From Planet to Patients - Health Under Threat

Andy Haines Medact re-launch conference

Country progress in reducing under-five mortality (MDG4)

On Track Insufficient progress

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African CountriesEritreaEthiopiaLiberiaMalawiTanzania

Countdown to 2015, report June 2012, Figure 3, progress updated for 2012 estimates

28 are African countries

49% in

Africa

All are African countries

Growth in Urban SlumsA total 227 million people in the world have moved out of slum conditions since 2000 but the absolute number of slum dwellers has increased from 777 million in 2000 to 828 million in 2010

Income Poverty1981 1990 2010

$1.25 / day 1.91 billion (43.1%)

1.22 billion (20.6%)

$2 / day 2.59 billion 2.40 billion

Illicit Financial Flows (IFFs) versus ODA, 2000-09 (in billions of current US$)

“ …. in many cases, there is a net financial outflow from poorer to richer countries – an alarming state of affairs” (p 38)

“Structural inequities in the global institutional architecture maintain unfairness in trade-related processes and outcomes” (p 132)

Commission on the Social Determinants of Health

Economic Governance Matters

Inequality (Gini coefficient)

Global Wealth Inequality = 89 (official exchange rates)

• Higher than wealth inequality in any individual country

• Top 5% individuals take 71% of global wealth%• Bottom half, take 1%• The middle 60% take 6%

Inequalities on the Rise

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Where are the world's bil-lionaires

http://royal.pingdom.com/2011/03/11/world-billionaire-stats-charts/

1,426 individuals have more wealth ($5.4 trillion) than the total 2010 GDP of South America ($3.5 trillion, pop. 392 million) and Africa ($1.6 trillion, pop. 1 billion)CIA World Factbook 2000-2010

8.5 million people (1/14th of 1%) own 84% of total global personal (private) financial wealth.

Henry, Price of Offshore Revisited

Public debt in advanced economies average %GDP

Post war reconstruction

SAPs

Banking bailouts

Source: IMF World Economic Outlook 2012, p. 101

Costs of the Financial Crisis (2008-10)• Direct public subsidy to banks: over USD 100 billion annually by the US/UK

governments– Total bank bailouts: USD 9 trillion*– Total stimulus: USD 2.4 trillion**– Total IMF emergency loans: USD 1.0 trillion

[total global ODA = USD 0.1 trillion]

• Recessionary effects and lost global economic income: around USD 4 trillion annually, expected to persist for many years, and likely ranging between USD 60 and 200 trillion

* This figure excludes large bailouts in Spain, Ireland, Greece and other non-G20 countries but some of this may be recovered as banks become profitable, if the bailout is in the form of (generally non-voting) shares** 25% spent on social welfare

Sources: Andrew Haldane, Executive Director, Financial Stability, Bank of England: The $100 Billion Question. Institute of Regulation and Risk, Hong Kong, 30 March 2010; UNICEF, A Recovery for All? 2012.

Health and Social Consequences of the Crisis

• In Europe and US states increase in suicides • In Greece, suicides have risen by more than 60% since

2007. • Labour market policies can reduce effects

• 28,000-50,000 excess infant deaths in sub-Saharan Africa in 2009

• Increase in out of pocket spending on health, ‘medical poverty’

(Sources: Stuckler, McKee, Basu et al. Lancet; Friedman and Schady. Health Economics)

Those who support fiscal tightening argue that it is indispensable for restoring the confidence of financial markets, which is perceived as key to economic recovery. This is despite the almost universal recognition that the crisis was the result of financial market failure in the first place… (p.V)

Total net Official Development Assistance (ODA) received worldwide in 2010 was $130.5 billion, compared to world military spending of $1629

billion.

How will breaching planetary boundaries affect human health ?

(Rockstrom et al Nature 2009)

• Non –linear effects • Synergies • Drivers –

consumption, population, urbanisation etc

• Putting health in an ecosystem framework

• Recent estimates suggest 40 % chance of 4º C rise in Temperature by 2100 with Business as Usual (IEA 2012, WB 2013)

An adaptability limit to climate change due to heat stress

Steven C. Sherwood and Matthew Huber PNAS 2010

Exceeding peak heat stress for extended periods should induce hyperthermia in humans

‘....It would begin to occur with global-mean warming of about on 7 °C, calling the habitability of some regions into question’

D.S.Battisti and R.L. Naylor . Science 2009

2010 – a harbinger of things to come? Pakistan floods ~ 20 m affected Chinese floods ~ 12m displaced

Russian drought and fires –wheat harvest down ~ 30% 56,000 extra deaths in Moscow and Western Russia

Record temperatures in 17 countries.

The Global Water Crisis

Water scarcity is growing - by 2025 more than half of the world’s population is projected to live under conditions of severe water stress

276 major transboundary watersheds cross the territories of 145 countries

70% of all freshwater is used for irrigation 50-60% of wetlands have been lost

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Percentage change in yields to 2050

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UN Devt Prog, 2009

Plus climate-related:• Flood/storm/fire damage• Droughts – range, severity• Pests (climate-sensitive)• Infectious diseases (ditto)

CLIMATE CHANGE: Poor Countries Projected to Fare Worst MODELLED CHANGES IN CEREAL GRAIN YIELDS, TO 2050

GDP without mitigation

GDP with stringent mitigation

2030

GDP

TimeCurrent

Mitigation would postpone GDP growth by one year at most over the medium term

Cost of mitigation in 2030: max 3% of global GDP

Impacts of mitigation on GDP growth(for stabilisation scenario of 445-535 ppm CO2-eq) ( Stern review)

Schematic graph

Health co-benefits from the ‘low-carbon’ economy

Through policies in several sectors e.g.• Housing• Transport• Food and agriculture• Electricity generation

Barriers to policy change

• Vested interests• Organised denialism• Political short-termism• Divided public opinion• Perception that change is

expensive and difficult

Climate Consequences of Regional Nuclear War

• Nuclear explosions ignite fires that burn whole cities• Soot lofted high into the atmosphere absorbs

incoming sunlight• Dramatic decrease in amount of light reaching the

surface• Large, rapid drops in surface temperature

International Physicians for the Prevention of Nuclear War

Graph courtesy of Alan Robock

Global climate change unprecedented in recorded human history

Nuclear War: The Impact on Agriculture

Decline in available food

Increases in food prices

Food inaccessible to hundreds of millions of the world’s poorest

World grain stores only sufficient for 68-80 days

215 million people added to rolls of malnourished

International Physicians for the Prevention of Nuclear War

Conference on the Humanitarian Impact of Nuclear Weapons convened by Norway last March attended by 128 States, the ICRC, a number of UN humanitarian organisations and civil society,

UNGA 68: Joint Statement on the Humanitarian Consequences of Nuclear Weapons 21.10. 2013

Why is needed.

• Addressing the interlinked crises- global environment, weapons of mass destruction, socioeconomic and governance.

• Rebutting attacks on science by special interests

• Putting health at the heart of development