Surviving Sustainability: Degrowth, Environmental Justice, and Support for the Chronically Ill
Andrew F. Smith
About Surviving Sustainability
In this deeply thoughtful and challenging article, Christine J. Winter asks us to rethink what we usually mean by words like “sustainability,” “progress,” and even “a good life.” She brings together ideas from environmental justice, disability studies, and Indigenous knowledge to argue that many mainstream sustainability models—especially those tied to economic growth—actually leave out the people most vulnerable to injustice: the chronically ill, disabled, and economically marginalized.
Winter critiques the idea that a “sustainable” society has to keep growing and optimizing at all costs. Instead, she advocates for degrowth—a movement that calls for reducing overproduction and consumption so that society can become more just, inclusive, and ecologically balanced. But Winter takes this further. She asks: How do we care for people who can’t always participate in conventional forms of productivity? What does it mean to build a society that doesn’t just survive, but where people who are chronically ill or disabled can truly thrive?
This article pushes back against ableist and capitalist assumptions about value and contribution. It invites us to imagine a radically inclusive version of the good life, where justice includes rest, interdependence, and care—not just constant work and consumption. Winter’s vision ties the personal to the political, showing that environmental ethics must be intersectional to be truly sustainable.
Before You Read
What do you picture when you hear the word “sustainability”? Maybe green energy, recycling, or eco-conscious habits. But Christine Winter wants to shake that up. She asks: Sustainable for whom? And who gets left behind in mainstream environmental and economic models?
This article invites you to think about justice in a broader way—not just as environmental protection or economic reform, but as a commitment to human dignity, disability justice, and care-based communities. It challenges the idea that we can only build a good society by growing the economy or maximizing output—and instead offers a vision where slowing down, caring for others, and including diverse bodies and lives is actually the key to survival and flourishing.
Before you dive in, reflect on what kind of world supports your well-being—and whose well-being often gets overlooked in conversations about sustainability and the future.
Guiding Questions
- What are the main critiques Winter makes of mainstream sustainability models?
- What does “degrowth” mean, and how is it different from traditional ideas of progress?
- How does Winter connect disability justice to environmental ethics?
- How might her ideas change the way we think about what a good life—and a good society—looks like?
Surviving Sustainability: Degrowth, Environmental Justice, and Support for the Chronically Ill
ABSTRACT:
The quest for ecological sustainability—specifically via prioritizing degrowth—creates significant, often overlooked challenges for the chronically ill. I focus on type-1 diabetes, treatment for which depends on nonrenewables and materials implicated in the global proliferation of toxins that harm biospheric functions. Some commentators suggest obliquely that seeking to develop ecologically sustainable treatments for type-1 shouldn’t be prioritized. Other medical concerns take precedence in a post-carbon world marked by climate change and widespread ecological devastation. I challenge this view on three grounds. Its proponents (i) fail to treat type-1 as the public health issue it is, particularly within the context of what Sunaura Taylor calls disabled ecologies. They (ii) deny persons with type-1 an equal opportunity to pursue survival.And they (iii) presume without warrant that treating type-1 is an all-or-nothing affair. Indeed, research by biohackers points to suboptimal but potentially workable ways to make type-1 survivable in a post-carbon future—so long, I stress, as their findings are cripped in a manner that foregrounds the demands of environmental justice.
KEYWORDS: Chronic Illness, Degrowth, Disability, Environmental Justice, Sustainability, Type-1 Diabetes
Introduction
During a graduate course on theories of sustainability I taught a couple years ago, I asked my students to read a section of Derrick Jensen and Aric McBay’s What We Leave Behind. In this section, the authors document the devastating ecological effects of medical waste. It’s ironic, they remark, that while ongoing improvements in healthcare have increased life expectancy and enhanced quality of life for people throughout much of the industrialized world, the medical system that delivers this care “has employed methods that create even longer lasting hazards” (Jensen and McBay 2009, 137). The list of these hazards is long. It includes infectious and radioactive materials, unused medications, myriad disposables that contain toxic forms of plastic and heavy metals, and (lest we forget) reams upon reams of paper dumped into landfills. What’s to be done about this the authors don’t say. Maybe this is because they reject the proposition that an industrialized medical system can be made sustainable—or even that it can survive the changes to fossil-fuel driven energy and technology infrastructures that are all but certain to occur over coming decades.
For what it’s worth, I largely agree with Jensen and McBay’s considerations. I’m embarrassed to admit, though, that this led me to neglect the concerns I raise in this essay. The extent of my negligence came home to me in full force as I read a term paper for the course by a student with type-1 diabetes and associated comorbid conditions. “I’ve taken four to seven injections of insulin every day for the past twenty-two years,” she writes. This adds up to “about 40,000 disposable needles I’ve used in my life,” which is no small matter, since single-use disposable syringes alone place a significant burden on the global waste stream (my student cites Krisiunas 2011). For that matter, so do glucose monitors, insulin pens and pumps, and synthetic insulin.
Surely there are ways to lessen the hazards associated with medical waste, including that which is associated with type-1. But if it’s indeed the case that our medical system can’t survive impending transitions to our current energy and technology infrastructures, what happens to those who depend on this system for their very lives? Are treatments for chronic illnesses like type-1 invariably unsustainable?[1]“Are people like me alive when we shouldn’t be?” my student fatefully asks.
Unfortunately, Jensen and McBay don’t broach these questions. They remark inthe preface that What We Leave Behind was originally constructed as two separatesingle-authored books. It’s clear from the context that McBay authored the sectionon medical waste. Being a paramedic, he’s well positioned to speak in gritty detailon the subject. What’s not clear, though, is why he fails even to acknowledge thatconcerns like those raised by my student require attention. After all, he also wrote abook on preparing for life after “gridcrash” (McBay 2006). Maybe he doesn’t com-ment on chronic illness (or disability) there either because he doesn’t see any wayfor people like my student to survive. Or maybe, like me, he’s guilty of negligence.Enough, though. Can those living with type-1 survive ecological sustainability?
Enough, though. Can those living with type-1 survive ecological sustainability?If so, what’s required to ensure the just provision of sustainable treatments for type-1?These are my core questions. We’ll see that the hurdles required justly to treat type-1 in an ecologically sustainable manner appear to be high. But I don’t think these hurdles are insurmountable. Where there’s a will, there may well be a way.
I begin by laying out what I mean when I refer to sustainability and why thetoxicity of the most common treatments for type-1 in the industrialized world todayrepresent only part of the problem. The bigger issue is transitioning to a post-carbonenergy future. Given the vagaries of this transition for abled persons, some com-mentators—including Cindy Parker and Brian Schwartz (2010) and David Fleming(2016)—essentially write off chronically ill and disabled persons. Other medical con-cerns ostensibly take precedence in a post-carbon world marked by climate changeand widespread ecological devastation. I challenge this view on three grounds. Itsproponents fail to treat type-1 as the public health issue it is, particularly withinthe context of what Sunaura Taylor (2019; 2020) aptly calls disabled ecologies. Theydeny those with type-1 an equal opportunity to pursue survival. And they presumewithout warrant that treating type-1 is an all-or-nothing affair. Indeed, research by biohackers points to suboptimal but potentially workable ways to make type-1 sur-vivable in a post-carbon future—so long, I stress, as their findings are cripped in amanner that foregrounds the demands of environmental justice.[2]
2. Sustainability and Type-1
What people mean when they speak of sustainability can be hard to pin down, in partbecause the term itself is riddled with tensions and ambiguities. Some scholars ques-tion whether its use in ecological contexts makes sense (Alaimo 2012; Mentz 2012).But given how ubiquitous sustainability discourse has become in these contexts, Iprefer to specify what I mean in using the term rather than jettisoning it.
Richard Heinberg provides a helpful cue. On his account, the term sustainability applies to how societies function in relation to the ecosystems on which they rely.A sustainable society is “capable of maintaining itself for many centuries into the future” (Heinberg 2007, 85), barring the unforeseen, because it meets five specifiable conditions. (i) The resources that are critical to the function of the society aren’t over-used. (ii) Population size and rates of provision consumption remain stable enough to prevent overuse. (iii) Overuse of renewable materials is avoided because their consumption doesn’t exceed their rate of replenishment, as dictated by the function of the ecosystems from which they’re drawn. (iv) Overuse of nonrenewable materials is avoided because their consumption declines—ultimately, to zero—at a rate greater than or equal to the rate of depletion. (v) Substances introduced into the biosphere by human activities are rendered harmless to biospheric functions (ibid., 88ff).
Facilitating sustainability doesn’t immunize a society from collapse. Rather, sus-tainable societies are conducive to (comfortable) human habitability given the sortsof ecological, geological, and climatological variations to which our species has beenexposed throughout our existence. The ecosystems in which a society is embeddeddictate the shape and scope of its infrastructure and the day-to-day activities ofits inhabitants. Ecological context matters. Time, scale, and stressors matter, too.Healthy ecosystems are robust (resistant to internal failure), adaptable (responsiveto changes such that overall functionality is maintained), and resilient (able to with-stand and bounce back from disruption). They’re both giving and capable of re-plenishment in a way that ailing ecosystems typically aren’t. As a result, the severedamage to biospheric functions caused primarily by industrialization—which ne-cessitates abatement of harmful substances and extensive ecological revitalization—further limits provision usage if overuse of both renewables and nonrenewables isto be avoided.
Because their bodies lack the capacity to produce insulin, persons with type-1are unable to utilize glucose. Instead of being absorbed into the cells, it remains in thebloodstream. This leads the body to produce excess blood acids, or ketones, whichis lethal if left untreated. The miracles of modern medicine that today make type-1survivable over a long life are a product of an array of scientific breakthroughs andtechnological innovations that have been made possible by industrialization. Butthese miracles have been achieved at a steep ecological price, for the products cur-rently used to treat type-1 in one way or another violate all the stipulated conditionsof sustainability. I focus on violations of the fourth and fifth conditions. Namely,treating type-1 today relies on numerous nonrenewable materials—most notablypetroleum. Moreover, these treatments are implicated in the global proliferation oftoxins—most notably associated with the production and use of plastics—that aredeeply harmful to biospheric functions. Let’s assess the concern over plastics first and then turn to the problems associated with dependence on petroleum
2.1. The Toxicity of Type-1 Treatments
Synthetic plastics, the primary input for which is petroleum, are versatile materials. They can be manufactured to be lightweight, strong, durable, flexible, sterile,and corrosion resistant, as well as having superior thermal and electrical insulationproperties (Andrady and Neal 2009). They’re also typically inexpensive in compar-ison to existing alternatives. This makes them ideal for incorporation into syringes,insulin pens and pumps, glucose monitors, and the packaging for them all. It alsohelps to explain why some eighty-five percent of medical equipment includes plas-tics (North and Halden 2013). But these qualities come at a price. “The problem,”Peter Victor states, “is that the very features that make synthetic materials so attractive are the same ones that sometimes make it difficult, even impossible, for nature to cope with them” (2008, 73).
Over twenty major forms of plastics exist, depending on how their constitutive network of carbon, hydrogen, and oxygen monomers are bound together into macromolecules. In some situations, the breakdown of these macromolecules itselfis harmful to biospheric functions. But virgin plastics are rarely used by themselves.They’re routinely mixed with various additives-resins, dyes, molding agents, plasticizers—that are designed to improve their specified function. When these additivesare released, for example via leaching or incineration, they can introduce neurotoxins, endocrine disruptors, and other hazardous substances into the biosphere.
The health effects associated with exposure to some plastics with medical applications (including polyvinylchloride, polypropylene, polystyrene, and polycarbonate) range from physical deformities and brain cancer to early puberty and immune deficiencies, from endometriosis and behavioral problems to impaired memory and lowered intelligence, from low sperm count and impaired sexuality to motor skill deficits and reduced hand-eye coordination (Williams 2012). In some cases, sus-tained exposure may be the culprit. Others are harmful in very small doses, particu-larly when degraded. Both forms of exposure count as what Rob Nixon (2011) calls slow violence, or harms that occur gradually and often invisibly.[3]
Such harms are hardly isolated. Plastic debris, including medical waste, has ac-cumulated in every biome—from the poles to the equator and the Marianas Trenchto the Himalayan peaks (Teuten et al. 2009). Plastic debris is globally ubiquitous, andit’s killing species the world over, including humans. Potentially even worse, the pro-liferation of plastics may be altering genetic structures, which is bound to adverselyaffect biospheric functions in ways we can’t yet fathom (Cimitile 2009; Muncke 2014).
The production of plastics conceivably can be made sustainable, though. Re-search on a specifiable subcategory of bioplastics offers a promising avenue. Bio-plastics aren’t necessarily biodegradable, and biodegradability itself isn’t necessarilycompatible with sustainability. Biodegradable bioplastics may not break down underambient ecological conditions. As a result, they can end up being no more prefera-ble than polyethylene, a synthetic plastic used in disposable syringes. Polyethyleneisn’t itself toxic, but because it’s routinely produced with additives that accelerate itsdegradation when exposed to ultraviolet light it readily breaks down into constituentparts that themselves don’t degrade (Barnes et al. 2009). They can end up proliferating in pellet—and even microbead—form throughout both marine and terrestrial ecosystems, killing millions of organisms throughout the food web (Rozsa 2021).
Compostable bioplastics, examples of which are polyhydroxyalkanoates (PHAs)and polylactic acids (PLAs), do degrade in soil at rates consistent with other known compostable materials and leave no discernible toxic residue (ASTM Standard D64002004). In structure, they meet the dictates of the fifth condition of sustainability. But their production violated the fourth insofar it relies on a petroleum-based infrastructure, including (i) the petrochemicals and transportation fuels used to cultivate and ship the corn and molasses that serve as their main inputs and (ii) the numerous forms of complex equipment that are required to ensure that they’re safe to use for medical purposes. If the plastics used in treatments for type-1 are to be produced sustainably,either the infrastructure that facilitates their production must be made sustainable—along with the production processes themselves—or new sustainable remedies mustbe developed that can be produced independently of this infrastructure.
2.2. Uncertain Transitions
Proponents of sustainable development, or developmentalists, defend the feasibility of creating sustainable energy and technology infrastructures. Key here is transi-tioning from a growth economy to a steady-state economy (Daly 1996), or to aneconomy in which profit generation is decoupled from ecologically harmful formsof taking, making, and wasting. Whereas a growth economy depends on a perpetual quantitative increase in physical throughputs (more taking, more making, and little concern about wasting), a steady-state economy doesn’t expand beyond the capacity of ecosystems to regenerate provisions and reprocess waste. Qualitative improvements in technological efficiency along with the wholesale substitution of nonrenewables for renewables, particularly as energy sources, are the cornerstones of sustainable development. Together, developmentalists assert, these changes makeit possible to “maintain our technological lifestyles” (Tolinski 2011, 4), which are ahallmark of habitation in industrial society. Presumably, this includes the sustain-able mass production of type-1 treatments.
Transitioning from unsustainable industrialism to sustainable industrialism—which is what sustainable development amounts to—is neither easy nor straightfor-ward.[4] But renewable energy sources are proliferating. Technologies for large-scalecarbon sequestration are in development. The know-how already exists to reducephysical throughputs by at least seventy-five percent in every economic sector, in-cluding the notoriously resource-intensive medical sector (Hawken 2010). Andwhile zero waste isn’t currently possible, the conservation its pursuit inspires “willextend the useful life of the key ecological services,” states Anthony Andrady (2015,34). This buys time for further innovation while also giving the biosphere at least apartial reprieve so that it can have more time to repair itself.
John Michael Greer (2009, 91) notes, however, that industrial society has been in place long enough that we’re unable to conceive of circumstances in which it would cease to be. This may lead us to assume that the transition to sustainable industrialism is inevitable, or at least that the prospects for its emergence are good.Available evidence suggests otherwise.
The key problem for developmentalists is that there are no comparable renew-able substitutes for oil. “Pound for pound or barrel for barrel, crude oil containsmore energy than any other abundant naturally occurring substance on Earth,”Greer states, “and it is much less costly to extract, process, and use than anythingelse” (ibid., 164). Renewable energy sources, such as solar and wind, are more diffuse, in part because their supply is intermittent and unevenly distributed (Smil2008). Taking the necessary steps to concentrate and regulate their supply itself takesenergy, which today comes from oil and other nonrenewables.[5] It’s undoubtedly wiseto utilize fossil fuels to build post-carbon energy and technology infrastructures. Butit’s unclear how these infrastructures can match their predecessors in scale or scope.[6]Even if we ignore the inability of renewables to match oil as an energy source, we must account for myriad uses of oil other than for electricity that renewables can’t readily replace: from fuel for transportation to its role in the manufacture of steel,cement, rubber, glass, and pharmaceuticals (Lerch 2010).
Greer thus concludes that we neither have the time nor the material base to stave off the “decline and fall” of industrial society (2009, 11). Even Bill McKibben’s dreamof a “green Manhattan Project, an ecological New Deal, a clean-tech Apollo mission”isn’t likely to be enough (2010, 52). If the evidence provided by proponents of peakoil, or peakists, is accurate, industrial society is already on life support. For whilethe earth’s crust still contains vast quantities of oil, the issue instead is that its easilyaccessible, conventional, portions are much smaller. Understandably, “the fossil fuelindustry has typically targeted the highest-quality, easiest-to-extract resources first,”Richard Heinberg and David Fridley note (2016, 2). The unconventional sources—tight oil, deepwater oil, and tars sands—are increasingly what’s left in large quantitiesat this point, and it’s too costly monetarily, environmentally, and in terms of reducedenergy return on energy invested to extract in quantities comparable to conventionaloil (Sverdrup and Ragnarsdottír 2014). So even if we ignore the other prevailingproblems that come with relying on oil, it’s “fairly inevitable,” states Heinberg (2015,8), that we’ll relatively soon reach a point at which the investment required to find,extract, and refine oil won’t be worth the return. Indeed, insofar as conventional oil isthe slender plinth on which the global economy rests, diminishing returns on invest-ment are likely to lead to economic stagnation. This creates yet another formidable obstacle to the transition developmentalists envision (Fridley 2010, 230).[7]
While few analysts challenge peakism in principle, how quickly its full effects may unfold is subject to considerable debate.[8] But it’s clear that addressing global climate change and widespread ecological devastation, including rapid biodiversity loss and the resulting unraveling of both terrestrial and marine food ways, requires transitioning away from nonrenewables (and reining in the overuse of renewables and revitalizing compromised biomes the world over) as expeditiously as possible.[9]As such, it’s important to think now about what a post-carbon future means for treat-ing type-1.
The degrowth movement—manifest, for example, by municipalist movements(Bookchin 2005), Transition Towns (Hopkins 2011), and sustainable materialism(Schlosberg and Coles 2016)—is instructive. Degrowth advocates argue in favor of economic downscaling, or a reversal of the trend toward centralized energy production, globalized networks of consumption, and increased mechanization (Kallis2011 and Ellwood 2014). The reemergence of localization is key as a buffer against economic instability (Jackson 2017, 161f).
Sustainable societies are resilient in the face of climactic and ecological adversi-ties in part because risk is dispersed among disaggregated and substantially self-suf-ficient communities. When each community can, for the most part, see to its ownenergy, food, water, and waste disposal needs, disruptions within one communityare less likely to resonate throughout society. Furthermore, because localized com-munities are largely dependent for their survival on the ecosystems in which theyreside, they have a vested interest in ensuring that the needs and interests of theseecosystems govern the form their infrastructures take and the day-to-day activitiesof their members. This doesn’t obviate developing a robust trading network amongcommunities (Nabhan 2013, 6f), nor does it necessitate that communities be left totheir own devices in the face of adversity. The point of community self-sufficiency isto facilitate societal modularity: a dispersal of component parts that, while interactive, don’t compromise the integrity of the whole upon failure (Fleming 2016, 301).
Many such communities are likely to have access to forms of mechanization.It’s reasonable to expect the ongoing local provision of “the simplest of manufactured goods,” Heinberg asserts, but “we will likely never see families getting together in church basements to manufacture laptop computers or cell phones from scratch”(2015, 94–95). This sort of future boggles the industrial mind. It may seem to stand“at best, at the limits of practical possibility,” David Fleming remarks. Nevertheless, headds, its eventuation “has the decisive argument in its favor that there will be no alter-native” (2016, 301). Perhaps he’s wrong. But it’s difficult not to conclude that degrowthis likely to become much more appealing in a world marked by energy descent.
Consider, finally, what this means for treating type-1. Maybe it’s easier to produce medical-grade insulin (whether by genetically modifying bacteria, as is most common today, or by purifying extractions from cow or pig pancreases) and the materials required for its safe use in church basements than it is laptops or cellphones, but only by a matter of degrees. This is also true of insulin pens and pumpsand glucose monitors. The mass production and ready distribution of all such goodshereby seems unlikely under degrowth conditions. Does this mean that living withtype-1 is itself unsustainable? Providing a definitive conclusion exceeds my expertise. But it’s safe to state that the hurdles required to treat type-1 in an ecologically sustainable manner are high.
“We teach our kids to operate machines so sophisticated that almost no one can build one from scratch but not how to cook, sew, repair broken tools, or grow food. We seem less happy year by year,” Heinberg proclaims (2015, 31). Indeed, he concludes, we may end up finding that degrowth affords us the opportunity not only to live sustainably but also to “learn to be successfully and happily poorer” (ibid., 32).But who exactly is included among the “we” to whom he refers?
3. Altering Where the Philosophical Meets the Physical
Wittingly or not, Heinberg speaks from an ableist perspective. I doubt his sanguine statement about the potential benefits of degrowth is a sign that he thinks the concerns of the chronically ill aren’t worth acknowledging. It’s more likely that he’s guiltyof neglect, too. Yet this doesn’t lessen the extent to which his statement serves to render the chronically ill invisible. Worse still, it reinforces a troubling pattern.
Although it’s rarely stated explicitly, some commentators effectively call for writing off the chronically ill. The usual justification is based on the need for triage underconditions in which medical professionals are stretched thin and the capacity to meetthe needs of the chronically ill is prohibitively resource intensive. Fleming remarksthat in a post-carbon world “surgical procedures which stretch resources even of thepre-climacteric economy, will be abandoned.” The same is true of “long-term careof the profoundly and chronically dependent,” which is already economically unsustainable except among demographics who enjoy “exceptional wealth” (Fleming 2016,269). While offered as a description of future events, there’s also a prescription at workhere. Namely, we shouldn’t try to develop ecologically sustainable treatments for conditions like type-1 either because failure is inevitable or it isn’t worth the attempt.
For their part, Cindy Parker and Brian Schwartz (2010) argue in favor of focusing primarily on public health, given impending threats to food and water supplies,the eventuality of acute heat stress and worsening air quality, an increase in infectious diseases, and the need to deal with the mental health effects of energy descent. Theneeds of the chronically ill aren’t a priority. The authors are right to highlight emerging health concerns associated with climate change and ecological devastation. Buttheir wider considerations don’t support their conclusion. As I discuss shortly, the prevalence of type-1 is a public health issue. It’s at least partially the result of environmental factors and routine practices associated with industrialization that affectus all.
And in his polemic against industrial tourism, Edward Abbey goes well beyond neglecting the concerns of chronically ill, and disabled, persons. His considerationsare quite explicitly exclusionary. Abbey offers what Sarah Jaquette Ray calls the “‘disability equals alienation from nature’ trope” (2017, 50; see also Kafer 2017) that wasinitially popularized during the Progressive Era when the conservation movementin the United States was born. According to this trope, chronically ill and disabledbodies are treated as examples of “the machine’s corruption” (ibid.) of the harmonybetween humans and our environs. Consequently, “pristine” natural spaces should be reserved solely for able bodies, Abbey contends, because only able bodies—walking bodies, specifically, and in limited numbers—prevent the erosion of the ecological integrity of said spaces.
Getting back to nature means leaving industrial trappings behind, no longer being handicapped by “upholstered mechanized wheelchairs” (Abbey 1968, 51).Indeed, Abbey emphasizes, “we need waste little sympathy” (ibid., 53) for thosewho are unwilling or unable to uninhibit themselves, be they children, the aged, theinfirm, or those who are just lazy. Nor should we make accommodations for them.Abbey nowhere extends his polemic to wider concerns about ecological sustainability, but its logic is clear. Some people are fit for getting back to nature and somepeople aren’t. So much the worse for those who aren’t.
But what if it’s possible to alter where the philosophical meets the physical withrespect to the case at hand? The hurdles to meeting the needs of persons with type-1in an ecologically sustainable manner may be high. Yet, perhaps there are ways—physically—to lower these hurdles that are consonant with degrowth. Moreover,surely it’s—philosophically—worth our while to regard the lives of those with type-1as important enough to give the matter serious thought. Indeed, justice demands it.Starting with the philosophical, I offer three orienting propositions.
3.1. Orienting Proposition
Let me be clear. My goal in this section is to justify a commitment to the just research, development, and deployment of technologies that permit the local, down scale production of medical materials for the treatment of type-1. This requiresreprioritizing support for and empowerment of chronically ill persons generally. Ileave for later discussion the feasibility of producing these technologies, since what counts as feasible is partially a function of our priorities.
3.1.1. Proposition 1: Treat Type-1 as the Public Health Issue It Is
International epidemiological studies suggest that incidences of type-1 have in-creased fivefold in the past four decades (Vatanen et al. 2016). In the U.S., approx-imately 1 in 300 residents acquire type-1 by age 18 (Maahs et al. 2010). In othernations, these numbers are even higher. For example, type-1 was quite rare in Chinauntil forty years ago. But rapid industrialization and attending lifestyle changes haveled to an explosion in new cases (Zhang et al. 2008). It seems that our “technologicallifestyles” are both etiological and pathogenic with respect to type-1. Genetics playsa role, too, of course, as does immune dysfunction. But neither can account for theprecipitous rise of type-1 worldwide.
It’s long been suspected that a number of toxins—including alloxan (a bleach-ing agent), glyphosate (the active ingredient in a popular herbicide), and an arrayof endocrine disruptors—compromise beta cells in the pancreas, which inducestype-1-related autoimmunity (Zoeller et al. 2012). Exposure to gasoline and other petroleum-based products also has been linked to a spike in glucose levels (Isehunwa 2017). So has ingestion of nitrates and nitrites, which are routinely added to processed meats and organic fertilizers (Edwards et al. 2018).
Proponents of the hygiene hypothesis suggest that the rise of instances of type-1and a range of other autoimmune conditions is instead associated primarily with the loss of immune stimuli to which our ancestors were routinely exposed. Improvements in sanitation and health care delivery have altered the gut microbiome in ways that favor the development of autoimmunity (Giongo et al. 2011; Heikkinen 2013).Relatedly, researchers at the University of California, Davis, have found that a bacterial strain called B. infantis, once the dominant bacterium in the infant gut, has disappeared under conditions of industrialization. “According to their research,” KristinLawless notes, “this was probably caused by the rise in cesarean births, the overuseof antibiotics, and the use of infant formula in place of breast milk. Indeed, nine out of ten American babies don’t harbor this bacterium in their gut, while researcherssuspect that the majority of infants in less industrialized countries do” (2018a). Over nine out of ten American babies actually: 97 percent (Lawless 2018b, 99). These fac-tors help to explain why children in industrialized societies are more likely to havetype-1. The same may apply to the so-called 4-As (allergy, ADHD, asthma, and au-tism) among children and hypertension, hyperlipidemia, type-2 diabetes, heart dis-ease, certain cancers, and Alzheimer’s among adults and the elderly (Lawless 2018b,96 and 108ff).
This is not to say that a cure for type-1 should not be pursued, leveraging dein-dustrialization in the process. Within the framework being used in this essay, type-1qualifies as an unhealthy disability, to use Susan Wendell’s apt phrase. Persons withtype-1 are disabled by both environmental features that create a chronic, life-threatening condition and social features that make living with type-1 overly burden-some.[10] Wendell thus rejects the medical model of disability, whereby disability is treated purely as a health-related impairment and an individual misfortune (see alsoReynolds 2017). But she is critical as well of social models of disability, models premised on how social institutions are designed to privilege certain kinds of bodies and exclude others, that fail to reckon with “physical or psychological burdens that no amount of social justice can eliminate” (Wendell 2001, 18; see also Crow 1996 and Kafer 2017).
Perhaps with this in mind, Clare himself calls for a political shift in our under-standing of the value and function of cure. Such a shift foregrounds community,embodiment, and environmental justice in the face of collective vulnerabilities. Itrequires expanding our view of cure beyond both brute medicalization and bruteinstitutionalization in order to encourage and reshape “dynamic ecological interde-pendencies” (Clare 2017b, 247). This has the effect of focusing our attention awayfrom attempting per impossibile to wrestle control—whether medical or social—over chronic illness and disability and instead toward creating flexible and respon-sive public health infrastructures that enable full-spectrum support for “our fragile,changeable, adaptable selves” (Clare 2017a, 70).
Indeed, a transition in public health toward viewing both treatment and cure interms of fostering socioecological interdependencies becomes all the more pressingwhen we forthrightly acknowledge that we’re all part of disabled ecologies now. Dis-abled ecologies represent “the trails of disability that are created, spatially, tempo-rally, and across species boundaries, when ecosystems are contaminated, depleted,and profoundly altered,” Sunaura Taylor states (2020). They reflect that the vulnerability and dependency of our bodies is ecological as well as medical and social.Within this context all of us comprise “an increasingly disabled people in increasingly disabled landscapes” (ibid.; see also Taylor 2019).
Coincidingly, Julia Watts Belser asserts that while prognosticating about what a future marked by worsening climate change and ecological devastation holds is difficult, it’s high time for us forthrightly to acknowledge the scope and scale of the situation we face. “While I believe we can and must work to mitigate some of thenegative effects of climate change,” Belser states, “I think we must let go of the increasingly facile question, ‘What are we going to do to stop it?’ and turn our effortsto a different question: How might we make climate disruption more survivable, lessunjust?” (2020, 17; see also Johnson 2017 and Bretz 2020). As a matter of justice,especially under conditions of degrowth, experts in public health must ask the samewith respect to type-1.
3.1.2. Proposition 2: Give Due Credence to Equal Opportunity
In Corrine Duyvis’s fictional story “And the Rest of Us Wait,” the protagonist, Iveta,who’s dealing with the effects of a traumatic spinal injury, notes in a key conversation that she’s not confident about her chances of survival in the post-apocalyptic world that she and fellow characters face. Of course, no one can promise that sheand others with chronic forms of medical dependency will survive. “But you canpromise that, if we don’t survive, it’s not ‘cause you didn’t give us an equal chance.It’s not ‘cause you sped it along,” Iveta states (Duyvis 2016, 46).
It’s not a matter of being pragmatic or realistic to write off people in her situation, Iveta maintains. Doing so instead represents a conscious decision to denyother human beings an equal chance to make a go of it under less-than-hospitableconditions. This constitutes a clear injustice. It’s also a gross ableist misjudgment.
Indeed, Robert Hoge suggests that disabled persons in general are wronglyviewed as burdens in the first place. “They’re active participants negotiating their waythrough a world that is degrees harder” (Hoge 2016, ii) than that which their abledcounterparts face. More than most people, they are acutely aware of what it’s like todeal with adversity, notably including navigating unaccommodating and oppressivesocial institutions. They have the capacity to teach and lead when it comes to dealing with living under trying conditions
“Climate change asks us to grapple with loss, with change, with uncertainty, with fear,” Belser remarks. “This is affective terrain that many disabled people know inti-mately” (2020, 15). In this respect, Hoge adds, chronically ill and disabled personshave “got a head start” (2016, i) on abled persons. Their embodied knowledge ofvulnerability positions them well to face the existential, intellectual, and political re-ality of our shared ecological disability and to marshal interdependent networks ofsupport and community in response (Taylor 2011, 204; Wendell 2001, 30f).
This knowledge also positions chronically ill and disabled persons to resist whatKyle Whyte (2021) calls crisis epistemology, on the basis of which socially privileged persons ignore matters of environmental justice in order to respond to crises in a manner that protects their privilege. It’s no coincidence, Ray asserts, that Black, In-digenous, and other people of color in the U.S. routinely express grave concern re-garding climate change. Its effects—from natural disasters to pandemics to increasedexposure to airborne and water-borne particulate matter—fall disproportionately ontheir communities. But climate anxiety is largely a white phenomenon in the U.S.,Ray indicates, in some respects because it reflects latent racial anxiety in the form ofa yearning “to get ‘back to normal,’ to the comforts of their privilege” (2021).
Challenging a crisis epistemology via chronic illness and disability discourses highlights that climate anxiety also may reflect ableist anxiety. Not only should wehereby abandon the proposition of getting back to normal, whatever that may mean.We also must foreground demands for cultural decolonization and “de-ableization”(Janz and Stack 2017). Each in its own way expresses a demand for the equal opportunity of peoples and persons to survive.
I don’t mean to suggest here that we give due credence to the equal opportunity to survive to persons with type-1 and the like because of what they might be able to contribute. Rather, we shouldn’t presume that those with functioning pancreases arenecessarily better positioned to survive in whatever sort of more difficult future wemight face and use this presumption to speed the demise of those with dysfunctionalpancreases. There’s more to any of us than whether or not our bodies can produceinsulin.
3.1.3. Proposition 3: Reject Purism
Purism, states Alexis Shotwell, is an ethos based on “the idea that we can accessor recover a time and state before or without pollution, without impurity, before the fall from innocence, when the world at large is truly beautiful” (2016, 3). Operativehere, first, is a presumption that there was once an idyllic state of nature from whichwe’ve departed. The conditions of this natural state count as what’s normal. And ourfallen state isn’t just a departure from normality. It’s a perversion (Di Chiro 2010).As with Abbey’s considerations, this presumption has roots that extend back to theProgressive Era, during which an environmental ethic took hold among figures likeErnst Haekel, George Perkins Marsh, and Theodore Roosevelt that emphasized “are treat into the wilderness as a palliative for both the individual and the nation,”Ray remarks (2017, 30). More insidiously, hunting, hiking, living off the land, andforgoing modern conveniences were regarded as salient bases for moral, racial, and cultural purity (Taylor 2016).
In tandem with social Darwinism and the eugenics movement, life was thus portrayed as a contest for genetic and cultural survival. The naturally superior—namely, those who thrived under the conditions of the “strenuous life” that this environmental ethic reflects—had every right not just to dominate the weaker but to weed them out of the national fabric (Kelves 1985, 114; Haraway 1989, 57). This offers a backdrop for a second presumption, embodied by what Shotwell calls heal-thism.
From a healthist perspective, individual health is a moral imperative. The bodyis a temple that mustn’t be defiled. Illnesses are often indicators that the afflicted ha-ven’t properly taken care of themselves. Chronic conditions like type-1 are perhapsa different matter. But the stricken can be held personally accountable for how theymanage their treatment regime. To suffer inordinately as a result of type-1 hereby may indicate that one is behaving irresponsibly.
There’s no denying, Shotwell remarks with respect to purism, that there aremyriad substances that none of us should be exposed to should we want to live, letalone live well. “To be against purity is [. . .] not to be for pollution, harm, sickness,or premature death” (Shotwell 2016, 15). Rather, her central concern is with thenotion that the pursuit of sustainability should entail wiping the slate clean andreturning to an Edenic, pretoxic state.[11] Yes, people have lived sustainably. The suc-cess of our evolutionary development as a species depended on it. But “there is noprimordial state we might wish to get back to, no Eden we have desecrated, no pre-toxic body we might uncover through enough chia seed and kombucha” (Shotwell2016, 4). Humans always have lived in a world full of substances that are toxic to us.This has been a necessary condition for our survival insofar low-dose exposure to certain toxins—including from bacteria and viruses—supports the development ofour immune system and other critical functions (Elliott 2011).
Perhaps more importantly, Shotwell agrees with Donna Haraway’s call to staywith the trouble with respect to the pursuit of sustainability. In difficult times, we’re tempted to think that we must pursue the Edenic to avoid the apocalyptic. This en-courages us “to address trouble in terms of making an imagined future safe,” Har-away asserts (2016, 10; see also Clare 2017a, 70ff). To stay with the trouble, though, involves seeking means for “partial recuperation and getting on together” (Haraway2016, 10) as best we can, given the circumstances we face here and now.
From this vantage point, Shotwell suggests, we should regard complicity and compromise—in the sense that we must be prepared to negotiate with others from positions in which we’re all typically operating with suboptimal options—as starting points for action. “We are compromised and we have made compromises, and thiswill continue to be the way we craft the worlds to come, whatever they turn out to be”(Shotwell 2016, 5). From this perspective, it’s not that chronically ill and disabled per-sons are somehow compromised and abled persons aren’t. We’re all co-implicated.The best any of us can hope for, particularly in disabled ecologies, is a set of materialconditions that’s “partially shared, offers finite freedom, adequate abundance, modestmeaning, and limited happiness. Partial, finite, adequate, modest, limited—and yet worth working on, with, and for” (ibid.).
3.2. Biohackin
We move now from the philosophical to the physical. While there currently is noinfrastructure in place for the local, downscale production of the medical materialsneeded to treat type-1, the seeds of such an infrastructure do exist. Whether or notit’s feasible to treat type-1 sustainably is an open question. So is a just transition tosustainable treatment. But if we’re committed to staying with the trouble, it’s possibleto envision not merely the ready availability of suboptimal but passable options butperhaps even more-than-passable options, too.
The treatment of type-1 currently depends on both consumables and durablegoods. Disposable syringes, insulin pens, and insulin are examples of the former.Insulin pumps and glucose monitors are instances of the latter, although both includedisposable components. As they’re currently constructed, the production of insulin pumps and glucose monitors is likely unfeasible under conditions of degrowth. Soresearch into low-tech glucose monitoring and insulin delivery apparatuses is essen-tial. How to encourage large pharmaceutical firms to engage in such research is a tricky consideration, since the only obvious market for such options right now is the global poor—not a demographic that such firms typical have a financial incentive to target. One would hope in this case that public policy could support subsidization, but this is hardly a prevailing ethos at present.
For this reason, biohacking organizations provide perhaps the best option, al-though with certain important qualifications. Oakland’s Open Insulin Project (OIP)stands out. The primary goal of OIP is to develop a process for the production oflow-cost, open-source insulin, the research for which can be sold to a generic drugcompany. But the initial interest in “hacking diabetes” shown by one of OIP’s found-ers, Anthony Di Franco, was to develop DIY glucose systems and insulin pumps.The knowledge and technology now exist for both (Bradley 2014; Martindale 2016).
Setting aside the difficulties of making the electronic elements and battery sys-tems of these instruments readily refurbishable, if they can’t be replaced by low-techoptions, what of their disposable components? Is it possible to produce downscalecompostable bioplastics for this purpose? Available evidence suggests it is, althoughfurther research is required to make the production process not just sustainable butalso medically safe (Misra 2018). Compostable bioplastics are typically producedfrom sugars derived from food crops. Glucose and dextrose from corn are primarysources. It’s also possible to use agricultural detritus or food waste, which is pref-erable in terms of land use (Thompson 2009). Whatever their origination source,the sugars can then be converted through a DIY process by combining them with vinegar and glycerin over heat (Styles 2015).
Yet, given the difficulties associated with making DIY compostable bioplas-tics safe for medical use, it may be preferable to rely on reusable components. Thisincludes reusing syringes that have been properly sterilized. In this way, consum-ables are replaced by durable goods, diminishing material throughputs. Reusingsingle-use lancets is actually quite common not just in less industrialized localesbut also in the U.S. because of the exorbitant cost of insulin pens. While there areconcerns about skin infections and sepsis, the American Diabetes Association evenoffers tips on how to mitigate risks associated with reuse. And evidence suggeststhat complications are quite rare (Schuler et al. 1992; Puder et al. 2005).
OIP is committed as well to the development of a downscale precisely dosed ,synthetic version of insulin. Insulin is a protein. While it was initially produced for medical use by purifying minced bovine or porcine pancreatic material, synthetic insulin is made by inserting a gene that codes for the insulin protein into either bacteria or yeast.
Neither the knowledge nor the technology yet exists for its production on a large scale. OIP researchers have been able to create proinsulin from E. coli bacteria(Martin 2017; Fong 2018). But after persistent failures to produce insulin using thisprocess, the team switched to using yeast. This has proven more promising. “So far,”Dana Smith reports, “the [insulin] yields have been too low to purify” (2019). So theteam is “experimenting with different colonies of yeast to see if they can increase theoutput. If they succeed, they will go through the final steps of purifying and testingthe protein. Once they’re confident that what they’ve produced really is pure insulin,Di Franco will serve as the group’s first guinea pig and inject himself with it as hewould his regular medication” (ibid.).
OIP’s approach to insulin production isn’t DIY. The organization estimatesroughly a $10,000 investment is required to purchase the computers, pumps, plumb-ing, pH and oxygen sensors, and a sterilization system required to produce medi-cal-grade insulin via their chosen process. But Ryan Bethencourt of Indie.Bio, which provides seed money for biotech startups, is interested in funding maker spaces that not only can facilitate the creation of an open-source recipe for insulin but also ready means for safe home brewing (Tucker 2015). When it comes to homebrewing specif-ically, the matter of purification is hardly trivial. Plenty of things can go wrong, in-cluding contamination of ingredients and mistakes with any of the numerous steps.But Bethencourt suggests that the addition of extra amino acids to cells that expressinsulin may facilitate purification, and in fewer steps (Maloney 2015).
Bethencourt nevertheless acknowledges the reservations of naysayers. ShouldIndie.Bio succeed at creating a homebrewing method for producing insulin, the or-ganization is sure to rely on widespread replication by biohacking labs like OIP theworld over, including ReaGent in Belgium, BioFoundry in Australia, and Mboalabin Cameroon. More promising, though, at least in terms of ensuring safety, is theprospect of partnering with hospitals, free health care clinics, patient organizations, and diabetes groups that can support something more like microbrewing than home-brewing (Smith 2019).
The last of these approaches lessens but does not override another prevailing concern. OIP, Indie.Bio, and other such organizations are heavily enmeshed in whatKelly Fritsch (2017) calls neoliberal biocapitalism. Within a neoliberal biocapitalistlogic, life itself is economized; disability and chronic illness are viewed exclusivelyin consumeristic terms. As a result, chronically ill and disabled persons must be partof a viable market that permits them monetarily to communicate that they have therequired purchasing power to receive needed medical treatments. Formal access totreatment is premised on their ability to pay.
This makes cripping the work and organization of biohackers critical. To wit, in-terventions by and on behalf of persons with type-1 must occur within a frameworkin which neoliberal biocapitalist agendas are both made explicit and openly resistedvia chronic illness and disability discourses. The apparatuses of power that monetizetype-1 must be dismantled. Creating user-led infrastructures for the developmentand distribution of biohacked treatments for type-1 is key, as is working with ratherthan overriding the interdependent networks of support and community personswith type-1 (and their kith and kin) have labored to create and maintain.
Conclusion
Recall now my student’s fateful question: “Are people like me alive when we shouldn’t be?” As I rephrased it, can those living with type-1 survive ecological sustainability?Both philosophical and physical considerations suggest that these questions can be answered affirmatively and perhaps, I now see, even with a degree of sanguinity.Why sanguinity? Perhaps it’s the extensive legacy of persistence, resilience, and evenjoy in the struggle for environmental justice exhibited by disability activists and ex-pressed by disability theorists. Indeed, Ray proclaims, joy itself may be “the ultimateresistance to domination” (2021).
REFERENCES
Abbey, E. 1968. Desert Solitaire. New York: Touchstone.
Aguilera, R. F., et al. 2009. “Depletion and the Future Availability of Petroleum Resources.”The Energy Journal 30 (1): 141–174.
https://doi.org/10.5547/issn0195-6574-ej-vol30-no1-6
Alaimo, S. 2012. “Sustainable This, Sustainable That: New Materialisms, Posthumanism, and Unknown Futures.” PMLA 127 (3): 558–564.https://doi.org/10.1632/pmla.2012.127.3.558
Aleklett, K. 2012. Peeking at Peak Oil. New York: Springer.https://doi.org/10.1007/978-1-4614-3424-5
Andrady, A. L. 2015. Plastics and Environmental Sustainability. Hoboken, NJ: Wiley. https://doi.org/10.1002/9781119009405
Andrady, A. L., and M. A. Neal. 2009. “Applications and Societal Benefits of Plastics.” Philosophical Transactions of the Royal Society B 364: 1977–1984.https://doi.org/10.1098/rstb.2008.0304
Arani, A. 2020. “Mutual Aid and Its Ambivalence: Lessons from Sick and Disabled Trans andQueer People of Color.” Feminist Studies 46 (3): 653–662.https://doi.org/10.15767/feministstudies.46.3.0653
ASTM Standard D6400. 2004. Standard Specification for Compostable Plastic. West Consho-hocken, PA: ASTM International.
Bardi, U. 2014. Extracted. White River Junction, VT: Chelsea Green.
Barnes, D.K.A., et al. 2009. “Accumulation and Fragmentation of Plastic Debris in Global En-vironments.” Philosophical Transactions of the Royal Society B 364: 1985–1998.https://doi.org/10.1098/rstb.2008.0205
Barnes, E. 2016. The Minority Body. New York: Oxford University Press.
Belser, J. W. 2020. “Disability, Climate Change, and Environmental Violence: The Politics of Invisibility and the Horizon of Hope.” Disability Studies Quarterly 40 (4): 1–32.https://doi.org/10.18061/dsq.v40i4.6959
Bookchin, M. 2005. The Ecology of Freedom. Oakland, CA: AK Press.
Bradley, M. 2014. “Diabetes Patients Are Hacking Their Way Toward a Bionic Pancreas,”WIRED, 24 December, 2014.
Bretz, T. 2020. “Discussing Harm without Harming: Disability and Environmental Justice.” Environmental Ethics 42 (2): 169–187. https://doi.org/10.5840/enviroethics2020111615
Campbell, C. J. 2013. Campbell’s Atlas of Oil and Gas Depletion. New York: Springer.https://doi.org/10.1007/978-1-4614-3576-1
Chen, M. Y. 2012. Animacies. Durham, NC: Duke University Press.
Cimitile, M. 2009. “Plastic Pollution May Change Cattle DNA.” Scientific American, 9 March,2009.
Clare, E. 2017a. Brilliant Imperfection. Durham, NC: Duke University Press.https://doi.org/10.1515/9780822373520
Clare, E. 2017b. “Notes on Natural Worlds, Disabled Bodies, and a Politics of Cure.” In Disability Studies and the Environmental Humanities, ed. S. J. Ray and J. Sibara, 242–266.Lincoln, NB: University of Nebraska Press. https://doi.org/10.2307/j.ctt1p6jht5.11
Crow, L. 1996. “Including All of Our Lives: Renewing the Social Model of Disability.” In Exploring the Divide, ed. C. Barnes and G. Mercer, 55–72. Leeds: Disability Press.
Daly, H. E. 1996. Beyond Growth. Boston: Beacon.
Di Chiro, G. 2010. “Polluted Politics? Confronting Toxic Discourse, Sex Panic, and Eco-Normativity.” In Queer Ecologies, ed. C. Mortimer-Sandilands and B. Erickson, 199–230.Bloomington, IN: Indiana University Press.
Duyvis, C. 2016. “And the Rest of Us Wait.” In Defying Doomsday, ed. T. Dolichva and H.Kench, 1–47. Yokine, AU: Twelfth Planet Press.
Edenhofer, O., et al. 2009. The Economics of Decarbonization. Potsdam: Potsdam Institute for Climate Impact Research.
Edwards, T. M., et al. 2018. “Nitrate Induces a Type 1 Diabetic Profile in Alligator Hatchlings.”Ecotoxicology and Environmental Safety 147: 767–775.https://doi.org/10.1016/j.ecoenv.2017.09.052
Elliott, K. C. 2011. Is a Little Pollution Good for You? New York: Oxford UniversitPress.https://doi.org/10.1093/acprof:oso/9780199755622.001.0001
Ellwood, W. 2014. The No-Nonsense Guide to Degrowth and Sustainability. Oxford, UK: New Internationalist.
Fleming, D. 2016. Lean Logic. White River Junction, VT: Chelsea Green
Fong, C. 2018. “Open Insulin, Battle of the DIY Diabetic.” Makery, 24 April, 2018.
Forbes, J. D. 2008. Columbus and Other Cannibals. New York: Seven Stories Press.
Fridley, D. 2010. “Nine Challenges of Alternative Energy.” In The Post Carbon Reader, ed. R.Heinberg and D. Lerch, 229–246. Healdsburg, CA: Watershed.
Fritsch, K. 2017. “Toxic Pregnancies: Speculative Futures, Disabling Environments, and Neoliberal Biocapital.” In Disability Studies and the Environmental Humanities, ed.S. J. Ray and J. Sibara, 359–380. Lincoln. NB: University of Nebraska Press. https://doi.org/10.2307/j.ctt1p6jht5.16
Giongo A., et al. 2011. “Toward Defining the Autoimmune Microbiome for Type 1 Diabetes.”ISME Journal 5: 82–91. https://doi.org/10.1038/ismej.2010.92
Greer, J. M. 2009. The Ecotechnic Future. Gabriola Island, BC: New Society.
Hall, C.A.S., et al. 2008. “Peak Oil, EROI, Investments and the Economy in an Uncertain Future.” In Biofuels, Solar and Wind as Renewable Energy Systems, ed. D. Pimentel,109–132. New York: Springer. https://doi.org/10.1007/978-1-4020-8654-0_5
Haraway, D. J. 1989. Primate Visions. New York, Routledge.https://doi.org/10.4324/9780203421918
Haraway, D. J. 2016. Staying with the Trouble. Durham, NC: Duke University Press. https://doi.org/10.2307/j.ctv11cw25q
Hawken, P. 2010. The Ecology of Commerce. New York: Harper Business.
Heikkinen, S.M.M., et al. 2013. “Does Farm Environment Protect Against Type 1 Diabetes Mellitus?” Diabetes and Vascular Disease Research 10 (4): 375–377.https://doi.org/10.1177/1479164112474907
Heinberg, R. 2007. Peak Everything. Gabriola Island, BC: New Society.
Heinberg, R. 2015. Afterburn. Gabriola Island, BC: New Society.
Heinberg, R., and D. Fridley. 2016. Our Renewable Future. Washington, DC: Island Press.https://doi.org/10.5822/978-1-61091-780-3
Hoge, R. 2016. “Introduction.” In Defying Doomsday, ed. T. Dolichva and H. Kench, i–ii.Yokine, AU: Twelfth Planet Press.
Hopkins, R. 2011. The Transition Companion. Totnes, UK: Green Press.
Isehunwa, G. O., et al. 2017. “Effects of Petrol Exposure on Glucose, Liver and Muscle Glycogen Levels in the Common African Toad Bufo regularis.” Nigerian Journal of Physiological Sciences 32 (2): 139–145.
Jackson, T. 2017. Prosperity without Growth. New York: Routledge.https://doi.org/10.4324/9781315677453
Janz, H. L., and M. Stack. 2017. “Think Disability Is a Tragedy? We Pity You.” The Conversation, 27 August, 2017.
Jensen, D., and A. McBay. 2009. What We Leave Behind. New York: Seven Stories.
Johnson, V. A. 2017. “Bringing Together Feminist Disability Studies and Environmental Justice.” In Disability Studies and the Environmental Humanities, ed. S. J. Ray and J.Sibara, 73–93. Lincoln. NB: University of Nebraska Press. https://doi.org/10.2307/j.ctt1p6jht5.6
Kafer, A. 2017. “Bodies of Nature: The Environmental Politics of Disability.” In Disability Studies and the Environmental Humanities, ed. S. J. Ray and J. Sibara, 201–242. Lincoln. NB: University of Nebraska Press. https://doi.org/10.2307/j.ctt1p6jht5.10
Kallis, G. 2011. “In Defence of Degrowth.” Ecological Economics 70 (5): 873–880.https://doi.org/10.1016/j.ecolecon.2010.12.007
Kelves, D. 1985. In the Name of Eugenics. New York: Knopf.
Krisiunas, E. 2011. “Waste Disposal in the 21st Century and Diabetes Technology: A Little Coffee (Cup) or Beer (Can) with that Insulin Infusion (Set).” Journal of Diabetes Science and Technology 5 (4): 851–852. https://doi.org/10.1177/193229681100500405
Lawless, K. 2018a. “The Bacteria Babies Need.” The New York Times, 17 June, 2018.
Lawless, K. 2018b. Formerly Known as Food. New York: St. Martin’s Press.
Lerch, D. 2010. “Making Sense of Peak Oil and Energy Uncertainty.” In The Post Carbon
Reader, ed. R. Heinberg and D. Lerch, 207–210. Healdsburg, CA: Watershed.
Maahs D. M., et al. 2010. “Epidemiology of Type 1 Diabetes.” Endocrinology Metabolism Clinics of North America 39: 481–449. https://doi.org/10.1016/j.ecl.2010.05.011
Maloney, D. 2015. “The Biohacking Movement and Open Source Insulin.” Hackaday, 30 July,2015.
Martin, L. 2017. “Oakland’s Open Insulin Project Aims to Disrupt Diabetes.” Makezine, 16 March, 2017.
Martindale, J. 2016. “Home-Brew Hackers Build Smart Insulin Pumps Ahead of CommercialReleases.” Digital Trends, 18 May, 2016.
McBay, A. 2006. Peak Oil Survival. Guilford, CT: Lyons Press.
McKibben, B. 2010. Eaarth. New York: Times Books.
Mentz, S. 2012. “After Sustainability.” PMLA 127 (3): 586–592.https://doi.org/10.1632/pmla.2012.127.3.586
Misra, S., et al. 2018. “Medical Grade Biodegradable Polymers: A Perspective from Gram-Positive Bacteria.” In Fundamental Biomaterials: Polymers, ed. S. Thomas, P. Balakrishnan,and M. S. Sreekala, 267–286. Amsterdam: Elsevier.https://doi.org/10.1016/b978-0-08-102194-1.00012-8
Muncke, J. 2014. “Food Contact Materials: Practices, Agencies, and Challenges.” In Toxicantsin Food Packaging and Household Plastics, ed. S. M. Sneaker, 265–297. New York: Humana. https://doi.org/10.1007/978-1-4471-6500-2_11
Nabhan, G. P. 2013. Growing Food in a Hotter, Drier Land. White River Junction, VT: ChelseaGreen.
Nixon, R. 2011. Slow Violence and the Environmentalism of the Poor. Cambridge, MA: HarvardUniversity. https://doi.org/10.4159/harvard.9780674061194
North, E. J., and R. U. Halden. 2013. “Plastics and Environmental Health: The Road Ahead.”Review on Environmental Health 28 (1): 1–8. https://doi.org/10.1515/reveh-2012-0030
Parker, C. L., and B. S. Schwartz. 2010. “Human Health and Well-Being in an Era of EnergyScarcity and Climate Change.” In The Post Carbon Reader, ed. R. Heinberg and D. Lerch, 385–405. Healdsburg, CA: Watershed.
Puder, J., et al. 2005. “Using Insulin Needles Up to Five Times Does Not Affect Needle TipShape Nor Increase Pain Intensity.” Diabetes Research and Clinical Practice 67 (2): 119–123. https://doi.org/10.1016/j.diabres.2004.06.001
Ray, S. J. 2017. “Risking Bodies in the Wild: The ‘Corporeal Unconscious’ of American Ad-venture Culture.” In Disability Studies and the Environmental Humanities, ed. S. J. Rayand J. Sibara, 29–72. Lincoln, NB: University of Nebraska Press.https://doi.org/10.2307/j.ctt1p6jht5.5
Ray, S. J. 2021. “Climate Anxiety Is an Overwhelmingly White Phenomenon.” ScientificAmerican, 21 March, 2021.
Reynolds, J. M. 2017. “ ‘I’d Rather Be Dead than Disabled’—The Ableist Conflation and theMeanings of Disability.” Review of Communication 17 (3): 149–163.https://doi.org/10.1080/15358593.2017.1331255
Rozsa, M. 2021. “Plastic Pollution Threatens Our Health, Food Systems, and Civilization Itself.” Salon, 10 April, 2021.
Schlosberg, D., and R. Coles. 2016. “The New Environmentalism of Everyday Life: Sustainability, Material Flows and Movements.” Contemporary Political Theory 15 (2): 160181. https://doi.org/10.1057/cpt.2015.34
Schuler, G., et al. 1992. “Is the Reuse of Needles for Insulin Injection Systems Associated witha Higher Risk of Cutaneous Complications?” Diabetes Research and Clinical Practice16 (3): 209–212. https://doi.org/10.1016/0168-8227(92)90119-c
Schweikart, D. 2009. “Is Sustainable Capitalism an Oxymoron?” Perspective on Developmentand Technology 8(2–3): 559–580. https://doi.org/10.1163/156914909×424033
Shotwell, A. 2016. Against Purity. Minneapolis: University of Minnesota Press.
Smil, V. 2008. Global Catastrophes and Trends. Cambridge, MA: MIT Press.https://doi.org/10.7551/mitpress/7582.001.0001
Smith, D. G. 2019. “Biohackers with Diabetes Are Making Their Own Insulin.” Medium, 30May, 2019.
Styles, S. 2015. “Biodegradable Plastic Made Easily in 3 Simple Steps.” Paxonplastics, 2 September, 2015.
Sverdrup, H., and V. Ragnarsdottír. 2014. “Natural Resources in a Planetary Perspective,”Geochemical Perspectives 3(2): 129–341. https://doi.org/10.7185/geochempersp.3.2
Taylor, D. 2016. The Rise of the American Conservation Movement. Durham, NC: Duke University Press.
Taylor, S. 2011. “Beasts of Burden: Disability Studies and Animal Rights.” Qui Parle 19 (2):191–222. https://doi.org/10.5250/quiparle.19.2.0191
Taylor, S. 2019. “Disabled Ecologies: Living with Impaired Landscapes,” presented at University of California, Berkeley, March 2019.
Taylor, S. 2020. “What Would Health Security Look Like?” Boston Review, 28 May, 2020.
Teuten, E. L., et al. 2009. “Transport and Release of Chemicals from Plastics to the Environment and to Wildlife.” Philosophical Transactions of the Royal Society B 364: 2027–2045. https://doi.org/10.1098/rstb.2008.0284
Thompson, R. C., et al., “Plastics, the Environment and Human Health: Current Consen-sus and Future Trends,” Philosophical Transactions of the Royal Society B 364 (2009):2153–2166. https://doi.org/10.1098/rstb.2009.0053
Tolinski, M. 2011. Plastics and Sustainability. Hoboken, NJ: Wiley.https://doi.org/10.1002/9781118217849
Tremain, S. L. 2018. “Philosophy and the Apparatus of Disability.” In Oxford Handbook ofPhilosophy and Disability, ed. D. T. Wasserman and A. Cureton. New York: OxfordUniversity Press. https://doi.org/10.1093/oxfordhb/9780190622879.013.5
Tressman, L. 2005. Burdened Virtues. New York: Oxford university Press.https://doi.org/10.1093/0195179145.001.0001
Tucker, M. E. 2015. “Biohackers Aim to Make Homebrew Insulin, But Don’t Try It Yet.” NPR,15 July, 2015.
Vatanen, T., et al. 2016. “Variation in Microbiome LPS Immunogenicity Contributes to Autoimmunity in Humans.” Cell 165 (4): 842–853. https://doi.org/10.1016/j.cell.2016.04.007
Victor, P. A. 2008. Managing without Growth. Northampton, MA: Edward Elgar.https://doi.org/10.4337/9781848442993
Wagner, G. 2011. But Will the Planet Notice? New York: Hill and Wang.
Wendell, S. 2001. “Unhealthy Disabled: Treating Chronic Illnesses as Disability.” Hypatia 16(4): 17–33. https://doi.org/10.1353/hyp.2001.0062
West, C. 2019. “There Is Joy in the Struggle.” Harvard Divinity School, 31 May, 2019.
Whyte, K. P. 2015. “Indigenous Food Systems, Environmental Justice, and Settler-IndustrialStates.” In Global Food, Global Justice, ed. M. Rawlinson and C. Ward, 143–156. NewYork: Cambridge Scholars.
Whyte, K. P. 2021. “Against Crisis Epistemology.” In Handbook of Critical Indigenous Studies,ed. B. Hokowhitu et al., 52–64. New York: Routledge.https://doi.org/10.4324/9780429440229-6
Williams, F. 2012. Breasts: A Natural and Unnatural History. New York: W. W. Norton & Co.Zhang H., et al. 2008. “Increasing Incidence of Type 1 Diabetes in Children Aged 0–14 Yearsin Harbin, China (1990–2000).” Primary Care Diabetes 2: 121–126.https://doi.org/10.1016/j.pcd.2008.06.001
Zoeller, RT., et al. 2012. “Endocrine-Disrupting Chemicals and Public Health Protection: AStatement of Principles from the Endocrine Society.” Endocrinology 153 (9): 4097–4110. https://doi.org/10.1210/en.2012-1422
ABOUT THIS READING
This article was retrieved from The Journal of Philosophy of Disability. This work has a CC BY-NC-ND license associated with it.
- While chronic illness is hard to define with precision, Susan Wendell specifies that type-1,lupus, and other maladies that fit the bill are “illnesses that do not go away by themselves within six months, that cannot reliably be cured, and that [typically] will not kill thepatient any time soon” (2001, 20) ↵
- Within the context of this essay, the delivery of environmental justice requires the rectification of institutional arrangements that perpetuate inequitable allocations of socioecological hazards and inhibit adaptation to metascale forces like climate change, particularly by socially vulnerable peoples and persons (Whyte 2015). ↵
- Elizabeth Barnes (2016) and Thomas Bretz (2020) emphasize that with respect to regard-ing these phenomena as harms, what matters is less the specific impacts on affected per-sons than that these impacts are imposed on them without their knowledge or consent.The point here is that disability and chronic illness are not automatically or intrinsically harmful. In the present context, they are instead manifestations of epistemic injustice that operate within complex historical and cultural apparatuses of power (Tremain2018). ↵
- Numerous developmentalists contend that honoring market principles provides the most feasible and expeditious approach to facilitating sustainable development. This re-quires integrating the full ecological cost of production into market prices and making manufacturers responsible for bearing the enduring costs of environmentally destructive practices (Hawken 2010; Wagner 2011). ↵
- The quantity of raw materials needed to create solar panels, wind turbines, and batteriesfor energy storage includes a number of rare metals, the increasing demand for which isa constraint on scaling up renewable energy. Mining companies the world over reportdeclining ore quality. In many, perhaps most, cases it may not be possible to find ade-quate substitutes, since they, too, are depleted (Bardi 2014). Reliance on less-than-ade-quate substitutes, should they be identified, entails that the amount of energy produced by renewable sources will be reduced. ↵
- One study (Hall et al. 2008) estimates that the minimum energy return on investment(EROI) required to maintain industrial society is 5:1. Conventional oil sources exceed this (30:1), as do solar (11:1) and wind (25:1). Unconventional oil (3:1) and ethanol (1:1)don’t. And the EROI of both solar and wind are as high as they are only because of conventional oil inputs. Without these inputs, they would fall below the 5:1 threshold.Technological innovation on its own can’t save industrial society either, since it, too, is dependent on energy sources of a quality that only oil can provide (Greer 2009, 165). ↵
- Still another strike against the prospects for sustainable development is the increasing economic burden associated with climate change itself, including demands of foreign policy responses to failed states and mass migration, the added strain on public health, increased infrastructure maintenance and repair, countless hours of lost labor, higher insurance premiums, reduced crop yields, and more frequent and more damaging natural disasters (Edenhofer et al. 2009). ↵
- Geologists and their allies (Aleklett 2012; Campbell 2013) side with Heinberg’s (2007;2015) assessment that industrial society will collapse within only a matter of decades.Economists and their allies (Aguilera et al. 2009) take a more sanguine view, which sup-ports the prospects for developmentalism. ↵
- Coincidingly, David Schweikart (2009) contends that even if it proves impossible deci-sively to conclude that sustainable industrialism—or “sustainable capitalism,” his mainfocus—is an oxymoron, it is a profoundly bad bet to assume it is and an irrational deci-sion to pursue. Schweikart’s considerations point to a wider issue: just how worth sus-taining are industrialism and capitalism per se, whether sustainable or not, particularlygiven that the purported wellbeing of some comes at the expense of many others, includ-ing disabled and chronically ill persons? If Jack Forbes (2008) is correct this dynamicis not incidental, for both industrialism and capitalism are manifestations of wétiko, orthe normalization of cannibalizing the lives and livelihoods of socially vulnerable andoppressed peoples ↵
- By comparison, within the social constructionist framework Wendell favors healthy dis-abled persons experience “physical conditions and functional limitations [that] are rel-atively stable and predictable for the foreseeable future” (2001, 19), even if they too areaffected by arbitrarily debilitating social features. Persons with cerebral palsy, multiplesclerosis, and the like qualify as healthy disabled, according to Wendell. ↵
- Mel Chen’s considerations regarding the concept of toxicity underscore that this yearn-ing to return to an imagined pretoxic state is itself a reflection of “immunity thinking”(2012, 190), a particularly insidious aspect of purism. According to practitioners of im-munity thinking, social crises are at least partially attributable to “habitual scapegoatsof ableist, sexist, and racist systems (ibid., 192). In this respect, purism reinforces bothenvironmental racism and environmental ableism ↵
