Download Toward a Sustainable Planet - University of California, Berkeley

Toward a
Sustainable Planet
By Christopher E. Bush
Today’s popular media and scientific journals are filled with dire predictions
about the year 2050 and beyond. Increasing CO2 emissions may raise the
planet’s temperature by 2 degrees Celsius or more. The world population
could stand at as high as 10 billion people in 40 years, putting a huge
strain on dwindling resources.
hese two factors—climate change and rapid
population growth—are interrelated, and
combined they pose a major threat to global
health. If unchecked, they’ll lead to drought,
starvation, disease, and dislocation that will affect
millions across the globe. And although people will suffer
everywhere, the poorest nations and individuals will be
particularly vulnerable.
Not just bad weather
These effects will have the greatest impact on
populations that are already vulnerable to disease,
particularly poor children in developing parts of the
world. “Climate change doesn’t invent any new
diseases,” says Smith. “It works to exacerbate existing
diseases, especially for those parts of the world that
already have a high background rate. To put it bluntly,
if you doubled child deaths from diarrhea in Berkeley,
you’d probably have to wait five years to find one extra
death. If you doubled child deaths from diarrhea in
Zimbabwe, you’d get 50,000 the first year.”
According to Kirk R. Smith Ph.D. ’77, M.P.H. ’72,
professor of global environmental health, the health
impacts of climate change can be divided into three
categories. First, there are the direct impacts: As global
warming triggers heat waves and stronger storms,
populations in affected areas will suffer the consequences.
Deaths and health problems caused by heatstroke and
storm-related injuries, damage, and property loss will rise.
Climate change’s third level of impact involves effects
that operate through human agency, such as food price
increases. The environment affects how societies produce
and distribute food, as well as human migration patterns.
For example, global warming causes water shortages
and sea level increases in some areas, which in turn
creates refugee populations and camps that spread
disease more rapidly.
But these catastrophic outcomes aren’t inevitable.
There is still a lot of low-hanging fruit—simple measures
that can have a positive impact in reducing climate
change, slowing population growth, and improving
health outcomes today and in the future.
18
Next, there’s a second level of effects brought on by
changes in the natural environment. For example, a
warming planet and shifting precipitation patterns can
allow diseases like malaria to spread further and faster.
Berkeley Health Fall 2011
FEATURE
But the largest threat Smith sees is malnutrition.
“Changes in agricultural production and their effects
on food prices will mean fewer people can afford the
food they need,” he says. “Both the World Health
Organization and the Intergovernmental Panel on
Climate Change have estimated that malnutrition will
be the biggest health impact from climate change.”
Hunger’s effect, however, isn’t easy to quantify.
“Predicting the malnutrition impacts of climate change
is tricky,” says Smith. “You have to project not only
the effects on agricultural production, but also how
society responds. But society hasn’t shown much ability
to deal with the current misdistribution of food
worldwide, so there’s no reason particularly to think
it’s going to do better in the future.”
Guaranteed benefits
Despite the prospect of climate change impacting their
people’s health, nations have been slow to respond
to it. Smith believes there are two main reasons for this.
First, although global warming will seriously impact
them in the long run, governments—especially those of
developing countries—often face more pressing issues.
They need to improve economic output, increase the
number of jobs, and tackle existing health problems,
for example. Second, because climate change and its
effects are so complex, some people still doubt a
direct connection between human activities, such as
burning fossil fuels, and environmental problems like
regional droughts.
To help overcome resistance to tackling environmental
change, Smith has spent much of his career examining
the issue of co-benefits. “One way to frame this is just
because climate change has come along doesn’t mean
that the old problems have gone away,” he says.
“But there are ways that you can move toward both
the goal of solving those traditional issues and reducing
environmental impact at the same time.”
“We used to call this a ‘no-regrets’ strategy,” he adds.
“When we encourage policies that give a short-term
health benefit in the context of a longer-term potential
benefit for climate, there are no regrets. Even if the
climate benefit turns out to be not so important, still
you’ve gotten the short-term benefit.”
One example of a co-benefits program Smith points to is
his work to reduce the negative health consequences of
household combustion. Home cookfires and wood- and
charcoal-burning stoves are a leading cause of respiratory
issues in many parts of the world.
Because they produce substantial particulate pollution
and CO2, often in poorly ventilated rooms, these stoves
and cookfires are a double threat. Women and children
who spend a lot of time indoors and breathe the particulate matter are susceptible to breathing problems, and
greenhouse gas emissions increase global warming.
To combat these effects, Smith and colleagues have
focused on developing and providing low-emissions
stoves to families in developing parts of the world.
“You can increase combustion efficiency in two ways,
either by using better stoves or better fuels,” says Smith.
“You not only get a health benefit of a substantial size,
but also an environmental benefit, a reduction in the
risk of climate change.”
Working with a group of private companies and Sri
Ramachandra University in Chennai, India, Smith and a
team at the UC Berkeley School of Public Health recently
developed wireless monitors to transmit stove usage data
that help researchers assess effectiveness of the stoves
and the programs to disseminate them. The project,
which won the first-place $300,000 prize in the 2010
Vodaphone Americas Foundation Wireless Innovation
Project, is part of Smith’s efforts to provide a co-benefits
program that can positively impact both public health
and the environment in many parts of the world.
Changes in agricultural
production and their
effects on food prices will
mean fewer people can
afford the food they need.
Another example of a “no-regrets” strategy Smith points
to is giving women access to contraceptives. “When
that happens, there’s an immediate health benefit
because the two groups that most want to control their
fertility are young, unmarried women and older women,”
he says. “These are also the two groups that have the
highest rates of infant and maternal mortality.” Longer
spacing between births also has a direct health benefit
to children.
The co-benefit, he says, is the longer-term help for the
climate. Fewer people mean fewer greenhouse gasses.
A recent study published by the National Academy of
Sciences found that holding population growth to
7.4 billion by 2050 could reduce output of carbon dioxide
by up to 30 percent. “That’s a significant difference,”
continued on pg. 20
Berkeley Health Fall 2011
19
FEATURE
Sustainable Planet, continued
says Smith. “It shows that there are both health benefits
and climate benefits from just giving women the right to
choose how many children they have.”
The population divide
The relationship between reproductive rights and
population growth is central for researchers at the School
of Public Health’s Bixby Center for Population, Health,
and Sustainability. Professor Malcolm Potts, the Bixby
Center’s director, says that rapid population growth can
be slowed and that making voluntary family planning
universally available is the key to keeping the world
sustainable during the next 40 years.
“The world is now very divided demographically,” he
says. “There are a lot of countries, particularly in East Asia
and the developed world, where women are having
two children or fewer. But in a few countries, there is
exceptionally rapid population growth. Almost 95 percent
of population growth between now and 2050 will be in
the least-developed nations, and most of it will be from
unintended pregnancies.”
Potts believes that this division between the parts of
the world that have moved toward a low growth rate
and those where population is exploding—primarily in
Ndola Prata
areas such as sub-Saharan Africa, Afghanistan, and
Pakistan—is creating an unsustainable situation. “This
division is very bad for the world,” he says. “It’s bad
for the environment, and it’s bad for individual human
beings, who are suffering a lot.”
The good news, however, is that it’s a problem with
solutions. The Bixby Center has embarked on a number
of research projects and initiatives to improve education
about—and access to—sexual and reproductive health
options. “The two billion people living on $2 a day
or less are the ones who do not have access to the
family planning services and information that they need,
and they are having the unintended pregnancies,”
notes Potts.
Bixby Students in Action
As students, Henrissa Bassey M.P.H. ‘11 and Naomi Beyeler M.C.P., M.P.H. ‘11 spent time in
Nigeria helping launch projects for the Bixby Center for Population, Health, and Sustainability.
assey spent a summer piloting an
evaluation of the Girl-Child Education
Program, a project geared toward
delaying the age of childbearing among Nigerian
girls. “Research shows that girls who get married
early tend to have children early and are at higher
risk for negative health consequences,” Bassey
says. “If girls remain in school longer and have
increased educational opportunities, they
delay childbearing.”
Much of Bassey’s time was spent visiting schools
and collecting data about girls’ enrollment. She
20
Berkeley Health Fall 2011
also interviewed community members and the
girls themselves to gauge their feelings about the
program and family issues. “I would ask the girls
what the ideal age to get married was, because
a lot of them marry around age 14,” she recalls.
“They would say, ‘Do you want to know what I
think, or what my parents think?’”
Bassey, whose family is from Sierra Leone, is
working with her mother to launch a center there
for maternal and child health. She also plans to
eventually go to law school so that she can
integrate her public health skills with legal
training and ultimately write policies geared
toward underserved youth’s empowerment.
She is currently working at the Oakland
organization WestEd.
Beyeler was engaged in a different Bixby Center
project in Nigeria, this one focused on mothers’
groups and maternal care. “We started with a
model of group prenatal care where a health care
provider will see a group of women all at one
time and teach them how to do a lot of their own
care,” she says. In addition to improving maternal
health, the program also is designed to help
empower and build social support for the women.
In Ethiopia, as in many parts of sub-Saharan Africa, a
number of trends are exacerbating high population
growth, poverty, and poor health outcomes. Growing
urbanization, increasing incidence of premarital
intercourse, and biases on the part of existing sexual
health care service providers have combined to increase
the number of unintended pregnancies and related
morbidities and mortalities.
Karen Weidert M.P.H. ’10, an associate specialist at the
Bixby Center, is contributing to a survey of Ethiopian
youth about their preferences for receiving sexual and
reproductive health care services. The survey is aimed
at discovering how to combat these trends and find
the best ways to bring services to the people who need
them most. “There’s a lot of effort and money going
into different kinds of youth-friendly services,” Weidert
says. “But there’s not a lot of evidence about what’s
working. We see that some of these programs are
developed without asking the youth what they want.”
Also in Ethiopia, Associate Professor in Residence
Ndola Prata, the Bixby Center’s scientific director, is
leading research on the efficacy of making injectable
contraceptives more widely available. By training
community members—rather than just doctors and
nurses—to provide these contraceptives, women can
have much greater access and are more comfortable
about receiving them.
Almost 95 percent of
population growth between
now and 2050 will be
in the least-developed
nations, and most of it will be
from unintended pregnancies.
The Bixby Center is engaged in numerous other projects
across sub-Saharan Africa as well—in Tanzania, Zanzibar,
Ethiopia, and Nigeria—all aimed at improving reproductive
health and access to family planning resources.
A choice for change
Potts believes that being empowered with regard to
when and if to have children is a fundamental right. For
Bixby Center members, this belief helps steer their work
in reproductive health issues. “That’s a basic framework
in which we work,” says Potts. “To respect people and
continued on pg. 22
Henrissa Bassey and
Naomi Beyeler
Since her initial visit to Nigeria, Beyeler has
been back three times. She’s been collaborating
with traditional birth attendants to implement
a community-based surveillance system to track
health outcomes among women and infants.
Beyeler appreciates the opportunity the Bixby
Center has provided to help launch a new
program in Nigeria. “With a project like that, it’s
not only research,” she says. “It’s an intervention.
Being part of the planning and getting a project
started is an amazing experience.”
Berkeley Health Fall 2011
21
Sustainable Planet, continued
let them make their own decision. If somebody wants
to have six children, that’s fantastic. What we’re
interested in is the woman who doesn’t want to have
six children, but can’t exercise her right to have fewer
children because she can’t get hold of the information
and services.”
Weidert agrees. “We’re quite
focused on women having a
choice,” she says. “It’s their right
to have a choice when and if
they have children and how to
space them.”
All the evidence shows that
when women are offered ways to limit
their childbearing, family
Despite the progress that’s being
made, both Potts and Weidert
stress that there’s a huge, unmet
need for family planning that must be solved if
global population is to be maintained at a sustainable
level. They believe it is one of the top public health
challenges today.
Thirty years ago, Potts was among the first researchers
to sound the alarm about the potential devastation
AIDS would cause in sub-Saharan Africa. He believes
we are at a similar moment with regard to population
control. “In the Sahel on the border of the Sahara there’s
exceptionally rapid population growth—people are
having six and seven children. You’ve got abject poverty
and global warming is going to destroy what food
production they have in an ecologically vulnerable region.
I think in thirty years time there’s going to be as much
suffering in that area from population pressure and
climate change as there has been in the last thirty
years from AIDS.”
22
Berkeley Health Fall 2011
Both Potts and Weidert stress the importance and
urgency of giving priority to family planning. “All the
evidence shows that when women are offered ways to
limit their childbearing, family size falls,” says Weidert.
“That’s the only way to reach sustainable population
size falls.
levels. We just have to continue increasing access to all
forms of family planning, and give women the education
and choices they need.”
Potts asserts that the Bixby Center and the School of
Public Health can play an important role in helping the
planet achieve a sustainable population and healthier
future generations. “What a university can do is to get
in there early, look at the numbers, and project what is
going to happen,” he says. “We can design scientifically
valid studies and then work with somebody to get those
implemented. And then those people will take those
studies to senior decision makers and try and change
the policies.
“Sometimes it’s frustrating. You have to keep on
knocking on the same door. But that’s how change is
brought about. We’ve made it work in the past, and
we’ll keep on working it in the future.”