Feature

We must not go on like this

We live in a world scarred by vast – and widening – inequality. Yet this is not inevitable. Carolyn Stephens surveys the state of our ‘world of differences’

I find it increasingly difficult to write anything about sustainable development and health, at least not without experiencing some of Gramsci’s ‘pessimism of the intellect and optimism of the will’.¹

My confusion stems from trying to place sustainability and health in the context of what economists call ‘asymmetries’, gross inequalities of life chances, information and power internationally. For me, it is also about trying to live and work simultaneously in very different parts of this asymmetric world: London, Ghana, Liberia, India, Brazil, and Northern Argentina.

The greatest complexity is tied to working on sustainable development while living on a planet that looks scarily like Aldous Huxley’s Brave New World.

Where are we now?

To start on a pessimistic note: it is over 30 years since the phrase ‘sustainable development’ was coined and evidence shows that we still are not ‘meeting the needs of the current generation without compromising the needs of the future’.^{2 3 4 5}

Evidence suggests grimly that, in health and environmental terms, we are further from sustainable development than ever before. The world has never perhaps seen the scale of concentration of material, wealth and power that we witness today, nor the scale of difference in life chances between those who will live over 75 years and those who will die before their first birthday.

For the tiny minority (less than 10 per cent of the world population) who live to over 75 years sustainability continues on the whole to be about recycling domestic garbage, saving home energy and/or buying organic. Meanwhile, these lucky people continue flying, driving – and Christmas shopping – around the planet, as if there were no tomorrow.

Yet for the enormous majority of 1.3 billion people living on less than US$1 a day, sustainability is still mostly about surviving until tomorrow and hoping there will be a tomorrow. For many children, the prospects are getting more, not less, bleak.

The World Health Organisation reports: ‘Diarrhoeal diseases kill around two million children under the age of five every year, and are almost entirely related to unsafe drinking water and the lack of sanitation. Air pollution from combustion of fossil fuels for cooking and heating causes respiratory infections, which are responsible for up to 20 per cent mortality in children under five years of age.’⁶

On a macro scale, the tiny minority – and, inadvertently, the vast majority – are tied into an amazing consume/waste economy. Waste flows into the environment keep growing and consumption/waste cycles move fast. The World Resources Institute estimates that 50-75 per cent of annual resource inputs to industrial economies are returned to the environment as wastes within one year.⁷

Linked to our extraordinary consume-and-waste economies, the world climate is warming. The WHO reports: ‘The global average surface temperature has increased by 0.6° ± 0.2° C over the past century. Many areas have experienced increases in rainfall, particularly mid to high latitude countries. In some regions, such as parts of Asia and Africa, the frequency and intensity of droughts have been observed to increase in recent decades, and episodes of El Niño have been more frequent, persistent and intense since mid-1970s compared with the previous 100 years.’⁸

Then there is the asymmetry of opportunities. This starts with the birth of an individual into very different parts of the asymmetric world. The accident of birthplace then determines how long the child will live and most of the illnesses the person will suffer.

If the baby is born into a rural community in Ghana, India, Ecuador or Venezuela, the child is likely to have malnutrition and will die before the age of one from an infectious disease. If the baby is a boy born in a favela in Sao Paulo, Rio, Johannesburg or Manila, he is likely to die before the age of 18 years of a road traffic injury or of violence.

Worse still, an individual born in any country in conflict will face a compounded risk of ‘collective violence’, as well as what Venezuelan president Hugo Chavez calls the ‘thousand-headed’ risks of poverty. This is the case, for example, in Liberia, Palestine, Sierra Leone, Chechnya, Colombia and the Congo.

If the baby survives any of these risks, the child is still unlikely to go to school for any length of time, and as an adult will find it difficult to find safe remunerative work to support a family. The material consumption of these people will be one-thousandth of that of more wealthy individuals, yet they will be blamed for environmental destruction more than their wealthy counterparts.

The opposite life course will probably be true for someone born in Western Europe, the USA, Canada or Japan. In their long lives, this minority will have a major impact on global resources, as the UN Environment Programme has pointed out repeatedly: ‘Although only 5 per cent of the world’s population, the US and Canada consume nearly 25 per cent of total energy.’⁵

But there is another factor to consider – there are also local asymmetries the world over. An individual born into a wealthy family in the south will have life span akin to someone brought up in the so-called ghettos of the north inside every country. An individual born into the new ‘ghettos of the south’ – in the towns and cities of the north – will have a shorter life span than wealthier counterparts in the same country.

It is these local asymmetries that are gradually blurring the boundaries of north and south and bringing home, to those who want to see it, that ‘no man is an island’, as John Donne wrote in 1624.

One root of these asymmetries lies in unequal educational and work opportunities. The International Labour Organisation reports that 500 million workers earn less than $1 a day and 160 million people internationally are unemployed, of which 50 million are now in industrialised countries.⁹

Those who do get work find themselves trapped in production at any cost for the consume-and-waste economy. The WHO’s occupational health group has expressed the following concern – that in the context of globalised production processes ‘pesticides that are banned in certain countries are still sold in others, causing hazards for agricultural workers and consumers. There is a development of free trade zones, where occupational health and environmental legislation may be poor and where hazardous or strenuous production processes are concentrated’.¹⁰ All around the world are people tied to risking their health and futures for the consume-and-waste society.

International asymmetry in information and power

But it is the asymmetries in information and power that really alarm me. Perhaps it was the scale of these asymmetries that underpinned the profound disconnect in the perspectives of different powerful actors in the recent UN summit in Johannesburg.

At the summit, there was a vastly differing range of views of what represented reality. On the one hand, US secretary of state Colin Powell concluded, perhaps ironically given his country’s perspective: ‘I think it shows that we have a shared vision of how to move forward. I think it shows that the world is committed to sustainable development.’ UN secretary-general Kofi Annan talked oddly of beginnings: ‘We have started off well. Johannesburg is a beginning. I am not saying Johannesburg is the end of it. It is a beginning.’

On the other hand, Venezuelan president Chavez, chairman of the Group of 77, which represents 132 developing countries, expressed the views of many when he said: ‘The generalities that had been set out could be seen as retrograde. I would have preferred emphasis on human rights, such as the right to housing, health, drinking water, life.’ He concluded: ‘The world is standing on its head.’

Where are we going internationally?

If the world is standing on its head, what are we doing about sustainable development? There are two sorts of changes. One is procedural and is accommodated within business as usual. The other is more subtle, more profound and infinitely more difficult.

The majority of actions so far have been within business as usual. For example, sustainable development has spawned an industry – and few major multinational corporations, non-governmental organisations, universities, schools or local governments are without an environmental spin somewhere.

A mountain of projects have sprung up, bringing us case stories of success. These two actions mean that those of us living in the over-consuming minority of the world can hardly miss the calls to ‘do our bit’, although we can ignore them.

The environmental sustainability spin in institutions and structures can also highlight the incoherence of the ‘unspun’ bits, as major oil companies and agrochemical firms are finding, sometimes to their cost. Finally, environmental sustainability is becoming a critical thread in policies for countries as diverse as India, Brazil, Indonesia and South Africa.

On another front of business as usual, in the past few years we have made great strides in international laws for sustainable development. We must not forget the Kyoto protocol, which ploughs on despite resistance, but two new laws stand out in terms of health and sustainable development.

One is aimed at protecting biodiversity, including in food crops and medicines. When ratified, the Cartagena Biosafety Protocol to the UN Convention on Biological Diversity (CBD) will provide a regulatory framework for international trade in bio-engineered products, referred to as living modified organisms (LMOs).

The protocol is an environmental agreement aimed at protecting biodiversity, using the precautionary principle. It was adopted by more than 130 countries on January 29 2000 in Montreal, Canada, but must be ratified by 50 countries before it can be put into effect. As of November 2002, 81 countries had signed up and 38 had ratified the protocol.¹¹

The Convention on Rights of the Child is another important step forward, not simply for today but also for the future. It is the most universally accepted human rights instrument in history – it has been ratified by every country in the world bar two, the US and Somalia.

According to Unicef, ‘the convention uniquely places children centre stage in the quest for the universal application of human rights. By ratifying this instrument, national governments have committed themselves to protecting and ensuring children’s rights and they have agreed to hold themselves accountable for this commitment before the international community. The Convention on the Rights of the Child is the first legally binding international instrument to incorporate the full range of human rights – civil and political rights – as well as economic, social and cultural rights’.¹²

Together, these agreements represent ways forward in international rules and regulations – for the first time putting protection of the future and of the rights of future generations on safer ground. And the gradual creep of the rhetoric has awakened consciousness around the planet.

International law or environmental spin are unlikely, however, to make us sink or swim (or cool or fry) as a species. However, we may well sink or fry if we choose to ignore the world’s asymmetry. Not only do we need to recycle and consume less as a collective world population, but we also need to turn around this consume/waste, have/have not society. Fundamentally, we need to repair the divisions that have built up between peoples and communities as a result of the huge global asymmetries.

Finally, we do not want to go further into the world that UN Environment Programme calls a ‘Security First’ world. It states: ‘This scenario assumes a continued world of striking disparities. Socio-economic and environmental stresses give rise to waves of protest and counteraction. As such, troubles become increasingly prevalent the more powerful and wealthy groups focus on self-protection, creating enclaves akin to present day ‘gated communities’.⁵

Sustainability and health for current and future generations will come when every person begins to put living sustainably at the heart of the way they work and live internationally and personally. And that will come when each person tackles the asymmetry of vision that stops people all over the world from seeing how their personal actions affect others and will affect the future.

I agree profoundly with a colleague, Professor Christian Agbenyega of the University of Ada, Ghana, who wrote as follows a few years ago: ‘Blinded with education/I see, but I do not see/I feel, but I do not feel/…those who can make it keep dragging the rest/for ransom to the mythical land of “development”.’

Redefining ‘development’ is not impossible, and this brave new world has been created in its current form in a short few hundred years. Asymmetries of vision may diminish when access to information and to participation in decisions extends to the excluded majority.

And that leads me back to another quotation from John Donne: to achieve sustainability and health on a global scale, we need everyone to recognise that our mutual need for sustainability and health is fulfilled only when we really ‘never seek to know for whom the bell tolls – it tolls for thee’.