‘Environment, Health and Equity’

George MorrisNHS Health Scotland

Creating Better LivesGlasgow 20.10.2010

….in an era when disease was blamed on foul and noxious vapours

ENVIRONMENT/PLACE

…in an era when the big threat was seen to come from infectious organisms

ENVIRONMENT/PLACE

In an era dominated by concern over highly visible pollution

ENVIRONMENT/PLACE

How then, did late 20th century public health ever get to a point where mortality and morbidity were so often associated

with individual behaviours as though these were chosen in a social or physical

vacuum?

It was the Era of the “Black Box” there was seemingly…

‘NO P

LACE FOR PLACE!’

Environmental public health can make its biggest contribution through

extending its reach and relevance to health improvement and, critically,

health inequity

but how?

The problem is that the ‘traditional’ environmental health

agenda has, as its focus, environmental hazards

In future it must additionally be about ‘health promoting places’

and, crucially, consider risks and benefits to

individuals and specific groups within society linked to

environment

Exposure(or Experience)

EnvironmentalHazard or

‘Good’

HealthEffect

We need to consider more

carefully the way those (hazards or

good) environments translate to disease

or better health?

Exposure(or

Experience)Exposure

EnvironmentalHazard or ‘Good’

HealthEffect

ContextSocial and economic factors, cultural influences, factors relating to the individual

A more realistic representation!

Exposure

EnvironmentalHazard or

‘Good’

HealthEffect

ContextInfluences risk for the individual

Policy and

Action

A more realisticand policy-relevant representation

The Drivers that shape environment

or place

Exposure

EnvironmentalHazard or

‘Good’

HealthEffect

ContextInfluences risk for the individual

Policy and

Action

More realisticandMore policy-relevant

The Drivers that shape environment

or place

AN ECOLOGICAL

AN ECOLOGICAL

PERSPECTIVE

PERSPECTIVE

DEMANDS AN ECOLOGICAL

DEMANDS AN ECOLOGICAL

POLICY RESPONSE

POLICY RESPONSE

We’re in the Era of Ecological Public Health and policy must embrace:

• biological complexity,

• the ecological complexity of society

• the subjective world of individual human beings

• inter-subjective world of culture

• the interconnections between these

To be effective truly effective, ecological policy approaches must highlight the

interconnectivity amongst the determinants of health but also

amongst concepts e.g the individual and the collective and many complex

agendas e.g. public health, the ageing population, climate change and

inequity

A more holistic approach to Environmental Public Health can help

address ecological complexity and illustrate interconnectivity by framing

complex problems around the

axis of people and place

CONTEXTSocial, Cultural,Demographic, Economic, BehaviouralIncludes perception of environment

Modified DPSEEAModified DPSEEA ACTIONS

DRIVING FORCES:Economic, social, political

PRESSURES

STATE

EXPOSURE

EFFECT

Morris et al (2006)

‘Good Places, Better Health’seeks to do this

Governments don’t work in silos. Policies ‘bleed across to each other’. Understanding

this, and acting accordingly, is the embodiment of the integrated ecological

approach

We are encouraged that the ‘Good Places, Better Health’ can address the policy

fragmentation we have come to regard as normal.

“Reducing fragmentation of our political, our policy and our implementation approaches is

absolutely crucial for us to even grasp the level of complexity let alone start to address it”.

Monika Kosinska (European Public Health Alliance) (2010)

“I’ve no idea why people are afraid of new ideas. I’m

scared of old ones.”

John Cage