Geopolitical Determinants of mental health

By all accounts, the last 12 months have been tumultuous. The Russian invasion of Ukraine has led to food shortages, refugees, isolation of Russia with impact on energy supply. In addition, other natural events around the globe such as earthquakes in Taiwan, hurricanes in the USA, and flooding in Pakistan, have contributed to distress and stress among the populations especially those who are vulnerable. The impact of these events confirms the interconnectedness of the modern world but also highlights the futility of trying to deal with these matters in an isolated nationalistic way.

Meanwhile, in the UK we have a new Monarch and a new Prime Minister with inflation running rampant, a cost of living crisis and strikes looming ahead. The cost of living and fuel prices are rising, and a hot summer with unprecedented temperatures has led to drought and hose pipe bans. As we head towards winter, it is extremely likely that a large number of people will face a choice between eating or heating. Tragically, this is all occurring in the middle of a pandemic, which has by no means gone away.

There is considerable and impressive evidence from the WHO Commission on Social Determinants of Health led by Sir Michael Marmot that social factors such as poverty, overcrowding, unemployment, lack of access to public transport, lack of access to green spaces etc. can contribute to ill health, both physical and mental. However, what is often forgotten is that these social determinants are affected by geopolitical factors which can lead to increased displacement of people within and out of the country.

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Geopolitical determinants have to be seen in the context of a truly interconnected world where there are very few completely isolated countries. The interconnectedness works at very many levels from trade, manufacturing and exports to sharing of information. These geopolitical factors can be man-made such as climate change, wars and conflicts, and natural disasters such as hurricanes, tsunamis, earthquakes, and volcanic eruptions. Somewhere in the middle of it are epidemics and pandemics. As I write this, WHO has declared monkeypox to be a serious condition. In the past decades we have had Ebola, Zika, and SARS-1 epidemics.

These geo-political factors are often not taken seriously and regrettably many of our international organisations are failing to absorb and act on the seriousness of the impact these factors can have on the mental health and wellbeing of communities as well as individuals.

All of these factors affect the mental health of populations and individuals directly and indirectly. However, tragically, policymakers often do not take the impact of their policies on the mental health of communities and individuals into account when designing their policies. Geopolitical factors may push people away from their residences and expose them to additional stressors.

There is considerable research evidence to suggest that the numbers of refugees and asylum seekers increase during wars and conflicts but also during drought and flooding. Some of these migrants are for a short period whereas others can be long-term and permanent. Global migration is tempered and shaped by geopolitical factors. With war and conflict, the impact of violence, political unrest and food insecurity can lead to internal and cross-border migration. Urbanisation and industrialisation can lead to an increase in rates of psychiatric disorders. This is determined by economic cross-national factors.

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Clinical and research evidence has shown conclusively that refugees and asylum seekers as well as migrants have high rates of psychiatric disorders and often these are related to social factors after migration. The impact of epidemics and pandemics, although increasingly studied, still ignores the resulting bereavement and grief and survivor guilt in addition to the impact on wellbeing and mental health in general. As physical and mental health often are seen separately, the mental health needs of vulnerable people are less likely to be prioritised. The integration of physical and mental health is crucial in our understanding of the role that geopolitical factors play.

Geopolitical factors and determinants are truly international. Both supranational and intra-national factors have to be seen as a system of relationships between individuals, their human, economic, cultural and social capitals and assets, alongside communi­cation styles. Geopolitical determinants are thus to be seen as certain structures which modify various processes, which in turn influence the health of individuals and communities.

The direct and indirect effects of geopolitical factors are to be seen at emotional, physical, economic and social levels. Their impact has to be understood so that health and social care services can be improved. In addition, integration of health with education, employment, housing and justice is an absolute must. Geopolitical determinants thus cross national boundaries and influence nations, communities, families and individuals.

Types of cultures will affect responses. In socio-centric or collectivist outlines, the response may be seen in the context of community level. This was demonstrated in the case of the Ebola virus outbreak in Sierra Leone as described by Luke Mogelson in his 2022 book The Storm is Here. It illustrates that collectivist cultures can come together successfully in times of epidemics and understand what is needed. The role of cultural factors is evident in the acceptance of rules and restrictions. For example, in some cultures such as parts of the USA, according to Mogelson, the message to wear masks was ignored, whereas in others the message that wearing a mask to protect others was accepted readily.

Using a geopolitical approach in the framing of illnesses, be they physical or mental, is in the context of policy-making which can focus on both preventive and curative aspects of healthcare.

An important recognition which is likely to influence mental health is climate change. The environmental impact of climate change is self-evident but only limited attention is being paid to this. Recent heatwaves in continental Europe and the UK and flooding in Pakistan have highlighted that urgent action is needed to deal with the impact of climate change, in the way we live, work and play.

A truly international intervention is needed, but where is the leadership from the international organisations? Simply passing resolutions is not enough.

Concerted solid action is needed.

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