The science and politics of population health, 2011
Health professions appear to be increasingly engaged in countering the growing harm to health of adverse social trends, at least in developed nations. At the same time, however, they have become part of the problem because of a scientific emphasis on, and political advocacy of, a biomedical model of health based on individual cases of disease, and their associated risk factors and treatments, at the expense of a social model of disease prevention and health promotion. This has contributed to a separation of population health from social conditions, to the detriment of both.
Addressing poverty and inequality is important from a health perspective. However, contrary to the prevailing social-determinants (and social-justice) orthodoxy, the core social challenge is not primarily a poverty of the means to the end of ‘the good life’ as it is currently defined and pursued; it is a poverty of the end itself.
This broader, social perspective shows that material progress does not simply and straightforwardly make people richer, so giving them the freedom to live as they wish. Rather, it comes with an array of cultural and moral prerequisites and consequences (for example, giving priority to money and what it buys) that affects profoundly how people think of the world and themselves, and so the choices they make.
To a significant extent, conventional indicators and models of development are measuring Westernisation or modernisation, not human development. While the concepts may overlap, they are not the same thing; Westernisation, for all its benefits, includes costs to wellbeing that the indicators are missing.
Health is a way of better understanding humanity and how people should live. Just as someone who is unwell will be less able to function effectively and withstand adversity, so too will a less healthy population make a less resilient society. Population health may be an important factor in determining whether societies respond effectively to adversity – or in ways that make the situation worse.
… a broad view of population health and its social determinants – socio-economic, cultural and environmental - challenges the legitimacy of the dominant worldview or paradigm of material progress, and supports the alternative, sustainable development.
A new narrative of young people’s health and wellbeing, 2011
… a cultural focus on the external trappings of ‘the good life’ increases the pressures to meet high, even unrealistic, expectations, and so heightens the risks of failure and disappointment . It leads to an unrelenting need to make the most of one’s life, to fashion identity and meaning increasingly from personal achievements and possessions and less from shared cultural traditions and beliefs.
… a central dimension of the changed trajectory in health over recent decades, and which underpins the new story, concerns the declining significance of material and structural determinants of health and the growing importance of existential and relational factors to do with identity, belonging, certainty and purpose in life. There is a shift in emphasis from socio-economic causes of ill-health to cultural; from material and economic deprivation to psychosocial deprivation; from a problem of material scarcity to one of excess. With this has come a shift in significance from physical health to mental health.
The contrast between the old and new stories of young people’s health and wellbeing is part of a larger contest between the dominant narrative of material progress and a new narrative, sustainable development…. The health of young people should a focal point in the larger contest of social narratives. They should, by definition, be the main beneficiaries of progress; conversely, they will pay the greatest price of any long-term economic, social, cultural or environmental decline and degradation. If young people’s health and wellbeing are not improving, it is hard to argue that life is getting better.
Well & Good: Morality, Meaning and Happiness, Text, 2004, 2005.
The openness and complexity of life today can make finding meaning and the qualities that contribute to it – autonomy, competence, purpose, direction, balance, identity and belonging - extremely hard, especially for young people, for whom these are the destinations of the developmental journeys they are undertaking. ... Faced with a bewildering array of options and opportunities, we can become immobilised – or propelled into trying to have them all. Pulling together the threads of our postmodern lives isn’t easy. (p 4)
We see growth at the extremes of self and meaning, a loss of balance: pathological self-preoccupation at one end, the total subjugation or surrender of the individual self at the other. A vast consumer economy has grown to minister to the needs of ‘the empty self’; and religious cults and fundamentalist movements flourish as people struggle to find what society no longer offers. (p 6)
… it may well be that science will never give us clear-cut and objective recipes for making life better. Nevertheless, it is contributing to a growing willingness to question and discuss what, all things considered, makes a good life. For me – and this is a radical view in science - it is preferable that we obtain imperfect knowledge about the important issues of our times than precise answers to what are, in the overall scheme of things, trivial questions. (p 15)
I once read through a compilation of what the wise and famous have said about happiness. A couple of common themes stand out. One is that happiness is not a goal but a consequence: it is not something to be sought or pursued, but a result of how we live; related to this, it is not found by focusing on ourselves, but on others. A second theme is that happiness comes from balancing wants and means, from being content with what we have. Our materialistic, individualistic culture does not reflect this sage advice. (p 104)
... I am exasperated by the tendency of ‘laissez-faire culturalists’ - like laissez-faire capitalists - to ignore or downplay the growing evidence of the social costs of the practices they defend.... This failure is closely linked to transferring to the commercial media liberties that were initially intended to free us in our private lives. (p 144)
Is it out of laziness, greed or some misguided notion of rights and equality, that we forget that children are not adults; that however worldly they seem, they can be deeply disturbed by things adults take in their stride; and that we have a duty of care to guide their development and to protect them from harm and deprivation, moral as well as material? (p 145)
Never before have our images of social realities been so filtered and distorted. For all the cultural celebration of autonomy and self-realisation, never before have we lived so much through the experiences of others; and never before have we been so denied the drama, dignity and romance of our own lives. (p 146)
… the young are at the cutting edge of social change; they reveal most clearly the tempo and tenor of the times. The message seems to be this: when skating on thin ice, it’s best to keep moving; speed is the essence. (p 165)
For children and adolescents, these reforms mean encouraging the things they need if they are to achieve their potential: families who love and care for them; friends who cherish and stand by them; communities that respect and include them; schools that nurture and educate them; governments that support them; a world that makes sense to them; and a future that offers them hope. They also need, at least some of the time and in some respects, freedom from all these things, or from what they imply: freedom from care, from media intrusion, manipulation and exploitation, from adult intervention, supervision, worries; freedom to be themselves, to explore their world, to take risks, to set their own pace. (p 169)
The structures of modern societies, especially politics, commerce and industry, are still driven by the old ethos. In the spaces between these structures, at deeper levels of our individual and collective psyche, the new is emerging. We need to acknowledge this, to recognise in our social and political analysis and commentary the importance of richer philosophical, historical and scientific insights. (pp 209, 210)
In ordinary times, it is perhaps normal for different planes of perception and understanding of the human condition to remain relatively separate and distinct, with little ‘friction’, or influence, occurring between them. In transitional epochs, when what it is to be human is undergoing profound evaluation and radical alteration, these planes of perception need to come together in a single, interwoven, public conversation. Ours is such a time. (p 210)
... in both realms – the scientific and the spiritual – we are operating at the very limits of our capacity to comprehend ‘the grand scheme of things’.... At this conceptual level, our view is highly subjective, we can only express ourselves in metaphors; the moral lessons can only be human interpretations, not laws of science or of God. A sense of the spiritual encourages a moral life; it does not set moral rules. (p 223)
Perhaps we are seeing the centre of moral gravity shift from social institutions to individuals. Rather than morality being imposed on us by our institutions through frameworks of regulation, we, through our personal choices, will imbue our social structures and cultures with moral content. (p 228)
If all of this is hard to see from within our current ‘go for growth’ worldview, think of it this way: given what you know about the state of the world, current social conditions and trends, what you feel about your own life and what is important to your wellbeing, would becoming twice as rich in about twenty years in order to consume twice as much be your number one priority, your highest goal? No? Well, for our governments, which we elect, it is. This gives us an idea of the tensions being created by an increasingly outdated and dysfunctional Weltanschauung. It’s time for a new one. (p 251)
There can be no grand plan or strategy for bringing about whole-system change. It is a dynamic process of public and political debate, discussion and action that is messy, difficult, disturbing and protracted, undertaken at many levels in many different ways, with the eventual outcomes always uncertain. We are living in the turmoil of a profound transformation in Western culture. It is this hope in a new beginning, this excitement of the challenge, this imperative to look beyond our personal horizons that we must embrace. (p 266)
Never better – or getting worse? The health and wellbeing of young Australians, Australia 21, 2008
Our quality of life depends on the regulation by government of the social and physical environment to protect our physical safety and health. We also regulate business activities to ensure national economic benefits and financial propriety. We need to extend this regulation to guard against moral hazard and psychological harm. Those who decry ‘nanny states’ and ‘social engineering’ should acknowledge the benefits (for example, clean air and water and safer working conditions and consumer goods). They also need to recognise that the ‘media-marketing complex’ is now engaged in social engineering on a massive, global scale.
Policy reformers regard those who advocate transformational change as unrealistic because social change happens incrementally; transformers say reformers are being unrealistic because what they do is not fixing the problems. Both sides are right. This is the challenge we face: to match the scale of our response to the magnitude of the challenge. Meanwhile, for all the extra efforts we are making and the gains we have made, the gap between what we are doing and what we now know we need to do continues to widen.
Culture, spirituality, religion and health, Medical Journal of Australia, 2007.
Human health has multiple sources: material, social, cultural and spiritual. We are physical beings with material needs for nutritious food, clean air and water, and adequate shelter, as well as physical activity and sleep. We are also social beings who need families, friends and communities to flourish. We are cultural beings; of all species, we alone require cultures to make life worth living. And we are spiritual beings, psychically connected our world.
Science and religion, ABC Radio National, 2007.
We need science and religion to work together if we are to ensure our future. But this outcome requires both to show humility. There are things we mere humans cannot know, and it is hubris to think we can; and when we think we can, it becomes ultimately self-destructive. This is the real danger of fundamentalism – whether scientific or religious.
Is modern Western culture a health hazard? International Journal of Epidemiology, 2006.
Cultures bring order and meaning to our lives. Of all species, we alone require a culture to make life worth living, to give us a sense of purpose, identity and belonging – personally, socially and spiritually – and a framework of values to guide our actions. There may be many cultural paths we can follow in meeting human needs. This is the source of our extraordinary diversity and versatility, but it is also a source of danger: we can lose the path altogether, run off the rails.
One of the most important and growing costs of our modern way of life is ‘cultural fraud’: the promotion of images and ideals of ‘the good life’ that serve the economy but do not meet psychological needs or reflect social realities. To the extent that these images and ideals hold sway over us, they encourage goals and aspirations that are in themselves unhealthy. To the extent that we resist them because they are contrary to our own ethical and social ideals, they are a powerful source of dissonance that is also harmful to health and wellbeing.
Progress, sustainability and human wellbeing, International Journal of Innovation and Sustainable Development, 2006.
Those who debate the future of the world and the fate of humanity are usually divided into optimists and pessimists. They might better be labelled linear optimists and systemic optimists. Linear optimists believe we are 'on track' to a better future, and that the problems we face are mere 'glitches' we can iron out of the system. Systemic optimists, on the other hand, argue that we are straying ever further off the track and that current problems are symptoms of a deeper condition which must be addressed through whole-system change.
The many paradoxes and ambiguities we encounter when we examine ‘the big picture’ of human life today reflect not just its inherent complexity and our incomplete understanding of it, but also parallel processes of cultural decay and renewal, a titanic struggle as olds ways of thinking about ourselves fail, and new ways of being human strive for definition and acceptance.
History and legend show that when the gap between the ideal and real becomes too wide, the system eventually breaks down. In the meantime, however, it tends to become more oppressive, as those whose interests are vested in the status quo strive to maintain their control and advantage. And today, these individuals and groups have enormous economic, political and technological power to call upon. At the same time, however, there is growing evidence that the increasing weight of public opinion, scientific evidence and global events are tilting the balance in favour of a new cultural order.