FREDERICK M. BURKLE, JR., MD, MPH, DTM,FAAP, FACEP

PROFESSOR &

WOODROW WILSON SENIOR PUBLIC POLICY INTERNATIONAL SCHOLAR

SENIOR FELLOW & SCIENTIST

PUBLIC HEALTH, URBANIZATION, AND CLIMATE CHANGE:

The Common Thread of Public Health Emergencies

~

HarvardHumanitarianInitiative

“Disasters that adversely impact the public health system and its protective infrastructure related to water, sanitation, shelter, food, health, & energy”*

§ …Protective threshold is destroyed, overwhelmed, not recovered or maintained, or denied to a population…

§ Primarily measured as “indirect & preventable” morbidity & mortality

PUBLIC HEALTH EMERGENCIES

*Burkle, 2008, Institute of Medicine

HarvardHumanitarianInitiative

21st CENTURY: State of Public Health Infrastructure

• Globally, public health infrastructure and systems have disappeared, declined, or failed to keep pace with demands.

• Deficient dwellings; aged infrastructure

• Unavailable infrastructure & capacity to respond in crises/disasters: especially potable water, food, & sanitation

• Ecological & environmental changes

UNITED NATIONS INITIALLY PROJECTED THAT HALF OF THE WORLD’S POPULATION WOULD LIVE IN URBAN AREAS BY 2015-17

URBAN POPULATION DOMINANCE OCCURRED IN 2008

HarvardHumanitarianInitiativeRAPID URBANIZATION

• Public health physical and social protections fall below threshold levels resulting in a public health emergency status

• Determinants: population, population density, capacity of public health infrastructure & system

• Most evident in megacities of least urbanized continents of Asia and Africa

HarvardHumanitarianInitiativeRAPID URBANIZATION

• Urbanization rates vary greatly across the world

• USA & United Kingdom have far higher urbanization rates than China or India

• But have far slower annual urbanization rates since much less of population is living in rural areas

• Rapid urbanization is unsustainable

HarvardHumanitarianInitiative

URBANIZATION THRESHOLD

• Urban role in economic wealth creation for the country depends on continuous production of ecological goods & services from somewhere else

• An extensive external resource base of goods & services must be available & grow if urbanization grows

• While this was possible at one time, the resource base sustaining the human population is now in steady decline

• Cities over 10 Million; density, not population, is most sensitive indicator (e.g., Port-au-Prince, Haiti) > Density based on minimum of 2,000 people/sqKm > Mumbai:30,000/sqKm

• Unplanned urbanization in which public health infrastructure & system installed after urbanization

• Primary forces leading to public health emergency: > Land cover conversion > Urban topography devoid of forests/parks > Pollution

MEGACITIES

HarvardHumanitarianInitiative

POPULATION EXPOSED TO CONFLICT

RM Garfield, J Polansky, FM Burkle, Jr

LESS DECLARED WARS…BUT MORE PEOPLE EXPOSED TO CONFLICT THAN EVER BEFORE

HarvardHumanitarianInitiative2000s

I. Currently, many populations fleeing from sustained levels of “conflict intensity”in failing post-conflict countries

II. Increasing numbers of internally displaced populations (IDPs) migrating because of severe climate-related changes

Current patterns of IDP migration are regional rather than international

CHANGE IN MIGRATION TRENDS FROM REFUGEES TO INTERNALLY DISPLACED POPULATIONS (IDPs)

Spiegel, et al, LANCET, 2010

INTERNALLY DISPLACED MOVE TO URBAN AREAS IN LEAST DEVELOPED COUNTRIES

Spiegel, et al, LANCET, 2010

CONTRADICTIONS of GLOBALIZATION

• 6% of population are urban squatters in Developed countries

• 78% of population are urban squatters in the Developing world

• “Urban Diseminities” range from 35% to 93%

HarvardHumanitarianInitiative

GLOBALIZATION & URBANIZATION*

• Increasing health inequities & widening gap between ‘have & have not’ populations

• Produced an “invisible” population: population demographics and access to health are relatively unknown

• “Health for many has become a major security issue” *Schneider: Global PH & Int Relations,

Aus J of International Affairs, 2008**Burkle: Globalization & Disasters: PH, State Capacity & Political Action

J. of International Affairs, 2006

HarvardHumanitarianInitiative

WORSENING HEALTH INDICATORS

HarvardHumanitarianInitiative

URBAN SLUMS

• Highest Worldwide Under age 5 Mortality Rates (U5MR) & Infant Mortality Rates (IMR)

• Urban shanty towns: > 900 M vulnerable to cyclones, flooding,

& earthquakes > Growing at 25M/year: in disaster prone

areas > Mumbai: 1600 new families/day

• Sanitation ignored; infectious diseases more prevalent

*

URBAN HEATLH WORKFORCE CRISIS

HarvardHumanitarianInitiative

EMERGENCIES OF SCARCITY: WHAT WILL MATTER IN

2015-20?

• ENERGY • WATER

Intense “distributional conflicts” & “land grabbing” already occurring by import dependent countries

• FOOD

HarvardHumanitarianInitiative

PUBLIC HEALTH REDEFINED

• Humanitarian assistance has moved from rural to urban areas

• Humanitarian community is NOT prepared to protect the urban public health infrastructure…or system

• Not prepared to handle “emergencies of scarcity”

HarvardHumanitarianInitiative

REDEFINING PUBLIC HEALTH

• Disasters keep governments honest by defining the public health & exposing its vulnerabilities (Burkle, 1973)

• Global Health: Scarcity (climate change impacts, energy, water, food) now defines the public health of many countries

• Current Public Health Solutions: Reduction in growth rates (empowering women) Ensuring social protections Decrease carbon emissions Populations called upon to identify vulnerabilities…learn

how to reduce them (adapt)…redefine resilience If doesn’t work: Must have strong migration policies in place

HarvardHumanitarianInitiative

GLOBAL PUBLIC HEALTH RESEARCH REDEFINED

• Must be integrative: inter-disciplinary, inter-sectoral, inter-ministerial

• Do not leave Global Health research to policy makers & practitioners who are poorly prepared to interpret strengths & weaknesses of integrative research

• Global health is a ‘composite field’

Maclachlan, Globalization & Health 2009

HarvardHumanitarianInitiative

CONCLUSIONS

• “Public health emergencies must be seen as the common thread of many inter-related climate & urbanization crises” (Burkle, 2004)

• Do not assume that non-health decision makers (e.g., engineers, urban planners) understand the impact of urbanization on health

• Public health must be seen as a strategic & security issue…that deserves an international monitoring system (G20 Global Impact & Vulnerability Act) (Burkle, 1973)

THANK YOU!!