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‘Live Sustainably – Live Well’ Introduction

This paper introduces a project (Live Sustainably – Live Well) to develop local arrangements supporting the attainment of the UN Sustainable Development Goals (2015) (1) as well as supporting the attainment of public health policy locally to WHO recommendation (2). It recommends the publication of local guidance on attaining the Goals and WHO Health Policy(2), drawing upon local, national and international sources. Such guidance could include links to appropriate resources and would allow for the participation of NGOs, faith communities, trade unions and neighbourhoods. It might also be extended to include the monitoring of health and sustainability indicators locally.

This approach could lead to better and more informed action locally in implementing the Goals and Health Policy with local benefits as instanced by the REconomy Project (3) of the Transition Network (4)

The United Nations Sustainable Development Goals (2015) (1)

‘The United Nations (UN) Rio+20 Summit (2012) (5) committed all UN member nations to develop a set of universal sustainable development goals (SDGs), to build on the millennium development goals (MDGs) (6) , set to expire in 2015. The UN Sustainable Development Goals were published in September 2015. They seek to address Climate change and to avoid the dangers of crossing other planetary boundaries (boundaries describing a safe operating space for humanity in a period of massive human inspired change in the Biosphere), whilst creating a new global framework to eradicate extreme poverty, reduce inequality and expand opportunity. They seek to end hunger and food insecurity whilst ensuring healthy lives and wellbeing for all. The UN Human Development Report 2011 (7) states that the success of such initiatives will be dependent on local action and support by communities.

The introduction of the Goals was probably influenced by the work of climate scientists who had argued for the need to address not just Climate Change but a set of Planetary Boundaries designed to point to a safe operating space for humanity at a time of increased damage to the planet recognised as being caused by human activity.

The Stockholm Resilience Centre (8) observes that‘ In 2009, ... a group of 28 internationally renowned scientists identified and quantified the first set of nine planetary boundaries within which they suggested, humanity can continue to develop and thrive for generations to come. Crossing these boundaries could generate abrupt or irreversible environmental changes. Respecting the boundaries reduces the risks to human society of crossing these thresholds’. The Boundaries also have a regional dimension (so local action is appropriate-implied)’

Johan Rockstrom and W. Steffen (9) have argued that: ‘The world needs a new paradigm for development, one that pursues alleviation of poverty and economic growth while staying within the safe planetary boundaries that define a stable and resilient planet’ Johan Rockstrom and Mattias Klum10 suggest the need: ‘...to

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give the world a new framework to redefine global development by reconnecting economies and societies to the planet’ ..‘Climate Change is not just an environmental issue it is an economic and social one. This means that any future climate solution would require action in our economies, financial systems, how we build our cities, produce food and relate to one another . ‘We know that sustainability not over exploitation is the real basis for human wellbeing’, ‘There is a need to define a safe operating space for humanity on a stable planet’ (10)

Other influential writers have noted that:

‘Research now indicates that humanity’s impact on Earth’s life support system is so great that further global environmental change risks undermining long-term prosperity and poverty eradication goals.’ (Griggs et al, 2015) (8)

‘Transgressing a boundary increases the risk that human activities could inadvertently drive the Earth System into a much less hospitable state, damaging efforts to reduce poverty and leading to a deterioration of human wellbeing in many parts of the world, including wealthy countries, ‘Professor Will Steffen, researcher at the Centre and the Australian National University, Canberra (9).

The new Sustainable Development Goals ’ ... support ‘ a comprehensive framework of goals and associated targets, which demonstrate that it is possible, and necessary, to develop integrated targets relating to food, energy, water, and ecosystem services goals; thus providing a neutral evidence-based approach to support the Goals’ (Griggs et al 2015) (9) and their attainment.

The UN Human Development Report (2011) (7) believes that cities and communities have a major role to play in advancing this type of approach to sustainable development. It suggests that people must be given the opportunity to influence their future, claim their rights and voice their concerns. Democratic governance and full respect for human rights are key prerequisites for empowering people to make sustainable choices. Local communities must be encouraged to participate actively and consistently in conceptualizing, planning and executing sustainability policies. The long-term vision to eradicate poverty, reduce inequality and make growth inclusive, and production and consumption more sustainable, while combating climate change and respecting a range of other planetary boundaries.

WHO Policy Framework – Health 2020 (2)

Healthy Lives and Wellbeing are also aims of the new WHO Policy Framework (Health 2020) influenced by the Marmot Reports (12), (13). This sees sustainable living as being essential for healthy lives. The Policy Framework calls for the creation of supportive environments and resilient communities which implies the need for local organisation and local action.

British society is and has been characterised by extreme inequalities which bear upon health and, by implication upon access to sustainable lifestyles. These have been identified by several reports (Black Report (1980) (14), Acheson Report (1998)

(15), Marmot (2008 & 2010) (12, 13), by the ONS statistics and Multiple Deprivation Indices (published since 2000), and by several academic studies (Marmot and Wilkinson (2003) (16), Wilkinson and Pickett (2009) (17). The Marmot UK Report

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stresses the critical importance to health of sustainable living and supportive environments action as essential to reduce inequalities. The UN Sustainable Development Goals (2011) also call for action on inequalities. The recommendations of the Marmot Reports have been incorporated into the WHO Policy Framework ‘Health 2020’.

‘Health 2020’ represents a consensus of health policy makers, practitioners and academics as to the best possible approach to health Improvement in modern conditions. It is ethical, rooted in the concept of health as a right and the idea that sustainable living represents the best platform for working for health improvement. It seeks to improve health and reduce Health Inequalities. Health 2020’ can be applied at any level including the local. It includes: two strategic objectives: 1) improving health for all and reducing health inequalities and 2) improving leadership and participatory governance for health.

Health 20/20 identifies four priority areas these are;

1) Invest in health through a life-course approach and empower citizens.

2) Tackle Europe’s major disease burdens of noncommunicable and communicable diseases;

3) Strengthen people-centred health systems and public health capacity, including preparedness and response capacity for dealing with emergencies;

4) Create supportive environments and resilient communities.

Many British cities such as Brighton, Manchester, Liverpool and Cardiff have committed to implementing ‘Health 2020’ as WHO Healthy Cities however their ability to implement the policy is restricted by severe public expenditure cuts. Implementation of Health 2020 would require the engagement of the wider community, NGOs, trade unions, faith communities and the third sector in the public health agenda. Appropriate organisation of a project similar to the Reconomy Project (3) of the Transition Network (4) could support this.

Marilyn Rice and Trevor Hancock (18) write that “Although local government has a key role to play in creating a healthy community, it cannot play that role alone. Regardless of their priority area of concern – whether it be the environment, social activities, education, safety, public works, or any other – community members and organisations are also responsible for improving the living conditions, health and quality of life of the people living in their community and they are and need to be participants in that process”

Health Policy and the Settings in which it Operates

Health Policy has also been influenced by the Ottawa Charter on Health Promotion (1986) (19), ‘Health is created and lived by people within the settings of their everyday life, where they learn, work, play and love’. .’People should not be seen in isolation of the larger social units in which they live’ (This is known as the Healthy Settings Approach).

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According to the Ottawa Charter, Health Promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but of all sections of society, it goes beyond healthy life-styles to well-being.

The fundamental conditions and resources for health described by the Ottawa Charter for Health Promotion were: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity. Key strategies for health under the Charter included the need to build healthy policy, create supportive environments, strengthen community action and reorient health services which can be supported by local action.

WHO Health Policy, which has been influenced by the Ottawa Charter and the Healthy Settings approach, has formed the basis of many successful international policy initiatives such as Healthy Cities and action to challenge the social determinants of health. This approach has also been used to create a health and supportive environment in some institutions such as Healthy Schools and Healthy Universities.

The Transition REconomy Project as a example of Local Action on Economy

The REconomy Project (3) is part of the Transition Network (4), a global grassroots movement of communities seeking to strengthen their resilience to problems including climate change, rising energy prices, economic uncertainty and inequality by transitioning to a low-carbon economy, relocalizing production for basic needs, reskilling and emphasising connectedness, the Movement believes that the most appropriate level for this work is the community. REconomy works at creating new livelihoods and enterprises, and expanding their area of influence deep into their local economic system.

Public Health and Sustainable Living

Professor Blake Poland (20) of the University of Toronto has argued that; Climate change, Ecosystem degradation, Widening socio-economic inequities, Resource depletion and Energy insecurity, problems recognised by the Transition Movement, also pose major problems for public health. There is a need to;

1.) Understand and report on the health implications and impacts of our current unsustainable forms of development;

2.) Propose healthier public policies that support the transition;

3.) Communicate the importance of this issue, the health implications of our present path and the health benefits of the transition effectively with key stakeholders;

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4.) Work with others (sectors, movements, communities) collaboratively to bring about desired (cultural, social, policy, practice) change.

Marilyn Rice and Trevor Hancock (18) suggest that; “We also need to address ... global ecological and social challenges through local action in the settings where people lead their lives – and cities provide the overarching setting and context for this by including their homes, schools and universities, workplaces, hospitals and communities. A key strategy needs to be linking ‘healthy setting’ initiatives and ‘sustainable setting’ initiatives through global, regional, national and local networks specific to this purpose”

Rebecca Patrick, Mark Dooris and Blake Poland argue that (21);

Healthy Cities (based on the Ottawa Charter) can;

1) Help the Transition Movement broaden its understanding of health.

2) Develop a Co-benefits approach progressing strategies and agendas that are win-win for public health, carbon reduction and ecological wellbeing

3) Support shared learning.

4) Strengthen community and political action

This paper suggests that the application of the WHO Policy Framework ‘Health 2020’, the application of the Ottawa Charter for Health Promotion (1986) and the attainment of the UN Sustainable Development Goals (2015) could be facilitated by local action within a project with similarities to the ‘Reconomy Project’, such as ‘Live Sustainably –Live Well’. International and national policy requirements could be better communicated to local communities, trade unions, faith communities and NGOs leading to better and more informed decision making.

The advantages of using the international policy frameworks for Public Health and Sustainable living locally are;

1) Increased attention and focus given to the possibility of local decision making including the application of ‘Subsidiarity’, decisions which affect people’s lives being taken at the most appropriate local level.

2) Better quality and better informed local decision making.

3) Less reliance on the kind of vested interests, for instance, as identified by Ivan Illich (30) and David Simon (31), as this approach should help people minimise their vulnerability to such interests.

4) In decisions on food and nutrition this approach could support the better attainment of health and sustainability criteria. It would reduce the market impact of major organisations such as Asda, McDonalds and TESCO.

5) It would tend to reduce the effects of the massive deficit in movement which lies at the heart of many health problems, whilst reducing the impact of carbon intensive forms of transport such as driving.

6) It would support better co-ordination in achieving policy aims locally

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The World Health Organisation and health academics such as Sir Michael Marmot believe that there is a relationship a between Healthy and Sustainable Living so any local green economics process or local sustainable initiative needs to recognise this relationship or it is likely to create or exacerbate inefficiency and unfairness and this is likely to undermine its effectiveness. Decision making at every level is likely to be fairer and more efficient if the full health and sustainability effects are taken into account.

This initiative (Live Sustainably – Live Well) might be structured around the UN Sustainable Development Goals and might include both national and local guidance on working to attain the Goals locally with links to appropriate resources. It might support the local monitoring of indicators. The Ottawa Charter points to the need for the inclusion of: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity. Health 2020 points to the inclusion of local action on reducing inequalities, the need for good governance, the need to address ageing as well as the health of mothers and children within a life-course approach and the importance of health systems and the need to address the determinants of health locally.

Conclusion

This paper has suggested that local action to support the UN Sustainable Development 2015 and the WHO Policy Framework ‘Health 2020’ is appropriate to influence the local economy in a way which has similarities to the ‘REconomy’ Project of the Transition Network’, leading to better and more informed actions, decision making and monitoring locally, benefiting the locality . This project to be initially designated ‘Live Sustainably...Live Well’

Alan Cunningham

References:

1) United Nations, United Nations Sustainable Development Goals, UN September 2015. https://sustainabledevelopment.un.org/?menu=1300 accessed 28.6.2016

2)WHO, Health 2020, The New European Policy for Health, http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being accessed 28.6.2016

3) The Transition Network, ‘The REconomy Project’ – http://www.reconomy.org/about-reconomy/ accessed 28.6.2016.

4) The Transition Network, https://www.transitionnetwork.org/about accessed 28.6.2016.

5) United Nations, Conference on Sustainable Development Rio plus 20 2012. https://sustainabledevelopment.un.org/rio20 accessed 28.6.2016

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6) The United Nations, The United Nations, Millennium Goals http://www.un.org/millenniumgoals/ accessed 28.6.2016.

7) The United Nations, UN Human Development Report – ‘2011 Sustainability and Equity: A Better Future for All http://hdr.undp.org/en/content/human-development-report-2011 accessed 28.6.2016.

8) Stockholm Resilience Centre, Redefining Sustainable Development, http://www.stockholmresilience.org/research/research-videos/2013-04-05-redefining-sustainable-development.html accessed 28.6.2016

See also Nature, Policy: Sustainable Development Goals for People and Planet Griggs et al, accessed 28.6.2016 http://www.nature.com/nature/journal/v495/n7441/full/495305a.html

9) Nature 461, 472-475, 23.9.2019 ‘A Safe Operating Space for Humanity’ Rockstrom J, Steffen W. Et al http://www.nature.com/nature/journal/v461/n7263/full/461472a.html accessed 28.6.2016

10) Rockstrom and Mathias Klum Big World Small Planet – Abundance within Planetary Boundaries, (2015) published by www.maxstrom.se isbn 978-91-7126-334-6

11) UCL Institute of Health Equity, https://www.instituteofhealthequity.org/ accessed 28.6.2016

12) WHO, Report of the WHO Commission on Social Determinants of Health – Chair Sir Michael Marmot (2008) http://www.who.int/social_determinants/thecommission/finalreport/en/ accessed 28.6.2016

13) UK Department of Health, ‘Fair Society- Healthy Lives – The UK Marmot Report (2010) Chair Sir Michael Marmot http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review accessed 28.6.2016.

14) UK Department of Health, the Black Report on Health Inequalities – Chaired by Sir Douglas Black 1980.

15) The Stationery Office, ISBN 0 11 322173 8, Independent Inquiry into Inequalities of Health – The Acheson Report 1998

16) WHO Europe, Social Determinants of Health – The Solid Fact , –Sir Michael Marmot and Richard Wilkinson (2003) http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf accessed 28.6.2016

17) Richard Wilkinson and Kate Pickett (2009)- ‘The Spirit Level’

18) Equity, sustainability and governance in urban settings – Marilyn Rice and Trevor Hancock - Global Health Promotion – Volume 23 Supplement 1- March 2016.

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19) World Health Organisation (1986) - Ottawa Charter on Health Promotion –http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ accessed 28.6.2016.

20) Building Sustainability and Community Resilience in the face of Emerging Challenges to Health Equity –Professor Blake Poland of the University of Toronto. Lecture at UCLAN Preston 4th December 2013.

21) Healthy Cities and the Transition movement: converging towards ecological well-being? Rebecca Patrick, Mark Dooris and Blake Poland- Global Health Promotion – Volume 23 Supplement 1- March 2016.

22) Professor Tim Lang, ‘Where is the 21st Century Approach to Feeding the World ?’ Guardian 1st June 2011 http://www.theguardian.com/commentisfree/2011/jun/01/food-prices-doubling accessed 28.6.2016

23) Public Health England Guidance on Nutrition ‘Eatwell Plate’ https://www.gov.uk/government/publications/the-eatwell-guide accessed 28.6.2016

24) UK Chief Medical Officers, Guidance on Movement ‘Start Active Stay Active’ –

25) ONS Multiple Deprivation Indices for England 2010, 2015 https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015 accessed 28.6.2016 Area Profiles 2010

26) WHO Europe (1992) -City planning for health and sustainable development

27) WHO Europe ISBN 92 890 1348 6 ‘Health 21 – Health for all in the 21st century’ accessed 28.6.2016 http://www.euro.who.int/en/publications/policy-documents/health21-health-for-all-in-the-21st-century

28) Ontario Healthy Communities Coalition http://www.ohcc-ccso.ca/en/what-makes-a-healthy-community accessed 28.6.2016

29) Act Locally: Community –based population health promotion A Report by Dr. Trevor Hancock, Health Promotion Consultant Victoria BC for the Senate Sub-Committee on Population Health. http://www.parl.gc.ca/content/sen/committee/402/popu/rep/appendixbjun09-e.pdf accessed 28.6.2016

30) Deschooling Society (1973) -ISBN: 9780714508795, Disabling Professions (1987) 9780714525105, Ivan Illich.

31) The Wire HBO DVD, David Simon

32) United Nations Declaration on Human Rights (1948). http://www.un.org/en/universal-declaration-human-rights accessed 28.6.2016

33) WHO - Declaration of the World Health Organisation (1977)

34) Report of the Parliamentary Select Committee on International Development -UK Implementation of the Sustainable Development Goals. Accessed 28/6/2016

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http://www.publications.parliament.uk/pa/cm201617/cmselect/cmintdev/103/10302.htm accessed 28.6.2016

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