“Do the Math” for Population Health?

By David A. Kindig, MD, PhD

In recent weeks, I have been paying close attention to policy dialogues sparked by Hurricane Sandy. So when I heard Bill McKibben was bringing his Do The Math tour to Madison, I had to be there. The event made quite an impression on me, both in terms of packaging the argument for divestment in fossil fuel stocks, but even more particularly how McKibben has moved dramatically out of his academic comfort zone – understandably driven by his palpable fear that without action our planet will become uninhabitable within a few generations if not sooner.

McKibben is an environmental activist, who at age 27 wrote the The End of Nature. During his presentation he reflected that at the time, he thought a book was all that was needed to spark change. He now recognizes that while academic contributions are important, they’re not necessarily sufficient for social change.

McKibben has devoted himself to this work. He’s not a rock star type (even though the tour has all the elements, including a huge bus, high quality graphics, music, and videos from famous people like Desmond Tutu); this does not seem to be his comfort zone. He seems a bit uncomfortable in the limelight, and dresses very casually. He says he would rather be typing than touring the country.

The morning after attending the presentation, I awoke at 4 AM thinking about key elements of McKibben’s work and contemplating their relevance to broad population health challenges. Here’s what he’s done:

He has boiled down the evidence to clear Do the Math metrics

“It’s simple math: we can burn less than 565 more gigatons of carbon dioxide and stay below 2°C of warming — anything more than that risks catastrophe for life on earth. The only problem? Fossil fuel corporations now have 2,795 gigatons in their reserves, five times the safe amount. And they’re planning to burn it all — unless we rise up to stop them.”

He is trying to build a popular movement. In his case, he is drawing on both on the energy of young people, but also calling on elders and those with tenure to step up and lead with acts of civil disobedience that may carry more risk for young people (such as being arrested protesting the tar sands pipeline). He has enlisted scores of partner organizations across the country to join in the movement.

He has identified a specific action that may foster mobilization: urging universities and churches to divest their fossil fuel stock holdings so that the reserves aren’t burned. He likens it to the moral imperative that stimulated divestment in South Africa decades ago.

He has gotten out of his academic comfort zone, organizing this certainly exhausting bus tour across the country to draw attention to the movement.

Time will tell if this approach will be effective for climate change. Even if the answer is “yes,” I wonder whether the challenges we face broadly with respect to population health improvement can be addressed in this manner.

As complicated as climate change is, there is only one primary determinant – CO ₂ and related greenhouse gases.  Without underestimating the challenge of addressing climate change, it’s worth noting that the heavy lift here is on the environmental policy complexities – not on identifying the solutions, which are relatively straightforward interventions such as taxing carbon, developing renewables, and promoting energy efficiency. With regard to population health improvement, we have a double-edged heavy lift, where neither the solutions nor the politics are straightforward. It would sure help if we could boil ours down to a few actionable Do The Math metrics, but we do not yet even have consensus on what our population health goals are.

If divestment proves an effective strategy for climate change, what would the analogous mobilization strategy be for population health? And more importantly, would the cost of confrontation undermine long-term potential for identifying and building upon political common ground? It may simply be that the diffuse nature of population health challenges lacks the economic and moral imperative to spark large-scale social movement.

While I admit I haven’t become a complete McKibben convert (I haven’t yet signed the petition, still pondering the effectiveness of this action and any unintended consequences), I remain in awe of how he has put himself on the line for an issue that intellectually and morally consumes him. His inspiring example helps keep my doubts at bay as I continue to consider what form a similar movement for population health improvement could take.

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.

Comments

[Lauri Andress]

Ideally what we want to do is build a social movement and the elements of that kind of effort are well established.

[Robert Newsom]

David, I was there as well. Given the public and corporate resistance to change and the greed (by all of us who have money in retirement accounts)which makes burning that 2,795 gigatons almost irresistible: I wouldn't lose any more sleep about the effectiveness of this type of action. If it works great; if not then we have at least put our names behind doing something! You used to say "don't let the perfect be the enemy of the good" - sign the petition.