One planet,one people,one health,please

Farhang Tahzib looks at the health inequalities exacerbated by the effects of climate change, and the moral and ethical obligation to ensure that these are tackled, guaranteeing that no one is left behind.

The science and evidence are clear. Climate change is a public health emergency, the single biggest threat to global health, peace and security, ¹ a crisis multiplier, ² and a significant driver of health inequalities, with the poor and vulnerable, who are the least responsible to contributing to climate change, at greatest risk of suffering the consequences of actions mainly by the rich and powerful nations. These actions are also directly contributing to an unprecedented loss of biodiversity across the planet, with mass extinction of species and disruption of ecosystems which are fundamental to our very life, and that of our planet. Science and technological discoveries have also demonstrated that there are practical technical interventions which can support activities to tackle climate change and prevent further irreparable destruction of the planet and save lives. These interventions and activities require radical changes in the way we live and the way our communities and institutions are organised, with need for ‘an alternative economy, not just an alternative energy system’ ³ Science and technological discoveries have also resulted in contraction of the world into a single neighbourhood and accelerated the dissolution of the traditional boundaries that have long separated the nations and peoples of the world and revealed the interconnectedness, interdependence and oneness of humanity, the planet, nature and the environment. But it is also clear that science and technology alone cannot solve the problem. The problem is not the lack of science and technology but service to the common good, volition and fair equitable application.

‘We know 100 times more than we need to know’ as highlighted on an epitaph at the Peace Museum on the spot where the first atomic bomb was dropped on the city of Hiroshima ‘What we lack is the ability to experience and to be moved by what we know, what we understand and what we see and believe’. ⁴

The individual, community and institutions of society are key protagonists and chief stewards for health, from whose values and interactions the future emerges. Climate change, the pandemic and other public health emergencies have highlighted issues around our duties, responsibilities and obligations, and how they ought to be distributed, who should decide what we owe each other and how we should live our lives, as members of humankind and with nature and other living things on our finite planet. The challenges therefore do not merely require technical fixes but raise moral questions. These questions require a re-evaluation of norms and values and implications for policy and practice: as noted by Einstein, ‘a substantially new manner of thinking if mankind is to survive’ ⁵ .

OPEN IN VIEWER

The response of nations to the pandemic, such as around vaccine equity, climate change and other public health challenges such as racial inequity have been referred to as moral failures and tests of character with consequences. ⁶ Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, has noted that we are on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries. ⁷ A moral failure is an act or thought which is carried out when one knows that it should not be carried out, or conversely an act which is not carried out when one knows it should be carried out. Such issues did not fall from the sky but result from conscious choices of policies and practices driven by the attitudes, norms and values of leaders, revealing underlying systemic structural issues.

The scholars Smith and Upshur in reviewing the responses to the Covid-19 pandemic and learnings to prepare for future pandemics have highlighted that ‘Nothing will fundamentally change unless we truly understand and appreciate the nature of the lessons we should learn from these outbreaks. Our past failures must be understood as moral failures that offer moral lessons.

We can learn how to better curb the spread of outbreaks by using shiny new technologies, but unless we appreciate that we have a defect in our collective moral attitude as a global community toward remediating the conditions that precipitate the emergence of outbreaks, we will never truly learn. ⁸

It has been suggested that there is the urgent need to commit ourselves to a set of values that engenders an approach to global public health emergencies which embodies a sense of solidarity and global justice. ⁹ Solidarity, though, is not a mere sentiment for abstract armchair philosophical reflection but by definition a practice whereby people express their support for others that they see themselves as having something in common with. With climate change there are commonalities of all of us recognising earth as our common homeland, irrespective of skin colour, gender, religion, political values and that we are sharing the earth with nature and all other living things. It has been suggested that what is often cited as international solidarity is in fact camouflaged national self-interest. ¹⁰

Climate justice has become a core demand of activists, and environmental justice a major area of research, political discourse and growing social movement. The 2030 Agenda for Sustainable Development, the Intergovernmental Panel on Climate change, The Paris Agreement ¹¹ and other initiatives when the nations have managed to achieve unity of thought in world undertaking and framework for action, however limited, have begun to include aspirations and language around equity, inequality and leaving no one behind that has gone beyond the usual political narratives, and rhetoric. This has provided opportunities to question underlying assumptions, which drive continued socio-economic orthodoxies that support and maintain the scandalous social and economic inequities which continue ‘to kill people on grand scale’. ¹² This includes underlying assumptions that shape contemporary discourse, such as unfettered self-interest driving prosperity, and that progress depends upon its expression through relentless competition, endless growth and relentless material consumerism.

Climate change is indeed an emergency, and as Churchill noted at the start of the Second World War ‘The era of procrastination, of half-measures, of soothing and baffling expedients, of delays, is coming to a close. In its place we are entering a period of consequences’. ¹³ The consequences of climate change are serious and already apparent and future potential consequences as highlighted by scientists can be catastrophic if we do not act. Whether we act only after unimaginable damage, destruction, precipitated by humanity’s stubborn clinging to narrow self-interest, individualist and nationalistic perspectives and patterns of behaviour, or is to be embraced now by an act of consultative will recognising our commonalities as members of one humankind, living in a common homeland planet earth, is the choice before all who inhabit the earth. At this critical juncture, when the intractable problems have been fused into one common concern for the whole world, failure to address them would be unconscionably irresponsible.

Following the Second World War, there was the emergence of significant international and national organisations, such as the United Nations, UNICEF, World Health Organization and other agencies calling for greater international cooperation. The Statement by the 16th Public Health World Congress held in October 2020 on ‘Public Health for the future of Humanity – One planet, One people, One health’ ¹⁴ widely supported by public health associations and agencies around the world noted that

The science, the evidence and experience from the Covid 19 global pandemic, climate change and other public health emergencies clearly highlight our interconnectedness and interdependence with nature and our environments, the oneness of humankind and the case for a One Health approach to global health, and urgent need for evaluation and strengthening of international organisations and systems to serve all people on our planet.

Such transformation requires considering the earth as one country and humankind its citizens, and a new social contract of ecological trusteeship, responsibility and respect with the earth and nature. ¹⁵