LINKING HEALTHY LIVING AND SUSTAINABLE CONSUMPTION: EXTENDING THE NEXUS OF ANALYSES

Robert RattleResearcher

Human Dimensions of Global Change/Sustainable ConsumptionOttawa, Ontario, Canada

Tel: (613) 7295818email: at758@ncf.ca

rrattle@alumni.uwaterloo.ca

INTRODUCTION

Tobacco reduction efforts, both nationally and internationally, have emerged from a fringe movement to a coordinated governmentally driven and supported global initiative. Tobacco reduction, now an important policy and program initiative, seems antithetic to many economic objectives determining the general flow of market-based globalization - individual freedom of choice, growth, and the free market for instance. In reality, tobacco control programs and research have firmly discredited these assumptions, which enabled tobacco consumption to gain a strong foothold as a consumption process over the previous century. However, it took many decades for this knowledge to translate into action. Tobacco companies regularly intervene upon freedom of choice. The social determinants of health reveal that an individuals choice to smoke is profoundly influenced by their social environment, over which consumers have very little control. Embedded in this consumption process is an assortment of social meanings, expectations and processes. Identity and image formation, branding, and global and international associations have all been incorporated in the normalization of tobacco consumption. Promises of jobs, economic growth, and investment to national and local governments accompany the tobacco industry. Globalization - cost reductions, profit maximization, and product consistencies - has enabled tobacco corporations to leverage and manipulate taxation, regulatory, and legislative environments to their benefit. Thus the shift from knowledge to action took many years, and the war on tobacco continues today as the tobacco industry hungrily stalks developing nations as their next growth target.

The parallels between tobacco consumption and current global trends in the food industry are striking: the modern global food industry has effectively incorporated global market mechanisms - freedom of choice and food diversity, free market mechanisms, global trade and minimal government interventions, and the growth of food production and distribution networks worldwide to meet a growing demand. Food consumption also includes a diversity of social meanings, processes and expectations. Yet, as with tobacco, food consumption, for the most part, if properly consumed, is not an inherent and direct health risk. In fact, a nutritious balanced diet is essential to human health, and trade and market mechanisms seem to have indeed led to a diversity of healthy food choices in most industrial countries. So do the comparisons end here?

Perhaps not. The food industry has important, complex and obvious - direct and indirect - consequences for human health. Through the expropriation of lands, homogenisation of food through control over commodity chains, and the concentration of wealth and power, just to name a few, the food industry is contributing to some very unsustainable practices globally that have significant implications for population and ecosystem health alike.

In Low and Middle Income Countries (LMICs), food access is a serious concern. Global food commodity prices are established by market forces, and powerful transnational corporations influence prices and trends to their advantage. Food choices are allocated based on ability to pay,

and this often means even locally grown food within global commodity chains is beyond the financial reach of economically disadvantaged populations. This has generated serious health concerns. The World Health Organization has noted that malnutrition - access denied to a commodified global food system - is the greatest contributor to the global burden of disease.

Simultaneously, industrial nations are experiencing an increased incidence of cardiovascular disease, obesity and diabetes - diseases of affluence. Their profligate access to the global food marketplace creates unnecessary stress on themselves and the populations of LMICs alike. Aided and abetted by the flavour and colour industries, western diets characterized by high fat intakes, food choices from the top levels of the food chain, and highly processed foods with low nutritional quality are permeating dietary norms around the globe. The standardization of diets, taste, flavour and nutrition are accommodating a normalization of lifestyles, gender roles and time structuring.

The use of intensive monoculture and the application of fertilizers, pesticides and biocides contributes to significant local, regional and global pollution. These contribute to climate change, ozone depletion and the loss of both cultural and biological diversity. The effects of these local to global processes and impacts affect the least advantaged disproportionately. Predicated on the growth of food supplies efficiently allocated to a competitive market, the modern food industry fails to accommodate neither a fair distribution nor sustainable scale. Both the tobacco and food industries, following the implacable laws of markets, exert profound consequences on consumption and health.

Health is more than simply the absence of disease. The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (WHO, 1967) This includes "the extent to which an individual or group is able, on the one hand to realize aspirations and to satisfy needs, and on the other to change or cope with the environment." (WHO, 1984). Since the Lalonde Report (Lalonde, 1974), the health sector has recognised the importance of the social environment in shaping behaviour, and the limited ability of individuals to shape that structure. Thus the determinants of health began to emerge as a framework for characterizing health influences.

This approach is clearly applied in healthy living initiatives as evidenced through specific policies and programs in tobacco reduction for instance. Recognising the importance of numerous determinants of health and the social environment in shaping decisions has enabled healthy living initiatives to successfully confront some unsustainable and unhealthy consumption practices.

Sustainable consumption takes healthy living to a new level. Consumption practices can extend well beyond merely those that are direct contributors to health. They include all social, cultural, psychological, emotional and economic choices and practices. Sustainable consumption has also achieved some limited success, often at local scales, occasionally across sectors, however, rarely permanent. The incredibly complex mechanisms involved in our consumption choices makes achieving more sustainable consumption, particularly in light of globalization, extremely challenging.

Advances and successes in the fields of healthy living and sustainable consumption may be mutually reinforcing. Clearly, healthy living initiatives offer tremendous insights and lessons for sustainable consumption. Healthy lifestyle choices also offer a powerful and compelling reason to seek more sustainable consumption - improved population health and well-being. This approach also extends the nexus of analyses beyond merely the physical aspects of sustainable consumption, effectively merging them with the human dimensions of consumption activity. This is remarkably similar to current directions in sustainable consumption research which is revealing the creative and complex nature of consumption behaviour. Integrating sustainable consumption and healthy

lifestyle approaches may enhance the translation of knowledge - how consumption behaviour contributes to or imperils ecological and human health - into action at the levels needed for more sustainable consumption.

HEALTHY LIVING

The above WHO definition for health suggests health is a result of complex interrelationships between social, economic, political, technological, cultural, and environmental factors. In other words, health is determined by the composition and interactions between the human and the natural environments.

It should then come as no surprise to discover the rather limited role of health care facilities in determining population health. The Lalonde Report (GoC, 1974) observed that “the organized health care system can do little more than serve as a catchment net for the victims” of environmental and behavioural threats to health. From this insightful but modest beginning in the 1970's, development of the determinants of health model began to take shape. Today, it is widely recognised that there are numerous factors, or determinants, that affect the health of populations. These include: relative income and socio-economic status; education; employment and working conditions; social support networks; health practices and coping skills; healthy child development; culture; gender; physical environment; biology and genetic endowment; and medical services. To many, it might be quite unexpected to see most of these determinants with the possible exception of the last.

McDonald (2003) argues that social, economic and physical factors profoundly influence the use of tobacco. Indeed, he notes that “while only some tobacco users are significantly influenced by biological factors, virtually all tobacco users are subject to cognitive, affective, and environmental influences. Hence, an effective population strategy must do more than deal with the biological factors associated with quitting; rather, it must also address cognitive, social, economic and physical environmental issues.” (emphases in original)

Historically, health risk behaviours have been addressed through one-on-one interventions, such as the diagnosis, treatment, and management of disease. However, such efforts do little to address the broader social forces that influence the risk factors that might contribute to many of these diseases. In reality, while critical to mitigating the effects (not causes) of poor health, it - sickness care - is an ineffective intervention for health promotion and disease prevention. “...however important individual genetic susceptibilities to disease may be, the common causes of the ill health that affects populations are environmental: they come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live” (Wilkinson and Marmot, 2003). Individual interventions do not effectively alter the distribution of disease and injury in populations, as new people continue to become sick and injured even as others are cured.

The World Health Organisation has embarked on an ambitious program to better understand the social factors that influence the distribution of disease and injury in populations. Known as the Commission on the Social Determinants of Health (CSDH), the objective of this project is “...to bring the world’s attention to the reality that addressing health inequalities requires more than medical care” (CSDH, 2006).

Reducing Tobacco Consumption

At first appearances, reduced tobacco consumption seems antithetical to global market frameworks. In reality, the choice was evident - do nothing and allow the population health impacts to mount, or intervene to reduce the source of these population health risks.

Similarly, the options to achieve this objective were simple - either prohibit tobacco products in order to improve population health and risk political suicide (not to mention the challenges of enforcement!), or de-normalise tobacco consumption and allow society to ‘control’ its use.

Clearly, the desirable benefits from societal-level interventions is tremendous. Yet the challenge remained: how best to confront the barriers to this change. Tobacco advertising and promotion, for instance, is strongly linked with identity formation (McCool et al, 2001; Amos, 1997; Pucci, 1999; Saffer and Chaloupka, 2000; and Choi et al, 2002) and functions as a component of the consumption process (McCool et al, 2003; MacFadyen et al, 2003). Similarly, Dalton et al (2002) observe that: “Despite increasing anti-smoking sentiments in our society, negative reactions to smoking are rare ... Movies continue to model smoking as a socially acceptable behavior and portray it as both a way to relieve tension and something to do while socializing. By depicting positive images of tobacco use, movies have the potential to influence adolescent smoking behavior as much as any other environmental exposure, such as family or friend smoking.” Saffer and Chaloupka (2000) conclude “that tobacco advertising increases tobacco consumption.“ Images portraying tobacco consumption establish powerful social norms, directly and indirectly contributing to the initiation or continuation of tobacco consumption during search for, or assertion of, identity. Ultimately, tobacco use “is a learned and socially mediated behavior... attractive to children and youth because of associations they learn to make between tobacco use and the kind of social identity they wish to establish” (Lynch and Bonnie, 1994).

Indeed, the greatest strength in favour of tobacco consumption in the past has been its social normalisation. The tobacco industry has been intensely sensitive to trends in the social acceptability of tobacco consumption. “It is our opinion that the single most important issue facing our industry is the erosion of social acceptability of smoking...In the absence of a well-coordinated international campaign, we feel that this is an inevitable trend which will lead to continued assaults on the industry - and the smoker - in the twin areas of taxation and public smoking” PAHO (2002).

To resolve this challenge to the tobacco industry, their influential abilities were applied to improve their corporate image. PAHO (2002) observes that the tobacco industry “developed plans aimed at improving its corporate image by making itself an integral part of the communities in which it operated.” This effort included community development programs, contact with government officials and the media, donations to universities, scholarships, educational sponsorships, and donations to government ministries.For instance, the tobacco industry funded “healthy community pilot programs with municipal authorities, which include smoking cessation seminars” (PAHO, 2002). This achieved two primary objectives. The first was the obvious improvement in corporate image. Secondly, by focussing on an intervention at the individual level, the result would have minimal effect on population health. In doing so, the tobacco industry was able to ineffectively address the problem of smoking, and, simultaneously, enhance their image as a socially responsible corporation, effectively leveraging their capital to increase tobacco consumption. Transnational tobacco companies have been acutely aware that individual interventions are ineffective when confronted by the rising tide of social practices that increase tobacco consumption. PAHO (2002) has observed that “Tobacco industry programs to combat youth smoking provide essential inoculation against the eroding public image of the companies and against meaningful regulation of tobacco promotion. The rationale is that, if the industry is already trying to discourage youth from smoking (albeit through weak and ineffective campaigns), there is less reason for governments to develop their own, and typically

stronger programs. Indeed, tobacco industry youth campaigns are developed in anticipation of perceived threats of marketing restrictions.”

Tobacco consumption reduction has had to transform social expectations and the vast spectrum of social environments that facilitate and motivate tobacco consumption. This has proven a far more challenging task than the individual interventions of disease diagnosis, treatment and management.

Healthy Diets

At first glance, a healthy nutritious diet year round in countries that have limited growing abilities many months of the year seems a great success. Rare and exotic fruits and vegetables can be found year round in local supermarkets of northern countries. Fish and seafood can be consumed as readily in desert and prairie towns thousands of kilometres from any seaport as in coastal villages. A full spectrum of dietary choices can be had for the right price. However, a healthy diet is more than simply access and availability. As consumption activities, the growing, processing, transportation, access, preparation and utilisation of food are also important to a healthy diet. These all have exceedingly complex and tremendously important consequences for human health and well-being.

Some of these consequences also include risks, including direct health risks, from our global food provisioning system. Global food growing, distribution, processing, packaging and utilisation now depend on substantial energy and resource intensive processes. Industrial processing often strips food of vital components and nutrients, sometimes to be added later as an afterthought. Whether the sum of its parts will prove to be equal to the original whole remains to be answered. Furthermore, the expropriation of lands for export crops, homogenisation of food through control over commodity chains, and the concentration of wealth and power within the global food industry have contributed to some rather alarming social trends worldwide.

The global food industry relies on the use of intensive monoculture and the application of fertilizers, pesticides and biocides. This contributes to significant local, regional and global pollution, climate change, ozone depletion (Smil, 1997) and the loss of both cultural and biological diversity. Global transport networks are energy intensive and are significant contributors to climate change.

Access can also be a barrier in industrial countries, albeit to a limited, although growing, extent. Unlike industrial nations, however, food access is a serious concern in Low and Middle Income Countries (LMICs) (Lappe and Collins, 1986). The World Health Organization has categorised malnutrition - access denied to a commodified global food system - as the greatest contributor to the global burden of disease. Global food commodity prices are established by market forces, and powerful transnational corporations influence prices, trends, and commodity chains to their advantage. (Pimbert et al, 2001) Food choices are allocated based on ability to pay, and this often means even locally grown food within global commodity chains is beyond the financial reach of economically disadvantaged populations.

Moreover, much of our consumption activity is accompanied by wastes and pollution. This has had a tremendously detrimental impact on the dietary habits and food consumption practices of many traditional, Aboriginal and subsistence societies. From local site contaminations to the long range transport of pollutants, consumption activity has polluted the environments and sources of food essential to these societies. Furthermore, much consumption activity has interrupted or changed migration patterns of important wild game. The dilemma is that traditional diets are being altered, conforming to the path of western processed diets, leading to health and well-being consequences from malnutrition and diabetes to community disruptions to cultural transformations.

Achieving a healthy diet is clearly more than access and availability. Approaches that seek to improve the sustainability of diets must recognise these complex human-environment couplings, and the consequences of inequity derived through commodity chains and societal practices.

SUSTAINABLE CONSUMPTION

The goods society uses (including those that support services) generate significant environmental problems through their extraction, production, use and eventual disposal. These can range from resource depletion, pollution of the air, water and land, and growth in the levels of solid, toxic and hazardous wastes. This can have direct and indirect consequences for human and ecological health. In LMICs, pollution is a major cause of premature death. Conversely, many diseases in more affluent nations are now considered 'lifestyle' diseases, with people dying from the overindulgence brought on by over- and mis-consumption (Princen, 1999). Ironically, over a billion people continue to lack access to supplies of safe water, adequate sanitation and nutrition, and energy for basic needs. Over-indulgence can also generate indirect effects, disproportionately impacting less affluent populations incapable of the technological and economic insulation affluence affords. This human deficit has tremendous health, justice, developmental, and social consequences. Given the asymmetrical distribution of benefits and impacts, clearly there are significant social consequences of current consumption activity both within and across nations. Accordingly, achieving more sustainable consumption suggests the need to confront both the social and environmental dimensions of consumption activity and its drivers.

Consumption choices are mediated by many social institutions, infrastructures and technologies, political and historical decisions, and norms of practice and social processes. In reality, both individual and social choices are shaped by these underlying and largely invisible structures generally beyond the control of individuals and specific policy choices. In fact, our decisions and choices are often driven into “unsustainable patterns of consumption, either by social norms that lie beyond individual control, or else by the constraints of the institutional context within which individual choice is executed” (Jackson, 2005). Clearly, the prevailing social environment has tremendous consequences for our consumption decisions.

A key element of the prevailing social environment is that of economics, or more precisely, market driven ideologies. For instance, conventional sustainable development discourse separates economics from the social environment. A key supposition of economics in conventional sustainable development models is growth, or continued expansion of the human economy: an attempt to incorporate more people into the consumer economy (the proverbial 'bigger cake' or a ‘rising tide raises all ships’). Many national policies thus seek to increase living standards. Unfortunately, scant evidence supports this approach, demonstrated by the tenuous links between standard of living (increasing material affluence) and quality of life beyond certain ‘threshold’ levels (Max-Neef, 1995; Elgin, 1993; and Schor,1991 and 1998). Raising living standards and expanding opportunities also imbue billions of new consumers with the necessary aspirations and tools for ‘the good life’ while simultaneously maintaining prevailing income and power relations. Yet it also ensures consumer lock-in for billions of new consumers (Rammel and van den Bergh, 2003; Tisdell, 2003; Wilson and Tisdell, 2001; and Michaelis and Lorek, 2004), and reinforces social practices and institutional mechanisms that favour increasing standards of living, economic growth, and consumption.

This development approach can quickly produce an efficiency paradox, ultimately generating a ‘rebound’ effect in energy and materials consumption (Khazzoom, 1980; Brookes, 1990; Berkhout et al., 2000; and Binswanger, 2001). While efficiency might address allocation, it fails to address

distribution and scale. In fact, efficiency simply attempts to expand the pie, rather than redistribute it. Indeed, neo-classically derived economic assumptions fail to accommodate, as even the remotest possibility, the redistribution of income and power. This being essential to maintain a Pareto optimum. Since redistribution is out of the question, raising the tide, or growth, seems the only viable alternative to improve the lives of the billions who suffer daily injustices. However, where current ecological footprints already surpass sustainable levels of consumption on a global level (and indeed in many local areas), expansionist development approaches are simply untenable.

Within this prevailing social environment, consumption serves many purposes, often simultaneously. Jackson (2005) identifies several roles, including utilitarian and improved well-being, symbolic, lock-in, and evolutionary adaptation. What these all bring to the table are different, although perhaps overlapping, perspectives, constructed and devised by people and societies through changing technologies, philosophies, politics, histories and experiences. The institutional frameworks, social organisation, technological mechanisms and political and historical decisions that have contributed to current states and trends in consumption activity is therefore incredibly complex.

Underlying all of these features is the vitally important role of the human environment in their construction, propagation and evolution. This is important to note, as environmental and social research and policy has historically focussed on the proximate causes of environmental damage and social inequality. Recently, attention has shifted towards their underlying social and economic driving forces. The social context in which choices are made can profoundly shape those choices. This phenomenon can establish powerful motivational forces which can produce, indirectly, tremendously greater environmental and social consequences (Rosa and Dietz, 1998; Vayada, 1988; Manno, 2000; Brown and Cameron, 2000; Kilbourne et al, 2001).

The current human environment enables the inequitable distribution of social power and wealth, and thus the ability for certain social actors to manipulate decisions (individual and, more importantly, societal) to their advantage. Thus, for instance, transnational food industry corporations and associations are able to influence commodity chains and governments. This enables them to determine product consistency, volumes, pricing, and markets. In turn, this functions to normalise global lifestyles and practices (Fuchs and Lorek, 2001; Schlosser, 2003). Similarly, the tobacco industry has used its substantial social power and wealth to influence communities, regions, nations, and international agendas to their benefit.

LINKAGESInforming Sustainable Consumption

The tobacco industry has wielded its influence by functioning at the level of societal values. For instance, local and national governments have often competed for access to lucrative tobacco markets for the narrow objectives of jobs creation and economic development opportunities. At present, tobacco companies have targeted LMICs, which are desperately seeking economic opportunities, as export and manufacturing producers for the tobacco industry.

A similar phenomenon is emerging in the food industry. For example, large corporate food retailers have entered the organic market. The result has been changes to organic standards, increased transport of organic produce as large retailers simply bypass the small local producers, and stimulated demand for large scale organic farming that resembles the scale, mechanization, processing and transportation of conventional farming.

Past trends in health and sustainable development research and practice have emphasized precisely those approaches that are shaped by prevailing social institutions and mechanisms. Ironically, in many cases, the social environment that supports and encourages these approaches represents the underlying challenges to achieving their objectives, such as more sustainable consumption trajectories.

Healthy living successes and sustainable consumption research suggest surprisingly similar approaches. They both have recognised the incredibly important role of the human (or social) environment in mediating consumption choices (both individually and across society); and the tremendously powerful influence that indirect factors can exert on choices and decisions. The case of tobacco consumption reveals the importance of these social environments - the institutions, structures and processes that form key inputs to both individual and societal choices - and the equally important need to confront these environments through different direct and indirect policies and actions.

Tobacco reduction strategies have become profoundly aware of and sensitive to the social acceptability of tobacco consumption, and this has directed their level of intervention. If sustainable consumption research could translate the social acceptability of consumption expectations and practices, perhaps much more success could be made. As with tobacco consumption, it will be tremendously difficult to change these expectations and individual and societal behaviour when “so many forces conspire against such change.” The experiences from tobacco reduction efforts offer both hope and guidance. Sustainable consumption will have to leverage these experiences.

Reducing tobacco consumption is synonymous with conservation, although the motivational factor is health promotion and disease prevention - healthy living - rather than environmental protection. The benefit of this approach over strict conservation is its grounding in a direct, physical, observable and, dare I suggest, economically desirable outcome. Even from this narrow perspective, many economic costs of poor health are known and can and do influence policy. Both private and public health insurance is well recorded and serves as an influential mechanism. As people become sick and ‘unproductive’, there are direct measurable costs to economies. Thus the sustainable consumption objective of healthy living is ultimately the beneficial outcomes for population health, the fundamental driver for all development.

Informing Healthy Living

However, this approach must be extended. If the objective is simply improved population health from a direct intervention, healthy living approaches may neglect vital indirect and complex synergies with ecological health. The social environment of market-driven globalization generates a number of conflicts between health and economic objectives. For example, economic arguments have driven many concerns about smoking prohibitions. Nevertheless, reduced tobacco consumption has been shown to have limited if not beneficial economic effects. OTRU (2003); OTRU (no date); Allen (1997); B.C. (1982); PSFC (2001); USDHHS (2000); and Warner et al (1996) Similarly, Warner and Fulton (1994) estimated that in the absence of the tobacco industry, total employment in Michigan would have risen due to a redistribution of spending away from tobacco products towards other goods and services. Additionally, they conclude that total incomes would also have risen significantly. “...tobacco has a negative net economic impact in all but the most tobacco-dependent region. Thus, it appears inappropriate to raise concerns about adverse economic impact in opposing policy measures that would discourage tobacco use.” In itself, this statement reveals the expectation and desire for continued economic expansion, and insofar as the tobacco industry stalls that growth (or interventions to reduce tobacco consumption do), it is seen as

undesirable. Yet economic growth in most sectors has been linked to undesirable environmental, social, and population health consequences (Daly and Cobb (1994); Daly (1996); Max-Neef (1995); Coleman (2001); Atkinson (2004); United Nations (2005)) Economic growth is clearly predicated upon certain value structures, institutional frameworks, and social processes which have important implications for population health and healthy living.

Similarly, proponents of reduced tobacco consumption assert little or no net effect on economic activity, particularly any negative impact on GDP. This is evident in the situation of smoking bans and event sponsorship, for example. (OTRU, 2003); (OTRU, no date); (Allen, 1997); (B.C., 1982); (PSFC, 2001) Numerous studies have explored the effect smoking restrictions on the economy, generally supporting the contention that there will be no net negative economic impact. Thus, in the same way that Darwin felt compelled to present the theory of evolution in a manner that closely resembled the beliefs of his time, supporters of smoking restrictions, primarily health promoters, also feel compelled to assure such restrictions satisfy prevailing economic goals of growth without questioning the diverse outcomes of those goals on population health.

Healthy living approaches must often struggle with these apparent contradictions to identify appropriate directions to improve population health within the prevailing social framework. Without the insights from sustainable consumption, healthy living activities could reveal a rather nasty paradox: social and individual shifts in response to healthy living initiatives may function against such healthy policy actions, thus diminishing or even counteracting their benefits. Consumption shifting may be towards life long learning, organic foods, or physical activity. However, it may just as readily be for travel, consumer goods, or alcoholic beverages and illicit drugs. These shifts are critical in determining both population health (the realm of assessment for healthy living initiatives) and ecological health (the sphere of analyses for sustainable consumption). Regardless, continued consumption, and indeed the promotion of such by health practitioners, is viewed as integral to accepting policies intended to reduce tobacco consumption.

While reduced tobacco consumption has certainly been desirable and beneficial for population health, it still functions as a servant to the prevailing social environment. Reduced tobacco consumption must ultimately be supplemented by economic activity to persuade decision makers of its merits. Yet this growth may be undesirable for population health.

Current disconnects such as these between healthy living, sustainable consumption and economic growth need to be resolved. There is certainly a critical role for the prevailing social environment in health promotion and healthy living activities that has yet to be accessed at a deeper level. This macro-framework which significantly influences tobacco consumption and consumption behaviour remains largely untapped.

Interventions that satisfy the prevailing social environment - such as efficiency improvements or the diagnosis, treatment and management of disease - may appear effective. In reality, they fail to confront the factors present in the prevailing social environment that contribute to the global burden of disease - the common causes of disease that affects populations. They do not alter the value structures, institutional mechanisms, or social frameworks that generate prevailing consumption paths. This might make for good political optics, but poor practice for reducing the undesirable consequences of consumption.

Our consumption choices are dependent on many factors. The prevailing social environment is vital in determining the level of healthy living and sustainable consumption we are likely to achieve. Both will require important changes in behaviour. However, “It is unreasonable to expect that people will change their behaviour easily when so many forces in the social, cultural, and physical environment conspire against such change” (Smedley and Syme, 2000). Sustainable

consumption and healthy living offer valuable insights into the behaviour shaping role of social environments, and the importance of indirect forces. These will be important to motivate and support key behaviour changes for more sustainable consumption and healthy living.

CONCLUSIONS

Tobacco policy has achieved significant success de-normalising the practice of smoking in a politically charged climate. To have illegalized tobacco in the formative years of the war on tobacco would have been simple political suicide - smokers vote, and with some 30% of the population smoking in those days in industrial countries, an introduced ban on the product would have meant the early end to any career politician, not to mention further action to reduce tobacco consumption. This approach would have been seen as a direct attack on individual freedoms and other values attributed to the prevailing social environment. More importantly, however, is the fact that tobacco markets are global: unilateral action may have been untenable. Illegal smuggling could have simply moved the tobacco industry underground, exposing the health sector to risks much more difficult to measure, quantify and predict. The social environment that made smoking a socially accepted practice and, simultaneously, a population health risk, had to be tapped and leveraged.

Within the prevailing social framework of market-driven globalization, transnational corporations seek to increase profits and reduce expenses by opening markets, modifying or shifting production to achieve efficiencies, influencing supply chains, flexing capital to modify global trade rules, tax and regulatory frameworks, and employing legal and other mechanisms to effectively compete in the, and expand their, global marketplace. It should be little surprise to observe countries with progressive tobacco reduction policies promoting tobacco consumption in developing countries as a means of export driven growth. Likewise, low and middle income countries continue to aggressively court tobacco companies to tap into their revenue generation, economic, and jobs creation opportunities while simultaneously enacting tobacco reduction policies.

The environment within which consumption decisions are based and behaviours are formed is incredibly complex, and represent a fundamentally important determinant for achieving more healthy living and sustainable consumption. Healthy living and sustainable consumption research and practice can offer each other vital insights.

One final word. While a population health approach has been taken here, other approaches, or frameworks, need also to be investigated for their contributions to sustainable consumption and vice versa. For example, indigenous populations hold many holistic worldviews and frameworks that might also help define and demonstrate the linkages between human activity, our choices and sustainable consumption (Foley, 2004). Conversely, the growing knowledge within the domain of sustainable consumption can help cut across and marry these different, and sometimes quite divergent and distinct, worldviews and frameworks. There is clearly much work ahead of us.

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