Gauden Galea | Systems Approach to Health and Innovation in the Era of Low Carbon Economy


On December 22, 2021, on the first anniversary of the establishment of the Peking University Institute for Global Health and Development (PKU-iGHD), the “2021 Peking University Global Health and Development Forum: Human Health and Medical Innovation in the Era of Low Carbon Economy”was successfully held.  Mr. Gauden Galea, WHO Representative in China delivered a keynote speech at Health Development in the Post-Pandemic Era Session.

In my brief presentation, I have only affirmation for the speakers that have done before, and I will try and put the points that are held in common between us in to a framework that relates to the sustainable development goals, and to the framework for the future in our region, and for the future of public health.

Indeed, in 2018, the Western Pacific region of WHO came together with all the member states at the regional committee, and decided that the future thematic priorities were focused on four key areas. And this is pre-pandemic. There was, in looking forward in the next few years, the member states of the Western Pacific decided to focus on the thematic priorities of health security, of NCDs and aging, on climate change and the environment, and on reducing inequity and reaching the unreached.

And indeed they did prioritize on climate change and the environmental health with a focus on all the issues that have been discussed here in the context of a low carbon economy, but also putting that within a system approach. A general concern with complex adaptive systems in general, but also with the systems that have been spoken about in terms of healthcare delivery and their impact in today's context with the climate and the climate crisis. If one looks at the sustainable development goals and looks at them from the context of the area, we are concerned within WHO goal number three, that aiming for good health and wellbeing. And you relate that to each of the other sustainable development goals. The connection between them, the edges between each of those pairs of nodes is a major link with the environment. Either a major contributor to environmental health or a major danger to environmental health. In the context of the Glasgow COP26, the WHO convened a large number of organizations and academics and made a special health argument for climate change. And I will summarize the action components within the future framework and within those health arguments.

Faced with the pandemic, we have to start with the pandemic and end with it. We need to commit to a healthy recovery. We need to align climate and health goals. We need to support a fossil free recovery. We need to prepare for the next pandemic, which may be happening now. The danger of a pandemic remains with us, and it is not just dealing with the one we have now but always getting ready for disease X, the next pandemic. We need to adopt multi-sectoral approaches with health and all policies. And we need on an immediate basis to commit to vaccine equity. Our health is not negotiable. As we discuss all these solutions, we need to keep the overall aim in mind. We need to close the 1.5-degree gap in order to stay alive. This is a step change in ambition and we must each country, as China has done need to submit ambitious, healthy climate plans. We need to scale up finance for those vulnerable countries that need to tackle the climate and the health crisis. We need to step up our plans and funding for adaptation and resilience.

We need to increase act on loss and damage. In doing this, there are multiple opportunities for addressing and taking advantage of co-benefits between climate, between human health, between animal health, with ecological considerations. The very concept of One Health is founded on co-benefits. We must maximize and measure the health co-benefits for climate action at all levels of government, thus honoring every person's right to health, recognizing that the current and future generations have a right to a safe, clean, healthy, and sustainable environment. And in doing so, we need to continue to invest in the science that strengthens the case for co-benefits and develops as we have seen solutions for connecting the benefits to the climate and the benefits to human health. At the same time, we need to build health resilience to the climate risks. This involves a process of regular assessments. WHO has tools that can assist member states to regularly conduct these vulnerabilities and adapt health vulnerability, and adaptation assessments. We need to develop and implement evidence based adaptation plans for health, and we need to strengthen the climate resilience and environmental sustainability of health systems and facilities.

Jodi Sherman's presentation on this theme has been very impressive and convincing. We need to address the energy systems in ways that protect and improve our climate. We need to phase out polluting fossil fuels. We need to ensure that people in urban and rural environments have access to clean air, adopting WHO's air quality guidelines and doing all that is necessary in order to adhere to those guidelines, and to provide the people of this world with air that is breathable of the highest quality. In doing so we need to invest in clean solutions for household energy. We have billions of people in the world who do not have clean heating, lighting, and cooking solutions. And at same time, as we create energy systems that are in the developed world that are increasingly sustainable, we also need to consider those billions who do not yet have energy security in their household. As part of the health systems approach, we need to power the health sector with clean energy. And we need to find a just transition for those workers and communities who will be affected by this shift in the industry, by providing support, training, and opportunities for those who will be transitioning out of the fossil fuel sector.

Our cities are increasingly attracting large parts of the population already our home to more than half of the world's population. And within those cities, multiple opportunities for re-imagining our urban environments, our transport systems, and our mobility. We need to phase out the internal combustion engine and reduce private car use. We need to prioritize walking, cycling, and public transport, and we need to create people centered cities, not least using the zoning and virtual systems that can create communities within communities, reducing the need for mobility, taking advantage of everything from telecommunications to the modern digital solutions that we are seeing and discussed at this meeting. We have heard the appeal both from academia and the private sector today that we should be using nature as the foundation for our health. And this includes a number of actions. We need to halt the destruction of nature, preserving biodiversity and carbon rich ecosystems, halting the depredation of virgin forest, for example, protect and restore ecosystems. We need to recognize that there are deep inter-connections between human, animal and ecosystem health, and we need to promote nature based solutions. We have heard discussion, which I can only reinforce of the circular economy.

We need to look at an important component in sustainability and that is resilient food systems. I think of food in terms of food quality, food security, and food safety. And these three connect deep the agricultural, industrial, trade practices that guarantee security, quality and safety of the food have great impact on the food systems impact on the environment. We need to nourish our future by improving access to diets that are sustainable and affordable. Removing harmful agricultural subsidies, supporting a just agricultural transition away from unsuitable farming practices that damage the environment and risk human health, mainstreaming biodiversity for nutrition and health. We need to look at the way we finance all this our health systems, our food systems, our energy, and change our, or at least address our financing in a transition towards what is increasingly being called a wellbeing economy. Basically we need to stop funding pollution, ending harmful subsidies for fossil fuels both domestic in each country and as well as in our programs of development assistance abroad.

We need to close the health financing gap. And discussion has been made not only health financing gap between richer and poorer countries, but also financing gaps between, or at least financing imbalances between the high tech hospital based systems that we see in so many countries in favor of more community based primary care, such as was mentioned by Mark McClellan earlier on. Like we do in medicine, have a, do no harm policy for public finance. We need to prevent investments in unsustainable and polluting activities that can threaten communities wellbeing. And there are many nations that are vulnerable and feeling the effect of climate change. Not least in our region the climate crisis is affecting very strongly and already very dramatically the member states in the Pacific, in our region. We need to provide financial and debt relief to those countries that are facing the impact of the climate crisis and that are at the forefront. And we need to both prepare a population of healthcare professionals that are aware of these issues as well as to listen to them and work with them, to prescribe as well as implement urgent climate action.

This means basically that we need to be looking at the curriculum of development for health workforce. We need to update them to take issues of co-benefits of One Health, of a health systems approach into the training of our doctors, nurses, and other health professionals. We need to bring climate action into the healthcare sector. We need to enable health professional advocacy and use the energy of the young upcoming generation of health professionals to help protect the health of future generations. Within this very brief few minutes, I am shoehorning a large amount of actions. But if we look at each of them and we look at the connections between them, we see that the health risks and the health systems and health services are part of large complex adaptive systems. And therefore whatever area of important action and prevention or care, that we look at within the health sector, we see deep connections between that and the environment.

Here is an illustration on tobacco and its environmental health impacts. We tend to think of tobacco as a behavioral concern, but indeed it is very much an environmental concern. It is an environmental concern in terms of policies such as pricing and marketing, that facilitate or encourage smoking or tobacco use. But also we need to be looking at the supply side, all the agricultural concerns. The way that tobacco growing impacts the livelihoods of the farmers, the impact that it has on the land. These are all part of the unsustainability of the tobacco industry even at the production and at the supply side. I've already spoken, and others have as well about the impact of the food system on the entire sustainability spectrum. Our meat production has impact on greenhouse gas emissions. Our agriculture has impact on land use and its sustainability on the use of scarce water resources. Everything is connected in complex systems. And others have spoken eloquently about the impact of the health sector itself. Our buildings, our healthcare facilities have a very direct impact on emissions, on use of disposables and unsustainable investment and behaviors.

And in this illustration, there is a picture of the panoply of actions that are needed in order to make our own health systems walk the talk and adopt national environmental sustainability policies, ranging from sustain procurement to utilizing innovative models of care, such as shifting to primary healthcare and using more telemedicine as opposed to the highly resource intensive high tech care, that is so-called centers of excellence, the disease palaces that are our hospitals. Hoping that this very rapid overview of the interaction between our health systems sustainability and the One Health principles, the co-benefits that lie between them and a focus on the core actions that we need to be taking with urgency, I hope to have at least tied together many of the threads that have been so eloquently presented by other speakers. Thank you very much for your attention.

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