by David Shearman

Summary
This paper was written in 2002 soon after DEA was formed and was intended as a summary of the reasons for our formation.
Solzhenitsyn said,

“If you want to change the world you must first change yourself”.

This article analyses the psychological and ideological mechanisms which impede doctors and the community from making appropriate responses to the many impending world crises. It is important to examine how these mechanisms have affected the conservation movement because in seeking sustainable health and wellbeing, we must teach and lobby for the maintenance of the global environment, the biosphere. Denial is caused by the size of the problem in question and the individual’s perceived inability to do anything about it. The ideology of economic growth and increasing individualism leads to antagonism towards environmentalists who work for community values and the preservation of the commons. The medical profession may counter some of these impediments by using its standing to facilitate its access to those in power and by setting personal examples in sustainable behaviour. Medical organisations that demonstrate a lack of self-interest will play a key role in effecting change.

“If you want to change the world you must first change yourself”. These words from Solzhenitsyn apply to all of us for we are part of the global mass of humanity responsible for numerous impending crises around the world. These include war, famine, poverty, environmental destruction, population overload and climate change all of which increasingly threaten our wellbeing, health, and survival.(1) It is difficult to be optimistic about our progress to sustainability when the world’s most powerful nation is rolling back the meagre environmental advances of many decades and is refusing collective international measures to mitigate climate change. Furthermore an understanding of the Western economic ethos, with its need for eternal ‘growth’ and consumerism to provide stability and jobs, indicates that it is unsustainable. This ethos, driven by powerful companies, willing governments and international financial instrumentalities, is so fundamental to our way of life that it seems impossible to change or even modify it. The lack of progress to sustainability in developing countries is equally depressing, where poverty, overpopulation and disease burdens result in land clearing, deforestation and overcropping.

Now if these words were written for the general public they would be regarded as unjustifiable gloom and doom. This response is part of the denial process by which each of us copes with problems so overwhelming that we cannot comprehend them. The statement of Jacques Chirac, President of the French Republic at the World Summit on Sustainable Development in Johannesburg in 2002 recognised this denial “Our house is burning down and we’re blind to it. Nature, mutilated and overexploited, can no longer regenerate and we refuse to admit it”.

Those who analyse these issues come to recognise that revolution needs to occur, not with the guillotine, but with education and a new enlightenment. This paper will examine some of the human mechanisms that impair our progress to sustainability, health and wellbeing. Suggestions for activism to promote our agenda will be made for doctors and scientists.

The word sustainability requires exploration. We should be aware that the word has become corrupted as in ‘sustainable development’ when the economic imperative has been placed firmly before the ecological.(2) We need to examine more precisely what we mean by a sustainable way of life that will maximise human health and wellbeing, for in global terms this may probably mean gains for some and losses for others.

Lessons from the conservation movement
Many of our difficulties in effecting change will parallel those experienced by the conservation movement in Western societies which for several decades has opposed land clearing, the use of fossil fuel, deforestation etc. We now recognise that their agenda has had a strong health component, though they did not promote it as such. The conservation movement consists of a fluid network of community groups with multiple agendas and value systems, but with the general ethos of improving the environmental and social fabric of society.(3) In general, their membership is representative of the general community though the larger more structured groups are more frequently middle class and well educated.

The general community, therefore, identifies the conservationists as ‘different’ because they are seen to have a common goal even though there are multiple goals. They attract anger and hostility because their goals inhibit the exercise of individualism in present society and the right of the anthropocentric individual to carve out personal needs unhindered by communal responsibilities. Their agenda is seen to be antidevelopment, “ it will cost jobs”, to be an impediment to the progress of civilisation, “we will live in caves again”, and to be left wing because communal need is espoused instead of individual liberty. The ‘Greenies’ betray the ‘normal‘ community because they threaten the acquisition and accumulation of wealth and resources by individuals and companies.(4)

The environmentalist is also seen as the bearer of bad tidings which lead to two reactions. Firstly, there is denial which is a defensive mechanism activated by an overwhelming problem for example world poverty, famine, genocide or environmental calamity.(5) Denial occurs because one individual can do little about it. Furthermore an individual can accept the scientific evidence but deny responsibility and the provision of additional evidence may increase denial and lead to antagonism. More images of malnourished children and more details on the severity of climate change are suppressed and ignored. Secondly disputation of the claims and predictions of environmentalists is a frequent reaction. It is frequently asserted that these claims lack scientific validity or that the recommended reforms will lead to totalitarianism.(6) This attempt at marginalisation is commonly used by government and industry with scientific data provided by their own employees.(2)

The way forward
In pursuing our agenda of sustainable health and wellbeing, the medical profession will experience some of the same perceptions and difficulties. Those working in Public (environmental) Health who espouse these views may be marginalised as mere public servants who are not ‘real’ doctors caring for patients. In this regard we should recognise that Public Health has suffered under the ideological yolk of small government, particularly in the USA, (7) and in many countries its research budget is minuscule compared to laboratory research which is seen to have economic spin-off from its discoveries. Those working in climate change modelling and predictions will be attacked like the ‘Greenies’ for their environmental perspective, and because the enormity of many of their predictions activates the denial mechanism.

The medical profession has distinct advantages in pursuing the agenda of sustainability and we need to utilise them. In the eyes of the public our opportunities to stimulate change are strongest when our motives are seen to be unselfish. Then, above all, our comments are best heard for we earn the enhanced respect of our communities. The considerable achievements of Médecins Sans Frontières and Physicians for the Prevention of Nuclear War show what a tiny minority of our profession can achieve when they become involved in unselfish humanitarian causes. The standing of doctors can facilitate access to those in power. Our resources should be concentrated here because our health message is complicated and requires detailed personal explanation. Those lobbying should represent the profession as a whole, thus emphasising that the agenda is important to the entire profession and does not emanate from a subgroup that benefits from research funding. Networking and the involvement of representatives from different groups, as employed by the conservation movement, is often important.

The principle of collective responsibility is also important and is emphasised in the newly formed Doctors for the Environment Australia,(8) a branch of the International Society of Doctors for the Environment. The rationale for the formation of such an organisation is to represent environmental health separately from what might be seen by public and government as the self interest of national organisations, eg. the AMA, the Colleges and other professional organisations. These strategies can also be used by scientists and the initiative by the Wentworth group of distinguished scientists is a useful model.

Each doctor will need to recognise that they can assist the agenda of sustainability and health in so many personal ways. Only a tiny minority are members of the selfless organisations mentioned above, yet it is important for the entire profession to recognise that a world descending into conflict and environmental chaos will seriously imperil our ability to utilise the benefits of our medical research and advances in patient care.

 The public came to recognise that a smoking doctor was an increasingly rare species. Some advocate that obese doctors should also become rare!(9) How should the doctor behave to promote sustainability? Society has moved to the point where the rich cannot buy everything they think they need! (10). Too often we, in the medical profession, are seen to indulge in this profligate consumerism that is destroying our environment. However, expensive fuel saving cars are also prestigious! We can lobby individually and collectively to ensure that our compulsory superannuation and investments are not being used to destroy our environment. Like the environmental movement we must infiltrate the instruments of government, the environmental protection authorities, the government reviews etc. for all have an environmental health component and an opportunity to educate. It should be our duty to engage with global issues as part of our obligation to alleviate human suffering.

Finally, we must radically examine our medical curriculum by asking ourselves why so few of our colleagues have any commitment to these aims. Public Heath is prominent in the curriculum yet we are not producing graduates who are imbued with global citizenship and its commitments. This indeed is a challenge in the university geared to the economic machine, but we should not be deterred!

(1) Shearman, D (2002) Time and Tide Wait for no Man. British Medical Journal. 325. 1466-1468.
(2) Beder, S (1993) The Nature of Sustainable Development, Scribe, Newham, Vic
(3) Doyle T (2000) Green Power. UNSW Press
(4) Shearman, D and Sauer- Thompson, G. Green or Gone. Health , Ecology, Plagues and our Future. 1997, Wakefield Press, Kent Town, South Australia pp.170-171
(5) Cohen S (2001) States of Denial. Knowing about Atrocities and Suffering. Polity Press, Cambridge UK
(6) Rubin C T (1994) The Green Crusade. Rethinking Roots of Environmentalism. Free Press, New York
(7) Garrett L (2000) Betrayal of Trust. The Collapse of Global Public Health. Hyperion, New York
(8) Doctors for the Environment, Australia, Inc. www.dea.org.au
(9) Burry J N. (1999) Obesity and Virtue. Is staying lean a matter of ethics? MJA 171, 609-610
(10) Hamilton C (2002) The Politics of Affluence. Australia Institute