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Why Climate Change Is Worsening Public Health Problems
By Chelsey Kivland and Anne Sosin
Around the world, the health care debate often revolves around access.
Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, recently announced, "All roads lead to universal health coverage." Discussions for how to translate this vision into a road map for action is central to the agenda of the WHO's executive board meeting this week in Geneva.
Yet focusing on access is not enough. The imperative for access must be paired with a frank acknowledgment that climate change is making communities around the world more vulnerable to ill health. A 2017 commission of The Lancet, a leading health research journal, tracked the effects of climate change on health and found evidence of harms "far worse than previously understood."
As a global health professional (Sosin) and a cultural anthropologist (Kivland), we have witnessed how the global exchange of health technology, expertise and aid has contributed to dramatic gains in the delivery of health care in Haiti and other settings, especially around infectious diseases. Yet climate change threatens to undermine the health gains in vulnerable communities across the globe.
As firsthand witnesses to sharp health disparities globally, we argue that world leaders need to insist that any health care strategy must address the social and environmental vulnerabilities driving poor health in the first place.
The Health Burden of Climate Change
Climate scientists argue that global warming is exacerbating extreme weather events. And natural disasters are often the source of health crises, particularly in fragile settings. Consider the case of Puerto Rico. The official death toll of the storm was estimated at 64; however, later reports have estimated that the disruption of health care services contributed to upwards of 1,052 deaths on the island.
Lagging recovery efforts have exposed how natural disasters deepen the relationship between socio-economic inequality and health disparity. In Puerto Rico, where poverty rates are double those of the poorest continental state, people already struggling with illnesses such as diabetes and kidney disease have seen their conditions worsen as the long-crumbling health care system is overwhelmed with patients and neglected by the mainland government.
The health impacts of the storms may persist even beyond the restoration of health services.
Hurricane Harvey exposed the toxic afterlife of disastrous storms. Storm damage to 40 industrial sites released chemical toxins linked to cellular damage, cancer and other long-term health problems. As The Lancet's Commission on Pollution and Health found, air, water and soil pollution is now the leading environmental cause of death and disability, accounting for more than 9 million deaths annually. These numbers will only grow in the face of climate-induced disasters.
Restoring health care systems is vital for these communities, but it will merely treat the symptoms and not the causes of post-disaster illness. We believe that policymakers must address the link between environmental and health crises.
Haiti as Case Study
We have learned this lesson from our work in Haiti. Once a death sentence in rural Haiti, today HIV is largely controlled thanks to widespread access to antiretroviral therapy. The prevalence of the disease in pregnant women fell from 6 percent to just over 2 percent in the 10-year period from 1993 to 2003. Likewise, vaccines against cholera, introduced in 2015, have proven to be up to 90 percent effective against the disease.
However, even as vaccine coverage continues to grow, the population remains at risk for cholera and other emergent threats. Only 58 percent of the population has access to safe water and only 28 percent has access to basic sanitation. These conditions worsen in the wake of natural disasters. Hurricane Mathew in 2016 triggered spikes in cholera and other waterborne diseases, especially diarrhea, the second leading cause of death among children.
Hitting the one region of Haiti that had not yet been denuded of trees and vegetation, Hurricane Matthew seemed to complete the destruction of the country's food systems.
Since the late 1980s, the erosion of waterways, loss of habitats and destruction of agricultural land have fueled the importation of cheap, processed foods. Rice and pasta have replaced a diet once rich in fruits, vegetables and whole grains. The high-sugar, low-nutrition foods contribute to the dual health burdens of obesity and under-nutrition.
These trends are ongoing, but they are exacerbated by the disastrous shocks of extreme weather events, which are made more likely by climate change. As Hurricane Matthew came ashore, it decimated fishing villages and tore through farming communities, killing livestock, uprooting crops and denuding backyard fruit trees. The United Nations estimated that 800,000 people suffered food shortages.
Closing the Vulnerability Gap
Haiti is often cast as behind the global curve. But as a reflection of the dangerous intersection of climate change, poverty and ill health, it is in fact predictive of what is to come in the rest of the world. Haiti teaches us that our own health is not bound up simply in the present decisions we make about health care systems but rather more broadly situated in the changing natural environment.
Closing the access gap has been a long battle and the gains cannot be underestimated. Yet the challenge ahead is even more daunting. Whereas increasing access has centered on extending health care technologies to underserved populations, closing the vulnerability gap will require approaches that extend beyond the health sector and national borders.
In the past year, the health care debate in the U.S. has centered on attempts to limit or expand access to care. Meanwhile, the Trump administration has left the Paris agreement and unraveled environmental protections for national and transnational corporations—with little resistance from health advocates. We believe that leaders must recognize that environmental policy is health policy. Rollbacks of environmental regulations will cause far greater consequences on health, in the U.S. and globally, than any health care bill.
Fixing health care systems while we undermine the environmental conditions for health are a textbook example of what Haitians describe as "lave men, swiyè atè"—washing your hands but drying them in the dirt.
Reposted with permission from our media associate The Conversation.
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By Sue Branford and Thais Borges
Ola Elvestrun, Norway's environment minister, announced Thursday that it is freezing its contributions to the Amazon Fund, and will no longer be transferring €300 million ($33.2 million) to Brazil. In a press release, the Norwegian embassy in Brazil stated:
Given the present circumstances, Norway does not have either the legal or the technical basis for making its annual contribution to the Amazon Fund.
Brazilian President Jair Bolsonaro reacted with sarcasm to Norway's decision, which had been widely expected. After an official event, he commented: "Isn't Norway the country that kills whales at the North Pole? Doesn't it also produce oil? It has no basis for telling us what to do. It should give the money to Angela Merkel [the German Chancellor] to reforest Germany."
According to its website, the Amazon Fund is a "REDD+ mechanism created to raise donations for non-reimbursable investments in efforts to prevent, monitor and combat deforestation, as well as to promote the preservation and sustainable use in the Brazilian Amazon." The bulk of funding comes from Norway and Germany.
The annual transfer of funds from developed world donors to the Amazon Fund depends on a report from the Fund's technical committee. This committee meets after the National Institute of Space Research, which gathers official Amazon deforestation data, publishes its annual report with the definitive figures for deforestation in the previous year.
But this year the Amazon Fund's technical committee, along with its steering committee, COFA, were abolished by the Bolsonaro government on 11 April as part of a sweeping move to dissolve some 600 bodies, most of which had NGO involvement. The Bolsonaro government views NGO work in Brazil as a conspiracy to undermine Brazil's sovereignty.
The Brazilian government then demanded far-reaching changes in the way the fund is managed, as documented in a previous article. As a result, the Amazon Fund's technical committee has been unable to meet; Norway says it therefore cannot continue making donations without a favorable report from the committee.
Archer Daniels Midland soy silos in Mato Grosso along the BR-163 highway, where Amazon rainforest has largely been replaced by soy destined for the EU, UK, China and other international markets.
An Uncertain Future
The Amazon Fund was announced during the 2007 United Nations Climate Change Conference in Bali, during a period when environmentalists were alarmed at the rocketing rate of deforestation in the Brazilian Amazon. It was created as a way of encouraging Brazil to continue bringing down the rate of forest conversion to pastures and croplands.
Government agencies, such as IBAMA, Brazil's environmental agency, and NGOs shared Amazon Fund donations. IBAMA used the money primarily to enforce deforestation laws, while the NGOs oversaw projects to support sustainable communities and livelihoods in the Amazon.
There has been some controversy as to whether the Fund has actually achieved its goals: in the three years before the deal, the rate of deforestation fell dramatically but, after money from the Fund started pouring into the Amazon, the rate remained fairly stationary until 2014, when it began to rise once again. But, in general, the international donors have been pleased with the Fund's performance, and until the Bolsonaro government came to office, the program was expected to continue indefinitely.
Norway has been the main donor (94 percent) to the Amazon Fund, followed by Germany (5 percent), and Brazil's state-owned oil company, Petrobrás (1 percent). Over the past 11 years, the Norwegians have made, by far, the biggest contribution: R$3.2 billion ($855 million) out of the total of R$3.4 billion ($903 million).
Up till now the Fund has approved 103 projects, with the dispersal of R$1.8 billion ($478 million). These projects will not be affected by Norway's funding freeze because the donors have already provided the funding and the Brazilian Development Bank is contractually obliged to disburse the money until the end of the projects. But there are another 54 projects, currently being analyzed, whose future is far less secure.
One of the projects left stranded by the dissolution of the Fund's committees is Projeto Frutificar, which should be a three-year project, with a budget of R$29 million ($7.3 million), for the production of açai and cacao by 1,000 small-scale farmers in the states of Amapá and Pará. The project was drawn up by the Brazilian NGO IPAM (Institute of Environmental research in Amazonia).
Paulo Moutinho, an IPAM researcher, told Globo newspaper: "Our program was ready to go when the [Brazilian] government asked for changes in the Fund. It's now stuck in the BNDES. Without funding from Norway, we don't know what will happen to it."
Norway is not the only European nation to be reconsidering the way it funds environmental projects in Brazil. Germany has many environmental projects in the Latin American country, apart from its small contribution to the Amazon Fund, and is deeply concerned about the way the rate of deforestation has been soaring this year.
The German environment ministry told Mongabay that its minister, Svenja Schulze, had decided to put financial support for forest and biodiversity projects in Brazil on hold, with €35 million ($39 million) for various projects now frozen.
The ministry explained why: "The Brazilian government's policy in the Amazon raises doubts whether a consistent reduction in deforestation rates is still being pursued. Only when clarity is restored, can project collaboration be continued."
Bauxite mines in Paragominas, Brazil. The Bolsonaro administration is urging new laws that would allow large-scale mining within Brazil's indigenous reserves.
Hydro / Halvor Molland / Flickr
Alternative Amazon Funding
Although there will certainly be disruption in the short-term as a result of the paralysis in the Amazon Fund, the governors of Brazil's Amazon states, which rely on international funding for their environmental projects, are already scrambling to create alternative channels.
In a press release issued yesterday Helder Barbalho, the governor of Pará, the state with the highest number of projects financed by the Fund, said that he will do all he can to maintain and increase his state partnership with Norway.
Barbalho had announced earlier that his state would be receiving €12.5 million ($11.1 million) to run deforestation monitoring centers in five regions of Pará. Barbalho said: "The state governments' monitoring systems are recording a high level of deforestation in Pará, as in the other Amazon states. The money will be made available to those who want to help [the Pará government reduce deforestation] without this being seen as international intervention."
Amazonas state has funding partnerships with Germany and is negotiating deals with France. "I am talking with countries, mainly European, that are interested in investing in projects in the Amazon," said Amazonas governor Wilson Miranda Lima. "It is important to look at Amazônia, not only from the point of view of conservation, but also — and this is even more important — from the point of view of its citizens. It's impossible to preserve Amazônia if its inhabitants are poor."
Signing of the EU-Mercusor Latin American trading agreement earlier this year. The pact still needs to be ratified.
Council of Hemispheric Affairs
Looming International Difficulties
The Bolsonaro government's perceived reluctance to take effective measures to curb deforestation may in the longer-term lead to a far more serious problem than the paralysis of the Amazon Fund.
In June, the European Union and Mercosur, the South American trade bloc, reached an agreement to create the largest trading bloc in the world. If all goes ahead as planned, the pact would account for a quarter of the world's economy, involving 780 million people, and remove import tariffs on 90 percent of the goods traded between the two blocs. The Brazilian government has predicted that the deal will lead to an increase of almost $100 billion in Brazilian exports, particularly agricultural products, by 2035.
But the huge surge this year in Amazon deforestation is leading some European countries to think twice about ratifying the deal. In an interview with Mongabay, the German environment ministry made it very clear that Germany is very worried about events in the Amazon: "We are deeply concerned given the pace of destruction in Brazil … The Amazon Forest is vital for the atmospheric circulation and considered as one of the tipping points of the climate system."
The ministry stated that, for the trade deal to go ahead, Brazil must carry out its commitment under the Paris Climate agreement to reduce its greenhouse gas emissions by 43 percent below the 2005 level by 2030. The German environment ministry said: If the trade deal is to go ahead, "It is necessary that Brazil is effectively implementing its climate change objectives adopted under the [Paris] Agreement. It is precisely this commitment that is expressly confirmed in the text of the EU-Mercosur Free Trade Agreement."
Blairo Maggi, Brazil agriculture minister under the Temer administration, and a major shareholder in Amaggi, the largest Brazilian-owned commodities trading company, has said very little in public since Bolsonaro came to power; he's been "in a voluntary retreat," as he puts it. But Maggi is so concerned about the damage Bolsonaro's off the cuff remarks and policies are doing to international relationships he decided to speak out earlier this week.
Former Brazil Agriculture Minister Blairo Maggi, who has broken a self-imposed silence to criticize the Bolsonaro government, saying that its rhetoric and policies could threaten Brazil's international commodities trade.
Senado Federal / Visualhunt / CC BY
Maggi, a ruralista who strongly supports agribusiness, told the newspaper, Valor Econômico, that, even if the European Union doesn't get to the point of tearing up a deal that has taken 20 years to negotiate, there could be long delays. "These environmental confusions could create a situation in which the EU says that Brazil isn't sticking to the rules." Maggi speculated. "France doesn't want the deal and perhaps it is taking advantage of the situation to tear it up. Or the deal could take much longer to ratify — three, five years."
Such a delay could have severe repercussions for Brazil's struggling economy which relies heavily on its commodities trade with the EU. Analysists say that Bolsonaro's fears over such an outcome could be one reason for his recently announced October meeting with Chinese President Xi Jinping, another key trading partner.
Maggi is worried about another, even more alarming, potential consequence of Bolsonaro's failure to stem illegal deforestation — Brazil could be hit by a boycott by its foreign customers. "I don't buy this idea that the world needs Brazil … We are only a player and, worse still, replaceable." Maggi warns, "As an exporter, I'm telling you: things are getting very difficult. Brazil has been saying for years that it is possible to produce and preserve, but with this [Bolsonaro administration] rhetoric, we are going back to square one … We could find markets closed to us."
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