SDG3: Good Health and Well-Being

In this episode of About Sustainability..., Erin, Andre, and Bob invited Eric Zusman back to talk about SDG3 on Health. Eric works on co-benefits between air pollution mitigation and climate action, which has significant implications for public health. Meanwhile, Erin provided some context and perspectives based on her public health background. 

We started the discussion with what it means to be ‘healthy’ and what is required to attain good health. We then moved onto what SDG3 emphasises (and what it does not), what is missing from SDG3, global progress on the goal, and COVID-19’s impacts on our efforts and on health systems more generally. We then looked more deeply into air pollution specifically, as it is responsible for the premature deaths of approximately seven million people annually. We explored linkages with climate change, solutions that benefit air quality, climate mitigation and health, and the challenges or tradeoffs of implementing such solutions.

Related links

• UN Department of Economic and Social Affairs’ Goal 3 Page
• Sustainable Development Solutions Network (SDSN)’s 2022 Sustainable Development Report
• Strengthening the Linkages Between Air Pollution and the Sustainable Development Goals
  • This policy brief argues featuring air pollution more prominently in the structure of the SDGs could deliver significant health benefits.
• Sustainable and Inclusive Solutions to Air Pollution and Climate Change in Southeast Asia: Participatory Governance, Social Co-benefits and Co-Innovation
  • This issue brief presents ways that policymakers in Southeast Asia can support sustainable and inclusive solutions to air pollution and climate change with health co-benefits.
• One Atmosphere: Integrating Air Pollution and Climate Policy and Governance
  • This paper argues that more rigorous research is needed on how governance can help achieve air quality, climate and health co-benefits.
• Integrating Clean Air, Climate, and Health Policies in the COVID-19 Era: The Role of Co-benefits and the Triple R Framework
  • This policy brief argues that co-benefits can be a useful concept to integrate climate, air pollution and health policies in the COVID-era.

About our guest:

Eric Zusman is a Research Leader at the Integrated Sustainability Centre at IGES. Apart from his expertise in multilevel governance, sustainability transitions, and SDGs generally, he has extensive experience in air pollution mitigation and co-benefits of climate mitigation and air quality improvements (and health).

"About Sustainability..." is a podcast brought to you by the Institute for Global Environmental Strategies (IGES), an environmental policy think-tank based in Hayama, Japan. IGES experts are concerned with environmental and sustainability challenges. Everything shared on the podcast will be off-the-cuff discussion, and any viewpoints expressed are those held by the speaker at the time of recording. They are not necessarily official IGES positions.

Episode Transcript

Erin (00:12):
Hello and welcome to another episode
of About Sustainability..
.
This is Erin,one of your co-hosts.
We are charging on with ourseries on the Sustainable
Development Goals or SDGs.
And this time, wetalked about SDG3 on Good
Health and Well-Being.
I was joined by two co-hosts,André and Bob, and our guest,

(00:33):
Eric Zusman, whose voice youmay have heard on a previous
episode on theIntergovernmental Panel
on Climate Change.
Eric works on a lot ofdifferent things, but he is
passionate about improving airquality and mitigating
climate change, bothof which are crucial
public health topics.
We started the conversation offwith what it means to be

(00:54):
healthy and what isrequired to attain good health.
We then moved onto what SDG3 emphasises and
what it doesn't,global progress on the goal,
and the impacts of COVID-19.
By the way, you'll hear me makea point about a majority of
deaths these days being causedby non-communicable diseases,
which are basically diseasesthat are not infectious,

(01:17):
even in developing countries.
Now, this is true, butin the poorest countries of
the world, the burden ofcommunicable diseases is
greater thannon-communicable diseases,
skewed to a largeextent by health outcomes in
Africa.
So...
This is just to add a littlemore nuance to the discussion.

(01:37):
So after discussingSDG3 generally, we looked more
deeply into air pollution,an environmental exposure that
is responsible for 7 millionpremature deaths annually.
We explored linkages withclimate change,
co-benefits solutions thatachieve air quality,
climate mitigation and healthobjectives simultaneously,

(01:57):
and the challenges or tradeoffsof implementing such solutions.
In this episode, there's a lotwe covered, but also a
lot we couldn't, like otherenvironmental determinants of
health and the linkages betweenclimate change and
health more generally.
Still, I hope that thisconversation gets you as

(02:18):
excited about public health asI am and gets you thinking
about the challenge of ensuringhealthy lives and promoting
well-being for all at all ages.
Today, we're going totalk about SDG3,
which is on health.
The goal is titled "ensurehealthy lives and promote

(02:41):
well-being for all at all ages".
And that seems like avery ambitious goal,
but first, I'd like to discusswhat it really means to lead
a healthy life.
What does that mean?

Eric (02:54):
Thanks a lot, Erin, for introducing this and
starting this off with the link.
What is a really interestingquestion and interesting way of
talking about SDG3.
And I think what makes it sointeresting is that usually
when we think about what itmeans to lead a healthy life,

(03:17):
we think about diseaseor some of the immediate
threats to health.
And of course, thoseare still quite relevant and
quite important, especially asit relates to, for instance,
the health of children ormaternal health and whatnot and

(03:37):
diseases-communicable diseases...
But I think what we see withSDG3 is, for lack of a
better term, a more expansiveview of what it means
to be healthy.
And this is evident,for instance, in the fact that
SDG3 also puts some emphasis onmental health and also a lot of

(03:59):
emphasis on thinking aboutwell-being and also thinking a
little bit about some of thethings that you as an
individual andalso as collectives,
as governments, need to do toto achieve, you know,
good health, both in aconventional sense and more
focusing on some ofthe mental dimensions.
For instance, one of thetargets on SDG3 is on

(04:23):
universal health coverage.

Erin (04:24):
Right.

Eric (04:25):
And I think this is quite in some ways progressive,
forward looking, aspirational,what have you.
So I think the nice thing aboutthe SDGs in general and this
SDG specifically is it sets upa new set of norms,
if you will, on what it meansto be healthy and what you need
to do to achieve that.
So I think that's quitea nice feature of the SDG.

(04:47):
And also of course we'll relatemore towards some of the
environmental issues -environmental health issues
that we'll deal with laterin the podcast.

Erin (04:55):
Yeah, that's a really good point.
Actually, the World HealthOrganization (WHO) Constitution
states or defines health as"the state of
complete physical, mental andsocial well-being and not
merely the absence ofdisease or infirmity".
So in that sense, you know,it's not really about whether
or not you get this disease,but it's about whether you

(05:18):
truly feel that you are healthyand truly feel like you can
thrive in society.
But actually, I have to say,the way that the targets- maybe
we'll discuss this a bit later-but the way that the targets
and indicators are framed,I feel like they're still
looking at really the absenceof disease or tracking those

(05:38):
aspects more so thanencouraging healthy behaviours
or healthy systems and so forth.
So I thought thatwas quite interesting.

André (05:47):
Mm hmm.

Bob (05:48):
I just wonder if it makes sense to quickly read through
what the targets are.
So Target 3.1 isreduce maternal mortality.
3.2 is end all preventabledeaths under five years of age.
3.3 is tofight communicable diseases.
3.4 is to reduce mortality fromnon-communicable diseases and
promote mental health.

(06:09):
3.5 is to prevent andtreat substance abuse.
3.6 is to reduce roadinjuries and deaths.
And then we have universalaccess to sexual and
reproductive care,family planning and education;
achieveuniversal health coverage;
reduce illnesses anddeath from hazardous
chemicals and pollution;implement the WHO Framework

(06:31):
Convention on Tobacco Control;support research development
and universalaccess to affordable
vaccines and medicines;increase health financing and
support health workforcein developing countries;
and finally improve earlywarning systems for
global health risks.
I read the summariesof the target texts from
globalgoals.org and not theactual target text.

(06:54):
So for anybody reading along,it may be different.

Erin (06:58):
Mm hmm.

André (06:59):
That's a lot, hey?

Eric (07:00):
Yeah.
Yeah, yeah.

André (07:01):
Well-

Bob (07:02):
Pretty broad.

André (07:03):
Well, I was just going to ask, what- if any of you
guys have any idea what theymean by social well-being?
You read it in the WHO-

Erin (07:10):
Yeah-

André (07:10):
That sounds like a very nebulous concept to me, but any
idea?

Erin (07:14):
I think it pertains to the loneliness epidemic.
So essentially, you know,how people have different
ties and connections...
I guess has the underlyingassumption that people need to
be around other peopleto feel ultimately mentally
and physically well.
So....
How that is defined is a lotmore nebulous, like you said.

(07:35):
You know, it's not like withphysical health - it's
very clear, you know,what the outcome is.
Mental health, less so,but still, there are some
clinical criteria in some cases.
But with social health,you know, some people are
totally fine being on their ownand then other people are
really not fine with that.
So there's a range.
Yeah.

Eric (07:54):
I think it's interesting.
I think that there's a perhapsanother dimension of this too,
and that I mean, I think thesocial connectivity is part of
the story, but I think thatthere's - you know, and this is
also a nebulous concept, too -but I think there's a growing
amount of work on justhappiness and whether or not
people feel content,not necessarily connected to a

(08:15):
broader community,but fulfilled with themselves
and what they'redoing and whatnot.
When I was doing a little bitof background on this, I was
looking atthe Sustainable Development
Solutions Network (SDSN).
So this is an initiative thathas started in parallel with
the SDGs and taking alot of the impetus from

(08:37):
Jeffrey Sachs.
And they track how countriesare doing on the SDGs.
There was, in their trackingfor this SDG, there's actually
like an index on...
Maybe it's well-being or maybeit's happiness, but it's like a
broader index that they'reusing to look at how countries

(08:57):
are doing on someof the less quantifiable
dimensions of this, but- so Ithink it's, you know,
it's partiallysocial connectedness, but I
think it's also having somejust a sense of happiness
and feeling fulfilled.

André (09:12):
Just a quick overarching point, which I
think now is the right timeto make this, and that might be
not all that accurate, but Ithink just as a very
general rule, the lack ofphysical well-being is more of
a challenge in thedeveloping world,
and mental well-being, or lackthereof, is more of a
challenge or at least a focusin the developed world.

(09:34):
And I think part of thereason- well, part of the
reason for the former- the mainreason for the former goes back
to poverty, I guess.
And the main reason forthe latter, I think is -
and again, this is very broadlyspeaking - but is is largely
that the changes in societythat come along
with developed environments.
One of those changes is that isless contact with other people

(09:56):
and less of a social atmosphere.
And I'm thinking of SouthAfrica where I grew up, as has
these two worlds living verymuch side by side.
And I- something that I'venoticed spending time in the
poorer parts of the country,something that's very quickly
evident is the vibe, you know?
How much interaction thereis between people.
And I'm sure there are,you know, mental health issues

(10:19):
in those communities.
But there's such a strongsocial vibe and, of course,
there are socialproblems as well.
But I think that I can sort ofsee why mental well-being is
more of an issuein more cloistered societies
than than those.
So I'm really putting myselfout there because I'm far from
an expert in this area.
This is more of an anecdotethan anything else, but maybe

(10:39):
just to set the scenea little bit.

Erin (10:41):
Yeah, I definitely agree that mental health is, I guess
maybe more talked about,perhaps, in the
developed world, although Ican say that, maybe the way
that we conceptualise diseasein a conventional sense is
mostly communicable disease.
And in that sense, of course,you know, we have a lot of the
Global South stillsuffering from, you know,

(11:02):
things like malaria,[tuberculosis] (TB)
and so forth.
And there's a lotof money, actually, that goes
into these programs.
So we feel like, you know,there's a lot of
issues around that.
But then, when we think aboutthe majority of deaths now,
they're actually caused bynon-communicable diseases
around the world.

(11:23):
And I can't really tell youwhat the distribution of
that is, but I suppose thatthat happens a lot in the
Global North as well asthe Global South.
So it's very interesting.
I think it's also because it'sa lot more difficult in
terms of, you know,understanding the causal
pathway and prevention andtreatment of things like
diabetes or canceror heart disease.

André (11:46):
The non-communicable diseases.

Erin (11:47):
Right.
Exactly.
Yeah.
And one other, I guessstatistic is that it actually
varies quite a bit dependingon the age.
So age ranges.
So if you look at under five,so like babies essentially,
a lot of deaths happened dueto communicable diseases.
So things likediarrheal disease, for example.

(12:09):
But then when you look at itfrom 5 to 14 or 14 to 49 or
something like that, it shiftsto other types of- well,
non-communicable diseasesbecome much more prominent.
And then, of course, there arealso sex-based [differences].
So particularly for 14 to 49 orsomething like that, males tend

(12:32):
to have a much greatermortality rate for injuries and
roadside accidents asopposed to females.

Eric (12:41):
Can I ask a quick question ?
And I think thisis a really good point.
Do you think that the- and Bobread off some of the targets -
do you think that SDG3 does agood enough job of taking into
consideration some of thesedifferences across age groups,
across gender?
Or could there be more of aneffort to capture some of

(13:04):
these differences, do you think?

Erin (13:06):
Yeah, thank you for that question.
I do think that they do,implicitly- so there is a
specific targetfor traffic accidents.
So, you know, you're reallyspeaking to a certain group.
Right?
Although it'snot really explicit.
And there is another targetabout reproductive
and sexual health.
So that's also speakingto a different group, although,

(13:28):
of course, everyone can play arole in that - it's not just
women and girls.
So there are elements of,you know, at least with sex-
baseddifferences or disparities,
they do consider those.
But I feel that- I guess thisis a legacy of the MDGs (the
Millennium Development Goals),but a lot of it is still based

(13:48):
around the communicablediseases like HIV, malaria and
TB and so forth.
And there is some discussion ofnon-communicable disease,
but none of it isreally that explicit on certain
age ranges...
Yeah.

André (14:06):
It's just a small question slash correction.
You mentioned malaria as acommunicable disease, but I
don't think it is, right?
Because it can't be passed fromone person to another.
So maybe the questionwould be, what is a
communicable disease?
Because it can be communicatedby a vector, but the vector is
not a human being.

(14:26):
So I would have thought malariaas a non-communicable disease.

Erin (14:30):
Yeah.
So actuallycommunicable diseases, I think,
include vector borne diseases.

André (14:35):
Okay.

Erin (14:35):
Yeah-

André (14:36):
Oh, I didn't know that.
Okay.

Bob (14:37):
I was really surprised to find reduce road injuries and
deaths in there.
It seems to be kind ofdifferent than all the other
targets and the way you mightapproach fixing it also seems a
lot different than allof the rest of them.
There- they seem to be...
You might change health policyor you might change the

(14:59):
distribution of access tohealth services or health
products for maintain theother ones, but for road
injuries and deaths...
I'm curious how that fits in.
I don't know if anybody'sresearch has turned up anything.

André (15:14):
I guess it's just the numbers, right?
It's simply because it'ssuch a high mortality area.
But that's just my speculation.

Erin (15:21):
Yeah.
No, I think that's it, yeah.
I think they basically pulledout the most common causes of
death for each maybe group or,you know, like strata and then
determined- well, at least formales in of a certain age,
you know, that is areally big issue.
And traffic accidents are...
You know, we don't really talkabout them that much,

(15:44):
but there's certainly aprominent cause of death.
So yeah.

Eric (15:49):
Several years ago, we did a lot of work on looking at the
impacts of different policiesin the transportation sector.
And we did a lot of work onthis theme of co-benefits,
which I think we'll come backto later in this podcast.
Of course, the air pollutionstory is quite prominent.
So, you know, if you introducedifferent interventions in the

(16:12):
transport sector, it canreduce air pollution.
That has big health impacts.
But I also remember that one ofthe other big impacts was
the traffic accidents.
And there been a lot ofinterest and growing amount of
research - this is about tenyears ago or so on -
estimating these impacts.
And so I suspect that,you know, that has caught the

(16:33):
attention of both the healthand the transport community.
But the other thing that Ithink that is also interesting
and also points to one of theissues that Bob raised is,
in some ways, it does feel alittle bit out of place in this
in this goal framework.
But, you know, the one of thethings that's missing from the
SDGs is that there's no goal onsustainable transport

(16:55):
or sustainable mobility.
And so my intuition is that,you know, they put this in SDG3
and also I think there's someindicators and targets on
sustainable transport under SDG11 on sustainable
cities and communities.
But the absence of having agoal on sustainable mobility- I

(17:16):
know some in the sustainabletransport community were
pushing for having, you know,their own headline goal - is
part of the reason youget this here.

Erin (17:23):
Interesting.

Eric (17:24):
Yeah.
Yeah.
But I think part ofthe challenge is, I don't know
if the health communitynecessarily has all the answers
to this this issue.
So that's- in some ways,this health goal was a little
bit cobbled togetherin some places.
Yeah, yeah.

Erin (17:39):
Yeah.
That's very true.
I think- I'm personally veryinterested in systems and how
the built environment or othertypes of environments
shape the health, lifecourse ofan individual or a
group of individuals.
And I felt like a lot of thetargets and indicators - maybe
this is a critique of thecurrent goal as it stands

(18:02):
- don't really...
They're lookingat these outcomes, right?
Mortality due to X or number ofpeople living with Y and not
really looking at, you know,what is kind of the
underlying systemic, I guess,solution or cause
behind these conditions.

(18:22):
And of course, you know,this is not something that the
health community or like themedical community can
necessarily do much about.
Like, for example,with urban health, you would
have to really restructure theway people live and where
people work and what...
how they play or how they spendtheir time and all that.

(18:43):
So that's not really somethingthat the medical community can
do that much about.
But still, it just, to me,feels like a fundamental piece
is missing from this goal.

Eric (18:57):
So I like this comment, Erin, and I agree
with you wholeheartedly.
And so I want to follow upon it, but I also want to come
back at you and everybody witha question on this.
So I also feel like that thesystems piece is missing here
to some extent.
I think it's not only thehealth goal, but I think in
many of the goals, the SDGs,interconnections are under

(19:20):
emphasisedperhaps or understated.
And part of that is, I think,as you rightly point out,
I don't know if the healthcommunity can necessarily
support the built environmentor redesign the
built environment, but I thinkthere could be more of an
effort to make thoseconnections within the goal
perhaps and, you know, point toways that the health community

(19:42):
could work with the sustainableurban environment community,
etc.
, etc.
.
Having said that, so if we hada redo at the design of SDG3,
is there anything specificallythat you would want to put in
or take out for that matter?
Or...
I just want to preface thisby saying, like, for instance,

(20:03):
that the folks at SDSN and Ithink also folks from IIASA,
this is the InternationalInstitute for Applied Systems
Analysis in Austria.
Their The World in 2050initiative- they have this
initiative to look atwhat the world should look
like in 2050.
When they thoughtabout the SDGs, they've put

(20:26):
forward six necessarytransformations and one of the
transformations is basicallymodernising health systems with
a strong emphasis on universalhealth coverage, but they don't
necessarily bring in some ofthe other elements to that,
to that core.
So there's a systems element.
But some of theother things like for instance,
traffic accidents arenot necessarily there.

(20:47):
So I guess my question is,is there anything that's
missing or anything that couldbe revised if we had to do this
again?

Bob (20:54):
I was surprised to see that suicide is not in
there explicitly,although mental health
is covered, you know,suicide is not explicitly
called out as one ofthe targets, which was
surprising to me.

Erin (21:05):
Actually it is an indicator.
But...

André (21:08):
It's an indicator.

Erin (21:09):
Yeah.
But again, you know, one Iguess additional critique of
that before we moveto Eric's question- very big
question on, you know,what is, you know, how do
we redesign SDG3...
Is that there is, you know,depression and anxiety.
There are other things thatpeople live with that,
you know, don't necessarily-I mean, they could
lead to death, but, you know,death isn't the only outcome

(21:32):
that we shouldbe concerned with.
Right?
Yeah.
So that's, I guess,another critique that I have of
this in terms of measurements..
Yeah, I think it matters thatwe know who is living with it
in addition to who's dyingof it, if that makes sense.

Eric (21:48):
Yeah.
That's a very good point.

André (21:51):
It's the drivers and the effects of this, too.
And that's- it just reminds meof the traffic accident thing
where the the effect is verymuch health related, but the
driver has nothing to dowith health, really.

Erin (22:02):
Exactly.

André (22:02):
Yes, it is a- I agree it's a bit of a strange one to
have in there,the traffic accident one.

Erin (22:08):
Yeah.
So any thoughtson Eric's question?
Wow.
So that's afundamental one, isn't it?

André (22:14):
About what- what should have been included that wasn't
included?

Erin (22:18):
Yeah.
Yeah.
I mean, if I could...
I mean, of course, this isnot comprehensive, but just an
idea to put out there- just as you were
saying about transport, right?
Given how many people live incities now, you know,
the emphasis on cities and howwe build healthy cities should
be really present here, which Ithink is present more in SDG 11

(22:40):
than this [goal].
So for SDG3, I would say thatthere should be more of a
framing around how tomake parks, for example,
more accessible for physicalactivity or, you know,
air pollution mitigation;sustainable transport, again,
also very importantfor air pollution;

(23:01):
safe water....
Water is also a huge issue,and I guess that's already
covered by, you know, SDG6,I think, to some extent.
But again, another fundamentalthing that we need to have.
And then of course, I'm gladthat they included universal
health coverage and retentionof the health workforce,

(23:22):
because, again, that is really,really important.
And I think we've seen theissues really- well, I guess
the vulnerability of our healthworkforce in the past few years.
And appreciating the people whoactually work in this space,
I think also should be moreprominent going forward.
Yeah.

(23:43):
So just a few ideas.
Of course,not comprehensive, but...
Yeah

Eric (23:46):
Yeah.
It's...
It's difficult to think about,you know, the hypothetical
or the counterexample.
But I think, let's just say ifwe're going to do the SDGs
again in 2025, of course,we're- you know, 2030 is
supposedly the expiration dateof the SDGs.

(24:07):
And I think, you know, in thenext year or two, actually,
we'll probably start thinking alot more about future SDGs.
But I think one thing thatwould probably appear in a
future SDGs would be somethingon pandemics or, you know,
something on major globalhealth crises, although I don't
know exactly how thatwould be structured.

(24:27):
But, you know, obviously,given the COVID experience,
I think that wouldbe something that would be
prominent, basically.
And I have a feeling that,you know, some of the issues on
the- mental health I thinkwould be- and wellbeing...
I think those would alsoperhaps be more prominent.
But yeah, those are just somesome quick observations or

(24:48):
some quick thoughts.

Erin (24:49):
And in addition to pandemics, climate change,
right?

Eric (24:53):
Yeah, yeah, yeah.
For sure.
For sure.

André (24:56):
I was just going to say that education- I mean,
education is fairly prominentthroughout the SDGs and it is
mentioned once under thetargets, Target 3.7,
one of whichis actually the universal
healthcare related one.
But I think that it's underemphasised in general across
the SDGs and I think that's thecase for SDG3 as well.

(25:18):
I guess- it's a foundationalmust-have that could
be emphasised more.
And I guess I haven't- I'm notas familiar with indicators as
I as I should be, there may bea bit more in there -but if I
were in charge, then there'd bemore about education.
Yeah.

Erin (25:35):
Yeah.
No, it's super important.
Right?
And I think like anotherprominent thing that I guess is
kind of missing here is thatthe SDGs, I assume
are global goals,but implemented at the national
or local level.
And well, at least having grownup in the Philippines,
there was a lot of anecdotal,I guess stories about a lot of

(25:56):
Filipino doctors leaving thePhilippines and going somewhere
else to earn more money.
And so this issueof brain drain is also
really important.
And I think, you know,retention of the health
workforce really means,you know, creating an
environment that- you know,a financial or whatever working

(26:20):
environment that is good enoughfor people or to stay, I guess.
Yeah.
It's not just...
Yeah.
I mean, in addition to havingthe proper education, I think
it's about creating thatworking environment that
works for everyone.

André (26:35):
Mm hmm.

Eric (26:36):
I mean, I fully agree with this.
And, I mean, I think one of theother things that we've seen,
if I keep on harping on theCOVID issue, but the COVID is a
health crisis that's made itmore challenging to deal
with other crises, to keep goodpeople working on health.
You know, it's led toreductions in workforce

(27:00):
and labour retention.
And so there's like this sortof multiplier effect that can-
some of these crises can haveon to the other parts of the-
So for instance, like Iremember reading that,
you know, there have beensignificant gains in reduction
in cases of TB(of tuberculosis), which is,

(27:22):
you know, part of the goal.
But a lot of those gains or theimprovements have been
diminishedsignificantly by COVID.
And to personalise this alittle bit more, I have a good
friend who livesin southern India.
She has a condition where sheneeds to go see a doctor who is
about 5 hours awayfrom her house.

(27:44):
Because of COVID,she couldn't go.
I mean, it wasjust not feasible to go.
And this is also in some ways-I mean, it's also been
exacerbated by climate changebecause southern India has been
hit by heat wavesand sudden rain.
And so I think theseinteractions between some of
the effects within the healthgoal and then some of the
environmental health impactsalso made it more difficult to

(28:07):
achieve some of the sort ofmore conventional parts of the
goal that were also partof the MDG structure, too.

Erin (28:14):
Yeah, that's such a good point.

Eric (28:16):
Yeah.

André (28:17):
Also, you know this, I'm always going on
about tradeoffs, but I thinkthat this illustrates a really
massive way in whichthe whole world has become
familiar with, and that is thiskind of balancing act between
treating COVID for- respondingto COVID for health reasons and
responding to COVID foreconomic reasons or reasons of
keeping the economy going.

(28:39):
And, you know, I think thearguments about the degree to
which that wasaddressed successfully,
that will continuefor decades still, probably.
But it seems like,you know, it's a discussion
worth having.
It's not necessarily always theright thing to do to segregate
people and prevent them fromhaving any contact with each

(28:59):
other if that means that itresults in economic ruin,
because economic ruin hasyou know, it causes lost lives
further down the line.
Right?
It's just more indirect.
So I know this is a verycontroversial topic, just to
point out that this brings upone of those unfortunate trade-
offs which we're probably stilllearning how to handle.

Erin (29:20):
Yeah, I think that's a key point because at least in
public health, we learned thatsocioeconomic status is a
fundamental causeof health outcomes.
So if we think about thesesystemic conditions, right,
that create good health or badhealth for someone or

(29:41):
create vulnerabilities, I thinkto that extent, we really have
to think carefully about whattypes of policies we employ.
And just to add tolike isolation, for example,
again, we talkedabout mental health, right?
And that's been a huge issuefor a lot of
people everywhere, you know.

(30:02):
Traditional approaches- I mean,this is a very
traditional- like quarantining,self-isolation is a
very traditional, paternalisticpublic health intervention.
And that's usually how wedo it until like vaccines
come around, I guess?
But I mean, in this case,even if the vaccines have
come around, you know,implementation has been an

(30:24):
issue and variants and so forth.
So it's not as easy, I guess.
It's not as easy asin the textbooks.
Yeah.

Eric (30:34):
I mean, I read somewhere that the impacts of COVID where
this was, I think at thebeginning of this year, so that
the numbers have increased,but I think there were 5
million deaths worldwide due toCOVID at the beginning of 2022.
And...
But the estimates were thatthere were three times those

(30:54):
number of deaths due to theindirect effects of COVID.
So 15million deaths collectively.

André (30:59):
Wow.

Eric (31:01):
And so you're talking, you know, 10 million
additional- ballpark figure,but 10 million deaths from
disruptions due to COVID.
And obviously, I'm sure there'sa lot of debate over how you
define what those indirectimpacts look like.
But the fact that we're talkingtwice the size of
those impacts, I think gets tothe heart of things.

(31:22):
Yeah.
Yeah.
There are trade-offs and how doyou design policy interventions
given these this complexitypolicy is almost inherently a
blunt instrument, right?
So it's challenging to takeinto consideration all of
those contextual factors.

Erin (31:39):
And just to add, you know, those numbers are shocking.
But, you know, during this thepast two and a half years,
people have not really- peoplehave been more reluctant to
seek medical care for thingsthat they might find.
Maybe, you know, they found alump somewhere, but they
haven't been really been ableto get the care that they need.

(31:59):
Then, you know, you haveanother set of delayed
diagnoses of certain illnessesor certain conditions.
And so...COVID I think,you know, depending on how you
measure it, disruptions andI mean, not necessarily covered
per se, but certainly COVID-these types of disruptions to
the health system really take atoll on not just those

(32:23):
suffering from thatparticular illness,
but on everyone.

Eric (32:27):
Mm hmm.

André (32:29):
Can I ask a very general question?
What are the- and lookingat physical health, you know,
just health in the most sort ofbasic sense of the word- what
are the biggest sort of thesingle biggest threats to
physical health worldwide?
And I know that that differsfrom place to place.
But I remember reading a whileago that malaria, I think,

(32:53):
is still the biggestkiller as a single disease.
Certainly more thanCOVID still, although I think
there was some signthat COVID might overtake it.
But I'm- I don't know if youguys have any knowledge of the
figures there and others aswell that are sort of
particularly large problems.

Erin (33:12):
Sorry.
Yeah.
I don't have the numberson like, you know...
But I think malaria isdefinitely up there.
One thing I can say is thatwhat's tricky about like the
treatment of non-communicablediseases that no single
non-communicable disease hasequivalent deaths as like the
major communicable diseaseslike malaria, HIV or so on

(33:32):
and so forth, right?

André (33:32):
But together-

Erin (33:33):
Together.
Yeah, they really representlike the majority of premature
deaths ordisability-adjusted life years.

André (33:39):
Okay.
But is that the case in thedeveloping world as well?
Even in the developing world?

Erin (33:46):
Yeah.
Yeah, I think that is the case.
But again, like Isaid earlier, you know,
it really depends on agegroups and, you know,
certain segments ofsociety as well.
So for really justbroad strokes, I think that
is the case.

André (33:59):
Mm hmm.
Okay.

Eric (34:01):
Yeah...
I'm looking this up onright now, and...

Erin (34:03):
Oh yeah, well.

André (34:04):
I should've done it before this.

Eric (34:05):
No, no, no, no, no, no, no.

André (34:07):
I just- I would have thought that tuberculosis and
malaria together killed morepeople in the developing world
than all non-communicablediseases combined.
But I stand undercorrection very much.

Eric (34:23):
Yeah.
I mean, I'm just looking thisup on Our World in Data.
This is based on the GlobalBurden of Disease study,
which is waspublished in 2019, and still
has a really greatdatabase for all of this.
So the greatest killer globallyis cardiovascular disease

(34:43):
(393.11 million), followed bycancer, followed by
neonatal disorders, and thensort of all other
non-communicable diseases.

André (34:57):
Okay.

Eric (34:58):
Interestingly, to come back to some of issues that we
raised before,transport injuries are the 12th
biggest and mental disordersour sixth biggest.
Huh.
So yeah, that saysa lot actually.
I mean that says- suggests partof the reason that's structured

(35:21):
the way it is.

André (35:22):
Can I just ask that I- we covered the whole COVID
complication factorquite thoroughly, I think.
But do you think there'sanything more to say about what
we could be doing better orwhat progress- what progress
looks like, I guessyou could say.

Eric (35:39):
In terms of how we're doing on SDG3.
I mean, all of thisis really contingent on how you
define progress, but, at a veryhigh level, looking at the
once again, this SustainableDevelopment Solutions
Network assessment,things don't look great.
Basically, in almostthe whole world,

(35:59):
challenges remain.
And those challenges are,perhaps not surprisingly,
most significant in developingcountries and
very broad strokes, the lowerthe level of development,
the bigger the challenges.
I think that's fair to say.
Okay.
So that's sort of the glasshalf empty view of the world,

(36:20):
but the glass half full view ofthe world is that there has
been significant progress,especially before COVID,
on many of the health targets.
And some of these, I think,reflect the fact that,
as mentioned previously inthe MDGs, there was a
significant emphasis on health.
So there were three differentMDGs that were

(36:41):
related to health.
And so I think there's beensome continued momentum
from the MDGs.
And I think health ministrieshave continued to focus on,
for instance, maternal healthor working on the impacts of
malaria or tuberculosis.
So the trends in some of thekey countries like India,
for instance, priorto COVID, were pretty

(37:03):
promising, although, when youlook at it at a sort of
aggregate level, you might notsee that as much, in part
because the goals themselvesare so aspirational.
So it's a lot to expectdeveloping countries to
basically eliminate some ofthese diseases or to get to the
place where theindicators are set.
So I think that that's anotherside of the story.

(37:25):
And then I think the third sideof the story is, if you look at
like the air pollution side onTarget 3.9, it's pretty evenly
split between- developedcountries are pretty much on
target to achieve 3.9;developing countries,
not so much.

(37:45):
But when you look atit a little bit finer
grain of detail, part of theexplanation for that - and this
is something that, you know,one of folks is working with
you on the podcast, Simon Olsenhas highlighted - part of the
explanation for that is becauseof these spillover effects.
So a lot of countries havebasically relied heavily on

(38:07):
developing countries tomanufacture goods and services.
And this requires energy.
And sometimes this energy isgenerated with fossil fuels.
It also requires more transportand other activities.
So I think there is animportant argument to be made
for greater efforts toharmonise and collaborate on

(38:28):
especially health and then,you know,
air quality improvements,environmental threats to health.

Erin (38:35):
Yeah.
Maybe we can move on to theenvironmental determinants of
health and maybe we can talk abit about Target 3.9 "reducing
the number of deaths andillnesses from hazardous
chemicals and air,water and soil
pollution and contamination".
And maybe Eric can talk alittle bit about that?

Eric (38:55):
So thanks.
Thanks a bunchon this one, Erin.
And I mean, obviously, this isa very important target.
And I mean,it's something that's,
can I say, near and dear tomy heart, because it's one of
the three places that airpollution is reflected

(39:15):
in the SDGs.
In terms of the environmentalthreats to human health,
it's the biggest one.
I think it's really importantthat it's reflected in the SDGs.
Having said that, and I'm goingto be a little bit
controversial here, I think itwould have been better if there

(39:35):
was a full headline goalon air pollution.
I mean, I understand why thisis where it is.
The World Health Organizationis the custodian agency for
overlooking progress on thehealth impacts of air quality,
both indoor andoutdoor air pollution.
But I think as a resultof this, you don't have as much

(39:57):
attention to the seriousimpacts of air pollution as you
would if it had itsown headline goal.
So, you know, there aregoals on, for instance, life on
land and life below water,on climate change,
and sustainableconsumption and production,
as well ascities where there's also

(40:19):
an indicator onPM2.5 on particulate matter
(fine particulate matter).
But I think as a result of thefact that it's sort of spread
out into different placeswithin the SDGs, you don't get
as much effort and attention tothis as you would if it had its
own headline goal.
Yeah.

Erin (40:36):
Yeah, yeah.
That's actually a reallyimportant point
because I think, the way Iunderstand how the messages
were structured was that theyhad certain, I guess,
cross-cutting issues in afew different places.
So maybe air pollution wasone of those.
But I guess the trade-off isthat there is less emphasis if

(40:57):
it's kind of embeddedin all these other goals.
Yeah.

Eric (41:02):
Yeah.
I think as a resultof that, there's sort of two
things that happened.
One is perhapsmost importantly, the voluntary
national reviews- these are thereports that come from
different countries on whatthey're doing on the SDGs.
They tend to downplay airpollution or don't mention
it so much.

(41:22):
This is not across the board.
But, you know, for instance,one of our colleagues,
Mark Elder, just published apaper on different policies
that were listed in VoluntaryNational Reviews from countries
in ASEAN, and you wouldnaturally assume that air
pollution policies wouldbe up there.
But it was actually one of thepolicy areas that didn't get
so much attention.

(41:42):
And of course, you have,you know, water pollution and
climate change and whatnot,but not having a
headline goal, I think isproblematic for, you know,
what national policymakers arereflecting in their SDG plans.
And it also hasan impact on, you know,
resource allocation and whatnot.
And I think the other thingthat gets neglected as a result

(42:05):
of this is - and we talk alittle bit about this in terms
of health more generally - butis sort of the forward and
backward linkagesto other goals.
So it's less likely thatcountries will start thinking
about integration between airpollution and climate change
because there's no headlinegoal on air pollution and
there's nothing directlymentioned in the climate action

(42:25):
goal that says anythingabout air quality.
Can talk a littlebit more specifically about why
that's problematic, but thoseinterlinkages, I think,
get neglected when you don'thave a headline goal.
That's my main point.

Erin (42:38):
Hmmm.
André?

André (42:39):
Yeah.
I just wanted to make anotherpoint about trade-offs and to
do with air pollution,indoor air pollution, which is
kind of one of the areas thatyou look at most, right, Eric,
which as far as Iunderstand is caused mostly by
wood burning stoves.
Is that just- am I limiting myunderstanding to Africa?
Or is that kindof applicable across the board?

Erin (42:58):
I think that's- Yeah, it's mostly cookstoves.
Yeah.

André (43:02):
Right.

Eric (43:02):
Yeah.

André (43:03):
Right.
So with the trade-off here,with the kind of some
contention is that, that's arenewable resource that's being
used for heat and for cookingthat which is causing
incredible health problems.
Eric, can I quickly ask you,do you know what the global
numbers are for deaths byindoor air pollution per year?
Do you have any idea?

Eric (43:23):
Yeah, don't quote me on the exact exact figures, but I
think overall it's, you know,7 million premature deaths per
year from air pollution.
4.2 is coming from ambient,so that's primarily outdoor
air pollution, although it'stough to draw a line sometimes.
And 2.8 is coming fromindoor air pollution.

André (43:43):
Okay.

Eric (43:44):
And as you suggested, the vast majority of
the course, the indoor airpollution is the-

André (43:50):
Wood burning stoves.

Eric (43:51):
Yeah.
And in developing countries.

André (43:53):
Right.
Right.

Eric (43:55):
You know, Africa and South Asia and,
to some extent, Southeast Asiaand Central Asia.
Yeah.

André (44:02):
Thanks a lot for filling that in.
So the tradeoff that I wantedto kind of just maybe ask you
about and ask about solutionsis that, you know, this is a
renewable resourcethat's being used.
And the argument is- and itseems pretty convincing- that
the quickest way to get cleanenergy to those people,
energy that's not going to putthem at direct risk

(44:22):
of pollution, is fossilfuel-based energy.
And I know that there are lotsof initiatives to get solar
panels on roofs and that kindof thing, but that's a lot
more difficult, and it's goingto take a lot longer than
connecting them to anexisting grid, which is in the
vast majority of cases,fossil fuel-run.
So I just wanted to kind of 1)point that out and 2) ask you

(44:45):
if there are sort of any lightson the horizon as far
as that's concerned.

Eric (44:50):
Yeah.
So I think there aresome trade-offs there.
There's no question about it.
And I think, you know, part ofthe story is, right, that you
want to try to getpeople to LPG or electricity-

André (45:03):
That's gas, right?

Eric (45:05):
Yeah, yeah.
LPG, liquefied petroleum gas,to some extent as
quickly as possible.
Although as youalso intimated, there are some
decentralised renewablesolutions out there, as well as
some efforts to, for instance,use biogas and biodigesters,
which are perhapsmore sustainable alternatives.
But you would also hope that,simultaneously, there would be

(45:26):
broader shifts within theenergy structure to
more renewable, you know,to the shift away from,
you know- So if youelectrify that, you would then
also rely more on large-scalesolar installations or
eventually windpower or hydropower,
or what have you.
So it's- you're right tohighlight that there are some

(45:48):
unquestionablysome tradeoffs there.
And it's not a perfectlyseamless transition, André.
But I think the hope is that,you know, with some mix of
these different solutions,that the benefit calculus will
weigh heavier on health andthen that will hopefully-
you'll get some catch-up withsome of the energy transitions

(46:10):
away from fossil fuels.
Yeah.

André (46:12):
Just to kind of push you a little bit on that one- I
don't know how much you knowabout this, but I'm
thinking about, you know,an NGO probably based somewhere
in the West in Europeor the US, or maybe Japan,
that has sort of limitedresources to bring clean energy
to sort of maybe a village,you know, that kind of scale.
And if they're anenvironmental NGO,
they're probably going to tryto get people to put solar

(46:35):
panels in their rooms ratherthan trying to connect them
to the grid.
And I guess, like you answeredthe question very well there,
but like in a real-lifesituation like that, which I've
seen a few times in South Africaand neighbouring countries...
Are they doing the right thingor should they be, how do
you say, biting their fist fora while and giving those people
what they need as quickly aspossible and then working on

(46:57):
the longer-term renewable solution.

Bob (46:59):
But wouldn't putting solar panels on the roof usually go
along with connecting to thegrid because solar panels
providing standalone power to ahouse is a lot more complicated
than- at leastmy understanding is, if it's
not connected to the grid,it's a lot more complicated
in some ways.
Whereas if it- I mean because...
Battery batteries are involvedin that case, right?

André (47:21):
Yeah.
And I don't know.
I don't know.
I'm just thinking of a coupleof projects that I've seen.
So I really don't know howrepresentative they are.
But yeah, the ones that I'mthinking of are sort of really
low-budget projects wherethey've tiny batteries
involved in that.
Certainly there's no connectionto the grid.
But that's my-

Erin (47:37):
Electricity for lighting and that kind of thing?

André (47:39):
Yeah.
Very basic stuff.
Probably noteven cooking actually.
So I'm not sure how relevantthis example is, even.

Eric (47:44):
If I can say maybe two quick comments on André's
question and I have- Bob,I'm sorry, I have less response
to your question, but forAndré's question, in my
personal experience, what I'veseen is there's two things.
One is that the sort of- theNGO community that's had the
most success where I've workedon these issues in Southeast
Asia has actually focused moreon not necessarily

(48:07):
energy transitions,but just cleaner cookstoves.
So stoves with fans on thebottom that help burn the
biomass more efficiently,stoves that have some type of
ventilation system so thatyou're not breathing
in the particulates.
And then-

André (48:22):
So it's even more low tech than the solar panels.

Eric (48:26):
Yeah.
And then gradually perhapsmoving from there to LPG or
what have you.
But on the NGO side, I thinkthere's limited resources and
they're also they havelimited policy levers.
Right?
So a lot of times what they'redoing is working with
communities to educate them onthe impacts and then
demonstrate the improvementsfrom improved cookstoves.

(48:47):
And then also, I mean, the thingthat's helped them....
- because it's also been even achallenge to get communities to
transition to the improvedcookstoves because they-
they're not super expensive,but they're- they can be,
you know, 2 to 3 times,4 times, 5 times as expensive
as just starting a fire or evenmore rudimentary versions - is

(49:08):
setting up community-basedbusinesses to manufacture the
stuff and then creating sort ofa value chain where people are
involved in the manufacturingin terms of the end of the
marketing and then-

André (49:20):
Creating sustainability, as you know, continuity, right?

Eric (49:23):
Right.
That's right.
Exactly.
Exactly.
And a lot of times thesebusinesses are run by women.
And so ithelps to communicate, because a
lot of times, the people aremaking decisions on the
cookstoves are women,so it helps to
communicate those benefits.
So that's one piece of thestory that I've experienced and
seen some success with.
And then the other piece that Ithink is important is in terms

(49:45):
of the solar, like themini-solar, what you're talking
about is - I've just readarticles on this, I haven't
experienced it personally,but there's been a lot of
struggle to get some uptakeon these programs.
And one of the ways thatthey've found some success is
to highlight and to demonstrateand to advertise or market

(50:08):
the stoves, first andforemost, has a way
for people to use cellphonesand charge up their phones.
So it's first and foremostabout that communication.

André (50:20):
How does that work?
How does it work, Eric?

Eric (50:22):
So there's an adapter on the stove or, you know,
there's an adapter on the solarpanel for charging phones
basically as well.

André (50:31):
I see, I see.

Eric (50:32):
So it's multi-functional and communities that have had
those adapters have done betterwith the stoves than
communities that haven't.

André (50:39):
Wow, interesting.

Eric (50:40):
So those are some of the things that I've observed or
read about and itmakes sense in some ways.

Erin (50:47):
Yeah, I learned in graduate school that with
respect to cookstove-related interventions, one key
issue is stacking.
So essentially, yeah, like youget a new improved cook stove,
but you don't throw out theold one, you just get-
you know, you could get doublethe amount of cooking done,
I guess.
So it's complicated.

(51:08):
You know, people behavein unpredictable ways.
Yeah.

Eric (51:12):
Yeah, yeah.
This is very, very true.
And yeah, that related to whatErin mentioned, it's partially
a stacking story whereyou try to cook more.
But also what I've understoodis that the flavour from the
older stoves are better.
It has a sort ofsmokier flavour, you know,
more barbecued.
And so for certain dishes,they'll cook with the older

(51:34):
cook stove and forcertain dishes, cook with
a newer one.
And it's not so straightforward,basically to get people to turn
away from technologies thatthey've depended upon for long
periods of time.

André (51:43):
Hmm.

Eric (51:44):
Yeah, I mean, this is a little bit off track, but I'll
just relay a story when we weredoing some of this work
on climate, gender, air qualityin Southeast Asia.
And then we had a really bigmeeting with an agricultural
minister from a countryin Southeast Asia.
I'll leave it at that.
And we were basically trying topersuade him that it would be

(52:08):
good for women to get involvedin climate mitigation
activities by getting involvedin these cookstove businesses.
Or another businessthey had was manufacturing
biodigesters.
So he listened toour whole thing.
And, you know, thisguy was, you know,
pretty astute and whatnot.
And after we were all done,I mean, I was shaking
the whole time.
I was really nervous because Iwas like in the presence of

(52:28):
this minister, blah, blah, blah.
But he turned to us and said,"Yeah, but you know, if you
start taking women out ofthe household, who's going to
cook the food?"

Erin (52:38):
Gosh.

Eric (52:38):
"And who's going to take care of the kids.
And especially, you know,when the men come home from
the field, who's going to bethere for them?" This is all to
say that there's multipleinterlocking issues here and
that they're quite caughtup in sort of cultural
sensitivities and whatnot.
And I was sort of astounded bythis whole reaction at the same
time as, you know, dumbfounded.

(52:59):
I didn't really knowwhat to say after that.
It's sort of anonstarter, basically.

André (53:03):
Hmm.

Erin (53:05):
Wow.

Eric (53:05):
And so it's does speak to some of the challenges of
trying to change lifestyles inways that are healthy,
and especially when you'recoming at it from an angle of,
you know,changing international norms,
it makes sense.
But once you start bringingthis down to different contexts
and levels of decision-making,not that far actually from the
international level - I mean,this was an
agricultural minister, so - itbecomes much more complicated.

Erin (53:30):
Hmm yeah.
What a story.

Eric (53:34):
Yeah.
I mean I think the other thingthat is discouraging or not so
useful about having the airquality issue in the health
goal is that this linkage toclimate change, right?

Erin (53:45):
Yeah.
Oh, can you actuallytell us more about that?
What is the linkage between airpollution and climate change?

Eric (53:51):
Yeah, so there's a few of them actually.
So one of them is, a lot of thesources of air pollution are
coming from the burning offossil fuels, which is also one
of the key sources of climatechange - of greenhouse gases,
of carbon dioxide.
So a lot of times when you burnfossil fuels, you'll create
things like this fineparticulate matter ([PM2.5])

(54:13):
that gets into your lungs andit's not so good for you and
also create gases thatwarm the climate.
And so if you were able toreduce the emissions of from
fossil fuels or stop burningfossil fuels altogether,
then this would be...
This would be a good thing forclimate change and for air

(54:34):
quality and for health.
And all of these benefits thatwe get from this,
we call this co-benefits,multiple benefits
of interventions, where yousort of you can kill two birds
with one stone or actuallymultiple birds with one stone
(although that's not so goodfor the biodiversity goal,
might I add.) And so that's oneimportant part of the story.

(54:57):
Another important part ofthe story is, so while a lot of
things that we do that polluteair come from fossil fuels,
there's also like some thingsthat we do that don't
necessarily generate a lotof carbon dioxide.
So the cookstoves story isactually one of them.
Other ones include thingslike diesel fuel.

(55:18):
So these are dieselpowered engines...
Like, diesel actually is,compared to regular petroleum -
it's more efficient.
So it can actually have agood impact on, if you're
comparing the diesel-poweredvehicle to a gas-
powered vehicle, at leastin theory, it will
reduce your CO2.

(55:39):
It's more efficient.
But the problem is that,especially in developing
country contexts and even insome developed countries too,
diesel producesmore particulate matter.
It produces more of these fineparticles that's not so
good for you, especially ifit's burned without filters
on the tailpipe.
They call itdiesel particulate filters.

(56:01):
And in developing countries,a lot of times, they don't have
filters on there because youneed to have high-quality fuel
to use these filters.
So part of the story is thatdiesel and cookstoves and,
to some extent, the burning ofbiomass in like fields,
the burning of crop residue,also the creation of bricks,

(56:23):
brick kilns.
These things allcreate black carbon.
It gets a littlebit confusing, but anyways,
black carbon leads to warmingin the climate in the near term
as opposed to the CO2.
CO2 can sit up in theatmosphere for about 100 to
1000 years or so, but the blackcarbon sometimes is like seven
days to 14 days or so, and itgoes up there for a real short

(56:47):
period of time and it absorbs alot of heat in that real short
period of time and leads toreal intense warming and in a
short period of time,exacerbating or making worse
the existing climate change.
And so, you know, if I had achance to do it over again,
I would put a lot more emphasison these - we call them short
livedclimate pollutants (SLCPs),

(57:08):
like the black carbon thatcomes from the particulates as
well as- and that's sort of acall that sort of a more air
pollutionfocused co-benefits approach,
as well as a more conventionalco-benefits approach which
might focus more on reducingfossil fuels (a good thing for
long term climate change,and then also get some

(57:29):
reductions inother air pollutants).
And all of this type of story,though, is really missing
from the SDGs.
So once again, if I had achance to do it again, I would
put some more emphasison these type of interlinkages.
A third set of interlinkages isalso- they're looking more and
more at the relationship whenclimate is warmer.

(57:52):
How does that lead to changesin air quality and how does
that make air quality moredangerous or air pollution more
dangerous?
So you have hotter weather andmakes it more difficult for
people to breathe,and, you know.
And so these typeof interlinkages, I think,
are really sort of missing.
And some of the tradeoffs that André mentioned, too,
I think are,to some extent, missing.

(58:13):
So, yeah, these are some of thethings that I would focus on.
The natural place to that Ithink to work on this is the
WHO- the World HealthOrganization just released a
new set of airquality guidelines, which are-
last year, and they're muchstronger on many of the key

(58:33):
pollutants than theprevious ones, which were in
2005 or 2006, so almost15 years ago.
The natural starting point forme, if we were going
to do on air quality oratmospheric pollution goal,
would be to drawonto these draw upon these
new guidelines.
So for instance, the guideline- there's different parts of
the guideline - but therecommended guideline for

(58:55):
particulate matter 2.5 (forfine particulates) used to be
50 micrograms per cubic metre,and now that's down to five
micrograms per cubic metre.
If we had that typeof guideline, incidentally,
almost 99% of theworld doesn't achieve that
guideline right now.

Erin (59:11):
Yeah.

Eric (59:12):
So the closest is Australia and Oceania, which is
around like seven microgramsper cubic metre.
So if we had those typeof guidelines, I think it's
aspirational of course,and developing countries would
be- really struggle to getanywhere close to that.
But maybe there couldbe some- there are some
interim targets, so maybe youcould have a more tiered
structure for differentcountries at different

(59:33):
levels of development.
But I think that would besomething that could have huge
impacts on health.
And I mean, the interestingthing is even at very, very low
levels of concentrations ofPM2.5, there are health impacts
and recent studies are showingthat even if you go from one
microgram to two micrograms,there's a more or less a linear
relationship between the healthimpacts and that even at

(59:55):
those very, very low levels.
So...

Erin (59:58):
Yeah, that's an important point.
Yeah.
I just wanted to do like a wrapup question, which is that the
UN General Assembly passed aresolution in late July this
year where they recognisedhealth as a human right.
And this is not a legallybinding document by any means,

(01:00:19):
but it's more about normssetting and hopefully nudging
governments to dothe right thing.
And I guess my question is,how will this make a difference
if it will make a difference?

Eric (01:00:30):
Yeah.
So that'san interesting question, Erin.
I mean, I think, you know,this framing of different
issues and themes as a humanright is trying to appeal to
the better senses of differentgovernments to get them to do
the right thing.
And I think you're right thatthis is partially an effort to
do some of this norms setting.
And I think it might have someimplications for,
for instance, a post-2030 SDGsas we see a gradual effort to

(01:00:55):
make stronger linkages betweenenvironmental concerns,
health concernsand human security.
I think, you know, what we'veseen with Ukraine and COVID has
really put a lot of emphasis ontrying to appeal to this
security framing in a way thatwill make linkages between

(01:01:19):
these different issues so thatyou'll get less Ukraine type of
interventions and moreinterventions that protect the
security of human beings and insome ways, you know,
subsuming national interestfor human interests.
And so I think that that hassome potential to do that.

(01:01:41):
I think about...
You know, I was watching thenews the other day and there
was a short documentary onwhat's happened in Afghanistan
after the US left and theTaliban has retaken control.
And they were interviewing awoman who works in a hospital

(01:02:04):
in Kabul and she was basicallyexplaining that, you know,
there's been a lot of interestin trying to reinvest
in education, agriculture...
but she's one of thefew women, actually,
that's still able towork in this 'new' Afghanistan,

(01:02:28):
if you will.
But her contention was that,"the first thing we need to do
is take care of the medicalsystem and people's health,
because if we don't have that,then all of these other things
we really can't eventhink about, like education or
some of the other initiativesthat are moving forward".
So I wonder, you know, if bytrying to make some linkages

(01:02:49):
between human rights and health,as in making health
a sort of fundamentalhuman right, could appeal to
some of these governments thatare disconnecting those things
in some ways.
And so I think that, you know,changing those norms and
putting it in those terms mighthave some influence even at the

(01:03:11):
national and local level wherewe need some of these
changes to happen.
Those are just somethoughts for myself.

Erin (01:03:17):
Thank you.

André (01:03:18):
I guess we'll get onto - I forget which SDG it is, but -
I think there are a couple ofwhere human rights in general
might stand out a little bitmore than this one.
So it'll be interestingif it comes up again.
But like yeah, this is maybejust a rhetorical question.
You know, the question of whatdoes a right- what does it mean
to say that somethingis a human right?

(01:03:40):
I would- my contention would beis that it's meaningless unless
it's backed up bythe ability to enforce it.
And I know thatsounds a little bit militant,
but unfortunately, that's kindof more or less what it
boils down to.
Or if everyone agrees,everyone in the society
agrees on it.
But, you know, this would bekind of be one or the other.
So I didn'tknow about that particular...

(01:04:02):
Was it the UN or was it the WHO-

Erin (01:04:03):
UN.
UN General Assembly resolution.

André (01:04:06):
Right.
Yeah.
So I guess the question iskind of, you know, to what
extent it'll be adopted at thenational level, which is really
where it matters as faras that kind of thing is
concerned.
Yeah.
But I guess it's good thatpeople at least thinking
in that direction.

Bob (01:04:27):
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