Andrea Ubiali
Economic growth has produced – throughout history – enormous benefits in terms of quality of life and innovation, albeit distributed in highly unequal ways. Today, however, the uncritical pursuit of perpetual growth is no longer sustainable and risks leading us to ecosystem collapse.
The current debate on the climate crisis is increasingly affecting the medical-scientific community which, to an increasing extent, is becoming interested in themes and topics that could traditionally be considered marginal or even excluded from the interests of the healthcare sector. It is in this context that Richard Smith, former editor of the BMJ, publishes an article focused on the theme of economic degrowth, presented as the only solution (perhaps) capable of saving us (1).
Although the topic of the climate emergency has become in some ways mainstreamsome aspects – including that of degrowth – still remain little known. In fact, arguments on climate change often start from a reductionist approach that focuses on a single element – carbon dioxide (CO2) emissions – leaving the broader socio-economic context of reference in the shadows (2). The excessive focus on CO2 emissions tends to orient the debate around the topic of energy production and consequently the need for a transition that leads to the replacement of fossil fuels with renewable ones, leaving everything else unchanged. The crisis we are facing however is not exclusively a climate crisis due to excessive production and accumulation of CO2, but should be recognized as a multifaceted ecological crisis, in which climate change represents one of many problems, including: deforestation, loss of biodiversity, desertification and land consumption, ocean acidification, environmental pollution, poverty and inequalities, conflicts and migrations. These elements are intertwined with each other and are influenced by the characteristics of our economic system.
In his editorial Smith explicitly cites the work of Jason Hickel, scholar of economic anthropology and author of the book Less Is More: How Degrowth Will Save the World (3), in which Hickel describes the capitalist economic system, explaining that the element that characterizes it is growth. Economic growth is an essential condition for the survival of the system. It has produced – throughout history – enormous benefits in terms of quality of life and innovation, albeit distributed in highly unequal ways. Today, however, the uncritical pursuit of perpetual growth is no longer sustainable and risks leading us to ecosystem collapse. Economic growth is in fact linked to the consumption of the material resources available on the planet, and this consumption is the main cause of environmental and ecosystem damage. Infinite economic growth, such as that required to keep the economic system alive, is not compatible with the physiological limits of survival of the planet. Continuing to pursue growth would make compliance with the Paris Agreement more difficult, if not impossible, and could make the energy transition futile. Since it is not possible to decouple economic growth and consumption of material resources, Hickel describes the idea of growth green, hypothetically supported by renewable energy alone, like a mirage, from which political decision makers should quickly move away to look for alternative strategies (4). The alternative would be to abandon growth in favor of de-growth or post-growth models. Scenarios of this type have already been described at a theoretical level and in some cases tested at a local level (5, 6). The formulas proposed for degrowth may vary depending on the theoretical framework proposed, but what the different models have in common is the tension aimed at achieving economic well-being contextually to social and environmental well-being, rather than to the detriment of them. The use of a single and obsolete indicator such as GDP is rejected, in favor of the use of multiple indicators that more adequately account for the complexity of reality and planetary limits. Furthermore, the idea of growth is replaced with that of a fair and just redistribution of resources and their more democratic management.
The idea of degrowth risks being unpopular and politically unappealing, especially if presented by associating it with concepts such as: sacrifice, renunciation, deprivation. Renunciation is indeed a key component of degrowth, but upon closer inspection it is eminently the negative and deleterious aspects of the current economic system that we are asked to renounce, primarily the extreme degree of inequality that characterizes the current distribution of wealth global (7). There is no need to grow when the resources necessary to satisfy our needs already exist. Our problem lies not in the production of wealth, but in the distribution and access to resources. Furthermore, in Hickel’s proposal some sectors of the economy should be considered ecologically harmful and should be limited. The sectors we should at least partially give up include: the defense and fossil fuel industries, fast fashion, the junk food sector, planned obsolescence products, the private car, SUV and aviation sectors, marketing and advertising. The downsizing of these sectors should be adequately accompanied by social policies for employment, which guarantee protections for workers in the sectors undergoing downsizing, with the possibility of being re-oriented towards other socially and ecologically useful sectors.
While some sectors of the economy are being scaled back, others need to be strengthened and expanded. These sectors coincide with the main public services (8).
Healthcare e instruction they should be universal and free. Many European countries already follow this model, which should be strengthened and adopted everywhere.Limit the number of residential units that a private individual can have – with the obligation to sell surplus properties – would lead to the placing of new housing units on the market, with a positive effect on lowering prices and the possibility of access to the house. It would also be easier for municipal institutions to expand their stock of public housing which could be quickly made energy efficient and subsequently made available for rent at popular prices. public transport It should be of high quality, efficient, sustainable and available free of charge or at the lowest possible price, to minimize dependence on private cars. food system, burdened by problems such as the spread of ultra-processed and health-damaging foods, supply chains dependent on plastic packaging and long-distance transportation, energy-intensive production systems, monocultures and factory farming, it could be transformed through state justice programs food in a system that guarantees universal access to nutritious and predominantly vegetarian food, based on regenerative agriculture, with predominantly local production and consumption.Water ed energy they should be managed as public utility services, with a two-level pricing system: a portion of energy and water should be available free of charge to satisfy primary needs. Additional usage above quota may be charged at a progressive rate to discourage excess usage. The public energy system can also be geared towards rapid decarbonisation, while rules governing the water system can be used to prevent over-extraction by private companies and ensure a stable and equitable supply, even during periods of drought.L ‘internet access it is necessary for daily life and should be considered as a public utility. A basic monthly package should be available for free, with additional data and other services available at market prices.
The added value of having universal and efficient public services consists in the fact that they can guarantee access to essential goods for the entire population, with a production and supply system that requires less aggregate consumption of energy and material resources, and which responds to greater democratic control.
But how can these services be financed? The traditional answer is that paying for public services requires first higher GDP growth: increasing the production of (unnecessary, or potentially harmful) goods or services, then taxing the revenues from that production to finance public production of essential goods .
In reality – says Hickel – there is no reason why public production should rely on funding from previous private production. Any government that has sufficient monetary sovereignty can directly mobilize public production, simply by issuing public financing to do so. As Keynes pointed out: whatever we can actually do, in terms of productive capacity, we can pay for (9). And when it comes to productive capacity, high-income economies already have far more than they need. The deployment of public finance simply shifts the use of this capacity from business to the public, where it can be used for democratically ratified social and ecological goals, rather than for capital accumulation.
Hickel concludes by stating that the global environmental movement should make these demands its own, which have the advantage of simultaneously taking into consideration the needs of the planet and the concrete needs of people. This element could represent the key to a fruitful alliance between the ecological movement, trade unions and the working class, which would give greater strength to everyone’s requests. The health sector, for its part, cannot fail to recognize the fact that these demands follow very closely the recommendations formulated long ago – although never actually implemented – by the WHO Commission on Social Determinants of Health (10), aimed at redress inequalities in health through transversal action on all the main determinants of health and an equitable redistribution of money, resources and power. In this sense, the healthcare sector should also side with this alliance, to sign and support the exact same demands.
Andrea Ubiali, public health specialist, Bologna
Bibliography
Smith R. Perhaps only degrowth can save us. BMJ 2023; 382 :p1545 doi:10.1136/bmj.p1545Deivanayagam TA, Osborne RE. Breaking free from tunnel vision for climate change and health. PLOS Glob Public Health. 2023 Mar 9;3(3):e0001684. doi: 10.1371/journal.pgph.0001684. PMID: 36963098; PMCID: PMC10021701.Hickel J. Less Is More: How Degrowth Will Save the World (2020). ISBN: 9781786091215Hickel, Jason & Kallis, Giorgos. (2019). Is Green Growth Possible?. New Political Economy. 25. 1-18. 10.1080/13563467.2019.1598964.Raworth, Kate (2017). Doughnut Economics: Seven Ways to Think Like a 21st Century Economist. Vermont: White River Junction. p. 254. ISBN 9781603586740Velotti L. Ecosocialism and degrowth: let’s talk about it. Jacobin Italy. inequality knows no crisis. 2023 J. Universal public services: the power of decommodifying survival. https://www.jasonhickel.org/blog/2023/3/18/universal-public-servicesJohn Maynard Keynes: How Much Does Finance Matter, 1942.World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health – Final report of the commission on social determinants of health. 2008. https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1