Ecocity Philosophy

MYTH: Countries Should First Get Rich, Then Worry about Health and the Environment

Excerpt from Beyond Apologies, Defining and Achieving an Economics of Wellbeing by Debra Efroymson

Debra Efroymson is Regional Director of the Canadian NGO HealthBridge. She has been living in Asia since 1994, working on reproductive health, tobacco control, gender issues, and liveable cities. She is the co-founder of the local NGO Work for a Better Bangladesh and of the Institute of Wellbeing, also in Dhaka. She frequently writes and speaks on a number of topics related to health, the environment, and economics. In April 2015 she published the book Beyond Apologies, Defining and Achieving an Economics of Wellbeing which is available for free download at Institute of Wellbeing or from a number of websites (just search under the title or send Debra an email for a pdf). Contact her at

“MYTH #11: Countries Should First Get Rich, Then Worry about Health and the Environment”


How one looks at public health and the environment varies greatly depending on whether one focuses on economic growth or on wellbeing. According to the economic growth model, wealthier societies have the resources to provide better health care and better living conditions for their citizens. Wealthier societies also have the motivation and resources to preserve the environment. Poorer societies, on the other hand, are struggling for survival and so cannot afford to worry about health or their natural surroundings. Make money first, this conventional view argues, and the rest will take care of itself. Unfortunately, this view promotes comfort for those who already have it and dangerous procrastination for everyone else.

Can we have prosperity if people and the environment are not healthy?

An estimated one and a quarter million people around the world die each year as a result of traffic crashes; an additional twenty to fifty million suffer non-fatal injuries, including lifetime disability. Internationally, for those aged fifteen to twenty-nine, years, traffic injuries are the leading cause of death.[i] Diseases directly linked to air pollution are another leading cause of premature death, responsible for more than three million early deaths annually.[ii] More driving and higher speeds mean more crashes, worse air pollution, and less physical activity; wider roads mean less space for farmland and green space. Yet when it comes to the choice between promoting transport systems that would reduce driving (focusing on trains, light rail, good infrastructure for walking and cycling, and policies that make driving more costly) or promoting the use of cars (building more roads, widening existing ones, adding more flyovers and elevated expressways), transport planners and funders opt for the latter. They claim that economic growth requires more infrastructure for cars and trucks rather than for people. There is, they say, a necessary trade-off between the economic benefits of roads and their negative consequences. Similarly, every mine, every polluting industry, and every attempt to resist improved workplace safety is justified based on economics; illness and death are simply the price of doing business (‘collateral damage’ is another phrase often used). Damage to health and the environment is justified as long as it contributes to prosperity; attempts to protect health and the environment are unwarranted brakes on economic progress.

The importance of the environment to human wellbeing should transcend monetary figures. In his film An Inconvenient Truth, former United States vice president Al Gore displays a scale that weighs gold bars against the earth. Yes, the gold bars look tempting, but it obviously makes no sense to sacrifice our planet for them. One cannot destroy the environment and then buy one’s way out of the destruction. Yet, while people may acknowledge the need to save the environment in a general sense, for any single decision they typically view ‘the economy’ as more important. People have already sacrificed much for the economy, why not a little more? It is not possible to return to a pristine state of nature. It is no easy matter to decide how much of one’s comfortable lifestyle (for those who have one) and ambition to live better, in a material sense, one should sacrifice to avoid doing a little more damage to the planet.

It is unwise to forget Gore’s scale entirely. Economic growth, as measured by growth in GDP, necessarily takes a toll on the environment. This includes climate change that scientists have tied to all the carbon dioxide and methane generated from transport, industry, and livestock. It includes environmental damage that results from paving over the countryside to make space for industry. It results from the continuous building of more roads and highways. It results from power plants that generate power in environmentally damaging ways, and from the creation of ever greater amounts of waste. These are not trivial concerns that we can postpone to a future day when countries will be better able to afford to address them. The environment affects people’s health and overall wellbeing today. It is not a separate entity; it is the space that people inhabit. It is not that people should save the environment out of a sense of goodwill or charity; it is the environment that enables life to exist on the planet.

Nature's Economics: Human economics are completely dependent upon natures. Within human economics there is the ancient “gift economics” that starts with suckling babies and harvesting nature’s bounty directly with those having, making and giving to those needing and reciprocating in complex ways. When things get complex and the “artifact list” of a culture become to long to be managed without a neutral medium of exchange, capital appears to speed transactions, store and quantify value.

“Nature’s Economics” illustration by Richard Register: Human economics are completely dependent upon nature’s. Originally appears in “Baku, Azerbaijan“.

Meanwhile, the focus on economic growth means that governments often fail to take seriously the environmental catastrophes caused by industry and instead wink at corporate violations of whatever regulations do exist. When industrial growth is always regarded as being more important than a clean environment, the damage that ensues is ignored. Ignoring it does not make it go away. Industry is far more generous about sharing the damage it creates than it is about sharing the profits such damage generates – what Paul Krugman calls privatizing health and socializing loss. The mess industry creates is left for everyone else to clean up or suffer in. A recent example is British Petroleum’s (BP) handling of the disastrous oil spill in the Gulf of Mexico, a spill caused by its own negligence and by its successful lobbying of the American government to prevent the enforcement of reasonable safety measures. According to the New York Times, regulators had been warning offshore rig operators for more than a decade of the need for stronger safety measures. There was nothing new about the accident in the Gulf except its size: between 2001 and 2007, there were, according to the Times, 1,443 serious drilling accidents, “Yet the federal agency continues to allow the industry largely to police itself.”[iii] BP also lobbied against stricter regulations: “Last year,” the Times article notes, “BP, the owner of the well that blew up in the Gulf, teamed with other offshore operators to oppose a proposed rule that would have required stricter safety and environmental standards and more frequent inspections. BP said that ‘extensive, prescriptive’ regulations were not needed for offshore drilling, and urged the minerals service to allow operators to define the steps they would take to ensure safety largely on their own.” Industries lobby, governments listen, and the environment and the public suffer.

Corporate-owned mainstream media contributes to the problem by encouraging people to be unconcerned about the health of people or of the planet and by portraying corporations as good global citizens seeking to improve the state of both. The behaviour of corporations leaves no choice: to prioritize healthy people and a flourishing environment over the growth of GDP and corporate profit, a number of measures will be needed to rein in corporate activities.

Technology as a shortcut

If market forces alone are not enough to protect health and the environment, what about technology, which has achieved amazing results over the past few decades and particularly the past few years? Mainstream economists and their followers claim that it is possible to have it all: that technology will save the environment without people having to change their lifestyles. To some, this thought is appealing. If the river floods, dam it. If fresh water becomes a growing problem as glaciers disappear, desalinate salt water, which is in abundant supply. If cars pollute, run them on biofuel. Call me a Luddite if you will, but it seems that each technological solution brings new problems in its wake. It is a bit like the patient who needs drugs to deal with the side effects of her other medications.

Dams provide electricity, water, and some measure of flood control. They also displace millions of people and completely distort the environment. The water collected in reservoirs, which is often full of plants from the flooding of the pre-existing area, is a serious source of gases that contribute to climate change.[iv] Desalinating salt water is costly, in terms of both money and the fuel required. Biofuel can be a net loss, given the amount of conventional fuel that is needed to grow, harvest, and transport the vegetable components of which it is made (chemical fertilizers are petroleum-based, and farmers these days tend to use tractors rather than oxen). Growing of corn and other components of biofuel also takes land away from food crops for people, thereby exacerbating rising food prices and world hunger. Cars were envisioned as a wonderful technology to free people from the horse and buggy and to allow residents to escape polluted, congested cities; television was meant to expand people’s horizons and provide them with wonderful sources of information. There was once a belief that nuclear weaponry would make the world safer, as nobody would dare to start a war given the potentially disastrous global consequences. Human arrogance can lead us into dangerous territory, suggesting that people can overpower nature or rewire the world to suit their needs. The tsunami that devastated several Asian countries and part of Somalia in 2004, hurricane Katrina in the American city of New Orleans in 2005, the tsunami in Japan in 2011, and other extreme weather events are reminders of how powerless humankind remains in many circumstances, no matter how advanced its technology. Technology can make people’s lives better in many ways, but it cannot rewrite the fundamental rules of life, including that non-renewable resources are limited and that pollution has deadly consequences.

White Sands untouched

Towards a Better Way: Prioritizing Health and the Environment

Healthier people are better able to take care of themselves and their families; they lead better lives. The planet sustains humanity; a healthier environment means healthier people. When wellbeing is the priority, it is obvious that health and the environment are priorities. Regulations imposed and money spent to preserve and improve health and the environment is a net benefit and an investment, not a cost. Money is of very little use to someone if it obtained at the price of that person’s health. Economic and health policies would look very different if people felt that it is illness, not health, which is unaffordable. It is time to reject any definition of prosperity that posits unhealthy people living on a sick planet, even if it also posits an abundance of material goods mostly accumulating in the hands of a few.

The need for more and wiser government investments

It is possible to overcome the opposition of a tremendously rich and powerful corporation. Successes in tobacco control illustrate the possibilities. The success of a decades-long campaign to ban Nestlé’s marketing of infant breast milk formula is another example. But corporations are by no means the only culprits in the poor state of public health and the environment. In too many countries, governments focus on subsidizing industry and giant corporations and fail to invest in the basic needs of their citizens. They ignore the fact that the social determinants of health include housing quality, education level, and (to some extent) income. When they do fund health, governments tend to focus on big hospitals in cities rather than on easily accessible primary health care centres throughout the country. When the focus is on treatment, prevention is ignored, often entirely.

Nor should concern about economics act as an excuse that allows for further deterioration of the environment. Any short-term gains made by those polluting the environment are more than offset by long-term costs for everyone.

Government investment should also support a return to traditional farming methods. Governments need to put and an end to highly profitable, highly polluting Concentrated Animal Feeding Operations (CAFOs). CAFOs are morally abhorrent in the way that they treat the animals, but they also impose an enormous cost in terms of releasing climate-change-inducing methane into the atmosphere and tremendous amounts of contaminated fecal waste into the groundwater. Chemical-based industrial agriculture also contributes to pollution, leaking petroleum-based fertilizers as well as dangerous insecticides and other chemicals into the world’s waterways. Sadly, and as a direct result of policy rather than practicality, junk food in the United States has become cheaper than healthy food. Agricultural subsidies in the United States favour crops such as corn and soybeans that are key ingredients in fast food, soft drinks, and animal feed. Fresh fruits and vegetables for direct consumption receive no such subsidies.[v] Nor is information about healthy diets easy to come by. In some poor neighbourhoods, food choices are even worse: fast food outlets completely dominate the food scene and fresh produce is a rarity.[vi]

If governments took a longer-term view of the costs and benefits of the policies that they were enacting, if they prioritized health and the environment instead of economic growth, then the fallacies of mainstream economics would become clear. It is a sure indication that an economic system is ‘sick’ when it fails to give priority to health or to the ability to sustain life on the planet.

Choosing the environment and employment

Recognizing that jobs are important does not mean that people should always be ready to sacrifice the environment to create more jobs. To the accusation that one cares more about the environment than about the suffering unemployed, the correct response is not to back down, but rather to reply, “Actually, I care about both.” Good jobs are jobs that are healthy for the people doing them and for the environment. People do not need to go along with the assumption that it is necessary to make a choice between jobs and economic prosperity on the one hand and human and environmental wellbeing on the other. That type of reductionist thinking has gotten us into the current mess; it will not get us out.

There are a number of ways to make existing jobs healthier. One is to improve and enforce workplace safety. Policies that mandate a shorter workweek (thirty-six or forty hours/week) would allow more people to be employed, with all people working fewer hours and thus having more time to pursue other activities that contribute to their and their families’ wellbeing. Nor would such a shift cause any reduction in productivity; in fact, it would likely mean a gain. Workers are less productive and more accident-prone when they are tired, as happens if they regularly work more than forty hours a week. The shorter workweek would thus benefit not only employees, but employers as well.[vii]

Government policies should not favour large businesses over smaller ones, nor should they subsidize wealthy corporations to create substandard jobs. The current practice of subsidising employers through tax benefits and then having to provide food stamps and other benefits for its workers because the salaries they pay are too low to live on, is in fact a double subsidy to the corporation at the expense of the employees. McDonalds has created a website to explain to its fulltime workers how they can get by on the minimum wage that the company pays, by holding a second job and spending no money at all on food, clothing, or heating.[viii] In the meantime, Don Thompson, the company’s new CEO, receives a pay package of almost $14 million. The average McDonalds employee would have to work one million hours to earn as much as Mr. Thompson.[ix] Meanwhile, the jobs created by the opening of a fast food restaurant or a big box store replace jobs that already existed in local shops, many of which go out of business when the behemoth comes to town. The question is not whether a policy will create jobs, but whether it will create more and better jobs than it replaces, or whether a better alternative, in terms of job quality and health and environmental effects, already exists.

Pedi-cab Tuk Tuk in India. An example of job creation that helps the environment and the health of the driver!

Pedi-cab Tuk Tuk in India. An example of job creation that helps the environment and the health of the driver! Image from “Mobility in Cairo’s Informal Areas

Governments can support local, intensive industry and repair. In some countries, this includes making traditional fishing nets, baskets, and other products from natural materials. In reality, the exact opposite often occurs. In 2002, the Government of Bangladesh closed Adamjee Jute Mill in response to the World Bank’s complaints about corrupt management at the firm and its insistence that the company be closed. The mill, which had been operating for more than fifty years, was the largest jute mill in the country. The jute it processed provided biodegradable local materials and generated employment for about 30,000 people.[x] A recent article suggests that the mill will reopen, with ‘modern machinery’ and jobs for 5,720 people.[xi] Surely less draconian measures could have solved the corruption problem and saved employment. It is too late for Adamjee Jute Mill; there is still time to save other local, non-polluting industries.

How does one have both employment and a healthy environment? Policies that discourage employment by encouraging automation should be repealed, except in cases where such policies protect people from really awful jobs. Since payroll taxes and worker benefit schemes – including pension funds, health benefits, and vacation and sickness leave – can make it more expensive to hire workers than to replace them with machines, many companies opt for automation, particularly when they receive tax breaks for capital investments. What if those investments were subjected to tax rates that were high enough to make it less costly to hire people than to replace them with machines? This is particularly important in countries where unemployment rates are high. A range of policies could be developed and enacted to reward employers for hiring and to punish them for replacing people with machines. Any benefits to industry should, of course, only be proffered when the businesses pay at least a minimum wage; it makes no sense to subsidize companies to underpay their workers.

The environmental impact of the move to automation is direct. Machines that require fuel to run, as well as having environmental costs in their creation and disposal, replace human workers. (People also require fuel to operate, but that is true whether they are employed or not.) Labour-intensive activities and techniques, on the other hand, typically replace fossil fuel with human input, more employment, and less waste disposal, thus benefiting the environment. When the goal is to maximise employment rather than production, it is possible to choose both jobs and a healthy environment.

It would be interesting to know what the effect might be on a national economy of promoting economic policies that favour the environment and employment. Fortunately, there is already evidence from an ‘experiment’ conducted in the Netherlands between 1980 and 1983. (The work is old but the ideas are, if anything, more valid today than ever.) The experiment used computer models to compare different growth scenarios: two focusing on growth and production, and an alternative ‘conserver-economy’ strategy that focused on saving the environment and using less energy.[xii] Measures used in the models included the accounting of goods and services produced as well as of: environmental ‘goods’ such as energy, natural resources, and plant and animal species; the safety of the future in terms of the environment and natural resources; the distribution of scarce goods or income; working conditions; the degree of free choice in terms of whether to spend one’s time working or in other ways; and leisure time. A university and government agencies calculated the results of the different scenarios. On the surface, the conserver-economy appeared less prosperous: compared to one that emphasised production, the conserver approach resulted in a lower GDP and less total income, agriculture, industry, and services. However, it did not cause a decline in employment, and it led to a significant increase in the share of income going to those doing the work. There were astonishingly large predicted decreases in various types of pollution. These are all estimates, but based on a detailed analysis of the various scenarios, vast improvements would occur through the implementation of a conserver-economy in terms of preservation of plant and animal species, emissions of various air pollutants, water pollution, solid waste, radioactive waste, burning of coal, changes to the landscape, and workers’ incomes. Health and the environment clearly are not mutually exclusive with economic wellbeing – as long as we stop using GDP as our measure of progress.

For those used to living in a world of disposable products, it may be hard to imagine anything different. However, most of the world does not take consumption quite so much for granted, as do Americans. In Dhaka, trash is often picked through a few times before it is collected. In many countries, the repair of various articles (electronics, shoes, bicycles) is a major source of income, as is the regeneration of ‘garbage’ into something useful. Nor will people’s standard of living necessarily decline if they switch from several pairs of plastic sandals to one pair of repaired leather ones. The ‘conserver-economy’ acknowledges this. It focuses on: preventing pollution, saving energy, using more solar power, discouraging car use through parking fees and a ban on new garages/roads, etc., reducing the use of artificial fertilizers/ pesticides and inducing a shift to smaller farms, promoting high density mixed use areas, and encouraging services such as repair shops and small retail shops. This model provides employment and is good for the environment. The model also favours ‘short-time working’ to reduce unemployment (more people working fewer hours).

Surely, a small decline in monetary income in exchange for more equality and an improved living environment is a worthwhile trade-off. As Hueting notes, “In the right conditions, environmental conservation creates employment. … In my opinion this is the most important conclusion that can be drawn from the scenario exercise.”[xiii] Another major conclusion is that it can work. Although the model would play out differently in various settings, the main findings hold: burning less fuel and using more human effort would create more employment, more equality, and a cleaner environment.

A direct approach to increasing wellbeing rather than consumption and an appropriate measuring system to evaluate progress would eliminate the incentives to make money while harming health. A wellbeing-focused approach would illustrate that the value of health goes far beyond simple dollars and cents. Such an approach would also help in demonstrating the need to incorporate health – both in terms of access to health care and of the living conditions that promote health – into declarations of/actions on human rights. Canadian environmental activist David Suzuki, for example, is working to include the right to clean air and water in Canada’s Charter of Rights and Freedoms; ninety-five countries already recognize the right to a healthy environment.[xiv] Essential human rights should not be limited to the right to assembly, religion, and free speech.

While it is true that it is not possible to have it all — employment, a healthy environment, and all the material goods we desire — it is possible to have a lot. It will be easier to make sensible decisions if the full range of options with their costs and benefits are known. It is time to stop believing that difficult choices must be made between employment and the environment, or between health and the economy. It is time to maximize health, employment, and the environment within a broader definition of prosperity.



[i] World Health Organization, “Road Traffic Injuries Fact Sheet N°358,” March 2013.

[ii] “Global Shift Away from Cars Would Save US$100 Trillion, Eliminate 1,700 Megatons of Carbon Dioxide Pollution,” ScienceDaily, 17 September 2014.

[iii] Eric Lipton and John Broder, “Regulator Deferred to Oil Industry on Rig Safety,” The New York Times, 7 May 2010. This case is also discussed at length in Joshua Holland, The Fifteen Biggest Lies About the Economy and Everything Else the Right Doesn’t Want You to Know About Taxes, Jobs, and Corporate America (Hoboken, New Jersey: John Wiley & Sons, Inc., 2010).

[iv] This has been described in many places. See, for instance, Duncan Graham-Rowe, “Hydroelectric Power’s Dirty Secret Revealed,” NewScientist, 24 February 2005 and “Reservoir Emissions,” International Rivers (

[v] Annie Corrigan, “Marion Nestle (Part 2): Food Policy, Local Food and Food Labeling,” Earth Eats, 13 July 2010.

[vi] See, for example, Janne Boone-Heinonen, Penny Gordon-Larsen, et al., “Fast Food Restaurants and Food Stores,” Archives of Internal Medicine Vol. 171, No. 13, 11 July 2001. and Rudd Center for Food Policy & Obesity, Access to Healthy Foods in Low-income Neighborhoods: Opportunities for Public Policy (New Haven: Yale University, 2008).

[vii] Sara Robinson, “Bring Back the 40-hour Work Week,” Salon, 14 March 2012.

[viii] Annie-Rose Strasser, “McDonalds’ Budget for Employees: Get a Second Job, Turn off Your Heat; How about Just Paying Them a Living Wage?” AlterNet, 17 July 2013 and Minyanville, “McDonald’s Sample Budget Sheet Is Laughable, But its Implications Are Not.” NASDAQ, 27 July 2013.

[ix] Leslie Patton, “McDonald’s $8.25 Man and $8.75 Million CEO Shows Pay Gap,” Bloomberg News, 12 December 2012.

[x] Anu Muhammad, “Closure of Adamjee Jute Mills: Ominous Sign,” Economic and Political Weekly 37.38 (21-27 September 2002): 3895-3897.

[xi] “Adamjee Jute Mills to Restart with Modern Machinery,” Fibre2fashion News Desk – India, 13 September 2010.

[xii] Roefie Hueting, “An Economic Scenario for a Conserver-Economy” in The Living Economy.

[xiii] Hueting, “An Economic Scenario.”

[xiv] David Suzuki Foundation, “Right to a Healthy Environment,” accessed 28 September 2014.