Thursday, March 26, 2015

Federal dietary guidelines recommend cutting back on red and processed meat, sugar and refined grains

The Department of Agriculture and the Department of Health and Human Services have released proposed 2015 Dietary Guidelines for Americans. The guidelines, released every five years, "provide authoritative advice about consuming fewer calories, making informed food choices, and being physically active to attain and maintain a healthy weight, reduce risk of chronic disease, and promote overall health," says USDA.

It shouldn't come as a surprise that the 2015 guidelines recommend eating healthier foods, while cutting back on less healthy alternatives. "The committee basically recommended Americans take up a diet that is higher in vegetables, fruits, whole grains, low- or non-fat dairy products, seafood, legumes and nuts," Chris Clayton reports for DTN The Progressive Farmer. "We should cut back on red and processed meats and sugar-sweetened foods, drinks and refined grains. And we should be moderate in our alcohol."

Recommended cutbacks of certain foods have not gone over well with those food producers, who met this week to give feedback on the Dietary Guidelines Advisory Committee's recommendations, Clayton writes. The North American Meat Institute argued that "lean meat, poultry, red and processed meats should all be part of a healthy dietary pattern because they are nutrient-dense protein."

Shalene McNeill, a nutritionist for the National Cattlemen's Beef Association, "told the committee that its recommendation to exclude lean meat ignores decades of nutrition science," Clayton writes. McNeill said Americans should be encouraged to eat more lean meat, along with fruits, vegetables and whole grains. Grain, sugar and milk producers also expressed displeasure with the proposed rules.

Most nutritionists have embraced the proposed rules, but say the key is getting people to adopt them, Andrea McDaniels reports for The Baltimore Sun. Among those rules is limiting sugar intake to 200 or less calories, or 10 percent of total calories, per day. Currently, Americans get about 13 percent of their calories, or 268 calories, from added sugar.

"On the flip side, some foods once shunned are now accepted," McDaniels writes. "Research has found that cholesterol-high foods are no longer believed to contribute to high blood cholesterol, so people can now indulge in shrimp, eggs and other foods that were once off limits, the panel said. Rather than focus on cholesterol, people should curb saturated fat to about 8 percent of the diet."

The panel also said "up to five cups of coffee a day are fine, so long they are not flavored with lots of milk and sugar," McDaniels writes. "The panel also singled out the Mediterranean diet—rich in fish and chicken, fruits and vegetables, nuts, whole grains, olive oil and legumes—for its nutritional value."

Wednesday, March 25, 2015

Heroin bill finally passes and is signed into law; Naloxone program put into motion; dating-violence bill sent to Beshear

By Melissa Patrick
Kentucky Health News

The long-negotiated bill to tackle Kentucky's heroin-overdose epidemic passed in the final hours of the 2015 legislative session.

Almost immediately after the heroin bill passed the Senate, a bill to offer immediate civil protections to dating partners who are victims of dating violence was passed after being held in the chamber since February 13 -- likely because Democratic Rep. John Tilley of Hopkinsville, chair of the House Judiciary Committee, was the original sponsor of both bills.

Tilley told reporters that the passage of the two bills meant it had been a successful session.

Gov. Steve Beshear signed the heroin legislation, Senate Bill 192, into law Wednesday, March 25, less than 12 hours after it passed, so that its emergency clause could put it into effect immediately. The dating violence bill, House Bill 8, has been delivered for his signature.

"Senate Bill 192 is tough on traffickers who bring these deadly drugs into our communities, but compassionate toward those who report overdoses or who admit they need help for their addiction," Beshear said in a release. "I applaud our legislators for putting aside partisan interests for the greater good of all Kentuckians who have been affected by this devastating drug."

The bill passed the Democrat-controlled House 100-0 and the Republican-controlled Senate 34-4. Republican senators John Schickel of Union, Joe Bowen of Owensboro, Chris Girdler of Somerset and Paul Hornback of Shelbyville voted against it.

The stickiest issues were a needle-exchange program, which many senators opposed, and tough new penalties for drug traffickers, which Tilley and many House members said would not be effective. The new law allows needle-exchange programs of approved by local governments, and the tough penalties, but allows the judge to be lenient in sentencing if the defendant is an addict.

The bill also allocates money for drug treatment programs; includes a "good Samaritan" provision that allows a person to seek medical help for an overdose victim and stay with them without fear of being charged; access for addicts and their families to the drug Naloxone, a drug that reverses the effects of an overdose; and allows the Department of Corrections to provide an approved medication to inmates to prevent a relapse in their addiction.

"The bill includes provisions that are important to law enforcement and me: increasing penalties for large volume traffickers, expanding access to treatment, and getting heroin overdose reversal kits into the hands of our first responders. I know this legislation will save lives," Attorney General Jack Conway said in a news release.

Hornback argued that "forced rehab doesn't usually work," providing addicts with Naloxone and free needles simply enables them and the bill does not allow addicts any "consequences for their actions."

He said that while he knows there are people dying from heroin overdoses,"I didn't make that decision for them and I for one, and a lot of my constituents are tired of paying for people's bad decisions and that is what this (bill) does."

Tilley said in an interview after the vote that needle exchange programs are proven to work, will save taxpayers money and are absolutely necessary to "stem the tide of two tidal-waves that are headed Kentucky's way: HIV and Hepatitis C and Hepatitis B."

"The cost of treating someone with HIV is $350,000. The cost of treating someone with Hepatitis C is $85,000. The budget now had a $55 million hit just with the explosion of Hepatitis C last year. We can't afford that in Kentucky," he said. Advocates say the programs can be a gateway to treatment and rehabilitation.

Meanwhile, Conway and first lady Jane Beshear announced that funding for Naloxone kits would be made available to the hospitals in Kentucky with the highest rates of heroin overdose deaths. The kits will be provided free to every treated and discharged overdose victim at the pilot-project hospitals.

They made the announcement at the University of Louisville, which treated 588 people in 2013 for heroin overdoses, a news release said. In 2013, the latest data available, 230 of the 722 autopsied overdose deaths, or 32 percent, were caused by heroin, according to the Kentucky Office of Drug Control Policy.

Tilley and Republican Sen. Whitney Westerfield, also of Hopkinsville, "forged a friendship that allowed the two men to work out differences on a pair of high profile bills fraught with political pitfalls," Adam Beam reports for The Associated Press. "Westerfield, a former prosecutor, is running for attorney general against the son of Democratic Gov. Steve Beshear, giving Democrats all the reason in the world not to work with him."

The AP notes that Republican Sen. Chris McDaniel wrote the first draft of the heroin bill that passed the Senate in January, but it omits McDaniel's other role: candidate for lieutenant governor on a slate headed by Agriculture Commissioner James Comer. As the Senate prepared to give the final bill final passage, Republican Floor Leader Damon Thayer accused the House of not passing McDaniel's bill because of his candidacy.
Read more here: http://www.kentucky.com/2015/03/25/3767938_political-compromises-brokered.html?rh=1#storylink=cpy

County Health Rankings look familiar, but show that some counties overcame bad factors to have encouraging outcomes

The 2015 County Health Rankings for Kentucky, compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation, have been released. For the fourth year in a row, Oldham County ranked highest in Kentucky for health outcomes. Statistical differences among closely ranked counties are very small, so rankings are arranged in quartiles (quarters) in the maps below.

The rankings fall into two categories: factors and outcomes. Health factors, left, include the health behaviors (with factors such as adult smoking), clinical care (with factors such as the ratio of population to primary-care physicians), social and economic factors (such as the percentage of children under 18 in poverty) and physical environment (with factors such as the percentage of workforce that drives alone to work). Oldham County was followed by Boone, Woodford, Scott and Anderson counties. Clay County ranked last, preceded by Martin, Leslie, Wolfe and Knott. Generally, health factors and outcomes reflect income and education levels.

Health outcomes, right, include premature death, poor or fair health, poor physical health days, poor mental health days and low birthweight. Boone County ranked first, followed by Oldham, Shelby, Fayette and Jessamine. Owsley County ranked last, preceded by Floyd, Leslie, Clay and Perry.

Some counties, such as Morgan and Wayne, overcame their poor health factors to have better-than-average outcomes. To see the full, specific list of county rankings, click here.

Tuesday, March 24, 2015

Health reform law has been good for hospital finances, health-care costs, Obama administration says

U.S. hospitals have saved billions of dollars because the federal health-reform law has provided coverage for patients who were once charity cases, the Obama administration announced Monday, the fifth anniversary of the Patient Protection and Affordable Care Act.

"Hospitals also saw fewer emergency room visits, which rack up far higher costs and often leave hospitals with the tab," Sarah Ferris writes for The Hill, which covers Congress. "The government’s report, which focuses on the benefits of Medicaid expansion, is an effort to entice states that have been politically resistant to expanding the program."

Kentucky hospitals have acknowledged that the law has reduced their losses from "uncompensated care," but say other aspects of the law have created a mixed effect, depending partly on hospitals' ability to adapt. The increase in coverage has brought hospitals much more money, but they say continued problems with managed-care Medicaid have cause them financial difficulty.

From paying patients' point of view, the law appears to have reduced inflation in health-care costs, but has not achieved advocates' goal of reducing costs. A White House report said, "Since the Affordable Care Act was enacted, health care prices have risen at the slowest rate in nearly 50 years. Thanks to exceptionally slow growth in per-person costs throughout our health care system, national health expenditures grew at the slowest rate on record from 2010 through 2013."

For the White House's Kentucky-specific list of benefits of the law, click here.

Reform law 'quietly accomplishing the goals it was created to achieve,' McClatchy Newspapers reporter writes

The federal health-reform law is still controversial and still facing a legal challenge, but "is quietly accomplishing the goals it was created to achieve," Washington correspondent Tony Pugh reported for McClatchy Newspapers on the occasion of the law's fifth anniversary. (The Lexington Herald-Leader is a McClatchy paper.)

"The nation’s uninsured rate has plummeted as more Americans enroll in Medicaid or in federal and state marketplace coverage," Pugh notes. "The law’s consumer protections and insurance-benefit requirements have improved the quality of coverage for millions of people who get health insurance outside the workplace. Premiums for marketplace health insurance have largely been reasonable and have increased only moderately thus far. Long-term cost estimates for providing coverage under the law have been falling."

Howver, Pugh writes, "The law may never overcome the bitter politics that surrounded its enactment and that partly define its legacy. Long viewed as a government overreach, the health-care law has been problematic for those who want the private insurance market to dictate who gets health insurance and what it should cost. . . . Moreover, the law’s requirement that most Americans have health insurance is seen as an infringement on individual freedom. The Supreme Court ruled in June 2012 that the so-called individual mandate didn’t violate the Constitution."

The White House issued a state-specific list of the law's benefits. For Kentucky's, click here.

Monday, March 23, 2015

Obama says health-reform law working better than expected

President Obama made this statement on the fifth anniversary of the Patient Protection and Affordable Care Act:

On the five-year anniversary of the Affordable Care Act, one thing couldn’t be clearer:  This law is working, and in many ways, it’s working even better than anticipated.

After five years of the Affordable Care Act, more than 16 million uninsured Americans have gained the security of health insurance – an achievement that has cut the ranks of the uninsured by nearly one third.  These aren’t just numbers.  Because of this law, there are parents who can finally afford to take their kids to the doctor.  There are families who no longer risk losing their home or savings just because someone gets sick.  There are young people free to pursue their dreams and start their own business without worrying about losing access to healthcare.  There are Americans who, without this law, would not be alive today.

For Americans who already had insurance before this law was passed, the Affordable Care Act has meant new savings and new protections.  Today, tens of millions of Americans with pre-existing conditions are no longer at risk of being denied coverage.  Women no longer have to worry about being charged more just for being women.  Millions of young people have been able to stay on their parents’ plan until they turn 26.  More than 9 million seniors and people with disabilities have saved an average of $1,600 per person on their prescription medicine, over $15 billion in all since the Affordable Care Act became law.  More than 70 million Americans have gained access to preventive care, including contraceptive services, with no additional out-of-pocket costs.  And the law has helped improve the quality of health care: it’s a major reason we saw 50,000 fewer preventable patient deaths in hospitals over the last three years of data. 

The cynics said this law would kill jobs and cripple our economy.  Despite the fact that our businesses have created nearly 12 million new jobs since this law was passed, some still insist it’s a threat.  But a growing body of evidence – actual facts – shows that the Affordable Care Act is good for our economy.  In stark contrast to predictions that this law would cause premiums to skyrocket, last year the growth in health care premium costs for businesses matched its lowest level on record.  If premiums had kept growing over the last four years at the rate they had in the last decade, the average family premium would be $1,800 higher than it is today.  That’s $1,800 that stays in your pocket or doesn’t come out of your paycheck.  And in part because health care prices have grown at their slowest rate in nearly 50 years since this law was passed, we’ve been able to cut our deficits by two-thirds.  Health care costs that have long been the biggest factor driving our projected long-term up deficits up are now the single biggest factor driving those deficits down. 

The Affordable Care Act has been the subject of more scrutiny, more rumor, more attempts to dismantle and undermine it than just about any law in recent history.  But five years later, it is succeeding – in fact, it’s working better than even many of its supporters expected.  It’s time to embrace reality.  Instead of trying yet again to repeal the Affordable Care Act and allowing special interests to write their own rules, we should work together to keep improving our healthcare system for everybody.  Instead of kicking millions off their insurance and doubling the number of uninsured Americans, as the House Republican budget would do, we should work together to make sure every American has a chance to get covered.


Five years ago, we declared that in America, quality, affordable health care is not a privilege, it is a right.  And I’ll never stop working to protect that right for those who already have it, and extend it to those who don’t, so that all of us can experience the blessings of life, liberty, and the pursuit of happiness in this country we love.  

Sunday, March 22, 2015

As tax deadline nears, most uninsured appear likely to choose penalty; some with coverage are having to refund part of subsidy

Kentucky Health News

Most people facing a tax penalty for not having health insurance appear likely to pay it instead of taking advantage of a special opportunity to but coverage and minimize the penalty.

"Major tax-preparation firms say many customers are paying the penalty and not getting health insurance," reports Stephanie Armour of The Wall Street Journal. "Research also suggests that many people who lack health insurance will pay the penalty and not get covered this year."

Many polls have found that many if not most people without health insurance are unaware that they are subject to a tax penalty under the federal health-reform law. That percentage appears to be declining as they prepare their income-tax returns, but a poll taken in late February found that when told of the penalty, only 12 percent of the uninsured said they would get coverage.

For many people, the choice is simply financial, since coverage for them would be more expensive than the penalty -- 1 percent of their income, or $95 per adult or $47.50 per child, whichever is larger. Others say they don't need coverage, and some object to the penalty or the law altogether.

The penalty will increase to 2 percent of income and $325 per adult or $167.50 per child for the 2015 tax year, so if you are uninsured and don't qualify for Medicaid or one of the law's exemptions, the end of the special enrollment period, April 30, is the last chance to avoid that penalty.

"In late February, H & R Block reported that its uninsured clients had paid an average penalty of $172," reports Abby Goodnough of The New York Times. "The money comes out of refunds, while people who do not get refunds are required to pay the Internal Revenue Service by April 15."

Some people who have coverage "might find another unpleasant surprise: As many as half the nearly 7 million Americans who got subsidies to offset their premiums may have to refund money to the government, according to an estimate by H & R Block," the Journal reports. "The subsidies are based on consumers’ own projections of their 2014 income, but some estimated incorrectly and received overly generous credits. Those people will see smaller-than-expected refunds or could owe the government money."

"H & R Block also found that as of Feb. 24, just over half of its clients with subsidized marketplace coverage had to repay a portion of their subsidy because their 2014 income turned out to be higher than what they estimated when they applied for coverage," the Times reports. "The process includes "new forms that even seasoned preparers are finding confusing."

The Obama administration announced last month that 800,000 people with insurance bought under the reform law had received incorrect information needed for their tax returns. About 10 percent of them have still not received corrected forms, it announced Friday. "The administration said people who have not received the corrected forms do not have to wait to file their taxes and will not have to pay any additional tax due to the effort," The Hill reports.

The Wall Street Journal reports, "Consumers who already filed their tax returns using the incorrect forms provided though state or federal exchanges won’t be required to file amended forms, and the Internal Revenue Service won’t assess additional taxes, said Mark Mazur, the Treasury Department’s assistant secretary for tax policy."

Saturday, March 21, 2015

KET to focus attention on cancer with Ken Burns series March 30-April 1, live call-in program on night of April 1

Kentucky Health News

KET will show a three-night series, "Cancer: The Emperor of All Maladies," by Ken Burns, an in-depth look at the history of cancer, patients' stories and the "latest scientific breakthroughs that may have, at last, brought researchers within sight of developing lasting cancer cures," the network says in a news release.

The series, which will air March 30, 31 and April 1 at 9 p.m. ET, is based on the Pulitzer Prize-winning book The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee.

KET will air companion programs to this series that will focus on Kentuckians.

Bill Goodman will host Dr. Mark Evers, director of the Markey Cancer Center at the University of Kentucky, on "One to One" March 29 at 1 p.m. ET to discuss the latest news in cancer care and research. This show will also air on KET2 March 31 at 7:30 p.m. ET.

On April 1 at 8 p.m., Renee Shaw will host a live call-in program, "Answers for Cancer," as part of KET's "Health Three60" series. This show will offer viewers a chance to ask questions about cancer screening, treatment and recovery resources in Kentucky.

A recording of the program will air on KETKY April 6 at 9 a.m., April 10 at 11 a.m., April 11 at 4 a.m. and April 13 at 2 a.m. (all times ET).

Viewers can submit questions to the original program via Twitter at @HealthKET, by email at healthnews@ket.org, or by phone at 800-753-6237.

Panelists on the program include Donald Miller, director of the James Graham Brown Cancer Center at the University of Louisville; Patrick Williams, medical director at Norton Cancer Institute; Timothy Mullet, lung cancer specialist with UK HealthCare, who is himself a cancer survivor; and Fran Feltner, director of the UK Center for Excellence in Rural Health.

This show will also offer a pre-taped segment that spotlights cancer screening outreach efforts in Kentucky that target high risk populations.

Authors of The Great Diabetes Epidemic will talk on KET about its causes, myths, complications, treatment and prevention

Kentucky Health News

The message that the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention want readers to take from their book is that "diabetes is a serious, but preventable disease, if proper early interventions are implemented through a community-based, public health approach," KET says in a press release.

Authors Dr. Gilbert Friedell and J. Isaac Joyner will discuss this message with host Renee Shaw, and look at the root causes of the high number of diabetes cases in the U.S. and what needs to be done about it, on "Connections with Renee Shaw" on KET2 Friday, March 27 at 5 p.m. ET and on KET Sunday, March 29 at 1:30 p.m. ET.

Other topics discussed include common misconceptions and barriers to treatment, belief systems around diabetes that aren't based on fact, and the significant health ramifications of the disease, including complications such as blindness, amputations and renal failure.

"In Kentucky alone, for example, there are 72,000 diabetes-related cases of blindness and visual impairment diagnosed each year – roughly 200 per day," KET notes.

Health reform law drives a trend to include lifestyle changes in a patient's health care plan, alongside traditional medicine

Lifestyle changes can play a huge role in treating and warding off many health conditions and thanks to the Patient Protection and Affordable Care Act there is now a shift to include helping people make these changes part of their health care plan, Laura Ungar reports for The Courier-Journal and USA Today.

In the first of an occasional series called "HealthVoices" that focuses on "areas where policy, public health and people intersect," Ungar tells the story of Kevin French, who self-describes himself as "the quintessential unhealthy Kentuckian" and how lifestyle changes have made a difference in his health.

French tells Ungar that with the help of medical professionals and The KentuckyOne Healthy Lifestyle Center in Louisville he has "learned how to eat well, handle stress, exercise and "basically change everything."

"My medicine usage has declined somewhat. I'm still on medicines but not the dramatic type like I was. Some of them's been cut in half," French told Ungar. "Several costs of medicines have declined dramatically."

The center provides "medically supervised exercise, nutrition counseling, stress management and classes in disciplines such as yoga" and is the third such facility the medical system has opened in Louisville, Ungar writes.

Experts say that the ACA is driving this "colossal shift" in health care away from the "traditional reliance on pills and procedures by patients as well as the American medical system," Ungar writes, but she also notes that the patient must also make a commitment to these lifestyle changes if it is to work, as French has.

A cardiologist at the center, Paul Rogers, told Ungar about the importance of lifestyle changes, especially exercise. in warding off cardiovascular disease, one of the state's biggest killers.

"Compared to even the best medical therapy, we can decrease heart attacks, strokes and deaths by between 35 and 45 percent by changing lifestyle. The thing I see that holds people back most probably is effort and fear," Rogers told Ungar. "The recommendations these days are 30 minutes of…aerobic activity six times a week. I think if people started devoting themselves to that, that would change the health of our state dramatically."

At roundtable on food and agriculture, Prince Charles says we need to reconnect with the food system and nature, keep stock

Prince Charles "called for urgent restructuring of local and global economies to save humanity from itself" in a whirlwind visit to Louisville on Friday, James Bruggers reports for The Courier-Journal.

In addition to a speech at the Cathedral of the Assumption, the heir to the British throne briefly participated in a roundtable on health and the environment and a similar gathering about food and agriculture, at which he said people need to become "intimately acquainted again with the food system and nature," as The Courier-Journal put it.

"I am very keen on connecting people to school gardens," he said, "and encouraging them to keep their own chickens and the occasional pig." Here's The C-J's raw video from the roundtable:

Friday, March 20, 2015

Earth can't afford to keep supporting our consumerist society as it now exists, Prince Charles tells Louisville audience

Kentucky Health News

Transcript of The Prince of Wales’s speech at the Cathedral of the Assumption, Louisville, following an introduction by Wendell Berry (subheads added)

Ladies and gentlemen, it has been an immense pleasure to spend our last day in the United States here in Louisville, guided by a very special lady. Christy Brown, if I may say so, is one of the most remarkable people I have come across; a true force of nature, with an unbounded enthusiasm to bring people together across a whole range of important issues, and with the determined tenacity to make things happen. I know from my own experience, it is very hard to say "no" to Christy Brown! It was she who asked me to articulate the principles of harmony which I have long believed to lie at the heart of how we respond to the immense challenges and dangers facing humanity. So I can only hope you are all prepared to put up with such articulation.

I must say, it is also very special to have been introduced by such a great advocate of harmony, Wendell Berry, who I am incredibly touched said those wonderful words about me. He is a very special son of Kentucky. I only wish I had time to visit his farm. I will now embarrass him by telling you that he has long been a hero of mine. I remember him once describing his farm here in Kentucky. Half of it, he said, sits at the top of a hill and the other half at the bottom, which, as he put it, "is what you call a learning situation…"

Now, to return to Christy's request: In the 1960’s, as I remember so well, a frenzy of change swept the world in the wave of post-war “Modernism.” There was an eagerness to embark upon a new age of radical experimentation in every area of human experience which caused many traditional ideas to be discarded in a fit of uncontrollable enthusiasm – ideas that will always be of timeless value for every generation confronting the actual realities of life on this Earth. I remember it only too well – and even as a teenager I felt deeply about what seemed to me a dangerously short-sighted approach, whether in terms of the built or natural environment, agriculture, healthcare or education. In all cases we were losing something of vital importance – we were disconnecting ourselves from the wealth of traditional knowledge that had guided countless generations to understand the significance of Nature’s processes and cyclical economy. It always seemed to me that in this period of change some subtle balance was being tragically lost, without which we would find ourselves in an increasingly difficult and exposed position. As, indeed, we have.

I have been trying to point out ever since where I feel the balance needs righting and where some of the discarded, but timeless principles of operating need to be reintroduced in order to create a more integrated approach. It has turned out to be a peculiarly hazardous pastime. But I have come to the inescapable conclusion that the legacy of Modernism in our so-called post-Modern age has brought us to a crucial moment in history; prompting a lot of uncomfortable questions.

The first question I want to ask is how we have landed ourselves and the rest of the world in the mess that it now struggles to overcome? We have more than enough scientific evidence that proves this to be so. But what is it that drives us on to exacerbate the problems? Why do we tip the balance of the Earth’s delicate systems with yet more destruction, even though we know in our heart of hearts that in doing so we will most likely risk bringing everything down around us? In the thirty years or so that I have been attempting to understand and address the many related problems, I have tried to ask myself what it is in our general attitude to the world that is ultimately at fault? In doing so, of course, it must have appeared as though I was just flitting from one subject to another – from agriculture to architecture, from education to healthcare – but I was merely trying to point out where the imbalance was most acute; where the essential unity of things, as reflected in nature, was being dangerously fragmented and deconstructed.

The harmonious system of nature is collapsing

The question that should surely keep us all awake at nights is what happens if you go on deconstructing? I fear the answer is all too plain. We summon up more and more chaos. I have also spent a long time wondering that if we could identify the key fault, would it be possible to fix it? And if we could, what would that “fix” amount to in practical as well as philosophical terms? What worries me is that at the moment there is not a lot of attention given to the way we perceive the world. We take our mechanistic view of it for granted and believe that the language of scientific empiricism which so dominates our discussion is the only form of language we need to guide us. So let’s be clear – whereas the empirical view of the world makes observational deductions about the laws of nature, the philosophical deals with the meaning of things; and the religious concerns itself with the sacred presence in things. They each have a role to play.

The way in which empirical enquiry has developed to this position of dominance since the Enlightenment has certainly enabled us to improve the material realm of the human condition. But let us also recognize that this progress was only possible because of an earlier and crucial shift which took us away from a traditional sense of participation in nature to the claim of mastery and exploitation over the natural order that has reaped such a troubling and bitter harvest. That earlier shift, away from seeing ourselves within nature to us standing apart from it, gradually undermined what I have always felt, deep down, to be the true situation – that if we wish to maintain our civilizations, then we must look after the Earth and actively maintain its many intricate states of balance so that it achieves the necessary, active state of harmony which is the prerequisite for the health of everything in creation. In other words, that which sustains us must also itself be sustained.

But we are not keeping to our side of the bargain and, consequently, the sustainability of the entire harmonious system is collapsing – in failing the Earth we are failing humanity. We are standing at a moment of substantial transition where we face the dual challenges of a world view and an economic system that seem to have enormous shortcomings, together with an environmental crisis – including that of climate change – which threatens to engulf us all.

Of course, we have achieved extraordinary prosperity since the advent of the Industrial Revolution. People live longer, have access to universal education, better healthcare and the promise of pensions. We also have more leisure time; opportunities to travel – the list is endless. But on the debit side, we in the industrialized world have increased our consumption of the Earth’s resources in the last thirty years to such an extent that, as a result, our collective demands on nature’s capacity for renewal are being exceeded annually by some 25 per cent.

Back in the 1950’s and right up to the 1990’s it seemed credible to argue that the human will was the master of creation; that the only acceptable way of thinking was a mechanistic way of thinking; that the Earth’s natural resources were just that – resources – to be plundered because they were there for our use, without limit. But for all its achievements, our consumerist society comes at an enormous cost to the Earth and we must face up to the fact that the Earth cannot afford to support it.

Just as our banking sector has been struggling with its debts – and paradoxically also facing calls for a return to so-called “old-fashioned,” traditional banking – so nature’s life-support systems are failing to cope with the debts we have built up there too. If we don’t face up to this, then nature, the biggest bank of all, could go bust. And no amount of quantitative easing will revive it. It seems to me a self-evident truth that we cannot have any form of capitalism without capital. But we must remember that the ultimate source of all economic capital is nature’s capital. Our ability to adapt to the effects of climate change, and then perhaps even to reduce those effects, depends upon us adapting our pursuit of “unlimited” economic growth to that of “sustainable” economic growth. And that depends upon basing our approach on the fundamental resilience of our ecosystems. Ecosystem resilience leads to economic resilience. If we carry on destroying our marine and forest ecosystems as we are doing, then we will rob them of their natural resilience and so end up destroying our own.

We are not separate from nature

No matter how sophisticated our technology has become, the simple fact is that we are not separate from nature – like everything else, we are nature. The more you understand this fact the more you see how our mechanistic way of thinking causes such confusion. Modern agri-industry, for instance, may have made enormous strides to feed the burgeoning world’s population, but at a huge and unsustainable cost to ecosystems, through massive use of artificial fertilizers, herbicides, pesticides and water. It is a reductive approach to one issue that is patently not durable because it sustains nothing but its own decline, solving one problem by creating countless others.

This, of course, is not the way nature operates. In nature the entire system is a complex unfolding of inter-dependent, multi-faceted relationships and to understand them, we have to use “joined-up” thinking. The ancient Greek word for the process of joining things up was “harmonia.” So, “joined-up thinking” seeks to create harmony, which is a very specific state of affairs. In fact, it is the very prerequisite of health and well-being. Our bodies have to be in harmony if they are to be healthy, just as an entire ecosystem has to be. This is the way nature operates. Natural sciences like microbiology and botany tell us very clearly that every kind of organism, be it big or microscopic, is a complex system of interrelated and interdependent parts – which makes each organism a microcosm of its local environment; the very essence of it, in fact. The sum of these parts builds and maintains a coherence – an active, harmonic unity – with no waste. No one part operates either in isolation or beyond the limits set by the whole.

Facing the future, therefore, requires a shift from a reductive, mechanistic approach to one that is more balanced and integrated with nature’s complexity – one that recognizes not just the build-up of financial capital, but the equal importance of what we already have – environmental capital and, crucially, what I might best call “community capital.” That is, the networks of people and organizations, the post offices and bars, the churches and community halls, the mosques, temples and bazaars – the wealth that holds our communities together; that enriches people’s lives through mutual support, love, loyalty and identity.

Just as we have no way of accounting for the loss of the natural world, contemporary economics has no way of accounting for the loss of this community capital. This is why we need to ask ourselves whether the present form of globalization is entirely appropriate, given the circumstances confronting us. There are, clearly, benefits, but we need to ask whether it requires adaptation so that it also enables, as it were, globalization from the bottom up. This, after all, is the way nature operates! At the moment we operate under a form of globalization that tends to render down all the rich diversity of a culture into a uniform, homogenized mono-culture. This is where the Modernist paradigm needs to be called into question before the damage being done is irretrievable. …

One of the chief architects of our present economic model was Adam Smith. Interestingly, he was another who recognized that, although individual freedom is rooted in our impulse for self-reliance, it must be balanced by the limits imposed by natural law. As he prepared his book, The Theory of Moral Sentiments, he moved away from the notion that we are born with a moral sense and preferred the principle of there being a sympathy in all things. It is this sympathy that binds communities together. But there is little chance of such sympathy if what people need is provided through commercial structures that place an ever greater distance between the supplier and the consumer, because economies of scale can destroy the economics of localness. It has become, again, a purely mechanical process with no room for the complexity and multi-faceted dimensions of a proper local relationship between a community and the suppliers that serve it.

A balance between the market and society

Once again, there has to be a balance between the market on the one hand and society on the other, otherwise real problems occur. … This is why city-level policy to encourage healthy local food systems could scarcely be more important. It is a way to ensure a harmonious relationship between the city and its hinterland, fostering greater understanding and respect for the services that the rural environment and economy provide. It is also a means by which a circular economy can be generated where wastes become resources rather than pollution.

So, with that in mind, how could we better empower all sorts of communities to create a much more participative economic model that safeguards their identity, cohesion and diversity – one that makes a clear distinction between the maintenance of Nature’s capital reserves and the income it produces? That is the challenge we face, it seems to me – to see nature’s capital and her processes as the very basis of a new form of economics and to engage communities at the grass roots to put those processes first. If we can do that, then we have an approach that acts locally by thinking globally, just as nature does – all parts operating locally to establish the coherence of the whole.

Here in Louisville, for instance, I met with representatives of your major food and drink manufacturers, and also spent time with farmers and food producers at what, I would suggest, is a very significant idea – the creation of the Food Hub and the development of the area around that proposed site. Re-localizing your food systems and encouraging the many small and medium-sized farms that surround your city to consider how best to offer locally produced food would make a tremendous difference to the long term sustainability of your economy, especially if real attention was paid to the health of the soil. A long time ago it was President [Franklin] Roosevelt who gave a very prescient warning when he said - "a nation that destroys its soils destroys itself." So, of central importance will be how to reconcile our urban and rural development. The actions of leading cities like Louisville can provide a demonstration of what can be done that is of value not only to the United States, but also globally.

Likewise, as far as human health is concerned, I was alarmed to hear from your leading cardiologist here, Dr. Bhatnagar, just how directly the high rates of air pollution you struggle with are related to the high levels of cardiovascular disease. If you recognize that the quality of the air is not just an "environmental" issue, but a very serious economic issue, then you can see that the health of people directly affects the health of an economy. So perhaps, at the end of the day, it might be cheaper to join up the dots and put paid to the pollution, rather than pursue the more expensive option of encouraging people to take yet more pills to help their hearts?

So, having spent the day here in Louisville, I can only offer my warmest congratulations not only for what you have already achieved, but also what you are striving for in the future – a model of truly integrated and holistic thinking on a city scale and a beacon of inspiration for others to learn from – for instance, your work in helping build communities such as at the African American Heritage Centre, the boldness of the vision for the Food Hub project (why wouldn't we all want to shorten the links between consumer and producer?); the remarkable potential of a new discussion between the health insurance companies and your major food companies who, of course, would love to become more sustainable if only the financial climate allowed them.

Could this, then, be part of the solution to the problems we face? Could it be one that might give us hope, for we do still have within our societies and within our existing technologies the solutions that will enable us to transcend our current predicament. All we lack, perhaps, is the will to establish a more entire and connected perspective. There are many examples where communities have replaced the short-term impulse with the long-term plan. But part of that strategy – to my mind at least at the heart of it – is the need for a new public and private-sector partnership which includes NGO [non-governmental organizations] and community participation. It seems to me that for this to work we need to ensure that community and environmental capital is indeed put alongside the requirements of financial capital and that we also develop transparent means to measure the social and environmental impact of our actions.

We certainly need to refine our ability to measure what we do so that we become more aware of our responsibility. This validates the need for “accounting for sustainability,” which has since become known elsewhere as true-cost accounting – a method by which businesses can take proper account of the cost to the Earth of their products and services, and which I initiated and developed 11 years ago. It is encouraging that this approach is being tested by a range of companies, government departments and agencies, and I hope that it can be adopted more generally so that well-being and sustainability can be measured, rather than merely growth in consumption.

We also need, dare I say it, new forms of international collaboration to value ecosystem services. For instance, the world must recognize the absolutely vital utility that the rainforests provide by generating a real income for rainforest countries – where, incidentally, some 1.4 billion of the poorest people on Earth rely in some way on the rainforests for their livelihoods – an income which can be used to finance an integrated, low-carbon development model. Paradoxically, the answer to deforestation lies not solely or even mainly in the forestry sector, but rather in the agricultural and energy sectors.

It is also increasingly possible to enhance efficiency and economic rates of return by linking different sectors together in what are called “virtuous circles.” You can see this in the relationship between the waste, energy and water sectors where the waste product of one process becomes the raw material of another, thereby mimicking nature’s cyclical process of waste-free recycling.

Alternatives need to become mainstream

The trouble is, at the moment, so many of these brilliant ideas sit on the fringes of our economy. They are seen as “alternatives” when they need to become mainstream. But for this to happen and for such alternatives to be effective, it will require a system of long-term consistent and coherent financial incentives and disincentives; otherwise, how else will we achieve the urgent response we need to rectify the situation we face?

Another example of an alternative that needs to become mainstream, and which would enhance both community and environmental capital, lies in the way we plan, design and build our settlements. I have talked long and hard about this for what seems rather a long time – and look what it’s done to me! – but it is yet another case where a rediscovery of so-called “old fashioned,” traditional virtues can lead to the development of sustainable urbanism. This approach emphasizes the integration of mixed-use buildings and the use of local materials to create local identity which, when combined with cutting-edge developments in building technology, can enhance a sense of place and real community.

Our need for these solutions is going to grow exponentially as our global population rises and our ecological and economic crises deepen. Is this not a rationale for investing massively in these new and more integrated approaches which, thereby, could help to create the kind of “virtuous circles” based on environmental and community capital that I have mentioned this evening? Such investment would also, I can’t help thinking, have the added benefit of creating many new jobs.

But are we prepared to take such a step? As Mahatma Gandhi pointed out, “The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.” The starting point is to see things differently from the current, dominant world view which in so many ways is no longer relevant to the situation in which we find ourselves. The worst course would be to continue with “business as usual” as this will only compound the problem. We must see that we are part of the natural order rather than isolated from it; to see that nature operates according to an organic “grammar” of harmony and which is infused with an awareness of its own being, making it anchored by consciousness. It is an interconnected, interdependent function of creation with harmony existing between all things.

We are, ladies and gentlemen, at an historic moment – because we face a future where there is a real prospect that if we fail the Earth, we fail humanity. And I don't know about all of you but, as a grandfather, I have no intention of failing my, or anyone else's, grandchildren.