Jonathan Patz: Meeting the Health-related Millennium Development Goals

We’ve made progress in some. For others, we’ve made no progress or have gone backwards. In general we have not come close to meeting these, but there are incremental gains.

The first thing is to not try to tackle them in isolation. When we have disconnected ministries — ministries of finance and development, ministries of environment, ministries of health — if those ministries are not collaborating, they will go off and do their one narrow area in some cases can have unintended consequences. So number one is to really move forward with systems thinking and understanding the interdependencies of all of these.

For the environmental sustainability goal, it is extremely important to understand its crosscutting effect. If we try to solve the other problems today with massive agriculture, unsustainable harvesting of resources like overfishing the oceans, or fouling our air quality as we’re trying to bring people out of poverty with economic development based on fossil fuels — if we are providing health for today’s generation without thinking toward sustainability of natural resources, we’re sacrificing the health of future generations for today’s health. And we don’t want to be in that situation.

Environmental sustainability cuts across most of all of the other Millennium Development Goals. If we were to reduce malaria and yet climate change and deforestation increase the risk of malaria in a certain area, we’ve undermined our progress. When you think of climate change’s effect on agriculture, heat waves, air pollution and infectious diseases — if we move forward on all these health fronts without solving the climate change problem, we might lose ground significantly, as climate change can affect all these issues. A recent study showed that globally climate could double the numbers at risk of malnutrition by the middle of this century from heat waves and crop failures. That’s one example of where the interconnections of all of the millennium goals need to be thought about.

My philosophy as a public health scientist is that the further upstream in the causal chain of disease you can intervene, the more people you’re going to protect. So the more you can have primary prevention — that is, either removing the hazardous exposure or making people immune to that exposure — the more people you’ll save and will benefit.

Many of our illnesses start way upstream, with how we design our cities, what is the air quality or water quality like, what is the social fabric of our communities. Rather than looking at simply the medical model — detect symptoms and treat — the further upstream we can get at the population health level, the better off we’re going to be in protecting the health of the masses.

It’s these types of upstream environmental population-based interventions that really I think are some of the most important toward reaching the Millennium Development Goals. And a lot of these interventions are multiple-win situations. Look at biking rather than driving: You’ve got personal fitness benefits, you’ve got air quality benefits, you’ve got person economic benefits, you also emit 4 trillion pounds less of CO2. When we look at the interconnections of these issues, we can see that there are multiple risks tied together, but there are also multiple solutions. If you do one thing, you can have multiple beneficial outcomes as well.

There’s a perfect example with climate change mitigation policies: REDD, reducing emissions from deforestation and degradation. If you preserve the forest, you have your CO2 sink for climate change mitigation, you’ve got an intact ecosystem for biodiversity. And you also are helping to regulate the emergence of malaria, because our studies show that deforestation in the Amazon increases the abundance of the worst mosquito vector in that region. So by protecting the trees you have multiple beneficial outcomes.

Now obviously there are trade-offs for everything. What about the potential income people could have if they cut these trees? This is where an interdependent, intergenerational perspective is so important. Because if you destroy ecosystems and you go sell the wood, then what happens to that land later? You’ve essentially eliminated a resource for the next generation. That’s what I’d call intergenerational inequity.

As we make public health gains in agriculture and nutrition and malaria eradication — if we ignore environmental factors, if we ignore the fact that climate change can increase the risk of malaria and waterborne disease and malnutrition, if we only focus on the acute problems without looking at these longer term environmental foundations upon which public health depends — clean air, clean water, intact ecosystems — if we ignore those, they’re going to bite us in the future.