Sustainable Chemistry - reflecting on ambitions for #healthandclimate

Of course, it was on twitter that I first heard that the Sustainable Chemistry building was burning down. Late Friday night (12th Sept 2014), I watched the live webcam set on the building next door, where we've often had meetings, and was filled with surreal shock to see the whole building site engulfed in flames. I had watched construction progress everyday, cycling to work at Institute of Mental Health on Jubilee campus, University of Nottingham.

As this disaster has made national news, I thought it might be an opportunity to reflect on what I felt the building project was trying to achieve (from a partially independent viewpoint!).  In doing so, I will try to link the corporate idea of sustainability and health with the community approaches which I've been involved with in the Transition Towns movement and others.

I have to admit, when I first saw the hoardings go up, proclaiming a carbon neutral medicinal chemistry research building, I was skeptical. I have conflicted views on this - my PhD was studying biochemistry, sponsored by biotech company, yet more recently I've become committed to the idea that communities can do much to improve their health. Furthermore that a community-based approach can bring added social benefits and avoid the environmental detrimental impact that seems inherent with the pharmaceutical industry.

However despite my assumptions I was sold on the idea of sustainable chemisty, following a talk by the man who has been the driving force behind the development of the GSK sponsored wooden building.
http://sresearchnet.wordpress.com/2014/05/29/presentations-discussions-reflections-lunch-how-we-celebrated-230514/
Prof Pete Licence told us about the work that they had been doing in improving efficiency of catalysis in the reactions involved in creating pharmaceutical compounds. Through carefully adjusting conditions such as high pressure and uv light, the energy required for reactions within chemical processes can be significantly reduced (I don't remember the details - please don't quote me on this!). This is good news in terms of the 'carbon-footprint' of drugs in the future, potentially reducing the carbon-footprint of our healthcare.

Secondly Pete presented research on using non-conventional feedstocks for creating pharmaceutical compounds. Traditionally the large majority of 'ingredients' in chemical production are based on oil and gas, meaning that our pharma is inextricably linked to the 'fossil fuel' industry, with inherent implications for climate change and peak oil. Within transition towns movement we have discussed the potential of using plant-based compounds for the starting materials for drug production, but I had not realised that 'serious' academics and pharma companies were working on this - so this was great news.

Thirdly the point of Pete's talk was that all this work was going to continue in a carbon-neutral building. This was being built out of sustainable forestry (European I think), and would include the latest technology in insulation, laboratory design, even including solar panels and green roofing. The aim was for carbon-neutrality in 5years, followed by carbon embedding - it was hugely ambitious and expensive. Pete commented that the cost was way above 'normal' and was only possible with the generous and deep commitment of Sir Andrew Witty, the chancellor of the university and also (non-coincidentally!) chief exec of GlaxoSmithKline pharmaceutical giant. http://exchange.nottingham.ac.uk/chancellors-breathtaking-day/
So great ambition for sustainability and health - all good?

While I do support the above ambitions I do have critiques or concerns on each point. My over-arching concern is the creeping medicalisation and industrialisation/corporatisation of health and healthcare. The concern is that the marketing-corporate side of pharma means that people are viewed as customers to whom healthcare is sold, therefore care becomes treatment-focused rather than centred on a person's individual needs (patient-centred). My preferred approach is for community-based prevention and health improvement, i.e. let's invest in how communities can support people to be fit and healthy, rather than prioritising investment in drugs and treatments (of course we need both). Thus the criticism of the first point, is that investment in efficiency of processes may lead to increased production (more people consuming more pharma products) and increased profits, with little reduction in environmental impacts.

The second point that I mentioned from Prof Pete's talk was the most significant - the use of plant-based feedstocks. The main concern with this approach is that, similar to biofuel, in time it could pose similar threats to global food production as biofuel. That is, farmers may convert from food production to 'drugs' production due to it's higher returns. The potential impact on prices and availability of food would exacerbate inequality and malnutrition, having knock-on effects on global health. Thus, if organisations and institutions with interests in global health focused on nutrition and 'low tech' approaches to health, healthcare and prevention, this could be  many times more 'sustainable' (equitable) than advances in 'green-pharma'. At the heart of concerns is the question of whether we can 'trust' pharma corporates to place people and planet first, and profits second. Or whenever we buy into the corporate agenda, we inevitably exacerbate global inequality. This goes back to discussions within Transition Towns and also relates to the new Naomi Klein book (recent review in Guardian)
http://www.theguardian.com/books/2014/sep/14/naomi-klein-interview-capitalism-vs-the-climate
 - can we achieve the necessary reduction in carbon footprint, and essential improvements in global health and inequality within the current corporate framework, or do these goals inherently run against the grain, thus we should call for a 'new system'. In health terms, this isn't as radical as it sounds, just going back to WHO Alma Ata declaration of Health for All, through primary care and community health.
http://www.who.int/social_determinants/tools/multimedia/alma_ata/en/

Thirdly - can chemistry/pharma industry and research ever be 'sustainable' - is this a realistic or useful goal, considering the likely cost and risk (including the fire - which is part of the risk of building with wood). Or could this investment be better placed elsewhere? I don't think I'm giving 'chemists' an excuse to ignore carbon footprint, but would it be just as good to have solar panels on the building next door - or for example the Trent or Portland Buildings? I should note that University of Nottingham has already won awards for the energy efficiency of it's campus.
http://exchange.nottingham.ac.uk/the-greenest-campus-on-earth/

Maybe sustainable chemistry was aiming to take it a step too far - in terms of cost (including risk) v benefit (including 'leadership')?

Adaptation to protect health, also politics & communication

Is now the time for health & wellbeing in the Transition Movement (part 4/4)

The negative impacts on health and wellbeing of climate change are many and varied. Furthermore it might not come as a surprise that often vulnerable people and communities are the most at risk from climate change and extreme weather events. This was powerfully demonstrated in England during the floods of last winter (2013/14). Adaptation isn’t just flood barriers and defences, but could include Transition-type activity of building resilience and support for people who experience flooding. This may protect against the physical and mental health impacts of damp housing and disrupted infrastructure. With particular health needs in mind, as residents in Cockermouth in 2009 found when the river flooding caused disruption of the pharmacist and GP practice, access to drugs can become an emergency. Can Transition Initiatives encourage or enable emergency access to drugs such as insulin for diabetics or oxygen for people with chronic obstructive pulmonary disease (COPD). This may mean stockpiling certain products on which members of the community are dependent, or somehow preparing transport links for supply of these, despite disrupted infrastructure.

Wider political aspects

I’m going to try to not end on a negative note, but penultimately, it is important to acknowledge the wider political aspects of health and social care. Again similar to climate change, huge vested interests are at work, within healthcare and within the determinants of health; food, transport, housing, finance... Political issues and corporate interests which may impede a community enjoying sustainable healthy lifestyles may have to be tackled in future. But in the meantime, or on the way, we can bring many benefits within our projects and these should be explicitly valued, as part of the ‘Impact of Transition’.

Language is critical

And this is where Transition can really show the health people what to do. Communication about health issues is often at risk of being turned into pejorative headlines in the media, which may lead to negative attitudes and even stigma against particular health conditions. Advocacy for healthy lifestyles can often be perceived as having moral overtones. Therefore it is important to apply the values that I consider to be at the core of the Transition Movement; positive action and inclusivity. Let’s make sustainable health and wellbeing a party to which everyone is invited!

 

Influencing sustainability of local health and social care services

Is now the time for health & wellbeing in the Transition Movement (part 3/4)

I have a feeling out there in Transitionland, and in communities generally, that people feel that healthcare is too big a nut to crack. Particularly in England (and UK) where the NHS is seen either as a political football or as a huge behemoth of an organisation, people can feel impotent to ‘make a difference’. But this is just the same as climate change. However there are few things that are really on our side (compared to the Energy sector for example); a) health and social care is still delivered by people (not machines), b) the NHS is on our side (on paper at least), c) there are huge supply chains that run through our whole economy (and therefore through many communities).

a)      Healthcare and social care is people-based (and will be for the foreseeable future). NHS is the largest employer in England (although dwindling with privatisation). This means that every community contains a large proportion of health and social care workers. Inevitably some can be found within Transition Initiatives, or can be encouraged to join! Staff can be an important link of communication between the community and the surgery, clinic or hospital.

b)      Again I feel that many people see the NHS as a huge impenetrable institution. However NHS Trusts and GP practices are increasingly keen to listen to patients and the community. Try to avoid cynicism and send your views in, or as above, talk to staff. The SustainableDevelopment Unit for health and social care does have an influence on NHS organisations, but the board of the hospital is more likely to take action if they also feel pressure from the community, eg to recycle more. The new Sustainable Development Unit emphasises the importance of community and resilience, giving a common language for Transition Initiatives to address these issues.

c)       Procurement for the NHS is a huge opportunity. Recent guidelines recommend ‘sustainable’ procurement, and encourage hospitals to choose local suppliers to reduce transport. Again, food is an obvious example, but procurement covers all sectors and therefore must draw upon businesses in almost every community (I guess). If carbon footprint of a product is lower than the competition, it should give an advantage in the tendering process, and hence encourage sustainability in many local businesses. Could Transition Initiatives support their local business to win NHS tenders – possibly through REconomy type projects?

 

Healthy communities and prevention

Is now the time for health & wellbeing in the Transition Movement (part 2/4)

Another approach to health that is very well aligned with Transition is Healthy Cities. In fact the Healthy Cities Network UK recently had a joint meeting with Transition Network to discuss shared agenda (Oct 2013 see event details).The settings approach to health encourages any community to actively seek to optimise the benefits to health at every opportunity. For a town or suburb, this may include tackling aspects which are detrimental to health, including fast food outlets and betting shops. 

Another good example is walkability of the neighbourhood. If parents can walk with their children to school, this is an indicator that the whole community can benefit. If streets are designed for walking it may lead to fewer cars and hence less pollution. Of course pollution is harmful to health; as highlighted in the smogs in England earlier this year as well as impacting on the climate. Walkable streets are often green streets, with trees and grass verges. The greenery can reduce noise pollution and absorb air pollution (so best not to grow food on the verges!) Again calmer, greener streets can better for people with disabilities, who may need to use a car, or for people with learning disabilities or dementia. Lastly traffic-calmed streets and green streets have been shown to increase sociability of neighbourhoods, and English ‘Homezones’ have partially helped here.

I’m particularly keen on enabling healthy lifestyles because this can prevent ill-health. Prevention has got to be better than cure, especially considering the carbon footprint of cure (healthcare)– from pharmaceuticals to hospitals. A great example linking prevention with climate change and our corporate-driven culture is obesity. Commodification and global trade of food have played a big role in causing both climate change and the increasing rates of obesity, I would suggest. The corporate, profit-driven, pressure to aggressively market high calorie food cannot be matched simply by public health campaigns and diet fads. This is a good example of the corporate determinants of health. Our corporate influenced food environment and car-dependency will increase the likelihood of obesity, which will in turn cause further health problems down the line, including diabetes, heart disease and stroke. The carbon footprint of treating these diseases should clearly be avoided, let alone the suffering and disability. 

Potentially community based initiatives are the best place to start to counter the negative impacts of food marketing and car-dependency, because they may change social norms rather than focusing on individual behaviour. If Healthy Cities or Transition Towns can start to address these issues and improve health, disease can be prevented, along with a huge carbon footprint of hospitals and drugs.

Is now the time for health & wellbeing in the Transition Movement (part 1 of 4)

Just noticed this tweet and it reminded me to write a blog on health and transition. 

Professionals in healthcare (NHS) and public health (independent Directors of Public Health and Departments of Public Health in Local Government) are getting political; for example denouncing the aspiration that food and drink corporates can regulate themselves with ‘responsibility deals’. Whilst it is now well established that the social aspects of our lives affects our health and length of life (social determinants of health), a new concept has emerged; the corporate determinants of health. This concept is more outspoken indicating that large corporates, including multinationals, almost inevitably, are blind to the detriments to health that their activity causes. It’s another argument to reinforce the view that the global capitalist, neoliberal, model is not benefitting the majority of people, in health terms, as well as other living standards. I see Transition Movement as a 'viable alternative', if you like, to corrosive capitalism.

I was really pleased that Transition Network have chosen to focus on Health and Wellbeing as it’s theme of May 2014. Here’s my thoughts on how transition initiatives could consider how they currently benefit health of their locality, and how health benefits could be maximised.

Let’s start with what’s currently happening out there in Transitionland...

I’ve been involved on and off with several Transition Initiatives in England over the last 6 years. My feeling is that many of the projects may already have benefits for health and wellbeing which may not be explicitly recognised and valued. I’ll just run through 2 of the most common examples; food and home insulation. 

Growing food primarily may have nutritional benefits, but there may be further benefits from the whole project; the physical activity of horticulture, vitamin D from being out in the sunshine (but wear a hat and sunscreen in intense sunshine!) Then there are social and mental wellbeing benefits of interacting with fellow gardeners, a feeling of productivity and self-sufficiency, and a tendency to direct attention to nature for a while, rather than the self-absorption that consumerism encourages. Most tenuously, perhaps, using a permaculture type approach may reduce rainwater run-off and hence protect from flooding and the negative impacts of health that this causes. 

How many transition food projects value and shout about the many health and wellbeing benefits that they bring? (Five Ways to Wellbeing can be a useful way of capturing these benefits). I should add that gardening is not only for those who are fit and able, as the paragraph above might imply, but should aim to be inclusive. Gardening programmes have enabled people with disability or dementia, for example, to benefit.

Home insulation can improve housing conditions. Poor housing is a key factor for ill health, recognised as one of the social determinants of health. Damp can lead to mould spores and irritation of breathing difficulties. Excess heat or cold can worsen health conditions and lead to premature death for vulnerable people. Poor energy efficiency leads to money wasted on energy that could otherwise be spent on improving nutrition or necessary medicine. No surprises that poor housing leads to poor mental wellbeing. So do your housing projects capture benefits for health and wellbeing? As mentioned the social determinants of health may be the best approach for estimating these benefits.

In next blogs I'll go on to discuss:

Healthy communities and prevention

Influencing sustainability of local health and social care services

Adaptation to protect health

Wider political aspects and Language