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 benefits, is 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.

“Regional overload” as an indicator of profound risk: a plea for the public health community to awaken

Comments welcome. First draft of an abstract for a chapter in a forthcoming book to which I have been asked to contribute called: "Health in the Anthropocene: Living Well on on a Finite Planet" My slides are here, for a talk at the University of Waterloo, Canada on April 5, 2018.

Public health is the field of medicine charged with protecting human well-being, via the identification of health risks and the development and implementation of effective strategies to lower such dangers. Public health workers have a long history of promoting new paradigms and tackling vested interests, often with great difficulty and against immense opposition. Their campaigns often take decades to be successful, even at a regional scale.

Today, the greatest threat to global public health is barely visible within public health circles, although, like blind men palpating an elephant, some of its many manifestations are recognized. These identified protuberances have several names. Ecological public health, climate change and health, and even planetary health have arisen, in recent decades, as sub-disciplines of public health. The risk of nuclear war to health has seen the awarding of two Nobel Peace prizes to health-related lobby groups. Tropical medicine has evolved to international health and global health.

Yet, none of these emerging sub-disciplines or fields, as yet, fully integrate the health risks arising from what McMichael called “planetary overload”. Central to this (Malthusian) conceptualization is the risk of large-scale conflict, famine and infectious diseases, acting, increasingly, in combination, in ways that reduce human well-being, as a consequence of linked “eco-social” phenomena. 

Crucially, ecological and environmental contributors to these crises must be recognized not just as living elements of the biosphere, such as crops, coral reefs and forests, but inert resources, particularly of fossil fuels and the rare elements needed to drive the accelerating energy transition. Although the health community is belatedly awakening to the public health harm that climate change constitutes, there is scarcely any recognition, within public health, that the growing scarcity of these inert resources risks the triggering of social consequences with profound adverse health consequences, many of which are already apparent, in examples of what Butler has termed “regional overload”.

There is a growing number of recent examples of this; from Syria to Yemen, South Sudan, north-east Nigeria and Myanmar. However, very little analysis exists, within public health, of the shared causal pathways which underpin these localized public health catastrophes. 

There are many reason for this scarcity of analysis. One is the bias, within most public health fields, to problems in high-income settings. Publications on (for example) public health in South Sudan are rare, and data-rich papers are almost non-existent, due to the difficulties of safely obtaining such data. This leads to a reinforcing cycle, a positive feedback loop, where there is little market or appetite for analysis, and where such papers, if submitted are unlikely to be accepted due to their likely deficiencies. 

Another important impediment is of disciplinary boundaries and suspicion of the “academic other”. These factors contribute to the failure of academic institutions and health funders, who are overwhelmingly embedded in a milieu of neoliberal signals and incentives, to recognize the need for a new paradigm to emerge, if humanity is to thrive in this and coming centuries.

***
PS regional overload is long-standing, and is different to what really concerns me; which is regional overload in the context of tightening global limits to growth. That really warrants a new term, or phrase, but it is too premature to attempt that.

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Enhancing the ‘glue’ that slows migration

A shorter version of this article was published in the national newsletter (number 129) of Sustainable Population Australia, in September 2017. That version did not include an additional comment regarding Senator Sarah Hanson-Young, nor the three paragraphs describing my own attempts to enhance “glue”.

In 2016 the US journalist Thomas Friedman wrote a pair of articles, published in the New York Times, called “Out of Africa”. He describes a visit to a village in the far northwest of Senegal, worth the trek, he says, “if you’re looking for the headwaters of the immigration flood now flowing from Africa to Europe via Libya.” In this village he finds almost no young or middle-aged men; instead they have left for Europe, in search of opportunity. According to Friedman “the village’s climate-hammered farmlands can no longer sustain them, and with so many kids — 42 percent of Senegal’s population is under 14 years old — there are too many mouths to feed from the declining yields.” This scene is repeated right across the Sahel, including Niger, which has a total fertility rate of over 7.

Supporters of Sustainable Population Australia are unlikely to need much convincing that the human carrying capacity of much of northern Africa has been exceeded. In 2002 I co-authored a paper for a conference of the International Union for the Scientific Study of Population which argued that human carrying capacity can be conceptualised as an emergent property of five kinds of capital: human, social, natural, physical and financial. Applying this analysis to sub-Saharan Africa, it is clear that its natural capital (e.g. the capacity of its soil, water, climate and human ingenuity to grow food) is not keeping pace with population growth. Nor is its infrastructure (physical capital). At the same time, word of mouth, mobile phones, and the internet provide hope to many of its people that migration to Europe might provide the means not only for a better life to those who can escape, but a means to send some money home (remittances) enabling the import of food and other means to keep life tolerable, for those for stay behind. Staying behind makes sense for the frail, old and young, who not only avoid the arduous and dangerous journey to Europe, but will not need to be housed and fed in a foreign and strange land.

The vectors that drive migration are most commonly analysed as “push” and “pull”. These are surely not hard to comprehend by non-Indigenous Australians, all of whom are descendants of people who arrived more or less yesterday, compared to the time our earliest ancestors left Africa, perhaps 100,000 years ago. But, in addition to these factors, there are two more, which I termed “glue” and “fend” (deterrence) in a report I contributed to in 2005, commissioned by the Australian Conservation Foundation and the Australian Medical Association (and wrote about in a blog in 2015). For “fend” one only has to think of the hard line approach of Peter Dutton, President Trump and in other countries such as Hungary.

But the “glue” factor seems less well understood, including in Australia. But it is surely not hard to understand. I am very happy to be an Australian living here, where my mother tongue is understood, I am familiar with the culture, and I have the means for a reasonable life, including a sense of safety. Having lived overseas for 5 years, I know that what Australia can offer me, is, in general, at least as good as anywhere on Earth. Of those 5 years, about a year has been in Asia, including in many rural areas. I know that not every Asian seeks to migrate; they are tied to their homeland by memory, affection, culture and economy.

However, looking forward, in the context of still rising population growth, sea level rise, and other manifestations of adverse environmental change it is easy to conceive how push and pull will loosen glue, in many parts of the Asia Pacific, as is already evident in much of Africa. For many Rohingya (a persecuted Muslim minority largely in Myanmar) this has already happened.

Australian politicians and the glue factor

I have met Philip Ruddock (a former Australian minister for migration) at three events organised by recent migrants to Australia. The last time I saw him he told me foreign aid from Australian was a luxury we cannot afford. In the context of intractable budget deficits (significantly due to the immorality of multinational corporations, Australia’s richest people and their tax lawyers) the position of the Liberal National coalition is that aid is a form of bad debt, an indulgent consumption. In response, I argued that aid was a glue and stability enhancing investment that would enhance global and Australian quality of life. But he gave no hint that he understood.

Sarah Hanson-Young, until recently the Greens spokesperson for migration, has repeatedly criticised Australia’s cruel, duplicitous, expensive, and unaccountable policy of deterrence (fend) to asylum-seeking but she too, to my knowledge, has very rarely if ever been reported talking about the need to enhance the glue dimension to migration. However, I have recently been told, she is in fact well aware of this dimension – if so, why does the media rarely if ever include Sarah’s comments on this? (added December 2017, this sentence is not in the published newsletter).

My own involvement in “glue”

In the late 1970s I decided to study medicine, primarily to try to improve health in the South, then called the Third World. 1989 I co-founded the non-government organisations BODHI and BODHI Australia, now two of the oldest Buddhist-influenced aid organisations based outside Asia. BODHI’s primary goal can be condensed to an attempt to enhance glue and to reduce push, pull and fend.

The arguments made here have been more or less clear to me since a long conversation in 1990 with Dr Maurice King, chief populariser of the concept of “demographic entrapment”. I won the 2001 Borrie Prize (awarded in 2002) by the Australian Population Association (APA) for a long essay that traced the rise and fall of Malthusian thinking within demography. This was an adaptation of the second chapter of my doctoral thesis (Inequality and Sustainability), which was supervised by Professor JC (Jack) Caldwell, a co-recipient of the 2004 UN Population Prize.

Despite winning the Borrie Prize, my resultant article was then rejected by a series of demographic journals, include the Journal of Population Research (the APA journal), the Population and Development Review and at least five more. Today, despite having published at least 50 articles, chapters and reports of relevance to global population dynamics, I have not yet been published in a primarily demographic journal. I share Maurice King’s opinion that mainstream demography has been corrupted by neoliberal forces who deny limits to growth, not only physical but social.

Conclusion

It is clear that Australian political elites have given up on global “health and wealth for all”, despite ostensibly supporting the Sustainable Development Goals, which will be a mirage if business as usual continue. It is not only shameful but stupid that Australia has thumbed its nose at the Pearson Commission target for overseas aid. Our approach of miserly aid, rampant fend (the funding of which probably now exceeds that for aid) is sewing the seed for future misery, both here and abroad.

About the author

In 2002 Colin Butler was commissioned by Frank Fenner, of the Australian Academy of Science, to write a report on Australian carrying capacity. In 2013 the Australian Academy of Science published a chapter in which he argued that the Australian population must be substantially increased, even though this would reduce the Australian quality of life, given the global demographic pressure. However, he argued, this must be accompanied by much greater engagement in the struggle for global development.

Health workers and the tragedy of Syria: rejected by the Lancet

Now that I am in my 7th decade I must be older than the current power holders in the Lancet; I fear they follow fashion but lack wisdom. They rejected this letter: read it for yourself.

Health workers and the tragedy of Syria

In 1994, Lancet published my essay which included the sentence "Those in the developed world may watch with horror  ..  if followed by closure of the demographic trap through war, epidemics, famine, or all three".(1)

To lament the 6th anniversary of the catastrophe in Syria, your editorial has repeated the “h” word: “The world has stood by in horror, watching the death toll rise and the humanitarian and refugee crises spread their indelible stain on the world map and human history.”(2)

Birth rates in Syria were declining before the war started, however they were still far above replacement.(3) A combination of systemic, interacting factors, including Syrian peak oil,(4) aquifer depletion, climate change exacerbated drought,(5) and a five-fold increase in youth unemployment between 2000 and 2011 (to 48%)(6) generated a milieu in which brutal and violent conflict took root. Checkmate – entrapment. Using alternative language, Syria, like famine and conflict beleaguered South Sudan, Yemen, Somalia and north east Nigeria exemplify contemporary cases of “regional overload,”(5) just as Rwanda did in 1994.

The identification of environmental factors as contributors to these health and humanitarian disasters is not “environmental determinism” as some critics have claimed. Nor does such identification in any way excuse egregious human rights abuses arising from entrapment. However, because these environmental and demographic contributors to past, current and future calamities have been warned of for decades,(7) it does demonstrate how many political and civic leaders have been ill-informed, if not negligent, in following their duty of care for the well-being of their populations.
 

But it is not just the leaders in these countries who are responsible. In most cases, such leaders have followed the majority of academic opinion, which, for decades, has sidelined, and even ridiculed anything related to limits to growth.(7) Promoters of such wishful thinking arguably, are even more responsible.

Health practitioners cannot, ourselves, do much to alter the trajectory of civilization, but it possible that a tiny nudge in the right direction could deliver a planetary rescue that currently looks improbable. Part of that nudge is to remind those who care about Syria and its people that many of the drivers of its catastrophe were predictable. This is not “I told you so” gloating, but an appeal for all with influence to look more deeply and widely at causes, in order to alleviate and prevent much future human suffering, for Syrians and many others, perhaps for us all.

1.    Butler CD. Overpopulation, overconsumption, and economics. The Lancet 1994; 343: 582-4.
2.    Editorial. Syria suffers as the world watches. The Lancet 2017.
3.    Eberstadt N, Shah A. Fertility decline in the Muslim World, c. 1975–c. 2005: a veritable sea-change, still curiously unnoticed. In: Groth H, Sousa-Poza A, eds. Population Dynamics in Muslim Countries; 2012.
4.    Ahmed N. Peak oil, climate change and pipeline geopolitics driving Syria conflict. The Guardian 2013.
5.    Butler CD. Regional overload and the consequences it has for health. BMJ blog 2017.
6.    Taleb ZB, Bahelah R, Fouad FM, Coutts A, Wilcox M, Maziak W. Syria: health in a country undergoing tragic transition. International Journal of Public Health 2015; 60(1): 63-72.
7.    Butler CD. Planetary overload, limits to growth and health. Current Environmental Health Reports 2016; 3(4): 360-9.

Regional overload, planetary health and population displacement

On the same day that President Trump was inaugurated, the BMJ blog published a version of this as "Regional overload and the consequences it has for health".

This is a rather bland title, but at least they kept "regional overload" in the title. It was originally called "Regional overload, planetary health and population displacement". I had submitted it as an opinion piece. It got reviewed, and I hoped they would then publish it in their journal. It increasingly looks as if the BMJ thought it was too controversial, which is a pity. Some dialogue with the anonymous reviewer is here.

The version in the BMJ blog is very short - there was a 600 word limit. I'm slowly adding links.

I'll also gradually annotate this, in bold red.

Almost 1% of the world population, mostly children, is forcibly displaced (including 11.7 million Syrians), an increase of over 50% from 2011. [1]  

This should be regarded as one of the biggest public health problems in the world, as well as a humanitarian and a security problem. However, violence and health, especially state violence and health, has long been on the periphery of public health. Many doctors are uncomfortable about mixing politics with public health, however, public health and social medicine are inextricably political.

Here I propose that the public health catastrophe in Syria be conceptualized as a canary (or sentinel) case of “regional overload,” relevant to the emerging public health sub-specialty of planetary health. [2,3,4].

Planetary health has been defined as "the health of the human civilisation and the state of the natural systems on which it depends. I have published the central ideas in this essay many times before, starting in 1991, but not in a high impact journal for several years.

However, it is only recently that I thought of the term "regional overload", which I first used in a paper now under review for several months for Current Opinion in Environmental Sustainability, and then in a book chapter, also still under review, co-written with Dr Kerryn Higgs. Kerryn, like Ian Dunlop, is an Australian member of the Club of Rome. She is the author of "Collision Course: Endless Growth on a Finite Planet", reviewed here by Ian Lowe. The chapter is called "Health, population, limits and the decline of nature", for the Sage Handbook of Nature.

I submitted a longer version of the blog published in the BMJ to the Lancet. It was rejected without review, but the forthcoming journal Lancet Planetary Health expressed interest in publishing a longer version, but only if I pay US$5,000. This is more than I can afford, though I am sympathetic to the dilemmas of making academic publishing viable; eg see "Predatory publishers in science" and "A call for publishers to declare their conflicts of interest" in the Journal of the Royal Society of Medicine, in 2007.”

In 1990, Maurice King warned, in a prominent article in the health literature, of “demographic entrapment.” [5]

I first met Maurice in London, in early 1990, when I was studying for a diploma in tropical medicine and hygiene, and he was working on this paper. I had known of Maurice's foundational work in primary health care since being advised to read his edited book “Medical Care in Developing Countries", which I still recall buying, second hand, near the Newcastle (NSW) railway station, in 1984. I took it with me when I first went to Africa, in 1985.

Maurice and I got on so well in 1990 (Maurice was born in the late 1920s, just before my father) that soon after I visited him and his family, in Leeds. I stayed overnight with them - and again, in 1994). I remember him talking of the hopes and fears he had for his paper. These fears were well-founded, as Maurice soon found himself vilified. My first paper in the Lancet, in 1994, in part defended Maurice concerning these attacks. I wrote, in part:

"Verkuyl did not claim that contraception alone will solve Third World problems, any more than King(4) proposed the denial of medical care to children in developing countries as a means of avoiding closure of the demographic trap."

At that stage I was bemused by the fact that King's critics had not only not given him the benefit of the doubt, but had not even read it carefully. His character and intent were attacked by people who seemed to have no idea of his very large contribution, sustained over decades, to improving health in developing countries.

Soon after, the leading epidemiologist Tony McMichael wrote of “planetary overload.” [6] 

Tony, who was my most important teacher and mentor, from 1993 until his death in 2014, published a book by this tile in the same year that I first met him. It was influential in public health circles.

Both concepts are related to Malthusian thought, and thus to the theory of evolution, which accepts, as fundamental, competition for finite resources, often between co-operating groups. [3,7] 

It has long been fashionable to ridicule Malthus, yet the theory of evolution remains widely accepted. Each of the two main scientists (Darwin and Wallace) who developed this theory acknowledged their debt to Malthus. Malthus is ridiculed for ideological reasons, not that different to the reason the BMJ appear to have declined to publish this (it would be nice if I am wrong about this!)

Demographic entrapment is argued to occur in extreme cases when population growth outpaces that of development, triggering population “checks” including from conflict, famine, epidemics, and out-migration. [5] Examples include in Ireland (mid-19^th century), Rwanda (1994), and, arguably South Sudan and Syria today. [6]

My paper in the Lancet in 1994 was published in the same month as the Rwandan genocide, a 

chilling coincidence which has strengthened my interest in that part of Africa, and these demographic factors in general.

Annotations to be continued, when I find time.

Planetary overload posits that the human impact on Earth is non-sustainable. [3,7] Planetary overload is unlikely to be homogenous; some regions will be overloaded before others. Plausible contemporary examples of regional overload include Yemen, the Sahel and Bangladesh; here I focus on Syria, given the magnitude of its current situation.

Two key papers have reviewed substantial evidence to conclude that climate change has aggravated the recent Syrian drought, unprecedented in severity, and, in turn, this contributed to food price shocks, rapid internal migration, and ultimately its civil war and population displacement crisis. [8,9] Analysts in support of the link between environmental stressors and conflict stress violence emerges in a “milieu” whose elements in Syria include rivalry, grievance, inequality and outside interference. Importantly, this is not “environmental determinism,” as some critics have asserted. Instead, climate change acts as a “threat multiplier” of conflict. [3,10]

The total fertility rate in Syria before the war was falling, but far above replacement. [2] High Syrian population growth reduced the “demographic dividend,” which helps to promote economic and human development in low-income settings with high population growth. A consequence of Syria’s high fertility rate was growing youth unemployment, reported as 48% in 2011, a five-fold increase from 2000. [2] Large numbers of young, underemployed, under-fulfilled men (“youth bulges”) often accompany high population growth, and have long been linked to violence. The need for economic growth to reduce Syrian poverty, accelerated depletion of groundwater, another key resource. [8,9]

The Planetary Health Commission argued that many health gains are achieved by eroding Earth’s natural systems that provide essential services “on which human civilisation depends”. It suggested that if populations attain health by exploiting the environment unsustainably then this is likely to be at the expense of other populations, now or in the future. [4]

Although humans have always modified nature, today, too many humans are feasting on the ecological underpinnings of global and planetary health. Those with ample “feed” thrive, but at an increased cost to others, including many of the Syrian population, whether killed, living in fear, or displaced.

I have argued that the population displacement from Syria can be conceptualised as a form of regional overload, in turn related to planetary health. But not all causes of regional overload are from overconsumption by the rich. Conditions in Syria, much of the Sahel, Burundi and elsewhere will be greatly improved by education, human rights, slower population growth, and greater scientific acknowledgement of these imperatives.

The problems besetting planetary health are formidable. Scientists and medical practitioners cannot, themselves, alter human destiny, yet have a duty of care to be as accurate and dispassionate as possible. A proper diagnosis may yet enable the remedies which can alleviate much future human suffering.

Colin Butler is an adjunct professor of Public Health at the University of Canberra, Australia, and co-founder of the NGOs BODHI and BODHI Australia. He is founding co-chair of Health Earth and lead author for the section on health in the forthcoming flagship Global Environmental Outlook report of the United Nations Environment Programme, called Healthy Planet, Healthy People.

Not commissioned, Peer reviewed.

References: 

1. UNHCR. Global Trends Report. Forced Displacement in 2015: UNHCR 2016.
2. Taleb ZB, Bahelah R, Fouad FM, et al. Syria: health in a country undergoing tragic transition. International Journal of Public Health 2015;60(1):63-72. doi: 10.1007/s00038-014-0586-2
3. Butler CD. Planetary overload, limits to growth and health. Current Environmental Health Reports 2016;3(4):360-69.
4. Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet 2015;386:1973–2028. doi: 10.1016/S0140-6736(15)60901-1
5. King M. Health is a sustainable state. The Lancet 1990;336:664-67.
6. McMichael AJ. Planetary Overload. Global Environmental Change and the Health of the Human Species. Cambridge: Cambridge University Press 1993.
7. Butler CD. Human carrying capacity and human health. Public Library of Science Medicine 2004;1(3):192-94.
8. Gleick P. Water, drought, climate change, and conflict in Syria. Weather, Climate, and Society 2014;6:331–40. doi: 10.1175/wcas-d-13-00059.1
9. Kelley CP, Mohtadi S, Cane MA, et al. Climate change in the Fertile Crescent and implications of the recent Syrian drought. Proceedings of the National Academy of Sciences (USA) 2015;112(11):3241-46. doi: 10.1073/pnas.1421533112
10. Schleussner C-F, Donges JF, Donner RV, et al. Armed-conflict risks enhanced by climate-related disasters in ethnically fractionalized countries. Proceedings of the National Academy of Sciences 2016;113(33):9216-21. doi: 10.1073/pnas.1601611113