Download George Morris PP - Centre for Confidence and Well

‘Environment, Health and Equity’
George Morris
NHS Health Scotland
Creating Better Lives
Glasgow 20.10.2010
….in
an era when disease was blamed on
foul and noxious vapours
…in an era when the big threat was seen
to come from infectious organisms
In an era dominated by concern over
highly visible pollution
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…
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
We need to
consider more
carefully the way
those (hazards or
good) environments
translate to disease
or better health?
Environmental
Hazard or
‘Good’
Exposure
(or Experience)
Health
Effect
A more realistic
representation!
Environmental
Hazard or ‘Good’
Context
Exposure
(or
Experience)
Exposure
Social and economic
factors, cultural
influences, factors
relating to the
individual
Health
Effect
A more realistic
and policy-relevant
representation
Context
Influences
risk for the
individual
Environmental
Hazard or
‘Good’
The Drivers that
shape environment
or place
Policy
and
Action
Exposure
Health
Effect
More realistic
and
More policy-relevant
Context
Influences
risk for the
individual
Environmental
Hazard or
‘Good’
The Drivers that
shape environment
or place
Policy
and
Action
Exposure
Health
Effect
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
‘Good Places, Better Health’
seeks to do this
DRIVING
FORCES:
Economic, social, political
PRESSURES
Modified
DPSEEA
ACTIONS
STATE
CONTEXT
EXPOSURE
Social, Cultural,
Demographic,
Economic,
EFFECT
Behavioural
Includes perception of environment
Morris et al (2006)
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