Ecological economics for human and planetary health

By Martin Hensher

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While we increasingly understand that humanity’s Anthropocene trajectory has become fraught with danger for our own species and for others, one area in which the modern era has brought enormous benefits is that of health.  We might argue over whether pre-modern life really was nasty or brutish, but for most people it was unquestionably short.  In Australia, average male life expectancy at birth in 1890 was just under 47 years; by 2018, it had risen to just over 80 years (AIHW, 2019).  Between 1960 and 2017, global life expectancy rose from 52 to 72 years (World Bank, 2019).  The infectious diseases that blighted much of human history were increasingly controlled, fertility rates have fallen, life expectancy has risen, and the result is – in all but a few of the most conflict-ridden and grindingly poor nations – a globally ageing population for the first time in human history.   While there is an enormous amount still to do to secure better health for everyone, these are extraordinary achievements and gains, which must be carefully safeguarded and protected.

Ecological economists have long recognised that human health is a vital component of and prerequisite for human well-being; indicators of sustainable well-being almost always incorporate mortality or life expectancy as a crucial element.  However, ecological economists’ engagement with health issues has typically not proceeded much further than this point.  My background is as a health economist and health policy-maker; part of my current work aims to apply ecological economics principles to health and health care issues.  The World Health Organization (WHO) has recently published its “Ten Threats to Global Health”, which provides a useful lens through which to consider how ecological economics might contribute in future:

  1. Non-Communicable Diseases
  2. Air Pollution and Climate Change
  3. Fragile and Vulnerable Settings
  4. Weak Primary Health Care
  5. HIV
  6. Dengue
  7. Vaccine hesitancy
  8. Global influenza pandemic
  9. Ebola and other high-treat pathogens
  10. Antimicrobial Resistance

(Source: WHO, 2019)

Ecological economics has great potential to contribute to dealing with the threat of Non-Communicable Diseases (NCDs).  A number of core risk factors increase the likelihood of several NCDs, especially tobacco and alcohol use, obesity, diet, physical activity, and environmental pollution.  These risk factors are in turn direct consequences of overconsumption and uneconomic growth, and of unsustainable and harmful consumption patterns and deep inequalities in wider society.  Ecological economists should be closely involved with the emerging transdisciplinary field of syndemics – synergistic epidemics which interact with each other (e.g. malnutrition, obesity, and the health effects of climate change).

Ageing also poses a challenge to ecological economics.  Policies need to ensure that we can age healthily (rather than spending ever longer periods in ill-health), and ecological macroeconomics needs to develop plausible solutions to sustain post-growth economies with ever-increasing proportions of older citizens.  More immediately, we should attend to the warning signs of faltering or falling life expectancy in some high-income countries (especially the USA and UK).  At best, these are signs of deep inequalities and failures of social protection systems; yet ecological economists are well-placed to investigate whether they might be the first signs of uneconomic growth manifesting itself in rising mortality, and even as precursors of more generalised crises.

The interest of ecological economists in the harms to human health arising from environmental pollution and climate change should be obvious.  There is substantial effort globally to highlight and address the growing health impacts of climate change.  More recently, there has been a sharper focus on the health harms of all forms of pollution, with estimates indicating that 16% of all deaths globally are caused by pollution, 92% of which occur in low and middle income countries (Landrigan et al, 2018).

Meanwhile, health care is an enormous industry globally, accounting for close to 10% of global GDP.  Yet billions of people still lack reliable and affordable access to basic health care.  Evidence is growing of overconsumption of health care itself – whereby overdiagnosis and overtreatment yield little or no benefit to patients, yet expose them to the risk of various harms which accompany medical care.  The problem of resolving the coexistence of underconsumption and overconsumption – i.e. to deliver the “right care” to everyone – is a central challenge for health system sustainability everywhere.  Meanwhile, the environmental harms caused by health care systems themselves are increasingly being recognised.

Concern is growing that climate change, changing land use and urbanisation are all heightening risks from established and emerging infectious diseases and high threat pathogens. Traditional infectious disease control through immunisation programs is increasingly threatened by “vaccine hesitancy” (a polite term for the damage caused by anti-vaxxer conspiracy theories).  Meanwhile, antimicrobial resistance (AMR) – especially but not only antibiotic resistance – is viewed by many public health specialists as a potentially existential threat to sustaining modern health care systems, while already killing over 700,000 people globally each year.  AMR should be a problem tailor-made for ecological economists – a negative externality caused by overconsumption (in both health care and livestock agriculture), a global commons problem with extreme market failures, which threatens to deliver an era of medical regress if not dealt with.

A growing “planetary health” movement seeks to highlight and safeguard the critical interdependencies between human health and the health of Earth’s natural systems on which we depend.  Planetary health shares many of the same preoccupations and world views as ecological economics – yet so far there seems to have been limited interaction between the two.  This situation needs to be rectified – and I would suggest that it is ecological economists who need to reach out to the planetary health movement with concrete offers of support and collaboration.

References

Martin Hensher is Associate Professor of Health Systems Financing and Organisation at Deakin University’s Institute for Health Transformation.  He has thirty years’ experience in health policy and economics, having worked for the European Commission, the South African National Department of Health, as a senior civil servant in the UK Department of Health and Government Economics Service, and a senior executive in the Tasmanian Department of Health and Human Services.

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