ authors such as ecofeminist Charlene Spretnak press the critique of science further to suggest that the same cultural influences which led to the increasing mechanisation of our human self-understanding also led to the degradation of our sensuous understandings of, and responses to, the natural world.21 Putting this argument in its starkest terms: psychologists remind us that, often, a necessary precursor to an act of rape against another person is that the perpetrator (usually male) objectify their victim first. By ‘objectify’, we mean rendering the victim an it: by the psychological act of withdrawing sympathy and denying value, autonomy and dignity to the victim. Now, when someone objectifies a person in this way, we understandably feel horror. But when we objectify non-human nature in this way—as the widely accepted scientific picture of nature and reality has done for much of the past 300 years—many of us no longer even flinch. We call it ‘rape’ when we objectify a person; but when we objectify nature, we call it science. As historian and ecopsychologist Ted Roszak puts it: ‘At the psychological level, rape stems from a distinct state of mind that is the same whether the victim is a woman or a rainforest’.22 And as a cultural force, science has been among the most pervasive influences in Western, and increasingly globalised, modernity. Many environmental thinkers, perceive this alienative psychology—which estranges us from felt and sympathetic relationship with more-than-human nature—as among the fundamental roots of modernity’s environmental predicaments. Moreover, they suggest the portrait of reality that much of modern science has provided us with—in its earlier Newtonian and Cartesian phases, and in many more recent quantum and postmodern phases—has only served to invite and deepen that experiential estrangement from the natural world. Indeed, even among contemporary environmental humanities, we still commonly find conceptions of knowledge of the natural world that are no less psychologically underdimensioned.23

Politics of ecology has often overlapped with the politics of feminism, since both have perceived the patriarchal, and commonly masculinist, aspects of objectification.24 Such ecological politics also finds common cause with much Indigenous and post-development scholarship—not least because the ecologically destructive aspects of modernity appear all too obvious to those Indigenous and other scholars for whom animist reciprocity with the natural world may still remain a vividly experienced reality.25

Wade Pickren in Psychology and Health: Culture, Place, History insists Western modernity needs to learn from non-modern and Indigenous cultures in order to cultivate a new psychology of health that might help us ‘through our growing climate crisis and its sequelae to a better, more humane society, where our oneness with the earth is positive for the earth as well as for humans.’26 Jay Griffiths similarly suggests that, when it comes to environmental awareness, we need a change of heart… a metanoia. And the humanities, including the arts and an earth-embracing cultural theory, have a crucial role to play in that:

we need a change … which involves culture going … ‘down’ to its roots, profound in the deep earth, in the root of the word cultus: nurturing care and respect, and offering truths to humanity. In its evidence and reliable data, science offers its truths, but from art we need truths of a different order: … parables to embody it and ethics to sustain the implementation of that knowledge. It is through stooping that art conquers, Lear on the heath, finding his common humanity on the common ground. This is the profound task of art, to find seeds of transcendence deep in the dark and minding earth.27

If Griffiths is right, then an ecologically dimensioned healthcare need not be solely a matter of privation, belt-tightening or simply less. For once we begin to expand our conceptions of ‘care’ towards convivial fellowship with the other-than-human beings with whom we share our destiny on the earth, maybe we will make a happy discovery that, in so doing, we also expand the compass of our lived experience … of wealth, well-being and what it might mean to be fully human.