Joint comment: Incoming chairwoman of Gavi Alliance Ngozi Okonjo-Iweala and WHO Assistant Director General Dr Flavia Bustreo
With climate finance as a key lever in the Paris accord, countries concerned with the costs of a low-carbon development pathway may borrow a page from the playbook of health finance experiences. Societies that invest in low carbon growth will likely emerge as those with the healthiest and most productive workforce according to our authors.
As negotiations in Paris drew to a resolution earlier this month, developing countries' concerns about having carbon "space" for development and the notion of "differentiated responsibilities" for cutting carbon emissions were common refrains. Similarly, fulfilment of a pledge by developed countries to invest at least $100 billion annually in low-carbon and renewable technologies needed by developing countries is regarded as essential to the agreement's future success.
Now that the treaty has been signed, however, some broader reflections on its economic implications might be useful drawing from experiences and lessons learned in a linked, but still under-recognized arena of climate impacts, and that is the health sector.
Its apparent that health and climate are inextricably linked. The same inefficient fuel and energy technologies driving CO2 emissions are also driving a rising toll of air pollution emissions - which stands at some 7 million premature deaths every year. Tens of thousands of people die every year from direct climate impacts, including heat exposures, severe weather, drought and under-nutrition, and climate-sensitive diseases. And those numbers will rise sharply in the face of inaction, posing huge costs for developed and developing economies.
But what's equally important - and yet often ignored - is that countries that take the most assertive action to reduce climate pollutants of all sorts - short and long-lived - may also benefit the most health-wise, socially, very immediately, and in terms of their economic growth.
Start with the basics Let's start with the basics. Healthy workers are generally more productive than unhealthy ones, and thus healthy populations support economic growth. Between 2000 and 2011, almost one quarter of real income growth in low- and middle-income countries resulted from a healthier population and workforce. Much of this gain can be traced to the huge new investments in key disease control campaigns over the past several decades - including dramatically stepped-up access to vaccines, anti-retroviral treatment for HIV/AIDs, and antimalarials. These investments led by the global health sector included reduced prices for essential medicines, vaccines and medical technologies, deemed essential to combat diseases that stunted and threatened development in low- and middle-income countries, and even globally.
Such investments proved to be highly cost-effective because of the lives saved and the disease toll avoided. Rates of HIV/AIDs infection, malaria and other neglected diseases of poverty are on the decline.
Now, as the world grapples with the challenges related to climate change ecosystem impacts, direct health impacts of extreme weather and rising temperatures, and also a rising epidemic of non-communicable disease (NCD), a similarly "health-conscious" campaign of smart growth strategies in the energy, transport, housing and other sectors can tackle all three factors at once, for a triple benefit.
Air pollution--driven by many of the same dirty energy sources as climate change - is a key factor in the NCD epidemic. It is responsible for a large share of deaths from heart disease and stroke as well as respiratory diseases and cancers. Indirectly, as well, traffic injuries, physical inactivity and obesity also are linked to carbon-intensive and unsustainable development, particularly in cities.
So low-carbon development strategies can strike at the nerve centre of the growing epidemic of non-communicable diseases. Sustainable development in rural areas and "smart cities" can help promote access to clean household sources of energy, and ensure safer, healthier mobility and more physical activity - critical to women and children's health, as well as health throughout the life-course. Reducing air pollution can also boost crop productivity, which is stunted in areas with heavy ozone concentrations, helping to protect food security.
Win-win for national-based actions and economic growth Countries that do the most may also benefit the most locally and immediately - a real win-win for national based actions, and good news for economic growth.
The savings in health and health care costs enjoyed by shifting to low carbon and renewable energy sources have been estimated in the trillions of dollars by the International Monetary Fund, offsetting by far the costs of new investments. And a healthier population can help spur healthy economic growth - growth delinked from carbon emissions.
In South Africa alone, for example, treatment costs from kerosene-related burns and poisonings have been estimated at nearly US$30 million annually. Switching to cleaner, safer sources of energy could thus generate large, immediate savings that quickly justify new investments in climate adaptation and mitigation projects.
In the longer term, the potential savings in the direct costs of climate-induced human suffering and healthcare costs are, on their own, significant enough to justify major investments now. Nigeria, for instance, faces a greatly increased risk of flooding due to climate change, which by 2030 could affect the health of an additional 801,700 people in a variety of ways including drowning and outbreaks of infectious diseases. Averting or mitigating this risk would also avert the higher health-related costs that go with it.
Given that health is effectively an economic asset for countries working hard to identify fresh financing to address climate change, it is crucial they consider it as a key factor among the actions needed for climate adaptation and the co-benefits of mitigation, as they begin to implement the Paris treaty.
Financing actions on climate change The ways in which current investments in carbon-intensive growth are resulting in ill-health as well as climate change are well documented by a number of major international reports. A recent study by the International Monetary Fund estimated that fossil fuel combustion is effectively "subsidised" by approximately US $5.3 trillion a year - up from US $2 trillion in 2011 - because polluters rarely pay for the health or environmental damage they cause.
The same study further concluded that placing a "nationally appropriate price on carbon" would cut outdoor air pollution deaths (currently 3.7 million per year) by half, and reduce greenhouse gas emissions by over 20%. This would raise approximately 3% of GDP, or US $3 trillion per year. This revenue could be reinvested in growth-enhancing public spending - for example in health, education and the green economy. It would also save hundreds of thousands of lives.
Health is, in the IMF analysis, key to the arithmetic, accounting for about half of the overall value of the gains from a nationally appropriate carbon price. The reductions would mainly be in deaths and disability from the products of coal combustion.
In reality, the IMF's estimates of the health gains are probably conservative. In addition to the potential lives saved from reducing outdoor air pollution there is strong evidence of the enormous health gains that could be made, for example, by introducing cleaner and more efficient household energy to reduce indoor air pollution (currently estimated at 4.3 million deaths per year), and more sustainable urban transport systems that facilitate walking and cycling, reducing deaths from physical inactivity (currently 3.2 million deaths per year).
Measuring costs and benefits, investing in health Low- and middle-income countries are well aware of the health and economic benefits from local action against climate change, but some may be discouraged from investing unless the advantages are spelled out during implementation of the new treaty. Conversely, proper recognition could be a catalyst for action.
The first challenge for developing economies is to reject the old technologies and engrained attitudes that have given us polluting and inefficient systems. The second is to select the best and cleanest energy options and to leapfrog inferior or polluting ones. The third is to avoid the narrow view that measures "costs" and "benefits" only as financial transactions. The health community is understandably wary about putting a price on a human life, and takes a rights-based approach that values every person equally.
So, by cutting carbon emissions, countries can save lives and free up huge sums to help finance action against climate change. These are compelling reasons to make health a cornerstone of the work that begins in the new reality introduced by the COP21 Paris Agreement.