Published byAnnette Gerritsen
Published on30 May 2017
This article has been written by George Lueddeke, Chair One Health Education Task Force, One Health Commission.
Time to ‘stop, think and do!’
Human existence is deeply embedded in the natural world and the survival of all species, including our own, is wholly dependent on a healthy planet. But the health of our planet is in serious trouble (1). According to the authors of ‘Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health,’ (2) while ‘human health is better today than any time in human history’ as life expectancy has risen across the globe and child mortality rates have fallen significantly, our progress to date has come at a steep price, some have called the Ecology Paradox: ‘we have been mortgaging the health of future generations in order to realize economic and development gains in the present.’ (2). Evidence of this trade-off abounds, including, as highlighted by the Center for One Health Research at the University of Washington, ‘biodiversity loss, climate change, particulate air pollution, ocean acidification, and deforestation.’ (3).
A specific example that confirms ‘the degradation of nature’s life support systems,’ cited in The Living Planet Index (4) should “make us stop and ”think”: “In less than two human generations, population sizes of vertebrate species have dropped by half. These are the living forms that constitute the fabric of the ecosystems which sustain life on earth and the barometer of what we are doing to our planet, our only home.”
The Rockefeller report underscores how ‘this environmental degradation can pose a serious threat to human health in the future, and calls for urgent research and policy action to address these large-scale problems, ’ (3) particularly considering past failures that can be traced to weaknesses relating to ‘concept/empathy, knowledge and implementation.’ (2). It is therefore re-assuring that global initiatives to mitigating the effects of an increasingly compromised natural world – including the very real potential of ecosystem collapse – are taking place not only through transdisciplinary scientific research but also on the social front, as governments are beginning to realise that policies must ‘balance social progress, environmental sustainability and the economy.’ (2) The UN-2030 Global Goals, targets, indicators (5) and the Paris Climate Agreement (6), agreed late 2015, and the priorities reported in the World Economic Forum (WEF) 2016 report (7) are prime examples as are educational, research and information-sharing initiatives driven by such organisations as the World Veterinary Association and the World Medical Association (8) as well as the One Health Commission (9) and the One Health Initiative (10).
Recent public pronouncements by global spiritual and thought leaders, such as Pope Francis (10), Nobel physicist Professor Stephen Hawking (11), and Sir David Attenborough (12), to name several, have been intensifying and have voiced the ‘folly of a limitless world.’ (1) Their collective message is clear: the human race is highly vulnerable and the status quo, considering, as examples, climate change, inequalities, inequities, economic uncertainties, ideological extremism, food security is unsustainable and we have not only to do things differently but also to do different things.
A case in point is the African continent which is experiencing uncontrolled and rapid rural to urban population growth, shown in Figure 1. As highlighted in the publication Global Population Health and Well-Being (1), ‘Africa’s population reached one billion in 2009 and joined India and China as the third region of the world. It is expected to grow by more than 500 million people in the next 17 years and a further 500 million by 2050, with 60% of its population living in cities, compared to 1950 when the continent had fewer than 500,000 urban dwellers.
Figure 1: Growth of Africa’s largest cities. Source: Frontier Strategy Group, Capturing Africa’s Transformative Urban Growth (2011) (13)
The Frontiers Strategy Group (13) estimates that ‘By 2040, it will have 1 billion urban inhabitants and by 2050, 60% of all Africans will be living in cities. Lagos, Nigeria – which will shortly overtake Cairo as Africa’s largest city – grows by 58 residents every hour; at an estimated 10.5 million inhabitants today, Lagos is 40 times larger than it was in 1950.’ By 2100 predictions are that Africa’s population will be between 9 and 13 billion. Given that currently about 70% of Africa’s population live in slum conditions, the challenge to already ‘Overstretched and under-resourced municipal authorities…to provide water, electricity and social services, not to mention governance and security’ will continue to be immense.
However, because of climate change, the World Bank (14) projects that the most severe socioeconomic impacts are likely to be felt by those living in coastal regions:
‘…as the coastal cities of Africa and Asia expand, many of their poorest residents are being pushed to the edges of livable land and into the most dangerous zones for climate change. Their informal settlements cling to riverbanks and cluster in low-lying areas with poor drainage, few public services, and no protection from storm surges, sea-level rise, and flooding. These communities—the poor in coastal cities and on low-lying islands—are among the world’s most vulnerable to climate change and the least able to marshal the resources to adapt…They face a world where climate change will increasingly threaten the food supplies of sub-Saharan Africa and the farm fields and water resources of South Asia and South East Asia within the next three decades, while extreme weather puts their homes and lives at risk.’
Social consequences of a fragile world
Antimicrobial resistance (AMR) to infections
The urgency of tackling the basic health infrastructure in existing and emerging cities alongside the severe shortage of health professionals is made clear by the increasing threat posed by antimicrobial resistance (AMR) to infections – caused mainly by worldwide overuse and misuse of antibiotics or antimicrobials (15). Exacerbated by the ease of intercontinental travel today, densely populated cities may be most at risk as resistance to first-line drugs to treat infections, such as, MRSA (methicillin-resistant Staphylococcus aureus, and tuberculosis (TB) malaria HIV influenza, to name others, are on the rise. Organisations such as WHO, the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE), applying a ‘One Health approach to promote best practices to avoid the emergence and spread of antibacterial resistance, including optimal use of antibiotics in both humans and animals’ are committed to reducing AMR (16).
It is estimated that AMR kills about 700,000 people annually with predictions that ‘the number of deaths per year would balloon to 10 million by 2050,’ costing ‘the world up to 100 trillion USD.’ In terms of comparison, ‘that is more than the 8.2 million per year who currently die of cancer and 1.5 million who die of diabetes, combined. ’ As shown in Figure 2 most AMR deaths ‘would fall unevenly across the world, with the global south and Asia suffering to a greater extent and losing greater amounts of income. In one example, they estimate that 25 percent of all deaths in Nigeria could be caused by resistance if trends continue unchecked.’ (15).
Figure 2: Global AMR deaths (15)
World Happiness Report 2017 and personal well-being
With the aim of redefining ‘the growth narrative to put people’s well-being at the center of governments’ efforts, ” and ‘considered to be the proper measure of social progress and the goal of public policy,’ the United Nations published its fifth World Happiness Report (WHR) in 2017 (17). The report involved a survey of 155 nations focusing on six factors that ‘explain happiness differences among countries and through time: income, healthy life expectancy, having someone to count on in times of trouble, generosity, freedom and trust,’ with the latter measured by the absence of corruption in business and government.’ Norway came out on top followed by Denmark, Iceland, Switzerland, Finland, the Netherlands, Canada, New Zealand, Australia and Sweden. It is significant that ‘In richer countries the within-country differences are not mainly explained by income inequality, but by differences in mental health, physical health and personal relationships: the biggest single source of misery is mental illness .’ In this regard report authors conclude that ‘The USA is a story of reduced happiness,’ dropping from third place among the OECD countries to 19th in 2016.
Happiness in the African continent
Perhaps, unsurprisingly, ‘Income differences matter more in poorer countries.’ With a focus on ‘peace and security’ alongside a ‘fresh and flourishing economy,’ Algeria is ranked first out of 54 countries in the African continent and fifth among the Arab countries, ahead of Qatar, Saudi Arabia, Kuwait and Bahrain (17). Contributing a chapter, ‘Waiting for Happiness in Africa,’ to the World Happiness Report, lead author Valerie Møller from the Institute of Social and Economic Research, Rhodes University in South Africa and research colleagues (18) conclude ‘that Africa is struggling,’ given considerable inequalities in life evaluations in African countries.’ The current situation seems especially problematical and disappointing, according to the authors, given Africa’s assets: ‘youthfulness…in an increasingly ageing global society… the continent’s rich mineral wealth…its agricultural land… and huge increases in foreign direct investment, which ‘eclipsed development aid for the first time since the colonial era.’
According to the authors, while the African countries generally favour democratic rule, they also highly value ‘freedom from the experience of deprivations in everyday life’ or ‘less lived poverty’ and ‘expect much more of their democracies than just civil liberties such as free and fair elections. They are just as likely to associate democracy with better living conditions—with basic services such as clean water, electricity, and housing—as with regular elections, competing political parties, and freedom to criticise government.’
It is noteworthy ‘that on average across 35 African countries, only about two-thirds of the people live in communities with an electric grid (65%) and/or piped water infrastructure (63%), and less than one in three have access to sewage (30%), while more than three times as many have access to cellular phone service (93%). Only about half (54%) live in zones with tarred or paved roads.’ It is estimated that ‘the continent would need to invest up to $93 billion a year until 2020 for capital investment and maintenance.’ (18)
One of the factors constraining progress between those ‘who yearn for change and greater life chances is that there is a dramatic disconnect between Africa’s longest serving leaders and the continent’s youth, with about ‘70% of African citizens…younger than 30 years’ and demanding not only ‘democratic representation and economic participation’ but also ‘greater access to education and to skills that will lead to employment.’ (18)
In this regard the authors raise a crucial question that has major implications for Europe as well as the continent: what will happen to Africa’s youth who do not find jobs in their countries of birth by their mid to late twenties? Will they despair, join extremist groups, or emigrate?’ Many have decided to leave the continent – with over ‘80,000 of the passengers on the Mediterranean people-smuggling boats have come from sub-Saharan Africa’ – and to seek a better life but thereby, as the authors note, also overwhelming Europe (18).
Moreover, as ‘There are over 200 million young people aged 15 to 24 at present, constituting 37% of Africa’s labour force but (60% of the continent’s total,) there is little doubt that ‘Africa will need to provide jobs for its youth if it is to meet their aspirations for the good life.’’ It is estimated that 18 million jobs will need to be created every year just to accommodate Africa’s current jobseekers.’ (18) As shown in Figure 3, unemployment in South Africa alone in 2013 was 53.6% (19)!
The development of the continent’s infrastructure with investments ‘up to $93 billion a year until 2020, ‘ according to the Programme for Infra-structure Development in Africa, could be a key catalyst for providing employment opportunities.
Unquestionably, major investment is needed in Africa’s youth to address barriers to youth employment and ‘avert avert a population ‘time bomb’ (18)! To their credit, the authors conclude on an optimistic note, emphasising that Africa is an optimistic continent and that this optimism is shared ‘most of all by the youth who have their lives ahead of them…(and) might serve as a self-fulfilling prophecy for the continent.’
Figure 3: Youth Unemployment 2013, total (% of labor force ages 15-24) Source: Dalberg Research (2013) (19)
Towards a new worldview
In the light of increasing global risks (technological, environmental, social, geopolitical), Professor Hawking recently revised his estimated 1000 year timescale ‘to turn things around on our planet’ to 100 years (20). His vastly reduced timescale should come as a wake-up call! While there are no easy solutions, he has also argued compellingly that ‘more than at any time in our history’ our species needs to ‘work together’ and ‘to break down, not build up, barriers within and between nations.’ (16)
Challenges that face us – ecological, large-scale migration, AMR, well-being and youth employment – briefly discussed in this paper are indicative of the need to adopt a new worldview that ensures we are able to live on a planet that is ‘compatible with our needs as human beings but also an outer world that is compatible with the needs of our ecosystem.’ (1, 21). In short, there is growing consensus that our greatest social problem in this century is to change the way we relate to the planet and to each other (22). The seventeen UN-2030 Global Goals are pointing us in the right direction but arguably could benefit significantly by adopting and applying a unifying perspective or a ‘unity around a common purpose, ’ (3) espoused by Marco Lambertini, Director General of World Wildlife Fund International (WWF International).
As illustrated in Figure 4, consensus around this ‘unity’ encapsulated in the One Health concept could lead to the formulation of policies and approaches that are not only about ‘preserving biodiversity and wild places, but just as much about safeguarding the future of humanity – our well-being, economy, food security and social stability – indeed, our very survival.’ (3).
Figure 4: Linking the UN-2030 Global Goals to the One Health Concept, Policy and Approach. Source: G Lueddeke, 2nd WVA and WMA Global Conference on One Health (2016) (23)
The authors of ‘A Vision for Human Well-being: transition to social sustainability (24) make the point that ‘environmental sustainability,’ which ‘ examines living within the limits of the natural world,’ must rank equally – in policy and practice – alongside ‘social sustainability.’ In practical terms, this means ‘providing for material, social and emotional needs, avoiding behaviours that result in poor health, emotional distress and conflict, and ensuring that we do not destroy the social structures (such as families and communities), cultural values, knowledge systems and human diversity that contribute to a vibrant and thriving human community.’
Education for life and sustainability
As concluded in UNESCO’s Educating for a Sustainable Future (25), lifelong learning continues to be our best (only?) option for understanding and tackling the huge socioeconomic, geopolitical and environmental problems facing us. However, while academic performance acquiring proficiency in the basic academic skills certainly remains an education priority worldwide, studies have confirmed that in both the economically advanced and poorer nations the main focus of education is still largely on academic performance, not on the health and well-being of students and much less on future prospects and the sustainability of life in their own communities, nations and the planet.
It is for these reasons that Goal #4 of the seventeen UN-2030 Sustainable Development Goals (4) is crucial as it emphasises the importance of students’ developing the ‘knowledge and skills needed to promote sustainable development through education for sustainable development and sustainable lifestyles. In this regard curriculum themes should include aspects relating to ‘human rights, gender, equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.’
‘One Health’ education task force developments
Against this background, the One Health Commission (7) and the One Health Initiative (8) believe that much more attention must be given to enable learners from early years to tertiary education and beyond to gain a better thematic understanding and respect for the fragility of our planet, global interdependencies and threats, cultural diversity/intolerance, and care for the community of life in general.
To these ends, the Commission established the One Health Education Task Force mid 2016, and, since that time, the group has been engaged with the development of a global education project (concept paper (26), press release (22), webinar and conference report (27) that focuses on children and young adults with a view to ‘achieving meaningful societal change and preparing future leaders to create a healthier world.’
The SDG-One Health education project proposal
The main outcome to date of these developments has been to propose a Commonwealth multi-country and multi-partnership project entitled ‘One Health Education: Advancing the UN-2030 Sustainable Development Goals.’ The proposal is premised on the belief that education does indeed hold the key to creating a better future for all and that global solutions call for far-reaching changes in how we think and act for the dignity of fellow human beings…’ As UNESCO has posited,
‘It is not enough for education to produce individuals who can read, write and count. Education must be transformative and bring shared values to life. It must cultivate an active care for the world and for those with whom we share it (requiring) transforming the way people think and act …’ (25).
Involving Commonwealth nations in the first instance (28), the project development team aims to raise awareness about the SDGs and One Health and encourage policy-makers, teachers and learners from early years to tertiary education and beyond to develop a better understanding of how we relate to the planet and each other and to ensure a more sustainable future for all life.
The project therefore calls for involving ministries of education/health/others, and faculties of education and encouraging – through pilot education projects, as outlined in the conference report (27) – the embedding of knowledge, skills and values about the SDGs and how to achieve these and One Health within and across education curricula. In the longer term, the project seeks to strengthen social engagement and ‘to mainstream and scale up a modern workforce to deliver the 17 SDGs through a holistic and integrated ‘One Health Education’ system disseminated across the 52 Commonwealth countries.’
Finally, with a view to finding solutions to the unsustainable world that we have created, three central tenets may be helpful in shaping ‘a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.’ (4).
- that all life – human, animal, plant – is interconnected;
- that our future on the planet depends on taking care of ourselves and each other within an ecologically sustainable environment regardless of who we are and where we live;
- that learning is making personal sense of the world and taking individual and collective responsibility to ensure the planet can continue to thrive through preventive measures – respecting cultural diversity and holistic care for the community of life (29).
As WWF International Director General reminds us ‘Now we must work to ensure that the upcoming generation can seize the opportunity that we have so far failed to grasp, to close this destructive chapter in our history, and build a future where people can live and prosper in harmony with nature.’ (3).
Building this future can essentially be realised in two main ways: first, sharing and adopting the values, principles and practices underpinning One Health across key sectors – governments, corporations, researchers, educators, civil society- and collaborating on transdisciplinary initiatives; and, secondly, encouraging children and youth to develop their understanding of and respect for the world they inhabit and each other through education and contributing conscientiously and unwaveringly to ensuring the sustainability of people and the planet throughout their lives.
Sincere appreciation for taking time to review and comment on the article is extended to the following members of the One Health Commission: Dr Joann Lindenmayer, Chair, Board of Directors; Dr Cheryl Stroud, Executive Director; and Dr Gretchen Kaufman, Senior Advisor.
Correspondence: George Lueddeke, [email protected]
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