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Contact: Mary Tobin,
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STATEMENT OF
THE
STATE OF THE
PLANET 2004: MOBILIZING THE SCIENCES TO FIGHT GLOBAL POVERTY
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Contents
- Science to Build
a Prosperous and Sustainable Future for All
- Over-Arching
Recommendations
- Energy Section
- Energy Recommendations
- Food Section
- Food Recommendations
- Water Section
- Water Recommendations
- Health Section
- Health Recommendations
Science to Build a Prosperous and Sustainable
Future for All
For two days, scientists from around
the world gathered at Columbia University to examine the
relationship between the human condition and the condition
of the Earth. Focusing on four essential determinants of
human well-being – energy,
food, health and water – these leading experts assessed
how science and technology can best be mobilized to achieve
sustainable development. The development challenge is to
enable the poor to meet their basic needs for energy, food,
health, and water, recognizing that these needs are also
human rights under international law and long-standing international
commitments of both the rich and poor nations. The Millennium
Development Goals, agreed on by all of the world’s
governments, are critically important poverty reduction targets
to be met by the year 2015. The sustainability challenge
is to achieve development while protecting the world’s
ecosystems, ensuring that economic activity does not undermine
the biodiversity, climate, and other natural processes on
which our security, well-being, and life itself depend. These
scientists have identified areas for priority action as well
as new research initiatives.
The recommendations that follow are based on consensus achieved
among a broad cross-section of these experts, and are meant
to help policy makers and the public understand the scientific
underpinnings in several critical areas of sustainable development.
In addressing these issues, the conference participants recognized
the stark contrasts of the challenges facing the rich and
poor. In the poorest countries, where an estimated 800 million
people are chronically hungry and where extreme poverty leads
to some 20,000 avoidable deaths per day, meeting basic human
needs has first priority. Providing safe energy for cooking,
clean water for drinking and sanitation, sufficient food
for basic nourishment, and systems for disease control and
prevention are paramount and urgent global challenges, in
which the high-income countries will need to help the poorest.
Environmental degradation in these places is often both a
direct cause and consequence of the struggle to meet basic
needs on a daily basis, as when poor rural households cut
down forests to clear land for farming or to harvest fuel
wood for cooking. Women typically face the greatest burdens
of this daily struggle for survival, and often suffer the
added hardships of legal and social discrimination.
In the rich countries, where basic
human needs are exceeded by a very wide margin, the pursuit
of increasingly affluent lifestyles also has broad and
pervasive impacts on Earth. By loading the atmosphere with
greenhouse gases, the high-income countries are making
a dangerous contribution to long-term climate change, with
potentially dire risks for societies both rich and poor
in all parts of the world. Maintaining and indeed improving
the standard of living in the developed world without irreversibly
depleting global resources and altering natural systems
is the rich world’s sustainability
challenge.
The world therefore faces multiple
and complex challenges: extreme poverty and the environmental
degradation causing and resulting from poverty, as well
as pervasive environmental consequences of affluence that
must be brought under control. Ecosystem resilience and
stability, which sustains healthy human communities, must
be maintained through environmentally sustainable practices
in energy, food, water and health management. The scientists
have therefore aimed to identify paths of sustainable development,
which will permit the poorest of the poor to improve their
lot decisively, while permitting the rich to enjoy improvements
in living standards as well, but in both cases in a manner
that protects the environment and the vital services of
the Earth’s ecosystems.
These problems are amenable to human solutions, but only
under four circumstances, which constitute over-arching recommendations
of the scientists.
OVER-ARCHING RECOMMENDATIONS
1. The rich countries must help the poor countries to
escape from the trap of poverty, consistent with international
obligations of international assistance and cooperation.
The first step in this effort should be to meet the Millennium
Development Goals, the internationally agreed targets for
poverty reduction by the year 2015. The needed financial
assistance from the rich countries is of crucial importance
for poverty reduction but is modest in size relative to
the income of the rich countries, within the international
target of 0.7 percent of rich-world GNP in official development
assistance.
2. Both rich and poor countries must heed the lessons
of science and foster the benefits of under-utilized and
yet-to-be developed technologies. We must support increased
national and international scientific and technological
efforts to achieve technological breakthroughs in energy
systems, food production, health care, and water management.
Not only must we make a special effort to address the technological
needs of the poorest, as these are often neglected, but
also to build and sustain scientific capacity in the poorest
countries.
3. All key stakeholders must have
a voice in approaching these problems in a cooperative
and respectful political environment, mindful of international
commitments and legal obligations concerning human rights,
poverty reduction, and the environment. Free-market, profit-driven
solutions alone will not be sufficient. Sustainable development
will also require governmental leadership; new forms of
taxation of social ‘bads’ such as pollution, and budget
subsidies of social ‘goods’ such as research
and development of new technologies, in order to align
social costs and benefits; inter-governmental cooperation;
participation by civil society; and greater corporate social
responsibility.
4. These problems will require multilateral approaches,
and a strong United Nations system, since the scale and
nature of problems necessarily transcend national boundaries
and require global solutions. ^back
to top
ENERGY
What energy strategies would allow all countries
to pursue improvements in living standards while avoiding the
negative impacts on climate and ecology associated with the
use of fossil fuels?
In the energy field, the challenges of sustainable development
differ drastically for three broad groups of countries: the
rich countries; the middle-income countries that are in the
midst of rapid development; and the low-income countries where
populations are struggling, and often failing, to provide for
their most basic needs.
Providing affordable and environmentally
sustainable energy to a future world population of up to
ten billion is a major challenge. Current energy technology
would be unable to satisfy the energy demand of the planet
at a state of future development that could only be sustained
by per capita energy service levels typical of today’s
industrialized nations. Current technology would either be
too expensive or too damaging environmentally to operate
on such scale. Resistance to the necessary change is to a
large extent driven by the notion that the required changes
would be economically devastating. For energy more than for
any other field, progress could be made by developing affordable
and practical technologies. Needed are technologies with
new improved end use energy efficiency like hybrid electric
cars, renewable energy supplies like photovoltaics and bio-fuels,
and carbon capture and storage technologies that can make it
possible to continue the use of fossil fuels in a carbon constrained
world. While the emphasis may vary in the different regions
of the world, the goal is ultimately the same.
In rich countries with a high standard of living and high
per capita energy service levels, the major challenge is the
transition to an environmentally sustainable energy system.
While further reductions in conventional pollutants are still
necessary, that problem is well on its way to being solved.
The most difficult challenge is to find ways to provide plentiful
and affordable energy without emitting vast amounts of carbon
dioxide into the atmosphere.
To head off the potentially extremely dangerous consequences
of human-made climate change, the rich world must affect drastic
reductions in carbon dioxide emissions over the next few decades.
Additional energy consumption must be effectively carbon neutral,
and after 2050 the energy infrastructure must move to near
zero net carbon emissions. Stopping the destruction of forests,
while in itself an important goal would only marginally change
the required reductions in carbon dioxide emissions. The problem
is urgent, as the time available for a transition to a carbon-neutral
economy is short when compared to the natural lifetime of energy
infrastructures; the scale of emission reductions required
over the next 20 to 50 years is very large. Maintaining access
to energy will require new technologies, in some combination
of renewable and nuclear energy, energy conservation and industrial
carbon sequestration. Carbon capture and storage technology
is important, as alternative forms of energy by themselves
are unlikely to achieve the necessary scale of operation in
the time available. Political and economic structures and institutions
that can promote this process are still lacking or are in their
infancy. Considering the large per capita share of carbon dioxide
emissions that emanate from the rich nations, global fairness
warrants that these countries should take the lead in the transition
to a carbon-neutral energy infrastructure. This could be done
by supporting emission reductions in the developing nations.
In rapidly developing countries such as China and India, the
first order of business is to provide sufficient and environmentally
clean energy. Large-scale electrification and industrialization
causes pollution problems similar to those of industrialized
countries in the past, but they are even more severe because
of higher population densities. The most important and pressing
need is for advances in the energy infrastructure while reducing
conventional pollutants drastically. However, the developing
nations cannot remain on the sidelines when it comes to managing
carbon dioxide emissions as their contributions are beginning
to dominate the total world carbon budget. As a result, rapidly
developing countries need to assure that their development
is compatible with future reductions in carbon dioxide emissions.
For the transition period, opportunities abound for cooperation
between developed and developing nations. Areas of common interest
include international carbon trading, which would allow industrial
nations to purchase carbon dioxide reductions associated with
energy conversion facilities, like power plants, built in growing
economies as well as efforts to reduce particulate pollution
from power generation, and even more importantly from small
industrial and domestic use of coal and biomass fuels. By eliminating
soot emissions one can address radiative forcing of climate
change as well as regional pollution issues in a single problem.
Replacing coal and biomass fuels with cleaner burning fuels
is an area where the interests of industrialized countries
and developing countries meet.
While it might be tempting to encourage
poor countries like those in sub-Saharan Africa to suppress
their progress toward a lifestyle exemplified in the developed
nations, the developed nations cannot hold the poor world’s
progress hostage to their own concerns over climate change.
People in the poorest countries often lack access to the
most basic energy resources for which access should be an
entitlement as human health and life depend on it. The poorest
countries in the world do not significantly contribute to
greenhouse gas problems, and an accelerated transition from
the burning of firewood and dung to commercial hydrocarbons
would reduce, rather than increase, local ecological impacts.
Not insisting on leapfrog technologies makes it possible
to consider liquified petroleum gas (LPG), kerosene and diesel
oil on an equal footing with wind, solar energy or biomass
energy. In many cases, these conventional energy carriers
would prove to be more cost-effective and less damaging to
health and environment than current practice. Giving people
access to better cooking fuels, electric power and fuels
for machinery and transportation needs would not materially
affect the greenhouse gas balance of the world, but it could
make a huge difference in the quality of life and economic
prospects of poor nations. Raising the cost of access to energy
by insisting on leapfrog technologies (e.g. renewables to avoid
greenhouse gas emissions) would likely hamper the economic
development in the poorest regions.
Immediate needs center on minimum electricity for lighting
in low population density rural areas most cheaply provided
by distributed generation and clean cooking fuels. A transition
to LPG or a synthetic alternative like dimethyl ether could
form the basis of broad energy infrastructure. Eliminating
indoor biomass and coal combustion because of the severe health
impact has to be a major goal. The biomass saved, e.g. from
agricultural residues could instead be used to provide one
source for clean synthetic fuels like dimethyl ether for cooking
and heating and/or electricity for lighting and other basic
uses.
RECOMMENDATIONS OF THE ENERGY
PANEL
1. In the industrialized countries, accelerate introduction
of energy infrastructures that will lead the global transition
to carbon-neutrality. Without caps on carbon emissions,
probably managed by carbon trading, it will be extremely
difficult to make the necessary reductions in CO2 emissions.
Safe and publicly acceptable carbon capture and storage
will be an essential part of the response and will have
to be developed and implemented soon.
2. In the rapidly developing economies,
provide clean and plentiful energy in ways that align today’s
energy infrastructure investments with progress towards
long-term carbon neutrality. This will include commercialization
of gasification technologies for electricity and synthetic
fuels production, deploying carbon capture and storage
technologies in safe and publicly acceptable ways where
cost effective. Support from the industrialized countries
will be necessary.
For areas with physical and institutional infrastructures
that are adequate to support a market economy for energy
inputs and productive outputs, the development of efficient
energy markets, in which prices reflect costs, including
environmental and social costs, is a prerequisite for efficient
consumer choice and for attracting the necessary energy
system investment.
3. In the poor countries of the world,
access to greatly increased quantity and quality of energy
services is a prerequisite to poverty reduction and economic
growth, giving particular emphasis to ensure access to clean
liquid or gaseous fuels and electricity at levels adequate
to satisfy basic human needs. Immediate growth of energy services
should not be constrained by avoidance of fossil fuels
or caps on global carbon emissions. Emphasis on short-term
economic benefits can, under the right circumstances,
lay a foundation for environmental sustainability. Increased
access to clean fuels has particularly significant impact
on women’s lives. In very poor areas with low demographic
density and agricultural productivity, concessionary
funding will be required to begin to provide energy with
appropriate technologies (decentralized or centralized)
adequate to satisfy basic human needs.
4. To drive the development and application of low-carbon
and eventually carbon-neutral technologies, it will be
necessary to mobilize investment on scales far in excess
of present levels. Most of the capital for this investment
will initially need to come from industrialized countries,
but the investment should take place within a framework
that can leverage the transition elsewhere to carbon neutrality,
especially in rapidly developing countries. Because a stable
climate is a public good, public policy instruments will
be necessary to drive this investment. There is an important
place for innovative mechanisms that link public and private
interests.
5. Enhanced energy efficiency measures are often the most
cost-effective options in making clean and reliable energy
services affordable for all, while facilitating realization
of a low carbon energy future. But in order to accelerate
diffusion of such options clearer signals and incentives
will be necessary, including removal of the substantial
market and non-market barriers.
^back
to top
FOOD
What action is needed to ensure
that agriculture meets the needs of the world’s hungry, that agroecosystems and
fisheries remain viable, and that ecosystem loss does not threaten
Earth’s ability to feed its population?
The right to adequate food is a fundamental
right recognized in international law. Food availability
is improving for the world as a whole, but under-nutrition
remains the single most important cause of human mortality,
directly or indirectly causing roughly 8 million deaths per
year or 30 percent of the total. The Earth is failing to
feed its population particularly in Asia, where most deaths
related to under-nutrition occur, and in Africa, which is
the only major region where the prevalence of malnutrition
is increasing. Obesity, the other side of malnutrition, is
also increasing throughout the world, but is not a direct
focus of this panel’s work.
The causes of under-nutrition derive
from inequitable political, social, and economic conditions
as well as unfavorable ecological circumstances, and these
all combine to influence both productivity and distribution.
Science-based technological innovations together with community-based
indigenous knowledge are both necessary but not sufficient
to eliminate hunger from the world. Enabling policies and
political action must work hand in hand with increasing productivity
and access to healthy food. The world’s
agro-ecosystems will require substantially higher investments
in new ecoagricultural technologies and also a wide range of
changes in natural-resource management, the development of
institutions and infrastructure, and innovations in government
policies around the world. Increasing the productivity of existing
cropland will reduce the degree to which many of the world’s
poorest people rely on forests, rangelands, and natural fisheries – either
as primary sources of food or as an important supplement and
food ‘safety net’ when crops fail or emergencies
arise – while changes in the management of those natural
systems are also important in themselves.
RECOMMENDATIONS
OF THE FOOD PANEL
The world’s food shortages are geographically concentrated
in South Asia, where access to food rather than total food
production is the main constraint, and Africa, where region-wide
lack of food is the primary issue. Approximately half of the
world’s hungry people are in small-scale farms in marginal
areas that were bypassed by the Green Revolution. An additional
22 percent are rural landless people, 8 percent are people
dependent on natural resources – the pastoralists, fishers
and forest dwellers and the remaining 20 percent are the urban
hungry. The rural poor are driven further into poverty by local
population growth against a relatively fixed land base, giving
them little choice but to exploit their limited natural resources
in an increasingly unsustainable manner. To help impoverished
people escape such ecological poverty traps, the high-income
countries need to help these regions to:
1. Increase investment in the development
and dissemination of new and existing technologies adapted
to the needs of farmers of the poorest areas, most notably
replenishing soil fertility and improving small-scale water
management in Africa, as well as new crop and tree varieties
or livestock breeds, developed through both conventional
breeding and biotechnology, and other management practices
appropriate for local ecological conditions, such as conservation
tillage and integrated pest management. Innovations are needed
especially for areas where nutrients have been depleted and
must be replenished through inorganic fertilizers, agro-forestry,
green manures and other techniques; where moisture stress
must be alleviated by water harvesting, mulching, or irrigation;
and where crop losses from burgeoning pest problems need
to be controlled by appropriate integrated pest management
strategies. In all of these places, local investments and
innovations can be complemented by the introduction of seed
varieties that have locally-appropriate growth habits, stress
tolerance, and product characteristics. Furthermore, much
more interdisciplinary research is needed on the interactions
of agricultural production systems and landscape ecology, to
facilitate innovations in field and landscape management that
enable local people to both increase agricultural productivity
and enhance and restore biodiversity and ecosystem services
(“ecoagriculture”).
2. Expand efforts to build local institutions and infrastructure
for collective action and market development for vulnerable
regions and fragile resources, to increase the relative profitability
of more ecologically sustainable ways to obtain crops, livestock,
wild game, fish and forest products, and to reduce the labor
burden especially on women and children. These investments
include property and inheritance rights for women, improved
roads and other transport and communications infrastructure,
local procurement for school meals programs and food-for-work
programs, capacity building for collective action and rural
institutions for credit and savings, market development and
household security. Food systems should be oriented, in addition
to overall productivity, towards meeting nutritional requirements.
Improvements in the food system should be complemented by direct
nutritional programs to meet needs of vulnerable populations.
3. Renew momentum towards trade reform
of global markets, to improve low-income farmers’ terms
of trade with the rest of the world, especially through increased
access of tropical farmers and fishers to the markets of
the high-income countries, as well as international policy
coordination to protect marine fisheries and encourage sustainable
aquaculture.
4. Restore degraded lands, forests, fisheries and rangelands,
to improve food security, reduce risks, diversify food sources
and generate new sources of rural livelihoods. In particular,
it is important to eliminate the most destructive practices,
encourage development of more selective and sustainable harvest
methodologies, and establish protected areas of sufficient
size and connectivity. This will be facilitated by securing
local ownership and management rights, supporting local investment
in resource rehabilitation, developing effective governance
and management systems and encouraging the development of local
resource-based enterprises. Encourage transformation of crop,
livestock and fish production systems and landscapes to produce
both food and ecosystem services such as watershed protection,
wildlife habitat and biodiversity.
^back to top
WATER
How can regional and local water resources be best developed
and managed to meet rural and urban needs for safe drinking
water, food, ecosystems services and economic development,
while contributing to the reduction of poverty, disease and
the impacts of natural and environmental hazards?
Water is often cited as the emergent global resource crisis
of the 21st century. Water is central to managing agriculture,
ecosystem services, sanitation, human health, and natural disasters,
and hence it is key to meeting the Millennium Development Goals.
Nearly a billion people in poor countries lack access to safe
drinking water. Globally, the dominant water use is for agriculture,
and the pre-eminent concern has been the dramatic variability
of natural supply in space, time and quality. Changes in climate,
soils, watershed drainage systems, and the use of chemicals
aggravate these concerns, with consequent threats to human
and ecological health. One of the major problems is that water
development is a means to different and competing ends. Each
sector develops its own priorities and policies, considering
water only as a factor of production. Because water development
(hydropower, navigation and agricultural irrigation, municipal
and industrial water supply and sanitation) also directly affects
ecological sustainability, it has come under intensive scrutiny.
Subsidized development of water, particularly for agriculture,
combined with weak efforts to protect resource quantity and
quality, has led to inefficient use of water resources and
a general neglect of maintenance of that infrastructure, along
with unreliable access for other uses. Human health impacts
can be closely correlated with degradation of source water
quality and to lack of access to safe water supplies, especially
at the rural, village level.
The combination of management, policy,
regulatory, legal and economic incentives that serves as
the impetus for integrated water resources management (IWRM),
is a key factor that will determine the success or failure
of improving water management in the developing world. Proper
governance objectives that would stimulate adoption of technologies
and adaptive management principles that would promote sustainable
use are urgent goals. Historically, water management has
dealt with risk and uncertainty and reduction of vulnerability
in an infrastructure intensive and centralized manner. Developing
water storage and distribution infrastructure is still a
vitally important component of water management, in that
it provides the buffering capacity for the uncertainties
associated with climate variability and ultimately climate
change, and contributes to system robustness, resilience
and reliability. This is especially true for developing nations,
where each flood and drought results in substantial declines
of 10 to 50 percent of GDP. Nevertheless, an important part
of the new IWRM paradigm is an emphasis on the ‘soft
path’ or adaptive management component that relies on
an entirely different set of management measures for risk bearing
and risk sharing under uncertainty. In this context, the introduction
of rational water pricing policies with judicious subsidies
to the poor to provide access, while enabling water producers
to enter the market, tap a variety of water and wastewater
streams as inputs, and develop effective distribution strategies
is needed. Innovations in property rights systems that lead
to equitable, compensated water transfers and improved water
use efficiencies are also needed.
In the semi-arid to arid tropics and
sub-tropics, where the vast majority of the world’s
poorest people live, water may be the most constraining influence
on improving the livelihoods of people. The dramatic seasonal
and inter-annual variation in rainfall poses a significant
supply challenge, particularly in areas in Asia, Africa and
South America, where population densities are high. It is
clear that clever water storage strategies that are environmentally
friendly are needed, consisting of both necessary infrastructure
and non-structural options. Given limited land, displacement
of populations or their economic migration due to water scarcity
becomes an important issue. The combination of local versus
central storage and delivery systems that is most effective
from the perspective of regional sustainability is not always
clear. Analyses that expose the key issues in making such
a choice are needed. The role of seasonal to interannual
climate forecasting in facilitating more efficient supply
and demand management in such regions may be important.
Predictability may be relatively high, and if adaptive management
strategies contingent on probabilistic forecasts can be employed,
estimates of storage needed may decrease, water use efficiencies
could increase, and environmental indices may improve.
Economic progress in rapidly developing countries leads to
extensive modification to watercourses. These modifications
aim to reduce flood and drought impacts. Pollution, i.e. the
introduction of novel chemicals (including antibiotics, hormonal
agents, and other pharmaceuticals) and its chronic impacts
are a major concern. Flood control works provide a sense of
security that promotes increased floodway development and exposure
to potentially larger floods, but at the same time enhance
the economic productivity of those lands. A better understanding
of the long-term risks of such developments is needed to avert
potential environmental degradation and catastrophic losses
of life and property.
We have to focus our attention on
the developing world with strategies that fall into four
basic categories: 1) Develop large scale water infrastructure
that will provide the needed buffering capacity, robustness
and resilience to withstand the vagaries of climate variability
and change; 2) Focus on ‘small
is beautiful (and inexpensive)’ strategies for villages
and remote rural areas; 3) Concentrate on upgrading technical
and institutional management capacities at all levels; and
4) Continue to focus on developing and transferring technological
innovations that, hopefully, will compensate for the myriad
difficulties associated with IWRM. Improved forecasting techniques
will undoubtedly improve operation and management of existing
water delivery systems, and open up possibilities for the trading
of water rights and other risk-sharing programs. But forecasting
requires much more investment in scientific research, as well
as installing and maintaining a hydroclimatic monitoring system
in each river basin. Advances in modeling and data collection
technologies need to be translated into practical use through
appropriate investments. Recent advances in genetic engineering
and biotechnology are expected to have the greatest impact
on food security and agriculture, alleviating some of the stresses
on fresh water supply, as the vast reservoirs of brackish groundwater
might be used for certain forage crops. Advances in fusion
energy and cheaper solar power would alleviate water supply
problems for the large urban areas on the coasts, making desalination
an economically competitive option. Cheap solar energy would
do the same for small villages and remote rural areas, making
subsistence much easier by making available groundwater sources
for water supply and small-farm irrigation water for livestock,
while reducing the costs of water treatment and sanitation.
RECOMMENDATIONS OF THE WATER PANEL
1. Reform water pricing, property rights, and water trading
systems to promote increased water use efficiency and sustainability,
while enhancing access to safe drinking water and to irrigation
water for the poor through judicious subsidies. International
financial and technical assistance is vitally needed for
the poorest countries. Water rights re-allocation must
be accompanied by compensation. Develop and adopt mechanisms
for shifting from agricultural water subsidies to financial
support for the adoption of technology and policy measures
that promote water and environmental conservation. Promote
the testing and adoption of biotechnological advances that
enhance food production in water deficient conditions.
2. Develop and apply seasonal to inter-annual hydrologic
forecasts for regional water allocation and economic planning
to promote integrated multi-objective surface and ground
water management. Invest in installing and maintaining
hydrometeorological and water quality monitoring networks
as the precursor to effective forecasting. Focus research
on projects that characterize and predict long-term anthropogenic
changes in global and regional hydrologic cycles and their
effects on climate, on carbon, nitrogen and phosphorous
cycles, and hence on the sustainability of life.
3. Develop new storage systems (e.g. subsurface) to meet
water needs and simultaneously investigate ways to implement
measures for water quality and ecological protection, increased
conservation, local water harvesting and re-use needs.
4. Evaluate and promote the development of local, point-of-use
solutions for meeting safe drinking water and sanitation
goals, particularly in poverty-stricken areas where access
is poorest. Develop and market locally appropriate technology
and delivery systems. Promote regulated decentralization
of water supply development and management.
5. Develop cost-effective mechanisms for restoring degraded
aquatic habitats and ecosystems, and protecting these rehabilitated
systems, by sustaining their basic hydrologic inputs (minimal
environmental flows).
6. Focus on multi-sectoral integrated water management
(navigation, hydropower, irrigated agriculture and municipal
and industrial water supply) and the necessary institutional
policy reforms that are required for more effective management.
Treat equity and human well-being on a par with economic
efficiency and environmental sustainability, mindful of
international and legal obligations concerning human rights
and the environment.
7. Develop emergency preparedness and disaster response
plans for floods, droughts and related infrastructure failures
(dam safety, pipeline ruptures, sewage treatment failures
or toxic chemical spills). ^back to top
HEALTH
What actions are needed to address
the world’s preventable
diseases, emerging diseases and problems that disproportionately
affect the health of the world’s poor?
The state of human health on the planet
is precarious. Despite the scientific and technical advances
of the past fifty years, from the discovery of DNA as the
molecule of heredity to the sequencing of the human genome,
important and potentially devastating public health problems
affect nearly all the world’s
populations. Most affected are the poor. Gross disparities
in rates of illness, disability, and premature death exist
between rich and poor in all countries, as well as between
rich and poor countries.
The current health needs of the world’s population cannot
be adequately addressed with the resources that have been made
available to date. Studies suggest that the minimum spending
level required to have an appreciable impact on the major causes
of morbidity and mortality in developing countries – to
reach the health-related Millennium Development Goals – is
about $40 per capita per year. Yet in today’s world it
is rare for health budgets in the poorest countries to exceed
$10 per capita per year. To make matters worse, much of this
is devoted to administrative costs and to hospital maintenance,
and only a portion funds programs that reach the majority of
the population. Very little money is allocated to strengthening
the weak health systems that are characteristic of today’s
world. Health systems are further rendered ineffective by political
instability and by poor management – including skewed
priorities, corruption, and lack of incentives. As a result,
poor people pay out of pocket for health care of dubious quality,
often having to choose between health and food or other essentials.
Despite the remarkable gains made
in much of the world during the course of the twentieth century,
it is frustrating to those who work in the field of public
health, and surprising to many of those who do not, that
safe and cost-effective interventions are available for the
prevention and treatment of many of today’s
most important diseases. The implementation of these interventions,
however, is grossly inequitable. The risk of a woman dying
from pregnancy-related causes in the least developed countries
is more than 10 and as high as 100 times that in the industrialized
world. This unacceptably high maternal mortality, combined
with inadequate family planning programs that would give women
greater control over their reproductive health, has had important
consequences on the health of both women and children. So,
for children, mortality rates also vary widely – five
of every 1000 children born alive will die in Japan before
reaching their first birthday, compared to more than 100 in
a large number of countries in sub-Saharan Africa and many
in Asia – and most of these deaths are from common diseases
such as diarrhea and pneumonia.
These disparities are the rule, not
the exception. A significant portion of these deaths can
be averted by the application of existing knowledge and technology;
however, ineffective and unjust political, social, and economic
policies severely constrain efforts to do so. Further investment
in the generation of new knowledge is also required – a failure to invest in appropriate
research will result in the application of yesterday’s
solutions to tomorrow’s health problems.
For example, advances in medicine, specifically the development
of highly-active antiretroviral treatment, have transformed
HIV/AIDS from a debilitating disease that resulted in death
in the prime of life to a manageable chronic disease in most
of the industrialized world. But it continues to kill millions
each year in Africa, where 40 million people remain infected
and where access to effective treatment remains available for
only the privileged few. As a result, health care costs for
HIV-associated conditions, for futile hospitalizations, and
for funeral expenses, combined with the loss of income generated
by heads of households have thrown families into abject poverty.
The expected life span of a child born in southern Africa today
has fallen to less than 40 years in some countries. Modern
medical technology must be made available where it is needed
most.
It must be added that in spite of the current emphasis on
the provision of antiretroviral drugs to people with AIDS in
developing countries, treatment alone will not solve the problem.
Much stronger and more vigorous prevention strategies need
to be implemented in order to stop HIV transmission in the
first place. Countries like Uganda and Thailand have shown
that this can be done.
Malaria, for which both preventive and curative strategies
are available, continues to exact a severe toll. Up to a billion
clinical cases and a death toll of an estimated 2.7 million
occur every year, most of them in Africa. Children and pregnant
women are particularly most vulnerable to malaria, making them
more susceptible to infection, severe anemia and death. Over
30 million women living in malaria endemic African countries
become pregnant every year exposed to significant threats to
themselves and to their babies.
Like, malaria, tuberculosis is spreading
rapidly and threatening to cause serious problems throughout
the world. Both infections are increasingly resistant to
the relatively inexpensive drugs that have been used to treat
them but, although newer safe and effective treatments are
available, their deployment is inhibited by the notion that
they are “too expensive.” Other
emerging and re-emerging diseases, including BSE, SARS, and
avian influenza, progressive degradation of existing ecosystems,
and the threat of biological terrorism, all make the world
a more dangerous place in which to live.
Human health is intimately related to the environment. Ecological
and hydrological systems should be monitored in order to forecast
disease emergence. Furthermore, we must improve our understanding
of pathogen transmission within and between wildlife, domestic
animals, and human populations.
Chronic conditions, including cardiovascular diseases, cancer
and diabetes, clinical depression and other mental health conditions,
as well as injuries and intentional violence (especially towards
women and children), are increasingly important causes of premature
death, morbidity and economic hardship in developing countries.
Tobacco use, sub-optimal dietary practices leading to both
under-nutrition and obesity, low levels of physical activity,
and environmental pollution related to unchecked urban sprawl,
are changing the epidemiological profile for the worse and
have remained essentially unaddressed in much of the world.
RECOMMENDATIONS
OF THE HEALTH PANEL
1. Political will to invest in improving health care systems
must be developed through strong and maintained advocacy efforts.
Public health is an essential component of poverty reduction
strategies. Governments in both the industrialized and developing
worlds must recognize that health is not only a fundamental
right recognized in international law, and at the center of
human and social development itself, but is also a crucial
factor for economic growth.
2. The prevention of commonly occurring diseases, both acute
and chronic, must be recognized as the essence of public health.
Access to safe water and appropriate sanitation, adequate nutrition
and healthy food consumption behaviors, and appropriate use
of less polluting energy sources, along with other prevention
efforts such as tobacco control and family planning can make
enormous contributions to reducing preventable morbidity and
mortality.
3. Health spending must be massively increased for both prevention
and treatment. As essential as prevention is, when people fall
ill, they have a right to effective and affordable care. For
the foreseeable future, most low-income countries will require
large and sustained infusions of external aid, combined with
greater allocations of national budgets to the health sector.
This aid must be coupled with effective governance and oversight.
Stringent limits on health spending currently imposed in many
financial programs supervised by the international financial
institutions need to be relaxed or abolished. Policies regarding
intellectual property rights and trade agreements, including
affordable drug pricing for all, should be crafted so that
it is more likely that medical technology, drugs and vaccines
will be developed for and made available to the poor. In particular,
the poor should be protected against excessive personal expenditures
on basic health care that push them toward or over the poverty
threshold. In most middle-income and some high-income countries,
notably the United States, more efforts are required to ensure
that everyone within these societies has affordable access
to necessary preventive and curative health services.
4. Health systems must be strengthened:
they are a core social institution, to which every individual
should have access. The lack of a functional, regulated health
system is more than a result of poverty – it is a characteristic
of it. Indeed, in order to achieve the health-related Millennium
Development Goals and to ensure that further progress can
be made in the future, strong health systems, characterized
by appropriate policies formulated on the basis of sound
scientific evidence and not ideology, enforceable legal support,
public trust, and effective management, are a sine qua non.
5. Targeted programs, such as those that address the AIDS
crisis and the preventable burden of death and disease affecting
women and children, are urgently needed. But unlike the disease-specific
eradication programs of the past, these programs address more
chronic conditions and will have to be maintained in perpetuity.
Accordingly, public health initiatives with relatively narrow
objectives should be designed in ways that ensure that they
contribute to the strengthening of sustainable health systems
and they should be held accountable for doing so.
6. Human resources for health are in crisis. Both national
health system staffing policies and international immigration
and labor policies are partly to blame. Chronic conditions,
both communicable and non-communicable, have been responsible
for the premature deaths of many health professionals and teachers.
In developing countries, opportunities for increasing the number
and the competence of health staff at all levels of the health
system should be created and appropriate incentives offered
to retain the services of health staff in whom significant
investments have been made. Richer countries also need to train
more health professionals and deploy them effectively.
7. There is a need for further investment in knowledge generation,
dissemination, and application. In addition to the application
of current knowledge, North/South partnerships that contribute
to the development of public health and medical leadership
in research, policy formulation, management, and service delivery
are essential.
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