Global Health and Environmental Health are merging – but without more attention to gender, they won’t get far.

There is a popular cartoon that has shown up recently in my social media feeds. It generally shows three tidal waves of ever increasing sizes descending on a city. The smallest is COVID-19, the second is labelled recession, and the largest, so big you almost don’t notice it at first, is labelled climate change. The city that is about to be overwhelmed has a small speech bubble “don’t forget to wash your hands.”

It may be funny, but it is true. 

Humanity is undoubtedly on the cusp of ever-intensifying crises that like a Russian dolls seem  to envelop each other. Looming recession. Growing inequality. Food Insecurity. Structural racism. Extremism. Global warming. Biodiversity loss. Global pandemics. Mass climate migration. And to that list, we would add: Gender inequality.

Climate change is certainly the biggest of these beasts. Some call it an inequality multiplier, some call it the great revealer. But all agree that when systems are already cracked or broken, climate change has a way of making the problems exponentially worse. A hospital already struggling to access clean water will fare much worse under a drought; warming temperatures is making malaria, zika, lyme and other vector-borne diseases much more common in places they weren’t before.  It’s not just that there is one crisis after another, but increasingly research is pointing out what should be obvious: these crises are deeply interconnected, something COVID-19 has made abundantly clear. The virus most likely spilled over onto humans through an animal – likely a bat – whose habitat humans are destroying in order to or raise cattle or plant monocultures like soy and corn. These crops are directly connected to the obesity epidemic, which ironically also makes people more susceptible to the virus. The pandemic has overwhelmed many health care systems in developing and developed countries alike, exposing and multiplying the gender, racial, and socioeconomic inequalities that these systems are built on.  

But how can we start to bring these issues together under one umbrella?

In the past decade and a half, three prominent frameworks have emerged to conceptualize the interconnection of environmental health and human health: EcoHealth, One Health, and Planetary health. While all three show promise for understanding the connections between human, animal, and environmental health, increasingly scholars are arguing that they exclude gender and racial dimensions of health and the environment.

NEW FRAMEWORKS FOR SEEING INTERCONNECTION

In 1717, an Italian Physicist and epidemiologist Giovanni Maria Lancisi noted in his now famous essay “On the Noxious Effluvium of Marshes” that malaria outbreaks coincided with the location of swampy marshes, linking putrid air – which he called ‘mal aere’ –  to febrile symptoms. The Pontine Marshes, south of Rome, fields that had been deforested and filled with stagnant water, were especially known to produce copious amounts of malaria. We now know that it isn’t the air, but rather the insect that breeds in those fields that causes malaria, yet our understanding of how the health of ecosystems and diversity of animals impacts us as humans still lags far behind.

Understanding that the health of people is inevitably linked to the health of ecosystems is not a new concept. It can be found in many indigenous and traditional concepts of health as well as historically among early veterinarian, health, and conservation practitioners as far back as early Greek and Islamic philosophers. But it wasn’t until recently that  frameworks for understanding, researching and conceptualizing these links were made. Although all three frameworks come from different academic and theoretical backgrounds, they all promote a paradigm shift towards conceptualizing health as a broad system that includes animal, human, and environmental health with an emphasis on the resiliency of systems within it. 

EcoHealth is the oldest of the three approaches and stems from the conservation movement and similarly is a systems-based approach to promoting health and well-being with a focus on social and ecological interactions. It was strongly influenced by the international wildlife conservation organizations and is more concerned with the wildlife–human interface. EcoHealth has considered, for example, how human population growth, latitude, rainfall and wildlife diversity correlate with emerging infectious diseases. 

OneHealth, which emerged at the turn of the century, came largely out of veterinary medicine. It recognizes that 75 percent of new or emerging diseases come from non-human animals, and more than 60 percent of known infectious diseases that affect people are transmitted from animals, such as rabies, salmonella, or malaria. OneHealth calls for a conceptualization of health that sees human, animal and environmental health as One – hence the name.

Planetary Health is the newest of the frameworks. Called into being in 2014 by Richard Horton, it deals with “the health of human civilization and the state of the natural systems on which it depends”. In 2015, the Rockefeller Foundation and The Lancet launched the concept as the Rockefeller Foundation–Lancet Commission on Planetary Health. While planetary health has multiple overlapping principles and ideas with both One Health and EcoHealth, it has been put forward as a new science. Planetary health tends to focus more on human health connections with climate change, ocean acidification, freshwater usage, land use and soil erosion, pollutants and the loss of biodiversity; and less on zoonotic transmission between humans and animals. 

THE CASE FOR A FEMINIST APPROACH TO ECO/ONE/PLANETARY HEALTH

While all three frameworks definitely promote an interdisciplinary framework, they have been criticized for excluding gender explicitly. Gender is considered in passing in these frameworks, more in some than others. The Africa One Health University Network (AFROHUN) explicitly recognizes the role and importance of gender in One Health and has developed, for example, a Gender, One Health and Infectious Disease short course that applies gender analysis to disease surveillance, response, and control. Gender equity is considered one of EcoHealth’s main pillars, although scholars within Ecohealth recognize that “current practice does not go far enough in recognizing the disparities in the health conditions of men and women and does not yet lead to specific interventions that result in gender equity.” Gender is mentioned only in passing in Planetary health although there are some attempts to link the two, for example Women Leaders in Planetary Health.

But ignoring gender is not only problematic, it also ultimately makes these frameworks less resilient and sustainable, not to metion perpetuates existing inequalities. We know that risk of infection and access to health services differ between men and women. We know that when surveillance, control and responses to diseases are designed without explicit gender analysis, they are more likely to miss crucial understandings of the causes, consequences and implications of the diseases and have less well designed solutions. We know access to environmental resources, impacts on the environment, and differences in the value of the environment differ according to gender. We know women are disproportionately affected by climate change, environmental degradation, natural disasters, and biodiversity loss and that the climate crisis will only make gender disparities worse. We know that men, especially white men have a much higher risk tolerance for potentially environmentally destructive technologies. We know that studies show that women’s unequal access to land, energy, and resources negatively impacts both human and environmental well-being. We know that women globally make up 70% of the health workforce, yet only 25% of global health organizations have gender parity at senior management levels even though we also know that women’s leadership in political decision-making processes improves policies as well as making then more equal.

Without including all genders, and without an explicit recognition of the gender inequalities that exist and explicit ways to address those in One/Eco/Planetary Health, true transformative change in the face of the environmental, health and the climate crisis that we are facing will not be possible. But it is precisely at the intersection of these multiple crises that transformative change can happen. 

An increasing field of scholars is looking at how a more inclusive and feminist approach to Eco/One/Planetary Health can be key to truly sustainable change. I’ve summarized here what the main tenants are, and what is necessary to bring true transformative change for all through these approaches:

  • Recognizing first and foremost that any knowledge about humans, animals, plants and the larger environment is situated and embodied. Bringing together the “partial perspectives” of a diverse array of people and voices through collaboration and intersectional knowledge production is the only way we come to a more objective and comprehensive account of One/Eco/Planetary Health
  • Global health and Environmental health is dependent on the unpaid labor or women that needs to be recognized and compensated. More attention needs to be paid to women’s lives, the gendered structural constraints and opportunities, and the institutions and assumptions that naturalise inequalities – gender or otherwise
  • Gender equality can not be achieved without racial and socio-economic justice and vice versa.  In order to bring about truly transformative and sustainable change, One/Eco/Planetary health must be more than interdisciplinary, it must be truly intersectional. 
  • Global Health and Climate Change suffer from top-down and technocratic interpretations. A feminist approach to One/Eco/Planteary Health would reorient the framing of health towards an ethics of care
  • Health culture needs to be changed both formally and also informally. But health system and institutional change is difficult and requires complex solutions as well as economic and societal transformation. This change needs to be taken up by everybody in the culture, not just by women, BIPOC and LGBTQ leaders.

Ultimately, we are in a situation where waves of different crises threaten to overwhelm us, ones that go beyond climate change, recession, and COVID-19. Seeing the interconnections between these crises, focusing on the metaphorical ocean rather than the waves, is a first and important step. But that approach also has to be intersectional, recognizing the different impacts and relationships we all have with it. Without that, it’ll likely swallow us all up.

Cartoon credits: Original (without green wave) by Graeme McKay. Edited cartoon credit unknown

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