Reframing Environmental and Health Issues in the 21st Century

*Presentation, SIT Study Abroad Academic Directors Workshop, Belem, Brazil. August

2008

Reframing Environmental and Health Issues in

the 21st Century*

by

Dr Nat Quansah

2000 Goldman Environmental Prize Recipient

Academic Director

Durban Community Health Program

SIT Study Abroad, a Program of World Learning

18 Alton Road

Glenmore

Durban 4000

South Africa

Tel: +27 76 561 68 15

[email protected]

We must be a generation of people who listen to common sense

and take responsibility in taking care for our own health and that

of our environments. We need to respect and appreciate diversity

and work to complement each other for the good of our health

and environment. Our lifestyles, actions and behaviors must

reflect our adherence to the old adage ‘prevention is better than

cure’ rather than wanting to experience the negative effects of

destroying our environments and becoming ill before redressing

and treating ourselves. Humanity is already paying the

unpleasant prize for procrastinating and being imprudent in

ignoring common sense and not complementing each other in

taking care of our health and that of our environment.

Health and environment have become subjects of concern in the present era.

But why is it only now that we’re realizing this? Health and environment

have always been and will always be subjects of concern. Common sense


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dictates that we take care of our health and that of our environment, but we

do not listen. We’ve disregarded this to our own peril. The result of not

listening to common sense is the mess that we find ourselves in now.

Let’s take a quick look at the title to see what it entails:

Reframing: this indicates the existence of a frame (structure) that appears to

not function as it should and therefore needs to be retouched, reshaped.

Something needs to be done to enable the current frame function properly.

We need to reframe.

Environmental: Relating to the environment.

And what is the Environment? What comes to mind when we hear the

word environment and more so ‘save the environment?’

I believe most of us consider the environment that needs to be saved as the

forests of Africa, Asia or Latin America. We forget that the environment is

what’s around us – our immediate surroundings, all factors that affect the

life and activities of living organisms - people, plants and animals –

whatever impacts us directly and immediately as well as indirectly and

farther a-field thereby influencing our behaviors and actions.

There’s diversity of environments – natural, artificial, physical, spiritual,

ecological, economic, academic, social etc. – all of which I consider to be

reflections and manifestations of the diversity of Nature (note that humans

are part of Nature). To attain a balance in life, all the various environments


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must function in a complementary manner. Unfortunately, there’s no balance

as there appears to be no complementary functioning of our environments.

Humans have and are currently laying too much emphasis on the economic

environment instead of seeking and trying to maintain the balance thru the

complementary functioning of all the diverse environments.

Health: According to the World Health Organization, Health is a state of

complete physical, mental and social well-being and not merely the absence

of disease or infirmity1.

Issues are subjects of concern; cases. And of course the 21st century is the

current era; the present time, our time.

What are the environmental and health issues?

For me the main issue is getting human beings to change attitudes,

perceptions and actions with respect to our health and environment. We

must listen to common sense and take up our responsibilities to work to

attain good health for humanity (as individuals and as a group) and our

environment thru complementary actions.

The underlying set of ideas, principles, agreements, and/or rules that provide

the basis for the current environmental and health policies and activities, I

believe, is flawed. The framework within which these are supposed to

function is biased against almost all other forms of health care and

environmental systems but in favor of the so-called modern health care

system and the environmental system based on the paradigm of exclusion.


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Other systems have been and are being looked down upon, belittled, ignored

and at times demonized.

It’s the results on the ground that makes me assert to the foregoing. If a

strategy is attaining an undesired result then that strategy needs to be

modified and/or changed. And I believe that our health and environment

strategies are attaining undesired results.

We need a framework within which health and environmental policies and

activities can function to truly deliver the desired goal. The desired goal

being, enabling people and our environments to be healthy and remain

healthy. And for that to happen require changes in attitudes and perceptions

as to who is responsible for our health and that of the environment.

Individuals as well as groups (institutions) must want to and need be allowed

to take up their responsibilities for their health as well as that of the

environment.

Most of our actions and behaviors tend to go contrary to common sense

when it comes to environmental and human health but we try to find

justification for these anti-common sense actions and behaviors. And the

justification has almost always been scientific and economic.

BEHAVIORS THAT GO CONTRARY TO COMMON SENSE

We continue to pollute our environment ignoring the fact that the end result

is a great disaster. Common sense has been sounding the alarm bells all

these years to the effect that our actions and inactions are having disastrous


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impacts on our environment and health but we do not listen to act to prevent

or redress the situation. We evoke the absence of proof and the need for

scientific evidence for the looming danger. How sad and how strange?

Even when scientific evidence has been provided in support we still do not

listen. We hesitate or refuse to act trying to ‘pass the buck’ and find

scapegoats. ‘The greatest polluters must act first; no the emerging economic

powers are also polluting and must act as well.’ Instead of taking

responsibility to act we’ve turned this into a tennis match, engaging in

conferences and coming up with resolutions and declarations while each

continues to pollute. We continue to invest in activities, technologies and

products that have negative impacts on our environment and health.

Our waters, air and lands have been and are being polluted with chemicals

and other waste products while at the same time our minds are being

polluted with economics and monetary values and ideals.

We cannot drink but processed and bottled water because our waters have

been polluted with hazardous chemicals or so we’re made to believe. Some

inhabitants of our planet now have to wear facial masks in their towns and

cities to protect themselves from the suffocating menace of pollutants. Foods

that we eat have to be packaged and be loaded with additives and so called

supplements because our lands cannot yield the normal food crops, fruits

and vegetables that we use to have and need anymore. The lands have been

and continue to be polluted. Work and other places of activities must be

disinfected because we’ve polluted these places with so much dirt and waste.

Meanwhile the disinfectants are themselves pollutants. Personal hygiene has


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been neglected. Sanitation is in shambles. Waste management is at times

non-existent in certain places.

We are getting use to or have become use to the destructive effects of our

actions on our health and that of our environment so much so that we now

consider the abnormal as normal and the unnatural as natural. The air we

breathe in hurts our eyes and is detrimental to our respiratory organs until we

‘get use’ to this polluted air. We take pride in producing artificial chemicals

that mimic natural compounds but are alien to, persist and cause damage to

the natural environment – chlorofluorocarbon (CFCs);

dichlorodiphenyltrichloroethane (DDT).

Examples of how our minds have been corrupted (influenced)

NEED FOR SCIENTIFIC EVIDENCE

We’ve been made to think and use the absence of scientific evidence as a

reason to reject or belittle other systems that we don’t understand or that

appear strange to us. We sometimes use this same argument of the need for

scientific evidence to hide our real underlying motives – economic

(monetary) interest and to make others dependent on us.

We want to have scientific evidence before we accept to act or react whereas

common sense would dictate that we go ahead sometimes to act or react first

before asking science to confirm (that is if science can be brought into the

picture). Yes, scientific evidence is useful. But not all situations have been

and can be backed up by scientific evidence. So what happens when science


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hasn't been able to, and/or cannot provide the evidence in support? Do we

reject it? This is what we're being made to believe. But, NO, is my answer.

We shouldn't reject an issue just because there's no scientific evidence to

back it up. Think of the many different situations in life where science has

been late to, hasn't been able to provide yet or can not provide evidence.

Case: Remember mothers' breast milk and breastfeeding babies? The breast

milk and breastfeeding babies were looked down upon, belittled, ridiculed

and ignored until science has proven that mothers' breast milk is the best

thing that ever happened to babies and breastfeeding babies is 'good' and

'safe' not just for babies health but for the mother as well. But a lot of harm

would have been caused and damage done for this behavior of ridiculing and

rejecting breastfeeding and breast milk all in the name of the absence of

scientific proof.

Case: Take again the case of traditional medicine and its use of biodiversity

(especially medicinal plants) as well as the role of traditional healers in

healthcare. We are often asking for scientific evidence for proof of efficacy

and wanting to know what makes and how the plant product works. But it is

not always that scientific evidence can proof the efficacy. Nor can science

decipher the so called active principles and how they function. So we turn to

belittle the effects of traditional medicine and its' professionals by citing

placebo and psychological reasons for the efficacy of traditional medicine.

But common sense should let us accept that the patient getting well is proof

enough of the effectiveness of this system and the medicines it uses.


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Scenario: A 30 year-old lady was prescribed the inhalation of the vapor of

an infusion of three medicinal plants by a traditional healer to treat her

common cold problem.

A medical officer friend of hers sees her and comments: “oh, you know the

common cold would have disappeared in three days anyway.’ Inferring that,

it was not the traditional healers’ medicinal plants treatment that made her

well.

At the same time, another 30 year-old lady with a common cold problem

was prescribed a pharmaceutical product by a medical officer. She gets well

and the medical fraternity acclaims the virtue of the pharmaceutical product.

Why? Wouldn’t the common cold have disappeared anyway in this case as

well? Why claim that the common cold disappeared because of a

pharmaceutical product and not a medicinal plant? Isn’t it the same virus?

We must not belittle a profession or system because we don’t understand it.

Our belittling other health care systems has resulted in humanity been at the

losing end.

The strange thing is that even with scientific evidence in support, we still

invent other reasons to enable us belittle and reject the positive contribution

of the traditional medical system to humanity’s wellbeing.

We evoke the presence of fake or quack traditional healers as well as our

‘not knowing the dosage required’ as reasons for not accepting the role of

these professionals and accepting the prescriptions that they provide. But let

me ask: have you ever come across any one making a fake of something


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useless (of no value)? Those who make fake currencies, for example, go for

the largest bill not the least. You see, the presence of the fake or quack

traditional healer to me reveals the existence of the real good traditional

healer. Let’s look for and work with these.

Similarly the fact that we don’t know the dosage doesn’t mean all do not

know. Somebody knows and that somebody is the traditional healer. These

traditional healers are the professionals of the system and they know the

dosage required. It is in humanity’s interest to respect these and allow them

to offer their expertise. After all they’ve been vanguard of humanity’s link

with Nature.

The use of biodiversity in whichever form for any reason had provided the

user with a tangible reason to want to help save that biodiversity. When our

survival has depended on biodiversity, we’ve tried to save biodiversity. It

had been a reciprocal relationship. That’s common sense, isn’t it?

But no, we are currently not following the dictates of common sense. And

the reason for turning away from common sense is monetary (economics).

No activity or behavior is out of bounds so long as the economic and

monetary gains are there for the grabs even when such an activity or

behavior will eventually have negative effects on the health and environment

of humanity. Classical examples are the continued production and sale of

cigarettes and our reliance on fossil fuel.

Our minds have been and are being polluted to become totally dependent on

science and economics. Nothing is valuable unless proven scientifically


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and/or has a monetary (economic) aspect. We are being made to believe that

humanity’s wellbeing can only be right when the economics is right backed

by a scientific proof. We’re gradually and systematically being weaned off

common sense and other values. The human dignity is being lost.

We forget though that whoever loses the ability to listen to and act in

accordance with common sense loses part of what makes him/her a human

being – the capacity to reason and be responsible. Once incapability and

irresponsibility sets in worry follows. But you know to worry is a major

factor in making one unhealthy. Good health is being well - being balanced

in mind, body, soul, spirit and the pocket. Let’s strive for the balance.

Preventive vs Curative Activities: Our efforts have focused much more on

curative rather than preventive activities. Why pollute and then turn round to

clean it up? In polluting our immediate surroundings of home, workplace,

school, play ground, pathways, roads, water courses, rivers, oceans, air,

farmlands, agricultural fields etc. we end up making not only that immediate

surrounding (environment) unhealthy but also the unseen environment far a-

field. When the different polluted and overexploited immediate surroundings

are put together, the cumulative effect of these minor (micro, so-called

insignificant) disturbances is, I believe, what we’re seeing and experiencing

as ‘climate change’ with its health and other disastrous outcomes that are

being manifested in our time.

But it’s the economics of it; some one has to make monetary gains out of our

inconveniencies and our fear. For how long must this continue? The

economy is necessary and important but it doesn’t augur well when we make


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the economy rule us instead of making the economy work for our good. If

science and money were to find their balance in common sense that will

augur well for the health of humanity and our environment.

Health care is, supposed to be, the prevention, treatment, and management of

illness and the preservation of mental and physical well being through the

services offered by the medical, nursing, and allied health professions2.

Health care embraces all the goods and services designed to promote health,

including “preventive, curative and palliative interventions, whether

directed to individuals or to populations”. The organized provision of

such services may constitute a health care system.

But which health care system? Meeting global health care and

environmental needs has focused more on curative and palliative

interventions rather than preventive and holistic. Strategies put in place are

meant for the preservation of our mental and physical well being. But this

must not be the case. Our mental and physical well being must be allowed to

accommodate change, thus strategies for mental and physical well being

must aim at the conservation and NOT the preservation of these. You see,

when we try to preserve living things we work against Nature and working

against Nature is a recipe for disaster.

Public health is "the science and art of preventing disease, prolonging

life and promoting health through the organized efforts and informed

choices of society, organizations, public and private, communities and

individuals."3


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Choices: Did I read ‘informed choices?’

Most governments have adopted (are forced to adopt) the allopathic medical

system as the official system for their country to the detriment of all other

forms of health care systems that existed before and still exist (often times

underground for fear of recrimination). But this official system is not able to

meet the health care needs of all. The majority of citizens are unable to

access the services of this official system because they cannot afford the

cost. Meaning the services of this system are not available to them.

You see affordability, accessibility and availability, are related and

inseparable4 and coupled with cultural acceptability and personal

responsibility – become what I consider to be the five main pillars of health

care system. And all five need to be part of a system before that system can

claim to be effective and efficient. These, however, are often absent in

official health care systems.

Responsibility: Achieving good health and remaining healthy is an active

process that requires putting in place effective strategies for staying healthy

and improving one's health. This requires the input of all but the primary

responsibility and effort for this, I believe, must rest with us as individuals.

What others (family members, governments, NGOs, institutions, etc) do

must come in to complement NOT to replace individual or group of

individual efforts.


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We’ve been made, however, to believe that our health care needs and that of

our environment can only be met by someone else. In so doing, we’ve turned

the majority of humans into beggars by encouraging (sometimes forcing)

them to become totally reliant and dependent on the ‘experts’ (medical

officers, conservationists, scientists, and politicians) who have become,

themselves, dependent on those with the economic power. But to be totally

dependent defeats the principle and reality of being human. You lose your

dignity.

Economics: At the heart of this, though, is the fact that we’ve turned both

environment and health into economic activities. Our actions show that we

prefer seeing more people become sick to not being sick because we can

make more money out of that. But we forget that the more unhealthy people

there are, the more negative the effect on the economy. The impact on an

individuals’ health can have global dimensions. First, the effect is on that

individual, then the persons’ immediate family and then impacts his/her

colleagues, friends, community, his/her country and then globally

(remember malaria, bird flu, HIV Aids, tuberculosis, etc?)

Similarly, governments and NGOs have been made to believe that they can

attract more financial resources only if they can create more places as

protected areas even if it means denying local communities access to their

local resources while making a mess of their own surroundings. Economic

giants just think and act let’s provide more financial resources for

environmental conservation and public health programs but continue to

pollute and wreck havoc on our planet.


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Need for change: The third option (The Integrated Health Care System)

Finding way(s) that successfully meet human and environmental health care

needs effectively and efficiently requires a re-think and a re-act of both

environmental and health policies and activities.

I call for this re-think and re-act and in so doing propose what I term the

third option approach to health and environmental care provision – the

Integrated Health Care System (IHCS). It is a system that consciously

targets and harnesses peoples’ links with Nature (biodiversity) thru use as a

positive tool to arrive at meeting the health, economic, biological and

cultural (bio-cultural) diversity conservation needs of people and their area

simultaneously4.

The IHCS reinforces peoples’ links with Nature thru the use of biodiversity

rather than severing people’s links with Nature. It thus provides people with

a tangible reason to want to take up their responsibility to safe Nature.

We must not destroy peoples (especially local communities) ability to take

up their responsibilities to take care of their local environment. We must

work towards making each locality pursue its uniqueness according to its

diversity to complement the others. We must take care of our environment

(in terms of resource use and management) at the different places. Resources

must be used NOT abused. When this is done and the micros are in good

shape putting the pieces together will provide an overall healthy global


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environment. Remember, the micros are as important as the macros (if not

more important). This equates to what the late President John F. Kennedy

said: ‘A journey of 1000 miles starts with the first footstep.’ One cannot

arrive at the 1000 mile mark if he/she cannot take the first footstep. The

same as to build a mansion or whichever edifice starts with the foundation

stone. Note that the mighty Amazon River, the Nile, Lake Victoria and all

other rivers and lakes start as trickles at a source. You see, micros (small,

tiny) are important hence the importance of the individual as a contributor to

the success of the welfare of humanity must not be neglected.

The way forward must be to listen to common sense and work to

complement each other focusing more on preventive activities while being

ready to cure when the need to cure arises and not the other way round.

Before I end I’ll like us to reflect on the following four statements:

True or false:

The health of the environment determines the health of those

inhabiting that environment.

An unhealthy environment will make those living in and around it

unhealthy.

A healthy environment can become unhealthy if those inhabiting it

live an unhealthy lifestyle and do not take care of that environment.

Healthy people will strive to create, maintain and live in a healthy

environment


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The first three statements, I’ll agree are true. I find it difficult though to put

the fourth statement in the same category of true as the others. The actions of

human beings as inhabitants of planet earth make me say so. Our actions

appear to be geared towards making our environment unhealthy. As a result

we are becoming unhealthy residents ourselves.

Finally let me draw our attention to an event that took place at the turn of the

century so as to put into perspective what I’m trying to advance as to the

need to reframe environmental and health issues.

In pursuance of United Nations General Assembly resolution 53/242 of 28

July 1999, the Ministers of Environment and heads of delegations met in

Malmö, Sweden from May 29 to 31, 2000 to review important and emerging

environmental issues and to chart the course for the future. They came up

with a 25 point declaration that they committed themselves (and thus

humanity) to. I cannot go thru all due to time constraints but the following

should help us put things into perspective. I present these with my emphasis

(in bold) comments as I go along.

First the Conclusion of the declaration

25. At the dawn of this new century, we have at our disposal the human and

material resources to achieve sustainable development, not as an abstract

concept but as a concrete reality. … We can decrease poverty by half by

2015 without degrading the environment, we can ensure environmental

security through early warning, we can better integrate environmental


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considerations in economic policy, we can better coordinate legal

instruments and we can realize a vision of a world without slums. We

commit ourselves to realizing this common vision5.

To arrive at the above conclusion, our honorable Ministers noted:

Conscious that the root causes of global environmental degradation are

embedded in social and economic problems such as pervasive poverty,

unsustainable production and consumption patterns, inequity in distribution

of wealth, and the debt burden,

Also conscious that success in combating environmental degradation is

dependent on the full participation of all actors in society, an aware and

educated population, respect for ethical and spiritual values and cultural

diversity, and protection of indigenous knowledge,

Declare that:

7. To confront the underlying causes of environmental degradation and

poverty, we must integrate environmental considerations in the

mainstream of decision-making. We must also intensify our efforts in

developing preventive action and a concerted response, including national

environmental governance …. All actors involved must work together in

the interest of a sustainable future.

Comment: Environmental concerns have been neglected by those in

position of trust, hence the call by our Ministers for the need to integrate

environmental considerations in the mainstream of decision-making.


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Emphasis has been laid more on curative actions, hence the call to develop

preventive actions.

The rule has been each one for him/her self with no respect for what the

others are doing, often trying to destroy the other for economic gains. The

call for all actors to work together is great. There’s the need to work to

complement each other.

10. The role and responsibility of nations based on the Rio Principles, as

well as the role and responsibility of the main actors including Governments,

the private sector and civil society, must be emphasized in addressing the

environmental challenges of the twenty-first century. Governments are the

primary agents in this process…

Comment: Yes governments are lead agents but the responsibility to

take care of the environment must rest with all and sundry with the

individual acting first. After all, it is individuals that make up

Governments, private sector and civil society. If individuals outside

Government were to do it right, those individuals in Government will

have no option but to do it right. As it stands now, we’re always waiting

for the other (especially the government) to act first. No let’s be the ones

to act first for the good of our health, that of others and our

environment. We must be action oriented not passive nor reactive.

11. The private sector has emerged as a global actor that has a significant

impact on environmental trends through its investment and technology

decisions. In this regard, Governments have a crucial role in creating an


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enabling environment. …A greater commitment by the private sector

should be pursued to engender a new culture of environmental

accountability through the application of the polluter-pays principle … and

the establishment of a precautionary approach in investment and technology

decisions.

Comment: I believe that the environment being considered by our

Ministers here is the economic and legal environments; making it easier

for the private sector to access the resources of the natural and physical

environments. Other environments must be considered.

I ask myself with respect to the 2nd part of declaration – Why allow

people to pollute in the first place? Polluter-pays principle is a license to

pollute. Often those who pollute most are the ones capable of paying.

17. Science provides the basis for environmental decision-making.

There is a need for intensified research, fuller engagement of the scientific

community and increased scientific cooperation on emerging environmental

issues, as well as improved avenues for communication between the

scientific community, decision makers and other stakeholders.

Comment: Informing but not misinforming people must be the norm

unfortunately certain within the scientific community delight in

confusing us by using technical terms and concepts difficult to

understand.


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Imprudence. We talk about and feel the effects of global economics but

forget or ignore the effects of global health and environment. I believe the

economic environment can only function well when it is complemented

by other environments.

Stop playing the blame game: We are making a mess of our environment

with its consequent negative impact on the health of all. And instead of

stopping and wanting to make amends we rather turn around to apportion

blames. Playing the blame game will never work. Let’s step back, listen to

common sense and get out of our cloaks of greed and irresponsibility and be

responsible to help make it right. If each one of us does it right wherever we

are, the sum will be right.

Action speaks louder than words. Let’s turn the d’s of our words into k’s

of works. This is doable. Let’s do it, starting from here and now.

Thank you for your attention.

1. WHO (2006). "Constitution of the World Health Organization" World Health

Organization

2. http://medical-dictionary.thefreedictionary.com/health+care

3. http://en.wikipedia.org/wiki/Public_health

4. Quansah, N. (2001). Pharmacies for Life

www.ourplanet.com/imgversn/122/quansah.html

5. http://www.unep.org/malmo/malmo_ministerial.htm

http://www.who.int/governance/eb/who_constitution_en.pdf

http://medical-dictionary.thefreedictionary.com/health+care

http://en.wikipedia.org/wiki/Public_health

http://www.ourplanet.com/imgversn/122/quansah.html

http://www.unep.org/malmo/malmo_ministerial.htm

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