Editor’s Note: After “War and Peace?”, we are happy to publish the second excerpt from Dr. George Lueddeke’s highly commended and timely book, Survival: One Health, One Planet, One Future (pub. 2019/2020). This comes from Chapter 2, “Climate change: focus on Africa, Asia and the coastal poor.”
Previous books by the author include Transforming Medical Education for the 21st Century: Megatrends, Priorities and Change (translated into Chinese) and Global Population Health and Well-Being in the 21st Century: Toward New Paradigms, Policy and Practice.
Chapter 2, “Climate change: focus on Africa, Asia and the coastal poor”, from Survival: One Health, One Planet, One Future, partly reproduced below, focuses on how the people and wildlife from these highly populated regions are likely to face the greatest consequences of climate change and biodiversity loss including infectious diseases and AMR (antimicrobial resistance) and scarcity in terms of food, water and livable land.
This chapter, in a sense, serves as a backdrop to the discussions at the forthcoming G-20 Summit in Rome on 30/31 October and the UN Climate Change Conference in Glasgow (COP26) on 31 October-12 November 2021 – neither of which will be easy. The outcomes are far from certain as China has already voiced conditions to the US although both nations are responsible for more than 40 percent of the world’s total annual output of CO2 of about 43 billion tons, much of which remains in the atmosphere for thousands of years.
With growing global risks, the sustainability of our planet and species continues to hang in the balance – especially with ‘power increasingly concentrated in the hands of so few, and powerlessness in the hands of so many.’
Climate Change: Focus on Africa, Asia and the Coastal Poor
Impact of climate change on coastal regions
The World Bank projects that the most severe socioeconomic impacts are likely to be caused by climate conditions – particularly affecting those living in coastal regions – whose inhabitants ‘face a world where climate change will increasingly threaten the food supplies of sub-Saharan Africa and the farm fields and water resources of South Asia and South East
Asia within the next three decades, while extreme weather puts their homes and lives at risk. Along with threatening the yield of crops (cereal and non-cereal), in East Africa, there is already the risk of a decrease in per capita water availability to the point of reaching scarcity levels.
In addition, the World Bank report observes that ‘many of their poorest residents are being pushed to the edges of livable land and into the most dangerous zones for climate change. Their informal settlements cling to riverbanks and cluster in low-lying areas with poor drainage, few public services, and no protection from storm surges, sea-level rise, and flooding.
The UN 2030 Sustainable Development Goals and the New Urban Agenda
Across many regions, time is running out for rural and municipal planners. For, although ‘The global proportion of urban populations living in slums has fallen from 46 percent in 1990 to 30 percent in 2014,’ the UN Development Statistics and Information Branch reports that ‘Simultaneously the urban populations have grown, leading to a situation where the absolute numbers living in slums have increased from 689 million in 1990 to 881 million in 2014.’
Continuing disparities between the rich and poor, escalating and limited land-use, energy shortages, and environmental protection, infrastructure needs alongside ‘bureaucratic inertia,’ and corruption continue to take their toll.
In many urban regions, as shown in Figure 2.1, a ‘dystopian urban vision’ is being created – especially in Asian and sub-Saharan African nations that are far removed from aspirations outlined in the UN-2030 Sustainable Development Goals (SDGs).
The extraordinary population growth – mostly in Africa and Asia- with urban populations ‘accounting for 66 percent of the global population by 2050’ versus 28% in 1950, adding ‘2.5 billion urban dwellers …the equivalent of roughly 192,000 people moving into cities across the world every single day for the next 35 years’ is unprecedented.
Achieving SDG 11: Making cities inclusive, safe, resilient and sustainable and its seven targets remains a major challenge worldwide – especially the most fundamental Target 11.1, to ‘ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums.’
It is estimated that almost a billion people (880 million – about 1 in 4) currently live in substandard housing. In practical terms achieving the targets set for Global Goal 11 means that ‘one billion new houses will be needed by 2025 to accommodate 50 million new urban dwellers annually.’
The prospect of meeting SDG 11 targets looks bleak in contrast to the optimism shown in the more idealistic 1970s.
Reflecting on the UN-Habitat beginning years and ‘the first Habitat conference in Vancouver in the more idealistic years,’ Dr. Roger Williamson, an Institute for Development Studies Visiting Fellow with Cities Cluster, commended the inclusiveness of UN-Habitat which ‘was open to NGOs, academics and other stakeholders, not just national governments’ with meetings ‘held every two years,’ ‘providing a vibrant and untidy marketplace of ideas with many levels of involvement and networking opportunities. The original ‘headquarters were located in Nairobi – in line with desire of the South to be better represented globally’ but shifted to New York and Geneva with ‘UN-Habitat languishing near the bottom when indicators such as staff morale are reported.’ Lack of funding has been a key issue, ‘with multilateral organisations’ placing ‘UN-Habitat in its lowest category for aid impact.’
Implementation of the New Urban Agenda, the main outcome of the Habitat III Conference in Quito, Ecuador, in 2016, attended by representatives of around 140 national governments, including at least 11 presidents, in addition to the then UN Secretary-General Ban Ki-moon, has been slow. Despite the global importance ascribed to the conference, it has not attracted a high profile in subsequent years. Moreover, ‘the organisation has had trouble retaining support and significant funding from the OECD countries.’
The report of the UN High-Level Panel highlighted ‘the gap between huge urban challenges and the perception (not just from governments) of the underperformance of UN-Habitat’ but unsuccessfully called for the establishment of ‘UN-Urban, analogous to UN-Energy and UN-Water, to coordinate all UN urban activities.’ Dr. Williamson contends that the way forward requires better ‘coordination, coherence and distilling the New Urban Agenda,’ which also hold the key for meeting the UN 2030 Global Goals.’
It is clear that worldwide ‘Over the last 20 years, despite increasing demand, housing policies have not been prioritized in national and international development agendas… As a result, adequate housing is widely unaffordable for a relevant part of the world population.’ It is also apparent that, as acknowledged by former UN Deputy Secretary-General Amina Mohammed in her opening remarks at a high-level UN conference in 2017, that ‘the UN is not delivering sufficiently in cities’ and that ‘While cities are hubs of promise, jobs, technology, and economic development, they are also the epicentre of greenhouse gas emissions and many of the challenges of sustainability.’
Dr. Joan Clos, former Executive Director of UN-Habitat and Secretary-General of Habitat III, conveyed at World Habitat Day in 2016, reminded us about the centrality of urban life in the 21st century, stating that “our cities and homes define who we are, in many ways. They determine whether we will have access to education and job opportunities. They define our ability to lead a healthy life and the level of our engagement in the collective life of the community… it means ‘much more than having four walls and a roof.”
Cities and homes are also, according to former UN Deputy Secretary-General Amina Mohammed, the places ‘where the battle for sustainability29 will be won or lost.’ It is, therefore, difficult to understand why, as Dr. Williamson comments, ‘multilateral organisations’ have placed ‘UN-Habitat in its lowest category for aid impact.’
Rise of non-communicable diseases and global studies on infectious diseases
Crowded and often unsanitary living conditions alongside poor lifestyle choices account to a large extent for the steep rise of non-communicable diseases (NCD) – now close to 70 percent of all global deaths. In 2015 ‘the leading causes of NCD deaths were cardiovascular diseases (17.7 million deaths, or 45% of all NCD deaths), cancers (8.8 million, or 22% of all NCD deaths), and respiratory diseases, including asthma and chronic obstructive pulmonary disease (3.9 million). Diabetes caused another 1.6 million deaths.’
Advances in medicine, diet and sanitation in the last one hundred years are continuing to make a difference in life expectancy – with improved sanitary conditions likely to be one of the leading contributors – the health and well-being of urban populations remains one of the biggest challenges facing cities and their sustainability. While life expectancy has increased, there are signs that decreases are occurring in the US and the UK, possibly linked to poor lifestyle choices (e.g., alcoholism, drug abuse [e.g., opioids]) and an aging population (e.g., dementia).
In addition, many infectious or communicable diseases are also re-emerging in the more developed nations.  Causes vary but are generally attributable to population mobility, air pollution, unhealthy lifestyles, pandemic infections, and globalisation of trade.
Table 2.1 below compares selected deaths and expenditures of communicable and non-communicable diseases -October 2013 and October 2017. The Worldodometer statistics show year to year increases for most health indicators, despite increased spending of over US$7.5 trillion per annum worldwide in 2017 – about US$4.1 billion daily. Of this amount over US$4.5 trillion were spent by the US alone but only about 3% were earmarked for preventive measures in the US and worldwide.
Table 2.1: Comparison of selected health indicators (deaths and expenditures), October 2013 and 2017
While, as mentioned, ‘non-communicable diseases are the leading cause of morbidity and mortality in most developed nations,’ communicable or infectious diseases remain ‘a major public health concern around the world.’ Both the Ebola outbreak in West Africa and the Zika virus in Brazil ‘dramatically raised awareness of the global burden of infectious disease and raised questions about the preparedness of public health systems.’ SOURCE: Worldodometer statistics (2013and 2017)
The study, ‘Global Rise in Human Infectious Disease Outbreaks,’ analysed ‘global changes in the frequency of outbreaks of infectious disease between 1980 and 2013,’ covering ‘12,102 outbreaks of 215 diseases, with 44 million individual cases in 219 countries around the world. Key research findings, among others, summarised in Box 2-1:
The urgency of tackling the basic health infrastructure in existing and emerging cities alongside the shortage of health professionals is made clear by the increasing threat posed by antimicrobial resistance (AMR) to infections – caused mainly by worldwide overuse and misuse of antibiotics or antimicrobials. Exacerbated by the ease of intercontinental travel today, densely populated cities may be most at risk as resistance to first-line drugs to treat infections, such as MRSA (methicillin-resistant Staphylococcus aureus), and tuberculosis (TB) malaria HIV influenza, to name others, are on the rise. Antimicrobial resistance (AMR): Compromising the future of humankind?
It is estimated that AMR kills about 700,000 people annually with predictions that ‘the number of deaths per year would balloon to 10 million by 2050,’ costing ‘the world up to 100 trillion USD.’ In terms of comparison, ‘that is more than the 8.2 million per year who currently die of cancer and 1.5 million who die of diabetes, combined. ’
Most AMR deaths ‘would fall unevenly across the world, with the global south and Asia suffering to a greater extent and losing greater amounts of income.’ In Africa, it is estimated that 25 percent of all deaths in Nigeria could be caused by AMR resistance if trends continue unchecked.
Following the resolution reached during the sixty-eighth World Health Assembly in May 2015, for Member States to implement a Global Action Plan on AMR, the WHO in collaboration with the Food and Agriculture Organisation of the United Nations (FAO), and World Organisation for Animal Health (OIE) released a manual to assist countries to develop or strengthen existing National Action Plans (NAP). Some countries that did not have NAP on AMR like Tanzania have developed and launched their own NAP.
For the success of antimicrobial stewardship programs, which is among the priority actions in the NAP on AMR, country context including involvement of governance structures at subnational levels taking into account their strengths, existing opportunities for improvement, at taking actions to address weak areas is essential. The WHO Regional Office for Africa can improve on the current situation of AMR in the region through the establishment of regular reporting, monitoring and evaluation by countries in the region.
Thinking globally, Jim O’Neill, former Golden Sachs chief economist, was asked to spearhead a mission in 2014 to tackle antimicrobial resistance. Co-sponsored by the UK’s Wellcome Trust and the Department of Health, the independent international review – that drew on eight AMR thematic papers – culminated in a final report with a 10-point action plan (see Box 2-2)
As the O’Neill et al. study concludes, accountability for reducing ‘the demand for antimicrobials and in particular antibiotics’ lies with Governments along with the main sectors that drive antibiotic consumption: healthcare systems, the pharmaceutical industry and the farming and food production industry.’ On the other hand, with antimicrobial resistance on the rise and estimates showing that 700,000 to several million deaths result per year, we must all take responsibility for using antibiotics wisely to combat rising drug resistance. Failure to do so is potentially a threat to everyone’s health – humans and animals – and could ultimately lead to societal collapse…. There can be no doubt that to avoid a return to the ‘dark ages in medicine,’ with ‘more people dying of resistant infections than cancer,’ ‘Fundamental change is required in the way that antibiotics are consumed and prescribed, to preserve the usefulness of existing products for longer and to reduce the urgency of discovering new ones.’
Addendum: Fast Forward to 2021: The G-20 Rome Summit (30/31 October 2021) and beyond
Coupled with a life-changing global pandemic, we are also facing another common foe: climate change – causing extensive damage (almost irreversible?) to the air, land, sea- all of our own making – highlighted most recently in the UN Intergovernmental Panel on Climate Change report (IPCC).
Without question, we are responsible for the degradation of nature’s life support systems. It is clear that only a universal plan of action (One Health-SDGs) is able to address the root causes that have brought us to the global cliff edge we have today and the urgency to transcend the “ism’s”that divide us – including post-truth politics.
Our greatest challenges are twofold: how we relate to the planet and how we relate to each other – especially the need to protect ‘the vulnerable people around the world.’ To begin with, a reformed UN Security Council (UNSC) – reflecting the demographic changes in the past 70 plus years with Africa, India, SE Asia numbering over 4 billion people out of c. 7.8 – might consider how best to reconcile the social-economic-political “ism’s” that divide us. Their deliberations might include the historical, devastating impact of traditional extreme ‘Left-Right’ (‘win-lose’) combative views and post-truth politics that are increasingly on the rise this decade. Taken collectively, these continue to undermine the rule of law and democratic values and principles resulting in millions of innocent lives lost over past centuries, decades and to this day. As Lao Tzu, an ancient Chinese philosopher in the 6th century BCE is reported to have said, ‘A journey of a thousand miles begins with a single step.’ Given existential global risks, now is the time to begin this journey!
Worldwide -officially – there are over 5 million Covid-19 deaths to date and about 230 million cases with millions more who suffer long-term consequences. However, The Economist reports that ‘In many parts of the world, official death tolls undercount the total number of fatalities’ with deviations ranging from 54% in Russia to 62% in Nicaragua to as high as 71% in Egypt.
The pandemic has been a painful and compelling realisation that the biosphere is now in charge of our destiny – not humankind’s political credos nor vainglorious ambitions. Few in power seem to ascribe to the idea that ‘being more’ is better than ‘having more’ as eloquently phrased in the verse below. Financial losses are estimated at a staggering US$16 trillion already with estimates that the poorest countries will be ‘ $12tn worse off by 2025 due to Covid.’
Well-known naturalist and broadcaster, Sir David Attenborough, wisely observed:
‘No species has ever had such wholesale control over everything on earth, living or dead, as we now have. In our hands now lies not only our own future, but that of all other creatures with whom we share our planet.’
His latest book, A Life on Our Planet: My Witness Statement and a Vision for the Future, reinforces his *wake-up* call and raises the existential question: “Will any human aspirations or perceived anthropogenic differences matter on a dystopic or potentially ‘dead’ planet by 2100?”
The ball is now unquestionably in humanity’s court. As former UN Secretary-General Ban-Ki-moon cautioned at the COP22 Climate Conference in Marrakech on November 15, 2016 – ‘There is no Plan B’.
Now five years later with the climate crisis deteriorating, COP26, which ‘many believe to be the world’s best last chance to get runaway climate change under control’ is scheduled for 1-12 November 2021 in Glasgow, Scotland.
Will it result in success or failure? If the latter, WHY? And – then what? ‘There is (still) no Plan B,’ and time may indeed be running out for us all as Professor Carl Sagan (1934-1996) reminded us in his book, Pale Blue Dot, published over twenty-five years ago!
‘Our planet is a lonely speck in the great enveloping cosmic dark.
In our obscurity, in all this vastness,
there is no hint that help will come from elsewhere
to save us from ourselves.’
Editor’s Note: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com. — Featured Photo: Image by Pete Linforth – Pixabay