A Time for Hope? Pursuing a Vision of a Fair, Sustainable and Healthy World
| Author | Sharon Friel |
| Published date | 01 May 2018 |
| Date | 01 May 2018 |
| DOI | http://doi.org/10.1111/1758-5899.12557 |
A Time for Hope? Pursuing a Vision of a Fair,
Sustainable and Healthy World
Sharon Friel
Australian National University
Abstract
The confluence of social and health inequities and global environmental degradation shines a light on fundamental rup-
tures in society. A systems view of humanity reminds us that this status quo is not static, and that the shifting political
and economic sands provide an important window of opportunity to collectively change the system towards the public
good, such that communities are able to live with good health, dignity and in an environmentally sustainable way. To
enable this, global policy, and in particular global health policy must break out of the policy silos and refocus in a systems
way. If the system is to adapt, an ambitious vision for the system is needed that is different to the status quo. No one reg-
ulatory model that can improve complex societal problems, rather we must use a plurality of approaches. Reorienting the
system to achieve positive outcomes depends on reimagining the purpose of structural regulatory powers, and the releas-
ing the agency of networks of concerned actors. In a hyper-connected world there are many partners to help create sys-
tems of hope.
A journey from despair to hope
It would be very easy to be overwhelmed with despair
given the dreadful atrocities that plague the world (Box 1).
No country is immune from these concerns but such life
and death experiences are not distributed evenly between
or within nations. This author grew up in a society where
boys could expect to die before the age of 54 years; where
deindustrialisation and long term unemployment among
men eroded their sense of self, and where the image of that
society was portrayed as one of the feckless poor and pov-
erty of expectation (Hanlon et al., 2006; Walsh et al., 2009).
But, that same society also had high levels of community
cohesion and resilience, organised political action for social
justice, and ultimately proper public investment in human
and social capital. Over time, improvements occurred in
some social, economic and health outcomes.
The purpose of this vignette is to illustrate four points:
first, a focus only on the pathology of the problem obscures
the fact that systems such as these are not static, they can
and do change; second, if systems are able to adapt, what
is the ambitious vision for such a system that is different to
the status quo; third, understanding the ‘how’to affect posi-
tive system change requires understanding the intersections
between structure and agency through coherent intersec-
toral policy plus cohesive networks of actors, and finally,
there is no one regulatory model that will improve complex
societal problems, rather we must use a plurality of
approaches.
These four points are the focus of this paper. Drawing on
evidence and perspectives from public health, systems
science, international economic law, political science and
regulatory studies, this paper offers some reasons why there
is hope, at a time of shifting political, economic and envi-
ronmental sands, that the status quo can be changed
towards a society where all communities, globally, are able
to live with dignity, good health and in balance with nature.
Moving beyond pathologies to understand the
system
Shining a spotlight on the ‘wicked’policy problems, as
described in Box 1, has been a dominant focus of global
and public health research, and arguably also climate
science and economics research. Indeed there has been sig-
nificant progress made over the past few decades in under-
standing the causes of global health inequities. There is now
a wealth of evidence showing that inequities in people’s
everyday living conditions in childhood, education, employ-
ment, their built environment, and health care contributes
to inequities in health outcomes (Marmot et al., 2008). Daily
living conditions are shaped by structural factors including
economic globalisation, urbanisation, commercial determi-
nants, and the cultural norms and values that pervade insti-
tutions and communities (D’Souza et al., 2003; Kickbusch
et al., 2016; Labonte et al., 2011). These structural factors
generate and distribute power, income, goods and services,
and together with daily living conditions affect health
inequity (CSDH, 2008, Ottersen et al., 2014). We also know
that climate change both exacerbates these inequities and
is caused by the same underlying drivers of health inequi-
ties (Friel et al., 2008; McMichael, 2017).
©2018 University of Durham and John Wiley & Sons, Ltd. Global Policy (2018) 9:2 doi: 10.1111/1758-5899.12557
Global Policy Volume 9 . Issue 2 . May 2018
276
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