Sharon Friel  0:03  
So delighted to join the conference. A marvellous, marvellous event. I'll begin by acknowledging that I'm on the unseeded lands of the Ngunnawal and Ngambri people and pay my respects to Elders past, present, and emerging. So what we're going to speak about today is planetary health equity and particularly a focus on how to exit what we're referring to as the consumptogenic system. I'm Sharon Friel from the Menzies Centre for Health Governance at the Australian National University. I'm joined by wonderful colleagues, I'm just going to give a few opening remarks in a second and then we'll move into panel mode, where I'm joined by colleagues, Professor Steve Allender from Deakin University, who's going to speak about a systems approach and why it's so important and we've heard about that already today. Professor Fred Gale from the University of Tasmania, who's going to speak about the political economy, which is really fundamental to everything that we're talking about it, followed by a professor Fran Baum from Flinders University, who is going to pick up the issue that's already been flagged around the commercial determinants of health, also be joined by Professor Kathryn Bowen from Melbourne University who is going to take us into the international institutions space. And then Lucie Rychetnik from Australian Prevention Partnership Centre, is going to tell us how we make action happen. But really just picking up on the issues of the key change-makers. So it's a very broad eclectic sweep of issues that we think are fundamental to addressing the consumptogenic system because this is what happens if we don't address the consumptogenic system. This is the illustration from New Orleans for nearly 2000 people lost their lives. Oops, too much to go just yet. But what New Orleans was showing was not just about climate change and the increased frequency intensity of hurricanes, but really shining a light, a spotlight, on the social fault lines in the US. And of course, the inequities, the social inequities, interacting with something like Katrina really playing out for populations who were more socially disadvantaged, who didn't have access to transport, to escape, and who generally were living, in living conditions that you can see here from the Ninth Ward, which were already bad for their physical and mental health, and then on top of that, we put to climate change. So that's what's going to happen, that's happening to us here in Australia, is happening all over the world. And unless we do something about the consumptogenic systems, that's just going to get worse. So what do we mean by this idea of the consumptogenic systems? So, the various solvers who are on the panel and others in the audience have been part of thinking about these issues, we've put a large expression of interest into the ARC for a Centre of Excellence around these issues. But what we consider a consumptgenic system to mean is this web of social institutions, of public policies, of business, practices and models of ways of governing, of social norms and values of those power inequities, those power relations between the various different actors and sectors that are involved in such a system, which absolutely incentivise manufacture, reward, encourage, ways of being and the generation of excessive production and consumption of these fossil fuel ways of being, ways of living ways of, marketing selling of goods and services, that absolutely are not good for the planet, really bad for our health and are fairly unequally distributed. So that's what we mean by the comsumptgenic system. It's not just what you and me and others put in our mouths. So the way that we live our life, it's the big systems of production and consumption. So fundamental to that system, are these issues of power, which are around interests, different interests, different ideas, discourses, and institutions. And this is drawing on political science literature to try and understand what's deeply embedded within this cmsumptgenic system that I'm referring to. So just a little illustration of what's happening and we're going to pick up on these points when we get into the panel discussion. So the Carbon Majors Report, so the 100 top producers, fossil fuel producers, you can see listed here. The data is a little bit old, but we heard all of this discussion through the COP. So accounting for about 70% of global industrial greenhouse gas emissions, but it's really, really concentrated. These data at the time, there were 25 corporates and state owned fossil fuel entities that were accounting for about half of global industrial greenhouse gas emissions. So very strong commercial interests in this space. Investment, I think, is really the main game is, and the big money managers are right in there in that fossil fuel space. These are some of the largest money managers in the world. And of course, it's now moved into the trillions, not just the billions, but there have been developments. BlackRock has started to signal that they will be moving their investment portfolio away, we'll wait to see if that actually happens. But remember, those three names are up there on the screen BlackRock, Vanguard and StateStreet Corporation. Because they're there in the food system. So within the HEAL network we'll be speaking about food security, food systems, healthy and sustainable food systems. The fossil fuel investors are also the investors in the food system. And the food system as the industrial food system, as it is currently made up, we know is contributing to a very significant problem in terms of malnutrition, and in terms of global greenhouse gas emissions and a whole lot of other biodiversity issues. So I said investment, I think is there a big issue, a big strong interest right there in the consumptogenic system that is influencing what happens in fossil fuel industry within the food industry and there's a whole load of other areas. And we'll speak about the commercial determinants in the panel. So that's some of the interests and these interests are all about creating and normalising hyper-consumption, because otherwise they don't make any money, they don't generate new markets, they don't generate and they want to generate new products, new commodities and new services. So it's all about trying to market, trying to normalise, trying to create demand for more and more stuff: fast food, fast fashion, etc. So the idea of consumption gets implanted into our brains. And of course, there's a parallel session talking about some of these issues at the moment. And then in terms of institutions, so we want coherent multi-sectoral policy. If we're going to do anything about climate change and health inequities, planetary health inequities, this bi-directional relationship it's not just about health policy. It's not just about climate policy. It's about economic, it's about social, it's about foreign policy, as well. So we need the institutions and the policy settings to be in place for that. And I think we've saw, what we saw in COP and the deliberations already today tell us that, certainly here in Australia, our institutions are not aligned in a way to do anything about this system. So we've got governments so reluctant to implement policy because of this pervasive paradigm idea of the market, of just go out and educate people and it's their responsibility. They chill right back from do nameless thing that's going to annoy their constituencies or their voters. We've got business opposition that absolutely is lobbying and resisting the implementation. We saw that, again, at COP and then also, what we hear is there's a quiet demand, if there's any demand for government action from the public and from civil society, but Mark Howden reminded us earlier that actually in Australia, the public is demanding action. So it's that alignment of these things together. And that's creating such a problem. That is an alternative, of course, there's an alternative, what might sustainable, healthy and equitable consumption systems look like, which is what we're interested in. Consumption isn't going away, production isn't going away, it just needs to be done very, very, very differently. And what **Robert Stoller** economic has pointed towards is what a system could look like that keeps us within that ecological ceiling with a strong social Foundation, which is vital for the social justice, social equity and health equity concerns that we're speaking about. So that was a whirlwind tour of what comsumptogenic system might be, that we think comprises, it's really about the politics, it's really about all those contested interests, that vested interests, and the ideas, the ideational, the discursive ways of making us be within society, and the institutions that are set up or not to advance an alternative policy option. So we're going to move into the panel. And I'm going to ask for Steve and Fred and Fran and Kathryn and Lucie to obviously make sure you've got your videos on. I don't have a way of doing spotlighting, so apologies for that. Let me stop sharing my screen. And so I'm just going to go in order as I had them up in the screen. And I've asked each of the panel members just to take no more than 3 minutes, because I do want us to try and have a bit of a run up at 72 participants so we might struggle to have a very engaged discussion, please use the chat function, anything and everything in the air. So Steve, over to you: why a systems approach?

Steve Allender  12:14  
Thanks, Sharon. And it's a real pleasure to talk to you from Wathaurong country this afternoon. I'm going to preface the why systems approach based on my background, particularly in health. And in health, I think we've known for a long time that the causes of chronic disease and other health problems are complex. And by that we mean things things like heart disease, obesity, diabetes, are actually a result of the interplay of multiple elements, you know, genetics, diet, level of activity, environmental exposure, among other things. And as we heard Sharon talk about those different important drivers of climate and consumption in the last talk, they're all really important and really relevant. But as with health, I think similarly, until recently, the way we deal with complexity is to adjust for it and design it out of our studies. So if we can randomise everything out apart from one intervention, we can see the effect of that one intervention. And that's fine until you try and take that highly controlled experiment and apply it outside of a tightly controlled environment. And what we've seen in health, and I think what we've seen in other realms is that as soon as you lose that fidelity of delivering intervention with tight control, what happens as a result very significantly, and if you took malaria as an example, it's fundamentally preventable. If you take the malaria tablet at the right time of the day. And the right dose, that's not the question. The question is, how do you ensure people are taking the dose, the dose gets to the person and they take it. Or similarly, in obesity, we know how to prevent obesity, we don't, we know what to do to prevent obesity, we don't know how to make that happen, how to create the system that that's easy to happen. So more recently, our work looking at the Global syndemic of obesity has shown that malnutrition in all its forms is impacting on our human environments, and vice versa. And it's a complex interplay of multiple relationships of consumption. And so more recently, we've moved to this idea of using systems thinking, which embraces this multiple intersecting drives and this complexity to use that as the basis of the design of a solution. So instead of pretending we're going to focus on one exposure, one outcome, one driver, one outcome, we're actually trying to take the whole lot, consider what's important and use it as the starting point for addressing our problems. So the quarter system science, from my point of view, and from many point of views, is really deliberately and actively trying to place the rigours of science, a scientific method to understand that complexity and use it as the basis to embed solutions. It's just critical to say that's further tempered by engaging participants at all level of a system in that work. So to understand the points of intersection, where we intervene, how the delivery should look, how we have evolved our efforts to improve a problem need the members of that system as a part of it, and that can mean Federal Cabinet but it also means the citizen who has a vote and everyone in between. And I think that speaks a little bit to what Mark was saying about community interest and action. So what one of the things we're working hard on is evolving the processes and tools and people on the call now of the sticky software, we've invented as one example, which are tools to help people join together to understand the complexity, find those points of intersection, and see what's possible, relevant and impactful for them to act. And so a key characteristics of systems thinking and system dynamics, which is where our thinking is generated from is to gain an operational understanding of why problems occur, so that the solutions are meaningful and impactful and also feasible. So that's a very top level summary of why systems thinking. But our hope starts to point to ways we might consider that complexity and use it in our response instead of ignoring it or panicking about.

Sharon Friel  16:09  
Brilliant, Thanks, Steve. I've never heard a better explanation of systems thinking in three minutes. That was awesome. So Fred, so we've got this complexity. Tell us all about the political economy, why we've got to embrace the Political Economy approach to this.

Fred Gale  16:28  
Thanks, Sharon. So yeah, so we have a consumptogenic system, which is visiting endless harm on individuals and the planet. And I think it's widely accepted that we need to take action. The question, of course, is, what action should we be taking, and how, in a sense, radical, should we be thinking. Political economy is a discipline which purports to understand what wealth and value is when it comes to material culture, and to give advice to society at large and of course, governments in particular, as to what they need to be doing, to create wealth. And the history then, of political economy is quite interesting, because there have been a diversity of ways of conceptualising not so much what wealth is, although there has been debate about what wealth is, but the meaning of value, and the institutions that are required then to deliver value. And we can go back to Adam Smith, in the Wealth of Nations in 1776. And if you are moved to read Adam Smith, and you don't have to read the entire tone, but you could just read the first few chapters, you'll be struck by his identification of three, three basis of value, three basis of economic value, these are: use value, the values that things have because they are useful; labour value, the value that things have because Labour has been embodied in them; and, of course, his own in a sense, preferred concept of value, which is exchange value, the value that things have because they have power to be exchanged for other things. And the history of political economy in the 19th century was a vigorous debate then around which of these values should should be embraced and become hegemonic in a sense, and which should be de-prioritised. Of course, in modern liberal democracies, we've ended up very much endorsing exchange value as our understanding of what things have value. Simultaneously, we had a whole discourse in the ecological literature around what might be of value from an ecosystems or ecological perspective. And without going into any detail on that, we can kind of tease out the underlying idea in the ecological literature as something called function value, that is the value that things have for the function they're performing within the system in which they are operating. So in a nutshell, I think what we have is a pluralism of value out there in terms of ideas. But we've actually got institutions that are reducing that plurality down to a single conception of value within liberal democracies, which is, what value is, is exchange. Those people who can generate exchange value or to be validated and admired and encouraged, and those that are kind of suggesting that there are other things going on that we need to be paying attention to are marginalised. So I think the task for thinking about the consumptogenic system, from a political economy point of view then, is to bring these other values back in, not in, not to deny that there is something called exchange value, that would be perfectly silly. But to suggest that, in addition to exchange value, things have other values. And this then goes back to Steve's comment that, to me suggests a much more participatory, deliberative discussion around what might have value when people are making either individual or indeed, collective decisions. So I'll stop there.

Sharon Friel  21:23  
Lovely, thanks Fred. And Fran, of course, the commercial determinants are all about trying to keep that particular focus of value, and they do it. Do you want to tell us a bit more about the commercial determinants?

Fran Baum  21:37  
Yeah, thanks, Sharon. And hello, everybody, I'm speaking to you from **Ghana** land. And in public health in the last probably five years, the commercial determinants of Health have really come to the fore, and more and more people are paying attention to them. And I think that probably started with our roots in looking at the tobacco industry. And of course, that's been an amazing success story where we've reduced smoking in males, for instance, from 72% at a peak now to about just over 12%. So and that was largely done by looking at tobacco industry tactics and how they were shaping people's smoking choices, and then disrupting those by a whole range of different methods. And in recent years commercial determinants have looked at the fast food industry as well. But as the sort of discipline of public health has defined social determinants, it's taken a much broader look. So in a paper that's forthcoming in The Lancet, led by Anna Gilmore, we've defined commercial determinants as the systems, practices and pathways through which commercial actors drive human health and health inequity. So that's massive. And when you think about it, commercial actors can be anything from people say informal sellers in a township in South Africa, right through to massive, transnational companies. And it's really, in terms of the work I've done and I think in in terms of the climate, is there's transnational corporations that are making a huge impact on our health. Of the 100 largest economies in the world, 71% of them are transnational corporations. So that's a massive amount of power. And in health, we've begun to look at the kind of whole lifecycle, if you like, of a corporation, how do they lobby governments. And we know that, for instance, the carbon tax was very much removed from public discourse because of lobbying from the mining industry, that was a massive effort on their part through that industry groups to do that. There's also much more talk of taxation and how many corporations avoid tax and now governments are moving to do something about that. But that very clearly is one of their practices. And in public health would say, Well, look, because that money's been taken out of the public purse, we can't spend that on public good. And that's a really important calculation. And then, of course, there's all this sort of products that are produced very often fossil fuel industry has an obvious impact. But it's looking at the way in which they exert political influence the way in which they'll have different occupational health and standards in different countries, depending on whether they're strict, so when we compared South Southern Africa with Australia, was very clear that the same company, Rio Tinto, was a being much more strict occupational health and safety legislation than they did in southern Africa. And then I think, come, Sharon has pointed to the sort of less obvious commercial determinants in terms of investment fund managers, and I think we also see that in terms of how the big international transnational consulting companies are really infiltrating government through outsourcing of policy by governments, which in turn, really reduces the code, the scope for public sectors to. Sorry, I had a timer on and it won't stop. Yeah, so I think that has. Ah! That's it. No, it's not. Sorry about that. It stopped. That's another commercial determinant of health: Apple. I think they're controlling our lives. So there we go. So just finally, I mean, there is business can be part of the solution. We've seen that to some extent in this country where the hands of the government is forced by this business. But sometimes that sustainability can be either greenwashing or health washing. But the main point is that these commercial determinants are really dictating much of what happens to climate change and public health. So I think for any research programme, they need to be an increasingly central part of how we actually change those practices and regulate and controlling.

Sharon Friel  25:56  
Lovely thanks Fran. And that touches on one of the questions in the chat from Christie, who is asking about the role for government in legislating against advertising, for example, absolutely part of the suite of government responses to counter some of the issues that Fran has spoken about. So Katrhyn, Fran shown us, has spoken about these, you know, the transnational corporations as a key player and interest in this consumptogenic system. You've done an awful lot of work within the UN system. Do you want to maybe just give us some reflections as to how these international organisations, institutions, can play a role or do play a role in addressing this connection with climate change and health inequities?

Kathryn Bowen  26:48  
Yeah, thanks Sharon. And apologies, I may have an interruption as well, similarly to Fran but my dog: she's slightly anxious at the moment. So fingers crossed, I'll be fine. But yeah, I thought I'd just share some reflections. And I'm coming from the lands of the Boonwurrung people, so I'd like to yeah pay my respects to their Elders past, present and emerging. And so really, the reflections I thought, provide today a three main reflections. And I hope to do that nice and quickly. So we can have some time for discussion. So when I was thinking about the role of international agencies, I was also thinking the role but what do we need to understand in terms of international agencies. And so my reflections are particularly on my work, as Sharon said, with the UN, so a variety of UN agencies, including the WHO UNDP, UNEP, as well as multilateral development banks, so what we call the MDBs. So this is the Asian Development Bank, the World Bank, the African Development Bank, but also really important international agencies that we need to be considering as well with our research is international, non-government organisations as well. So I just thought, using those agencies, and there's obviously more than that, but at least that provides a good basis for these reflections. So the first one is that, that international agencies are key partners of ours, as researchers, they're really, really important to work and collaborate well with. And this really relates to the point around co design, and I'm sure we're all familiar now with this term co design and how important it is to genuinely and effectively work with all of our partners. And in this case, my experiences with predominantly international partners. We're getting better at this this CO-design element of working in research, but there's still a long way to go. So I think that that's one of the areas that it's really important for us as researchers to make this a central element of the work that we do. It's no longer about researchers coming to agencies at the end of their projects and talking about the work that they've done. It's actually about talking about the priorities of the different actors we might be working with, up front. And that's a really important principle that guides my own work. And I've seen the change over the last 20 years to this to using co-design as a central element. And I've I really do feel that this changes the experience and the impact of our research on public policy. So the second point I would note is the importance of understanding that there are competing priorities for these international agencies. So they're not just dealing generally on one issue, they're dealing with a multitude of issues. So it's really important that we're very clear on the message that we are delivering so that this cuts through. Because there's always competing interests, which we've talked about vested interest, that's obviously a key concern as well. But if we just look at health, we know that health is siloed so firmly: it's women's health, it's HIV/AIDS, it's TB, malaria, it's reproductive health, all these silos. And from my experience, anyway, bringing in climate change into that siloed approach has been a really big challenge. So it's about really being clear on our message and making sure this cuts through. And they'll, international agencies, will all and with most partners, will always want to know what difference will the work make. And this also links back to the importance of co-design. So in order to really support the listening and those conversations that can be had, it's really vital that it's clear what the difference is that the work will bring. And what are the points of collaboration and connection between the research you might be doing, and the interests of international agencies. And then my third and final point is around policy and programmatic windows of opportunity, as we call them, really. So it's important for us as researchers to be, you know, linked into the real politic of funding cycles and programme design timeframes. It's not. There's my dog, it's not severe. Luna. I might have to put her outside in a minute.

Sharon Friel  31:35  
Just doesn't agree with what you're saying.

Kathryn Bowen  31:38  
She's a stubborn one. Um, it's just, I think, hang on, just put her outside. All right, this is live working from home. So yeah, it's not sort of sufficient or good enough to expect agencies to work to our timeframes as researchers. We need to be really clear and aware of what the timeframes are that these agencies are working towards, and be strategic with when we present our potential research ideas. So that, they all my three, three main points, but then I did have one final point I added at the last minute, and that was all around, it's the role of international agencies and the potential of getting our research perspectives in their, on their radar, also is dependent on their leadership. So who is in charge? What are their values? And this links to what Fred was saying, as well, and what agency do they have to make a difference? And this is your point earlier, Sharon, around institutions aren't set up for transformational policies. And that's generally the case. But it's, it also depends on who who is at the helm of these agencies and really, that makes a big, big difference. Thank you. 

Sharon Friel  33:00  
Lovely. Thanks, Kathryn. And that sets Lucie up fairly nicely. So Lucie, ah Kathryn's been pointing to these, a number of principles and practical considerations in taking forward to, not just this research agenda, but this action agenda. You've done a lot of thinking about that whole space of knowledge translation, how are we going to solve it? And it relates to some of the points that I just said, you can back onto camera there, you're talking about leveraging COVID and how, like, you're just kind of shifting that value that we embrace, not just in Australia, but globally around sort of the market economy, and how to use COVID. So Lucie you're going to tell us how to do that, aren't you?

Lucie Rychetnik  33:51  
Hi. Hello, everyone. Hello from Dharawal Country. I guess I thought it would be useful just to share a few examples of some change makers, and it reflects back to what Steve was saying about the need to really focus on the system. I think we've long realised that both in health and in climate change, we need to move away from that focus on individual behaviour, and really start looking at the structural drivers and start changing the systems around us. So I just wanted to put it into; I might just put actually put some links into the chat so people can follow up and have a look at a bit more detail. But the first one is the Climate and Health Alliance, as you know, they've been around for about 12 years as a major movement-building an advocacy group and they've been working with health care without harm on the global green and healthy hospitals. And the work there really is a focus on transforming health systems. And this town said, you know, the health system really needs to recognise that we're part of the problem, so I think it's really important to be able to do that. And the other one that's worth looking at, I thought is the Ellen MacArthur Foundation: they're really looking at working with industry, as partners, to transform industry and business so that they become more circular, thinking in terms of the circular economy so that moving away from that sort of take it out, take the resources, make something and then throw it away. That they call it the take make waste system. And to really focus on something that's much more regenerative. The other group is C40. That's looking at cities. And they've got 90, even though it started off with 40 cities or just the name, then they have 97 cities involved. And it actually makes up about 25% of the global economy in terms of population. So really substantial group. And the final one, there is the Donut Economics Action Lab. So Sharon shared with you, Kate Ray with concept of the donut. And Kate Ray was actually, came from Oxfam before she became an academic. And so she's very much focused on implementation and practice. And she was really working with her team thinking about what, how do we actually create change? It's nice to have this conceptual theoretical diagram of the donut. But how do we get that implemented. And so she set up this Action Lab about a year ago, a year and a half ago, which is really about demonstrating that it's possible to implement the concept of the donut, within cities and within countries. And I guess the thing like my reflection is that some of these groups that are really creating change, their networks, their partnerships, their alliances, and they're focusing on creating systems change, some of them, many of them are international. And I think that bodes well for HEAL. I think now HEAL is a network, it's a partnership, a lot of the money will go towards supporting infrastructure and networking and collaboration. So I think I'll finish with that. I think that's the sort of real key to creating change, is to work in collaboration and actually focus on changing the system around us.

Sharon Friel  36:58  
Thanks, Lucie. Some brilliant pointers in the chat from Lucie there. So I suppose, I hope what this session has done is really to, we haven't been able to get into all of the details of what is a huge agenda. But it's pointing really, I think, to one that is no silver bullet. To, we cannot take a micro-reductionist approach to addressing climate change and health inequities, we have to really pay attention to these macro-structural systems based issues. And all of that is a long game. It's both incremental as well as trying to create systems of transformation, I think. I think it's a political struggle. As soon as you talk about climate change and health inequities is absolutely political. If you want to hear a beautiful talk about the power of the people, a plug for France talk tomorrow in a webinar with us at the ANU at 1230 tomorrow and about the role of people power, and addressing some of these, exactly these sorts of issues. I hope it's giving you a flavour of some of the opportunities for action, whether that's through like the deal, the donut Economic Action labs, taking a systems approach that Steve has spoken to, and then thinking about how do we analyse the political economy, the commercial determinants, so a whole suite of activities for us going forward. So this really is just an invitation to join. If you're interested in these sorts of things. Please reach out. There are many of us on this particular session who are very actively engaged with it and we'll be continuing to do so.