Vital mobilities: Integrating healthcare,climate change,and mobilities

Abstract

Deepening the theorisation of the relationship between bodies and climate change, we introduce vital mobilities – external societal circulations that enable critical internal bodily circulations. Vital mobilities addresses a need for theories and methods to mitigate healthcare disruption, decarbonise health services, and support well-being. First, informed by mobilities literature, we develop a method to conceptualise and intervene in specific vital mobilities. Second, we demonstrate its analytical potential via two illustrative cases, asthma inhalers and malaria vaccines. Finally, we suggest future research agendas emanating from geography's integrative disciplinary atmosphere: surfacing circulations, documenting coagulations, sharing adaptations, envisioning futures, and conceptualising beyond vital mobilities.

Keywords

asthma climate change health healthcare malaria mobilities vital

I Introduction

‘We needed to get goods from here to there’, states the humanitarian worker. ‘Here’ was the nearshore and ‘there’ was a far shore, a few days ago connected by a bridge and now a torrent of rushing river. This disruption was the consequence of Hurricane Igor which hit Atlantic Canada. The storm caused stream flow to increase from 10 to 600 cubic metres per second (Sodero, 2022). Infrastructure crumbled causing widespread road and bridge washouts, isolating more than one hundred communities for up to 10 days. The usual way of moving people, goods, and services was disrupted resulting in lack of basic provisions, such as insulin and methadone, and missed appointments, like chemotherapy and dialysis.

The inability to access healthcare is a situation familiar to communities around the world grappling with severe weather, from floods to fires. Healthcare, climate change, and mobilities are increasingly symbiotic. This article is situated within health geographies, building on a sub-disciplinary evolution from disease-focused medical geography to the focus of health geography on well-being (Kearns and Moon, 2002), more-than-human social-ecological understandings (Andrews, 2019), and climate change (Nichols and Del Casino, 2021). We frame vital mobilities as external societal circulations that enable critical internal bodily circulations, from distributions of asthma inhalers to malaria vaccines. Vital mobilities as theory and method provides tools to articulate, analyse, and adapt to a post-normal climate, addressing a pressing need for new ways to think through and act on mitigating healthcare disruption, decarbonising health services, and supporting well-being (Sodero, 2018).

As Sodero (2022) demonstrates in her examination of the mobility impacts of hurricanes, infrastructure, planning, and logistics struggle to meet community needs in the face of increasingly severe weather. Complementing and extending research on health mobilities (Gatrell, 2011), including COVID (Schimkowsky, 2022), disability (Bell and Cook, 2021), reproduction (Speier et al., 2020), and therapeutic mobilities (Kaspar et al., 2019), vital mobilities is a grounded means by which to identify novel and effective adaptations to real-world climate impacts. Vital mobilities explores the relationship between societal and bodily circulations with a focus on mobilities imperative for life, bringing a multi-scalar, material, and more-than-human lens to the provision of health services. To this end, we centre an ethic of ‘entanglement and care’ highlighting a relational dynamic in the achievement of vital mobilities that centres the climate (Fishel, 2019: 351).

Identifying mobility in emergency as understudied, Adey (2016) examines how emergencies produce mobility: ‘whether in flight or response, emergencies demand highly intensive forms of movement that radically transform one’s life chances and quality of life’ (2016: 32). In this article, we take health protection to be an explicit consideration of emergency. Vital mobilities such as insulin supply chains entail routine, every day, and even mundane circulations that enable care. However, vital mobilities also often entail a sense of urgency, from the scale of the individual, such as an ambulance responding to a reported heart attack, to the community scale, such as scrambling to deliver aid to respond to storm impacts (Savitzky, 2018), to a global scale amid a climate emergency that requires decarbonisation at the same time as severe weather disrupts often geographically diffuse vital mobilities. Central to our work is Adey’s emphasis on ‘quality of life’ indicating an orientation beyond surviving towards flourishing. Within vital mobilities, one goal is preventing disruption, with a secondary goal of managing disruption to prevent disaster. While both emergency and disaster require immediate action, an emergency holds unfulfilled adverse potential, what Adey and Anderson term an ‘interval’ (2011: 1092) and may not tip into the realm of disaster defined by significant loss of life and damage to community fabric, both concrete and cultural. Matthewman argues for a mobilities turn in disaster scholarship to highlight complex spatial and temporal dynamics: ‘the worst disasters may not be concentrated in time and space . . . that they may be devastating without being spectacular (as with heat waves), that they may affect more than humans (as with mass habitat destruction or ocean acidification), and that they may even appear ambient (as with global air pollution)’ (2017: 8) speaking to the unexpected, pervasive, and reciprocal relationships that link healthcare, climate change, and mobilities.

This paper has three parts. First, informed by Adey’s work (2016) on emergency mobility, we identify a five-part method – focus, care, circulation, coagulation, and adaptation – to support researchers as well as practitioners, community members, and patients in researching vital mobilities and as a means of adapting to climate change, decarbonising healthcare, and bolstering community well-being. This method is informed by broader mobilities literature related to healthcare, climate change, and emergency. Second, focusing on two illustrative cases –the circulation of asthma inhalers and malaria vaccines – we apply the method, demonstrating the complexity of vital mobilities, particularly the ways in which climate change increasingly shapes healthcare priorities. Third, by connecting bodies and the broader environment we contribute to health geographies, nature-society geography, and mobilities scholarship, identifying a vital mobilities research agenda: surfacing vital circulations, documenting coagulations, sharing adaptations, envisioning futures, and conceptualising beyond vital mobilities.

II Vital mobilities as method

We use the term ‘vital mobilities’ in part due to Bennett’s (2010) work on vital materiality with ‘vital’ indicating not only the vibrancy and dynamism of social life that encompasses humans, animals, and materials, but also the critical nature of healthcare-related mobilities. Informed by Bennett, Fishel (2017) uses the human body, and the microbes and bacteria therein, as an entry point for fostering a global politics based on commonality rather than division, positioning the body as a ‘lively vessel’ subject to diverse flows, from disease to capital (2017). This corporeal grounding challenges paradigms centred on individuality and isolation to create a material basis for cooperation. Vital mobilities impact all bodies, and range from molecular to global scales, co-constituted with diverse and motley materials and environments, from bacteria to heat waves. ‘Vital’ further resonates with bodily systems, like pulse and blood pressure, as well as critical infrastructure, such as drinking water reservoirs (Collier and Lakoff, 2015), the global distribution of humanitarian kit (Redfield, 2013), and the imperative of climate action for human health (IPCC). ‘Vital’ also relates to debates on vitalism (Philo, 2007), which for some is framed as a binary (i.e. alive/dead) and for others as a spectrum (e.g. Anderson, 2020 on Indigenous ontologies of animacy and vitality; Chen, 2012 on lifeliness and deathliness). For the purposes of this article, Tsing’s (2021) work on life from ruins and collaborative survival guided by an ethic of lifeliness are key to our understanding of vitality.

The value of vital mobilities as method is that it offers a common entry point for researchers, practitioners, and community members to engage with, contest, and build upon. In this effort, we are informed by Adey’s (2016) theorisation of emergency mobilities, including seven characteristics: absence, anticipation, coordination, difference, inhuman, mobile machines, and times. A strength of Adey’s framework is its versatility. However, we find that a more specific and structured method is useful in thinking and feeling through vital mobilities (see Philo, 2007 on felt experience). Complementing an instrumentalist approach to analysing and assessing supply chains (i.e. thinking), we appreciate the epistemological value of nuanced lived and affective experiences (i.e. feeling). For example, a disruption that is minor in terms supply chain evaluation, could incur high levels of stress for health professionals and patients.

We identify five steps: focus, care, circulation, coagulation, and adaptation. The choice of terms elicits bodily and ecological dynamics to underpin links between societal and bodily circulations. Drawing on Fishel (2017), these terms are descriptors as well as metaphors that align with a planetary politics based on community and commonality (Kearns, 2021). The ordering is intentional, underlying the movement of goods, people, and services from points of production to points of care, in what are often continuous, if vulnerable, circuits. Further, while flexible enough to encompass a vast range of vital mobilities, the method allows for structured comparison between different mobilities and is a starting point for discussion and debate. We delve into each component of vital mobilities as methods in greater depth with an explicit focus on the intersection of healthcare, climate change, and mobilities. For some researchers and practitioners, climate change may be peripheral to their engagement with vital mobilities, but the following illustrates a transferable multi-scalar, materialist, and more-than-human approach.

1 Focus

There are innumerable potential entry points for homing in on vital mobilities. It might be a medical good or disease (Lavau, 2014 on viruses), patient or healthcare professional (Cassidy, 2020 on asylum seekers; Keil, 2014 on people who are unhoused), environmental or infrastructural (Fredriksen, 2014 on shelter topologies). In the case of climate change, focal points might include carbon mobilities (Paterson, 2014), efforts to decarbonise healthcare delivery (Kmietowicz, 2021), or the experience and impacts of extreme temperature on professionals (Price et al., 2018). At the point of production and transport, pharmaceutical cold chains and medical equipment may be disrupted. At the point of care, hospitals may be forced to evacuate due to fires or hurricane (King et al., 2016). The diversity of possible focal points applies within as well as across a range of cases. As a result, the chosen focus is indicative of a prominent or compelling element of a given case according to researchers and impacted communities.

2 Care

Care is an impetus for mobility: it ‘underlies, effects, and contours the mobility practices of people – in other words, people are moved by care’ (Balcom Raleigh, Kirveennummi, and Puustinen, 2020: 54). At a local scale, Porter et al. identify how during the first COVID waves, young African women altered their mobility practices to protect elderly parents and children highlighting ‘entanglements between everyday mobility practices on city streets and negotiated relations of care within the household’ (2023: 21). Care is an ongoing practice that is relational and dynamic; through shared vulnerability and suffering it can foster connection vital to climate action (Eriksen, 2022). At a global scale, Kaspar (2019) in her work on therapeutic mobilities, analyses transnational cancer treatment as an act of care that intersects with health systems marketization, highlighting disparities in medical travel. Mckay, in contrast, explores the economic and emotional ‘care chains’ entailed in economic migration by Filipino workers (2007: 175), while Huey and Schwiter (2021) describe how Western European agencies hire Eastern European women to work as live-in-carers for seniors, resulting in precarious employment that neglects workers via slow violence and the ‘non-innocent’ politics of care (Wiles, 2024). Underpinning many of these care practices are mobility patterns, including flights to obtain or provide care, premised on infrastructure and pricing that privilege fossil fuels, illustrating the degree to which healthcare, climate change, and mobilities are intertwined.

Discussion of the more-than-human in the context of climate change and mobility is thrillingly diverse but with a common theme of interconnection. From botanical decolonisation (Mastnak et al., 2014), to parasites and disease (Southern and Dillon, 2022), to species co-mobilities (Scott, 2020), there are efforts to link human bodies and ecologies, promoting an ethic of consciousness and care. Diverse social-ecological relations are transferable to rethinking contemporary assemblages, infrastructures, and logistics of vital mobilities, namely, by recognising unexpected, pervasive, and reciprocal relationships, infusing climate considerations into healthcare delivery. The ‘more-than-human’ is writ broadly, including material conditions brought about by climate change and affecting life – both of humans and other species. Health-related considerations include zoonotic disease vectors, such as mosquitoes, to fungal-sourced penicillin, to the fact that anthropogenic climate change compromises the vitality of species via events such as heat waves and forest fires (Scott, 2024). A given focus can imply a hierarchy, such as privileging human over mosquito life (see Part 2: Malaria Vaccines) or be viewed as an opportunity to flatten and reframe social-ecological dynamics and related understandings of care (see Part 3: Conceptualising beyond vital mobilities).

3 Circulation

Here, we focus on efforts to nuance the space/time between the anchoring nodes of production and care. Salter (2013) foregrounds the role of circulation and assemblages in mobility, while Cowen speaks to the ‘biological imperative’ for circulation given reliance on global supply chains (2014: 3). In the case of vital mobilities that impact life chances such a biological imperative is literal. Likewise, Chua et al. propose that logistics, as the ‘science of circulation’, not only results in moving goods, but shapes how humans understand space (2018: 617). To this end, they propose a three-prong approach to analysing logistics that translates to vital mobilities, namely, surfacing power dynamics, vulnerabilities, and contestations, informing our research agenda (Part 3). This approach shifts vital mobilities from the realm of the mundane and overlooked, especially in high income contexts, to a critical site for attention. Gregson et al. (2017) also explore the space/time between production and consumption, moving beyond narratives of seamlessness to a finer grain appreciation of the spatial, temporal, and competitive frictions shaped by ecological dynamics, labour, technology, and more. They argue that logistics is an ‘art of accommodating’ such dynamic and disrupted mobilities (2017: 381); an observation that takes on greater significance when dealing with healthcare, climate-related disruptions, and intersections between the two where life and health are on the line.

Within mobilities scholarship, Forman’s (2018) work on natural gas is applicable to vital mobilities, focusing on what happens between nodes as a neglected area of scholarship, highlighting the journey of materials to permit a fuller understanding of circulations and attendant complications. For example, between nodes, natural gas circulates in complex and potentially dangerous ways that are obscured by unseen pipelines and narratives of seamlessness. Circulation offers a critical entry point for introducing and incorporating more-than-human dynamics, from emissions to weather events, from microbiomes to animal migrations, into understandings of vital mobilities.

4 Coagulation

Challenge or change to circulation of vital mobilities may come from typically undesired friction (Tsing, 2005), turbulence (Chua et al., 2018), and disruption (Graham, 2010) – all synonyms for what we term coagulation. It is possible to conceive of a spectrum that ranges from friction on one end to unruliness (Cisani, Presti, and Pearce, 2020), danger (Adams-Hutcheson et al., 2017), and debilitation (Alexander, 2022) on the other. Philo refers specifically to ‘dangerous coagulations’ (2014: 493). Salazar (2021) explores immobility, with a focus on COVID, concluding that mobility and immobility are co-present, while Birtchnell and Büscher, in response to the Icelandic ash cloud, a profound atmospheric event albeit not caused by human carbon pollution, examine the ‘strange, surprising and potentially revealing nature of strandedness in a world of mobile lives’ (2011: 1). In short, mobilities scholars explore and challenge a preponderance of negative connotations to unexpected changes in routine mobilities (Cresswell, 2011).

From a bodily perspective, coagulation refers to the thickening and slowing of blood which can allow life-threatening clots to form. However, in the case of injury coagulation is desirable as clotting stops bleeding. Coagulation, understood as slowing or stopping of circulations, offers a productive entry point for engaging in and reimagining healthcare interventions. Whether intentional or unintentional, experiences from friction to debilitation offer a springboard to consider wide-ranging perspectives from patients to labourers, local environments to global climate. Intentional, local, and slow (er) mobilities, as a counter to just-in-time capitalist logics, have the potential to create a spatial/temporal opening for more-than-human mobilities that yoke bodies and environments together (Sheller, 2018). In the case of vital mobilities, this may mean developing adaptive capacity, to which we next turn.

5 Adaptation

The enormous range of foci for vital mobilities and corresponding diversity of circulations and possible coagulations suggests an equally broad set of possible adaptations. These could range from what De Coss-Corzo (2021) describes as reactive patchworks, to scrambles, that is ‘abrupt’ de- and re-mobilisations (Savitzky, 2018: 662), to proactive innovations and transformations (Brown, 2014). Focusing on a broader, ‘promiscuous politics’ of emergency mobility, Adey explores ‘how social relations might flourish’ amidst disruption, from individual acts of care to energising social movements (2020: 377). Useful to both reactive and proactive orientations is the concept of adaptive capacity generally, and adaptive mobilities specifically where adaptive capacity is the ability of a community to cope with disruption through learning. However, as with critiques of resilience, adaptive capacity can also be leveraged to maintain, rather than transform, the status quo (Grove, 2014). Ingham et al. (2019) use a proactive approach when examining adaptive mobilities in Bangladesh due to changing flooding patterns. They propose an emergency mobility paradigm that integrates cultural practice, government policy, and community survival.

Likewise, Sodero (2022) in exploring the disruptions caused by hurricanes in Atlantic Canada, proposes a climate routing paradigm which asks how society can correct course to reduce climate impacts and prepare for severe weather disruption, just as mariners adjust course based on wind and currents. To this end, she makes recommendations, two of which we outline here. First, embracing green and blue refers to considering human and ecological mobilities in tandem, such as by increasing storm buffers like living shorelines and accommodating ecological flows like swollen rivers to prevent and reduce disruption to vital mobilities. Second, in the case of disruption to lean global supply chains or local healthcare delivery, rebranding redundancy means ensuring back-up options and associated skills are available across scales. For example, active transport, like walking, biking, and canoeing, paired with technologies like drones, electric vehicles, and personal water scooters (i.e. Sea-Doos), may characterise future post-disaster vital mobility constellations.

III Applying vital mobilities: Asthma and malaria

Next, we use vital mobilities as method to analyse the movements of asthma inhalers and malaria vaccines. While asthma is chronic and malaria vector-borne, both are increasing in prevalence and geographic range due in part to climate change, driving demand for public health resources. Globally, each disease affects about 250 million people, with about one million people dying annually (WHO 2023a; 2023b). We selected these cases as both focus on the development of specific medications, prompted in different ways by climate impacts. We present each case in brief before comparing the two.

1 Asthma inhalers

Climate change reduces air quality due to interactions of heat, ground-level ozone, and particulate matter, as well as damp conditions and longer allergy seasons (Kinney, 2008). Reductions in air quality contribute to respiratory conditions, like asthma, that restrict airways (D’Amato et al., 2020). In the UK, approximately five million people are treated for asthma (NICE, 2022). In turn, asthma drives inhaler distribution and use which constitutes a vital mobility by facilitating oxygen circulation within the body. Surprisingly, due to the climate-polluting propellants used in inhalers, they contribute a significant three percent of the total National Health Service carbon footprint (NHS, 2020), in turn worsening the climatic conditions that exacerbate respiratory conditions (NHS, 2020).

The focus of this vital mobility is inhalers and related gases, both gases used in inhalers and oxygen as essential to human respiration. Since 2021, the Greater Manchester Medicines Management Group (GMMMG) has been revising how, when, and what type of inhalers are prescribed as a key component of reaching NHS net zero. To this end, the prescription of Dry Powder Inhalers (DPIs) is now prioritised over traditional Metered Dose Inhalers (MDIs); DPIs are 10 to 30 times less polluting than MDIs (Woodcock et al., 2022). Most patients use one MDI inhaler per year and a switch across the NHS to DPIs will halve associated carbon output (NHS, 2020). Altering inhaler prescription practices decouples the circular relationship between asthma, inhalers, and climate change. This entails care for the climate through shifting to lower carbon medication and for patients through a modified treatment which diminishes the drivers of asthma. GMMMG (2021) publishes the relative carbon outputs saved through DPI use, measured in miles driven in an average car. Providing a yardstick for assessing the ecological impact of a vital mobility, this measure also highlights that just as with inhalers themselves, their production and distribution has a circular relationship with asthma and climate change, particularly with the rise of home prescription delivery that – another vital mobility (Unnikrishnan and Figliozzi, 2021).

As well as emphasising the continuity and variety of interlinkages between climate, healthcare, and mobilities, this highlights consideration of inhalers’ circulation. GlaxoSmithKline produces inhalers in the UK and expanded its facility in Ware, 40 miles north of London, doubling production to almost 40 million inhalers per year, of which 95% are exported to 74 countries (GlaxoSmithKline, 2016). Kindeva (2022) announced production plans in Loughborough, UK, about 100 miles north of London, for low-carbon MDI inhalers to be marketed by 2025, pending regulatory approval. Both examples highlight the geographic extent to which inhalers must be circulated beyond production nodes, generating questions about how decarbonisation is factored into manufacture and transport. Coagulation may occur if severe weather impacts production or distribution (e.g. flooded manufacturing facility; washed out road in the UK or importing country). Further, coagulation may result if demand outstrips supply, or if those in need cannot readily access inhalers, such as people who are unhoused. Each example risks coagulation of air flow for patients who rely on inhalers. Consequently, adaptation may entail accommodating disruptions due to severe weather, such as decentralising and decarbonising inhaler production and distribution; accommodating growing demand for newer medical technologies, both as popularity amongst prescribers grows and as need is driven by increasing respiratory illness rates; and broadening access to prevention and care of respiratory illnesses in and beyond UK.

2 Malaria vaccines

Rising temperatures and increasing rainfall extend habitable conditions for mosquitoes as vectors of malaria and numerous other diseases; mosquitoes are more active in warmer wetter environments, incubating and spreading viruses more effectively (Karypidou et al., 2020). Female mosquitoes carry the malaria virus, transmitting it to humans when feeding on blood. Currently, almost all malaria cases occur in sub-Saharan Africa, 80% in children under five (WHO, 2023b). A projected 50% increase in global incidence by 2050 indicates the climate-driven spread of endemic malaria into southern European, including Romania, Bulgaria, and North Macedonia (Fischer et al., 2020). With weaker healthcare systems and economies than their neighbours (Watson, 2019), these countries can ill afford the devastating socioeconomic impacts seen in sub-Saharan Africa, such as temporary cognitive impairment in children surviving malaria (Milner et al., 2020), in addition to 40% of public health budgets allocated to malaria response and 70% lower per capita income than non-endemic countries due to lost productivity, impacting community well-being and national quality of life indicators (WHO, 2023c). Fortunately, this trajectory may be slowed by the emerging vital mobility discussed next.

There are diverse ways to control malaria, from using bed nets to removing stagnant water. Until recently, medications were geared towards treating the disease with anti-malarials, such as Atovaquone-proguanil (Malarone). However, the malaria landscape is shifting with emerging biomedical interventions focused on preventing malaria, including genetically modified mosquitoes, mosquito birth controls, and – for humans – malaria vaccines (Batha, 2019; Waltz, 2021). Genetic modifications and birth control are contentious, illustrating the subjectivity entailed in some vital mobilities and raising important questions about mosquito mobilities as both disease carriers and pollinators that prefer pollen to blood (Mizejewski, 2022).

The focus of this vital mobility is on the first malaria vaccine, RTS,S/AS01 or Mosquirix. The vaccine was developed as a non-profit initiative with funding from the Gates Foundation, the PATH Malaria Vaccine Initiative, and GlaxoSmithKline. It constitutes a vital mobility by facilitating the circulation of malaria antibodies in humans. It was approved for use in 2021, with 1.5 million children in Ghana, Kenya, and Malawi receiving at least one of four doses by April 2023 via established local vaccination networks (WHO, 2023c). The vaccine is moderately effective, reducing hospital admissions due to severe malaria by 30% (WHO, 2023c). The development and distribution of the vaccine are an expression of care for infants and children in and beyond sub-Saharan Africa who are harmed by malaria to a disproportionate and devastating degree.

Circulations include those that contribute to disease spread, like diverse mosquito species, multiple malaria viruses, and human blood, as well as counter-circulations such as the social-material networks entailed in vaccine development, testing, and distribution, and movement of antibodies within recipients (Roxby, 2021). The development of malaria vaccines prompts the question of how vaccine circulation, in terms of efficacy and volume, can be hastened. The development of an effective vaccine was a slow, coagulated process challenged by the fact that malaria is comprised of ‘thousands of genes compared to around a dozen in coronavirus, and a very high immune response is needed to fight off the disease’ (Roxby, 2021: n. p.). There is the need for extensive testing and regulatory approvals that for Mosquirix stretch back at least 20 years, raising questions about how such processes can be accelerated and prioritised, ethically, technically, and politically.

Adaptation includes increasing vaccine production in countries with endemic malaria, as well as in countries where malaria is (re)emerging as the geographic range of mosquitoes grows due to warmer and wetter conditions (Karypidou et al., 2020). Further, Bartlow et al. (2019) highlight efforts to model and forecast complex vector-borne and zoonotic disease circulations, particularly as climate change accelerates and obfuscates the changes that they aim to track. Academics and public health professionals struggle to stay ahead of, or even keep pace with, changing conditions coagulating responses to rapidly emerging malaria outbreaks, nonetheless new diseases. Humans are in a race to enact adaptations faster than mosquitoes adjust to changing conditions and new habitats, spreading malaria further.

3 Discussion

Asthma inhalers and malaria vaccines are both medical innovations developed, in part, due to climate change impacts related respectively to air quality and mosquitoes as disease vectors. Inhalers relieve asthma symptoms, while the current Mosquirix vaccine mitigates the impacts of the malaria virus. In terms of care, concern for the climate and reaching net zero within the NHS by 2040 while maintaining patient healthcare is a central factor motivating prioritisation of DPI inhalers over MDIs, while care for children’s survival and development, and concerns about broader pressure on healthcare resources and regional economies motivates malaria vaccine development.

In both cases, DPIs and Mosquirix are extensions of existing technologies, namely, using inhalers and vaccines as means of circulation. Both use existing distribution pathways, via the UK’s health service and sub-Saharan vaccination networks. This is not to detract from the import of these biomedical innovations, but to observe how these vital mobilities are rooted in and rely on existing physical and social infrastructures. It is interesting to note that GlaxoSmithKline is central to both cases, pioneering the development of low-polluting MDI inhalers and the Mosquirix vaccine. This was not a determining factor in the selection of the cases but does raise questions about how climate change is shaping the research agendas of pharmaceutical companies and how those companies both drive, and are increasingly driven by, ecological impacts.

Disruptions to production and distribution channels by severe weather risk coagulating the circulation of both inhalers and vaccines. Such disruptions can occur at multiple scales, from far-removed overseas production facilities to the last mile on local roads to the point of care, highlighting unexpected, pervasive, and reciprocal relationships that link healthcare, climate change, and mobilities (see Sodero, 2018 for donated blood examples). Adaptations can include enacting policies that promote localising and decarbonising production; building on cultural knowledge and practices to develop transport strategies attuned to changing environmental conditions (embrace green and blue); and ensuring back-up plans are available in terms of transport modes, product, and skills (rebrand redundancy) (Sodero, 2022; Ingham et al., 2019).

Finally, weaving through both asthma inhalers and malaria vaccines is the significant role of the more-than-human in co-constructing human health. Particulate matter, imperceptible to human eyes, can induce an asthma attack, while a mosquito bite can kill a human. Such social-ecological power dynamics beg climate action. This brief foray demonstrates the potential for vital mobilities as method to prompt critical engagement in the multi-scalar, material, and more-than-human dynamics entailed in healthcare delivery.

IV Researching vital mobilities

Next, we develop an agenda for vital mobilities research. Five interrelated avenues emerge: surfacing vital circulations, documenting coagulations, sharing adaptations, envisioning futures, and conceptualising beyond vital mobilities. Guided by an ethic of vitality, lifelieness, and care, we deepen understanding of the relationship between bodies and the broader environment.

1 Surfacing vital mobilities

Vital mobilities, from circulations of paracetamol to pacemakers, are often opaque. To understand and act on the ways in which vital mobilities are susceptible to disruption, including climate impacts, researchers, healthcare professionals, decision-makers, and to some extent community members, carers, and patients, need to understand where goods and services originate and how they get to points of care. However, describing, nonetheless analysing, such mobilities is challenging given a wide range of factors, including geographic diffusion, a dearth of documentation, lack of transparency, government deregulation, proprietary rights, and patient privacy. A whole range of mobile methods from go-alongs and sensory ethnographies, to photos and log books, can be leveraged in creative ways with a range of actors, from producers to patients, from carbon emissions to non-human species, to piece together not only the logistics, but care as well as ‘power dynamics, vulnerabilities, and contestations’, entailed in such vital journeys (Andrews, 2020; Büscher et al., 2020; Chua et al., 2018: 617). For example, the role of GlaxoSmithKlein prompts questions about how climate change intersects with the priorities of established, emerging, and localised pharmaceutical producers in high- and low-income contexts.

2 Documenting coagulations

From global shocks such as Russia’s war in Ukraine, to national policy changes such as Brexit, to local road washouts, movements of medical goods and health professionals are subject to acute and chronic disruptions. There is a growing literature on pharmaceutical shortages (Barbosa-Povoa et al., 2019). This is such a persistent issue that the European Medicines Agency (2023), for example, maintains a national register of shortages. In the humanitarian sector, there is a ‘perpetual shortage’ of certain goods like ready-to-use therapeutic foods, such as Plumpy’nut, an energetic paste used in cases of severe malnutrition (Bamborough, 2022: n. p.). For both regional and international researcher and practitioner communities, there is value in leveraging existing databases (e.g. World Food Programme and European Medicines Agency) to analyse trends within vital mobilities. Such databases can assist in documenting, analysing, preventing, and addressing coagulations, while also being attuned to the social-ecological possibilities of intentional, local, and slow (er) mobilities counter to just-in-time capitalist logics. Ideally, such databases will identify causes of coagulation including impacts of extreme weather. Beyond databases, researching the lived experiences of labourers, patients, health professionals, and others grappling with shortages and disruptions will provide a fuller account of coagulation within and between nodes, ideally contributing to newer, more caring adaptations (Andrews et al., 2021; Connell and Walton-Roberts, 2016).

3 Sharing adaptations

Just as communicating disruptions within and between organisations is useful, so too is sharing adaptations. These may be reactive patchwork fixes (De Coss-Corzo, 2021) and scrambles (Savitzky, 2018) that occur at bodily, infrastructural, operational, organisational, and/or ecosystem scales. For example, patients, carers, and health professionals may employ a range of adaptive approaches. Informally and undesirably, this may look like patients skipping or sharing medication doses to make supplies last longer, while formally this may mean changing treatment protocols (e.g. using Gatorade rather than saline for hydration). Disability scholarship (e.g. Hall and Wilton, 2017; Park et al., 1998), including patient movements (Williamson, 2008) and activist affordances (Dokumaci, 2023), is valuable in thinking through adaptations to climate-related disruption, given that people with disabilities are often expert in navigating infrastructures and systems not designed with their needs in mind, and who are at the forefront of experiencing embodied climate impacts (Inclusion Scotland, 2021). However, it is important to note that care and the multiple pathways through which it is expressed, informal and formal, is simultaneously an invaluable and undervalued resource that, akin to compassion fatigue (Figley, 2002), may diminish due to overstretching of care providers and underfunding of care systems. Adaptations can also entail proactive paradigm shifts such as adaptive mobilities that centre cultural practice, government policy, and community survival (Ingham et al., 2019), from preventative healthcare to climate routing (Sodero, 2022), as well as innovations and transformations (e.g. Birtchnell and Urry, 2013 on 3-D printing; Hildebrand and Sodero, 2021 on drones). Further, there is a digital dynamic from ‘call centre nursing’ (Thompson, 2019: 38) to the use of WeChat by health professionals (Tso, 2022) that extends the possibilities for embodied and material adaptations.

The concept of localisation has traction in the humanitarian sector in response to limitations of global, just-in-time supply chains. Improving response quality, addressing shortages, and increasing local investment are central to localisation agendas (IFRC, 2023). In healthcare, the concept is not as central. One example, however, was that prolonged saline IV shortages following Hurricane Maria, which hit Puerto Rico in 2017, prompted a consortium of New England hospitals to explore possibilities for local production. While there is a logic to localisation, it too comes with challenges. For some, quality assurance is a concern when comparing known international suppliers with new local suppliers, as is a lack of capacity in national regulatory authorities in low- and middle-income contexts (Bamborough, 2022). From a climate perspective, the life-cycle environmental impacts of centralised versus decentralised production, including production and transport emissions, need to be calculated on a product-by-product basis. In some short-term calculations, healthcare and climate considerations may appear in tension.

4 Envisioning futures

Efforts to green healthcare, such as decarbonising the UK National Health Service to net zero by 2040 (Kmietowicz, 2021) and privileging an ethic of inclusivity in community care (Gleeson and Kearns, 2001) are central to vital mobilities, and conversely vital mobilities are central to efforts to green healthcare; they are mutually reinforcing projects. From greening healthcare, as exemplified by a shift towards lower-polluting asthma inhalers in the UK (NHS, 2020), to addressing inequities in terms of communities most vulnerable to endemic and emerging malaria, it is possible to envision and enact a range of interventions that centre care for communities and the climate. Making connections between climate change, medical supply chains, and patient outcomes, as well as between climate change and transmission of disease from animals to humans, such as in a One Health approach, may prompt climate action where previously lacking (CDC, 2023). Methods to research and build scenarios that integrate zero emission and net negative emission vital mobilities, and healthcare more generally, guided by an ethic of care are needed (e.g. Büscher, 2020 on social futures; Levitas, 2013 on utopia as method).

5 Conceptualising beyond vital mobilities

Applying the vital mobilities method to circulations of asthma and malaria highlights the need for broader discussion about adjacent mobilities. There are multiple phenomena which would benefit from greater attention in mobilities scholarship, such as emergence of new/old viruses due to polar ice melting (Lemieux et al., 2022); health needs specific to vulnerable mobile populations, such as asylum seekers (Follis et al., 2020); and how donated blood shifts from vital to dangerous if circulating vector-borne disease (Sodero and Rackham, 2020). Further, how do we account for or describe mobilities which are detrimental to human health but integral to ecologies, such as movements of mosquitoes, ticks, and sandflies which transport and transmit Dengue Fever, West Nile virus, and Zika virus? And, for example, in the case of malaria, subsequent management of mobilities via genetic modification and birth control in mosquitoes, as both disease carriers and pollinators (Mizejewski, 2022).

V Looking forward

Climate impacts, like poor air quality and vector-borne disease, shape vital mobilities by increasing demand for healthcare, in the form of inhalers and malarial vaccines. At the same time, climate change through severe weather impedes vital mobilities highlighting failures and fixities restricting response and resulting in coagulations. Further, vital mobilities contribute to climate change, driving the need for innovations such as producing less-polluting inhalers, localising anti-malarial production, and producing and transporting medical goods using zero-carbon, or even net negative, technologies.

Our goal in writing this article was to introduce vital mobilities – that is external societal circulations that enable critical internal bodily circulations – by developing a theory and method that allows researchers, practitioners, and community members to describe and analyse specific, grounded medical mobilities and use this as a springboard for critical engagement and action. From movements of asthma inhalers to malaria vaccines, we connect bodies and the broader environment contributing to health geography, nature-society geography, and mobilities scholarship, identifying research avenues with a goal of mitigating healthcare disruption, decarbonising health services, and supporting well-being.

Geography offers a uniquely integrative disciplinary atmosphere for bringing healthcare, climate change, and mobilities into conversation to conceptualise vital mobilities, as theory and method. Transcending disciplinary silos and integrating seemingly disparate topics allows for an agile and timely intervention in fast emerging social-ecological dynamics. Building on the approaches of others, such as Adey (2016) on emergency mobility, Bennett on vital materiality (2010), and Kearns and Moon (2002) on health geography, vital mobilities creates a structured but flexible approach for geographers working and collaborating at the pervasive, reciprocal, and often unexpected intersections of health, climate change, and mobilities.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Stephanie Sodero

Author biographies

Stephanie Sodero is a Lecturer in Climate Change and Health at the Humanitarian and Conflict Response Institute (University of Manchester) and author of Under the Weather: Reimagining Mobility in the Climate Crisis (McGill-Queen’s University Press, 2022).

Chris Sinclair is a British-German international humanitarian affairs researcher. After ten years in the private sector focussed on international affairs and security, he recently completed an MSc in International Disaster Management at the University of Manchester and now focusses on disaster risk reduction, with a particular interest in the impact of climate change and its overlap with human security and health.

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