6 General social and environmental conditions
Neo-materialist explanations focus on the way in which adverse socioeconomic and psycho-social environments, and the health-damaging mechanisms associated with them, are socially constructed. Concurring with this, Link and Phelan argue that social conditions remain fundamentally important to health and moreover that: ‘we need to be mindful of the potential health impact of the entire array of social, political and economic policy we humans develop, such as social security, child welfare, education, or the location of potentially polluting industries’ (Link and Phelan, 2002, p. 732).
For example, in recent years the need to provide health and social care for an increasingly ageing population has worried many governments. The potential for individuals to outlive their financial resources, for intergenerational antagonism and for problems with quality of life in older age are also concerns. In the American Geriatrics Society conference on ‘Creating Very Old People’, Louria (2005) argued that improving the health of an ageing population will require a broad systems approach to health that includes the following features:
- changes in retirement age
- strengthening (and replacing) social security systems
- mandating the requirement to save during working age.
Many commentators have also expressed concerns with increasing environmental degradation and the impact of this on both physical and mental health. For example, a study of depression and neighbourhood in New York City (Galea et al., 2005) found a strong association between depression and poor quality built environment; researchers concluded that more attention should be paid to physical environment and urban planning within public health promotion. Other psycho-social research has also identified a relationship between environment and mental health or wellbeing. For example, it is well documented that certain spaces and places can promote a fear of violence and crime. Frumkin (2001), however, suggests that the focus should be on the salutogenic effects of a closer relationship to nature, rather than on traditional public health concerns. Drawing on the biophilia thesis (the notion that human beings have an innate affinity with nature), Frumkin focuses on the four domains of nature and the way in which each of these can enhance health (see Box 7).
Box 7 The four domains of nature
Pet ownership may improve physical and mental health.
It is suggested that plants make places more pleasant and convivial, reduce stress and, possibly, promote healing
Natural landscapes are thought to reduce stress. Some research on this has been carried out in dental care and prisons.
This refers to being in the landscape, rather than just viewing it. Wilderness therapy has been used with people with mental health problems.
Thinking point: think of one example of where the domains of nature could be used to improve public health in a setting with which you are familiar.
If you think about some of the settings that are familiar to you, it is easy to see how some of these ideas are evident in everyday practice. For example, many schools have a class pet such as a hamster or goldfish.
Some schools have ‘wilderness areas’, ‘wildflower meadows’ or a community allotment, and may organise trips to city farms, or similar locations. Many pay special attention to achieving a convivial environment both within school buildings and on school grounds. However, although some researchers have argued in favour of the biophilia thesis, the evidence is mixed, and others have argued that nature has no positive effect on health and wellbeing.
Environmental degradation, coupled with shifting balances between production and consumption, can also have a considerable impact on physical health. For example, in relation to obesity, it is easy to see how the placing of commerce and leisure in out-of-town locations and the need to commute to schools and workplaces places an over-reliance on the car for both children and adults alike (Gard and Wright, 2005). Lack of children’s play facilities and open spaces, coupled with concerns with neighbourhood safety, also mean that children are less likely to engage in physical activity and more likely to participate in sedentary hobbies such as watching television or electronic gaming.
The issue of sustainability is also important here in that the unsustainable use of natural resources is a fundamental threat to human health. For example, for a healthy diet, most would agree that the local availability of affordable healthy foods must be improved. For sustainability, these foods should also be locally produced (so as to reduce food miles and energy consumption) and organic (so as to reduce the use of chemical pollutants). At the Third International Conference on Health Promotion the Sundsvall Statement on Supportive Environments for Health (WHO, 1991) acknowledged the fundamental link between environment and global health and called for the creation of supportive environments and for public health action at a local level. The United Nations’ 1992 Earth Summit developed a programme of action on sustainable development: Agenda 21 is a comprehensive plan of action to be taken globally, nationally and locally. It sets out twenty-seven principles to guide and underpin the action programme. These initiatives, and others, have had a significant influence on the UK-wide agenda on health and the environment, and in March 2005 all of the countries in the UK signed up to a shared framework for sustainable development (DEFRA, 2005). Box 8 considers actions at a number of different levels.
Box 8 The potential for environmental health action
Consumer action: fitting double glazing or loft insulation; purchasing ‘fair trade’ food and clothing
Citizen action: starting a local campaign; joining a community allotment
Household action: reducing energy and water consumption; recycling paper and glass
Community action: setting up a recycling project; establishing a skills-exchange scheme
Professional action: working in a sustainable way; supporting local sustainable projects
Local authority action: enabling public participation in environmental priority settings; setting and enforcing sustainability targets
Organisational action: assessing the potential for energy saving; purchasing from sustainable sources
National and international action: setting policy frameworks; encouraging change at lower levels.
Thinking point: consider your own environmental health actions.
A wide range of social, political and economic policies, at local, national and international levels, has a role to play in the social and environmental conditions that influence the health of individuals and communities.