Porritt condemns “dogmatic” decision to axe money-saving SDC

Jonathon Porritt, July 23rd 2010, Forum founders, General, Public Sector

As the former chair of the Sustainable Development Commission, I’m clearly going to be a bit biased about the government’s decision yesterday to get rid of the commission. So I’ve been working really hard to put myself in Ministers’ shoes in terms of the ‘rationale’ they’ve advanced for this reprehensible decision.

They’ve put forward four justifications:

1. It will save money

The SDC costs the taxpayer around £4 million a year, around 50% of which comes from Defra. The rest comes from the Devolved Administrations and other Whitehall Departments – all of which wanted to carry on working with the SDC. As George Monbiot has pointed out, the SDC’s advice on reducing costs through increased efficiency has already saved the Government many, many times that negligible amount, and would have gone on doing so year after year.

2. Sustainable development is now mainstreamed across government

Defra Ministers are now claiming that sustainable development has been embedded in every department. In other words, no specialist capability at the centre is any longer required, simply because the government ‘gets it’.

Like hell it does. To hear Caroline Spelman, Secretary of State in Defra, make such a totally fatuous claim after a few weeks in power is irritating beyond belief. She clearly knows nothing of the constant slog required (of the SDC and many other organisations) to achieve the limited traction that is all that can be laid claim to today.

There’s a rich irony here. The SDC is a UK-wide body. Neither Wales nor Scotland was in favour of getting rid of the commission, no doubt because both countries have done an infinitely better job than Whitehall on ‘mainstreaming’ sustainable development.

3. It will avoid duplication

This is a bit trickier, simply because the SDC does a number of different things. It advises ministers – and there are indeed lots of other people who do that. But rarely if ever from an integrated sustainable development perspective.

It helps countless public sector bodies (from the Audit Commission to the Department of Education, from Local Authorities to Primary Care Trusts in the NHS) to make sense of sustainable development, and no other government body does any of that.

And it scrutinises government performance on a completely independent basis across the whole sustainable development agenda – not just on climate change. And no other body does that.

4. Sustainable development is too important to delegate to an external body

It’s worth recording Caroline Spelman’s actual words here:

“Together with Chris Huhne, I am determined to take the lead role in driving the sustainable agenda across the whole of government, and I’m not willing to delegate this responsibility to an external body.”

Even after nine years working with dozens of government ministers, I’m astonished at such utterly brazen cynicism. The only thing Mrs Spelman has done so far as Secretary of State at Defra is publish a new strategy for the department. This has not one serious reference to sustainable development in it. Such is the depth of her concern.

If Defra’s next step is to get rid of what’s left of its own internal Sustainable Development Unit, then it will have literally no capacity to ‘drive the sustainable agenda’ even within Defra, let alone ‘across the whole of government’. And how can you drive anything if you haven’t the first clue what it actually means? And it just got rid of the only part of the system capable of providing you with a basic primer for beginners?

So let’s not beat around the bush: their justification for getting rid of the SDC is transparently vacuous, if not downright dishonest. This is an ideological decision – in other words, a decision driven by dogma not by evidence-based, rational analysis.

And the only conceivable reason for allowing dogma to dominate in this way is that the government doesn’t want anyone independently auditing its performance on sustainable development – let alone a properly-resourced, indisputably expert body operating as ‘a critical friend’ on an inside track within government.

I don’t suppose the Prime Minister was even consulted about such a footling little matter. But it’s clear that his advisors hadn’t the first idea about the kind of signal this dogma-driven decision sends out, ensuring that his claim that this will be the ‘greenest government ever’ is in deepest jeopardy.

It’s too early to make any definitive judgement about how the green agenda will fare under the coalition. But it’s not encouraging. ‘Greenest ever’ has to mean something substantive. Simply smearing a sickly ideological slime over everything just won’t cut it.

Jonathon Porritt was chair of the Sustainable Development Commission from 2000 to 2009

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Communities need skills to make the most of a Green Investment Bank

Will Dawson, July 3rd 2010, Cities, Climate change, Finance, Public Sector

The Green Investment Bank will be a big step towards a sustainable future, but the government must ensure that it unlocks the potential of local authorities and community groups as well as business.

The Green Investment Bank Commission’s report calls for the government to set up a flexible bank to reduce the risk to private investors investing in greening our power supply, increasing the energy efficiency of our buildings and our transport systems.

The bank, as proposed, would represent a big step towards a low-carbon economy, bringing greater energy security, new jobs and a higher quality of life.  Big advances in green infrastructure, like offshore wind farms, are crucial to change at the speed we need to see in the UK to meet carbon targets.

Yet there is much that a community-led approach to an energy revolution can bring too. And this can create local skilled jobs, strengthen community ties and help people lift themselves to a higher quality of life. Communities in energy cooperatives have saved a third off their energy bills just by changing their behaviour, offshore wind doesn’t do this. So I was delighted that the commission has understood the role of financial investment in this community-led approach too.

However, we also need investment in skills to enable local government and community groups to take advantage of this funding opportunity. At Forum for the Future we have been working with West Sussex County Council, the South East of England Development Agency and a group of local authorities and community enterprises in our Climate Finance initiative to find out how to do this, and making great progress with some inspiring people. Other initiatives like the Ashden Awards and the Low Carbon Communities Challenge are also leading the way.

The challenge now is to scale up so that every community takes action. The advisory group of experts we have been working with are often translators between sustainability and finance teams within local government. Good opportunities are often missed due to a lack of understanding. If we could develop these skills, then local authorities and groups like Transition Towns and energy co-ops will be the experts, creating the new ways of financing local investment in carbon reduction such as green bonds.

Without this development of local skills, most of the funds raised by a Green Investment Bank will go to big businesses to support big projects. This government has led on a big society agenda and the prospect of a Green Investment Bank presents a real opportunity for local people to take action for their future. But it must ensure they have the skills to do the job. The commission’s ambition is to have the bank up and running in six months so we have no time to lose.

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Mix blue and yellow: get green?

Ben Tuxworth, May 17th 2010, Climate change, General, Public Sector

Environment policy didn’t break the surface during the UK election campaign.  How will it fare in a coalition of parties at opposite ends of the political spectrum?

Amongst the many surprises was the near absence of environment from the parties’ campaigns and the first ever prime-ministerial debates.  Does it mean the British care less about the environment than in previous years?  Apparently not: the share of the green vote held up and the Green party won its first ever seat in the British Parliament (Caroline Lucas, Leader of the party and long time Member of the European Parliament, taking Brighton from Labour).

But with the parties fairly close to each other on much of environment policy, there were more points to be scored by talking about social policy (we are bracing ourselves for Conservative leader David Cameron’s ‘Big Society’, whatever that means) and of course, dealing with the deficit where we are up there with the European basket cases like Greece, Spain and Portugal.

Having torn lumps out of each other for months on these and other issues, our identikit party leaders now find themselves round the table in Britain’s first true coalition government in 65 years. I’ll spare you the constitutional niceties of how that came about. Suffice to say that political commentators, having had to speculate wildly for several days about what the outcome of the election might be, now find themselves, along with the new government in largely uncharted waters.  In a cabinet of 23, Liberal Democrats hold five posts,  including the responsibility for Energy and Climate Change, which has gone to Chris Huhne, millionaire businessman and one time contestant for the party leadership.   

This appointment throws into sharp relief the strategic and tactical questions this coalition raises for the future programme of the government, not least on environmental policy.  Despite substantial areas of common ground – on the need to cut emissions, boost renewable energy generation, and create a ‘green bank’ for investment in cleantech  for example - the Lib Dems have long been opposed to the replacement of Britain’s ageing fleet of nuclear reactors, whilst the Tories see nuclear as the mainstay of both emissions reduction and future energy security in the UK.  

This issue is such a clear divide, that in the formal agreement about the coalition the issue is dealt with directly, with a bizarre result.   The government (i.e. Huhne) will bring forward a ‘national planning statement’ which would give permission for new nuclear to be built, but then Lib Dems (including Huhne) would be allowed to abstain from the vote bringing it into force.  This in effect means that the Conservatives can push it through on their own, whilst the Lib Dems have (just about) a path of dignity in opposing it and allowing it.

What Green supporters who voted Lib Dem for their anti-nuclear stance will make of this is anyone’s guess.  In any case, both parties are agreed that there should be no public money for nuclear power, and since no nuclear power plant has been built, ever, without such subsidy, it will be interesting to see if any of the utility companies that were lining up to build the new capacity will still find it so appealing.   Lib Dems are presumably hoping not. 

Elsewhere the picture seems a bit clearer, and generally positive for the environment.  Campaigners are elated at the scrapping of Labour’s plans for a third runway at Heathrow.  The coalition agreement makes positive noises about a new high speed rail network – though it’s hard to see how that will be paid for any time soon. Though there’s no new target on the proportion of energy from renewables, investment in marine power and anaerobic digestion also gets a mention, as does a smart grid to link it all up, smart meters to make us all more frugal in using it, and other measures to boost energy efficiency in the home. And along with the promise of public investment in carbon capture and storage and a floor price for carbon comes an undertaking to prevent new coal-fired power without sufficient CCS to meet a demanding emissions standard.  

Some cynics have suggested that Lib Dems have been given jobs that are either so marginal to the Conservative project that they don’t matter, or require them to dip their hands in the blood of ‘dealing with the deficit’ and so alienate their supporter base.   A more nuanced view is that the coalition has enabled Cameron to do what he could not have done with a majority, giving him a reason to be more positive about the environment and Europe and move his party further onto the centre ground.  If he succeeds in finally decontaminating the Tory brand in this way, they argue, he will have laid the foundation for successive Conservative governments for many years to come.

Whatever the motivation, the new team have started with a bang.  Cameron swiftly announced that the government will cut its own emissions by 10% in the next 12 months.  Speaking to staff at the Department for Energy and Climate Change he said ‘I want this to be the greenest government ever’.  Meanwhile Huhne took up the reins at DECC, promising to put energy security ‘at the heart of the UK’s national security strategy’ and to ‘fundamentally change how we supply and use energy in Britain'.  Amen to that.

This blog first appeared in Grist

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Green issues are sidelined as the Big Party Circus rolls on

Jonathon Porritt, April 29th 2010, Forum founders, General, Leadership, Public Sector

In the first in a series of blogs in the run up to the general election, Jonathon Porritt considers the (lack of) climate change and sustainability policies of the three main parties and the unknowing support for the Green Party's wider policies.

It’s certainly a more exciting election than any I can remember for years. But it’s a bit of a nightmare from a sustainability point of view. 

The party manifestos themselves are OK – a considerable improvement on the 2005 manifestos. Out of the three major parties, you’d have to put the Liberal Democrats way out in front (as usual), if only because of the way in which they spread the ‘green content’ through the entire manifesto rather than having the usual ‘green section’ with everything else around it pretty grey and grim.

But beyond the manifestos, there’s been next to nothing on either climate change or wider green issues. The parties had a brief moment set aside to go through their green motions, but without any seriousness of intent whatsoever. Gordon Brown was there to launch a separate Labour green manifesto, but devoted almost all of his entire speech to yet another lacklustre rant against David Cameron. It’s never been his strong suit, as we all know, and Labour’s whole election campaign has made that very clear all over again.

We shouldn’t be too surprised at this, simply because it has always been like this. It could have been different this time around, given all the serious political interest in climate change over the last few years. But then Copenhagen crashed, scientists started messing up all over the place, and our wretched rightwing media seized their moment to intensify their promotion of the near-bonkers babbling of Nigel Lawson, Ian Plimer et al. And all that pretty much blew any prospect of climate change featuring in any serious way in this election.

Happily, beyond the Big Party Circus, there’s an astonishing foment of political activity going on elsewhere, touching on every conceivable aspect of sustainable development territory. I’ll be focusing on one or two of these over the next week or so.

If your principal concern is about policies, instead of personalities and presidential debates, then the Vote for Policies initiative has thrown up some fascinating findings. If you go onto their website you’ll be asked to compare policies in nine main areas without being told which political party they come from – and then you are asked to ‘vote’ for the policy you prefer. The parties those policies belong to are then revealed to you.

It’s highlighted the general popularity of Green Party policies. At the last count, it was ahead on 26%, with Labour on 19%, the Lib Dems on 18%, Conservatives on 16%, and UKIP and BNP bumping along at the bottom.

What’s astonishing me, looking at voters’ preferences, is how well the Green Party did on other policy issues apart from the environment: top on education, health, crime and welfare, and second (behind the Lib Dems) on democracy and the economy.

I’m not sure how much that will help Green Party candidates on the ground – but there could be a few surprises here too. I was in Cambridge on Tuesday, when a local poll put the Green Party’s Tony Juniper ahead of all the other parties! A win for the Greens in Cambridge would be one of the biggest election shocks of all time!

Caroline Lucas, Green Party Leader and candidate in Brighton still has the best overall chance of being the first Green Party candidate to beat our despicable first-past-the-post system. I’ll be down in Brighton on Saturday – so more on this next week!

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Smarter refurbishment is a must for the NHS

Anna Warrington, April 27th 2010, Built environment, Public Sector

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A £2 billion green investment bank is just a start

Peter Madden, March 24th 2010, Business, Finance, General, Public Sector

The big news in the Budget was the green investment bank – a welcome development, but only the start of what Britain needs to create a low-carbon economy.

The chancellor, Alistair Darling, announced that the government and private sector would each contribute a billion pounds and the bank’s initial focus would be on green transport and sustainable energy, particularly offshore wind power. The bank’s stimulus would unlock billions more of investment, he predicted.

Our future prosperity relies on making a rapid transition to a low-carbon economy, so a green investment bank is long overdue. We need to get this up and running as soon as possible to help Britain emerge from the recession and create the new jobs and businesses of the future.

The pledge of £2 billion is a good start but further funding will be needed to stimulate investment in the infrastructure we need to underpin a green industrial revolution. Sustainable energy and green transport are both important, but we also need to build a smart electricity grid to manage our energy use efficiently, and overhaul our homes and buildings so they are warmer and consume less power.

The green investment bank should also take a broad view of sustainable investment. An over-emphasis on carbon reduction will not serve the climate change agenda well in the long run if it ignores the needs of the poor, or the wider environment.

And it must create incentives for private investors to take a longer-term view and accept steady returns over a period of time. Public funds should not just create higher short-term returns for private investors.

The Government now needs to develop additional mechanisms to create a thriving green economy by stimulating local initiatives. We’d like to see funding to encourage small-scale initiatives throughout the country which will create new jobs, develop new technologies and launch new services.

Finally, investment in forests is vital to our future even though this will create few jobs in the UK. If we want to hold global warming at two degrees Celsius we will have to reduce carbon emissions by a massive 17 Gigatonnes in the ten years to 2020, according to a McKinsey study. They conclude that forests will have to generate more than half of that – nine Gigatonnes from avoided deforestation, reforestation and land use change – because there is not enough time for other technologies to fill the gap.

See Project Catalyst working paper for more on forest-based mitigation.

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Can the public sector lead us to sustainability?

Ben Tuxworth, March 1st 2010, Public Sector

As the recession ends in the private economy, it is just beginning for the 5.8 million public servants in the UK, and the millions more around the world.  Faced with swingeing budget cuts (several percent per year for the foreseeable future) can public sector organisations stay true to their commitments to carbon reduction, sustainable regeneration, ethical procurement, greener healthcare and a wealth of other new practices and initiatives?

In theory, yes.  If sustainable development thinking is no use to you in times of austerity, it is no use at all, and hard times should be when it proves its worth.   Sustainable development was developed as a concept to address the pressing problem of environmental degradation and its impact on human welfare – the mother of all recessions.  But for municipalities, health trusts, police authorities and the many other providers of public services, it’s very tempting to cut spending on expensive-looking ‘green’ activity when you have to slice 5% off the salami –  whether that means abandoning projects or closing down the teams and strategy units set up to run them.

It’s a much braver choice to use sustainability principles to guide where to wield the knife, and, more to the point, to use the same thinking to find efficiency gains, new ways of working, and deliver greater public value.

Doing that means understanding how sustainability relates to the core business of the organisation and its success in the long term.   So it’s a paradox that whilst the business case for sustainable development is regularly articulated and used as a justification for corporate investment – and as a kind of strategic security blanket – the public value case for similar action is seldom expressed. This leaves public bodies with only patchy and partial arguments for their sustainability commitments in tough times. 

Well, not any more.   A new Forum report highlights how sustainability principles hold the key to creating public value in austere times.  In ‘Stepping up: a framework for public sector leadership on sustainable development’ we set out how forward-looking public bodies can go beyond the business case to address market failure, build resilience and reinforce the crumbling social contract when  they use sustainability thinking to create public value. 

What does that mean in practice?  Stepping up sets out a nine-point plan for public sector organisations wanting to take the lead in using sustainability to deliver better services.  It starts with ‘making the case’- setting out that basic argument - examines linking policy and delivery, and goes all the way through to building a learning culture and running demonstration projects.   And there’s a self-assessment tool to check where you are on the journey – from ‘At Risk’ (of failing to comply with legal obligations and suffering financial and reputational hits) to ‘Systemic’ – one of those rare paragons using sustainability principles to maximise efficiency and public value creation over time.

Some are well down this road.  Others have barely begun.  Stepping up picks out some of the best examples of progress from around the world, whether public or private.  Swedish city Vaxjo’s use of bioenergy, innovative food procurement by PCTs in Cornwall, Vodafone’s stakeholder engagement process,  the GLA’s approach to policy integration, and InterfaceFLOR’s investment in staff capacity show how early adopters are pointing the way. 

But we believe any organisation can be a leader on sustainable development, and those that grasp the challenge in difficult times will emerge strongest from the recession, with more efficient services, more productive relationships with their communities and partners, and better prepared for the environmental shocks that lie ahead.  

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The Marmot Review: health and inequality in the spotlight once more

Jonathon Porritt, February 18th 2010, Forum founders, General, Public Sector

I spent last Friday at the launch conference for the Marmot Review – a report on health and equality and what we should be doing about them here in the UK.

It’s a really good report and powerfully reminds all those who see themselves as active in the ‘sustainable development community’ of the overlap with the public health/health and equalities community, and the importance of working much more effectively together than we’ve sometimes been able to in the past.

I won’t bang on about those synergies, two graphics in the Review illustrate these well. (See Fig 4.6 on cycling on page 127 or Fig 4.7 on green spaces on page 130 of the Review)

Some people say that this is all old hat.  The Black Report, the Acheson Report, the Wanless Report. And now the Marmot Report. Same old, same old.

In some instances, that’s true. But there are many completely new insights in this report, building on new evidence.  For instance, the principal recommendation (‘give every child the best start in life’) is based on new research looking at what happens between birth and the third year of any child’s life.

Just looking at the difference between the most advantaged and the least advantaged on indicators like birth weight, post-natal depression for mothers, regular bed times, being read to every day, breastfeeding and so on, you can see why this is the critical point of intervention. After the age of three, a lot of future interventions may well be far less impactful. And by the age of five, brighter, poorer kids have been overtaken by less bright kids from families that are better off.

Intriguingly, the most inspiring talk of the day came from the Deputy Chief Fire Officer from Merseyside. The Fire and Rescue Service on Merseyside has been running a community engagement and advocacy programme for the last 10 years, providing advice in the first instance on fire prevention, but then helping local residents think much more about all those things that exacerbate health inequalities (smoking, alcohol, drugs, poor quality housing, poor diets and so on), whilst simultaneously increasing fire risk – if only indirectly. His officers are now putting out 50% fewer fires than 10 years ago.

The Deputy Chief Fire Officer didn’t bring this out explicitly, but his presentation provided a powerful analogy for the whole day. Shift the effort (and the investment) upstream – into prevention and brilliant public service interventions in people’s lives – and the downstream costs can be progressively reduced. But if you don’t do that, there’ll be no reductions downstream.

The vast majority of health practitioners are well aware of that.  But the truth of it is that after 30 years of talking about prioritising prevention and public health, practically nothing has been done about it. Just 4% of total health spending in the UK goes on prevention and public health.

The Marmot Review doesn’t make a particularly strong case on that score. But the truth of it is that all its recommendations may well make no more progress than the recommendations of its predecessors unless that imbalance is addressed.

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A fair share

Helen Clarkson, February 15th 2010, General, Leadership, Public Sector

Peter Mandelson’s famous statement that Labour is “intensely relaxed about people getting filthy rich” has come back to haunt the party and will no doubt be wheeled out again in the coming election campaign.  

A new report notes that 13 years of Labour rule have done little to reverse the huge growth in the gap between rich and poor that developed under Margaret Thatcher’s Tory government in the 1980s.

The National Equality Panel (commissioned by Harriet Harman MP) published its report 'An Anatomy of Economic Equality in the UK'  in January.  It contains some worrying facts and figures about the distribution of wealth in the UK, with the panel finding “deep-seated and systematic differences in economic outcomes” between and within social groups. 

The report contains startling statistics about the growing gaps in earning and income inequality and their scale compared with other developed nations.  It also shows a persistent gender gap, with women being on the whole better qualified than men up to the age of 44, but with a median hourly pay of 21% less than men.  It points to continuing ethnic inequalities, finding that Pakistani and Bangladeshi Muslim men and Black African Christian men are paid 13-21% lower than White British Christian men with the same job and qualifications.  And it reveals that the richest 10% of UK population has more than 100 times the total household wealth of the poorest 10%.

Why does all this matter?  Mandelson qualified his statement by saying Labour was relaxed about the rich “as long as they pay their taxes”. But the figures in the NEP report debunk the myth of ‘trickle-down economics’: the idea that if those at the top of the pile become ‘filthy rich’ those further down will also reap the benefits.  Instead what it shows is that as the rich become richer, the wealth remains largely at the top and the rungs on the social ladder move further apart.

This has important consequences for society.  In their 2009 book The Spirit Level (out this month in paperback) authors Richard Wilkinson and Kate Pickett have made a compelling case that more equal societies fare better than more unequal ones.  Across a wide variety of indicators of social wellbeing including physical and mental health, obesity, violent crime rates and teenage births, they show that, once a country has reached the level of GDP which lifts it out of poverty, what matters is not how much wealth there is in that country but how it is distributed. 

There is a clear parallel with the depletion of our environmental resources.  Just as in the UK we see wealth concentrated in a small section of society, so on a global level the rich use far more than their fair share of available environmental resources such as carbon, water, and food.  We are only beginning to start thinking – largely through the climate debate – what the long-term implications of that unfair distribution might be, and how that will impact on all of us.

At Copenhagen this theme was taken up by the G77 nations.  But once again we saw world leaders seemingly ‘intensely relaxed’ about attaching more importance to protecting their national economies than the global need to reduce carbon emissions dramatically, for the benefit of all.

If we are to start thinking about truly sustainable development, where the needs of the present are met without compromising the ability of future generations to meet their own needs, then we need to start taking these issues of distribution more seriously.  We need to let the idea of trickle-down economics go for good. That requires a level of bravery and leadership that we haven’t seen in our politicians for many decades.  And more importantly support from an enlightened public.  Redistribution has fallen out of favour in recent decades - the question is how we’re going to bring it back?

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Our health depends on a sustainable future

Ben Tuxworth, February 11th 2010, General, Public Sector

If you live in the London borough of Kensington you can expect to live 17 years longer than people just seven miles away in Tottenham Green. This shocking statistic is revealed in a government-ordered review of health inequalities in England, published today. It’s forthright about their social, environmental and economic causes – but will it help us prepare better for a very uncertain future?

The review, published today, is called Fair society, healthy lives but the title might equally well have been ‘it’s bleedin’ obvious, but now we’ve proved it!’  Reducing health inequalities, says its author, Professor Tony Marmot, requires us to give people a good start in life, a decent education, a meaningful job, a healthy environment and supportive community, and then do stuff that stops them getting ill. Of course, doing all this at the same time and for everyone is the trick, and the review also points out the need for the agencies of government, both national and local, to join up to achieve these improved outcomes. 

And yet they don’t. Marmot proves once again how our society generally fails to pursue apparently complementary objectives in a complementary way – and in the case of addressing the causes of health inequality, has actually got steadily worse in the last decade or so.  The consequences of this failure to join up are depressingly familiar to the environment and development specialists who invented the concept of sustainable development back in the 1980s. 

Twenty years on from its entry into the debate, that concept has proved itself the only useful frame in which to understand and address the patchy nature of our social and economic progress, and its perverse outcomes. Sustainable development puts in context what public health specialists have known for generations: that health is not created by medical intervention, and that socio-economic inequality correlates relentlessly with health inequality. Marmot shows how our failure to understand this has serious enough consequences now. But given what we now know about environmental change, we need to understand the bigger picture if we are to stop things getting much worse – its consequences in the future will be far worse. 

Marmot doesn’t speculate much about what might be at stake or achievable in the long term, or indeed how changes in the global environment might impact on the effectiveness of the many policies it he proposes to address health inequality.  But if we are serious about creating health in a world of growing population and diminishing resource, it’s clear we are going to have to rethink the fundamentals, such as the roots of our GDP fetish, the way we treat our ecosystem, and what we understand by our responsibilities – to each other and to future generations.

Some of this ‘bigger picture’ comes out in the review.  It was conducted through a collection of working groups, and Forum for the Future was commissioned to develop a vision for a sustainable healthcare system as a contribution to the working group on sustainable development, which we have published separately here. While the review was underway we also worked with the NHS to imagine how environmental constraints might affect healthcare provision by 2030, and published Fit for the Future, now being sent to all NHS organisations in England. 

As we conducted those pieces of work it became clear that the model of creating health through ever more sophisticated and costly medical interventions is essentially ‘broken’ already, and will be impossible to sustain in any plausible future scenario. The sooner we think about the ultimate sources of health in the environment – clean air, safe and sufficient food and water – and reorganise ourselves differently to protect them, the better our chance of avoiding a very nasty surprise. 

Fair society, healthy lives is certainly alive to the need to address climate change and health inequality at the same time, via simple measures like home insulation and active travel. And it asks government "to put sustainability and well-being before economic growth", a bold demand which sadly both Tories and Labour seem unlikely to meet any time soon.  

Where we would have gone further is in placing these calls in the context of trends in global unsustainability and its impacts on our health in the future. How will we achieve health equality on one tonne of carbon a year each? What will collapsing food supply chains mean for our poorest communities? 

Without a more explicit framing of this sort, and a more compelling vision of what the future might hold, the risk is that Marmot’s call to address the causes of health inequality will remain in political terms a ‘nice to have’, rather than a central part of preparing us for the much bigger shocks that lie ahead. Perhaps the language of sustainable development is not flavour of the month, but sometimes, it really is the only way to understand our current predicament and what needs to be done. 

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