Local view: Eating locally can help us overcome climate change, obesity challengesOver the past few months we have seen a flood of op-eds and news articles on two important themes: the impacts and benefits of the Affordable Care Act and our urgent need to act on climate change.
By: Jamie Harvie, for the News Tribune
Over the past few months we have seen a flood of op-eds and news articles on two important themes: the impacts and benefits of the Affordable Care Act and our urgent need to act on climate change. On their surfaces, these issues appear to have little connection. But with closer analysis we see they are linked in important ways. This linkage provides an important evolving framework, “commons health care,” for promoting collective action for personal, community and global health and resilience.
Across the country, cities and their residents now recognize the price of health care is not abstract as money for police, roads, schools, affordable housing, parks and libraries also have been diminishing; whether we like it or not, we are all in this together. The Affordable Care Act is an important breakthrough in national efforts to manage skyrocketing health-care costs driven largely by a global obesity epidemic and further exacerbated by a global financial crisis. While some disagree with its approach, our current health-care treatment model is going bankrupt.
At the heart of the Affordable Care Act is a focus on primary prevention rather than disease treatment, because if we have fewer “sick” people we have lower costs associated with expensive treatment. As a result of the epidemic of obesity-related diseases, we simply cannot ignore the growing lines of “sick” outside our hospital doors. This concept aligns with what we’ve known but have disregarded for years, that more than 90 percent of our health is determined not by medical treatment but by our behaviors and our environment, such as whether we exercise, smoke, eat healthy foods and are socially connected, etc.
Recognizing that prevention trumps treatment fundamentally changes how we imagine what our health-care system can encompass. For example, community support for our parks and amenities might truly be considered an investment in our health. Similarly, efforts to increase food access are equally part of our new health system. This new health-care model increasingly will be driven and directed by community needs rather than the needs suggested by the pharmaceutical, medical-device and food industries. Community success in this commons health-care model necessitates citizen engagement, improved health literacy, and the development of community agency and leadership.
In the past two weeks, climate change has captured even more news. A study in the national academies of science now links major weather events to global climate change, and one of the leading Koch brother-funded climate scientists now agrees that climate change is human-caused.
As our recent floods demonstrate, climate change is intimately linked to the overall health of our city. As with the obesity epidemic, health care will be on the receiving end of climate change-related health impacts, including vector-borne diseases and heat stress, further compounding its current obesity-related challenges. Consider that in the 2003, the European heat wave, now linked to global climate change, caused 35,000 heat stress-related deaths.
We should recognize that climate change and obesity, both common drivers of health-care costs, are linked through our industrial food system. The food system (including deforestation for animal feed production) represents one third of total global emissions while 80 percent of health care’s climate footprint emissions, unrelated to building and equipment energy use, are associated with treating sick people. By addressing our food system, we can develop common solutions to common drivers.
Where might we begin? The Institute for Healthcare Improvement (ihi.org), a leading global health-care quality organization, issued a recent reminder that ultimately the communities themselves will have to define their health commons and their local boundaries or geographic scope, and will have to establish community metrics and benchmarks.
In practice, what might this look like? For starters, it means the development of a regional sense of place.
Within this commons, it includes community-designed metrics and measures and citizen agency such as a recent initiative to address food access in Lincoln Park. It is represented by the Accountable Care Organization recently announced by Essentia Health. It begins with a focus on our food system and includes a rapid transformation in the healthfulness of our food environment: less red meat, less sugar and less fried foods. It includes an imperative for responsibility and community-based approaches, including support for regional producers and supporting infrastructure. It requires support and engagement by our anchor institutions — our universities and hospitals — and increased investment in community-owned or worker-owned models, such as our local Whole Foods Co-op.
The predicted impacts to communities around the globe by climate scientists are daunting. Yet, as Elinor Ostrom, in her Nobel Prize-winning work demonstrated, the tragedy of the commons is not predestined. We simply need to establish our commons, create some
community-based rules, roll up our sleeves and get to work toward commons health care.
Jamie Harvie of Duluth is executive director of the Institute for a Sustainable Future, is a co-founder of the Commons Healthcare Network, is a co-founder of the Lake Superior Good Food Network and is a nationally recognized leader on health-care and food systems.