# Writing structure & approach 1. Introduction 1. Key terms, key concepts, definition 2. Problem statement from the question 3. Explain the challenges that you are tring to write on 2. GHP materials 1. Address the critical examination of the key concepts 2. Give nuances 3. GHP examples 1. Global policy is important, but anchor it in national level policy (or lack thereof) 2. Health effect of global environmental issues 3. Circle back to how normative probems in global arena affects or contributes to the problem 4. Counterargument / filling in the gaps / inequities 1. Critical analysis of reality 2. Socioeconomic angle 3. Corporate interest 4. Role of non-state actors 5. "On the other hand" 6. "However" 7. Power asymmetry 8. [[decolonization]] 5. Nuanced discussion # Air pollution Worldwide energy use from transport sector has risen steadily 2-2.5% per year since the early 1970s. The largest growth in in road transport has been in LMICs, where there has been larger population and economic grwoth compared to HICs. Air pollution negatively affects health and the different type and source of pollution affect health differently. There are particulate matters, with different sizes, i.e., PM 10 and PM 2.5 with 2.5 no visible to the eyes and when inhaled, can reach the lung and pass through the barriers and enter the bloodstream. According to the WHO, in 2019, 99% of the world's population was living in places where the strict guideline of clean air levels were not met. PM 2.5, because it can enter the bloodstream, impacted not only lung health and respiratory diseases, but also cardiovascular health, even contributed to cognitive disabilities and nervous system damage. In the urban setting, when the outdoor air becomes polluted, having the means to have a clean indoor air can only be achieved by certain group of population, with people from lower socioeconomic level couldn't afford to buy, for example, an air purifier. Hence, air pollution does not affect people equally and disproportionately affect vulnerable people. For example, Jakarta, Indonesia, which has been consistently ranked at the top of most polluted cities in the world, were surrounded by numerous coal plants which contributed to the toxic air in the city. As a result, Jakarta population constantly experienced upper respiratory infections, and children were more prone to develop asthma, experience more asthma episodes, and allergies. Even then, despite clear negative health effects from coal plants, it was a contention from the policy side. The provincial government recognises that the pollution originated from plants outside Jakarta, and the central government protected the coal plants activities by not measuring PM 2.5 despite well received scientific evidence on PM 2.5 effect on health. Civil society then crowd-sourced the air quality monitoring devices to monitor the air quality data and use them as an advocacy materials. Neo-colonialism in the form of demand for developing countries to stop using coal to power their countries. Unfair practices because in the early industrial revolution, the Western has reaped the benefit of energy abundance without having to deal with environmental consequences. ## Outdoor air pollution In Jakarta, the main sources are from coal plants near Jakarta. Jakarta has 8 coal plants in the range of 100km from the city, and 4 new plants were planned to start running. It has been heavily criticized and became a main contested idea during the last Presidential debate. Coal plants produced sulfur oxide, nitrogen oxides, and particulate matters that are proven to harm our health. The next one is transport. Jakarta is one of Indonesia's metropolitan cities where central government and business centres operate. People surrounding Jakarta came to Jakarta to work. On one occassion, the population living in Jakarta was estimated to be 8 million people, but during the workhours, +4 million people came to Jakarta to work. The third source is forest fire. Policy approaches to outdoor pollution ranges from setting ambient air quality standards and setting vehicle emission standards. An additional approach to protect public health is to implement [[air pollution alert systems]] that warn susceptible individuals on high air pollution days so that they may modify their behaviour (e.g. stay indoors, delay physical activity) on that day to reduce their personal exposure. ## Transport --> active lifestyle Transport sector has used fossil fuels are the primary energy source since the industrial revolution and propel economic growth through increased mobility. However, it is not without negative consequences. In Jakarta, one of the metropolitan city in Indonesia, vehicle combustions contributes around 30-50% of urban air pollution in the form of PM 2.5. A shift to electric vehicles is an option the government can explore to reduce vehicle combustions and create a cleaner air for the city. However, as Jakarta experienced rapid urbanization, people from all over Indonesia flocked to Jakarta because of its economic opportunities for a better living. Unfortunately, the economic growth is not followed by proper infrastructure, which resulted in poor housing condition, poor water and sanitation, which provides a fertile ground for other range of health risks. One of the innovative governance mechanism that has been discussed is pay-per-mile car taxes (road pricing) where people pay based on how many miles they drive a year. A major benefit is that it charges people for their direct use, making it more specific and fair based on the pollution people contributed. A negative is the potential increase in car tax if you live somewhere you depend on a car. Consequently, for an innovative governance to be implemented, there are complement measures that the government must consider and implement at the same time to [set off] the negative implications, such as promoting integrated public health transportation to allow people have an at least one climate-friendly option if they do not to use their cars. In London, the mayor implemented Ultra Low Emission Zone where the government set to protect the air of London. The London government did this with two policy approach: innovative financing through tax to enter the zone, and stricter vehicle emission standard. It has successfully reduced the number of older, more polluting vehicles from London. However, it is a contested issue, as there are pushbacks around complementary issues and the policy deemed bad for business because it incurs more operational costs for small business that operates in London. The other means that the government can do is to promote active and healthy lifestyle, through [[Active commuting]] with bicycle and car-sharing systems. Road transport is not only an important source of human exposure to air pollution but also presents a risk of injury and has implications for health through reduced physical activity. In Jakarta, the provincial government has constructed bicycle lane on major roads and promoted bike-to-work as a mean to promote active lifestyle. However, as with other cultural and behavioral change, it is not without resistance and challenges. For example, there has been an increase in road accident involving bikes due to motorcycles not being used to prioritize bikes, or motorcycles entered bicycle lanes to avoid congestion and thus, misused the dedicated lane. Shift to electric vehicle rife with political interest, such as government officials has a conflict of interest of stock in related companies. In Indonesia, the fiscal incentives to own EV benefit the rich more than addressing access to energy and solving climate or pollution issues. This policy is taken without meaningful complementary measures to incentivize public transport or active commuting. Hence, the health co-benefit from energy or environment policies has not been maximized. ## Indoor air pollution Second, dealing with indoor air pollution, which originated from a different source and type of energy, which contributed to pneumonia, the leading cause of child under five mortality in LMICs, where the answer should be expansion of energy. Promoting and bridging the energy divide between the haves and the have nots will improve energy availability for the vulnerable population and eliminate indoor air pollution that was produced by wood-burning inside the huts. On the other hand, energy availability does not always mean renewable energy is alway better. There is a trade off that needs to be understood, as countries would like to develop. Development requires energy, even if it means to extract and mine coal despite the agreed global policy goals such as [[Paris Agreement]]. From developing countries perspective, developed countries have enjoyed the benefit of early industrial revolution, and now when it is time for their turn to seize the opportunity, HICs would like to dictate and limit their choice, arguably a form of neo-colonialism. [[Countries at the highest income levels may contribute more-than-proportionally to the research and development of health technologies, generating positive externalities for other countries]] ## Open waste burning Combustion from open burning waste added to the outdoor air pollutants, with added discomfort through its odor and potential for uncontrollable fires, soil and water contamination. Waste management to collect and dispose, including landfil, recycling programs, and composing. Jakarta has an example harnessing integrated approach to waste management, working with civil society and one-stop-solution app such as JAKI as the official government complaint channel, and establish international partnerships such as with C40 Cities. # Energy Covered by SDG 7 (Ensure access to affordable, reliable, sustainable and modern energy for all) to be achieved by 2030. Shifting energy sources from fossil fuels or natural resources can mitigate climate change. At the international level, the amount of energy consumed per capita is strongly correlated with health, similar to [[Preston Curve]] concept. Indonesia's primary energy sources are coal (36.4%) and oil (28.1%) in 2022. The rest are followed by natural gas, biofuels and waste, and a tiny bit of hydro. The trends over time focused on oil and coal, with oil production relatively stable until coal production ramped out around the COVID-19 pandemic time and took over the number one spot. The renewable energy sources were relatively small, only 10%. In 2022, geothermal, solar, wind slowly increased over the years and approaching natural gas's energy supply. Fossil fuel still powers 80% of Indonesia's electricity, being the most easily accessible, valuable commodity in Indonesia to tackle energy poverty. Shifting to all renewable energy without proper phasing out would deprive the country of its energy sources. The condition happened because Indonesia's coal mines are vast, and thus, one of the world's largest coal producers and exporters. It's low-cost production makes it competitive in the global market. Moreover, coal industry are owned by politicians. The 2020-2022 timeframe especially has been influenced by China's energy crisis (shortages) and restriction on Australian coal imports due to political tensions, so Indonesia became the alternative supplier. This crisis was also exacerbated by Russia-Ukraine conflict's impact on energy supply and demand. In short, it's a combination of political, economic, and geographical factors. > Fossil-fuel producing countries have been known to exert influence in a variety of ways such as by subsidizing domestic oil prices, directing oil proceeds to key constituencies or by leveraging fuel supply or extraction contracts in international trade negotiations. However, these motivations can be counterbalanced by pressure from interest groups which have concerns about the fossil fuel industry for reasons including climate change, indigenous land rights and health risks. In 2023, Indonesia's enery transition began to gain momentum by launching Just Energy Transition Program (JETP). # [[Health impact assessment (HIA)]] # Healthy cities [[Healthy Cities Index]] Cities have an important role to tackle addiction and its health consequences: 1. Levy additional taxes beyond national/provincial ones 2. Restrict opening times and location of alcohol and tobacco outlets 3. Regulate product advertising (related to [[Framework Convention on Tobacco Control]]) 4. Smoke free areas 5. Provide addiction counseling and treatment services # [[ecosystem services framework]] The linkage between human and living beings in the world extends beyond sharing the space to live. Biodiversity and the concept of ecosystem services has garnered interest from the global health community because of the increasing concern and intensity of human, animal, and environment interface. Consequently, its health effects to human health also increased. Over the past century, the rate of extinction has skyrocketed and the result is human population takes over more of the animal's habitat, particularly wildlife habitat that were previously untouched by human activities. As the original or natural habitat disturbed by human expansion, a range of animals and plants were utilized by humans as part of their diet and increase the risk of transmission of animal-to-human disease. To counteract this reality, the global community has agreed and signed [[Convention on Biological Diversity (CBD)]] which stated to achieve the 20 Aichi targets as a multilateral treaty between >150 countries to converse biological diversity, promote sustainable use of the components of biological diversity, and equitable and fair sharing of the utilization of genetic resources. However, the implementation was more than a challenge. It is from the CBD that now we have the infamous Conference of the Parties (COP) Presidencies as the governing body of the Convention. CBD itself is not enough to ensure key objectives are met, hence there were several other provisions made to strengthen the aim, such as [[Cartagena Protocol on Biosafety]], [[Nagoya Protocol]]. Then, Archi targets was introduced to help drive effective and urgent action to halt the loss of biodiversity to ensure the ecosystem were resilient and continued to provide essential services. However, in [[Kunming-Montreal Global Biodiversity Framework]] or GBF, there were targets introduced to supersede [[Aichi Targets]] due to its slow progress after a decade and failure to meet many of its provisions. GBF is the advocate for [[One Health]] Approach, that aim to balance human, animal, and environment interface, and recognize the need for equitable access to tools and tech including medicines, vaccines, and other health products related to biodversity. Critiques to [[Aichi Targets]] 1. Insufficient to match its aims to reduce biodversity loss by 2030 2. Lack numerical targets to reduce unsustainable footprint of production and consumption 3. Suspected corporate lobbying for the removal of monitoring, accountability of business practices. Biodiversity spans across ecosystem, species, population, and genetics. Many human have benefited from the loss of biodiversity for their own livelihood, such as more land to use, security from the threat of wild animals. The ecosystem services framework refers to the whole ecosystem of life that support, regulate, and provision life for human. The ecosystem provides services such as food, fresh water, wood and fuel, and the supporting role such as nutrient cycles, soil formation and all of them relates to the constitutents of well-being, ranging from security (personal, resources, from diseases), health, and material for good life, good social cohesion, and freedom of choice and action. Example: 1. nickel mining in Indonesia resulted in loss of biodiversity, flooding in an area that were previously never flooded, occupational hazard for the workers who were employed without proper safety measures, and lastly nickel mined in protected areas such as forest and small islands which, on paper, must be conserved. The actors in Indonesia has protested the government's industrial policy to satisfy the nickel demand for electric vehicles, but if the process destroys the environment, is it really a "green policy"? It also exacerbates the economic disparities, with people in rural, indigenous people, suffers the consequences of political leaders' decision. 2. Yayasan ASRI Countries who sign up to the CBD must create and implement national strategies and action plans to conserve and enhance their biodiversity. Efforts to manage and conserve biodiversity in Indonesia consists of three aspects: conservation, utilization, and benefit-sharing, in accordance with [[Convention on Biological Diversity (CBD)]]. In 2010, COP 10 CBD became a milestone in the management of biodiversity by generating three global agreements, i.e. the [[Aichi Targets]] (global target to reduce the loss rate of biodiversity), the [[Nagoya Protocol]] (the agreement to regulate access and to share proits from the utilization of genetic resources) and Resource Mobilization as an important support for the achievement of global targets. COP 15 agreed on [[Kunming-Montreal Global Biodiversity Framework]], replacing [[Aichi Targets]]. Indonesia then renewed its national strategy and action plan. Indonesia has a dedicated web-based mechanism to manage and report progress towards the implementation of the National and Aichi Targets, and as a medium for exchanging information on the management of Indonesia's biodiversity, namely Indonesian Biodiversity Clearing House (Balai Kliring Keamanan Hayati) Specifically related to marine biodiversity and global fishery resources, in 2003 Indonesia adopted the Ecosystem Approach to Fisheries (EAF) as a follow-up to the ratification of the United Nations Convention on the Law of the Sea (UNCLOS). In line with this, Indonesia has designated 11 Marine Fisheries Management Areas (WPPNRI) in its marine waters and 14 Inland Fisheries Management Areas (WPPNRI-PD) in its inland waters. In 2023, concerning biodiversity in areas beyond national jurisdiction, Indonesia also signed the **Agreement under the United Nations Convention on the Law of the Sea on the Conservation and Sustainable Use of Marine Biological Diversity of Areas Beyond National Jurisdiction (BBNJ Agreement)**, which is a derivative agreement of UNCLOS. Limitations of ecosystem services framework: 1. Valued differently by different people, culture, and distribution of services 2. There is a lack of focus on inequity and difficulty to measure and compare the ecosystem services 3. It doesn't count or consider the commodification of ecosystem services and lack of focus on trade offs and disservices. Recent example of proposed policy solutions to link health and biodiversity is [[Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES)]]. The report highlights the disruptions to ecosystem and loss of biodiversity can contribute to the spread of zoonotic infections. # Sustainable Food production