Mandela

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Mandela

• Its not a tragedy to die with dreams unfulfilled,
  but it is a tragedy not to dream.
• Mandelas dream , shared by me and billions of
  others, is of all humanity living with each
  other in harmony and balance, and living in the
  world without destroying it.
• So develop a flourishing global civilisation.
• And in Ghandis words Live simply, so that other
  may simply live.

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GMC duties of Doctors/health professionals

• Two equal obligations
• To care for individual patients in a humane
  compassionate and scientifically effective way,
  without regard to status, sexual orientation,
  origin or any other.
• To ensure that the society we live in is health
  creating, so that all global inhabitants can
  enjoy good health.
• Same for all health professionals

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Preconditions for a health creating civilisation

• All peoples have reasonable access to economic
  and social resources.
• Earths gifts are shared amongst humans fairly
  without compromising future generations and other
  than humans
• Present attempts to be create this healthy world
  are undermined by two great problems-global
  climate change and the everywhere prevalent gap
  in resources between the materially rich and the
  materially poor
• If we are to fulfil our obligations health
  professionals must play a prominent role in
  addressing these problems.

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What do we need to do?

• Inform
• Affirm
• Advocate
• Innovate
• Disseminate

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What do we need to do?

• Inform
• -- health consequences of Climate change and
  the widening resource gap
• policies for mitigation
• policies for adaptation
• co-benefits of the above

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What we need to do

• Affirm. Measure and reduce personal CO2
  emissions. Ensure that the organisations we are
  associated with do likewise.
• Informing and affirming -putting our own house in
  order- wont solve the problem, but give us the
  moral right to advocate for global solutions
  which will.
• When in place, these global solutions will
  accelerate our own local initiatives.

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What do we need to do?

• Advocacy, stressing the need for a global
  framework which simultaneously tackles climate
  change and the resource gap, and so is health
  promoting.
• So a fair shares solutiona fair share of the
  residual carbon we can emit consistent with a 450
  ppm CO2 target, and of the resources which come
  from these emissions.
• Most feasible present fair shares option is
  Contraction and Convergence.

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Contraction

• Set a globally agreed carbon Budget, aimed at
  keeping atmospheric CO2 levels below 450ppm.
• Reduce this over an agreed, but negotiable time
  scale (probably 50 years) until the amount
  emitted equals the amount the world can cope
  with.( approx 8 billion tons of CO2 1.4
  tons/person/year).
• But this amount depends on protecting carbon
  sinks.
• By CONTRACTING the amount of Carbon emitted, this
  process will stabilise atmospheric CO2 levels.
• Allocate an equal entitlement of this capped
  budget to every global citizen.

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Convergence

• Move rapidly to an equal entitlement of the
  carbon budget to each person in the world. A
  CONVERGENCE to an equal share of earths bounties
  and support systems.
• Then frugal emitters( usually the poor) will be
  able to sell their unused entitlements to the
  profligate emitters( the rich). For compelling
  financial reasons, all will invest in low carbon
  initiatives.
• Given that each ton of CO2 entitlement will have
  a substantial financial value, this process will
  enable a framework based market transfer of
  money to the poor to fourish.
• This would more than cover 120/person which the
  UN millennium project has estimated will be
  required to deliver the millennium goals in
  Africa.

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Contraction and Convergence

• Creates a policy virtuous cycle at a global
  level, enabling economic and social progress
  within environmental limits.
• Unleashes a worldwide boom in low carbon
  entrepreneurial activity.
• Facilitates the development and implementation of
  virtuous cycles for coping with the problems
  of waste, excessive fossil fuel use, biodiversity
  loss, noise at National, regional , community and
  personal levels.
• Implementing virtuous cycles is essential for
  promoting sustainability and wellbeing.
• The many virtuous cycles of policy facilitated by
  C and C will deliver major health benefits.

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Health Benefits of C and C.

• Those arising from the mitigation of Climate
  change. KEEPING our COOL
• Those arising from the related transfer of
  resources. NARROWING the GAP
• Those rising from the facilitation of other
  virtuous cycles, moving those living in the Rich
  North to more physically active non obesogenic
  societies, in which obesity related disease will
  be less prevalent.

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Virtuous cycles facilitated by C and C

• Regional/National Level Distributed energy
  networks.
• Community level Influence procurement to
  create virtuous cycles of activity.-( the health
  service buys around 11 billion worth of products
  each year) . e.g
• a) locally grown organic food supplying health
  facilities.
• b) Influencing new buildings to improve the
  economic, environmental and social circumstances
  of the localities in which they are built.
• Personal level Set and promote good examples
  e.g.
• a) ride a bicycle,
• b) Insulate our homes using local materials and
  local workers.

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What do we need to do?

• Innovate-seeking new institutional forms for
  delivering the C and C framework and
• Disseminaterecruiting as many partners as
  possible.

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Take home message-1

• Global agreement to tackle climate change is
  imperative for our global good health-health
  professionals have a crucial advocacy role.
• Participation of the majority world is dependent
  on carbon constraint being coupled to a transfer
  of resources to the yet to industrialise and
  industrialising countries.
• These countries can then share in non fossil fuel
  dependent progress.
• The framework based market of Contraction and
  Convergence is the most feasible presently
  available tool to achieve this end.

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Take home message -2.

• C and C will facilitate many other virtuous
  cycles, providing a boost to sustainability and
  wellbeing, and therefore public health.
• Think, advocate and implement Virtuous cycles at
  all levels, including those which protect the
  globes carbon sinks.
• Join the many others who are clamouring for the
  global virtuous cycle of C and C.
• Make C and C the framework promoted by the UK at
  COP 15 ,Copenhagen 2009.

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Conference of the parties to UNFCCC ( COP)

• COP is the supreme decision making body of the
  UNFCCC. It is open to all signatories, and meets
  each year.
• First steps to a new global framework were taken
  at COP 13, in Bali Dec 07
• We must aim to make C and C the policy the UK
  proposes at COP 15 , Copenhagen 2009

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Atmospheric CO2 levels, global warming and fossil
fuel use.

• Stable level from 10,000 years ago to
  1800-280ppm.( not above 300ppm for 400,000 years)
• Present level 380ppm,increasing by 2ppm/year.
• Global temp has risen in parallel-predicted
  increases for 21st century are around 0.5
  C/decade.
• Fossil fuel is burned predominantly by the rich
  North. 80 million barrels oil/day- USA 20
  million, China 6, Japan 5, Germany 3, India
  3,UK1.9.
• Per capita emissions (tons of CO2 )USA-20
  UK-10 Africagt1 China-3.0 India-1.5.
• Sustainable per capita emission is approx 1
  ton/year. This amount is dependent on
  preservation of carbon sinks.( The biomass,
  particularly tropical forests ,and the sea)

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Ecosystems and Health-Impacts of climate change

• A Source of energy and materials.
• A Service for water, food , micronutrients and
  carbon recycling.
• A Sink for pollutants.
• A Space for living working and aesthetics.
• 60 of all ecosystems are already degraded or
  being used unsustainably.
• Global warming will aggravate the situation.

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Global climate change-aggravating the problem

• Unpredictable exposure to extremes of weather
  affecting water supply and crops.
• Expansion of range of disease vectors. Falciparum
  Malaria already causes 500 million cases/year,
  with one million deaths.
• Thermal expansion of water plus melting land
  based ice leading to sea level rises.100 million
  people and many cities are within half a metre of
  present sea level.
• Ensuing demographic, social and economic
  dislocation, with the likelyhood of 100 million
  new climate refugees.

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Deprivation and disparity, which will get worse
with global warming.

• 800 millions go to bed hungry. 1 billion have no
  access to clean water.
• Of 700 million primary school children, 125
  million, mostly girls, dont go to school.
• 2 billion people live on incomes below 1,000
  /year 1 billion on 30,000 /year.
• This disparity exists in both rich and poor
  countries.
• Personal income is a good marker of this
  disparity. Globally, ratio of income between top
  20 and bottom 20 has moved from 1135 (1998) to
  1150 (2004). Gini coefficient in UK was 0.29
  (1980), 0.4 (2002).

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Atheroma and global warming

• Atheroma, narrowing of the arteries, is the basis
  of most deaths in the developed world.
• Half of the 550,000 deaths /year in the UK,
• 11 of global deaths.
• Commonest in non exercising obese ( diabetic),
  eating high salt high cholesterol and energy
  dense foods, smoking and suffering from low
  status.

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Atheroma and global warming

• Atheroma occurs in the obesogenic societies of
  the minority world.
• These societies have flourished with the
  availability of cheap and plentiful fossil fuel
  energy.
• And are therefore the societies which provoke
  global warming.
• In carbon constrained societies, there will be a
  move to localism. We will once again use more
  human effort, as was the case in societies
  before the availability of cheap fossil fuel.
• The move to localism will unleash a series of
  virtuous cycles moving us toward a non obesogenic
  society. The reduction in the prevalence of
  atheroma will be an excellent marker of
  improvement.

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UN Framework Convention on Climate ChangeUNFCCC

• UNFCCC came into force on 21.03.1994.Its three
  objectives are to
• Gather and share info on GHG emissions , national
  policy and best practice.
• Launch national strategies for addressing GHG
  emissions and adapting to expected impacts,
  including the provision of financial and
  technical support to developing countries.
• Co-operate in preparing for the impact of climate
  change.

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Take up of C and C.

• Senior advocates in the European Union , India,
  Africa and UK.
• Archbishop of Canterbury , Michael Meacher, Ken
  Livingstone,and Colin Challen, chairman of the UK
  parliamentary all parties climate change group.
• German Advisory Council on Global climate
  Change.
• Aubrey Meyer, director of the GCI and inspiration
  behind C and C gets City of London 2005 lifetime
  achievement award.
• Fleming, the Tyndall centre and Domestic
  Tradeable Quotas ( Local variant of C and C).

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Millennium goals-2015

• Reduce by 75 maternal mortality rate.
• Halt and reverse AIDS/HIV epidemic.
• Halve number of people living without access to
  water/sanitation.
• Reduce under 5 mortality by 66.
• Halve the number of people living on less than
  1/day.
• Universal primary education.

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Energy equivalents.

• The energy in a kilo ( litre) of oil is 10
  kilowatt hours, equivalent to between 100 and
  200hours of human work.
• An hour of human work is therefore equivalent to
  5-10 grms ( I teaspoonful) of oil
• A 40 litre fill up of a petrol tank is equivalent
  to between 2 to 4years of human work.
• 1 kilowatt hour860 kilocals,3.6 megajoules