Inequality, Democratic Collapse and Climate Change: The Trial of Global Health Issues

Eunice Phillip, Key Correspondent for the Irish Forum for Global Health

The total contact time for delegates attending the two-day Global Health Exchange conference, held at the Royal College of Surgeon in Ireland (RCSI) during November 2018, was not more than 18 hours. This, however, cast no shadow over the richness of the different topics presented. In his welcome speech, Professor Ruairi Brugha, Head of the Department of Epidemiology and Public Health Medicine at RCSI, set the perfect tone by listing the ‘rising tide of inequalities’, ‘breakdown of democracy’ and ‘climate change’ as the three most influential issues facing the world. Subsequent presentations created a unified storyline with topics and discussions painting a vivid picture of setbacks and successes in achieving ‘Health for All’ in the Sustainable Development Goal (SDG) era. There were also many stimulating and engaging questions and answers sessions, and at the end of day two I was convinced global health issues have a cyclic pattern; the interplay between inequality, breakdown of democracy, and key player climate change. The challenge now is to come up with a game-changing solution, to make achieving the SDGs by 2030 a reality.

Climate change is estimated to have direct health damage cost of $2-4 billion by 2030, with over 200,000 additional associated deaths. This is an estimate, but according to Matt Robinson in his presentation on the Irish Perspective on climate change, “the effect of climate change on health in Ireland will be slow and insidious compared to the economic impact.” Could climate change be strengthening inequalities and health disparities?

Despite being among the highest contributor to global carbon dioxide emissions, rich countries such as Ireland, China, and the US, their relatively strong health systems mask the impact of climate change on the health of their citizens. Investment in public health in Ireland, for example, minimised the current outbreak of measles, and curtailed the threat of Ebola in the US in 2014 to just three cases. A different outcome is evident in the North Kivu and Ituri provinces of the Democratic Republic of Congo, where Dr Mike Ryan, of World Health Organisation, reported this week that the number of reported Ebola cases is now at 300. It’s the biggest outbreak in the country’s history.

Poorly resourced countries lack parity with more wealthy regions. Resources that, according to Lusungu Dzinkambani, are already spread thinly by, “tax cuts and treaties signed with rich countries in the colonial era. [It is] a period of low bargaining power.” When coupled with the human tendency for overconsumption of resources, extensive deforestation, and exacerbation of climate-related disasters, these poorer countries plunge deeper into a state of environmental, economic, and social insecurity. This often leads to conflict and democratic collapse.

Moving along this global health triad, Mark Andrew Maslin, in his summary of research on conflict and climate change, stated that, “the fundamental cause of conflict and displacement of large numbers of people is the failure of political systems to support and protect their people.” Climate change may not be a direct cause of war, but here is the dilemma. Over 30 million people compete for the receding Lake Chad water source. This results in loss of political power to the Boko Haram insurgency. Similarly, armed conflict is often fuelled by disputes over fertile land and water, such as the war in Darfur, and the Syrian conflict that led to the world’s largest human displacement, at 11 million in 2016. The common thread is climate change. Its effect on the dwindling resources of developing countries creates significant inequalities and breakdown in democracy that feeds back into the triad.

It reminds me of a moving carousel, but one with grave and fatal health consequences which, according to Geraldine McCrossan, “affects the delivery of health service due to the continuous movement of displaced people.” Dr Mike Ryan echoed this when he stated how, “armed conflicts complicate the Ebola response effort in DRC.”

Olive Moore, Head of Programmes at Trócaire, illustrated these impacts on a personal level by describing the anguish of a mother in response to the coming drought in Malawi. The women, an agro-ecological farmer with Trócaire Malawi, stated, “I know this work is rewarding, but my kids are hungry, and I know they are going to be sick.” This was the most defining moment for me at the conference. Children have contributed the least to climate change, yet they are most vulnerable to its impact of increasing inequality, the failure of democratic systems, and climate change.

This awareness must have echoed with other delegates, especially with the urgency of game-changing solutions that ended each presentation, each with the recurring themes of inclusion at the individual level and community engagement. Engaging the local farmer about farming methods to reduce soil degradation, or involving communities in food preservation, will minimise waste. Choosing locally grown foods will reduce the carbon footprint. It is crucial to that we are all ambassadors for a sustainable climate, by taking action personally and collectively and being mindful in all that we do; to stop the blaming and shaming and unify our actions against the health impact of climate change.

I left the conference convinced that climate change may be the defining issue of our time. But we have a greater chance of breaking the triad of global health issues and achieving the SDGs by 2030 if we follow the advice of Maureen O’Sullivan, TD, and focus more on collaboration than conflict. Sadly, this is not our natural style.

14th November 2018