Answering poor health

Gro Harlem Brundtland outlines the links between poverty, health and the environment and recommends practical action.

Twenty-four years ago, as a young environment minister in Norway, I was called out at midnight to be informed that there had been a blow-out in the Ekofisk field in the North Sea. After an intense week of crisis management, the well was capped and, luckily, the environmental damage was less than we had feared.

The Ekofisk blow-out in Norway was a turning point for the Norwegian people and for its politicians. For the first time the environment was recognized as an issue belonging at the centre of the country’s economic development. The blow-out was not only a threat to birds and coastline – even though this was serious enough. It was a threat to our whole development as a nation.

Meaningful societal change starts when the economic impact of an issue is acknowledged and understood. During the 1980s, global recognition of the economic impact of environmental change meant that it became an issue of interest to world leaders and decision makers.

Through awareness raising by civil society and the media, the economic, political and social importance of environmental degradation has become an issue for voters, politicians and governments alike.

Since the 1980s there has been significant progress on environmental issues, with new global conventions, reduced pollution in many countries, and keen awareness of the value and importance of sound environmental policies.

There have also been less welcome developments. Emissions of carbon dioxide are increasing and current international actions are not sufficient to prevent significant changes in climate and sea levels.

Over the past three years, we have seen a similar ‘awakening’ of public awareness to the importance of health in development.

Global alarm
Sadly, it has taken the HIV/AIDS epidemic to raise global awareness of the link between economic development and health. United Nations Secretary-General Kofi Annan asserts that ‘AIDS can no longer do its deadly work in the dark. The world has started to wake up.’ Frighteningly, it has taken 22 million deaths and more than 13 million orphaned children to act as a global alarm clock. Today, there are 36 million people living with HIV/AIDS.

One leader in the war against HIV/AIDS was a boy from South Africa named Nkosi Johnson. Complications from AIDS took 12-year-old Nkosi’s life in June of this year, but not before he put a human face on the tragedy that is the AIDS pandemic. Nkosi was one face, a poor child suffering from AIDS. Every one of the 36 million people suffering from HIV/AIDS is a human being who deserves our compassion, commitment and action.

Economic drain
Beyond the suffering, diseases such as AIDS, malaria, tuberculosis (TB) and many childhood diseases have a direct link to poverty. On an individual level, getting ill can mean economic ruin for the 3 billion people who already scratch a living on less than $2 a day. On a national level, new research shows that diseases drain billions of dollars from the gross domestic products of developing countries.

To increase understanding about the relationship between health and development I formed the Commission on Macroeconomics and Health nearly two years ago. The Commission is due to produce its report at the end of the year, but it has already assembled powerful evidence indicating the sizeable role that health plays in determining the economic prospects of the world’s poor communities.

The burden of HIV is a heavy one. HIV prevalence rates of 10-15 per cent – which are no longer uncommon and are considered low for some regions – can translate into a reduction of GDP per capita of up to 1 per cent per year. TB, which is exacerbated by HIV, takes an economic toll equivalent to $12 billion from the incomes of poor communities.

Africa’s GDP would probably be about $100 billion higher now if malaria had been tackled 30 years ago, when effective control measures first became available. Today, half a billion cases of malaria each year lead to the loss of several billion days of productive work.
Health and environmental issues are coming together in a unified demand for sustainable development policies
Both health and environmental issues are coming together in a unified demand for sustainable development policies. Unless we take drastic action over the next couple of years, negative environmental and health trends will together threaten the lives of billions of people on Earth through disease, environmental degradation and natural calamities.

As we look to the future we are presented with two radically different scenarios. The choice of which will become a reality depends on the level of global political commitment and action.

The first scenario is one of nightmare proportions. We could see the spread of HIV/AIDS, TB and malaria and the increase of antibiotic resistance to existing treatments. Climate change could lead to the spread of diseases such as malaria outside its tropical domain, and an increase in extreme weather and natural disasters would both kill and cause disease. We could also face increased food insecurity.

Sadly, this is where we are headed today if we do not take immediate and meaningful action.

Global investment
The second scenario is a real and positive alternative. It is one where the mortality of the main infectious diseases, including malaria, TB and HIV/AIDS is drastically reduced through concerted global investment in health. Where issues such as global warming and serious pollution are dealt with by forceful international action. Where global negatives, such as the use, sale and marketing of tobacco and other dangerous substances or products are dealt with through internationally negotiated regulation.

I am optimistic that we can and will choose the second alternative. The fundamental shift in thinking among world leaders and decision makers toward recognition of the causal connection between poverty, health and the environment has led to positive action being taken at the highest levels of international decision-making. Leaders of developing and industrialized countries have joined together in calling for increased investment in health for the world’s poorest. The United Nations is spearheading the creation of a dedicated fund to combat HIV/AIDS, malaria and TB. The goal is to raise $7-10 billion in new money each year for at least ten years.

The new Global AIDS and Health Fund will quickly channel new resources, without undue bureaucracy, to projects that are proving to be effective. The approach is revolutionary and will reform the way in which we use development assistance.

Despite recent setbacks in the global effort to protect our environment, I am optimistic. I believe that the facts, together with the growing understanding of the impact of global environmental degradation, will eventually persuade our leaders to take the difficult decisions necessary to ensure that generations after us can live rich and good lives

Dr. Gro Harlem Brundtland Director-General of the World Health Organization.

PHOTOGRAPH: Zambelli Renato/UNEP/Topham

This issue:
Contents | Editorial K. Toepfer | Answering poor health | Tackling water poverty | Everything connects | Up the gross natural product | Stopping AIDS | Whose city is it anyway? | Nutrition | At a glance: Poverty | Competition | World Bank Special: ‘Double burden’ | It’s not just, pollution | Smoke and fires | Breaking the cycle of poison | Pharmacies for life | Viewpoint: Change – or decay | The environment: why we must not give up | World Atlas of Coral Reefs | GTOS: An eyeglass on our planet

Complementary articles in other issues:
Oral A. Ataniyazova: Ask us, involve us (Disasters) 2001
Kristalina Georgieva: Disproportionate effects (Beyond 2000) 2000
Madeleine K. Albright: Changing course (The environment millennium) 2000
Mark Malloch Brown: Empowering the poor (The environment millennium) 2000
Leslie Roberts: Focus: Environmental degradation (Oceans) 1998