Reprinted from www.truthdig.com with author permission
It's time to start talking to our patients about climate change and the structural causes of disease. Hurricane Harvey has devastated Texas, leaving many dead, thousands with homes destroyed and billions in damage to infrastructure. Hurricane Irma pummeled the Caribbean and Florida at the same time that Hurricanes Katia and Jose were picking up strength in the Atlantic and threatening Mexico and the Eastern Caribbean. Forest fires are destroying regions of the Pacific Northwest. Meanwhile, in Nigeria, over 100,000 people have been forced to leave their homes because of widespread flooding, and in Southeast Asia over 1,200 have died due to historic flooding, which has left over one-third of Bangladesh under water.
These disasters did not come out of the blue, though. They are just a few examples of what results from an economic system that knows no limits. If the medical community wants to start addressing the systemic causes of illness, instead of just addressing the results that manifest themselves in various degrees of illness for suffering patients, we will have to make addressing the structural aspects of disease central to everyday medical practice.
The System's Toxic Effect
In medicine, we are often told not to "politicize" health care issues, not to be "too controversial" because "X" residency may not want to accept you, or "Y" employment opportunity may not want to hire you. Frankly, there is no more time for that, especially as we will continue to see more and more patients coming to our offices, clinics and hospitals damaged by this system. To take Texas as an example, in addition to the immediate physical risks associated with widespread flooding and infrastructure destruction, communities will be at risk for a number of health issues, ranging from inadequate access to medical care and prescriptions to an increased risk of mosquito-borne diseases to an increased toll of mental illness from psychological stress.
As usual, poor communities of color will face the largest burden during the most recent disaster, as they have over many years. In the immediate aftermath of Harvey's destruction, they now will have to sustain the threat of toxic pollution from damaged oil refineries, located near their communities, that were flaring off more than 5.5 million pounds of air pollutants into the atmosphere. (Flaring is done when rapid plant shutdown is required.) These same refineries have leaked chemicals into flood zones. In both methods of pollution, chemicals such as benzene and butadiene, known carcinogens, are released. Unfortunately, these communities, which have suffered from higher rates of respiratory illness and cancer mortality due to excessive environmental pollution from oil refineries, now will be exposed to even greater levels of toxic pollution.
Communities hardest hit by the complications of flooding (such as Port Arthur, Texas) are the same communities that also have suffered from economic devastation over the years as industry has moved abroad to find manufacturing hubs with lax regulations in places like Southeast Asia. These actions have led to high unemployment and all the psychological and physical illness that comes with it. By no coincidence, the residents of Bangladesh--who have suffered from economic exploitation for years, creating vast levels of poverty--now are suffering from the complications of widespread flooding, which will only compound the burden of suffering and illness the population faces.
Understanding what has led us to the situation in Texas and other states requires a more nuanced, systems perspective of evaluation. As Naomi Klein explained, it is important to understand the history that has led us to this point: "There is a moral imperative for informed, caring people to name the real root causes behind this crisis--connecting the dots between climate pollution, systemic racism, underfunding of social services, and overfunding of police." These connections now must be the focus for medical professionals in their daily practice.
Climate Disaster and Structural Violence: Symptoms From a Capitalist Cancer
What Klein references are what medicine often refers to as the "social determinants of health"--the subtle, upstream factors that continue to drive the devastation of health in communities around the globe. Falling under this umbrella term are forms of "structural violence" that negatively affect the health of communities. In "The New Human Rights Movement," author and activist Peter Joseph references the 1976 work of Gernot Köhler and Norman Alcock in their defining paper, "An Empirical Table of Structural Violence." In their work the authors define structural violence by saying, "Whenever persons are harmed, maimed, or killed by poverty and unjust social, political, and economic institutions, systems, or structures, we speak of structural violence, [which] like armed violence can have two effects--it either kills its victims or it harms them in various ways short of killing." Taking Texas as an example again, whether is it is illnesses communities suffered from before Harvey hit, or the number of illnesses they are at risk for now that it has hit, we see the destructive force of structural violence on the health of communities.
Understanding this definition, we see that companies have committed structural violence on communities for years by actively resisting environmental regulation, disregarding pleas of communities most affected and even ignoring official civil rights complaints to stop polluting around oil refineries. This is no surprise to those who understand how industry operates, as doing so would require funds being diverted from a corporate bottom line, which comes above all else in our current system. As investigative reporting has shown us, companies like ExxonMobil knew about the threats of climate change for years, but purposely misled the public to allow for continued, relentless fossil fuel extraction. They also chose to actively suppress scientific study and social movements that would curtail their bottom lines.
When you question what causes companies like ExxonMobil to act in this way and what leads to these conditions, you start to see that at the core is a neoliberal, capitalist economic market system that is designed for continual growth and profit maximization. As author George Monbiot has noted: "an economic system which depends on perpetual growth on a finite planet is destined to deliver disaster."
However, the fossil fuel industry is not the only industry to blame for the environmental destruction we are now seeing. It and the military-industrial complex and the factory-farming industry are some of the biggest polluters on earth today. They are operating inside of a system that allows a board of directors and a few wealthy shareholders to make the ultimate decisions about how the companies will operate.
These industries will continue to seek profit maximization at the expense of all else, because it is what the system requires. Continued military expansion, imperialist ventures, fossil fuel extraction and deforestation to make room for cattle grazing show how capitalism operates as a cancer, metastasizing to all aspects of society and every industry. The system commodifies everything it sees, as each industry attempts to continue producing the greatest possible return for shareholders while destroying the earth we inhabit. As we have seen time and time again, the end result of this market system of economics is the spread of illness and the suffering of communities around the world. As physicians, we see the suffering and death of our patients as the ultimate consequence.
What Is Medicine to Do?