TOWARDS INTERSPECIES AND INTERGENERATIONAL HEALTH EQUITY
Public health leaders have been adept at advocating for investment in the social determinants of health, but there is less evidence of similar public health leadership in protecting ecological resources and services critical to individual and community resilience (Stephen, 2020). Public health’s refocus on the environment has almost exclusively been on the built environment to the exclusion of the natural environment (Bracken et al., 2008). Too often, the environment is characterized as a source of public health hazards rather than of resilience. However, both the salutogenesis and socio-ecological perspectives see health in terms of the congruence of peoples needs with the structure and quality of their environment. Similar perspectives exist for domestic animal and wildlife welfare (Stephen and Wade, 2018). Despite a growing literature on the need for socio-ecological approaches to preparedness in the Anthropocene, too often management actions are business as usual. Health promotion programs that promote socio-ecological thinking need to consider who should be involved, whose experiences and knowledge should influence decision-making processes, and who defines and determines how determinants of health approaches will be used to promote health across species and generations.
The UN Universal Declaration of Human Rights (UN General Assembly, 1948) asserts that “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the w'orld.” A question arising from this declaration is: “Are these rights only applicable to the current generation of the human family?” The family of one of the chapter’s author currently spans 90 years and four generations. After the birth of a grandchild, the prospect of a great-grandchild becomes less of an abstract concept and more of a possibility. There may be someone in that family alive in another 90 years, and it is not unimaginable that a great-grandchild will be alive 120 years from now. A second question arising from the Universal Declaration of Human Rights is: “Are people the only members of the human family?” The question needs to be asked within the context of the Western w'orld where dichotomous constructions have imagined humans to be distinct from animals and society to be separate from nature. Modern science understands that humans are also animals and share several biological and social characteristics that are homologous to those exhibited in other animals, even in relation to the use of languages, tools, and social lives. Perhaps what sets humans apart from other organisms are characteristics such as our ability to speak as a result of a permanently descended larynx; the range, refinement, and scope of our tool use; cognitive abilities that enable full-blown language capacity as well as reasoning and planning abilities; and significant adaptability to a range of environments (Stockholm University, 2017). If we consider the human family less as a nuclear family and more of an extended family, one can start to imagine a different way of being in the world. Ancient non-Western worldviews have centrally integrated humans and animals into a family constellation. These cosmologies offer profound insight into conceptualizations and practices grounded in the principles of reciprocal care. Fulfilling the Universal Declaration of Human Rights, it seems, needs us to consider who and what is part of the family and over how long of a time.
Integral both to Indigenous ways of knowing and being and to Western work on sustainability is the notion of intergenerational justice wherein reciprocal care considers the needs both of current and future generations. One often cited articulation of this approach is the importance of cultivating relationships and societies wherein each decision involves a consideration of past, present, and future generations. Many Indigenous nations around the world are guided by and require decision-makers to pay attention to the knowledge and decisions of past generations and consider the impacts of our actions on the future generation (Tonmyr and Blackstock, 2010). Employing an intergenerational approach to equity requires a balance to be struck between acting now so as not to compromise future generations while at the same time distributing current resources and opportunities to ensure the well-being of all in the present generation. The challenge is to find ways to work together when there is a wide diversity of needs, interests, and knowledge amongst the members of the extended human family. As discussed in Chapters 6 and 9, a key to encouraging collaborative action in situations where different needs, knowledge, and values exist is to find a shared problem. Declining ecological health is a massive problem shared by people, animals, and ecosystems that might serve as an entry point to find win-win-win solutions by reducing inequitable access to the resources needed by all of the extended human family to thrive in a changing w'orld.
JUSTICE AND CITIZENSHIP IN PROMOTING INTERSPECIES AND INTERGENERATIONAL HEALTH EQUITY
The UN International Covenant on Economic, Social and Cultural Rights (in force in 1976) confers "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” but societies often fail to ensure this right is equitably and justly fulfilled (Gostin, 2011). Justice is concerned with equalizing relations between those wfho have pow'er and those who do not. The current generation of people wield the most pow-er in intergenerational and interspecies issues. Conservation, sustainable development, global health, One Health, and health promotion all need to confront three issues of justice: (i) justice between different people of the present generation, (ii) justice between people of different generations, and (iii) justice between humanity and other species. This leads to three questions a One Health practitioner should ask: Will achieving a health objective for one target group
- 1. Influence the chances for another group to also achieve their objectives?
- 2. Make it easier for another group to also achieve their objectives?
- 3. Make it more difficult for another group to also achieve their objectives?
When considering these questions, one needs to consider both whether there is equitable access to the determinants of health and whether the opportunities to benefit from these determinants are equitable. Intragenerational and interspecies justice is concerned with (i) the control of access to resources and capacity across time and species so the benefits produced by ecosystems can be enjoyed, (ii) the duties to conserve ecosystems, and (iii) the expectations to compensate for the harms caused by ecosystem degradation.
The unprecedented changes and threats arising in the Anthropocene require us to contemplate the social contract between the state and the individuals in health citizenship. Health citizenship combines the responsibilities of individuals to achieve healthy living with the responsibilities of the state to help all citizens achieve this goal (Spoel et al., 2014). No one person or group has an exclusive claim on ecosystems or the services they provide because natural ecosystems are not created by any person or group of people (Glotzbach and Baumgartner, 2012), yet every living thing depends on sustainable ecosystems - they are common pool resources. If we accept that current and foreseeable environmental change will constrain the distribution of the proceeds of economic growth as the primary means for achieving health equity, we need to conceive of health citizenship in socio-ecological terms and thus consider ecological citizenship as a core value of health promotion (Dobson. 2004).
Most health promotion efforts are directed at changing people’s behaviours to promote healthy living within their social environments, empowering people to make choices and confidently take responsibility for their health (Petersen et al., 2010). The WHO’s Jakarta Declaration on Leading Health Promotion into the 21st Century (1997), however, also recommended that decision-makers firmly commit to their social responsibility to protect the environment and ensure sustainable use of the resources. Health promotion and ecological citizenship are, therefore, fully compatible. Ecological citizenship entails the duties and responsibilities to ensure that ecological footprints are sustainable and provide a just distribution of ecological resources to human and non-humans alike. It entails the ability to recognize environmental issues when they arise and assume responsibility for preventing and resolving problems through individual and collective choices. The principal task to incorporating ecological citizenship into health promotion is to connect personal well-being to the ecological
BOX 3.2 CORE CONCEPTS INFORMING INTERGENERATIONAL, INTERSPECIES HEALTH EQUITY
Social justice: All people deserve and should have access to the same rights and resource regardless of race, socio-economic status, gender, or other characteristics.
Environmental justice: All people have the same degree of protection from environmental health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work regardless of race, socio-economic status, gender, or other characteristics. Ecological justice: Human beings and the rest of the natural world are provided enough protection and opportunity to allow them to live according to their own forms of life and live the fullness of their natural existence. Ecological citizenship: There are duties and responsibilities to ensure that ecological footprints make a sustainable impact and provide a just distribution of ecological space and components.
services and environmental endowments that influence health. This thinking is reflected in the 1993 UN Convention on Biological Diversity’s objective to conserve biological diversity and the sustainable use of its components with the fair and equitable sharing of the benefits arising out of its use. Because of the interdependence of the human-nature community, the idea of separating social justice from the environment seems inappropriate. There are, however, legal, philosophical, and religious debates about how far the community of justice can or should be extended to include future generations as well as non-human entities.
A first step in incorporating ecological citizenship into health promotion is to evolve and expand the concept of health literacy. The holistic health literacy described by Rask et al., (2014) includes environmental awareness and interest in the state of the world. As society increasingly urbanizes, the direct connections with the land, the sea, and the rest of nature are becoming more tenuous for a growing proportion of the population. Empowering people, organizations, and institutions to act for personal, intergenerational, and interspecies health in the 21st century goes beyond documenting and disseminating alarms about the un-sustainability of the current trajectory of humanity (Ansari and Stibbe, 2009). McMichael (as quoted by Fleming et ah, 2009) noted that
Until the public health community highlights the centrality to the overall sustainability project of long-term population health, and particularly its dependence on maintaining Earth's life-support systems, society will continue to miss the real point - namely, that ‘ecological sustainability’ is not just about maintaining the flows from the natural world that sustain the economic engine nor maintaining iconic species and iconic ecosystems. It is about maintaining the complex systems that support health and life.
Health promoters will need the ability to access, understand, integrate, and use information about health-related ecological effects to evolve and deliver health literacy services that help communities and individuals become aware of and concerned about the environment and its associated impacts on personal, inter- generational, and interspecies health, as well as help them gain the knowledge, skills, and motivations to work towards the solution of current problems and the prevention of new ones.