Posts Tagged ‘environmental health’
“But man is a part of nature, and his war against nature is inevitably a war against himself.”*…
Nathan Gardels argues that health is not personal, but environmental…
If it weren’t for his dogmatic anti-science views on vaccines and pandemics, U.S. Health and Human Services Secretary Robert Kennedy Jr.’s Make America Healthy Again movement would mark a transformative shift in our understanding of health care. At its core, MAHA grasps that placing the onus for being healthy solely on the individual in a sickening environment and a food supply chain contaminated by industrial chemicals is a misplaced responsibility.
How can we be healthy in a sick environment? That is the right question. But answering it entails not a rejection of scientific authority in the name of libertarian politics, but an embrace of science as the path to deeper discovery of how to heal the environment and mend a planet in distress, which are the affective conditions of human health.
This is a perspective laid out in Noema by Nils Gilman, Paul Kortba, Alex Marashian and others. “What if the most salient factors shaping health today lie not within the atomized individual or even their immediate social milieu, but in the fractured, volatile relationship between our species and the Earth system itself?” they ask.
For the authors, the science of salutogenesis, which focuses on the origins of health instead of the origins of disease (pathogenesis), should in our day and age be expanded to the planetary scale.
“Adding the idea of the planetary to salutogenesis isn’t just an effort to insert an ‘environmental’ layer into existing health models,” they write. “It requires a radical revision of how we understand what constitutes collective human health.
“Today’s dominant medical paradigm treats individual personal health as the primary object of concern and relegates the environment to the status of an external variable to be managed or mitigated. Planetary salutogenesis proposes a reversal: that planetary health is the fundamental condition, the enabling context, out of which durable human health, both individual and collective, emerges.”
In this, they follow the thinking of the philosopher Ivan Illich. In his book, “Medical Nemesis,” Illich spoke of “iatrogenic illness” — illness that results from mistreatment by a bureaucracy of physicians who abandoned the ancient idea of health as “balance” within the environment in which a person lived.
As he colorfully related to me in one conversation some years ago at his rustic compound in central Mexico, such a healthy balance could not be achieved by treating the person as a “detached immune system,” apart from their environment and the wholeness of their being, to be managed “from sperm to worm” by the “Brave New Biocracy” of modern medicine.
“An approach to health that is confined to the individual while ignoring this broader context,” the authors write in Noema, “is like carefully tending a wilting flower while ignoring the poisoned soil, acid rain and encroaching desert around it.”
Planetary salutogenesis explicitly acknowledges “the planetary scale of our interconnectedness and predicament. It reframes our approach to health and well-being by contrasting it with the assumptions of individual pathogenesis.”
“Human health,” the authors point out, “is inseparable from the planetary systems we inhabit and constitute. We are not self-contained biological units interacting with a passive external ‘environment.’ Rather, as biologist Scott Gilbert has described, we are holobionts in a vast, interconnected, living web that encompasses microbial, atmospheric, oceanic and terrestrial ecosystems.
“Concepts like the ‘eco-holobiont’ capture this reality of the human organism itself as a complex ecosystem, intrinsically linked to and shaped by its surrounding ecological matrix. Our internal environments mirror our external ones. Soil influences the human gut; fresh air and sunshine impact our physiological functioning; biodiversity affects our immune system and mental health.”
What planetary salutogenesis means in practice is an emphasis on proactively supporting well-being instead of focusing entirely on eliminating disease. As such, it shifts our approach from treatment to prevention, emphasizing the need to confront upstream drivers of ill health — industrial agriculture, fossil fuel dependence, inequitable economic models and anthropocentric worldviews. It also understands that health is relational and emergent, arising from mutualistic, regenerative relationships between humans and the more-than-human world. In short, this perspective is eco-centric, recognizing we are embedded inhabitants in a biodiverse world.
Planetary salutogenesis shifts the focus from genome to exposome,highlighting the critical importance of the totality of environmental exposures (chemical, biological, social, physical) from conception onward — in shaping health trajectories. And finally, in practice this would mean abandoning an economic paradigm obsessed with perpetual growth in favor of an ecological economics that emphasizes the need for balance and recognizes biophysical limits.
These new understandings put personal lifestyle changes as the path to health in perspective. While they may retain ethical and symbolic importance, the authors note that “a planetary lens reveals that true leverage lies in transforming the macro-systems that drive the crisis: energy grids, industrial agriculture, transportation networks, financial markets and consumption patterns. It illuminates the actual scale at which resources — financial, technological, political, social, ecological — must be mobilized and demands met.”
The Make America Healthy Again movement has opened a path toward salutogenesis as a new direction for health care. But just as health care is more environmental than personal, so too is the health of nations a function of the health of the planetary system. Making the Planet Healthy Again is an objective that serves all living beings…
The future of health will be planetary or there will be no future health: “Make The Planet Healthy Again,” from @noemamag.com.
See also the article to which Gardels refers: “The Future Of Health On A Damaged Planet.”
And as a reminder (as if one was needed), what Gardels, Gilman, et al. are advocating is something very differerent from the program of RFK, Jr… whose fantastic (in the most literal of senses) enthusiasms are, as they are being pressed into policy, already having an impact…
* Rachel Carson, Silent Spring
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As we reframe for resiliance, we might recall that on this date in 1935 the Dust Bowl heat wave reached its peak, sending temperatures to 109 °F in Chicago and 104 °F in Milwaukee. While the period is mostly remembered for its dramatic dust storms and for the displacement of about 3.5 million people from the Plains states from 1930-40, it also had severe health consequences: increased hospitalization for respiratory disorders, increased infant and overall mortality, and increased incidence of measles. (Recent scientific studies have demonstrated that dust transmits measles virus, influenza virus, and coccidioides immitis, and that mortality in the United States increases following dust storms with 2-3-day lag periods.) There were also severe mental health consequences.
“Old ways of thinking die hard, particularly when they were weaned by legally enforced monopolies”*…
According to the US Bureau of Labor Statistics, from 2000 to present, prices in the hospital industry have grown faster than prices in any other sector of the US economy. The $1.3 trillion US hospital sector accounts for 6% of US GDP, nearly a third of all health care spending (which is materially higher as a share of GDP in the U.S. than in any other country). The average price for an inpatient hospital stay is $25,000.
A new working paper from the NBER assesses the impact of these rising costs. From its abstract:
We analyze the economic consequences of rising health care prices in the US. Using exposure to price increases caused by horizontal hospital mergers as an instrument, we show that rising prices raise the cost of labor by increasing employer-sponsored health insurance premiums. A 1% increase in health care prices lowers both payroll and employment at firms outside the health sector by approximately 0.4%. At the county level, a 1% increase in health care prices reduces per capita labor income by 0.27%, increases flows into unemployment by approximately 0.1 percentage points (1%), lowers federal income tax receipts by 0.4%, and increases unemployment insurance payments by 2.5%. The increases in unemployment we observe are concentrated among workers earning between $20,000 and $100,000 annually. Finally, we estimate that a 1% increase in health care prices leads to a 1 per 100,000 population (2.7%) increase in deaths from suicides and overdoses. This implies that approximately 1 in 140 of the individuals who become fully separated from the labor market after health care prices increase die from a suicide or drug overdose.
– NBER WORKING PAPER SERIES- WHO PAYS FOR RISING HEALTH CARE PRICES? EVIDENCE FROM HOSPITAL MERGERS
Four of the authors of that paper looked more deeply into the issue, exploring why those costs are rising; they identified consolidation in the hospital sector– 90% of hospital markets are now highly concentrated, according to the thresholds set by the FTC and the U.S. Department of Justice– as a key culprit:
The study, conducted in collaboration with researchers at Harvard University, Yale University, and the University of Wisconsin-Madison, found that of 1,164 mergers among the nation’s approximately 5,000 acute-care hospitals that occurred in the United States from 2000 to 2020, the Federal Trade Commission (FTC), which is tasked with preserving competition, challenged only 13 of them — an enforcement rate of about 1%.
Meanwhile, the researchers show that the FTC, using standard screening tools available to the agency during that period, could have flagged 20% of the mergers — 238 transactions — as likely to cause reduced competition and increase prices…
Unchallenged hospital mergers should have had minimal effects on competition and prices if the FTC were optimally targeting enforcement, the researchers noted. However, using data on the prices that hospitals negotiate with private insurers, the researchers found that mergers the FTC could have challenged as predictably anti-competitive between 2010 and 2015 eventually led to price increases of 5% or more.
The researchers estimate that the 53 hospital mergers that occurred on average annually from 2010 to 2015 raised health spending on the privately insured by $204 million in the following year alone. Putting this spending increase in context, the researchers note that the FTC’s average annual budget and antitrust enforcement budget between 2010 and 2015 were $315 and $136 million, respectively…
The study found that mergers in rural regions and areas with lower incomes and higher rates of poverty generated larger average price increases, often in outpatient services. The researchers suggest this occurred because those regions — compared with higher income, urban settings—have fewer free-standing clinics that offer surgical and imaging services that compete against hospitals in the outpatient market…
Consolidation in Hospital Sector Leading to Higher Health Care Costs
As Cory Doctorow succinctly observes…
The health system is a perfect example of how monopolization drives more monopolization, and how that comes to harm the public and workers. Health consolidation began with pharma mergers, that led to pharma companies gouging hospitals. Hospitals, in turn, engaged in a nonstop orgy of mergers, which created regional monopolies that could resist the pricing power of monopoly pharma – and screw insurers. That kicked off consolidation in insurance, which is why most Americans have a “choice” of between one and three private insurers – and why health workers’ monopoly employers have eroded their wages and working conditions.
How consolidation in the hospital sector is increasing healthcare prices and creating even steeper costs more broadly in the economy. @nberpubs @AEAjournals @doctorow
* Mitch Kapor
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As we measure our blood pressure, we might send concerned birthday greetings to Janette Sherman; she was born on this date in 1930. A physician, toxicologist, author, and activist. She researched pesticides, nuclear radiation, birth defects, breast cancer, and illnesses caused by toxins in homes and was a pioneer in the field of occupational and environmental health.
Dr. Sherman served as a medical-legal expert witness in more than 5,000 workers’ compensation claims and served as an expert witness for residents in communities affected by environmental hazards, most famously the Love Canal neighborhood of Niagara Falls, N.Y. Her medical-legal files, among the largest collections of their kind in the United States, are preserved at the National Library of Medicine at the National Institutes of Health in Bethesda, Md.
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