Arquivo de etiquetas: Objetivos de Desenvolvimento Sustentável

The Proposal for Sustainable Development Goals- III

Financing for Sustainable Development

The sustainable development goals, in order to be achieved, are going to require a lot of investment. A lot of new infrastructure is going to have to be built. A lot of new kinds of power plants are going to have to be constructed. A lot of healthcare outlays will be required. A lot of education outlays will be required. Like anything in building for the future, investing is at the core of achieving the Sustainable Development Goals. And When investment is required that means mobilizing resources in order to be able to finance those investments. Who’s going to pay for the Sustainable Development Goals? How will they be achieved through effective financing? Well in the end we’re all going to pay in some sense because we have to pay for the goods and services that are part of our lives. We pay for them through our incomes, but we do it in one of two fundamentally different ways. One is we participate in markets as consumers and suppliers. Suppliers out to make profit. Consumers out to purchase goods and services. And in a market sector of our economy, of course it, it is the interaction of supply and demand, which both generates the economic activity and provides the motivation for financing. Businesses build factories because they anticipate that they’ll make profits from them. Those profits, to an important extent, will come by being able to sell goods and services to the public. The other way that we buy the things that we need is as citizens. Paying taxes so that governments can provide public services, whether it’s building roads or providing health care or public education or fire and police services or funding the national science foundations of our countries and the scientific research which underpins technological change. In this sense, one can say that sustainable development will be paid for by all of us one way or another. But tremendous fights, and sometimes very bitter fights ensue as to the proper balancing of financing between the market oriented profit-seeking investments of business driven by their sales of, of goods to consumers, and the financing that comes through the public sector. The free market philosophy says, let the markets do it. Government will waste the money or lose it or squander it in some way. Whereas advocates of public leadership say markets aren’t, taking on the investments in clean energy, and they don’t build the infrastructure, and they’re not providing health care for the poor. So we need a public approach. Of course, the truth is that these different kids of financing, public and private, and sometimes public-private partnerships are complimentary mechanisms to finance sustainable development objectives. Some things work very well through the private sector. Other things do not. At the core of our analytical understanding of these issues, it needs to be an analysis of where the right boundaries are. What are the most effective ways to allocate responsibility for financing between market-based, private sector financing and public financing? Well, we know that there are cases where the market has done brilliantly almost on its own. And I think the greatest example of this is the massive expansion of mobile telephony to all parts of the world. Here’s a great technological breakthrough. We all love our mobile phones. And in a short period of time, of, roughly 25 years, the number of mobile subscribers has increased from some tens of millions around 1990 to more than six billion subscribers today, including many of the world’s poorest people. This was not on the basis of a government program. This was on the basis of private providers looking for profit, making investments in base stations and other aspects of connectivity like fiber optic lines, and the consumers buying their phones and, and buying access to connectivity. So this is an example where markets have done it. Even though, of course, we should keep in mind that the underlying technologies that made this possible started with basic science, solid state physics, quantum mechanics, and then applied engineering, much of it of which was financed by the public sector originally and then taken up by the private sector. Now other kinds of activities in no way had the kind of dynamics of mobile phones. When it came to malaria control, when even markets plus subsidies were the preferred mode of organization for financing malaria control back more than a decade ago, the uptake was very, very small. When companies producing insecticide-treated bed nets were trying to market those bed nets to the public, they found that the poorest people absolutely were not consumers, were not customers for them, even though they needed those nets to stay alive. The fact of the matter is, they were so impoverished that they couldn’t afford them. And when it came to organizing the delivery of malaria control systems, community health workers, links to clinics, diagnostic services, outreach, availability and access to the right kinds of medicines, the private sector approach simply wasn’t delivering. Very, very poor people sick and dying of malaria were not customers. They were simply very poor people, and the systems did not emerge. Then came the global fund to fight AIDS, TB, and malaria. The President’s Malaria Initiative stepped up public financing. Through budgets, tax revenues being collected, either in the US and then used as international assistance, or in the malarious countries themselves where domestic budgets albeit limited because of the poverty of those countries, contributed to the fight against malaria. Then much more comprehensive measures could be introduced, but not as a profit-based activity, but as a provision of social services. Well, economics teaches us a lot about where the right boundaries are, and let me mention some of the reasons why the private approach which we’d love to be the universal one if it actually solved problems, doesn’t solve problems in particular and very important cases. First, for the poor. Markets, one can say, are designed to ignore the poor. The poor have no money or very little of it. They’re not good customers in many, many cases. And markets in that case when they feel you can’t make a profit from that, pass over the poor and the poor, if it’s a question of access to healthcare for example, can die as a consequence. And that’s why we discuss the concept of merit goods, that there are areas of our economic life: health, education and other areas where government should provide services whether people can pay for them or not because these are meritorious goods that for a number of reasons should be universally accessible. So, that’s one place where public financing is essential. Public financing is essential in areas where, for other reasons, it’s very hard to recoup the returns on an investment in a direct cash sense. Consider investing in basic science. That kind of knowledge is freely available.  Scientists need to publish their papers in, in journals that are read by everybody. The returns to science come in the broad improvement in society, in the uptake of that basic science, maybe by an inventor who then owns a patent. But the scientist doesn’t patent the basic forces of nature which the scientist is discovering or uncovering in her or his research. And so, basic science requires public financing because the profit motive by itself will not be sufficient. Fortunately many countries have recognized this, even for centuries, offering prizes or grants first from the kings and queens and princesses, now from our governments and voted by parliaments and congress, to agencies like the National Science Foundation, which support the basic science. And public finance we know to be very important for social insurance when people are left unemployed by shifts of global markets, when they succumb to other kinds of hardships that can’t be insured effectively in private markets. Government is there as a kind of social safety net. These are all reasons why public financing will be crucial for the Sustainable Development Goals. And, where for poor countries that don’t have a tax base, adequate to meet the SDGs in their own countries, international help from taxpayers from the high income countries will also play a vital role. Now there are many areas where the private sector is the natural way to finance advances. The big power plants that will be built will by and large be built by private companies in the future. But in order to give the right incentives, to have those investments, we know that we will need corrective pricing. For example a carbon tax, which shifts the investments of power generation companies to wind and solar power, as opposed to coal fired power plants for example. So even when the financing is within the private sector a proper regulatory framework and corrective measures, for example to put prices or taxes on social costs like pollution or carbon emissions, is very important to make sure that the private economy providing the financing is investing in the right areas, driven by market signals that are giving accurate indicators of overall social cost and social benefits. Now there’s been an ongoing debate, very emotional, I have to say, and very tense at some points, about one aspect of public finance. And that is when tax payers in one country help to provide public services in another country through official development assistance. Some have said this kind of aid as it’s called, ODA in the technical jargon, and aid in the day to day discussions and debates, is ineffective. There are harsh critics of foreign aid per se. There are others, and I’m among them, who say that that kind of tax payer financed approach where it’s tax payers in one country helping people in poor counties is vital and lifesaving and crucial for organizations like The Global Fund to fight AIDS, TB and Malaria or PEPFAR or other international development efforts aimed at helping very poor people. This debate about ODA or aid has been running pretty strongly during the whole period of the Millennium Development Goals, because MDG 8, the eighth of the Millennium Development Goals calls for increased official development assistance in order to implement the MDGs. Now, how is this debate posed? Let me try to put the sides out there clearly. One part of the debate, I’m in that camp, says aid can be useful, indeed, aid is vital in certain circumstances. Then there are the critics. And the critics come in a variety of areas. One camp says aid is unnecessary, let markets do it. I’ve just discussed why markets might not reach a lot of people, but the market optimists say let the markets do it, what happened with mobile phones can happen with other things as well. A second camp of aid skeptics says aid’s wasted. It passes through too many government bureaucratic hands and that it’s inevitable that it’s going to be wasted. A third argument is that aid is absolutely debilitating, not just wasted, but that it leads to a kind of dependency mentality which is demeaning. It takes away dignity and it takes away motivation. It creates a culture of handouts. And some few say what do we care about poor people. What do we care about what’s happening abroad. Just leave us alone. That’s not the dominant view among the aid skeptics. Most say well, if aid could work we’d be all for it but intrinsically it doesn’t work. Well, these camps have been duking it out, I would say, for quite a while. And I’d like to give, of course a view of why I have been in the camp that says aid’s important in view of these very often legitimate positions taken by the aid skeptics. So let me try as best I can to explain my position vis-à-vis these critical views. First, I want to agree with aid skeptics. Much aid is wasted. No question about it. I can’t stand some of the categories called aid. When cash bills in shoe boxes are given over to local warlords because somehow they’re friends in some conflict in Iraq or Afghanistan or some other place and that that’s categorized as aid. And this is part of our problem in evaluation. What is counted as aid includes many different categories of things, some of which I would agree with the aid skeptics right from the start. No way that that’s going to work. Keep our hands and our taxpayer dollars away from that. My argument is somewhat different. My argument is that aid can work and that it is vital in certain circumstances. It’s especially vital when people are very poor and facing challenges, often life and death, Malaria, AIDS, safe child birth, safe water, sanitation, growing enough food to stay alive, that can not be met by markets. Because these are not consumers that are going to give a profit. Not right now. And they can’t be met by the meager budgets of the poor countries. And so they need help. And then the question is, is it possible to help effectively without the corruption, the stealing, the inefficiencies of the bureaucracies. And my argument is yes if it’s done thoughtfully. We need to design the aid delivery systems in an effective way. Let me refer to my favorite example of this, two organizations. One is The Global Fund to Fight AIDS, TB, and Malaria, which I’ve discussed. The other is The Global Alliance for Vaccines and Immunizations. Both of them pool the aid from the richer countries, have an expert process of evaluating proposals for the use of the aid by recipient countries, and then monitor very closely whether that aid is effective. To my mind, that exemplifies the ways that aid can work. Pool the resources of many donors into a common pot so that the process is simplified, streamlined. Put it under careful scrutiny with expert review and with careful quantitative monitoring and evaluation. Check what’s being done. Don’t hand over that shoe box to a warlord, filled with cash. Rather, have a plan of action that a certain amount of money is going to be used to procure bed nets, anti-malaria medicines, diagnostics, emergency obstetrical equipment, and so forth. And then, monitor what happens afterwards by a close reading. The evidence in my view is quite strong; this kind of aid has worked. So, while there were huge skeptics ten years ago, The Global Fund and GAVI, in the case of the immunizations, have both delivered on their word. We’ve seen the results on the ground. There have been cases of corruption but because the system is closely monitored, because there are quantified targets, because there is follow-up even when there is money stolen, and there will be in any human system, it’s possible to stop, check, correct, and move forward. That kind of feed back system that is so essential. I believe we need more of those pooling mechanisms, more global funds in essence, for health, for education, for safe water and sanitation, for small holder farming, for access for all to low carbon energy sources, and to mechanisms to protect biodiversity. We have a global environment facility like that, that has been established under the Convention on Biological Diversity, a major step forward. Funding those global funds properly, managing them with rigor, professionalism, oversight, and therefore, efficacy is the hallmark of a successful official development assistance effort. The ideologues often say, it just doesn’t work. But all they’re doing, in my opinion, is lumping together the kinds of policies really doomed to fail with those that are compelling and likely to succeed, and blurring these differences, rather than clarifying them and saying let’s go in the direction in which success is very likely. Let me also say we need innovation in financing. We will need a lot more public-private partnerships, where private financing is linked also to public financing in a package, and to the right kinds of regulatory steps. We’ll need this to move to clean energy, to build safe infrastructure. We’ve had that kind of public-private partnership for technology development and for delivery of new technologies like anti-retroviral drugs, to fight AIDS. So the point is, official development assistance, to be effective, and public finance in general, to be effective, requires a serious process. Like anything we do. We need to be thinking, planning ahead, back casting and road mapping, monitoring, evaluating and updating our strategies. If we do this and if we provide an adequate level of public finance the Sustainable Development Goals are in a cost range of one to two percentage points of our national income for the kind of transformations needed. Maybe if the costs are on the high end, maybe two to three percentage points of our national income. They won’t break the bank. But they won’t happen on their own through market forces alone. A clear effective strategy of official financing of national budgets for national needs and of official development assistance for the poorest countries, in particular, will play a vital role in the success of the Sustainable Development Goals.

Universal Health Coverage I

The Human Right to Health

Good health stands at the very center of sustainable development. It is one of the most important goals of humankind, in and of itself. And good health is also vital for everything else we hold dear. It’s vital for economic development through a productive workforce through the ability of children to not only survive disease, but also to flourish, to learn to make their way through school.

911For the ability of a community to be able to undertake economic activities or to attract investment. So health has always been  regarded as central to basic human rights, basic human needs, and to the aspirations of ending extreme poverty. It’s notable that in the millennium development goals, for example, of the eight goals about ending extreme poverty in all its forms, three of the goals, absolutely centrally, are about health. MDG-4 is about reducing child mortality. MDG-5 is about reducing maternal mortality. And MDG6 is about controlling the mass, killer epidemic diseases like AIDS and malaria. And one can absolutely say that, all of the other goals as well, ending poverty and hunger, having children in school, gender equality, a safe natural environment. Are also goals in which health plays an important role.

Both as a determinant of outcomes and also, as one of the main objectives. It’s also an area where there’s progress. And the science of public health breakthroughs in modern medicine and breakthroughs in other areas, such as in food production or in clean water from safe infrastructure in urban areas, have contributed to important gains. But we know that the challenges of achieving health for all as it’s often called, or universal health coverage, when we see a picture of this young child, sick with malaria and remember that hundreds of thousands of children like this one, will die, of malaria unless the control measures that are effective and accessible are actually implemented. We’re reminded of the kind of challenge that we still face. Millions and millions of children, especially in the very poor countries, die each year of utterly preventable, or treatable causes that could be ended.

912These lives could be saved. Children who are dying today, or are left with lifetime disabilities could, with proper organization of our response, have happy lives and safe lives, that would give them the opportunities that of course, they want and we yearn for on their behalf. Since the beginning of the United Nations itself, the priority of health has been clear. And in the Universal Declaration of Human Rights back in 1948 it was already made clear that health is a human right, a part of our basic needs. As we know about the basic declaration, those were rights, are not the kind of rights that can be achieved all at once. They are to be progressively realized. But time is going, and we could move faster. When the World Health Organization was created as well, right in its central constitution, in 1948, it was declared that health the highest attainable standard of health, is a fundamental human right. Quote without distinction of race, religion, political belief, economic or social condition. Health for all, universal health coverage. One of the really notable global efforts to achieve health for all started in 1978 in Alma Ata now called Almaty Kazakhstan. When world health officials, the health ministers from around the world gathered and made a very important Alma Ata declaration. That called for health for all by the year 2000, a notable specific objective dated for 22 years after that event. Unfortunately, when the year 2000 came, it wasn’t health for all. Unfortunately, it was pandemics for many, many parts of the world almost contrary to the aspirations two decades earlier. The AIDS pandemic was running rampant millions and millions of people infected with the HIV virus. More then 20 million, millions dying every year. Malaria which is a tropical killer disease had risen tremendously in in number of infections and in number of deaths. Because the first line medicine used in Africa to treat malaria had lost its efficacy the parasite had become drug resistant to chloroquine and so 2000 was very bleak for malaria with a surging death toll.

The year 2000 was also bleak for tuberculosis another horrific scourge of humanity that claims millions of lives each year. With tuberculosis there was a surge partly riding on the HIV/AIDS pandemic, because immuno compromised individuals suffering from AIDS died in very large numbers from tuberculosis infection. There was also as with malaria, the crisis of drug resistance and new lethal very difficult to treat strains were spreading of what we called then, multidrug-resistant TB, tuberculosis bacteria that were resistant to way wide spectrum of traditional medicine. And this also became extreme multi drug resistant TB when even the rescue medicines lost their effectiveness as the bacteria continued to evolve resistance. In other words the year 2000 did not meet the hopes and aspirations of the health ministers who had assembled in 1978, nor did it fulfill the promise of the Universal Declaration of Human Rights, nor the Constitution of the World Health Organization. So, it was notable that in the year 2000, the Millennium Development Goals put three of the eight goals so centrally on health and took up the challenge of fighting these scourges that were spreading malaria, TB, AIDS, and other killer diseases. We’ve made a lot of progress since then. The distance from 2000 till now is a period of tremendous progress. It rekindles for us the hopes of 1978. Indeed we see within reach the possibility of truly honoring the commitment to help as a basic human right. Now health like education is a merit good. Remember that a merit good is a good that should be accessible very broadly or universally in the population. Health is considered to be such a good not only because it’s so vital for individuals that we feel from a moral and ethical point of view that everybody as human beings deserves access to health. But very practically, health is a merit good, because untreated disease is a threat for society and a threat that spills over to the rest of a population when an epidemic is left to fester and to spread. Think of the devastation that comes when a highly communicable disease races through a countryside, races through a continent, as AIDS has done. The death tolls that can result in the cost to the whole community are huge. We’ll see other reasons as well why government has a necessary leadership role, not only to ensure widespread coverage, but to ensure the efficiency and, the results orientation of the health care system. Now when we look at the actual experience, in health, this is like economic development itself, one of the real achievements of the modern era. Back in the industrial revolution, worldwide life expectancy was perhaps 35 years.

913Of course, we don;t have the, records to establish with precision, a world wide number. But something around the order of 30 to 35 years of life expectancy is a reasonable estimate. This does not mean that people were dying at the age of 30 or 35. It means that a newborn on average would reach, an age of 30 or 35 taking in to account that a very large number of deaths would occur within the first month after birth or the first year or the first five years. Once individuals reached an age of 20 or 25 or 30 there would be a chance, a good chance that they might reach 55, 60, 65. So life expectancy at birth is a measure that is made at the start date of life, just at the time of birth. And from there, to estimate statistically how long on average an individual can expect to live within the society. Now from 35 years in, 19, 1800 or so. By the time we got to 1950, just after World War II, there had been some gains in the average in the world. But remember, how much of the world was still mired in poverty and also in the aftermath of war. It’s estimated that during the five year period 1950 to 1955, worldwide life expectancy was perhaps around 46 years. That’s the average as estimated by the United Nations, but if you look at this graph that divides the world according to high income developed regions developing regions and the least developed countries. You can see that, for the developed regions of the world, life expectancy, in the period 1950 to 1955, was somewhere around 65 years already. Of course much lower still around 35 years in the least developed countries. Probably quite close to the health conditions that had existed at the start of the Industrial Revolution. We see from this curve though that the world has made progress and every category of country has made significant progress. By today, world life expectancy is perhaps 70 years, twice the life expectancy, roughly, at the start of the Industrial Revolution.

914This is one of the great achievements of modern humanity, one of the great achievements of modern science and of economic development. But one also sees the continuing large discrepancies between the high income and the low income world. In the high income, life expectancy is, almost 80 years. Whereas in the least developed countries, you can see from the graph,that life expectancy is, is still 60 years or even less. In other words roughly a 20 year, two decade gap in in life expectancy between the richest and the poorest countries. This gives us a, a measure of how much we have to do. Most of the causes of death in the poor countries are in some sense caused by poverty itself, suggesting that from a medical and public health point of view, these deaths are preventable. These diseases that are causing these deaths are treatable in many cases. In this interesting graph that you’re looking at we put on the horizontal axis the per capita income of countries. And on the vertical axis, the life expectancy at birth. And you see, in this graph, a rising curve. Richer countries, naturally, have a longer life expectancy. You also see in comparing the fitted curve for 1975 and for the year 2005, the two shown here with the dotted line for the earlier year, that the whole curve linking income and life expectancy has shifted up. This means that during that 30 year interval, at any given level of income, one expects a longer life in the more recent years.

Now why would that be? The answer is technological improvement, better ways to prevent disease. Better ways to treat diseases, that, that, occur, nonetheless. And the result is that even at the same income level year after year there is an improvement of health that comes from a rise of the productivity of our public health and medical systems, as well as of other parts of our economic life. 915For instance, the literacy and awareness of people themselves, so that they can pursue health seeking behaviors more ably, or they can use their mobile phones to call for emergency help, and this is one of the reasons why life expectancy rises. Now, what I find extremely pertinent about this graph is the very steep part of the curve at very low income. This means that when countries are very poor, small increments of income going from $1,000 per year to $2,000 per year leads to very steep gains of life expectancy. Those gains later on level off so that increases of income say from $25,000 per person per year to $26,000, the same absolute increase, would have a quite small effect on the average life expectancy. Whereas that gain at the very low levels of income have a massive increase. This is to be expect. There are, diminishing benefits of added income to many things including to happiness, but also to human health. But what’s important about this curve, in my view, is, it says that even small increases of income, or I would also argue, small increases in the amounts that we are able to invest in health, can have huge benefits for the level of health. One of the themes that I want to emphasize is that very low cost investments in poor settings can have huge effects on saving lives on extending life expectancy on extending the quality of life and the health of, of people during their lifespans.

916Not surprisingly, when you look at a world map such as this one, showing the mortality rates of under 5s. Meaning, for every thousand births the number of those children out of a thousand who will die before their fifth birthday. We see that the under five mortality rate is by far the highest in tropical Africa. And next is in south Asia. Those are our two locations we constantly see as being the epicenters of the challenge of extreme poverty. And much, much lower under five mortality rates in the other parts of the world. So our challenges in health are heavily focused in the poorest countries. And, that means geographically they’re heavily concentrated in two regions of the world, Sub Saharan Africa and South Asia. The next graph shows you another asp, very crucial aspect of health and this is maternal mortality. This is measured as the number of deaths related to pregnancy of, of women for every 100,000 live births. And so the numerator of this fraction, number of deaths in pregnancy, typically at childbirth, but it could also be pregnancy related has a huge variation between rich countries where very, very few women, thank goodness, die of pregnancy related causes. Compared with countries in the poorest regions, and poorest of all in tropical Sub-Saharan Africa, where maybe 1,000 woman die for every 100,000 births, an astounding risk of death due to pregnancy. Those numbers are coming down. We see that, that the maternal mortality rate in the developing regions is falling sharply. It was around 440 deaths per 100,000 live births back in 1990. And now below 250 deaths per 100,000 live births as of 2010. We see that in the high income regions, the developed regions, the numbers are very, very small, a few deaths per 100,000 live births. The reasons for death in rich and poor countries differ. But for one basic reason, the poor die of the same reasons that the rich die. They die of cancer, they die of cardiovascular diseases, they die of metabolic disorders, say, related to diabetes. But they also die of conditions that rich people no longer die of, mainly communicable diseases such as children dying of measles, or children dying of malaria, or children dying of other kinds of infections which would not kill their counterparts in the rich world. But do kill the children in the poor countries because the children are hungry, they’re undernourished. And one basic principle of health, is that under-nutrition leads to immuno-suppression. What does that mean? Under-nutrition leads to a camping down of the immune system, the ability to resist infectious diseases and so poor kids die of diarrhea or respiratory infections that would not kill a child in a rich country better nourished. But do carry away millions of children, into death in the poorest countries. The disparities between rich and poor and across ethnic groups, another kind of inequality that we’ve examined can apply within countries as well. The United States, we know being the most unequal of all the high income countries for reasons that we’ve discussed, also has very high disparities in life expectancy. This is a map showing the measure life expectancy across counties of the United States and we see that the Northeast seaboard of the United States. Say Boston or New York City have quite high life expectancies, but in the deep south of the United States, in Alabama, in, in Mississippi, in Georgia, in Louisiana life expectancy is several years less. And we also know that minority groups in the United States, especially the African American community, has many years less of life expectancy compared to the white, non Hispanic Americans. And so these gaps cross class lines. They cross racial lines and they have geographic counterparts as well related to ethnicity, race, and perhaps at least some direct effects of geography as well. To measure the variation over time and across countries in health we use a number of statistics. The life expectancy at birth is an example. Under five mortality, another example. Maternal mortality rate, a third example. Infant mortality rate, which is out of a thousand newborns the numbers who will die before the first birthday. There’s also a very important concept that I want you to know because it’s widely used and very useful called DALYs. DALYs is the acronym for Disability Adjusted Life Years. The idea is that a normal lifespan is 80 years, according to the calculations of DALYs[1]. If an adult dies at age 60, this is 20 lost life years. If that adult is sick between age 55 and 60 and not enjoying healthy years even in those final five years of life, that’s an added penalty for disability. Paralysis, blindness, the loss of a limb, other kinds of disabilities can be translated into a partial loss of a life year by making an assessment how much healthy life is lost by the particular disability. What DALYs calculate in any population is on average the number of lost life years plus the number of lost years to disability add up those two components from death and disability and you get dis you get disability adjusted life years. The DALYs. And these DALYs are used to understand the varying disease burdens across the world. An example of this is this rather complicated chart, but a very, very important one. Every bar on this chart is for a distinct region of the world. At the top is the high income countries. Next Europe and Central Asia. At the very bottom bar, of the chart, is Sub-Saharan Africa. What is being shown here, are the disability adjusted life years lost to disease per population. So a large bar means that there’s a lot of lost life years, either to death or to disability. And we see that Africa has, by far, the highest disease burden, and the high income world, not surprisingly, the lowest disease burden. But this bar in each grouping is divided by colors in a quite interesting way. Those colors refer to different disease categories. So take the dark blue, which is most to the left of each of the bars. That is the amount of loss of life years due to HIV/AIDS. We can classify all of the diseases into a few categories and then measure the disability adjusted life years lost to that particular set of conditions, and group that in a category. What do you see when you do this? Very, very important to note this, Sub-Saharan Africa, for example, has by far The highest disease burden of AIDS. This is not surprising. The very epicenter of the AIDS pandemic is in Sub-Saharan Africa. Now compare the bar for Sub-Saharan Africa with the bar at the very top for the high-income countries You can’t even see that the sliver for HIV/AIDS. That doesn’t mean,uh, of course that there are, is no, death and disease from HIV/AIDS in the high income world, of course there is. But it means that the burden of the disease per person in the population is very, very low compared to the massive burden in Sub-Saharan Africa. And look at the part of that bar for  Communicable disease. You have to scrunch your eyes and see a tiny little sliver. Well why is that? It’s because in the high-income world the communicable and parasitic diseases like malaria, like measles, like diphtheria or typhoid are virtually gone, almost not heard of. Many of these diseases are completely and successfully prevented by immunizations. Others are treated by antibiotics. People, and mainly young children in the case of sub-Saharan Africa, suffer these diseases in the poorest countries, but not in the richest countries. And that’s good news in the sense that it means we have tools already to shrink the bar of DALYs, of the disability adjusted life years, in sub-Saharan Africa and in south Asia. So that the disease burden can get under control. So that life expectancy can rise. So that the quality of life lived is higher, and so that a healthy population can also play it’s part in in more dynamic e-, and more inclusive economic development. Let’s see how we can attack the those disease burdens by now going on to look in more detail at the nature of the diseases, and what can be done about them.


Growth within Planetary Boundaries I

The Planetary Boundaries 

We’ve been talking about economic growth, how it started, how it diffuses, what the big problems are, how countries still trapped in poverty can spring free of the poverty trap. But the problem, we know, is more complicated than that. What if the world achieves economic growth? What if the poor countries, as they hope and rightly deserve, catch up with the high income countries? What then for the planetary boundaries? What then for an environment already under tremendous stress? Remember that sustainable development makes a key point, that economic, social and environmental systems are interlinked.

So, I want to focus now more deeply on how we might even conceive of bridging this terrible problem of global economic growth, the good that we want, the progress for poor countries, with a worsening environmental crisis. We have to understand the environmental systems and how humanity is effecting them. Then we have to look for practical approaches. How we can reduce the pressures that humanity is placing on the climate, on the oceans, on the land, or other species. So that we can reconcile these two objectives and indeed, make it possible to achieve all three of the basic goals of sustainable development. Economic growth, fairness and social inclusion and environmental sustainability.

Remember the concept of planetary boundaries or the fact that we’re living in as new geologic era, the anthropocene. Both these concepts, planetary boundaries and anthropocene, signify that humanity has become so numerous, our 7.2 billion people and rising, and so effective one could say, so productive in the capacity to mine and extract resources. To transform resources for production in industry, to consume, that we have suddenly, unprecedentedly as a species, hit these planetary risks and even dead ends if we’re not careful. The concept of planetary boundaries, I think it’s an extremely useful one, because when world leading ecologist Johan Rockström and many, many other leading ecologists got together, they asked the question in specificity. What are the major challenges coming from humanity’s impact on the physical environment? Can we identify those challenges? Can we quantify them? Can we identify what would be safe limits for human activity so that we can begin rather urgently because we’re late to this.

611To redesign our technologies and our economic growth dynamics so that we can have economic improvement while staying within the planetary boundaries. You’ll recall the picture that we looked at of the planetary boundaries around this circle. And I want to say a few words about each of these so that we can begin to look deeply at the question of how to reconcile growth and these various environmental threats. The first of the challenges and the biggest is climate change.


This is being caused by humanity’s use of particular technologies. Especially fossil fuels and the way we use land and grow animals and food that produces atmospheric change in the form of rising concentrations of a few particular gasses. Carbon dioxide is the most important of these. Nitrous oxide, methane and a few more industrial chemicals are the greenhouse gasses that have the property that they allow the sunlight in as ultraviolet radiation. But then, when the earth would re-radiate its heat to space, they trap energy in the form of the outgoing infrared radiation and thereby warm the planet. So these greenhouse gases are very particular molecules that have the property that they absorb infrared radiation.


And so when their concentration in the atmosphere increases, that warms the planet. It’s because of these greenhouse gases that life is possible in the way we know it, because that envelope of the atmosphere has made the earth warmer than say, the moon, which lacks an atmosphere. And is very, very cold as a result. But at the same time, if we perturb the greenhouse gas concentrations, raise them by raising the CO2 or the methane or the nitrous oxide in the atmosphere, then we endanger ourselves and other species. The second of the planetary boundaries is related, ocean acidification. This also comes from carbon dioxide in the atmosphere which is increasing because of human use of coal, oil, and gas. The oceans are being acidified, made more acid, by the fact that the carbon dioxide in the atmosphere dissolves in the ocean producing carbonic acid. And because of this acidity, various kinds of animal life, corals and shellfish and lobsters and very small plankton that also have these external shells made of calcium are threatened by the increasing acidity which makes it hard for the species to make their protective shells. Now, the pH of the ocean has already decreased by 0.1 unit on the pH scale from zero all the way to 14, the least acidic or basic end of the pH spectrum. A change of 0.1 in the pH oceans doesn’t seem like all that much. But this is a logarithmic scale. So, what a decline of 0.1 signifies is an increase of protons in the ocean of 10 to the 0.1. Or about 0.3, 30% increase of acidity in the ocean already with a lot more to come. If you look at this map of the ocean, you can see the changes that are already being noticed on average in different parts of the world.The oceans are not uniformly becoming more acidic. That depends on ocean dynamics. But the shading of this colored map shows that we’re already in an environment on a trajectory of dangerously rising ocean acidity. The third of these planetary boundaries is ozone depletion.

We learned a while ago accidentally, but thank God, we learned it, that certain industrial chemicals, those that were used at the time for refrigeration, mainly. Chlorofluorocarbons, or CFCs, when put into the air, would rise into the upper atmosphere, dissociate, and the chlorine in those CFCs would then cause the ozone layer in the upper atmosphere to dissociate. And a famous, horrifying finding was that there developed a big hole in the ozone over Antarctica. And when that was discovered by satellite of course people were rightly terrified. Because the ozone layer in the upper atmosphere protects us from too much ultraviolet radiation, saves us from skin cancer and many other harms. And humanity realized that this planetary boundary was already being crossed, the ozone was already being depleted unwittingly by us. This is what’s so frightening, we didn’t even know it until some brilliant atmospheric chemists unveiled the mechanisms by which these chlorofluorocarbons deranged and destroyed the ozone level.

614The next of the planetary boundaries is the heavy human caused loading of nitrogen and phosphorus. When farmers grow more food, you’ll recall that they put soil nutrients into the soil as organic fertilizers and as chemical fertilizers. Either way, incidentally, the nitrogen goes into the soil, some of it gets taken up by the crops. But a lot of it runs off the farm into the water, into the groundwater, and it collects in the rivers, and especially collects in the estuaries, the point where rivers meet the ocean. And that heavy pollution of nitrogen and phosphorus coming mainly from fertilizer use is creating a tremendous amount of ecological destruction.

We’ll have a look at that shortly. The next big challenge of planetary boundaries comes from our overuse of fresh water resources. We need fresh water every day to stay alive. Our crops need fresh water.


Of the total amount of fresh water that humanity uses, about 70% is used for agriculture, to grow our food. About 20% is for industry. And about 10% only, interesting enough, is for our household use, for hygiene and sewerage and, and and the rest. We use so much water, especially for our food production, that we are depleting very, very important sources of fresh water. For example, in the United States, in India, in China and in other parts of the world, we’re drilling for water in, in ground water aquifers, we are taking the water out, using it for irrigation. But taking the water out at a much faster rate than the water is being replenished by rainfall, and then by the water percolating back into the groundwater.

We’re depleting the groundwater. When it runs out, disaster. And that’s happening in many places in the world and will happen in many other places in the coming decades unless we are much more efficient in our water use. To grow food to feed our animals of course, humanity uses a massive amount of land. We also use land for our cities, for our parking lots, for our streets. But actually the urban areas, even though they seem to dominate, are only a few percent of the total land area on the planet. The farmland and the pastureland and the timberland that we use for forest products is a much, much larger proportion of the total land area. And humanity has been grasping over history for more and more land, more and more pasture land, more and more crop land. After all, the human population as we know has increased roughly ten times since the Industrial Revolution. That requires a lot more farmland to feed the 7.2 billion of us. The problem with that is that we share this planet with other species and as we grasp this land for our farmland, for our pasture land, for our timber land for our palm oil plantations and many many other uses.


We are literally chasing the other species away and off the planet into extinction in many cases. Our land use is having devastating consequences on biodiversity. The next category identified is aerosol loading. Small particles put up into the air because of industrial processes, or households that are burning coal into keep warm. And creating tremendous amount of air pollution, very damaging for the lungs. Claiming many, many lives per year. And with a heavy impact also on changing climate dynamics. Then there’s a very broad category of chemical pollution. Our petrol chemical industries, our steel industries, mining industries, not only demand a tremendous amount of land and water for their processing, but they add a tremendous amount of pollutants back into the environment. Many of these pollutants are persistent, they, they last in the environment, they accumulate, they can be very deadly for humans, for other species. And the range of chemical pollutants is so vast and the human and animal and plant health consequence is so large that it’s absolutely impossible to summarize, except to say that the problems are horrific in many places. China, the world champion of economic growth over the past 30 years, has also become the champion of polluted waterways of major cities, because of the extent of the heavy industrial processing.

And this all sums up to a final category of biodiversity loss. The death, the extinction of other species. We’re killing more animals and plants than we even know, than we’ve even met and catalogued scientifically, because we’re chopping down rain forest, poisoning environments, acidifying the oceans. Creating so much pollution and poisoning. That species are disappearing even before we’re able to identify and catalogue the millions of other species that share the planet with us and that we share with them. We are not stewards of global biodiversity right now. We are posing absolutely profound challenges. And when it comes to biodiversity loss, one could say that all of these planetary boundary threats, the acidification, the climate change, the land use patterns, the pollution, they’re all contributing to the loss of species, probably by the millions. It’s actually hypothesized, shocking as it may seem, that humanity is now causing the sixth great extinction wave of the planet earth. The other five, the first, for example, 440 million years ago. The next one, the second, 365 million years ago and so forth, weren’t caused by any species, weren’t caused by human beings, since we weren’t there. These were natural dynamics, whether it was, asteroid hits or whether it was the internal dynamics of the earth itself. These were natural processes. This sixth mega-extinction is not natural. It is the result of one species, that would be us, causing so much damage on the planet that we are putting millions and millions of other species at risk. And, since we depend on those other species, of course we are putting ourselves at profound risk. We are also creating a hugely unstable environment.


My colleague, professor James Hanson, recorded the extreme heat events on the planet from the 1950s till now shown in this series of maps. If you look at the map for 1955 and look at the dark red areas, you see a few places on the planet where there were heat waves in the June, July, August months of the year. And when you see those, you see that they were very particular places such as in, in Canada. Because of climate change, the number of those red splotches on the map which signify extreme heat, in that location, unusual to a massive extent for that locale, has been increasing in frequency very dramatically. You look at the map of 1955, just a couple of red regions. Have a look at the map of 1975, 20 years later, now there are a few more dark red regions of the map signifying places where extreme heat waves gripped those places. But, now jump ahead another 30 years or so to 2006 or 2007, suddenly the map is all red, it seems. The planet has been in engulfed by what was an extraordinary shock 30 years ago becoming common place now. We all know it, we’re feeling our own heat waves wherever we are. And being amazed year after year as new and very uncomfortable and often very dangerous records are set in very high temperatures gripping different parts of the planet each year. But what these maps are showing is that the frequency of these extreme events is absolutely shocking. Well, these are the planetary boundaries that have been identified. We know that we are already pushing against the limits. A

nd our question, in the coming analysis, is how can we think that that growth that we’ve been trying to decipher and promote can be reconciled with environmental sustainability and staying within these planetary boundaries when we already have so much challenge. That is our question, as we now delve more deeply into the intersection of economic growth and planetary boundaries.

What is Sustainable Development? I

 Introduction to Sustainable Development

Sustainable development is a crucial concept. It’s crucial for the world. But what does it mean? Our starting point has to be, how crowded our world is today. We’re 7.2 billion people. The numbers have soared. We’re up ten times since the start of the industrial revolution. Billions more people are likely to be added to the world’s population in the 21st century. This is making for a very complicated world. A world divided between great wealth and still crippling poverty. A world facing unprecedented environmental challenges. Sustainable development is really two ideas. One, is a way to understand this complicated world. How do the economic, the social, the environmental, the political, the cultural factors fit together? And the second aspect of sustainable development is the idea of sensible goals for this crowded, interconnected planet. How do we make the world both prosperous, fair and also environmentally sustainable, so that our numbers, and our economy don’t overrun the physical planet itself? That’s really the aim of the study of sustainable development. To understand the world and of course, to help improve the world. And we need to get into that complexity. Any idea there’s one answer, one simple, magic formula, one explanation, one force at work; we have to put that aside. We have to embrace complexity, because we are talking about a complicated, interconnected set of relations of a world economy that now spans all parts of the world. And connects all people, all businesses, technologies in flows of trade, finance, ideas, advertising, production systems, but also connects us with the physical Earth, in unprecedented ways. Humanity actually changing the climate, changing what specie survive on the planet, changing the chemistry of the ocean, changing the safety of the air, changing the access and availability of fresh water. It’s an unprecedented situation. It’s a fascinating situation. It will be the challenge of your generation. Let’s see what we can figure out of all of this and how through that knowledge we can do something about it. Have a look at this remarkable, the piece of technology the Maglev in Shanghai. Which carries people at speeds of more than 200 miles per hour, more than 400 kilometers per hour, to and from the city and the airport. It, it’s a magnificent piece of technology. A product of joint work of a major leading engineering companies and Europe and those in China. It’s been operating for the past decade. It is a kind of model of what sustainability can mean in the future. Because if a electric, trains, these, magnetic levitation trains or fast intercity rail based on electricity are powered by, clean electricity. Then we have a way of helping people to move helping goods and services to move in a way that’s safe for environment and technology is exemplified by the Maglev is definitely one way forward. But we also have to realize that not all the world right now is in, in the state of traveling to and from the airport in magnetic levitation. Let’s look a, another remarkable city another great city in many ways, but crowded beyond belief, the city of Dhaka. You see a crowds bustle, and actually a kind of transport you can hardly find anywhere else in the world. I’ve experienced it, it’s astounding to ride in a bicycle, a rickshaw or one of these buses on this incredibly crowded path. Thousands and thousands of people walking to and from work. Life out on the streets. What are we really seeing here? First, we are seeing one of the most crowded places in the world. We are seeing an example of the incredible rise of global population. Bangladesh is a country now, with around 160 million people. That’s more than four times the 37 million people in Bangladesh in the middle of the last century in 1950. Dhaka, itself, is one of the largest cities in the world right now but think of what’s happened. In 1965 Dhaka had about a half a million people. Today Dhaka has more than 15 million people. You can imagine how the infrastructure’s been completely over run. How transport systems, water systems, sanitation systems and all the rest Are facing unbelievable stress with this kind of population increase. This is also part of the reality of our planet. How do you achieve sustainable development in a, very low income, very crowded place like Bangladesh. Especially taking into account how vulnerable low-lying Bangladesh is to the climate change ahead.So, sustainable development for us, first, is a way to understand these complicated challenges. I think it’s useful to think of there being four dimensions to that puzzle.  There’s the economics, there’s the societal dimension, how our communities work, culture, civil society, there’s the natural environment and there’s our political or government systems. How do economic, social, environmental and government systems interact? The second way to think about sustainable development is not only as an analytical approach, one that takes a holistic view of society. But also as what we would call a normative or ethical approach, identifying goals for society. Sustainable development urges us to have a holistic vision of what a good society should be. Sometimes people say well good society is a rich society. But we know that can’t quite be it just to focus on the economics. If a country is rich on average, but all the wealth is held by very few people and most of the people are poor, Think most of us would say that’s not a good society in the sense, that we would aspire towards. So social inclusion is the second aspect of a good society. Meaning that economic well being is widely shared among different ethnic religious or racial groups in a country. It’s shared between men and women. So, there’s gender equality, it’s shared among regions of a country, so that there’s not just one pocket of prosperity in a sea of poverty. A third aspect of what we would think to be a good society is one that is a good steward of the natural nvironment. We all know that if we break the physical systems of biodiversity if we destroy the oceans if we deforest the great rain forests, we’re going to lose immeasurably. If we continue on a path that fundamentally changes the Earth’s climate in a way that’s unrecognizable for us in the way that humanity has developed. We’re going to face grave dangers. So from a normative perspective, environmental sustainability certainly seems right. If we care about the well being of our children and future generations. And for most of us we also care very much how government functions. People living in places with massive corruption with lawlessness. Where the politicians are not to be trusted. Where government services are not fair. Where there’s massive discrimination, insider dealing and so forth. This creates a lot of unhappiness. All over the world, people feel happier and better when they can trust their government. But unfortunately, many places in the world, people don’t trust their governments to be honest, to be fair, even to keep them basically secure. So from a normative perspective, we could say that a good society is not only a wealthy society. But is one that is prosperous and inclusive, environmentally sustainable and well governed. And our fundamental question will be how can we take sustainable development as a goal? Use our knowledge of the interconnections of the economy, of society, of the  nvironment and of governments. To think through this crowded 21st century in a world of massive divisions of wealth and poverty and world of unprecedented environmental stress. But also in a world of Maglevs and many, many other technological miracles. How can we find our way through, through this century to produce property that is inclusive, that is sustainable. And that is according to decent governance with rule of law, transparency and accountability. There are some very powerful ways forward to meet sustainable development as a goal a shared goal for the planet.


Objetivos de Desenvolvimento Sustentável (2016-2030)

Chagados a 2015 os Objetivos de Desenvolvimento do Milénio estão prestes a ser substituídos pelo Objetivos do Desenvolvimento Sustentável,  SDG serem atingidos até 2013.

Dos 10 ODM passamos a 17 objectivos.

Os SDG são:

Goal 1   End poverty in all its forms everywhere:

Acabar com a Pbreza em todas as suas formas em todo o lado

Goal 2   End hunger, achieve food security and improved nutrition and promote sustainable agriculture

Acabar com a fome, garantir a segurança alimentar, melhorar a nutrição e promover a sustentabilidade agrícola

Goal 3   Ensure healthy lives and promote well-being for all at all ages

Assegurar a saúde e promover o bem-estar em todas as idades

Goal 4   Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

Assegurar uma educação inclusiva e equitativa e promover a aprendizagem ao longo da vida para todos

Goal 5   Achieve gender equality and empower all women and girls

Assegurar a igualdade no género e empoderar as mulheres e a meninas

Goal 6   Ensure availability and sustainable management of water and sanitation for all

Assegurar a disponibilidade e a sustentabilidade do acesso á água e condições sanitárias para todos

Goal 7   Ensure access to affordable, reliable, sustainable and modern energy for all

Assegurar o acesso á fontes de energia, em quantidade e em qualidade, de forma sustentável, para todos.

Goal 8   Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all

Promover  o crescimento económico sustentável e inclusivo, o pleno e produtivo emporego e formas de trabalho decentes para todos

Goal 9   Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation

Construir intraestruturas resilientes, promover uma industrialização sustentável e inclusiva e inovadora

Goal 10 Reduce inequality within and among countries

Reduzir as desigualdades dentro e entre os países

Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable

Fazer cidades e assentamentos humanos inclusivos, seguros, resilientes e sustentáveis

Goal 12 Ensure sustainable consumption and production patterns

Assegurar padrões de produção e consumo sustentáveis

Goal 13 Take urgent action to combat climate change and its impacts*

Tomar medidas urgentes para combater as mudanças climáticas e os seus impactos

Goal 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable development

Conservar e usar de forma sustentável os oceanos e os recursos marinhos para assegurar um desenvolvimento sustentável.

Goal 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss

Proteger, recuperar e promover o uso sustentável dos ecosistemas, a gestão sustentável das florestas, combater a desertificação, parar e reverter a degradação das terras e parar a perda da biodiversidade.

Goal 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

Promover sociedades pacíficas e inclusivas para o desenvolvimento sustentável, providenciar justiça para todos e promover instituições responsáveis e inclusivas a todos os níveis.

Goal 17 Strengthen the means of implementation and revitalize the global partnership for sustainable development

Reforçar os meios de implementação e revitalizar a parceria global para o desenvolvimento sustentável

Para ver mais  Relatório dos ODM