Equality for all must be upheld as a guiding principle for all our societies
by Adeeba Kamarulzaman, Allan Maleche, Chris Beyrer
The Lancet Medical Journal
Still relevant: the 75th anniversary of the Universal Declaration of Human Rights, by Adeeba Kamarulzaman, Allan Maleche, Chris Beyrer for The Lancet Medical Journal
December 10, 2023, marks the 75th anniversary of the founding commitment of the modern human rights movement, the Universal Declaration of Human Rights (UDHR).
75 years on, the world is tested and tormented by an agonising array of conflicts in which human rights violations are not secondary outcomes, but rather central to such conflicts. Ethnic cleansing, collective punishment, apartheid, sexual violence as a tool of state terror, and the deliberate targeting of health-care facilities and workers are part of multiple ongoing conflicts in 2023.
The unprovoked Russian invasion of Ukraine in 2022, civil conflicts underway in Tigray in Ethiopia, Sudan, Myanmar, and Syria, the conflict between Israel and Hamas in Gaza, and the Saudi-led coalition's bombardment of Yemen, all have in common violations of the rules of conduct in war—specifically, attacks on civilians, health-care workers, health-care facilities, and infrastructure and other violations of medical neutrality.
These attacks are also violations of the right to health; through the denial of health-care access, they undermine the principle of dignity and the equal value of all human lives.
Armed conflict is an extreme domain of human rights abuses, but is only one of many settings in which human rights violations are taking place. Other concerns that undermine the right to health include the deliberate degradation of our environments and the climate for short-term profit and the widespread use of disinformation and misinformation that adversely affects people's rights to benefit from scientific progress. Disinformation related to the safety and efficacy of vaccines has led to multiple disease outbreaks and to losses of life during the COVID-19 pandemic.
Political and legal attacks on the rights of sexual and gender minorities, and on the rights of women, undermine the universality of human rights and are occurring in countries as diverse as Iran, Russia, Uganda, and the USA.
Indeed, in his opening address to the 53rd Council of the UN Human Rights Council in June, 2023, Volker Turk, the UN High Commissioner for Human Rights, reaffirmed the centrality of the UDHR for our deeply troubled times precisely because of its core principle of universality.
The global community backs away from the universality of human rights at its collective peril. In 1948, the UDHR was crafted in the wake of the Nazi persecutions of Jewish people, Roma, LGBT persons, individuals with disabilities, and others deemed unfit to live by the Nazi regime.
The relevance of the UDHR was also clear in the decades that followed World War 2, notably in the struggle against the avowedly racist apartheid regime in South Africa, which was also a struggle to realise universal rights. Equality for all must be upheld as a guiding principle for all our societies. The responsibility to protect rights cannot be left to our current political systems and human rights bodies, including the UN, because they are manifestly failing to do so in many places.
How relevant, then, is the human rights framework to health in these troubled times? How can the global health community press for universal health coverage, committed to by heads of states at the 79th Session of the UN General Assembly in September, 2023, when we see so many millions of people denied the most basic health services, including the substantial numbers of internally displaced people and refugees?
And what are the possible roles and potential actions health-care workers can undertake to address these threats?
First, the tools of population-based sciences need to be used more intensively and routinely to document and measure human rights abuses; this information can be used to hold governments and other actors to account. These tools, exemplified by the use of novel satellite technologies and video surveillance in the documentation of Russian atrocities in Bakhmut and other cities in Ukraine, hold great promise for accountability for war crimes.
Second, health-care workers must put human rights at the forefront of our work and become much more engaged in efforts to protect the rights of those we seek to serve. This is a pressing reality for many obstetric care providers in US states, for example, where multiple restrictions on reproductive and sexual health and rights have adversely affected the practice of medicine, endangered patients’ lives, and put health-care providers in legal jeopardy for providing essential care.
Third, medicine and health care must be a more active participant in advocacy for health-care access as a human right in all societies. No one should be denied health-care access by virtue of legal or immigration status—yet multiple health systems do just this, and providers must not be complicit in these denials of access to care.
Fourth, common cause is needed with those advocating for inter-related rights, including the movement for addressing the climate crisis and for climate justice, anti-racist struggles, the LGBTQ+ rights movement, and the global movement for women's rights to bodily autonomy, choice, and freedom from sexual and gender-based violence, among others. Health-care workers have agency in these struggles and need to influence these social and political debates. Health-care workers cannot stay in our professional domains and expect others to address these crises.
To address the rising tide of human rights violations and their many and varied impacts on health, the International AIDS Society and The Lancet convened a multidisciplinary Commission on health and human rights in 2019.
The Commission's report is expected to be released in early 2024. This report will aim to explore multiple domains of health and rights and will argue for a reinvigoration of the UDHR as a basis for protecting health in the 21st century.
Human rights protections are not optional, and they are not reserved for the fortunate few who are citizens of countries that now enjoy peace and prosperity. If we consider the climate crisis alone, our collective rights to enjoy a liveable and healthy environment are under existential threat.
Young people worldwide know that their survival is at stake, and many have been organising and winning court cases based on their right to a liveable future.
For those living under repressive regimes and trying to survive in the world's expanding zones of conflict and displacement, human rights have proven stubbornly cherished hopes for a better future. Health professionals must do everything we can to ensure that future and uphold human rights in protection of humanity's common survival.
* Adeeba Kamarulzaman and Chris Beyrer are the Co-Chairs and Allan Maleche is a Commissioner of the International AIDS Society-Lancet Commission on health and human rights; this Commission has been supported by the International AIDS Society and by the Desmond M Tutu Professorship at the Johns Hopkins Bloomberg School of Public Health.
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The overall environmental crisis is now so severe as to be a global health emergency
by Christopher Wolf, William Ripple, Johan Rockstrom
Bioscience Journal, UNU-EHS, BMJ, agencies
Life on planet Earth is under siege. We are now in an uncharted territory. For several decades, scientists have consistently warned of a future marked by extreme climatic conditions because of escalating global temperatures caused by ongoing human activities that release harmful greenhouse gasses into the atmosphere.
Unfortunately, time is up. We are seeing the manifestation of those predictions as an alarming and unprecedented succession of climate records are broken, causing profoundly distressing scenes of suffering to unfold. We are entering an unfamiliar domain regarding our climate crisis, a situation no one has ever witnessed firsthand in the history of humanity.
In the present report, we display a diverse set of vital signs of the planet and the potential drivers of climate change and climate-related responses first presented by Ripple and Wolf and colleagues (2020), who declared a climate emergency, now with more than 15,000 scientist signatories.
The trends reveal new all-time climate-related records and deeply concerning patterns of climate-related disasters. At the same time, we report minimal progress by humanity in combating climate change.
Given these distressing developments, our goal is to communicate climate facts and policy recommendations to scientists, policymakers, and the public. It is the moral duty of us scientists and our institutions to clearly alert humanity of any potential existential threat and to show leadership in taking action.
Climate-related all-time records
In 2023, we witnessed an extraordinary series of climate-related records being broken around the world. The rapid pace of change has surprised scientists and caused concern about the dangers of extreme weather, risky climate feedback loops, and the approach of damaging tipping points sooner than expected.
This year, exceptional heat waves have swept across the world, leading to record high temperatures. The oceans have been historically warm, with global and North Atlantic sea surface temperatures both breaking records and unprecedented low levels of sea ice surrounding Antarctica.
In addition, June through August of this year was the warmest period ever recorded, and in early July, we witnessed Earth's highest global daily average surface temperature ever measured, possibly the warmest temperature on Earth over the past 100,000 years. It is a sign that we are pushing our planetary systems into dangerous instability.
We are venturing into uncharted climate territory. Global daily mean temperatures never exceeded 1.5-degree Celsius (°C) above preindustrial levels prior to 2000 and have only occasionally exceeded that number since then. However, 2023 has already seen 38 days with global average temperatures above 1.5°C by 12 September—more than any other year—and the total may continue to rise.
Even more striking are the enormous margins by which 2023 conditions are exceeding past extremes. Similarly, on 7 July 2023, Antarctic sea ice reached its lowest daily relative extent since the advent of satellite data, at 2.67 million square kilometers below the 1991–2023 average. Other variables far outside their historical ranges include the area burned by wildfires in Canada, which may indicate a tipping point into a new fire regime.
Recent trends in planetary vital signs
On the basis of time series data, 20 of the 35 vital signs are now showing record extremes. As we describe, these data show how the continued pursuit of business as usual has, ironically, led to unprecedented pressure on the Earth system, resulting in many climate-related variables entering uncharted territory.
Climate change is contributing significantly to human suffering, with many climate impacts expected to further intensify in the coming years. We may have already experienced abrupt increases in certain types of extreme weather, possibly surpassing the rate of temperature rise.
In 2023, climate change likely contributed to a number of major extreme weather events and disasters. Several of these events demonstrate how climate extremes are threatening wider areas that have not typically been prone to such extremes.
As these impacts continue to accelerate, more funding to compensate for climate-related loss and damage in developing countries is urgently needed. The United Nations’ new loss and damage global fund established at COP27 is a promising development, but its success will require robust support by wealthy countries.
Motivated by recent events and trends, we continue to issue specific warnings and recommendations involving topics ranging from food security to climate justice. Coordinated efforts in each of these areas could help to support a broader agenda focused on holistic and equitable climate policy.
Economic growth, as it is conventionally pursued, is unlikely to allow us to achieve our social, climate, and biodiversity goals. The fundamental challenge lies in the difficulty of decoupling economic growth from harmful environmental impacts. Although technological advancements and efficiency improvements can contribute to some degree of decoupling, they often fall short in mitigating the overall ecological footprint of economic activities.
The impacts vary greatly by wealth; in 2019, the top 10% of emitters were responsible for 48% of global emissions, whereas the bottom 50% were responsible for just 12%. We therefore need to change our economy to a system that supports meeting basic needs for all people instead of excessive consumption by the wealthy.
The elevated rates of climate disasters and other impacts that we are presently seeing are largely a consequence of historical and ongoing greenhouse gas emissions. To mitigate these past emissions and stop global warming, efforts must be directed toward eliminating emissions from fossil fuels and land-use change and increasing carbon sequestration with nature-based climate solutions.
We should not rely on unproven carbon removal techniques. Although research efforts should be accelerated, depending heavily on future large-scale carbon removal strategies at this juncture may create a deceptive perception of security and postpone the imperative mitigation actions that are essential to tackle climate change now.
The effects of global warming are progressively more severe, and possibilities such as a worldwide societal breakdown are feasible and dangerously underexplored. By the end of this century, an estimated 3 to 6 billion individuals—approximately one-third to one-half of the global population—might find themselves confined beyond the livable region, encountering severe heat, limited food availability, and elevated mortality rates because of the effects of climate change.
Big problems need big solutions. Therefore, we must shift our perspective on the climate emergency from being just an isolated environmental issue to a systemic, existential threat.
Although global heating is devastating, it represents only one aspect of the escalating and interconnected environmental crisis that we are facing (e.g., biodiversity loss, fresh water scarcity, pandemics). We need policies that target the underlying issues of ecological overshoot where the human demand on Earth's resources results in overexploitation of our planet and biodiversity decline. As long as humanity continues to exert extreme pressure on the Earth, any attempted climate-only solutions will only redistribute this pressure.
To address the overexploitation of our planet, we challenge the prevailing notion of endless growth and overconsumption by rich countries and individuals as unsustainable and unjust. Instead, we advocate for reducing resource overconsumption; reducing, reusing, and recycling waste in a more circular economy; and prioritizing human flourishing and sustainability.
We emphasize climate justice and fair distribution of the costs and benefits of climate action, particularly for vulnerable communities. We call for a transformation of the global economy to prioritize human well-being and to provide for a more equitable distribution of resources.
As scientists, we are increasingly being asked to tell the public the truth about the crises we face in simple and direct terms. The truth is that we are shocked by the ferocity of the extreme weather events in 2023. We are afraid of the uncharted territory that we have now entered.
Conditions are going to get very distressing and potentially unmanageable for large regions of the world, with the 2.6°C warming expected over the course of the century, even if the self-proposed national emissions reduction commitments of the Paris Agreement are met.
We warn of potential collapse of natural and socioeconomic systems in such a world where we will face unbearable heat, frequent extreme weather events, food and fresh water shortages, rising seas, more emerging diseases, and increased social unrest and geopolitical conflict.
Massive suffering due to climate change is already here, and we have now exceeded many safe and just Earth system boundaries, imperiling stability and life-support systems.
As we will soon bear witness to failing to meet the Paris agreement's aspirational 1.5°C goal, the significance of immediately curbing fossil fuel use and preventing every further 0.1°C increase in future global heating cannot be overstated.
Rather than focusing only on carbon reduction and climate change, addressing the underlying issue of ecological overshoot will give us our best shot at surviving these challenges in the long run. This is our moment to make a profound difference for all life on Earth, and we must embrace it with unwavering courage and determination to create a legacy of change that will stand the test of time.
A United Nations University report released today finds that drastic changes are approaching if risks to our fundamental socioecological systems are not addressed.
The Interconnected Disaster Risks report 2023 published by the United Nations University – Institute for Environment and Human Security (UNU-EHS) warns of six risk tipping points ahead of us:
Accelerating extinctions; Groundwater depletion; Mountain glaciers melting; Space debris; Unbearable heat; Uninsurable future
Systems are all around us and closely connected to us: ecosystems, food systems, water systems and more. When they deteriorate, it is typically not a simple and predictable process. Rather, instability slowly builds until suddenly a tipping point is reached and the system changes fundamentally or even collapses, with potentially catastrophic impacts.
A risk tipping point is defined in the report as the moment at which a given socioecological system is no longer able to buffer risks and provide its expected functions, after which the risk of catastrophic impacts to these systems increases substantially.
These diverse cases illustrate that risk tipping points extend beyond the single domains of climate, ecosystems, society or technology. Instead, they are inherently interconnected, and they are also closely linked to human activities and livelihoods.
Many new risks emerge when and where our physical and natural worlds interconnect with human society.
One example of a risk tipping point that the report explains is groundwater depletion. Underground water reservoirs called aquifers are an essential freshwater resource around the world, and they supply drinking water to over 2 billion people. Around 70 per cent of groundwater withdrawals are used for agriculture, oftentimes when there is not sufficient water from above-ground sources available. Today, aquifers help to mitigate half of the losses in agriculture caused by drought, a phenomenon which is only expected to increase in the future due to climate change.
But the report warns that now it’s the aquifers themselves that are approaching a tipping point: More than half of the world’s major aquifers are being depleted faster than they can be naturally replenished. If the water table falls below a level that existing wells can access, farmers can suddenly find themselves without the ability to access water, which puts entire food production systems at risk of failure.
“As we indiscriminately extract our water resources, damage nature and biodiversity, and pollute both Earth and space, we are moving dangerously close to the brink of multiple risk tipping points that could destroy the very systems that our life depends on,” said Dr. Zita Sebesvari, Lead Author of the Interconnected Disaster Risks report and Deputy Director of UNU-EHS.
In the case of the “Unbearable heat” risk tipping point described in the report, it is human-induced climate change that is causing a global rise in temperatures, leading to more frequent and intense heatwaves that will in some areas reach temperatures in which the human body can no longer survive.
http://ehs.unu.edu/media/press-releases/press-release-new-un-university-report-warns-about-risk-tipping-points-with-irreversible-impacts-on-people-and-planet.html http://interconnectedrisks.org/ http://www.science.org/doi/10.1126/sciadv.adh2458
More than 200 health journals have urged the World Health Organization to sound the alarm on climate change and dwindling biodiversity. (BMJ)
Over 200 health journals call on the United Nations, political leaders, and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.
The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th UN Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. The research communities that provide the evidence for the two COPs are unfortunately largely separate, but they were brought together for a workshop in 2020 when they concluded: “Only by considering climate and biodiversity as parts of the same complex problem … can solutions be developed that avoid maladaptation and maximize the beneficial outcomes.”
As the health world has recognised with the development of the concept of planetary health, the natural world is made up of one overall interdependent system. Damage to one subsystem can create feedback that damages another—for example, drought, wildfires, floods, and the other effects of rising global temperatures destroy plant life and lead to soil erosion and so inhibit carbon storage, which means more global warming. Climate change is set to overtake deforestation and other land use change as the primary driver of nature loss.
Human health is damaged directly by both the climate crisis, as the journals have described in previous editorials,89 and the nature crisis.10 This indivisible planetary crisis will have major effects on health as a result of the disruption of social and economic systems—shortages of land, shelter, food, and water, exacerbating poverty, which in turn will lead to mass migration and conflict. Rising temperatures, extreme weather events, air pollution, and the spread of infectious diseases are some of the major health threats exacerbated by climate change.
“Without nature, we have nothing,” was UN Secretary General António Guterres’s blunt summary at the biodiversity COP in Montreal last year.12 Even if we could keep global warming below an increase of 1.5°C over pre-industrial levels, we could still cause catastrophic harm to health by destroying nature.
Access to clean water is fundamental to human health, and yet pollution has damaged water quality, causing a rise in waterborne diseases.13 Contamination of water on land can also have far reaching effects on distant ecosystems when that water runs off into the ocean.
Good nutrition is underpinned by diversity in the variety of foods, but there has been a striking loss of genetic diversity in the food system. Globally, about a fifth of people rely on wild species for food and their livelihoods.
Declines in wildlife are a major challenge for these populations, particularly in low and middle income countries. Fish provide more than half of dietary protein in many African, South Asian, and small island nations, but ocean acidification has reduced the quality and quantity of seafood.
Changes in land use have forced tens of thousands of species into closer contact, increasing the exchange of pathogens and the emergence of new diseases and pandemics.
People losing contact with the natural environment and the declining loss in biodiversity have both been linked to increases in non-communicable, autoimmune, and inflammatory diseases and metabolic, allergic, and neuropsychiatric disorders.
For Indigenous people, caring for and connecting with nature is especially important for their health. Nature has also been an important source of medicines, and thus reduced diversity also constrains the discovery of new medicines.
Communities are healthier if they have access to high quality green spaces that help filter air pollution, reduce air and ground temperatures, and provide opportunities for physical activity.
The health effects of climate change and biodiversity loss will be experienced unequally between and within countries, with the most vulnerable communities often bearing the highest burden. Linked to this, inequality is also arguably fuelling these environmental crises. Environmental challenges and social and health inequities are challenges that share drivers, and there are potential co-benefits from addressing them.
Global health emergency
In December 2022 the biodiversity COP agreed on the effective conservation and management of at least 30% of the world’s land, coastal areas, and oceans by 2030. Industrialised countries agreed to mobilise $30bn a year to support developing nations to do so. These agreements echo promises made at climate COPs.
Yet many commitments made at COPs have not been met. This has allowed ecosystems to be pushed further to the brink, greatly increasing the risk of arriving at “tipping points”— abrupt breakdowns in the functioning of nature. If these events were to occur, the impacts on health would be globally catastrophic.
This risk, combined with the severe impacts on health already occurring, means that the World Health Organization should declare the indivisible climate and nature crisis as a global health emergency.
The three preconditions for WHO to declare a situation to be a public health emergency of international concern are that it is serious, sudden, unusual, or unexpected; carries implications for public health beyond the affected state’s national border; and may require immediate international action. Climate change seems to fulfil all those conditions.
While the accelerating climate change and loss of biodiversity are not sudden or unexpected, they are certainly serious and unusual. Hence, we call for WHO to make this declaration before or at the 77th World Health Assembly in May 2024.
Health professionals must be powerful advocates for both restoring biodiversity and tackling climate change for the good of health. Political leaders must recognise both the severe threats to health from the planetary crisis and the benefits that can flow to health from tackling the crisis. But, first, we must recognise this crisis for what it is: a global health emergency. http://www.bmj.com/content/383/bmj.p2355
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