Planetary Health – the need for a strong health sector response
Concerns for environmental health have been increasing, and with good reason. The Planetary Boundaries framework by the Stockholm Environmental Institute has illustrated the upper limits of environmental degradation on a regional and planetary scale (to keep the biosphere stable and habitable). However, as has been seen in the context of climate change, developed countries have taken the larger piece of the carbon pie. The same holds good for any other environmental boundary – be it chemical pollution, loss of biodiversity, or land use change. As Naomi Klein explains in her book “This Changes Everything”, environmental degradation has been driven by capitalism and neoliberal globalisation.
In the conversations on environmental ceilings and limits, the important dimension of “equity” should not be forgotten. Oxfam’s “doughnut” model tried to address this gap in the discourse. They included a social foundation or base (alongside the environmental ceiling) which indicated the importance for meeting basic needs of all people across the planet to lead a life of dignity. Therefore, social justice on Planet Earth can only be achieved if the rich consume less (through both overall reduction in consumption and increased efficiency of resource use). It is also important to remember, that the poorest are also most dependent on local environments for livelihood, food and water. Therefore, environmental degradation directly impacts their ability to survive.
Energy is a good case study to take up in the context of India. A large section of the population is “energy poor” (not connected to the grid, or use biomass as fuel in kitchen), and need access to modern forms of energy. There is also a large section of the population which consumes large amounts of electricity and fossil fuels. In effect, there is a need for increasing efficiency, increasing distribution and reducing luxurious and wasteful use. There may also be a need to increase production to an extent. The opportunity exists to address energy poverty by leapfrogging existing grid systems to create multiple local energy systems using renewable sources such as solar, wind and pico-hydro. Several models for such systems are already in place in India and abroad. These systems will also help to address indoor air pollution to some extent. In addition, there is scope for encouraging the adoption of home based solar systems in rich households – as they are reliable for lighting purposes at the least (and several devices, including industrial machinery are now being powered by solar). Keeping in mind the evidence that air pollution (let alone climate change) is a key determinant of mortality in India (and across the world), there is enough reason to stay away from coal and petroleum. One study from Bangalore showed that children from poorer families are more impacted by ambient air pollution than children from richer families. Also, the main action against climate change needed in India is to address poverty, increase access to resources among the poor (especially marginal farmers and the landless in rural areas), and create systems to manage resources appropriately. There is a need to break the vicious cycle of poverty, exposure to toxic agents, and illness.
The health community in India needs to give high priority to environmental health – not primarily for research, but for action and advocacy. If “Health For All” is a goal, then environmental health should be a major priority. There is a need for peer support for action within and across institutions. The Sustainable Development Goals have provided basis for such action nationally and internationally. The coming year, 2017, is as good a time as any to start.