Thursday, April 11, 2019

Global Environmental Outlook 6: a critique of its opening sentence

The 6th Global Environmental Outlook has been released. This is the most important written product of the United Nations Environment Programme, appearing approximately at 5 year intervals.

The opening sentence of the executive summary of the first chapter reads:

"Providing a decent life and well-being for nearly 10 billion people by 2050, without 
further compromising the ecological limits of our planet and its benefitsis one of the most serious challenges and responsibilities humanity has ever faced.” 

The part I have highlighted in pink is powerful.

However, the part in red is at best confusing and at worst logically false, and either way it conveys (no doubt unintentionally) complacency.

What do the authors mean by "compromising"?  One definition I found was "expediently accepting standards that are lower than is desirable"; e.g. we were not prepared to compromise on safety."

A possible alternative to "compromising" (in this sentence) is "approaching", or "transgressing". But the idea that human activities will not further (or additionally) approach - or come closer to - the ecological limits is sadly misconceived. Ongoing damage to natural capital is inevitable, given that population is rising and the poor have a lot of catching up to do in terms of per capita resource consumption. Even if we do not collectively breach limits, we will certainly come closer to them.

Alternatively, but more far-fetched, is the idea that the authors intend to convey that humans might alter the limits. Technically, if humans had far greater knowledge and technological capacity, they might be able to do this, such as changing the planetary boundaries - but most people rightly would think that is hubris, especially by 2050.

After working on this blog (for well over an hour!) I think the authors probably intended "compromising" to mean "approaching" or "transgressing". 

Another weakness of this opening sentence is that it does not mention the word "social". There are also social limits, such as were reached, only yesterday, when  the Sudanese President was overthrown, in part because of increasing civil unrest due to reduced prosperity in part due to falling oil revenues - even though, officially, per person income in Sudan is suppose to be increasing.

So, the sentence would be clearer if written as:  "Providing a decent life and well-being for nearly 10 billion people by 2100, without pushing demands on ecological and social capacity beyond irreversible thresholds, thus triggering immense harm to human health and well-being on a planetary scale, is an immensely difficult challenge.” (Key changes italicised).

Note that I changed 2050 to 2100. It will be difficult to avoid these thresholds, on a global scale, by 2050, but perhaps not "immensely" so. It is possible that the buffers that separate us from those limits are wider than we currently appreciate, even though an increasing number of cases of "regional overload" are occurring, such as those described in the Global Report on Food Crises 2019. By 2050 we will definitely come closer to these limits, but we may nor critically exceed them - if we are lucky and work hard. But the challenge to avoid such limits by 2100, even if we greatly reduce greenhouse gas emissions, will be much harder, as climate change is but one aspect of the many challenges that civilization faces.

Wednesday, April 3, 2019

My encounters with philanthrocapitalism


My first paper on philanthrocapitalism and planetary health has recently been published (abstract below), and I am now  working on an offshoot, mainly about the Bill and Melinda Gates Foundation (BMGF) and its approach to malaria, polio and Ebola, aiming for the Journal of the Royal Society of Medicine. This evolving paper will also discuss complexity theory and how the focus of the Gates Foundation on "vertical" health programmes may be necessary but is far from sufficient. This paper will be adapted from a section of about 1,500 words, cut from the original paper, which is pretty long, even without it.

Most of the section below (A-E) was also cut from the published paper, mainly because one of the journal's anonymous reviewers took offense to it (and much else!) It has today been modified with two endnotes.

My own encounters with philanthrocapitalism

I have had several encounters (or near-encounters) with philanthrocapitalism, especially the Bill and Melinda Gates Foundation, its richest and most powerful variant. 

A. In 2015 I attended the World Congress of Public Health, held in India, a “developing” country. The keynote speaker in the opening session was an economist, employed by the BMGF national office. I remember being frustrated by the speaker’s conventional, non-ecological approach; a feeling that set the tone for a disappointing meeting. I recall reflecting that the speaker’s prominence was unsurprising, given the extent to which the BMGF had underwritten the meeting. But I did not then know that, in 2005, Bill Gates had been a keynote speaker at the 58th World Health Assembly, the annual showcase of the World Health Organization (WHO). Gates’ invitation, an unprecedented honor for a non-head of state, had, soon after, prompted the Peoples’ Health Movement to call for the Microsoft Corporation be declared an honorary ‘member country’ of WHO. See endnotes (1) and (2).

B. Someone I know was contracted by the BMGF to work in China. A condition of their employment was a clause preventing publication of any data conflicting with that officially approved by the Chinese government. 

C. A malariologist I know recently wrote to me to the effect that much of what he (and I) were taught by professors of malariology is now disregarded, though not due to improved evidence. 

D. Earlier, I collaborated on a paper indirectly critical of the BMGF’s claim to be able to eradicate malaria. The paper was eventually withdrawn, in order to not place at risk the funding of an institution which one of my co-authors was then directing.

E. The BMGF also funds thinktanks, including the International Food Policy Research Institute (IFPRI). In 2005 I was an invited speaker to an IFPRI meeting. My subsequent paper was rejected, without external review. I thought then that the probable reason, though unstated, was that my paper was too critical of neoliberalism (market preferring solutions).


My paper is also critical of the Wellcome Trust, mainly for its investment in tax havens and for its view that it is acceptable to invest in fossil fuels (see for example, which states in part: 

"In 2015 more than 1000 doctors and other health professionals signed a letter calling on the Wellcome Trust to stop investing in shares in coal, oil, and gas, but it refused. The charity has a massive investment portfolio which was then worth £18bn. The letter argued that not divesting legitimised an industry that had made no pledges to act on climate change.

A Wellcome spokesperson said, “The range of individuals and organisations working to improve human health is wide, and it would be surprising if this community did not contain a diversity of opinion about how best to reduce carbon emissions. The Wellcome Trust believes that engagement with the small number of energy companies in which we invest gives us the best opportunity to contribute to change, but we understand and respect the views of those who disagree.” 

Points F and G were not in the original draft:

F. I have been involved in two Wellcome Trust grant applications, one of which I led, and one job application. My personal experience with the Wellcome Trust has always been positive. Apart from its investment policy I still have great admiration for their achievements, and unlike the BMGF they have at least partly awoken to the risk to global health from failing "planetary health." 

G. I have never applied to the Gates Foundation for funds, but will send them my paper, and an exploratory letter, on behalf of Health-Earth


Focusing on the Bill and Melinda Gates Foundation (BMGF) as a case study, this paper explores the relationship between philanthrocapitalism, economic history, and global and planetary health. The Wellcome Trust is also briefly discussed, chiefly in the context of planetary health. The paper argues that in the last 45 years there has been an increased preference for market-based approaches, often called neoliberalism, particularly in the U.S. and its allies. This has generated greater inequality in many high-income settings and weakened the norm of taxation. This has provided a setting in which philanthrocapitalism has flourished, including the BMGF. The latter has in turn become an important actor for global health, partially balancing the adverse consequences of neoliberalism. Planetary health is here defined as the interaction between global health and global environmental change, including to the climate and other elements of the Earth System. Although the Wellcome Trust has recently made funds available for ecological health research, it continues to invest in fossil fuels. The Gates Foundation provide no or minimal grants for ecological or planetary health but appear to have recently substantially divested from fossil fuels, for unclear reasons. The paper concludes that these large philanthrocapitalist organizations partly compensate for the decline in attention to global health driven by market-preferring solutions, but remain insufficiently proactive in the face of the great dangers associated with declining planetary health. 

1. The original link to this ( is currently invalid, but it is cited in Gavin Mooney's book "The Health of Nations: Towards a New Political Economy" (Zed Books, 2012).

2. A press statement by the Peoples' Health Movement in 2014 complained not only that Bill Gates had been invited to address WHO in 2005, but that this high honour was extended to he or his wife twice more. It reads, in part, "It is unacceptable that the WHO, supposedly governed by sovereign nation states, should countenance that at its annual global conference, the keynote address would be delivered thrice in ten years by individuals from the same private organization, and from the same family.

The BMGF is the second largest funder of the WHO. It has come to occupy this place over the past two decades, because of the freeze on assessed contributions by member states. Currently, 80% of WHO’s finances come from voluntary contributions (including from countries and from private sources) and BMGF’s funding is ‘tied’ to projects that the foundation has an interest in funding.

BMGF’s munificence towards the WHO as well as towards many other global health causes is well known. Less well known is the Foundation’s investment policies that are clearly in conflict with global health."

Wednesday, February 6, 2019

Tasmanian fires, climate change, and reflections on petitions

The catastrophe of fires and climate change in Tasmania

Richard Flanagan is probably the most famous living Tasmanian, known for his 2014 Booker Prize  and his many essays critical of the abuse of power. He was once called “a traitor to Tasmania” in the Tasmanian parliament, and later told by the then premier that he and his writing were “not welcome in the New Tasmania” after he published an essay critical of the culture of the state Labor government of the day. 

Yesterday (Feb 5, 2019), Richard published a typically eloquent essay; this time about climate change, government apathy (his sub-title was "those in power laugh at us", referring especially to the current Australian prime minister's highly visible support for coal) and, the terrifying, health-damaging fires in Tasmania, which for the third time in six years (2013, 2016, 2019)  are devastating parts of the state. The current one seems the worst, and its health impact will be greatly magnified by smoke inhalation, in an island which already has a high rate of asthma, especially in indigenous children.

My petition and its complications (updated Feb 7)

A few days before Richard's essay was published I started a petition. This calls for the Tasmanian government, led by Liberal premier Will Hodgman, to play a more active role in educating the Tasmanian people about climate change. Although it is now clear, including in Tasmania, that the climate has changed (mainly due to greenhouse gas forcing), there is still time to reduce even worse consequences. In the three decades I have been researching climate change, mainstream politicians, whether socially conservative or left wing, have largely missed the point. Overwhelmingly, they have been indifferent to the arguments made by the environmental movement that adequate environmental resources are necessary for human well-being. We are steadily eroding our environmental buffer, in a process I call "environmental brinkmanship".

I have signed petitions before, but never initiated one. I used a web platform called "". According to their FAQs I was supposed to be notified via email once my petition became "promotable", presumably when it reached a threshold (as far as I can tell, the number is not stated on their website, but an email received Feb 7 advised that the number was 500 - however, when I discovered they were using my petition as a vehicle to raise money for themselves and their allies the number who signed was less than 300). Even now, (i.e. Feb 7) I have not received such notification, and the number who have signed exceeds 500.

When I accidentally discovered that people who signed this petition were being asked for money I felt deeply embarrassed. I now realise, after reading the fine print, that I could have asked for this fund raising option to be disabled, but not by ticking a box (which would have alerted me to its possibility) but instead by writing to their help section. I believe the box option would be more ethical.

I asked if they could contact the donors to offer a refund, but they declined, though they stated that they will make a refund if donors contact them. They suggested that I do this by posting an update. I will also try to contact some of the people who gave money; I think I have identified some by capturing their names, and in some cases facebook pics, as they flash past. I hope this update might reach some of them. is a profit-seeking company, and they provided a service to me for which I did not pay. But if they made this donation feature more transparent many would still agree; would still make money.

I am trying to find out what happens to these funds if the donated sum cannot be returned. At the moment, it seems that the funds raised can only be spent on advertising the petition (i.e. all the donated funds go to the company and its allies with whom ads can be placed). If this is correct then I am in a "lose lose" position. That is, I either spend the money on advertising, or the money is lost (and presumably goes to - I have written to ask them, and will update this blog if I learn more). Either way, I feel the donors have been ripped off and I sincerely apologise.


I have long felt ambivalent about petitions, now I feel distinctly uncomfortable, at least for those on This article also expresses concern, while this one sheds more light on their tactics and profitability. presents itself as an ethical business, and I don't mind if they make a profit. But I don't like the way they currently operate. 

If you have read this far, thank you. Please consider signing the petition, but please do not make a donation unless you want to give money to If you want to use your hard earned money to bring about change in Tasmania (and don't have time to directly contact a politician or use another method that takes time) then you might consider donating to an independent climate change lobby group such as the Climate Council. Or, you could donate to a charity such as the Red Cross that helps people harmed by fires and other emergencies (including in Tasmania), and which is also aware of how climate change is increasing the risks of disasters.

You might also reflect on this plea by firefighters for us all to take climate change far more seriously. It says, in part:
“Having just spent a majority of January supporting firefighting operations in Tasmania and New South Wales, I have seen the exhaustion that firefighters power through to battle increasingly uncontrollable fires, and the fear, anxiety and loss that communities suffer,” he said.

Thank you.

Friday, February 1, 2019

An appeal to the Tasmanian government to better recognise the links between fire and climate change

Tasmania is experiencing terrifying, health-damaging fires for the third time in six years (2013, 2016, 2019). The nature and risk of fires has changed in many countries, due to climate change; in Australia's island state the climate is hotter, drier and there is more dry lightning. The Tasmanian Fire Service website is excellent, yet climate change is barely mentioned. It needs to be a major subject heading, to help educate an uncertain public. The absence of climate change as a prominent theme on this site may reflect ambivalence or even attempted suppression of this issue by the Tasmanian government. This is not good enough. Please help us convince the the Tasmanian government to be part of the solution, not add to the problem.

Some politicians claim that making the link between climate change and tragedy is insensitive, but keeping silent on this issue would be like a doctor ignoring the smoking behaviour of a patient who just had a heart attack.

Climate change also threatens to greatly harm the summer tourism industry in Tasmania. Tasmania, which is already a world leader on carbon neutral electricity, must awaken to the many risks caused by climate change and, led by its democratically elected government, do what it can to reduce those risks.

Please sign and circulate the petition, and also write directly to Premier Will Hodgman at


It was my experience of being awoken by the smell of smoke, in the Tasmanian forest, in the heatwave of January 2103, which made me decide to be arrested for civil disobedience about the collective failure of Australians to do enough to slow climate change. In 2014 I became the first (and so far only) Australian contributor to the Intergovernmental Panel on Climate Change (IPCC) to have been arrested for civil disobedience on this issue, and the first (and, also, so far only) contributor to the health chapter of the IPCC.

Unfortunately, mainstream media almost completely ignored this at the time, with one exception.

Saturday, January 12, 2019

BODHI, the Bahujan Hitay Pune Project, and the ongoing work of Dr Ambedkar

In June 2019 the 16th Sakyadhita conference will be held, for the first time ever in Australia. See here for details. These are large meetings; the previous one, held in Hong Kong in 2017, attracted about 800 attendees from 31 countries. BODHI Australia will be attending this meeting, represented by at least 4 committee members and one partner, Karunadeepa. Below is the summary of our paper, and below that is our current draft of the full paper.

The paper is designed to be read; some repetition is deliberate

Authors: Maxine Ross, Karunadeepa, Emilia Della Torre; Colin D. Butler

Summary: In 1956 the great reformer Dr Bhimrao Ambedkar led, in Nagpur, India, a mass conversion to Buddhism, involving at least 300,000 people. Millions more have since converted in an ongoing social movement, still keenly needed, reaching for greater justice in India, particularly for women, and particularly for Dalits, once called “untouchables”. Since 2005 the NGO BODHI Australia (founded in 1989) has supported the work of a team led by Karunadeepa, a Dalit whose grandfather took part in the historic Nagpur conversion, and who for decades has worked for an Indian NGO, based in Pune, India, itself largely supported by the UK Karuna Trust, allied with Triratna, whose founder (Venerable Sangharakshita) first met Dr Ambedkar in 1952. The work BODHI Australia has supported with Karunadeepa and her team mainly seeks to enhance the life-chances of slum-dwellers, especially migrants from rural Maharashtra (not necessarily Dalit, nor Buddhist) by improving education, health and awareness of family planning. In 2017 Karunadeepa, with Dalit colleagues, started to develop a new NGO, the Bahujan Hitay Pune Project, entirely governed by Dalit women, which will extend and deepen this work, but which also presents new challenges. In this talk, Karunadeepa, during her first visit to Australia, will discuss these activities, together with representatives of BODHI Australia. BODHI’s work to support Dalit-led and other development-promoting projects in India may seem a drop but can also be seen as a key to inspire, to resist oppression, to support development and to assist escape from poverty and vulnerability.
Dr Ambedkar. original source unknown
Full paper:


This paper starts by acknowledging the traditional owners of the land this conference is held on, the Gundungurra, the Indigenous people who have thrived on this continent for at least 65,000 years. The authors of this paper are all apprentices of dharma. Between us, we have been exposed to about two centuries of close contact with Buddhism. One of us (Karunadeepa) was born Buddhist. However, none of us claim, or admit, deep knowledge of Buddhist scholarship. We thank the organisers of this historic conference for the opportunity to speak and to be published in this setting, alongside the work of people with far more scholarly knowledge of Buddhism than we will ever have.
The main motivation for this talk and essay is to provide information about the work of some followers (in Pune, India) of Dr Bhimrao Ramji Ambedkar, who lived in India from 1891 until 1956. Dr Ambedkar was 65 years old when he died, coinciding with the Buddha Jayanti festival, to honour Buddhism’s 2500th year. The Dalai Lama first arrived in India, mainly to attend this celebration, only a few days before Dr Ambedkar died.

Add caption
The traditional Buddhist dharma wheel, representing interdependence and liberation, was added to the Indian national flag at Dr. Ambedkar’s suggestion. Here it is on a stamp, issued to celebrate 2500 years of Buddhism. Source

While three of us were not born Buddhist, an important reason for our attraction to it is its links with social justice, or fairness, including its rejection of the principle that hereditarily transmitted inequality is legitimate. A basic teaching of many religions (maybe all of them) is the principle of cause and effect. In both Buddhism and Hinduism this principle is called karma, yet the dominant group in each of these two faiths, otherwise quite similar, appears to have a drastically different interpretation of this principle. Because we are not scholars, even more than from lack of time, we cannot trace these differences to early teachings. Instead, the observations in this paper are based mainly on our own personal experience, and our understanding of world events, both today and in the fairly recent past.

Whether or not there is a future life, the three authors of this paper, not born Buddhist, have all been, at various times, intensely moved by the unfairness of the social world, as was Dr Ambedkar, born a Hindu, but who converted to Buddhism in October 1956. This was in Nagpur, Maharashtra, in central India, at a mass gathering attended by over 300,000 people, one of whom was a grandfather of the fourth author of this paper, Karunadeepa, the only one of us who was born Buddhist.

In Australia, even among those of European descent, much inequality is passed through the generations, and along family lines, by privilege and unequal access to opportunity. Many people who are wealthy went to exclusive, expensive schools, where, in time, they send their own children. It is well-known, and not just allegation, that many rich people do not pay a fair share of tax. Mackenzie Bezos, the soon to be divorced wife of Jeff Bezos, the founder of the company Amazon, is reported to be due to receive almost US$70 billion in her divorce settlement. In so doing, she will become the richest woman in the world. Bezos, himself, is reported to have humble origins, the son of a teenage mother and a father who has been described as “deadbeat”. But his example of transition from hardship to fabulous wealth is more the exception than the rule.

Dr Ambedkar, who served as Law Minister in the first Indian government in 1947, was also exceptional. This was not through extraordinary entrepreneurial skills and alleged “robotization” of employees (the Bezos route), but from an vigorous and courageous intellect, some protection in childhood (due to descent from several generations of soldiers, including his father who rose to be an officer, in an army whose British leaders were far less caste-conscious than most Indians) (1) and hard work. Timing and history was also important. Ambedkar became a leading public figure through his central role in the struggle for Indian independence from Britain, recently reported as plundering the equivalent of $45 trillion from India during its long occupation (2).

We said that Dr Ambedkar was born Hindu. More accurately, as a member of the Mahar caste, he was born “untouchable”, meaning that close contact with him (even if indirect) was considered, by orthodox Hindus, to pollute or contaminate those who were conditioned, usually since birth, to consider themselves “higher born”, such as Brahmins.

For example, as a schoolboy, Ambedkar not only had to sit in a separate section at school (sometimes outside) but could not touch the tap if he was thirsty. In order to drink, a peon, considered “touchable” had to be found to turn it on.

Once, while travelling to visit his father, Ambedkar, aged 9, with a brother and two young nephews, all children, were stranded for over an hour at the station (following their first ever train ride), waiting for a servant that never arrived. The stationmaster was at first sympathetic to four well-dressed children, until discovering their lowly caste. Eventually, however, he helped them to find, with difficulty, a bullock cart driver, who agreed to take them to their destination, for twice the normal fee. But this was on condition that the children acted as driver while the driver walked, for fear of caste “pollution”. En route (on an overnight journey), as part of a harrowing ordeal, they were refused water (3).

Reflecting on this, Ambedkar wrote: “it left an indelible impression .. before this incident occurred, I knew that I was an untouchable, and that untouchables were subjected to certain indignities and discriminations.        All this I knew. But this incident gave me a shock such as I had never received before, and it made me think about untouchability--which, before this incident happened, was with me a matter of course, as it is with many touchables as well as the untouchables.

To non-Indigenous Australians the idea of caste might seem ludicrous. But there are traces of the caste system here too. We see it in films of past European royalty, and there are echoes in Australia’s treatment of asylum seekers and in the different punishments for white collar (executive) crime compared to those committed by blue collar wearers (working class). Discrimination based on skin colour, religion or age is officially banned (but persists) in Australia, though discrimination based on ability to pay is everywhere. We are nor arguing against laws and punishment, we are instead proclaiming support for the need for a fairer world, including of more equal opportunity.

Today, in India, the injustice of caste is milder, especially in urban areas, than in Dr Ambedkar’s time. This is partly due to Dr Ambedkar, partly to increased Westernisation of affluent Indians, and partly the work of liberal Hindus, such as the Ramakrishna mission. But chiefly, it is from the struggle and inspiration of tens of millions of people (sometimes called Dalits) who have renounced the legitimacy of caste as a concept. Karma may still exist, but it no longer can be unquestioningly interpreted as meaning, at least in India, that parental status and income completely determines one’s life course, though, naturally, the culture that children are reared in has a powerful “throwing” effect.

Many injustices still exist, in India and elsewhere, including for millions of “tribal” people. One group, seeking to reduce this injustice, and inspired by the teaching and legacy of Dr Ambedkar, is led by Karunadeepa. In 2017, with colleagues, almost all of whom are women, Karunadeepa started to develop a new non-government organization (NGO), called the Bahujan Hitay Pune Project. Since 1982, this work has been undertaken under the umbrella of a larger NGO, the Trailokya Baudha Maha Sangh Gana, but the time has come for a new, legally distinct group.

Bahujan refers to the people in the majority, meaning in India, “Scheduled Castes, Scheduled Tribes and Other Backward Castes”. Bahujan Hitay roughly translates as “for the welfare of many”. The work of the Bahujan Hitay Pune Project is principally with disadvantaged slum dwellers (scheduled castes and scheduled tribes) in this city of about six million, in the sprawling state of Maharashtra, parts of which are afflicted by drought and accompanying desperation, including farmer suicide. Consequently, many people migrate to Pune, seeking better conditions.

This work in Pune has, since 1982, been supported by the Karuna Trust a British charity founded by the late Ven Sangharakshita, who, as young man seeking to work for the good of Buddhism, based mainly in Kalimpong, in the Himalayan foothills, met Dr Ambedkar three times, including shortly before his conversion (4). Since 2005, this work led by Karunadeepa has also been supported by two NGOs with an Australian connection. These NGOs (BODHI and BODHI Australia) were co-founded by Colin Butler and his late wife Susan, in 1989. Since then, these groups have raised and distributed about A$0.5M to partners in six countries in Asia, mostly in India. The acronym means Benevolent Organisation for Development, Health and Insight. BODHI Australia also helps to support the Aryaloka Education Society, a Dalit-led NGO, based in Nagpur, which teaches basic computing skills, mostly to young women from poor villages.

In this talk, Karunadeepa, during her first visit to Australia, will discuss some of the activities of the Bahujan Hitay Pune Project. Four members of BODHI Australia’s committee, in addition to Karunadeepa, are attending the whole conference, and they hope to learn from and gain inspiration and encouragement from other individuals or NGOs engaged in similar development work.
Mrs Rubina Khan who trains slum dwellers in beauty therapy and hairdressing trainer. With permission.These three photos were taken in Pune, Maharashtra, India, in March 2018 (by Colin Butler)
Mrs Sushma Chavan, an assistant teacher in the an assistant teacher at the Hadaspar balwadi (kindergarten) (Pune), with her two daughters.

The boy (Aniketh) is soon to have surgery - provided for free by the Indian government. 

Whether or not there is a future life, we believe that the creation of good karma is important to try to reduce suffering, in this life. In our understanding of Buddhism, core values are compassion (karuna) and wisdom (panna or prajna), while the first Noble truth refers to the reality of suffering, not only of the perceiver, but also of others – human, animal and even Nature herself.

In the three decades of BODHI’s work the barriers facing partner organizations, in order to receive foreign funds have worsened. This steepens the challenge to reach the poorest people and to promote genuinely long-lasting development. But there is still great need. We ask for your support, either directly, or in many other ways.


1.  Queen C. The Great Conversion. Dr. Ambedkar and Buddhist Revival in India. Tricycle. 1993.
2. Patnaik U. How the British impoverished India. Hindustan Times. 2018.
3. Ambedkar BR. Waiting for a visa. In: Moon V, editor. Dr Babasaheb Ambedkar: Writings and Speeches. Bombay, India: Education Department, Government of Maharashtra; 1993.
4. Sangharakshita U. Ambedkar and Buddhism: Windhorse Publications; 1986. Free pdf of book here.

Sunday, October 14, 2018

Climate change, health and existential risks to civilization: a comprehensive review (1989-2013)

International Journal of Environmental Research and Public Health (published October 16, 2018)

See here for full text (open access)


Background: Anthropogenic global warming, interacting with social and other environmental determinants, constitutes a profound health risk. This paper reports a comprehensive literature review for 1989-2013 (inclusive), the first 25 years in which this topic appeared in scientific journals. It explores the extent to which articles have identified potentially catastrophic, civilization
endangering health risks associated with climate change.  

Methods: PubMed and Google Scholar were primarily used to identify articles which were then ranked on a three point scale. Each score reflected the extent to which papers discussed global systemic risk. Citations were also analyzed.

Results: Of 2143 analyzed papers 1546 (72%) were scored as one. Their citations (165,133) were 82% of the total. The proportion of annual papers scored as three was initially high, as were their citations but decline to almost zero by 1996, before rising slightly from 2006.

Conclusion: The enormous expansion of the literature appropriately reflects increased understanding of the importance of climate change to global health. However, recognition of the most severe, existential, health risks from climate change was generally low. Most papers instead focused on infectious diseases, direct heat effects and other disciplinary-bounded phenomena and consequences, even though scientific advances have long called for more inter-disciplinary collaboration.

Keywords: citation analysis; civilization collapse; climate change; comprehensive review; conflict; existential risk; famine; global warming; global health; migration

Sunday, October 7, 2018

Climate change, health and categories of effects

I wrote this for another paper, currently under review. However, it was cut, due to lack of space. Eventually, I hope to weave this material into another article, and also into the forthcoming second edition of my edited book “Climate Change and Global Health”. This also builds on a blog I posted in 2015 called “Climate change and heath: primary, secondary and tertiary effects.

1. Primary and secondary effects

The first categorizations of the health effects of climate change and health appeared in the early 1990s. Principally these identified two broad kinds of effect, most often called “direct” (such as from heatwaves, reduced cold or physical trauma from a more powerful storm) and “indirect”, such as from ecological shifts leading to an altered distribution of vectors (such as mosquitoes) or of food sources (see tables 1,2).

Table 1. There are many classifications of the health effects of climate change. This is one suggestion for the most obvious, least contentious effects. All of these effects interact with other factors, such as governance, infrastructure, technology and economic and other capabilities.

Heat stress, heat stroke (including occupational); heat stress resulting in impairment of chronic diseases (e.g. multiple sclerosis, cardiac or renal failure) or death, possible fetal abnormalities; in some cases improved health from reduced cold
Physical and or psychological harm and trauma from an intensified storm, flood, fire or other extreme event, such as drought or a storm surge
Long-lasting psychosocial effects from exposure to a climate change aggravated extreme event including post traumatic stress disorder, depression, loss of place and “solastalgia
The burden of disease of “direct” (“primary”) effects can be severe, as with the tens of thousands of excess deaths attributed to heatwaves in France in 2003 [1] and Russia in 2010 [2]. The burden from excessive heat is likely to substantially increase, especially if the Paris commitments are not met. Regions in which hundreds of millions now live are forecast as at risk of large-scale human abandonment late this century, including the North China plain and parts of the Middle East [3,4]. Looking further ahead, if urgent action to slow climate change by accelerating the energy transition is further delayed, substantial regions of the globe could experience wet bulb temperatures of 35 degrees or more, calling into question the habitability of even more some regions [5].
The burden of disease of the secondary effects (see table 2) of climate change, particularly of infectious diseases such as malaria, has long been forecast as significant [6]. However, although it is likely that climate change has increased cases of malaria in some settings, especially in highlands [7] the overall global burden of malaria has declined substantially in recent decades, mostly because of the increased use of insecticide impregnated bednets and more funding [8]. Note however, that such progress has recently stalled, especially in parts of sub-Saharan Africa [9]. I am unaware of any recent attempts to estimate the global burden of disease of malaria or other infectious diseases attributable in part to climate change, although a recent editorial in Geospatial Health provides an excellent summary of the key issues [10].

Table 2. Climate change has many less direct effects, which can be called “secondary”. Few if any of these are controversial. These effects also interact with other factors, such as ecological change, governance, trade, infrastructure, technology and economic and other capabilities.

Vector borne diseases (eg malaria, dengue fever, yellow fever, chikungunya, Zika), non-vector born zoonotic disease (e.g. schistosomiasis, Ebola, HIV/AIDS); other infectious diseases (e.g. gastro-enteritis, soil transmitted helminthiases)

Impaired food or water safety (microbial or toxic), reduced food diversity; reduced micronutrient concentrations in crops (due to higher CO2 levels)

Allergies, including thunderstorm asthma; asthma
Cardio-respiratory-neurological effects, such as from worsened tropospheric air pollution, or from climate change aggravated fires

Reduced food sovereignty, reduced micronutrient intake, but without the threat of starvation
Impact on other chronic diseases, such as cardiac failure, diabetes

2. Tertiary effects

Two papers, each published in December 1993, identified a third category of health effects, which the authors called “tertiary” [11,12] (see table 3). One paper stated “indirect effects are secondary, such as changes in vector-borne diseases or crop production, and tertiary, such as the social and economic impacts of environmental refugees and conflict over fresh water supplies”. The other paper additionally noted that: “There is a considerable literature on the effects of climate on disease which focuses principally on the primary effects of temperature on health. In relation to global climate change, however, it is likely that the secondary and tertiary impacts will outweigh the importance of the primary effects” [12].

This idea of a third major category of health effect has not yet been widely accepted. A 1996 book on climate change and health mentioned “more diffuse” effects including conflict and population displacement, but grouped these with indirect effects, rather than as a separate category [13]. An assessment for the U.S. National Assessment on climate change and health, published in 2000, identified five categories of health outcomes [14]. These were related to temperature, to extreme weather events (storms, tornadoes, hurricanes, and precipitation extremes); to air-pollution, and to two categories of infectious diseases. In turn these were each divided into two kinds; related to water and food, and vectors and rodents. This report did not discuss migration, social disruption, or conflict, perhaps because its scope was restricted to that of the U.S.

As mentioned above, it has long been understood that climate change can influence important social consequences (with health effects) such as population displacement, conflict and malnutrition. Malnutrition refers both to undernutrition (e.g. stunting, wasting and at its most extreme, death) and, also, to obesity and other problems associated with excessive calorie intake, sometimes (also) associated with micronutrient deficiency. Two of these effects (malnutrition – albeit probably meaning undernutrition – and conflict) were mentioned in the the first article I know of about climate change and health, published in the peer reviewed literature, a 1989 editorial in the Lancet [15], while Alexander Leaf, also in 1989, discussed both population displacement and the possibility of increased hunger [16].

These effects may also be considered tertiary not only because they are the least direct, but also because of their capacity to harm health is at such a large scale. For example, the conflict in Syria, which several experts think was contributed to by the most severe drought in its instrumental record [17] has displaced millions, had profound geopolitical effects in Europe, and killed hundreds of thousands of people, including children. The health effects upon survivors, both physical and mental, both in Syria and for those displaced, are undoubtedly immense [18]. Of course, climate change is not solely responsible for this catastrophe, and its exact contribution is disputed [19,20]. The total health impact of the Syrian conflict is likely to far exceed that of the 2003 European heatwave, particularly as much of the health harm to Syrians is to infants, children and young adults, whereas deaths from heatwaves typically result in a comparatively low per person loss of disability adjusted life years, as it is primarily the already frail and elderly who die [21]. The morbidity and mortality from the Syrian conflict due to anthropogenic climate change is likely to already be very significant, even using a highly conservative causal attribution.

It has also been suggested that the 2018 crisis of refugees seeking entry to the U.S. from Central America has been exacerbated by drought (interacting with social and other environmental factors including inequality and high population growth rates), which in turn probably has a climate change contribution [22]. There are many other examples, already, in which climate change has been argued to contribute to conflict, undernutrition, migration and other forms of population displacement [23]. For example, Hurricane Maria, which directly killed 64 people in Puerto Rico, contributed to at least 4,000 additional deaths in the following four months, due in part to the interaction of the storm with an already vulnerable social and physical system, with large-scale and long-lasting damage to electricity infrastructure [24]. It also led to migration to the U.S., particularly by younger people and those more economically able. 

Table 3. This lists the most obvious “tertiary” consequences of climate change that will have significant health effects. As with the primary and secondary effects, these interact with governance, infrastructure, technology and economic and other determinants.
Increased hunger, starvation or famine (exceeding a reduction in nutrient variety)
Mass migration or population displacement, including from climate change aggravated events such as famine, drought, sea level rise, violence and intolerable heat
Large scale conflict (leading to physical and mental trauma, death and morbidity, including from damaged health systems)
Significant social and economic disruption, impairing health and/or health systems

In 2005 a paper written by health workers, published outside the health literature, argued that the global health effects of eco-climatic change could be classed into four categories; three equivalent to primary, secondary and tertiary (though the paper did not use these terms), and a fourth, which it called “systems failure”, a euphemism for global civilization collapse [25]. This paper also predicted that the loss in disability adjusted years for the third and fourth categories would exceed the first two.

A figure in a chapter on climate change and health published in 2007 in the third report of the Intergovernmental Panel on Climate Change (IPCC) also recognized three broad categories of health effects. It called these “direct”, “indirect” and via “social and economic disruption” [26]. However, the text did not discuss the third category.

In 2010 the terms (and closely corresponding concepts) of primary, secondary and tertiary were revived, in a paper, and later, an edited book that failed to identify the earlier use of these terms [27,28]. Also in 2010, a report for several U.S. government agencies [29] classified the human health consequences of climate change into eleven kinds. These were listed alphabetically as asthma, allergies and airway diseases; cancer; cardiovascular disease and stroke; alterations in normal development; heat-related morbidity and mortality; mental health and stress disorders; neurological diseases and disorders; nutrition and food-borne illness; vector-borne and zoonotic disease; waterborne disease and weather-related morbidity and mortality. The report discussed displaced people (such as due to Hurricane Katrina) as a cross-cutting issue. It also recognized the possibility of conflict, war (outside the U.S.) and extensive undernutrition, both domestically and globally.

The health chapter in the most recent IPCC report [30] also referred to three kinds of health effects of global warming. It called these “direct” (mainly from “heat, drought, and heavy rain”), “mediated through natural systems” (e.g. “disease vectors, water-borne diseases, and air pollution”) and “heavily mediated by human systems” (e.g. “occupational impacts, undernutrition, and mental stress”). The first two categories in this classification correspond with primary and secondary, but in the third category only large-scale undernutrition would be classed as a tertiary effect, as defined above.

In 2015 another major Lancet report was released [31]. It proposed that impacts can be “direct” (e.g. “heatwaves and extreme weather events such as a storm, forest fire, flood, or drought”) or “indirectly mediated through the effects of climate change on ecosystems economies, and social structure” (e.g. “agricultural losses and changing patterns of disease” and “migration and conflict”). It thus grouped “tertiary” effects with “secondary”, though it used neither term. A figure in that paper which outlined the main direct and indirect effects focused solely on what this essay suggests are more parsimoniously termed as primary and secondary effects.


Apprehension of what I prefer to call the "tertiary" health effects of climate change has always been the primary motivator for my writing and researching on climate change (since my first letter, published in the Medical Journal of Australia, in 1991) [32]. I have argued above that these potential aspects were apparent in 1989, when articles first appeared mentioning all major "tertiary" components. I have also shown that the term "tertiary" was introduced in two papers published in 1993, already a quarter of a century ago. 

Although there is increased recognition of these risks, the vast majority of the climate change and health literature continues to focus on issues such as heat, infectious diseases and allergies. Important as these issues are - and they are certainly are valid - I believe that their future burden of disease is likely to be dwarfed by that of the tertiary issues; conflict, population displacement and famine. 

In 2014, in a chapter in my edited book called "Mental health, cognition and the challenge of climate change [33] I published a version of the following figure. In the next issue of the book the figure may be adapted, so that the label for the x axis (the horizontal axis) reads 2030. In 2014 I suggested that it might take until 2050 for the high burden of disease of the tertiary effects to be accepted, but that book was drafted before as much was reported about climate change and conflict in Syria, although an early paper was published in 2014 [34}.

I fear, given the events of 2018 - the fires, the floods, the hurricanes and typhoons, and the ongoing population displacement, as well as a gradually increasing acceptance of the role climate change plays in conflict - that the time in which the overwhelming risk of the tertiary health effects of climate will be widely understood may well be before 2050.  On the other hand, the vast majority of articles in the climate and health field continue to completely ignore its existential risk [35].

The proportional burden of disease of primary, secondary and tertiary effects (averaged over the 21st century) and the approximate time when these concepts and their relative burdens are accepted.

A powerful opposing force, however, is not just denial, nor just the political factors that seek to repress any whiff of legal liability, and hence minimize the risk of future reparations. One way to suppress such exploration is to refuse to fund research into the possible links. I think another reason has evolutionary roots. People like to portray themselves as “good", even moral. Even the Nazis probably did .. so while on one hand populations fully support policies that contribute to unspeakable misery, on the other hand they deny the reality of the links between their behaviour and the more displaced effects, especially if they are harmful. If the causes can be ascribed elsewhere ("local politics in Syria, not environment") then we can feel better about ourselves. A good example is that most Australians support offshore camps for asylum seekers, claiming this is “humane” because “it saves lives at sea”.  However, my view is that the causation of this and other tertiary effects is multi-factorial. Developed countries have largely contributed to climate change, but there are also many local factors that have contributed to the war, famine, displacement, and the risks people take which see some drown at sea.  
However, the  pendulum on the causes of the tertiary effects of climate change is currently too remote from recognition of the role that high-income countries have played in these catastrophes [36}, already and in future. And some people increasingly understand that climate change and other forms of planetary overload [37] pose profound risks to human well-being in high-income settings, such as 15 year old Swedish climate activist Greta Thunberg, who also keenly appreciates the equity dimension (see figure).

A tweet from 15 year old Greta Thurnberg, posted October 7, 2018


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2.         Shaposhnikov, D.; Revich, B.; Bellander,T.; Bedada, G.B.; Bottai, M.; Kharkova, T.; et al. Mortality related to air pollution with the Moscow heatwave and wildfire of 2010. Epidemiology 25, 359-364 (2014).

3.         Kang, S.; Eltahir, E.A.B. North China plain threatened by deadly heatwaves due to climate change and irrigation. Nature Communications (2018).

4.         Pal, J.S.; Eltahir, E.A.B. Future temperature in southwest asia projected to exceed a threshold for human adaptability. Nature Climate Change 6, 197–200 (2016).

5.         Sherwood, S.C.; Huber, M. An adaptability limit to climate change due to heat stress. Proceedings of the National Academy of Science (USA) 107, 9552-9555 (2010).

6.         Martens, W.J.; Niessen, L.W.; Rotmans, J.; Jetten, T.H.; McMichael, A.J. Potential impact of global climate change on malaria risk. Environmental Health Perspectives 103, 458-464 (1995).

7.         Siraj, A.S.; Santos-Vega, M.; Bouma, M.J.; Yadeta, D.; Carrascal, D.R.; Pascual, M. Altitudinal changes in malaria incidence in highlands of ethiopia and colombia. Science  343, 1154-1158 (2014).

8.         Bhatt, S.; Weiss, D.J.; Cameron, E.; Bisanzio, D.; Mappin, B.; Dalrymple, U.; Battle, K.E.; Moyes, C.L.; Henry, A.; Eckhoff, P.A., et al. The effect of malaria control on pPasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207-211 (2015).

9. Alonso, P., and A.M. Noor. The global fight against malaria is at crossroads. The Lancet 390:10112 (2017).

10. Bergquist, Robert, Anna-Sofie Stensgaard, and Laura Rinaldi. Vector-borne diseases in a warmer world: Will they stay or will they go? Geospatial Health 13 (1): 699 (2018).

11. Haines, A.; Epstein, P.R.; McMichael, A.J. Global health watch: Monitoring impacts of environmental change. Lancet 342, 1464-1469 (1993).

12. Haines, A.; Parry, M.L. Climate change and human health. Journal of the Royal Society of Medicine 86, 707-711 (1993).

13. McMichael, A.J.; Haines, A.; Slooff, R.; Kovats, S. Climate change and human health. World Health Organization: Geneva (1996).

14.       Patz, J.A.; McGeehin, M.A.; Bernard, S.M.; Ebi, K.L.; Epstein, P.R.; Grambsch, A.; Gubler, D.J.; Reiter, P.; Romieu, I.; Rose, J.B., et al. The potential health impacts of climate variability and change for the United States: Executive summary of the report of the health sector of the U.S. National Assessment. Environmental Health Perspectives 108, 367-376 (2000).

15. Anonymous. Health in the greenhouse. Lancet 333:819-820 (1989).

16. Leaf, A. Potential health effects of global climatic and environmental changes.  The New England Journal of Medicine 321 (23):1577-1583 (1989).

17. Kelley, C. P., Mohtadi, S., Cane, M.A., Seager, R. and Kushnir, Y. Climate change in the Fertile Crescent and implications of the recent Syrian drought. Proceedings of the National Academy of Sciences (USA) 112 (11):3241-3246. doi: 10.1073/pnas.1421533112 (2015).

18. Anonymous. Syria: A health crisis too great to ignore. The Lancet 388, 2 (2016).

19.       Selby, J.; Dahi, O.S.; Fröhlich, C.; Hulme, M. Climate change and the Syrian civil war revisited. Political Geography (2017).

20. Ide, T. Climate war in the Middle East? Drought, the Syrian Civil War and the state of climate-conflict research. Current Climate Change Reports:1-8; doi: 10.1007/s40641-018-0115-0. doi: 10.1007/s40641-018-0115-0 (2018).

21. Kovats, R.S.; Hajat, S. Heat stress and public health: A critical review. Annual Review of Public Health 29, 41-55 (2008).

22.       United Nations World Food Programme. Food security and emigration. (2017).

23.       Schleussner, C.-F.; Donges, J.F.; Donner, R.V.; Schellnhuber, H.J. Armed-conflict risks enhanced by climate-related disasters in ethnically fractionalized countries. Proceedings of the National Academy of Sciences, 113, 9216-9221 (2016).

24.       Kishore, N.; Marqués, D.; Mahmud, A.; Kiang, M.V.; Rodriguez, I.; Fuller, A.; Ebner, P.; Sorensen, C.; Racy, F.; Lemery, J., et al. Mortality in Puerto Rico after hurricane Maria. New England Journal of Medicine, doi: 10.1056/NEJMsa1803972 (2018).

25.       Butler, C.D.; Corvalan, C.F.; Koren, H.S. Human health, well-being and global ecological scenarios. Ecosystems, 8, 153-162 (2005).

26.       Confalonieri, U.; Menne, B.; Akhtar, R.; Ebi, K.L.; Hauengue, M.; Kovats, R.S.; Revich, B.; Woodward, A.; Abeku, T.; Alam, M., et al. Human health. In Climate change 2007: Impacts, adaptation and vulnerability. Contribution of working group II to the fourth assessment report of the intergovernmental panel on climate change, Parry, M.L.; Canziani, O.F.; Palutikof, J.P.; Linden, P.J.v.d.; Hanson, C.E., Eds. Cambridge University Press: Cambridge, UK,, 2007; pp 391-431 (2007).

27.       Butler, C.D.; Harley, D. The climate crisis, global health, and the medical response Postgraduate Medical Journal 86, 230-234 (2010).

28.       Butler, C.D. Climate change and global health. CABI: Wallingford UK, Boston, US; p xxiv + 303 (2014); paperback issue published 2016.

29.       Portier, C.J.; Thigpen Tart, K.; Carter, S.R.; Dilworth, C.H.; Grambsch, A.E.; Gohlke, J.; Hess, J.; Howard, S.N.; Luber, G.; Lutz, J.T., et al. A human health perspective on climate change: A report outlining the research needs on the human health effects of climate change. Research triangle park, NC: Environmental Health Perspectives / National Institute of Environmental Health Sciences. doi:10.1289/ehp.1002272 available: (2010).

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32.      Butler, C.D. Global warming, ecological destruction and human health. Medical Journal of Australia 155:351 (1991)

32.      Butler, C.D., Bowles, D.C; McIver, L., and Page, L. Mental health, cognition and the challenge of climate change. In Climate Change and Global Health, edited by C.D. Butler, 251-259. Wallingford, UK: CABI. (2014).

34.       Gleick, P.H. Water, drought, climate change, and conflict in Syria. Weather, Climate, and Society 6 (3):331-340. doi: 10.1175/wcas-d-13-00059.1 (2014).

35.      Butler, C. D. Climate change, health and existential risks to civilization: a comprehensive review (1989-2013).  International Journal of Environmental Research and Public Health (under review). 

36.      Butler, C.D. "Regional overload” as an indicator of profound risk: a plea for the public health community to awaken. In Medicines for the Anthropocene: Health on a Finite Planet, edited by S. Quilley and K. Zywert. Toronto, Canada, University of Toronto Press, 2019 (in press).  

37.     Butler, C.D. Planetary overload, limits to growth and health.  Current Environmental Health Reports 3 (4):360-369 (2016)