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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.
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.
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?
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.
Balance makes Newcastle Britain’s most sustainable city
Helen Clarkson, November 19th 2009, Cities, Built environment, General, Public Sector
Today we unveil our third annual Sustainable Cities Index and the big news is that Newcastle is Britain’s most sustainable city, knocking the previous two winners – Bristol and Brighton – into second and third places respectively.
This might come as a big surprise as unlike those other cities, Newcastle doesn’t have a reputation for being particularly ‘green’. But Newcastle has won because it does fairly well across the whole set of indicators we use to capture a balanced picture of cities’ sustainability, with no particular area of weakness.
The Sustainable Cities Index ranks Britain’s 20 largest cities according to their performance in three broad areas: their impact on the environment, their citizens’ quality of life, and their readiness for future challenges. Both Bristol and Brighton have great scores on our quality of life and future-proofing indicators, but perform less well on environmental impact, bringing them down overall.
For me that reinforces one of the key messages about sustainability, that it’s all about striking a balance between the economic, the environmental and the social, and avoiding trade-offs.
It’s also interesting that our cities that do have green reputations are weaker on environmental indicators than others. That could suggest that some of their reputation is built on the quality of life they offer, so maybe people do understand being green in that broader sense. Good news for those of us who make our living saying just that!
With all the talk over the last year about green economic recovery, we also thought it was timely to ask what that means at a city level. People use the term to mean a lot of different things from making existing business more energy efficient, right through to challenging the capitalist economic model.
We’ve found that there is plenty that local authorities can be doing to promote green economic recovery at different levels. They can work with businesses to understand their reliance on the local environment and society, they can direct their own spend on to more sustainable goods and services, and they can encourage and promote the innovation that we’ll need to move into a more sustainable future.
Our winning city – Newcastle – is located in the country’s first designated Low Carbon Economic Area. Manchester has plans to build on its industrial heritage to lead the way to a cleaner future. And Birmingham is also thinking about its contribution to the next industrial revolution.
Cities that find the sweet-spot of low-carbon innovation that grows the local economy, providing jobs and better quality of life will be the truly sustainable cities of tomorrow. The race is on.
The Standing of Sustainable Development in Government
Jonathon Porritt, November 10th 2009, Forum founders, General, Leadership, Public Sector
When I was still Chair of the Sustainable Development Commission, I was hoping to produce a snapshot of just how deep sustainable development had penetrated into the workings of government – since the election of the Labour Government in 1997, the establishment of the Sustainable Development Commission in 2000, and the issuing of the Sustainable Development Strategy, ‘Securing the Future’. As it happens, it didn’t get done. Which has allowed me a few extra months to reflect in less frenetic circumstances.
And that’s been helpful! I have to admit, I was feeling a bit grumpy back in July. There’s only so much head banging one can do before brain damage sets in! And so much of what the Sustainable Development Commission does is going on behind the scenes – received and acted on, for example, by bodies like the Environmental Audit Committee, the Office of Government Commerce, individual departments and so on.
And if one gets really disciplined about both sides of the balance sheet (the pluses and the minuses), the overall picture on the standing of sustainable development question is actually “not half bad” – and I’m constantly struck by just how impressed people from other countries are at the ‘sustainable development architecture’ that’s been created here in the UK, including the Sustainable Development Commission itself.
But there still remains something of a mystery here, despite all the good things, it’s demonstrably clear to me that not enough has changed on the ground. Plenty of good process but not enough good outcomes (and quite a few really bad outcomes!)
That’s the mystery I’ve tried to unravel in this new Report, unimaginatively entitled The Standing of Sustainable Development in Government. Not an all-singing, all-dancing retrospective, and certainly not a completely dispassionate study. But useful for all that, I hope.
£10 million will fund best community low-carbon initiatives
Jonathon Porritt, October 1st 2009, Public Sector
No sign yet (thankfully!) that the Government’s Low Carbon Investment Fund is at risk of ‘savage cuts’.
On Monday, the Department of Energy and Climate Change (DECC) launched its new Low Carbon Communities Challenge, which consists basically of a £10 million pot that communities can apply to for funding for their own low-carbon initiatives – which might be a housing retrofit scheme, a biomass plant, or even electric vehicle charging points.
Up to 20 communities will be selected as the lucky winners.
It’s a good scheme, underpinned by a ‘specialist support squad’ made up of partners with expertise from inside and outside government – including The Energy Savings Trust, The Carbon Trust, WRAP, and the Third Sector.
So let’s hope DECC is overwhelmed by applications!
Video shows way to low-carbon lifestyle
David Mason, September 22nd 2009, Futures, Public Sector
Health services make up a huge part of every developed country’s economy with a massive carbon footprint, so when you identify a way to cut emissions, save money and improve public health at the same time it’s of global interest.
So we’re delighted that the UK Foreign Office has posted a news video about Fit for the Future, our new report, which looks at a range of scenarios for future health services and gives guidance on how to create a more efficient, low-carbon system which delivers better public health.
The report focuses on the UK National Health Service, but we believe it holds lessons for every health service provider. It was jointly produced by Forum for the Future and the NHS Sustainable Development Unit, and will be sent to every NHS organisation.
In the video, filmed at the launch of the report, Neil McKay, the NHS Chief Executive with lead responsibility for sustainable development and Jonathon Porritt, founder director of the Forum, discuss the urgency of action and what the NHS needs to do to deliver low-carbon healthcare.
Health spending accounts for 16% of the US economy and 8.4% in the UK, according to an OECD survey. Across developed countries the average is 8.9% of GDP – and activities on that scale generate a massive carbon footprint.
The NHS is responsible for 18 million tonnes of CO2 each year which comes from various activities: energy used to power its hospitals; making and delivering medicines, equipment and other goods it uses; and staff, patient and visitor travel.
The World Health Organisation recently called for the health sector to take the lead in cutting emissions. "By reducing its climate footprint and moving toward carbon neutrality, the health sector can demonstrate the path forward in this age of global warming, thereby playing a leadership role in advocating for a healthy and sustainable future," said Maria Neira, Director of WHO's Department of Public Health and Environment.
NHS 'Fit for the Future' report released
Jonathon Porritt, September 15th 2009, Public Sector
Last year, the NHS launched its first ever Carbon Reduction Strategy. Apart from a few mischievous media comments (homing in on the gentlest of hints that hospitals might in the future be serving less meat as part and parcel of providing lower-carbon meals), it has been very well-received both within the NHS and beyond.
But a strategy is just a strategy, however good it may be, and there are an awful lot of senior managers inside the NHS who are going to take some persuading that climate change now needs to be moved rapidly up their agendas.
With the prospect of serious cuts in health spending from 2012 onwards now looking like a certainty, I’ve already come across a number of people who are convinced that “the environment” is going to be on a downward rather than an upward curve as managers focus on “getting the basics right”.
Sounds ridiculous, doesn’t it? But from their point of view, all the threats associated with accelerating climate change are “out there” somewhere in the future – and even the combined threat of rising energy prices and the Carbon Reduction Commitment (the price to be paid for every tonne of CO2 emitted by the bigger NHS Trusts), still leaves many unpersuaded about the need for radical change now.
It’s not just that short-term target-driven mandates always trump longer-term discretionary initiatives. Behind this all-too-familiar dilemma lies a much more profound problem, an inability to think very much at all about the future – with or without accelerating climate change. The vast majority of health professional and politicians, for instance, know that the current model of healthcare (more money needed, year on year, to address seemingly limitless demands for improved services) is broken. But it’s very rare indeed to hear any of them talking about this in public.
I’ve come to the conclusion that a fairly generalised lack of imagination about the shape of the future is one of the reasons we make so little progress on key policy challenges. Not least climate change.
Together with the NHS’ Sustainable Development Unit, Forum for the Future is hoping to do something about this, with its “Fit for the Future” project – examining four different “scenarios” for low-carbon healthcare in 2030. All four are pretty challenging (it’s not, after all, as if climate change isn’t going to be a dramatic or painful part of our lives in 2030, come what may), but “Service Transformation” obviously sounds a great deal more manageable than “The Environmental War Economy”!
You can check them out on our website – a bit of provocation, not just for health professionals!
Low-carbon NHS can make us fit for the future
Helen Clarkson, September 10th 2009, Public Sector
When I talk about the NHS and climate change, I’m used to a variety of responses. They normally run from “well they’ll have to treat malaria in the future won’t they?” to a baffled “what’s one got to do with the other?”
But consider the figures. The NHS employs approximately 1.3 million people and last year GPs held 300 million consultations. Its direct and indirect emissions add up to 18 million tonnes a year – about 3% of the UK’s total – the biggest carbon footprint of any public sector organisation in Europe.
The NHS has to form a major part of any plan to reduce our carbon emissions. But the sheer size and reach of the service means it has the potential to play a catalytic role in the UK’s transition to a more sustainable society.
So we were thrilled to be appointed by the NHS Sustainable Development Unit to help them understand that potential. In our joint report Fit for the Future we’ve shown how a low-carbon NHS can deliver better healthcare in the future.
We’ve looked at the social, political and economic responses to climate change that we might see over the next 20 years and the impacts that these will have on our health and the types of healthcare provision available to us. The report presents four scenarios describing radically different worlds in which the NHS might operate.
Looking across these worlds some clear messages emerge. The first is that far from the radical, robotic, high-tech future of healthcare that is presented by Hollywood, the realities of carbon pricing mean that money available to spend on healthcare is likely to get tighter and high-end treatment regimes are unlikely to be affordable. We need to start seeing a radical shift towards preventing illness rather than treating sickness, and this means a serious increase in the proportion of the NHS budget that is spent on prevention.
We also need to see the NHS, and other public service providers, equipping people with the knowledge they need to take more responsibility for their own health, as we see them doing in most of the scenarios.
We strongly believe that this isn’t necessarily bad news. By focusing on our wellbeing and leading more sustainable lifestyles we can find the low-carbon/high quality-of-life sweet spot. That’s something not just for the NHS to consider but other organisations in the public sector, and all of us as individuals.
So, yes, we may see malaria return to our shores. But when it comes to climate change it’s the societal impacts that pose the real challenge. The NHS is uniquely positioned to play a leading role in shaping a more sustainable future for us all.
Further information is available here.
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