Judul : Swedish Institute College Of Health Sciences
link : Swedish Institute College Of Health Sciences
Swedish Institute College Of Health Sciences
- i'm delighted to welcome you to this lecture by richard horton, who will speak on planetary health: perils and possibilitiesfor human civilization. for those of you whohaven't been here all day,
Swedish Institute College Of Health Sciences, and let me thank all those who have been for sticking with us, this is the culmination of this year's strauss symposium.
the strauss symposium, ormore formally known as the leila and melville straussclass of 1960 family symposium, is the leading conferencethat the dickey center puts on every year, and we rotate it between our differentcore areas of activity. mickey strauss was a admired and beloved memberof our board of visitors, who established thissymposium in a bequest several years ago,
and i want to thank again leila strauss, his wife and his son, scott strauss, who is a member of our board now, and a member of the facultyat the university of wisconsin and couldn't be here today. but they've been engaged all along and they're wonderful supporters of this event.
this is our third strauss symposium. i'm happy to say the inaugural one was held in 2015, and dealt with exploring new methods and technologies for early warning of mass atrocities, including genocide and other large-scale crimes against humanity. it supported another project that we've hadhere at the dickey center,
together with the unitedstates holocaust museum, the early warning project, which is a terrific portal on the internet where you can model and study mass atrocities andcrimes against humanity and try to figure out what are the factors that lead to such events. we also had, last year, an outstanding strausssymposium that was devoted
to lessons learned and bestpractices for the future after the nepal earthquake. and that was a really successful event and i think that this year's, this year's symposium onglobal health in an era of de-globalization hasbeen a fitting successor to those two events. our various panelistshave been saying all day that they don't like that title,
so i'm just going to abuse theprerogative of the microphone to say that it is none-the-less, it was wonderful to hear allthe defenses of globalization and i remain one of its great fans, but it is a time whenmany of us are worried about the engagement ofgovernments around the world and the financial resources of the major international organizationsand foundations to maintain the kind ofprogress that we have seen
in the last 25 years. and it's all the more reasonwhy we're delighted that richard horton is here today to discuss these issues. but it does not fall to meto introduce richard horton, instead that falls topresident phil hanlon, so i'm gonna ask him tocome up and do the honors. (audience applauding) - good afternoon, welcome everyone.
i am phil hanlon, thepresident of dartmouth college and it is an honor anda privilege to introduce your keynote speaker this afternoon. though i'm certain forthose of you in the room who are more into this field, he needs no introduction whatsoever. for more than 20 years,richard horton has served as editor in chief of the lancet, one of the world's mostrespected medical journals.
richard joined the lancet in 1990 after qualifying inphysiology and medicine with honors from theuniversity of birmingham four years prior to that. in 1993 he moved to new yorkas the north american editor and two years later returned to the uk to assume the role of editor in chief. under his leadership thelancet has played a critical role in shaping the global health agenda
and become an authoritativeglobal health publication. it's catalyzed scholarshipand shaped global policy around the emerging health challenges from the rising tide ofnon-communicable diseases in low and middle incomecountries to the links between climate change andhealth and the devastating effects of conflict and theresulting mass migration on health. in 2013 richard launchedthe lancet global health,
an open source journalfocused specifically on disadvantaged populations. richard was the first presidentof the world association of medical editors andis the past president of the u.s. council of science editors. he's written two reports for the royal college of physicians, doctors in society in 2005 and innovating for health in 2009.
in 2003 he authored the bookhealth wars about contemporary issues in medicine and health and is a regular contributorto the new york review of books and the timesliterary supplement. in 2011, richard was electedas a foreign associate of the u.s. institute of medicine. please join me in welcomingto the stage, richard horton. - thank you very much indeed. thank you, thank you.
president hanlon, ambassadorbenjamin thank you very much indeed for your kind wordsand it's a great pleasure to be here with you today. we've had a great day in this symposium and first of all wehave a little bit of fun with another ambassador nils daulaire, who was as you know representative in the department ofhealth and human services in the united statesgovernment in a previous era
under a different presidentand represented the united states on the executive board of the world health organization. we had a little bit offun because this man, sir henry wotton oncesaid an ambassador is an honest man sent abroadto lie for his country. we tease nils a littlebit about that today. but what's often not quotedis the part that follows that. a news writer is a dishonestman who lies at home
for himself. so that's me. so i started off as a medical doctor and now work at a medical journal. so you'll have to takewhat i say in the context of what sir henry wotton saidway back, 3-400 years ago. it's gonna be an, i hope,challenging tale about the predicament that we face as a species. who would have believedthat time magazine would
have ever put a quote likethis on its front cover just a few weeks ago? who would have believed that this country could have put as aleader of what is actually a major public health agency, a man who does not believein the relationship between carbon dioxide and climate change? who would have believedthat a country that has led the world in discoveryscience would submit a budget
that promises to eliminate $5.8 billion from that science budget? let alone take out the fogarty center, one of the foremost advocacyand delivery organizations that we have in globalhealth in the united states? who would have believed thatit wasn't just nih that was being attacked in thisunprecedented assault on science, but a whole series ofinstitutions that not only lead in america but lead inthe world in terms of your
soft power, your scientificpower, your contribution to global humanity? who would have believed thatwe are living at a moment where there is a rage against the global. where trust and belief inmultilateral organizations such as the united nations feels that it's at an all time low? who would have believedthat we would be alive at this moment today?
who would have believed itbecause we have an opportunity that's unprecedented inthe history of humanity? and that opportunity isexpressed in 17 sustainable development goals. those goals, in a sense,articulate a manifesto of hope for what we can doas a species in improving the lives of our fellowcitizens on this planet. i'm not gonna test you on the goals, but basically the first sixare goals that were embedded
in the millennium development goals and have been transferredinto our vision out 2030. and then we move intoa really remarkable set of commitment on energy forall, promoting economic growth, infrastructure, addressing inequality, resilient cities, andsustainable consumption. and then the pivot point issdg13 which is addressing climate change, whichlinks, of course perfectly. whoop, which links of courseperfectly with the paris
climate agenda. which was, despite what you might hear, one of the most remarkablemultilateral agreements i think that has been madein the history of human kind. it wasn't a legally binding document, but it set the world on a course, which even this countryis going to find difficult to divert us from. conserving oceans, protecting ecosystems.
promoting peace andrevitalizing partnerships. it sounds very utopian. john rawls, your greatphilosopher did write, indeed, in his theory of justicethe notion of a realistic utopia. and i think the sustainabledevelopment goals do set out a realistic utopia aboutwhat we could achieve. that's the opportunity, that's the prize for us to grasp.
for those of us working in health, we have our marching orders. and that's what we in our sector have to achieve overthe next 14 years or so. and it's a big set of asks around maternal mortality,child mortality, infectious diseases,non-communicable diseases, various substance abuseand alcohol, injuries, sexual reproductive health,universal health coverage,
the big one. because if you can achieveuniversal health coverage, many of these will fall into place. and pollution and variousother focal points for us to address. but those goals don'tactually tell us what sustainable developmentis really all about. sustainable development is not 17 goals. or a whole bunch of targets.
it's about somethingmuch deeper than that. so what is it? the idea of sustainable development, unlike the millenniumdevelopment goals is that it's a universal concept. it's not about people who areliving in extreme poverty. it's about everybody on this planet. you and me and everybody. and it's about our essentialinterconnectedness,
our essential interdependence,one with another. that is an inspiring idea, that we are related to oneanother in terms of our futures, our future trajectories. it's not only about us, it's also about the next generation. we can't make decisionsabout our future without taking account of thefutures of our children and our grand children.
equity is a definingidea in global health. but inter-generationalequity is the defining idea of sustainable development. it's not only about our species. it's about all species andthe dependence of all species on each other for our collective future. the oneness of all life. it's also about not justlife, but the relationship, indeed the symbiosisbetween life and the planet
that we inhabit. but it's also a warning. and it's a warning that says this, the threat that we faceis not carbon dioxide. the threat that we face isthe challenge to the systems that we have created as a species. the political, economic, social systems that govern our lives in this world. the challenge is to thosesystem as to whether we can
diagnose the problems that we face. whether we can understandthe challenges that we face and whether we have thecourage, the capacity, the will to act. let's look briefly, veryvery briefly at progress with the sustainabledevelopment goals so far. this is actually lookingat progress during the course of the millennium development goals and where are we?
we can see that we've madereally quite substantial progress in universal healthcoverage where we are today. this summary report cardwas published towards the end of last year. we've made some progress inaccess to modern contraception but it could be better. we've made some progressin access too clean water, and we know where we'redoing not very well, alcohol consumption and childhood obesity.
so we have a report card on our current progress. and we're working incollaboration with chris murray's group at the institute forhealth metrics and evaluation at the university ofwashington in seattle to try and track progress overthe next 14 or 15 years to see how we are progressingtowards the sustainable but again, there's aconcern that we should have. our target for those ofus in the health community
cannot just be sdg3, whichis insuring healthy lives for all. we will not achieve healthy lives for all unless we work at the interface between the sustainable development goals. there can be no healthunless we address education. education is absolutely critical. there's no point savingchildren's lives if we can't deliver those children toa strong educational system
that can fulfill theirfull potential in society. there's no point insaving children's lives if we don't also achievegender equity and equality. if we don't count women,reward women, give women the opportunity for politicalparticipation in society. if we do none of that, savinglives is not going to achieve or realize the hopes that we have. we will not be able toachieve healthy lives for all unless we create the fiscalspace to invest in our
health systems. and therefore we need tocreate economic growth. this picture, thisslightly strange picture of francois hollande and presidentzuma, i took when i was chairing an expo groupreporting into a commission on, as you can see here, health,employment and economic growth. it reported to the unitednations last september at their general assembly. and the essential ideais a very simple one.
to drive economic growth, one doesn't just invest in health, but one should be investingin health workers. investing in jobs andskills in the health sector. the health sector is oftenseen as a cost to an economy because we don't produce anything. but in fact, the latesteconomic evidence shows us exactly the opposite. that investing in the health sector
and i'm not talking about doctors here, i'm talking about nurses, midwives, community based healthworkers, pharmacists, a whole array of differentcadres of health work in the system can drive economic growth. so health is an engine for the economy. and we can't achieve healthy lives for all unless we invest in the rule of law. unless we invest in governance,
unless we invest in accountability, unless we provideopportunities for the state to intervene, but also limitthe powers of the state through the rule of law, we will not be fully able toachieve healthy lives for all. indeed when you look in plotsmeasures of the rule of law against various healthoutcomes you see some very interesting correlations andthat's why we are running a commission with georgetownuniversity in washington d.c.
looking at the relationshipbetween health and the law. so let's just stop and summarizewhere we've got to so far. the threats to our future arereal and they're existential. our successes, and therehave been successes, but they hide serious failures. the sdgs are inspiring andthey're deeply motivating to all of us to act, butour predicaments are not static, they're dynamic. global health sciencecan give us solutions,
but it also reveals the terrifying extent of our uncertainty andthe challenges ahead. and we are living at a moment, a moment that just a fewyears ago we would not have predicted. we are living at a momentwhen science is under attack and the vital partnerships that it's taken a decade or more todevelopment are under threat. so is that it?
we could perhaps stop there. or is something missing from this story? there was an essaywritten by thomas nagel, a philosopher in 2005 inphilosophy and public affairs called the problem of global justice. global justice is a great phrase and i've, many times,stood on stages and said, human rights, equity,global justice, this is what we're fighting for, and global health.
these are the values that we believe in. but then thomas nagelunfortunately wrote this essay that punctured my slightlyidealistic naivete. there can be no global justice. why can there be no global justice? his argument is justice asa concept can only originate within entities wherethere is sovereign power. and the only entities thatour species has created where there is sovereignpower are things we call
nation states. justice can exist within a nation state if the sovereign power so wills it. but we have no sovereignpower over the world. there is no world governmentso the concept of global justice is just simply impossible. it logically cannot exist. so his conclusion in hisfinal paragraph to this rather bleak and depressing essay is this.
the path from anarchy to justicemust go through injustice. and what he's saying ina rather eloquent way is things have to get really badbefore they go to get better. and boy things are gonna get really bad. so prepare yourselves. we're living in a different age. and global health has notyet begun to get to grips with the seriousness ofthis epochal transition that we are already inthe early stages of.
and if the global health community, if our universities andcolleges like dartmouth do not embrace the magnitudeof this transition, we are going to miss oneof the most important challenges that ourspecies faces or has faced in several hundred years. how many of you haveseen the films ice age? yeah, they're great movies,i've taken my daughter, who's 16 and wouldn't go with me now,
but when she was smaller she did. and they're great movies. but when i watched the iceage films, i hadn't really understood that we weretalking about 2.5 million years ago, so this was the pleistocene, that's the setting for those movies and that takes us up toabout 11,700 years ago. and that's the beginning ofwhat we have thought about as our era.
the holocene. a lot actually did happen in the holocene and although these graphslook a little bit bumpy and sometimes flat, thatconceals a lot of activity in terms of these various measures. ice cores, temperatures,carbon dioxide and methane parts per billion. but it's when you get tohere at the very very edge that things really start to happen.
so what is happening? so let's got from 1750 up to 1950. here you start seeing carbondioxide concentrations increasing, we'll cometo plutonium in a moment. and then we just startproducing lots of stuff. we're really good at manufacturing things. whether their concrete, plasticsor measures of pollution such as black carbon. but then it was around 1950,
the point that we now callthe moment of the great acceleration that thingsreally really take off. now people have been arguingfor the last 10 years or so, maybe a little bit moreabout when does this new era, the anthropocene really begin. the moment when you canactually measure the impact of human activity on the planet,and not just on the planet but changing the directoryof travel for the planet. some people put it back intothe industrial revolution.
some say there isn't such athing as the anthropocene, this is just a continuationof the holocene. but the time when most peoplethink that we should be considering is a very specific moment. and that specific momenthappened in the deserts of new mexico, july 16th, 1945. trinity. it was trinity that led to thisrise in radiogenic fall out. as being perhaps thecritical stratigraphic marker
of the anthropocene. plutonium started tobe detected in the soil around 1951 and it'sthat stratum of plutonium that the geophysicalcommunity are considering as the moment that weshould be thinking that we truly are in a new era. so, here we are, pleistocene, holocene and now we're in the anthropocene. let's take a very goodmeasure of the kinds of issue
that we're talking aboutin the anthropocene. pollution. we were talking earlier inthe symposium about the fact that climate change cansometimes seem a very abstract entity, doesn't feel thatit's having an impact on human lives. that actually climate changecan seem very very distant. but it is having an impact on human lives. if you think about it morebroadly in terms of the
ecological crisis that we are facing. so this is looking, this is work that has justrecently been published, just two days ago, in our journal. looking at from 1990 to 2015and looking at pm two point, less than 2.5 micrometers. and what you can see of courseis the story of the world in terms of its human development. you can see a collectionof countries here,
the united states in avery welcome position, right at the bottom interms of output of pm 2.5, but then what you see arecountries such as bangladesh, india dramatically, chinamore slowly, pakistan, seeing an increase arise intheir levels of pollution. a crude but never-the-lessreasonable markup for human development. as you see industrialization,consumption, population growth, technologicalchange, taking a grip
of these nations. when you then look at thecontribution of pollution, this particulate matterto deaths then you can see measurable increases over time. again this is 1990 from 2015and this is work from the global burden of disease studyagain from ihme in seattle. looking at deaths attributableto pm 2.5 in millions. and you can see this gradualincrease over the last 20 years or so.
and then you can see thehotspots in the world where this is already happening. so when you look at this legend here, there are some red areasare where you're seeing very high levels ofpollution related mortality and so you're seeing themacross south asia, china, parts of the middle easthere, parts of europe. this is happening right now. these are measures of theecological degradation.
the collapse in our ecosystemservices that we are seeing as a result of one particularmeasure of pollution. but this measure givesa slightly false view about the threat that pollution has. this work was published innature just a few weeks ago. and what it shows is theimportance of transnational pollution. pollution produced inone part of the world and its effect on anotherpart of the world.
so let's take, let's take an example. this is looking at theregion where deaths occurred and here the region wherepollution was produced. so let's take here. a big part of east asia and we go up here, there's 76,000 deaths inthis region of east asia. and over half of thosedeaths have taken place in, let me see here, sorry, 40% ofthose deaths have taken place because of pollutionwhich drifted from china.
or take this part, again,another part of this more south asia, 26% of deaths inother regions of south asia from pollution in india. and this is around 400, this is 26% of around 276,000 deaths. or take here, more closer to home. a smaller number, in canada,8000, just over 8000 deaths from pollution and about 47%of those deaths attributable to pollution that's comefrom the united states.
so this is the importantpart about interdependence. and that when we blame certain countries, we have to look at ourresponsibilities as well in terms of, in this case, thepollutants we are producing and the effects that they have. i'm giving you examples from middle and high income countries. but let's now look at someof the parts of the world which are facingparticularly acute threats.
unicef put out this warningjust a few weeks ago about 1.4 million childrenacross four countries in africa and the arab world who are at imminent riskof death from famine. from famine. why are they at risk of death from famine? because not only are theyfacing poor governance, economic collapse, disease,they're also seeing a prolonged period ofdrought which is exacerbating
the risks for these communities. it's certainly true that ifyou read the intergovernmental panel on climate change,then the impacts of climate change on human healthare currently small. but that's the wrong measure to look at. sustainable development isabout the oneness of life. and so we need to be lookingat the impact of climate change not only on ourspecies, but on all species to get a real sense of what is happening
and what will happen eventually to us. and when you look at, inthis particular case the rate of vertebrate extinctionsyou see over the course of 400 years or so, a dramaticincrease in the number of extinctions. and it's these data whichtell us that we are passing through a planetary momentwhich can be called the sixth mass extinction. what do we need to do?
we can lay out the problem,but what do we need to do? johan rockstrã¶m who leads thestockholm resilience center just two weeks ago publisheda road map for what we need to do over the next40 years to meet the goal of 1.5 degrees, two degreesincrease in global temperatures which fits with the paris agreement. and we need to recognizethat we are going to have to achieve, if we reallywant to achieve the objective of paris, this is going torequire a dramatic change
in our behavior. and this is why i say,talk about human systems. are we ready for it? can we do it? there's never been a testof human kind like this. here's what we're gonna have to do. we're here. by 2020 we are going tohave to see a peak in human carbon emissions.
that's just in three years time. after 2020 carbon emissionshave to turn down. if we're going to meet that1.5 to two degrees temperature. by 2030 we need to have eliminatedcoal from our energy mix. by 2040 we need to have eliminatedoil from our energy mix. by 2050 we need to haveput in place technologies which we have yet to discoverthat will begin to extract carbon dioxide from our atmosphere. in other words, right now,we have consistently passed
a threshold hitherto unpassedthat is 400 parts per million of atmospheric carbon dioxide. but by 2050, we needto have put into place carbon extraction technologiesto bring that figure down from 400 to around380 parts per million. this is a big ask, butthat's what's needed if we're going to achieve paris. our two biggest emittersof carbon dioxide, china and the united states.
we see strong leadershipfrom president xi jinping. i won't make a comment about this country. this book is in yourbookshop on main street. and i would encourage,there were two copies. and i would encourageyou to run and buy it. this is the silentspring of our generation. this is rachel carson's thesilent spring but written for us. tony mcmichael, an australianepidemiologist who became
intensely concerned aboutclimate and ecological collapse. and he wrote what is amanifesto of the evidence and for public actionon climate and health. famines, fevers and thefate of populations. he finished the manuscript in early 2014. and very tragically passedaway later that year. but two colleagues of hisplus his family discovered the manuscript and put it together finally so it was publishedfor the very first time
just a few months ago this year. two copies in your book store, i guess your book store, it's still open, it's only 5:19, if i seetwo people leave the lecture i won't be upset. in that, he absolutely correctly pinpoints the challenge that we face. this is not just a climatecrisis or an ecological crisis. the great undercurrentsthat shape the fates
of civilizations, theircultures, ideologies and power structures. that's his subject. the fates of civilizations. that's the unit of analysis we have. i trained as a medical doctor. what that meant was that isat in front of a patient, took a history, did aphysical examination. my unit of concern was thepatient in front of me.
and then i grew up anddiscovered something called public health and then my unitof concern was the community. what should be our unit of concern today? our civilization. our civilization becauseit's within our civilization that the systems exist forus to diagnose, understand, act upon the threats we face. so what should be theresponse of you and i, the scholarly communityto this new human epoch?
a couple of years ago wewrote about the idea of an urgent transformationrequired in our values and practices based on recognitionof that interdependence i talked about and theinterconnectedness of the risks we face. and we spoke about a move frompublic health to planetary health. we are very grateful tothe rockefeller foundation for giving us a grant sothat we could investigate
this idea a little further, a commission on planetary health. and the definition ofplanetary health is a very straight forward one. it's the health of humancivilizations and the ecosystems on which they depend. two important ideas at least there, one, the notion of thecivilization as the unit of our concern and second,the fact you cannot talk about
human existence withoutthinking about our existence in the context of broader ecology. because we face a challengeof massive ecological proportions. in fact, three challenges welaid out in the commission. the first is a challengeto our imagination. what do we mean when wetalk about prosperity? prosperity is not only gdp. it is not only financial objectives.
it is the notion of a double bottom line that is to say thinkingabout something more than just the money. thinking about the notionof prosperity in terms of our human relationships. about the connections wehave with the land and sea around us and how wemeasure that prosperity. a challenge about knowledge. we created universitiesand colleges like this one
that function on the basis of schools. schools of engineering,schools of medicine, schools of business. they live in their little worlds. they often have walls around them. they have faculty thatlive in those little worlds with walls around themand often don't interact much across those walls. sometimes the incentives aren'tin place for interaction.
but if we are really going togenerate the kind of knowledge that we must have to address these complex predicaments that weface, we have to tear down these walls to quote apast american president. and who would havebelieved now a much loved past american president. seriously, we have totear down those walls. how do we do that in aninstitution such as this? maybe you're already doingit, so i shouldn't say that.
at an institution like most of ours back in the united kingdom. and the third challenge isit's all very well generating the knowledge, but publishingpapers in a medical journal for example isn't much useif we don't do something about it. so what's our responsibility to act? this idea of planetaryhealth seems to have caught a little bit of imagination.
there are now symposia,meetings on planetary health, those of you in theconsortium of universities for global health just afew days ago in washington saw planetary health discussedacross several symposia. there's a planetary health alliance which is meeting in bostonin just a few weeks' time. led by sam myres at theschool of public health. this was a group of usmeeting at the rockefeller foundation last month in new york because
the rockefeller isinvesting further grants in supporting planetary health. the very first professorof planetary health, tony capon is now installedat the university of sidney. planetary health programsare springing up around the world. there's even a journal, planetary health, about which i will say nothing more. (audience laughing)
what does it really mean totalk about planetary health? great, another abstract idea. what does it really mean? it means looking at ourproblems in a different way. this is something who did recently, just a few weeks ago whichgives an example of it. we know that about sixmillion children under five die every year. we know the causes of those deaths.
infectious diseases being one example. newborn mortality being another big cause. those of us in the maternalchild health community and i include myself inthat because we publish work from that community forthe last decade or so, have a very fixed view about the causes and therefore the responseswe need for addressing child mortality. but there's another way of looking at it.
what about if you shine childmortality through the lens of the environment? then you get a completelydifferent picture which those of us in women'sand children's health have never talked about before. not seriously. about a quarter of all underfive deaths can be explained through environmental causes. but we just have neverthought about child health
in terms of environmental causes. so it's changing our frame of reference. it's changing the coordinateswith which we see a problem. that's the front coverof this week's issue of the lancet. if you still read paper. this is another exampleof planetary health. because planetary healthis asking us, remember, to look at the questions of the politics,
the economics and the socialsystems that we've created in our society to addressparticular problems. this is what you seefrom 1910 through to 2015 in terms of the share ofthe total income received by the top 1% of earners in the u.s.. and you can see from about the mid 1970s we've seen this gradual increase in terms of that proportion. and this is a series of fivepapers looking at inequality
in the united states. not only do we have anincome in equality problem, but we are seeing greaterstress on particular communities and of course you knowthis better than i do, because you've been livingthrough these debates about patient protectionand affordable care act. but as we've seen, worker'searnings have a very very gentle slope of increase,we've seen deductibles and premiums increase suchthat the gap between these
two lines is increasing. increasingly, the costsof health care become more unaffordable. if you then look at thatissue a different way, this is now looking at debt. and what are the maincontributors to personal debt in the united states? oil companies, creditunions, check guarantees, automotive, educational,personal services, insurance,
financial government, rental,banking, retail, utilities, cable, unclassified and theleader, medical and health care. which drives thatcatastrophic expenditure. but there's also a socialcrisis that exacerbates these inequalities and this figureparticularly blew me away. so this is looking atincarceration in 21 democracies in our world. from 1980 to 2015, and you can see thatmost of these lines are,
they might be slightly different levels, but most of these lines are broadly flat. you can see that some have seen increases, but look at this one. is this the kind of society that we want? in one of our great democracies? i consider myself anamerican citizen even though i'm not one. because everything thathappens here it affects me
and my family and all my friends. so, i want to be an americancitizen for the purposes of this discussion. that can't be something we're happy with. look at it a different way. this is inflationadjusted household income. across selected percentiles. i talked strata earlier andyou can see the stratums, the strata of americanlife in this picture.
again going back from 1970 to 2015 and you can see these deciles that this is looking atannual household income. the flat here, and rising here. again, the inequalityreally quite dramatically increasing and for this particular group which is the top 1% in terms of income. again escape velocity takingplace for this particular group in our population.
now that's only one part of the story. this is work that was publishedby the brookings institution again just a week ago. you may well be familiar withsome of their earlier work, angus deaton and anne case at princeton. looking at what theycall diseases of despair. and their particularconcern was this group, white non-hispanic americanswith a high school diploma or less.
and their observation isthat over the last 15 years, if you're african american,you've seen your total mortality, all-cause mortality decline, but you see for white,non-hispanic americans with a high school diploma or less, you've seen that increase. and that increase iswhat has driven the white non-hispanics total to have increased. now their argument of course is
this is the group of peoplewho are not just suffering lower incomes but theirseeing their family structures and their marriages challenged. they're seeing theirhealth systems destroyed, their education systems destroyed. no employment, no skills training. they're seeing the institutions,including the church for example, that normallybound their communities together falling apart.
and these are the diseases of despair often driven by new epidemics,for example opioid drug use for chronic pain. and their particular analysisis somewhat controversial, because it's focusing onthis particular group, a group that the currentpresident here has tapped into in terms of his popular support. bernie sanders wrote aneditorial to accompany the series we published this week.
and, wonder what lifewould have been like with him as president. and he wrote about anagenda to fight inequality. and he said this, "makingsure that every citizen "has the right to childcare, health care, a college "education and a secureretirement is not a radical idea. "it is as american as apple pie." we should be careful. mary bassett also wroteand she's the new york
health commissioner, alsowrote in this weeks issue of the lancet this, "anarrative that sees black and "latino individuals as on track, "and white individuals as now off track, "possibly due to neglect,will not yield a successful "public health response." and there's an importantwarning here that while we separate out different groupsand we do pay attention to white non-hispanic americans,don't forget this point
about interdependence. don't forget this point about communities. about social solidarity. and that's what's mary isidentifying here as so critical if we're really going to builda response to the threats that we face. now i can't come to youand say all this stuff about america without mentioning brexit. i've got one slide only on brexit.
so that was a bad day. for those of us whothought we were europeans. we made a mistake, it was our mistake. the 48% who lost, it was our mistake. and it was our mistakebecause we didn't understand the schism that had takenplace in british society, particularly england, english society. we thought that everybody hadbenefited from globalization. everybody had benefitedfrom being in europe.
and we didn't understandthat 52% of our population actually didn't agree with us. not only did they not agree with us, but they didn't like the factthat we had open borders. and they weren't comfortableas many of us were, sitting on tubes in london withevery different nationality you could possibly thinkof, half a dozen different languages being spoken at the same time. that celebration of globalization,of multiculturalism,
something that i want mychildren to enjoy and embrace, but for 52% of our population,they saw that as a threat. there's an interestinghistorical parallel here because this is a crisis thatbritain has faced in the past. and it is this notion ofisolation and how we address it. so i went back and ilooked in my history books. i'm old, i'm 55 years old. so i went back to when i was about 15, so 40 years ago.
and i discovered thispage from my history book. slightly childish writing,so apologies for that. but i had a section in myhistory book from class i actually headed "splendid isolation". and this is what the british really think. this is the problem about being an island. britain, from around 1875 onwards, under the influence of lordsalsbury pursued a policy of going it alone inwhich it held no alliances
or commitments to foreign powers. this was called splendid isolation. in the 1890s britain, on herown, elevated i think it was meant to be, my spellingwas never very good. elevated herself from atight situation with france over the sudan. both claimed sudan althoughthe french only wanted it for prestige. in the end britain got sudanand took away even more
prestige from france. this the british education. we're taught, we're taught to hate europe from the age of 15 onwards. this showed how successfulsplendid isolation was. the splendid isolationpolicy was also tested by the boer war and onceagain, we came out triumphant. i was horrified when i read this. education is indoctrination.
and i bought the whole lot. it's just an example ofhow an education system has a particular conception of the history of a nation and then transmitsit to the next generation. i have no idea what you teach. i'm sure it's not as bad asmy history was taught then. but this is an existentialcrisis about britain as a country in theworld, anxious and fearful about it's direction of travel.
40 years ago, i was taughtthat splendid isolation in the 19th century wasa solution to the threats we faced in europe andelsewhere in the world. in 2017, that's the cause of brexit. how do we get out of that? question to you, if planetaryhealth is so important, mr. president, you're the man with the budget. you can write any check for anybody.
- [phil hanlon] you got the job! - i want to know when the next professor of planetary health is gonnabe, the first professor of planetary health willbe appointed at dartmouth. it'll be a great day andi'll come and celebrate with him or her. i'm gonna close now. i'm gonna close with oneanxiety and two further thoughts and they're optimisticthoughts, don't worry.
the anxiety though first. and that is, it's ananxiety about our systems, it's about our democracies. are they capable of finding solutions? you know the great thing about democracy is i can write an editorialand demand on a, b, c, d, or e institution to do that, fantastic. that's the great thingabout freedom of speech. the problem is that it'srather harder to deliver
responses. not only that but we've createdsystems in our democracies where power is fragmentedand we tend to disagree with one another which paralyzes congress or paralyzes the british parliament. wouldn't it be so muchnicer to live in china? well, actually, don't knock it. we do a lot of work in chinaand when they understand that they have to act, boy do they act.
and they don't letanybody get in their way. which raises issues in and of itself. but there is a balance betweenautocracy and democracy. and there is a questionabout whether our democracies really can deliver. we have to buildextraordinary new coalitions if we're going to addressthe challenges we face. and the quality of our lives is going to depend uponthe quality of the way we
communicate with one another. so, lemme give you two examples. this is the man khalidmasood who drove his car into tourists crossing westminster bridge, who jumped out of his carand then fatally stabbed a policeman standing outsidethe house of commons. his photograph was onthe front page of every british newspaper, wason television screens and it led to another wave of islamophobia
in the united kingdomand attacks on migrants. shortly after this event took place, a young, iranian asylum seekerwas attacked in south london by a gang of 20 youngpeople, men and women. his head was kicked like a football and he's still lyingin hospital in london, almost certainly withpermanent brain injury. every year for the past eight years we've held a meeting inthe arab world called
the lancet palestinian health alliance. it's a meeting wherewe bring together about 100-150 young male andfemale palestinian scientists from around the region topresent their abstracts. research abstracts that wethen publish in the lancet to tell the story of their life, their health predicaments, their nation. this is a picture taken from an abstract that this young woman presented
just a month ago in march this year, at the meeting we heldin birzeit university just outside of ramallah in the west bank. she's happy, she's happyand smiling because she got her abstract acceptedand she's been telling me about it, she's a pharmacist. she's proud of her work. she's confident in what she's doing. she's free to do this work,
and she's encouraged to do this work. she is an empowered young muslim woman doing great things in her great country. so you compare the storiesof these two people and the images that we think of. khalid masood the terrorist murderer or this young lady whois presenting her work at our research meeting. it depends which imageyou show that tells you
a very different story about islam. we see this image allthe time in our media. we rarely see this kind of image. this is our responsibility. science, medicine, scholarship, building relationshipsbetween institutions like this or journals like ours withcommunities in other parts of the world can buildpeace, understanding and a different story that can give hope
and opportunity and shape the public mind. last week, just a few days agonow, april fourth and fifth, we held another meeting, this time in rome in a building,an unbelievable building, literally overlooking the roman forum. we were discussing thefuture of civilization in the ruins of a past civilization. the goal of this, withsomebody who directs the institutes mario negri in bergamo
was to heal the wounds between science and the catholic church. and the idea was that wewould look at the future of humanity not only throughthe lens of medical science, but also through the lensof the catholic church. we worked with cardinalravasi who has the pontifical council of culture in the vatican. and we even managed to getthe pope to come along, there's mario capecchi whodiscovered knockout mice
one of our speakers at themeeting, meeting the pope. that's alison abbott from nature magazine. again, if you'd asked me a few years ago, would the lancet have everworked with the catholic church, 1.5 billion people on theplanet to try and address issues around planetaryhealth, i think i might not have agreed that thatwould be a likely outcome. but we have to buildextraordinary coalitions. across faiths, acrossdifferent communities.
in three weeks time, i'llbe in israel for a week presenting with my colleagues in israel a series looking at theisraeli health system and the contribution of israeli academics, both jewish and arab to aninternational conversation about health. my goal is to try andbuild a linkage between our work in israel now and thelancet palestinian health alliance.
i'm not saying that i'mgonna be jared kushner that's not what i'm trying to do. all i'm trying to say isthat the one great thing that we have in our world is scholarship, science and medicine isthe opportunity to create extraordinary coalitionsif we choose to do so. this is what one personpresented at this conference in the vatican, john sweeney. and i just want to leaveyou with these words.
"there are two decadesleft to achieve the large scale decarbonisationnecessary to avoid dangerous climate change and thedangerous increase in health problems it will be accompanied by. two decades is one generation. that's how long we've got. last slide. this painting is by gustav klimt. it was completed in 1901.
it's a compositional sketch,you'll find it in the israel museum in jerusalem. klimt was invited bythe university of vienna to paint three paintings,medicine, philosophy and jurisprudence forthe great hall in the university of vienna. and the idea was to celebratethe great contributions of the university tothe world of learning. klimt was smart
and he wanted to editorialize on this great contribution. so this is medicine. here, a figure, a nakedwoman floating in the air represents life. and she's connected witharms and here the arm of a man to another group,again of human figures which is the river of life,containing this skeleton, in a black robe, death.
life and death, that's medicine. this is the goddess hygieia. the problem is that whenhe presented this painting, the faculty in the universityof vienna were furious. they called it pornography and perversion. why? because hygieia has turnedher back on humanity. she's not facing, whoops,sorry, sorry, sorry. she's not facing, she's notfacing the symbol of life
or the river of lifeand the threat of death. she's turned her backon those very things. through her arrogance,through her indifference, through her narcissism,through her love of her own achievements, she's ignoredthe predicaments that face her world. the painting was never shown. it was locked away ina castle for 40 years. and when the nazi's rakedtheir way through austria,
they burned the paintings, all that's left is thiscompositional sketch in the israel museum. that's the challenge,that's the predicament. let's not turn our back on humanity. thank you. as are the united nations. based in the un building. - do you want to take some questions?
- [richard] if you've gottime, i know it's a bit late. - okay, if you haven't already left, - [richard] to get those books. (laughter) - offered to take a fewquestions for aren't really floored already. actually, i'll ask one. - okay. - i'll abuse the prerogative.
- as an aspirationalamerican who gets to watch us from the perfectarchimedean point in london, why are we having this war on science? - oh boy. ya know, it's so hard to get into the head of steve bannon and understand where that comes from. i mean, i couldn't believe that uh, is it robert kennedy jr. orone of the kennedy family
when soon-to-be presidenttrump was holed up in trump tower in new york,apparently saw this man, thinking that he's going tohave a review of the safety of vaccines. it is difficult to understandwhere this comes from. i honestly don't know. i don't know. and again i would reflect this back on us. what have we done, whathave we failed to do
to communicate the contributionscience makes to society? something has gone wrongin that conv, i mean, it would be very easy to blame trump, blame steve bannon, blamethat group, you know, however many percentof people voted of him who were skeptical of the elites, of which we presumably are. but i think instead ofblaming those people who voted for him, we need to look at ourselves.
and one of the reasons i think,why we've not come across sometimes as the public goodthat we hope that we would be is that we've not focusedenough on how we communicate our ideas and ourcontributions to society. science should be inthe service of society. we know that it is, we know medicine is, but sometimes the way we present ourselves is too much about us,is too much about money that we want from sourcesof government or wherever
to support what we do and we don't go out and make a strong caseabout what our achievements have been for communities. and i think we need todo a better job of that. i do think this is amoment for us while we need to advocate to support andprotect our institutions of science and science funding, we also have to do a littlebit of inward reflection about where we've gone wrong.
'cause i do think we'vetaken some mistaken turns. (participant's words obscureddue to lack of microphone) of course. - i just want to add tothis that we have been pretentious enough tobe far from the people. as much as there are nodialog inside university and it's so shocking. as much there was no dialogwith the people we pretend to serve.
we pretend only. we are, i love this painting. we have turned the back. they don't understand whatwe do that means we don't talk to them. and your president talkto them in the wrong way. people have the sensethat they have been seen after long time of talkingto pretentious people. secondly, all people who want to do
or plan to do bad thing,because i don't believe that the men who run thisenvironmental institution doesn't know what he'sdoing, he just wants money. he doesn't work for his own. he work for many people like him. they know what they're going to do, but they need that money. so there are two dialog there. we need to be near thepeople we pretend to serve
and we need to fight forscience and do it differently. and there is also, whenwe see the big institution who give the money for thescience, it's for hard science that can bring hard things,that we produce a lot of money. not health. implementation scienceis totally neglected. try to find a grant forimplementation science. while if i, i can continue hours. - hello.- hi.
- again.- hello again. thank you for giving your talk. i have a question that'srelated to what i believe to be a political presentationof science in your lecture. and so my question to youis simply, do you think that science is apolitical? - absolutely. science is about choices. it's the choices that youmake if you're a funder
and what you fund. it's the choices we makeas journals and what we do, it's the choices thatscientists make in terms of what they choose to work on. those are all political choices. sometimes we've madedecisions to publish certain items which get us into trouble and we're told that we arebeing overly political. but when we published apaper looking at civilian
mortality in iraq afterthe march 2003 opening of the war in iraq, yeah,we were deluged with angry hate mail from theunited states telling us that we shouldn't havepublished that paper because it was a politicalattack on george bush. what was funny was thatthat was the paper in 2003 when it was mission accomplished. in 2006 we published anotherpaper from the same group. when things didn't lookquite so positive in iraq
after those initial months. when we published that paperwe got a lot of supportive letters from the unitedstates saying thank god you published this paperbecause that's the message we need to hear. and that tells me that theinterpretation of a piece of work including science is governedby the political context in which you publish it. everything's political, nothing is not.
i don't know who's moderatingthis, so i don't know whether i should just, - in conversations about global health and global responsibilityfor civilization, we talk about how it'sall of our responsibility. i wanted to ask what yourthoughts are on whose responsibility it was inthe context of authoritarian regimes such as the situationin syria and other countries. - oh my goodness me.
you want me to make a comment on syria? yeah, well, i'll tell youwhat we're doing there. we've set up a commissionon syria and global health. the global consequences ofthe syrian conflict for global syria is not just aconflict within a country or even within a region. as we're all seeing it'shaving global implications. so we're working with a teamat the american university of beirut and harvard, jennifer leaning,
to investigate these consequences. we published an interimproduct from that work just a few weeks ago lookingat attacks on medical personnel in syria and weare, the work will continue during the course of this year. so that's a slightlydiversionary way of not answering your question but to saythat i fully recognize that the subject you'reraising has deep consequences for health, medicine, global health.
i don't want to pre-judge the commission but i can promise you thatwe will give you an answer to that in the fullness of time. - i just wanted to ask--- hello. - brief question, hi. my question is, just forcontext, i was in malawi not long ago and themalawian doctors that we were working with, we weretalking about who protocols and they were talking abouthow important they are,
they've been using them, wonderful. and they said, well, how doyou implement the who protocols in america? and they were shocked tobelieve and to recognize and to understand thatamerica doesn't say follow the who protocol for pneumonia treatment or doesn't follow the whoprotocol for heart failure, you get the idea. for the sdg's same thing.
we are somehow functioningoutside of these global norms or these globalcommitments and we continue to do it which is whyi applaud you so loudly and strongly for the seriesyou did on inequity in america which most people really don't know about. so my question is,considering all of that, how do you think that we as citizens, how would you advise us to, in what ways would yousuggest we hold our government
more accountable to these global norms and are there ways to do thatwithout using a framework around racism and health in america? - thank you for the question. so i really do think thatthe scholarly community can play a very importantrole in holding governments or any power to account. i think the very act ofmeasurement, assessment, interpretation and then publication,
it was said earlier, you know, publication we should move on fromthat it's not a big deal. publication is an importantpart of accountability because it puts on therecord in a formal sense, a judgment, not just adescription but a judgment about the success or failureof a particular program. so the science communityhas a critical part in political accountability. it's just that we don'tthink about it like that.
the direction of travelwe've taken the lancet is to use the journal asa platform for political accountability. in a non-partisan way, in ourscience part of the journal, but never-the-less, as a toolfor political accountability. because political accountabilityis about measurement, it's about providing a forumfor transparent participatory review of that work,publication in the journal and then it's aboutmobilizing people to act.
which we can't do on ourown, but through coalitions we can. so i completely, i completelyshare the sentiment of your question. but it's, i want to see thenew england journal do that. i want to see other journals do that. because it seems to me inthis country they can be far more powerful than we can sincewe're not fully based here. - [phil] okay, one last question?
- thank you. my question's related to youridea of forming coalitions amongst differentorganizations across the world. and especially regarding thefact that different countries are producing a lot of um,countries, especially countries like india and chinawhich developing countries are producing huge amounts of pollution. how do you form coalitionswith countries like these when there is an argumentto be made that due to
factors like colonialism anderasure they've been held back for such a long timethat to reach development now they have to go throughthis whole process of, which other developingcountries, developed countries, have already done in the past. how do you like, and i doknow as an indian myself, that we are taking stepsto reduce our pollution and everything, but how doyou strongly form coalitions? - no, i fully agree with that.
and it can't be done by people like me, or anybody in the westtelling countries what to do. it has to come from the country. lemme give you an example,it won't be from india but it'll be from china. two years ago, we wentto see chen zhu who's the vice chair of thenational people's congress in the great hall of thepeople in tiananmen square. and we went to him and we said,
"what can the lancet do toassist you, your government in terms of its progressin health and development in china?" and he identified twoissues, one, how do we build a primary health care system? because hospitals dominate too much. and two, how do we produce healthy cities. because they recognize thechallenge of pollution. so these two commissionsare currently ongoing.
they're not led by the lancet. they're not led by western scientists. the one on pollution is ledby somebody who's a professor of earth sciences at tsinghuauniversity, pon gong, he's assembled an amazing teamincluding some internationals to produce a first draft of their report. i was in beijing a month ago with him, looking at that report,we'll be publishing it in october of this year.
it will be a report forthe chinese government written and led bychinese earth scientists and health scientiststo guide china in terms of its policy options. so i think the answer iswe provide the platform. we can provide the conveningpoint, the catalyst i hope, but what we have to do isto give it to scientists in the country who thenwrite their futures for themselves.
and india, absolutely, weshould be doing that too. - [participant] thank you, ilook forward to reading that. - on that note i hope you'llall join me in thanking richard for, - thank you very much. - i think uh,
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