# Session Overview ## Learning outcomes By the end of this session you should be able to: - Discuss the challenges and trade-offs facing decision makers wanting to pursue economic growth (to reduce poverty) but also needing to consider environmental sustainability. - Explain the notion of “co-benefits” in relation to sustainable development and health. - Discuss the Sustainable Development Goals, the aspirations they represent and challenges related to their governance and progress # 1. Sustainability: balancing economic development and environmental destruction? In 2009 the then Indian Prime Minister, Manmohan Singh, declared that “[…] _climate change cannot be addressed by perpetuating the poverty of the developing countries”_ (NDTV 2009). The point he was making was that India’s quickest and most economically productive route to “development” was not necessarily going to be the one that was best for the environment. Most western nations, to date the largest perpetrators of green-house gas emissions, grew rich on colonial expropriation of labour, land and their natural resources and fossil-fuel based economic development. ==As a leader of the most populous country in the world Singh was not prepared to compromise the rapid development of his country by capping fossil fuel use, because the urgency of pulling people out of poverty overrode longer-term concerns over environmental damage from his country’s perspective.== Many other low- and middle-income countries (LMIC) face similar economic development and connected environmental dilemmas. Namely, balancing the urgencies for economic development and their historical association with fossil fuel with increasing international pressure for investment in renewable energies and other green approaches to development. # 2. Health and Environment: Trade-offs and Co-benefits While the WHO pioneered some of the early environmental health movement, many issues that emerged from it became seen as a non-health (water-sanitation) issue with Ministries of Health often losing their environmental health expertise to other sectors; at the same time the prominence of environmental health within WHO faltered. At the [[Rio+20]] Summit in 2012, WHO lobbied hard for the inclusion of  ”co-benefit” targets to monitor progress on the added social, environmental and health benefits we get when we act to control climate change (and other environmental concerns), above and beyond the direct benefits of a more stable climate. Political commitments arising from the Summit (also known as the United Nations Conference on Sustainable Development) are reflected in the outcome document “The Future We Want” (United Nations, 2012). Co-benefits are understood as so called ‘win-win’ strategies, which aim to provide simultaneous environmental and development and/or health benefits. One example is cleaner air. For example, fossil fuels are not only the main source of greenhouse gases that cause climate change, but also a primary source of air pollution worldwide, which is a known cause of chronic ill health. Shifting renewable energy sources and thus burning less coal, oil and gas can not only help address climate change, but also have extra benefits (‘co-benefits’) for human health, due to cutting emissions of particulate matter, acidic gases, ozone-forming gases and toxic compounds that cause heart and lung diseases and cancer, killing millions of people around the world each year (Haines et al 2012). > It is important to note that policies of co-benefit are not straightforward and are dealing with the conditions of poverty and broader socioeconomic development. Historically, high income countries (such as United States, Japan, France and Australia) have achieved poverty alleviation and development through industrial fossil fuel economies and policies. There is limited precedence for such achievements via renewable energies, especially given their higher costs and subsidies relative to fossil fuels. However, there are strong arguments that investments in renewable energies can reduce health care costs in the mid and long term (Haines et al 2012). Hence, many countries such as India and Ghana, face complex decisions with relation to addressing climate change, poverty, health and other environmental and development challenges. ## Activity 1 As a health policy adviser, advise governments on fossil fuel policies vs renewable energies. Outline a brief argument from the perspective of the health sector, bearing in mind the concepts of trade-offs and co-benefits. #to-read Haines, Andy, George Alleyne, Ilona Kickbusch, and Carlos Dora. ‘From the Earth Summit to Rio+20: Integration of Health and Sustainable Development’. _The Lancet_ 379, no. 9832 (June 2012): 2189–97. [https://doi.org/10.1016/S0140-6736(12)60779-X](https://doi.org/10.1016/S0140-6736\(12\)60779-X). #to-read Romanello, Marina, Claudia Di Napoli, Paul Drummond, Carole Green, Harry Kennard, Pete Lampard, Daniel Scamman, et al. ‘The 2022 Report of the Lancet Countdown on Health and Climate Change: Health at the Mercy of Fossil Fuels’. _The Lancet_ 400, no. 10363 (November 2022): 1619–54. [https://doi.org/10.1016/S0140-6736(22)01540-9](https://doi.org/10.1016/S0140-6736\(22\)01540-9). Read pages 1619-22. ### Feedback - The comparatively rapid socioeconomic developments and associated health improvements in high income countries have occurred during a period of massive and relatively cheap fossil fuel use, where concerns for climate and pollution were comparatively less than they are now. - It assumed that, at least with current renewable energies technologies, achieving equivalent socioeconomic development to those HIC achieved with fossil fuels is likely to be very challenging. This is not only due to debates around the relative efficacies of renewable technologies, but also their costs of development and installation, as well as in some case feasibility (e.g. availability of wind for wind power etc). - However, if renewable energies are used they may contribute to better health outcomes in the present (e.g. less respiratory illness due to burning of less fossil fuels and hence, less air pollution), but also in the future too. This can be understood as a co-benefit generated from the use of renewables over fossil fuels. - While many renewable energies may be better in terms of climate change and in terms of contributing to decreasing future negative health events, they are not without potential negative consequences during their construction (e.g. their construction can required the mining of rare and often toxic substances or the damming of peoples locales). - A trade-off worth considering here, is that a focus on renewable energies, might mean governments do not take seriously the importance of energy conservation where appropriate and rather focus on increasing energy consumption. # 3. Process and governance challenges It was envisaged that the SDGs would build upon the MDGs converging with the post 2015 development agenda (Waage et al 2015). The Rio 20+ outcome document, _The Future We Want_ (United Nations 2012), attempted to set out an inclusive and transparent intergovernmental process for the development of the SDGs, as well as documenting what the authors understood as essential environmentally for a desirable and sustainable future (United Nations 2012, UNDESA, 2015). # 4. SDG progress and challenges ## 4.1 Global overview With pandemic, we are on track to NOT meet all SDGs. The trajectory of progress looks grim. UN Secretary-General António Guterres (at the time of writing serving two terms from 2016 to 2026) stating that ‘to recover from the Covid-19 pandemic and deliver global sustainability, we need an urgent rescue effort for the SDGs’ (United Nations 2022). The [_Sustainable Development Report 2022_](https://dashboards.sdgindex.org/chapters) (Sachs et al 2022) provides access to data used to inform the official [UN Sustainable development Goals Report](https://unstats.un.org/sdgs/report/2022/) that gives a global overview of progress on the implementation of the 2030 Agenda for Sustainable Development (United Nations 2022). It paints a worrying picture that almost none of the SDGs are on course to be met within the 2030 timeframe. The report strongly emphasizes that climate change impacts, the war in Ukraine, and particularly the COVID-19 pandemic have set back efforts to achieve the SDGs. Indeed, the report cites COVID-19 as having ‘halted progress on universal health coverage’ (SDG3), as well as alongside ‘rising inflation’ and ‘supply chain disruptions’, responsible for hampering ‘global economic recovery’ (SDG8). In addition, COVID-19 ‘has deepened a global learning crisis’ (SDG4), and contributed to setting back projections for poverty reduction, from a pre-pandemic projection by 2030 of 581 million still being in poverty (SDG1) to the current 2022 projection of 657-676 million remaining in poverty by 2030 (United Nations 2022). Meanwhile, in terms of funds to procure change, ‘Climate finance falls short of the $100 billion yearly commitment’ from high income countries, who reached only $79.6 billion in 2019 (SDG 13) (Sachs et al 2022, United Nations 2022). A report commissioned by Oxfam stated the ‘true value’ of climate financing is closer to $20 billion, with for example, fossil fuel companies continuing to receive subsides over $400 billion per year and total profits over $200 billion (Carty and Kowalzi 2022). ## 4.2 Country-level progress SDGs have a series of quantitative indicators, but there remain serious concerns around 'data gaps in assessing country-level progress towards SDGs'. According to a World Bank study (Kitzmueller 2021), most countries’ monitoring and routine data collection is inadequate. Indeed, ‘No country reported data on more than 90% of the SDG indicators, while 22 countries reported on less than 25% of the SDG indicators’ (Kitzmueller 2021). Oceania is the region with the highest overall percentage of missing data (Sachs et al 2022). ## 4.3 SDG Challenges and criticisms In an attempt to map and recognise that impacts arising from one country’s actions to meet the SDGs may affect another country or countries, the SDG reports also now document what they refer to as ‘spillover’. Spillover attempts to capture: Each country's actions can have positive or negative effects on other countries' abilities to achieve the SDGs. The Spillover Index assesses such spillovers along three dimensions: 1.    environmental & social impacts embodied into trade, 2.    economy & finance, and 3.    security (SDR 2022a) A higher spillover score is when a country causes more negative and fewer positive spillover effects and thus, adversely affects another country or countries abilities to meet the SDGs. The UN’s SDG’s spillover index ranks countries according to their spillover score, ordering them from number 1 as that which is estimated to have the least adverse effect on other countries to those with higher ranking, which are estimated as having greater adverse effects (SDR 2022a). Of those countries ranked in the [SDG’s spillover index](https://dashboards.sdgindex.org/rankings/spillovers)  (see a [map](https://dashboards.sdgindex.org/map/spillovers) here) that have the least or less adverse effects on other countries, only three European countries (Georgia, Albania and Romania) are in the top 100. While in the lowest rankings - the UK ranks 152, US 142, Japan 134, Finland 124, Sweden 139, Norway 146 and Denmark 137. Somalia, Burundi, Madagascar, Sudan and South Sudan, respectively, are ranked in the top five countries with _least_ adverse effects to other countries according to the spillover index, but are amongst the 20 reported lowest achievers according to the SDG index (SDR 2022b). > Taking the SDG and spillover indexes together, we can see that for the most part those ==countries that are high achievers according to the SDG index also appear to be those that have the most negative effects on other countries abilities to achieve their SDGs targets and vice versa==. This raises several important questions regarding the SDG approach. Although the SDG’s goals are ‘interlinked’ and there are explicit SDGs focused on ‘climate action’, land and water, they are widely criticised for lacking coherence on addressing environmental destruction and extraction. Furthermore, they insufficiently question the feasibility of economic growth as a viable solution for socioeconomic and ecological problems that many societies continue to face. Immediate progress in poverty reduction (SDG 1) or health and well-being (SDG 3) can be in the long-term at the expense of environmental sustainability, including biodiversity loss. For example, increasing deforestation of the Amazon and Atlantic Forest in South America into land for soya, fruit monocrops and beef production, some may argue is necessary to meet affordable consumer dietary needs, but is directly connected to biodiversity loss, land degradation and contamination of soil and waterways, as well as the destruction of many indigenous peoples’ ways of life. Another salient criticism that can be brought to the concept of ‘spillover’, like the SDGs, is that it is apolitical and ahistorical. More explicitly, its fails to engage with how colonial legacies, capitalism and international geopolitics continue to sustain unequal differences in socioeconomic over-development of high income countries and poverty and excessive ecological pollution and damage in middle and low income countries (Cousins et al 2021, Perry 2021). # 5. Summary Historically rapid fossil-fuel based economic growth has been central to the development of high-income countries and has been promoted as the means to health and well-being for middle and low income countries, but this is increasingly recognised as environmentally unsustainable. Thus, policy makers trying to promote sustainable development face the challenge of balancing trade-offs between the economic interests of their countries and the need to promote environmental sustainability of national energy solutions. Health has often been seen as low priority within global environmental and economic sustainability discourse, but the WHO’s promotion of the “co-benefits” of macro policy targets and interventions (e.g. around air pollution), which simultaneously have benefits for health (e.g., a reduction in respiratory ailments with decreases in air pollution) are gaining traction. The idea of co-benefits has become increasingly important as the global policy framework has evolved from the Millennium Development Goals – a shared aspiration for equitable development across the globe – to the Sustainable Development Goals, where for example, SDG 3 is dedicated to health, which is viewed as interlinked with all SDGs.   In 2022, the UN secretary general declared an urgent need to ‘rescue’ not only the progress made until recently on the SDGs (and previously MDGs), but also to ensure the future possibilities of their achievement. During the COVID-19 pandemic, progress was halted on universal health coverage and since the Ukraine war, increasing inflation has halted, if not reversed poverty reduction, food security and efforts on climate action. Furthermore, there are increasing bodies of research and political calls for more serious action on the interconnections between economic growth, expanding inequalities and histories of colonialism that continue to shape the geopolitics of global health, development and environmental destruction (including climate change) (see for example, Cousins et al 2021, Perry 2021, Baquero et al 2021). # 6. References ## 6.1 [[Essential readings]] ·       United Nations (2022). [The Sustainable Development Goals Report 2022](https://unstats.un.org/sdgs/report/2022/). Read pages 2 and 3, and browse pages 8-25. ·       Romanello, Marina, Claudia Di Napoli, Paul Drummond, Carole Green, Harry Kennard, Pete Lampard, Daniel Scamman, et al. ‘The 2022 Report of the Lancet Countdown on Health and Climate Change: Health at the Mercy of Fossil Fuels’. _The Lancet_ 400, no. 10363 (November 2022): 1619–54. [https://doi.org/10.1016/S0140-6736(22)01540-9](https://doi.org/10.1016/S0140-6736\(22\)01540-9). Read pages 1619-22 ·       Haines, Andy, George Alleyne, Ilona Kickbusch, and Carlos Dora. ‘From the Earth Summit to Rio+20: Integration of Health and Sustainable Development’. _The Lancet_ 379, no. 9832 (June 2012): 2189–97. [https://doi.org/10.1016/S0140-6736(12)60779-X](https://doi.org/10.1016/S0140-6736\(12\)60779-X). ## 6.2 [[Recommended reading]] N/A