Climate Accords: Potent Structural Determinants of Health

The enormity and complexity of the climate crisis requires public health to step up and draw not only from its usual disciplinary strengths but also from fields of anthropology, sociology, social ethics, and philosophy to propose solutions that center human rights and health equity in climate negotiations and eventual climate agreements.

With the COVID-19 pandemic raging due to willful governmental neglect across administrations and the political spectrum, the existential threat of climate change seemed to have taken a backseat in the public consciousness and discourse. This is despite the fact that the climate-induced extreme weather events — ranging from wildfires, floods, below-freezing temperatures in South Central United States, hurricanes, and so on — continue to increase in their frequency, severity, damage, and socioeconomic costs. Further, the climate crisis has far-reaching impacts in our societies that we have only begun to realize, ranging from exacerbating health inequities to increasing wealth inequality to an increased risk of cyberattacks.

Climate crisis does not get the same media attention, although this is changing over time, like other social issues despite it being an existential threat not only to the United States but the entire planet. This is important to highlight as media has the power to set and distort our social realities and public discourse agendas in sophisticated ways — including as it relates to the climate crisis. One such major event that is not covered as broadly, regularly, consistently, and frequently as it needs to be is international climate negotiations such as the landmark 2016 Paris Agreement, which for all its enormous flaws, provided some framework to move forward with climate action by keeping the rise of global temperatures below 2°C. Similarly, the 2021 United Nations Climate Change Conference being held in Glasgow is not a dominating issue in American public discourse despite it having seismic effects domestically as well as determining the fate of some of the most socially vulnerable and historically marginalized people in the world. This lack of vibrant discussion leads to a lack of urgency and decisions being made on our behalf without much representation of public opinion in those decisions.

Public health, defined as the science that “promotes and protects the health of people and the communities where they live, learn, work and play” constitutes a diverse set of sectors and stakeholders (governmental, non-profit, academic) with each having their unique strengths and limitations, ranging from political influence by federal and state governments restricting certain public health advocacy activities, funding constraints such as lobbying restrictions on philanthropic grants, and overwhelmingly narrow academic structures rewarding publications alone over action-oriented research and practice. This illustrates that public health is not monolithic. However, despite its disparate and wide-ranging, and ever-increasing scope as our understanding of social and structural determinants of health improves, it is broadly concerned with health and social inequities and is in part responsible for this lack of knowledge dissemination among the public to create a sense of urgency and climate action – this is especially the case for public health academia. This is partly due to public health academy seldom exploring, analyzing, and accounting for the structural determinants of health despite its grandiose, paradoxical claims. It is also because of appropriating the health equity vocabulary and treating it as a buzzword to be sprinkled on just about anything without internalizing or understanding the social and structural determinants of health, which also leads to many in the public health community conflating social determinants, social needs, and structural determinants of health. World Health Organization defines structural determinants of health as

“those that generate or reinforce stratification in the society and that define individual socioeconomic position. In all cases, structural determinants present themselves in a specific political and historical context. It is not possible to analyze the impact of structural determinants on health inequities or to assess policy and intervention options, if contextual aspects are not included. As we have noted, key elements of the context include: governance patterns; macroeconomic policies; social policies; and public policies in other relevant sectors, among other factors.”

Macroeconomic policies and international agreements influence population health in so many profound and often indiscernible ways and operate as key structural determinants of health. Climate negotiations and ensuing climate accords are one such structural determinant of health that public health ought to take much more interest in than it currently does. What our government negotiates, what it does not negotiate, how it negotiates, and which specific interests it represents at these climate negotiations, eventually reflected in the final accords, not only influences health here at home but also enables or hinders the efforts of health equity journey around the globe. Public health needs to approach climate negotiations and climate accords as one of the most powerful structural determinants of health — all things considered — instead of ceding this space to economists, technophiles, and twinkly-eyed free-market enthusiasts alone who erroneously see market-based solutions as the end all be all. All those fields have a critical role to play, but the enormity and complexity of climate crisis requires public health to step up and draw not only from its usual disciplinary strengths but also from fields of anthropology, sociology, social ethics, and philosophy to propose solutions that center human rights and health equity in climate negotiations and eventual climate agreements.

Public health scholars, practitioners, and researchers, particularly those interested in environmental health, social equity, and climate justice in a meaningful way, need to strategize and take a long-term approach to aim for well-defined outcomes such as (a) raising public consciousness on climate change negotiations and its repercussions both domestically and internationally; (b) advocating for a specific equity-centered set of negotiation agendas at the climate agreements; (c) generating political will among the public for a decolonial approach to climate negotiations; (d) providing the public and community organizations with an evidence-based set of recommendations that they can use for climate action and advocacy with their Congressional representatives and the executive branch. These are just a few of the many ways public health can support broad coalition building and engage in perennial climate action with long-term goals of influencing climate negotiations that meet the global health equity needs instead of corporate America’s greed.

Public health academy, specifically, needs to have ongoing public campaigns to engage civil society and support their climate advocacy efforts in Congress and abroad. Critically, it is important to be mindful of not conflating social and structural determinants of health and avoid proposing relatively inefficient interpersonal — rooted in individualism — or incremental solutions that miss the mark given the complexity and magnitude of the challenge and inevitability, in the face of inaction, of planetary collapse. The focus of the climate solutions should be macro-level policy shifts for climate actions and taking headlines such as “New budget deal marks the biggest climate investment in U.S. history” with a grain of salt. These are important steps in the right direction but arguably too little, if not too late. Avoiding a scarcity mindset — often a talking point of politicians and others selling climate snake oil solutions that only create a facade of climate action — and asking for much more through political engagement, action-oriented research, and advocacy is the only way forward for public health if it is to retain its credibility as a field concerned with equity.

Climate crisis is an existential threat. We have heard it over and over again. Now it is time to internalize it and re-think our approach to climate action in our research, practice, and the dailiness of our existence and approach climate negotiations with the care, urgency, and attention they deserve. We must engage in a self-reflexive process that allows us many capacious possibilities of climate action for a just, kind, and livable world.

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Ans Irfan
Ans Irfan, MD, EdD, DrPH, MPH, is a faculty member at George Washington University and a public health practitioner with expertise in equity, diversity, and inclusion. He is a Robert Wood Johnson Foundation Health Policy Research Scholar. Recent projects include: farmworkers health equity; the intersection of theology and public health; traffic wardens and climate adaptation in Pakistan; evaluation of physicians’ training on climate change and health; global and occupational health equity. He can be contacted at Twitter:@phscientist