In this paper, we reflect on and explore what remains to be done to make the concept of supportive environments—one of the Ottawa Charter's five core action areas—a reality in the context of growing uncertainty about the future and accelerated pace of change. We pay particular attention to the physical environment, while underscoring the inextricable links between physical and social environments, and particularly the need to link social and environmental justice. The paper begins with a brief orientation to three emerging threats to health equity, namely ecological degradation, climate change, and peak oil, and their connection to economic instability, food security, energy security and other key determinants of health. We then present three contrasting perspectives on the nature of social change and how change is catalyzed, arguing for an examination of the conditions under which cultural change on the scale required to realize the vision of ‘supportive environments for all’ might be catalyzed, and the contribution that health promotion as a field could play in this process. Drawing on sociological theory, and specifically practice theory and the work of Pierre Bourdieu, we advocate rethinking education for social change by attending more adequately to the social conditions of transformative learning and cultural change. We conclude with an explication of three key implications for health promotion practice: a more explicit alignment with those seeking to curtail environmental destruction and promote environmental justice, strengthening engagement with local or settings-focused ‘communities of practice’ (such as the Transition Town movement), and finding new ways to creatively ‘engage emergence’, a significant departure from the current dominant focus on ‘risk management’.
In this paper, we reflect on and explore what remains to be done to make the concept of supportive environments—one of the Ottawa Charter's five core action areas—a reality. As observed by Catford (Catford, 2007) and Nutbeam (Nutbeam, 2008), the Ottawa Charter has been hugely influential in shaping the ‘new’ public health. Its focus on supportive environments, developed further in the Sundsvall Statement (WHO, 1991), built on the emphases in the ‘old’ public health on ensuring clean and safe environments. The Ottawa Charter and Sundsvall Statement introduced a socio-ecological understanding—encouraging a focus on the settings of everyday life while highlighting the interconnectedness of people and the planet and signalling the imperative of sustainable development. In expounding the importance of supportive environments for health and human flourishing, the Sundsvall Declaration highlighted not only physical, but social, political and economic dimensions as well as emphasizing the need to respect and harness the skills and knowledge of women and indigenous peoples.
In looking to the future, our focus is on the physical environment, building on the recognition that damaging environmental and ecosystem change poses an enormous threat to human health (Hancock, 2007 and 2011; Nutbeam, 2008). Consideration of progress to date on supportive environments is provided elsewhere in this special issue (Pettersson, 2011). However, we would reiterate that the physical environment is intricately interconnected with social, political and economic dimensions (WHO, 1991). Indeed, ecological exploitation is increasingly the new vector for exploitation of indigenous peoples and other marginalized groups (Hossay, 2006; Salleh, 2009; Posner and Weisbach, 2010). As such, justice represents an overarching emphasis in this paper, which we begin with a consideration of three major emerging threats to health and health equity—namely ecological degradation, climate change and peak oil. We then reflect on recent responses and trends at global, national and local levels, before exploring how it is possible to move forward by refocusing the concept of supportive environments and affirming the contribution of health promotion.
While contemporary trends paint a worrying picture of possible futures [see (Hancock, 2011)], the pace of change makes predicting the specific future conditions, technologies, ideas and social revolutions that will reshape human culture and behaviour in the coming years challenging, although crucial. On the positive side, this uncertainty may incentivize action to rescue a better future for humanity and life on earth in the face of daunting environmental and social challenges (Macy and Brown, 1998). Our foremost interest is how health promotion can be effective under conditions of uncertainty and change.
EMERGING THREATS TO HEALTH AND HEALTH EQUITY
It is now widely recognized that demands placed on the planet vastly exceed its natural carrying capacity, and that these demands are compounded by a continued population growth and steadfast political commitment to economic growth (Speth, 2008). The declining ecological systems that Hancock (Hancock, 2011) describes place the existing global social order in serious question. That human civilization may be at the brink of catastrophic collapse is no longer dismissible as the apocalypticism of fringe elements; they are increasingly reflected in government-commissioned reports [e.g. (Hirsh et al., 2005)] and echoed by respected scholars [e.g. (Homer-Dixon, 2006; Chew, 2008; Skrimshire, 2010)]. Three threats—ecological degradation, climate change and peak oil—will increasingly dominate the public and political landscapes in the years to come, with the potential to radically transform society.
Since all human societies rely on resources and services (e.g. water purification) provided by nature, ecological degradation poses serious threats to human well-being. Accordingly, the World Health Organization now considers environmental hazards one of the defining issues for public health in the twenty-first century and a significant threat to achieving ‘Health For All’ and the Millennium Development Goals (Chan, 2007). Already, human impacts on the environment have become an international crisis that is said to be responsible for up to one-quarter of the global burden of disease (Smith et al., 1999). The conditions Hancock (Hancock, 2011) summarizes—especially for younger generations facing such daunting global insecurity in future prospects—have scarcely imaginable consequences for human mental health and physical health. The exponential nature of the decline suggests an increased risk of cascading ecosystem collapse, with the comprehensive review by the United Nations Millennium Ecosystem Assessment (2005), suggesting that ‘the ability of the planet's ecosystems to sustain future generations can no longer be taken for granted’.
Beyond general ecological degradation, there are worrying signs that a second emerging threat to global health equity—climate change—is accelerating faster than even the worst predictions of the Intergovernmental Panel on Climate Change (Hulme, 2009; Hansen, 2010; Urry, 2011). The social and economic impacts of climate change are predicted to be substantial (Stern et al., 2006), once again hitting the poor and marginalized hardest, especially in the global South where socioeconomic resources for adaptation are weakest (Adger et al., 2006; Roberts and Parks, 2007; Rao, 2009). There is a growing literature on current and predicted future health consequences of climate change [e.g. (Frumkin et al., 2008; Griffiths et al., 2009; Rao, 2009)]. This situation may also fuel new waves of environmental refugees, and potentially undo more than 20 years of poverty reduction work around the world (UNDP, 2008).
Peak oil is a third emerging threat to health and health equity (Harrison, 2006; Frumkin et al., 2007; Parker and Schwartz, 2010). Peak oil is not the end of oil but rather that point at which the rate of production enters terminal decline, typically occurring when half the oil has been used up, or 25–30 years after a peaking in the discovery of new oilfields (Bardi, 2009). According to a wide range of sources, including the usually conservative International Energy Association (International Energy Association, 2010), we are already past or very close to the global peak of oil production. The result is likely to be further volatility in oil prices, especially as human efforts to exploit more remote reserves such as deep sea and oil sands run into significant cost over-runs and encounter or cause significant ecological problems. Given the reliance on cheap oil in our increasingly globalized world, the consequences of constrained availability and sharp increases in fuel costs are likely to be substantial—in terms of societal impact, escalation of conflicts, food insecurity and stability of health systems (Hanlon and McCartney, 2008; Klare et al., 2011; Neff et al., 2011; Schwartz et al., 2011). As with environmental degradation and climate change, impacts are likely to have the greatest effect on the global South, the poor and the less powerful (Winch and Stepnitz, 2011), a point to which we return below.
The combined impacts of climate change, environmental degradation and peak oil are likely to be felt acutely at a time when the global economy remains extremely fragile following the financial meltdown of 2008, and as growth itself is in question (Victor, 2008; Rubin, 2009; Heinberg, 2011).
It should be noted that the ‘triple threat’ of environmental degradation, climate change and peak oil is closely interwoven with injustice in a society that is organized politically, economically and socially around the pursuit of short-term profit and accumulation of wealth. More specifically, social research from around the world has shown a clear pattern of unequal distribution of environmental risks according to social differences such as race, class, gender, indigeneity and other markers of social exclusion—factors which are also linked to ability to resist unjust conditions and advocate for better ones (Agyeman, 2005; Agyeman et al., 2003, 2009; Salleh, 2009). These vulnerabilities follow a predictable pattern in which environmental risk compounds an inequitable social distribution of a wide range of determinants of health such as access to safe and affordable housing, nutritious food, clean water and adequate, income enabling social and political participation.
In other words, damaging exploitation of the natural world and exploitation of fellow human beings are interwoven—making it crucial that social justice, long a signature element of health promotion, is understood to be inextricably linked to environmental justice (Masuda et al., 2008; Eyles, 2009). Unfortunately, those bearing the largest burden have the least voice in society and are often ignored when it comes to proposing solutions for better ecological stewardship—even when they are the most culturally, economically and spiritually tied to the land and reliant on its continued health for their own survival and well-being.
Our argument so far is summarized in Fig. 1. What is clear is that these threats have not yet been met with commensurate changes in policy, economic restructuring or significant shifts in consumer and institutional behaviour. Governments, industry and most of the general public appear to place considerable faith in the capacities of the market and technology to rise to the challenge. However, critics of ‘ecological modernism’ call for more fundamental reform (Homer-Dixon, 2006; Victor, 2008), limits to growth (Heinberg, 2011; Nickerson, 2006) and even the dismantling of capitalism itself (Jensen, 2006; Kovel, 2007). Others believe that rising environmental stressors will increase social inequity, and question how responses can be both sustainable and just (Newman et al., 2009).
How to avoid socio-ecological crises in a positive manner that promotes environmental, health and social justice? We may need to rethink our assumptions about the nature of social change (at least as it applies to the triple threat) and long-cherished assumptions about effective action that are central to health promotion theory and practice. In the following sections, we compare three perspectives on social change for what they suggest about effective health promotion practice. We make the case for a sociological perspective on ‘collective lifestyle practices’ characteristic of contemporary high-mobility, consumption and growth-oriented globalization. Based on this analysis, we go on to identify three promising areas for health promotion intervention in the coming decade.
RETHINKING SOCIAL CHANGE
In the global North, contemporary perspectives on social change have been dominated by accounts of ‘progress’ that emphasize incremental hard-won improvements in quality of life as triumphs of science and technology (Boudon, 1991; Victor, 2008). Despite critiques of meta-narratives of progress, many still believe that progress on environmental and social justice issues will result from rational planning and the right combination of data, moral suasion, intersectoral collaboration, public policy, risk management and market incentives. This reformist posture is often framed as a ‘reasonable’ alternative to more far-reaching or ‘radical’ demands. However, this comforting narrative is belied by numerous examples of serious ecological decline despite the best efforts of scientists, citizens and (ostensibly) well-intentioned governments at ‘risk management’. The decline of the North American cod fishery and the resultant social dislocation is but one example (Finlayson and McCay, 1998).
Contrasting with this emphasis on incremental ‘progress’, some believe that it will take the catastrophic collapse of ecological and social systems to catalyse change on the scale and depth required to reorient humanity on a sustainable path. It would appear that Speth [(Speth, 2008), p. 211] is not alone in noting that ‘unfortunately, the surest path to widespread cultural change is a cataclysmic event that profoundly affects shared values and delegitimizes the status quo and existing leadership’. This ‘push’ model of social change fits with Bourdieu's (Bourdieu, 1990, 1998) notion of hysteresis or crisis as the catalyst to changes in a society's accepted worldview and modus operandi. Historical analyses of societies that have collapsed as a result of exceeding ecosystem carrying capacity suggest that change often comes too late to save the majority of affected citizens (Catton, 1982; Diamond, 2005; Chew, 2008). This has led some commentators to characterize the present as a ‘race of the tipping points’: will climactic and ecosystem tipping points be achieved before social (change) tipping points (Poland and Dooris, 2010).
A third perspective on social change emphasizes the potential for wholesale cultural change akin to a widescale ‘awakening’ to the potential for a new way of being and organizing human affairs in alignment with life, ecology and ancient indigenous wisdom. According to some accounts (Macy and Brown, 1998; Korten, 2006), we are already in the midst of ‘The Great Turning’—a monumental shift from an industrial growth economy to a life-sustaining society that rivals the agricultural and industrial revolutions in terms of scale and impact. Hawken (Hawken, 2007) chronicles the emergence of an estimated one million grassroots groups doing vital environmental and social justice work at the local, regional and global levels. He claims this groundswell of action has eluded mainstream media attention because it does not match assumptions about contemporary social movements (e.g. that they must be led by charismatic leaders). Alongside this, Carlsson (Carlsson, 2008) posits a sea-change in people's relationship to work, with increasing numbers working reduced hours at the fringes of mainstream society in endeavours that embody their core values; and Hubbard (Hubbard, 1998) and others discuss the emergence of the ‘evolutionary consciousness’ movement.
The issue as we see it is less about which of these models of social change is more ‘accurate’ and instead about the effects of adopting one as the dominant cultural narrative about the future—and the implications this has for (health promotion) practice. We would contend that the incrementalist perspective on ‘progress’ offered by ‘ecological modernization’ serves powerful vested interests, fails to successfully dismantle the generative mechanisms favouring inequity and supports options compatible with a deeply flawed status quo [e.g. using climate change as an opportunity for the marketization of carbon in new carbon trading schemes—see (Goldtooth, 2009; Rogers, 2010)] when a more radical rethinking of the fundamental tenets of a globalized market-based growth-oriented economy is called for. Likewise, we believe that the second model—with its emphasis on ‘preparing for collapse’—while potentially ‘accurate’, offers few compelling options for policy and practice. Rather, drawing on the third option, our interest in this paper is to examine the conditions under which cultural change on the scale required to realize the vision of ‘supportive environments for all’ might be catalysed, and the contribution that health promotion as a field could play in this process.
RETHINKING EDUCATION FOR SOCIAL CHANGE: A SOCIOLOGICAL PERSPECTIVE ON CULTURE AND COLLECTIVE LIFESTYLE
There have been a number of attempts to explain the lack of meaningful action regarding climate change, environmental degradation and peak oil. However, these either adopt an individualistic perspective and engage in a form of psychological reductionism, or focus on the political and economic coordinates of energy and emissions path-dependency thereby providing little help in understanding social transformation or discerning agents of change. Furthermore, none of the models offers a coherent explanation of the interrelated triple threat phenomena as they occur at individual, small group, institutional and societal levels.
While environmental awareness has penetrated the public consciousness (Toronto Star, 2007), it is not certain how interest translates to action, in terms of changed lifestyle practices, structural changes or the spread of values, norms, dispositions and institutional forms representing a ‘culture’ of sustainability. Insofar as the public response to the triple threat has been underwhelming, it cannot be said to result from a lack of pertinent information. Building on the scholarship of researchers like Norgaard (Norgaard, 2011) on climate change, we suggest that although the basic premise of an enlightened, democratic and modern society is that information will lead to public and institutional responses, the triple threat poses a challenge to this paradigm. Large numbers of people in the global North who report being concerned about climate change manage to ignore it and not follow through on the implications either intellectually or politically. This phenomenon of ‘cultural inertia’ demonstrates that environmental education (increasingly an acknowledged component of coherent health promotion) has been inadequate to generate the scale of change to our collective lifestyle required to address the triple threat. In response to this, more robust sociological perspectives are needed to explain cultural inertia regarding climate change.
Combined with sociological insights drawn from French sociologist Pierre Bourdieu's (Bourdieu, 1990) theory of practice (Norgaard et al., 2012; Haluza-DeLay, 2008), research on social learning and some of our earlier work on unpacking the social context of collective lifestyles [(Haluza-DeLay and Berezan, forthcoming; Poland et al., 2006 and 2008) but see also (Frohlich et al., 2001)], we see the response to the triple threat as a social process across micro-, meso- and macro-levels that include the internalization of cultural practices in ways that reify individuals in terms of existing political economic systems and the collective expression of lifestyles. That is, current social organization and ways of life are so familiar and psychologically entrenched that the widespread change implied by the triple threat is nearly impossible for most people to conceive. According to Norgaard (Norgaard, 2011), this is how populations ‘live in denial’ despite awareness of the facts about climate change. Psychological and sociological theory holds that primary and secondary socialization lead people to construct ways of life and understandings of the world that guide every day interactions. Bourdieu uses the concept of ‘habitus’ to refer to the deeply internalized, durable dispositions that produce regularized practices of everyday life learned at the intersection of biography and environment. Individuals become the carriers of the orientations and practices that constitute our social order. In this context, a disjuncture opens between our taken-for-granted ways of living and socio-ecological conditions—such as new behaviours necessitated by the triple threat. When this occurs, there are powerful processes that work at the psychological, institutional and societal levels to maintain habitus and ensure social stability in spite of the evidence.
Thus, cultural and social stability creates a form of inertia that inhibits social change. In other words, consumption and industrial production, mobility and relative abundance, habits of mind and social practice of the privileged in the global North are shaped by pervasive cultural forces and the interplay of existing social institutions and psychologies at odds with new environmental paradigms (Urry, 2011). In the context of the triple threat, cultural inertia is rooted in this disposition to stability (Norgaard, 2007), as well as the social impracticality of living ecologically in an unecological society (Haluza-DeLay, 2008). If the triple threat requires societal restructuring and alteration of collective lifestyle practices, it is little wonder that individuated and knowledge-oriented education has been ineffective.
Although habitus can be a powerful source of resistance to change, we maintain that working from a more sociologically sophisticated understanding of the social context of transformative learning can open up new possibilities for working proactively on culture change. The most important observation from this model of learning and its supporting research is that a habitus—always based in social contexts—can maintain itself or change in supportive social conditions. An extensive literature on social learning and learning for sustainability has emerged in the last decade [e.g. (Falk, 2005; Wals, 2007)], much citing the importance of transformative learning (Lange, 2004; O'Sullivan and Taylor, 2004), experiential learning (Fenwick, 2000; Dillon, 2003; Le Cornu, 2005) and non-formal and incidental trajectories for learning (Marsick and Watkins, 2001). The literature concludes that, for adults at least, the social context of learning is central, meaning that learning environments are best understood as ‘communities of practice’ (Hildreth and Kimble, 2004; Wenger, 2006). Further, while much research has focused on individual environmental practice (Kollmus and Agyeman, 2002; Dietz et al., 2005), cultural studies and cultural geography emphasize how a distinctive culture of place emerges from the pragmatic and routinized interactions between engaged participants and social processes (Poland et al., 2005b; Hess et al., 2008). This accords with research on neighbourhood effects on health [e.g. (Popay et al., 2003; Finkelstein et al., 2005; Blackman, 2006)] and the many links between place and health, including the influence of the physical environment [e.g. (Frumkin, 2001, 2003; Dustin et al., 2010)]. Drawing on these bodies of scholarship, we propose that attention be devoted to creating ‘communities of practice’ (Lave and Wenger, 1991), where logics of practice relevant to the triple threat are legitimated and performed by others and facilitate efficacious personal and collective change. Drawing on a developing literature on the cultural and social learning outcomes of social movement (Hart, 1996; Earl, 2004; Williams, 2004), we also suggest that emerging grassroots place-based responses to the triple threat often function as ‘communities of practice’—not only shaping local policy, but also helping to create a ‘culture of sustainability’.
Transition Towns is one such movement. Originating in 2004 in the UK and now spreading rapidly around the world, the movement—for which the Transition Network (www.transitionnetwork.org) serves as an organizational hub—seeks an integrated and community-based response to the triple threat outlined above. Movement leaders argue that successful transition to a low-carbon society requires grassroots action to build community resilience, while emphasizing opportunities for greater connectedness, equity and quality of life (Brook, 2009; Davis, 2010; Hopkins, 2008; North, 2010). Unlike most environmental movements, Transition Towns explicitly emphasizes social equity and diversity in its discourses (Hopkins, 2008).
Transition Town initiatives can be seen as reflexive communities of practice for the anchoring and internalization of ways of living that make real a post-carbon society. A Bourdieusian perspective on Transition Towns emphasizes the tacit, pre-cognitive, contextual, place-based, experiential and practice-oriented learning associated with the embodiment and internalization of a habitus in social movement groups. This accords with what Bell (Bell, 2004, p. 226) describes as one of the goals of groups working toward a sustainable society: ‘living environmentally without trying’. Arguably, one of the main reasons pro-environmental attitudes among the general public are not matched by environmentally sound lifestyles is that our lives are socially organized in the context of a less-than-environmentally sound society. In Bourdieu's terms, for most people, an ecological habitus is mis-aligned with the social field. Drawing on research among environmentally active citizens in one Canadian city, Haluza-DeLay (Haluza-DeLay, 2008) concludes that several components are needed for development of an ecological praxis in existing social fields where sustainability is not a priority: We suggest that health promotion could play an important role in supporting each of these and in the next section turn our attention to implications for practice.
specific, place-based information on ecologically sound lifestyle practices consistent with the local ecosystems;
critique of existing social structures (political-economics, institutional and cultural);
sociological sophistication about how contemporary social relations resist an ecological worldview and lifestyle;
a sense of the possible (often anchored in storytelling);
association with a reflexive ‘community of practice’.
However, the Transition Towns movement has been subject to criticism for the dissonance between rhetoric and practice in relation to social equity and diversity, being predominantly white and middle class by its own admission (where it has taken root in the global North). Furthermore, the jury is still out as to whether Transition initiatives can accomplish a meaningful increase in community resilience, relocalization of production and concomitant shift in culture/habitus (Brook, 2009; Burton, 2010; North, 2010; Poland, 2010). Early indications, based on purely anecdodal evidence, are that:
community-building precedes meaningful shifts in everyday ecological practice, and this takes time;
most people's engagement with transition initiatives is nowhere near at the level seen, for example, in intentional communities and ecovillages, which raises questions about capacity to support the development of ecological habitus/praxis;
even for many core members of Transition Towns steering committees (let alone the broader membership), unecological practices such as vacation air travel remain the norm [see (Urry, 2010) for a provocative analysis of the relative intransigence of high-mobility globalized consumption culture].
IMPLICATIONS FOR HEALTH PROMOTION: BUILDING SUPPORTIVE ENVIRONMENTS
For us, a central question remains the how to avoid potential fear and social collapse, while engaging in a positive process that faces environmental and social justice challenges with creativity and humanity. In light of our discussion of the triple threat, our call to rethink social change and the implications of a sociological perspective on culture and collective lifestyle, we advance three directions for health promotion in securing ‘supportive environments’ for health in the coming decade.
The first is hardly a ‘new’ direction at all, but instead echoes a call for health promotion to return to its more radical roots (Baum and Sanders, 1995) and the articulation of a critical social science perspective in health promotion (Eakin et al., 1996; Poland, 1992). Given the rapid rate of ecosystem destruction, resource depletion and loss of resilience in socio-ecological systems, traditional resistance work and organizing aimed at halting or slowing the rate of destruction will continue to be of paramount importance. Health promotion can and should be at the forefront in calling attention to the impacts of ecosystem destruction, climate change and resource depletion on human health and well-being; in amplifying the voice of marginalized groups in this regard; and in more forcefully connecting environmental and climate justice to social justice (Masuda et al., 2010). This will require a more explicit alignment in solidarity with indigenous groups and allied social movements, a willingness to value other ways of knowing (Brown et al., 2005; Bopp and Bopp, 2006), and a willingness to reach out to other perspectives and fields of enquiry such as political economy (Carvalho, 2001; Coburn, 2004; Navarro, 2009), political ecology (Elliott, 2005; Robbins, 2004; King, 2010), ecofeminism (Littig, 2001; Salleh, 2009) and ecosocialism (Kovel, 2007). In this sense, we argue for a shift in root metaphor for health promotion from ‘helping’ to ‘bearing witness’ (Poland and Holmes, 2009). This would move the field much closer to critiquing existing social structures that impact environmental health and justice and for sociological sophistication about how contemporary social relations resist an ecological worldview and lifestyle—both of which are preconditions for ‘a sense of the possible’.
A second direction is a strengthening of engagement with local or settings-focused ‘ecological habitus work’. This imperative flows from our assessment of settings-/place-based movements and collectives as ‘communities of practice’ for generating knowledge about ‘living well in place’ and helping members integrate that into practices of daily living. It is beyond the scope of this paper to explicate this direction in detail, but a starting place can be found in the five components noted above for an ecological praxis. We would also point to connections to existing veins of practice with an established history in health promotion. One strong point of connection is the settings approach with its focus on the contextual nature of practice [e.g. (Chu and Simpson, 1994; Dooris, 2006 and 2009; Poland et al., 2000b and 2009)] and its strong history of work in communities [e.g. (Hancock, 1988)]; cities [e.g. (Kjellstrom, 2008)], workplaces [e.g. (Chu et al., 2000)], health services [e.g. (Pelikan, 2007)], schools [e.g. (Davis and Cooke, 2007)], universities [e.g. (Orme and Dooris, 2010)] and prisons [e.g. (Gatherer et al., 2005)]—as well as recent attention to the potential for working across settings (Dooris, 2004; HCC, 2010). In our recent review of settings-based approaches to local sustainability work (Poland and Dooris, 2010), we articulate six core principles: adopt an ecological ‘whole system’ approach; start where people are; root practice in place; deepen the social analysis; build on strengths and successes; and build resilience. We would reiterate that working locally to build resilience in the face of the triple threat means investing in community development as an arena of practice for health professionals (Butler and Cass, 1993; Labonte, 1993; Poland et al., 2000a; Germann and Wilson, 2004) and resourcing the development of collaborations with groups in other health and non-health sectors (Singer and Kegler, 2004; Poland et al., 2005a).
Our third direction is a paradigm shift away from an approach to health based on risk management (anchored in classical scientific apparatuses of surveillance, epidemiology and causative aetiology) towards ways of thinking and acting that reflect the complexity, emergence and interconnectedness that increasingly informs our understanding of contemporary issues.
Although upstream efforts to address social determinants of health are informed by the social sciences and a portion of the health promotion enterprise is anchored in qualitative methods and other ways of knowing, such work is not the mainstream of what is taught or funded—and, further, much qualitative research remains oriented to informing programs addressing individual behaviour (Poland, 1992). If the risks are socially produced as the triple threats are, they cannot be managed at the level of individual behaviour. More specifically, the limitations of a risk management approach in an increasingly uncertain and rapidly changing world, and its close alliance with ecological modernization and dominant narratives of incremental progress have been noted above.
Our understanding of this dimension is informed by theories of organizational learning and change (Senge et al., 2004; Scharmer, 2009), adaptations of complexity science to understanding social change and social movements (Westley et al., 2006), dialogical methods (Tandon, 1981; Isaacs, 1999; Labonte et al., 1999; Holman et al., 2007), work on the new cosmology (Swimme, 2001, 2008), indigenous ways of knowing (Elliott, 2005; Berkes et al., 2000; Smith, 2007; Kavach, 2010) and new ways of understanding the human story and our connection to the natural world (Harding, 2006; Hathaway and Boff, 2009). Specifically, we refer readers to a wonderful new book by Peggy Holman entitled ‘Engaging Emergence: Turning Upheaval into Opportunity’ (Holman, 2010). Drawing on complexity science, Holman describes emergence as ‘order (self-organizing novel coherent structures) emerging from upheaval and chaos’ and describes approaches, principles and practices for engaging creatively with the latent opportunities present within disturbances that threaten to undo conventional thinking and practices. Drawing on approaches such as Appreciative Inquiry and Open Space Technology, she emphasizes context-sensitive ways of working with groups to manifest collective wisdom, insight and emergent clarity about new ways of thinking and acting in the presence of system disruptions and apparent breakdown. Given the likelihood that the coming decade will be characterized by accelerated change, disruption to accepted ways of thinking and to systems of food and energy production associated with the triple threat, the book is a timely invitation to step out of old ways of approaching risk (as something to be ‘managed’ through linear incremental progress) and into new ways of engaging emergence and working with discontinuous change in profoundly democratic and dialogical ways. The book is also a very practical manifesto, full of tips and advice without being overly prescriptive. It aligns well with recent work on sensing and helping ‘midwife’ the change that ‘wants to happen’ [see (Senge et al., 2004; Westley et al., 2006; Hathaway and Boff, 2009)]. One of the intriguing aspects of Holman's work [and that of (Scharmer, 2009)] is its potential to bridge two of the models of social change presented earlier by linking upheaval and disruption (which catalyse and provide an opening for change) with intentional proactive collective engagement (to accelerate culture change and co-invent its operationalization into practice) in ways that strengthen community, build new partnerships and shift culture.
To meaningfully address the interconnected challenges of environmental degradation, climate change and peak oil, as well as their effects on health and social inequality, will require reconsidering the practices of the field of health promotion. So far, health promotion has not sufficiently addressed the key role of the environment as a mediating factor of the social determinants of health. Nor has it developed a robust theorization that explicitly bridges health promotion and environmental justice [but see (Howze et al., 2004; Schulz and Northridge, 2004; Buzzelli and Veenstra, 2007; Masuda et al., 2010) for notable exceptions]. In this paper, we have proposed means to do so, rooted in sociological adaption of the health promotion orientation to supportive environments.
First and foremost, healthy ecosystems are a foundation for supporting human health at individual, community and global levels. As summarized in Fig. 1, the triple threats of ecological degradation, climate change and peak oil pose threats that cross each of these levels; their health impacts are already becoming visible. Second, despite the welter of trans-disciplinary data about these threats, we see resistance to addressing them. This can be expected to exacerbate health risks for the near future, as well as health inequities. The central question is how to avoid serious societal crisis and civilizational collapse while engaging in a positive process that squarely faces the socio-ecological and environmental justice challenges.
To meet these challenges, we presented an approach to creating supportive environments that drew on Bourdieu's theory of practice, noting how an ecologically sound habitus is anchored in social context and requires social fields in which its logic is supported. Without healthy ecosystems, other health determinants pale in comparison. Therefore, we proposed, health promotion would do well to engage three strategies. First, it must be socio-politically engaged on the issue of sustainability. Secondly, it must see development of the orientation to live in ecologically healthful ways as its crucial task for the coming years, which includes something akin to what Hancock (Hancock, 2011) elsewhere in this volume refers to as ‘managing decline’. Thirdly, we suggested a paradigm shift from risk management to finding in upheaval the latent possibilities of reconfiguring social and environmental praxis—the opportunity described by Holman as engaging emergence of new possibilities. With the triple threat of ecological peril poised over global society, health promotion must meet a dramatically new challenge with radically new ways of conceiving and conducting practice.
We wish to acknowledge the contributions of several valued colleagues to the ideas that inform this paper: Paul Antze, Bob Brulle, Chris Buse, Fabio Cabarcas, Francisco Cavalcante, Bethany Elliot, Rebecca Hasdell, Kari Norgaard and Cheryl Teelucksingh.