‘Environment, Health and Equity’ George Morris NHS Health Scotland Creating Better Lives Glasgow

…. 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 20 th 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 PLACE 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) Environmental Hazard or ‘Good’ Health Effect We need to consider more carefully the way those (hazards or good) environments translate to disease or better health?

Exposure (or Experience) Exposure Environmental Hazard or ‘Good’ Health Effect Context Social and economic factors, cultural influences, factors relating to the individual A more realistic representation!

Exposure Environmental Hazard or ‘Good’ Health Effect Context Influences risk for the individual Policy and Action A more realistic and policy-relevant representation The Drivers that shape environment or place

Exposure Environmental Hazard or ‘Good’ Health Effect Context Influences risk for the individual Policy and Action More realistic and More policy-relevant The Drivers that shape environment or place AN ECOLOGICAL PERSPECTIVE DEMANDS AN ECOLOGICAL 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

CONTEXT Social, Cultural, Demographic, Economic, Behavioural Includes perception of environment Modified 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