This narrative was written up by Mihika Acharya, Communications Officer at 4SD and David Nabarro, Strategic Director, at 4SD Foundation, Geneva, Switzerland. It is based on presentations by David Nabarro at the Prince Mahidol Award Conference in Bangkok January 2023 on ‘Setting a new health agenda at the nexus of climate change, environment and biodiversity.’
The importance of biodiversity for people’s health and wellbeing
As humanity grapples with worsening climate change, successive COVID-19 waves, and deepening inequalities, it has become increasingly evident that many interconnected challenges threaten the well-being of people and the planet. It is vital that damage to nature and loss of biodiversity are included in efforts to secure equitable and sustainable futures .
Biodiversity provides humanity with food, water, medicine, a stable climate, and economic growth. Over half of global GDP is dependent on nature, and more than one billion people rely on forests for their livelihoods. But nature is in crisis. Accelerating climate change and the continuing destruction of nature threaten to undo the last fifty years of progress in development, global health, and poverty reduction, and to widen existing health inequalities between and within populations.
Climate change and damage to nature are affecting the lives and livelihoods of an increasing number of people, especially those on the lowest incomes, through increasing volatility and uncertainty around weather patterns and the loss of natural resources. As systems disturbances accelerate, they bring additional threats to poorer people everywhere, especially for those who have least agency and respurces. They are especially vulnerable.
For example, climate change and damage to nature amplify existing gender inequalities and pose unique threats to the lives and livelihoods of women and girls. Changing weather patters reduce access to clean water: this leads to reduced yields of food crops and adds to the challenges faced by women. Lack of water increases the challenges with management of menstrual hygiene. School-going girls may feel unsafe, and some may not feel able to access education: this impacts on the power and agency of women and girls in communities.
Climate change is affecting the behaviours of ecosystems, leading to changes in patterns of infectious disease and increasing risks to people’s health. Pathogens in the natural environment can spill-over to humans with potentially serious consequences: there are constant reminders of humanity’s vulnerability to outbreaks of zoonotic diseases such as those caused by Ebola and coronaviruses. SARS-CoV-2, the coronavirus associated with COVID-19, has caused the death of well over six million people since 2020. These vulnerabilities remind us that the human species is a part of nature’s world, and that nature needs to be treated with care and respect. Taking more than we give back, and not making space for species of animals and plants that preceded humans, creates an imbalance of resources on which people depend for life and livelihoods.
Recognizing that humanity is dependent on the resources of the planet , and that this relationship has a direct impact on the health of both, underpinned recent negotiations towards a sustainable agenda for the world. These were initiated in 2012 and the outcome was agreed by world leaders in 2015. This 2030 Agenda for Sustainable Development (and its 17 Sustainable Development goals, or SDGs), acknowledged that the challenges faced by people and planet are layered, interlinked and universal. They must be faced not only in lower- and middle-income countries but in high-income nations too. They affect all aspects of our lives, including people’s physical health, emotional well-being, and livelihoods.
Applying living systems approaches to the 2030 Agenda
The 2030 Agenda for Sustainable Development, with its SDGs has a broader set of objectives across a wider spectrum of socio-economic dimensions than its predecessor agreement, the millennium declaration, and the Millennium Development Goals (MDGs) of 2000. It is far more ambitious, recognizing that global challenges are universal and are interconnected. For example, the goal for health and well-being (SDG3) is linked with that for gender equality (SDG5), decent work (SDG8), and sustainable cities and communities (SDG11). In this way, the 2030 Agenda is a reminder that people are integral parts of all living systems. Splitting up global challenges and working on them separately, in siloes, is not the way to go. A focus on biodiversity targets alone, for example, might risk negative outcomes for people if human rights, sustainability, and equity are not adequately considered.
The ways in which national Governments and community organizations respond to agreements reached by world leaders in global forums (like the United Nations General Assembly), have impacts on the lives of people everywhere, particularly those who are most vulnerable. Effective local and national responses depend on scientists, specialists and community actors making their voices heard in every possible avenue. They seek to ensure that decisions are driven through people’s engagement, with constant attention to re-generating and safeguarding nature in the face of climate change. People’s behaviour, beliefs, and willingness to act, together, all influence the prospects for people’s future wellbeing. It is more important than ever that people are at the centre of development efforts and no one is left behind.
A ‘living systems’ approach offers a holistic way for all involved to work together when navigating complexity and negotiating contested issues. It helps groups to work for transformational change through including all groups of people as partners, acknowledging power asymmetries and encouraging exploration of embracing perspectives. Such an approach is helpful when addressing the consequences of COVID outbreaks, widening conflicts, accelerating climate change and damage to nature for the realization of the SDGs. Tens of millions of households are now experiencing the greatest cost-of-living crisis in a generation, and it is vital that responses reflect the expressed needs of those who are hardest hit, as well as an appreciation of what the the crisis means for them, and the support they need for health and livelihood security.
The navigation of power asymmetries reqires an understanding of the political context from the perspective of the people themselves and the political realities that they encounter. This is vital if people who feel disempowered are to acquire greater agency. External experts may seek to position themselves as politically neutral, but most find that, in practice, they must pay attention to how their actions reflect the interests of those with the greatest influence.
Living systems leaders become comfortable operating within this deeply political realm. They learn to be able to work with those who are making use of relatively limited power. They realize that people’s potential sources of power are not always the most obvious. They accept that working within political processes may appear messy to those focused on specific outcomes: systems transformation is not a straightforward process. Negotiations may not immediately lead to clarity – indeed, being explicit about the choices to be made can lead to greater tensions, to suspicions, and to outright discord.
One challenge faced by everyone is the tendency for all of us to share our perspectives with those with whom we expect to align. This helps us build our own sense of community. However, we are more likely to succeed if we can work with all who are involved in an issue even if they have views which differ from ours – connecting with those with whom we have not worked with before. This can create the potential for the emergence of renewed energy and enthusiasm for unexpected and potentially effective new collaborations.
Focusing on those most vulnerable so as to leave no one behind
The health of all people is a recognized priority in public health and development, features strongly in the SDGs, and is an important focus within responses to outbreaks. It must be taken seriously when the well-being of populations is a central feature of national policies.
To approach the SDGs with a people-centred and equity focus, with an emphasis on the interplay within living systems, requires seeing people as the primary actors in responses to public health challenges. It calls for the engagement of the many stakeholders that have an interest. For example: food systems are more likely to transform if the full range of stakeholders can connect, engage, and explore options in a systematic way. Attention needs to be paid to the identities of, relationships among, and sharing between stakeholders as this increases the likelihood that they will trust each other and act together in a meaningful way.
Responses to COVID-19 outbreaks have laid bare the necessity for a collaborative science-based living-systems-thinking. Such responses take account of the synergies across different issues: they help change the nature of the trade-offs that are faced when choices are made. Inter-disciplinary science and multi-sectoral working are essential and not an optional extra.
It is important that the values adopted by all who are engaged in such collective approaches are made explicit: they are most likely to advance if those involved all acknowledge and respect human rights agreements, draw on multi-disciplinary science, appreciate the need to act across sectors, and approach health as an inclusive, whole of society, issue. It is important to promote and protect the engagement, voices and interests of people with the least agency and greatest vulnerability when decisions are made. This consideration applies especially to women, indigenous people, young people, older people, smallholder farmers, labourers and more.
Enabling health workers to lead for systems change
Health workers have unique opportunities to lead by highlighting the challenges that are faced by people especially when their agency is limited. They can serve as advocates, making authoritative use of their experience and expertise. They can also be effective change agents, recognizing the importance of being authentic and accountable to those they serve. They are accountable when they engage openly with those they serve, taking stock and learning from what has been done, at all levels: it contributes to trust and impact.
Their impact is increased if they widen their circles of engagement beyond the health sector and communicate in ways that reflect on where people really are. Honest, open, and consistent communication is essential and has proved to be especially helpful when partnering with people on responses to outbreaks of disease and other threats.
All groups in society have parts to play. Those with the responsibility to govern, for example, are expected to respond to the knowledge, experiences, and challenges of all in society including those at the frontlines of crises, especially women and indigenous peoples. When they lose their sources of income or are forced to evacuate their homes by extreme weather, they are at risk of becoming more marginalized and experiencing multiple forms of violence. Inclusive, multilateral, equitable actions will ensure that all within communities are able to access the resources they need, and that the most vulnerable are in a position to use them.
There is a unique leadership opportunity for health workers of all kinds to lead n the health consequences of climate change and biodiversity loss. Lasting change starts and ends with alliances being built within communities, and the deepening of trust between people and those who serve them. It is more likely to happen when people perceive they are partners in change, being listened to and perceiving that they are able to impact on the decisions made about them.
It is vital that all decision-makers are constantly reminded, by those they serve, that the biodiversity-climate-health nexus does not affect everyone equally. Who people are matters. Where they are matters. Whether they are able to engage in decision-making matters. Whether they can participate as decisions are made, despite asymmetries in relative power, positions, and expertise, matters. It is important that climate change and biodiversity are included in conversations on health. It is at least as important that, as decisions about health and well being are made, there are accessible spaces in which people and their communities can engage in the decisions about health action.
Tackling the emerging complexities that abound in our world, especially at the biodiversity and climate nexus, is extremely challenging. Navigating them in ways that optimise the health and well-being of those who have the least agency, power, and resources, is even more so. Health workers have a vital and central role to play. They are counted on to help maintain the structures, spaces, and opportunities for inclusive engagement, dialogue, exploration, and accountability.