Advancing health by caring for nature
Meeting the needs of all people within the means of our living planet is rooted in policy choices that take a broad view – capturing what affects our happiness, the new types of inequalities arising from technology and climate change, and how to restore the bonds within and between societies
The world must commit to a transformative approach that promotes health and well-being. Living in the Anthropocene – an epoch defined by the human impact on our ecosystems – moves us into unknown territory. The challenge is to find a way of living that aims to meet the needs of all people within the means of the living planet. Policymakers require foresight, determination, courage and agility to shape the future.
In 2015 the world adopted a blueprint – the 2030 Agenda for Sustainable Development – and its 17 Sustainable Development Goals have been important in setting global priorities and highlighting the interrelationships among humanity’s big challenges. Today, as the world drifts apart geopolitically and multilateralism weakens, progress towards most of the SDGs is moving backwards. According to the World Bank, poorer countries are now contending with a deep, long-lasting crisis, reinforced by the pandemic and the war in Ukraine, that has increased global poverty and is reversing recent trends in reducing inequalities within and between countries. Human development, especially women’s rights, has also been set back by a full generation. Millions of people have fallen back into poverty because of out-of-pocket healthcare costs. We are clearly
on the wrong track.
In short supply
Public policy for the common good is in short supply. This is a legacy of the neoliberal decades. We do have models, knowledge and technologies at our disposal that could significantly improve health and well-being and create fairer, more sustainable societies. Yet they are not used widely to serve public purposes or the global good. The Covid-19 pandemic demanded a united response based on solidarity between developed and developing countries – but that did not arise.
Instead, vaccine nationalism and geopolitical vaccine diplomacy took centre stage. Fighting a global pandemic became an ideological issue of system competition. This does not bode well for addressing other global challenges together. It has further destroyed trust in a global governance system seen to favour the richest and punish the poorest. This makes global cooperation increasingly difficult.
The SDGs embrace complexity – what seemed initially to be a ‘nice to have’ approach has now become an existential necessity for our future. The post–World War Two organisations and governance modalities – based on silos and distinct technocratic solutions – have great difficulty in responding to simultaneous and cascading systemic crises that are triggered by inequality, climate change, pandemics, food insecurity, war, digitalisation and a weakening democracy.
The leadership challenge ahead is:
- how to engage in policymaking in such an extremely complex and dynamic environment,
- how to deal with uncertainty,
- how to deal with highly non-linear cause-and-effect relationships and the spillovers between policy sectors, and
- how to convey this new way of policymaking to the public.
This will challenge decision makers in new ways. In the face of multiple crises they need to build forward rather than react to risks, and reach out to other sectors and communities to engage them in co-designing the future.
New social contracts
A priority for co-design is to consider generating new social contracts that reflect the world as it is and will be – not how it was – and to define jointly what binds us in this much more dangerous world of power shifts and social unrest. Many of the premises on which the post-war social contracts – national and global – were drawn up no longer hold, ranging from the power relationships between men and women to the power relationships between countries.
Our very understanding of what we consider successful policies must be questioned at its core. All major international organisations agree that macroeconomic data alone, such as gross domestic product, do not provide a sufficiently detailed picture of the living conditions and the health and well-being that ordinary people experience and want. The measure we seek must be the health and well-being that people experience in the context of everyday life. These measures must also include environmental sustainability. Policies to promote well-being must address the structures that shape people’s aspirations and impact on their experienced well-being through social relationships over time.
The World Happiness Report 2020 for the first time ranked cities by their subjective well-being and analysed how the social, urban and natural environments combine to affect our happiness. The metrics proposed by the Organisation for Economic Co-operation and Development measure individual well-being through a combination of quality-of-life and material conditions and relate it to sustainability of well-being over time. But even the most progressive measures do not yet capture dimensions of well-being that we have only recently begun to acknowledge – such as the impact of structural racism or the level of violence against women.
New types of inequalities are opening in technology and climate change, which in turn show significant effects on health and well-being. The Covid-19 lockdowns have made clear how dependent we are for our well-being on supportive social and physical environments and social interaction with others as well as with nature. Feeling valued and feeling safe, and having dignity and opportunity are key components of perceived well-being. Having access to green spaces improves our well-being. Just as we begin to design the physical environment to fulfil ecological requirements, we can co-design our social environments to promote health and well-being.
We need, says Minouche Safik, to “restore the ties that bind”. We can no longer only consider our individual well-being and that of our closest family and friends but must also take the broader view and “recognise our global interdependence while also reknotting the ties of mutuality that hold our societies together”. This, she says, requires significant investments in people’s security and capabilities. But above all we must learn to manage risk collectively, in solidarity.
Refocusing on a common purpose
The SDGs aimed to set a common purpose for all peoples. But more than two years into the Covid-19 pandemic it has become clear how far removed we are from those goals, not only in terms of achievement but especially in terms of aspiration. Politicians need to counteract this trend. One approach could be to base their policies on the ‘doughnut’ model developed by economist Kate Raworth. It considers an economy as prosperous when 12 social foundations are met without overshooting any of the 9 ecological ceilings that need to be considered (see figure). Based on this, it is possible to identify the safe and just space for humanity supported by a regenerative and distributive economy.
No approach is perfect. But this is a sufficiently concrete start to co-design policies and address systemic risks and their combined impacts. We have no choice but to act now.
