Prof. K Srinath Reddy presented on health in the era of sustainable development. He discussed how health is impacted by social determinants, the physical environment, and political and economic systems. Key themes included urban design and transport, air pollution, agriculture and food systems, and climate change. Reddy emphasized the need for multisectoral approaches and highlighted several challenges, including the growing burden of non-communicable diseases, air pollution's impact on health, and the effects of climate change on health, nutrition, and food systems.

1. Prof. K Srinath Reddy
President, Public Health Foundation of India
Health In The Era Of
Sustainable Development

2. SDGs
MDGs
Strong Focus on MCH &
Communicable Diseases
Higher Investment In Health
Strong Focus On
MCH
NCDs
CDs
UHC

4. “ Health leaps out of Science and
draws nourishment from the
totality of Society”
- Gunnar Myrdal
(Swedish Economist, Nobel Laureate 1974)

5. HEALTH SYSTEM PEOPLE
SOCIAL
DETERMINANTS
(OF HEALTH &
NUTRITION)
Societal Personal
- Water - Income
- Sanitation - Education
- Food System - Occupation
- Environment - Social Status
- Social Stability - Gender
- Development - Networks
- Workforce
- Infrastructure
- Drugs, Vaccines & Technologies
- Financing
- Information Systems
- Governance
POLITICAL & ECONOMIC SYSTEM

6. PHYSICAL ENVIRONMENT
(Four Themes)
• Urban Design and Transport
• Air Pollution
• Agriculture and Food Systems
• Climate Change

7. URBAN DESIGN & TRANSPORT
• Conducive To ‘Active Living’
• Physical Safety (Traffic, Crime)
• Water, Sanitation
• Clean Air
• Accessible Health Services
• Disaster Resilient
• Climate Resilient

8. URBAN DESIGN & TRANSPORT
(Determinants of Active Living /Physical Activity)
• Land Use Mix Access
• Residential Density
• Street Connectivity
• Safety
• Infrastructure
• Aesthetics
• Perceived Distance To Destinations
• Public Transport
• Pollution (?)

9. • Air Pollution is the world’s single largest
environmental/pollution health risk.
In 2012
• ~7 million people died prematurely due to air
pollution.
• 2.7 million premature deaths were
attributable to ambient air pollution.
• 4.3 million premature deaths attributable to
household air pollution.
Source: WHO, 2014
AIR POLLUTION

10. Diarrhea / LRI / Other Infections
Cardio & Circulatory
Chronic Respiratory
Neoplasms
Source: IHME, 2013, Lim et al 2012
Key Risk Factors - Global (GBD 2010)

11. • Annually , 3.3 million
people worldwide die
prematurely from the
effects of outdoor air
pollution (mostly PM2.5).
• In 2010, 75% of such
mortality occurred in Asia -
1.4 million in China and
650,000 in India.
• This number will double
by 2050 to 6.6 million if
emissions continue to rise.
Death By Breath
(Max Planck Study. Nature, Sept 2015)

12. Household Air Pollution
3 billion people cook with solid biomass fuels
• Low-middle income countries: burden borne by women and
children. >50% under 5 deaths are due to pneumonia
(Risk Factor: soot inhaled from household air pollution)
• Diseases: Pneumonia, stroke, Ischemic Heart Disease, Chronic
Obstructive Pulmonary Disease, Lung cancer
• South Asia shoulders the biggest burden
“Having an open fire in your kitchen is like burning 400 cigarettes
an hour.”- Kirk Smith

13. Burdens from HAP and AAP in India (GBD 2010)
Source: IHME, 2013, Lim et al 2012
Deaths DALYs
Ambient
Air
Pollution
(PM2.5)
627,426 17.7
million
Household
Air
Pollution
~ 1
million
31 million

14. • 16,000 cities monitor and report ambient air quality
• Only 12% of the people living in those cities
reside in cities where this complies with WHO guideline levels
• Most polluted cities in the world:
• Asian cities: Karachi, New Delhi, Kathmandu, Beijing.
• Latin American cities: Lima, Arequipa.
• African cities: Cairo.
Burden in LMICs - Ambient Air Pollution
NEED BETTER METRICS FOR INTEGRATED EXPOSURE
MEASUREMENT AND ESTIMATION OF HEALTH EFFECTS

15. • Establishing and strengthening baseline relationships
– Links to cardiometabolic risk factors with chronic exposure
– Gathering greater evidence of association with Diabetes in adults and
endocrine disruption in children
– Strengthening evidence for multi-generational epigenetic effects
– Source and pollutant-specific effects (toxicity of various components of PM)
– Impacts of ultrafine particulates
• Predictive models
– Building on and localizing the work of the GBD
– Developing early warning systems
Air Pollution
Research Response : Priorities

16. •Estimating benefits and costs of action
–Air pollution and climate co-benefits
–Economic case : estimating the health costs
•Health System Response
–Health Workforce Preparedness
–Health Care Access And Quality
Air Pollution
Research Response : Priorities

17. HUMAN HEALTH
ANIMAL HEALTH
PLANT HEALTH
SOIL HEALTH

25. 2013-16

26. Metrics : Messages for Decision Makers
The need for action
• Agriculture and food system policies must make a greater contribution to
improving nutrition.
• Low and middle income countries are burdened by persistent undernutrition and
rapidly growing overweight, obesity and diet-related non-communicable
diseases.
• Existing tools used to measure nutrition links to agriculture and other
food policy interventions capture only parts of the food system.
• Evidence based policy making requires more rigorous and specific
metrics relating to all of the food system elements and their
dynamic interactions over time.

27. DATA GAPS ON DIETS AND FOOD SYSTEMS
• New metrics are needed to measure diet quality and
sufficiency, as well as food system efficiency and
sustainability. Improvements are needed in five key areas:
• Improving data on actual food intake (currently lacking in most
countries of the world)
• Agreement on how to measure diet quality
• Metrics that measure women’s roles in defining dietary choices
• Metrics to measure the food environment within which diet
choices are made
• Metrics to measure the health of food systems overall.

28. DATA STARVATION
• Six Nutrition Goals set By World Health Assembly (2012)
• More than half the countries do not collect statistics to
monitor progress
• 40% of countries which do – rely on surveys conducted
once in a decade

29. We Live In A World
This Will Get Worse If We Don’t CHANGE!
Where Food Systems Are
Threatening The Environment
And
Environmental Degradation
(From A Variety of Sources)
Is Threatening Food Systems

30. Climate Change Through Nutrition Lens-1
By 2100
40% of the world’s land surface will
likely experience altered climates
Up to 2050
• Agricultural output is projected to:
Fall by 2% per decade (due to impact of
climate change on crop and livestock
production)
• Food Demand is projected to:
Rise by 14% per decade (due to population
growth, urbanisation, poverty reduction)

31. Climate Change Through Nutrition Lens-2
• Higher production of staple crops will not be enough to
make agriculture more resilient to climate change or
better able to address the world’s need for improved diets
• Nutrient rich crops are more susceptible to droughts,
pests, diseases and temperature fluctuations
• Higher CO2 in atmosphere may reduce nutrient content of
staple crops
• Soil degradation also reduces nutrient quality

32. Sub-Saharan Africa and South Asia are
particularly prone to productivity losses
from climate change because major staples
in these regions are often already grown
above their optimum temperature, with as
much as 10% yield loss for +10C of
warming predicted in some locations.
www.sdsn.org TG07

33. Nutrition-sensitive Food Systems
Can Also Be Climate-smart
• While evidence of effective climate change actions remains scarce there
is ample evidence already of how to enhance diets and food systems in
the context of weather shocks and price volatility.
• Climate-smart actions supportive of nutrition means focusing on
diverse, high quality, healthy diets.
• Win-win solutions lie in the diversification of agricultural investments,
mitigating climate-related stresses on crop and livestock quality, greater
resource use efficiency along value chains, and protecting diet quality in
the face of supply and food price shocks.

34. Policy Recommendations
• Support variety of food production systems to minimize risks and enhance the
supply of more diverse foods in the diet;
• Promote efficiency, including waste minimization, along the entire food value chain
to meet higher food demand and enhanced resource use, while achieving dietary
diversification
• Focus domestic research and investments on mitigating climate-related food
system shocks and volatility, and adapting those systems to longer-terms stresses;
• Establish robust social protection programmes that stablise and enhance consumer
purchasing power, thereby protecting their diets and nutrition in the face of supply
shocks;
• Researchers should generate rigorous empirical evidence on effective investments
along food value-chains that are resilient to climate changes while delivering
positive dietary outcomes.

35. CLIMATE CHANGE
WILL HARM HEALTH IN MANY WAYS
• Vector Borne Diseases: Wider Reach; Higher Death Toll
• Water Insecurity
• Food Insecurity
• Extreme Climatic Events
• Displaced Populations
• Vulnerable Human Settlements

36. Mapping Links Between Climate Change and Health
• Most expected impacts will be adverse but some will be beneficial.
• Expectations are not for new health risks, but rather changes in frequency or severity of
familiar health risks

37. Variations in Earth’s average surface temperature, over the past 20,000 years

38. • Unequivocal evidence on climate change: rising sea levels and
global temperatures, retreating glaciers, extreme events, etc.
• Since the industrial revolution, atmospheric CO2 has
increased by 1/3rd.
• IPCC projects an increase in global temperatures by at least
1.8°C by 2100 in the best case. Up to 5.8°C if nothing is done.
• An increase in sea levels between 9 and 88 cm in the next
century.
• MOST OF THIS CHANGE IS RELATED TO HUMAN ACTIVITY:
ANTHROPOGENIC.
Climate Change: Evidence and Trends

39. Direct Effects Of Climate Change
Mainly from extreme events:
• Temperature extremes: Eg. The 2003 European Heat wave.
Most deaths were in vulnerable populations eg, the elderly with
pre-existing diseases.
– Over 70,000 estimated to have died in the hottest summer since
1540.
• Disasters: (Floods, Tsunamis)

40. Indirect effects of climate change
Act via:
• Changing patterns of disease: vector borne diseases
• Water sanitation and hygiene related diseases.
• Food shortages: reduced crop yields in the lower latitudes.
• Migration and population change.

41. Climate Change and Malaria under Different Scenarios (2080)
• Increase: East Africa, Central Asia, Russian Federation
• Decrease: Central America, Amazon [within current vector limits]
Change of consecutive months
> +2
+2
-2
< -2
A1
B2
A2
B1 Van Lieshout et al. 2004

42. Storms/Flooding
Flooding is heavily concentrated in Asia
Most human exposure to flood is in Asia. The top ten countries –
in absolute and relative terms - are in south and south east Asia.
From: Environment Solutions: www.environmentsolutions.dkSource: 2009 Global Assessment report on Disaster Risk Reduction

43. 2012 Flood in Pakistan (September)
• Monsoon floods in Pakistan during September, killed
more than 400 people and affected more than 4.5
million others:
– Tens of thousands have been made homeless by
heavy flooding in the provinces of Balochistan and
Sindh –
where 2.8 million were affected.
– The worst floods were in 2010, when
almost 1,800 people were killed and
21 million were affected.
• During 2011, many Asian countries experienced flooding,
including Bangladesh, China, India, Japan, Laos, North
Korea, Pakistan, Thailand, the Philippines and Singapore.
BBC news: 28 Sept 2012

44. Climate Change and Conflict
 Deviations from temperature and
precipitation patterns correspond to
statistically significant rises in conflict
 1-degree increase in temperature (warmer)
increased the frequency of interpersonal
conflict by 2.4% and intergroup conflict by
11.3%
Source: Climate and Conflict, National Bureau of Economic Research: October 2014
Marshall Burke, Solomon M. Hsiang, Edward Miguel

45. Health Co-benefits Of Climate Change Mitigation
Benefits in NCD risk factor reduction
• Public transport: cycling etc.
– In addition to reduced carbon emissions, improved physical activity-
reduced risk of NCDs
• Reduced red meat consumption
• Air pollution mitigation: reduced respiratory illnesses

46. INDUSTRIAL SCALE LIVESTOCK BREEDING
Obesity
CVD
Cancer
Climate Change
(↑ Methane;
Deforestation)
Food Crisis
(Grain
Diversion)
Pandemics
(Zoonotic
Diseases rising)
+ +
W
A
T
E
R

47. Climate Change: Methods Required to Assess Vulnerability
• Estimating the current distribution and
burden of climate-sensitive diseases
• Estimating future health impacts attributable
to climate change – across and within
countries
• Identifying current and future adaptation
options to reduce the burden of disease.
Source: Kovats, et al., 2003

48. C O P 21
( Paris ; December 2015 )
COP OUT! CLAP IN!
CO-OP 195CATCH 22
?

49. MULTISECTORALITY
MULTISECTOREALITY
Need for Transdisciplinary Research

50. Persons
People
Populations
PLANET