The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1.5° C and to restore nature.
There’s no doubt that for most people 2021 is the second year of the great pandemic, and for many it has been much, much worse than 2020. It’s the year of Delta and Delta-plus, and possibly soon the new variant Mu. So it might be hard to imagine why the climate crisis could be more important in 2021 than the COVID-19 pandemic. Yet 228 international medical journals will simultaneously publish an editorial this week saying exactly that.
The unprecedented editorial in these medical journals is aimed at the UN General Assembly which opens on 14 September 2021 that will discuss the need for collective action on climate change. This will be followed by the UN Biodiversity Conference [COP15] on October 11-15, 2021 and the UN Climate Change Conference [COP26] on 1-12 November 2021.
The sense of urgency is heightened by the report to the Intergovernmental Panel on Climate Change [IPPC] released in early August. The report, Climate Change 2021: The Physical Science Basis runs to over 3,900 pages. There are summaries, and summaries of summaries, for policy-makers. And there are Tweet-length explanations for them too. What it all says is clear enough.
Human activities have contributed to global climate change, including extreme weather, rising sea levels and rising surface temperatures. Hot extremes, including heatwaves, have become more frequent and more intense. Human-induced climate change has contributed to increases in agricultural and ecological droughts.
The evidence of this is visible. There were devastating heat waves, wildfires and droughts in several countries this year and it’s far from over.
What is also clear from the IPCC report is that we’re at a critical juncture. We’re about to exceed the internationally agreed 1.5 ºC limit on rising global temperatures. The report determined that we could pass this 1.5°C limit between 2030 and 2035.
What this means for human health is made clear in the editorial of the medical journals:
The risks to health of increases above 1.5° C are now well established. Indeed, no temperature rise is “safe.” In the past 20 years, heat-related mortality among people over 65 years of age has increased by more than 50%. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.
Also clear is the impact on food and nutrition and the ongoing pandemic of undernutrition:
Global heating is also contributing to the decline in global yield potential for major crops, which has fallen by 1.8 to 5.6% since 1981; this decline, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition. Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.
Even in the best possible scenario explored in the IPCC report we’ll still pass this 1.5°C limit. So no more talking, no more voluntary carbon emissions levels, no more ‘let’s wait and see’. We’ll see nothing through the fires, haze, heat exhaustion, and hunger. It’s time for action.
That’s why the 228 international medical journals are calling for urgent action by governments, pointing out (again) that the climate crisis is also an urgent global health crisis. And they say it very clearly:
Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.
So 2021 will be remembered as the year that the world changed course and averted a global ecological and health catastrophe. Or didn’t. It can’t get much clearer than that.
Hidayat Greenfield, Regional Secretary
 Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health, a joint editorial of 228 international medical journals. This is published online here in The New England Journal of Medicine.
 The report is the Working Group I (WGI) contribution to the Sixth Assessment Report (APR6) of the Intergovernmental Panel on Climate Change (IPCC).
 In 2009 more than a hundred Small Island Developing States, Least Developed Countries called to limit global temperature rise to 1.5°C above pre-industrial levels to prevent the worst of climate change impacts. This 1.5°C temperature limit was included in the 2015 Paris Agreement. In 2018, the IPCC published a report called Global Warming of 1.5 ºC which explained the climate impacts at 1.5°C of warming and why it is a critical limit we should not pass. A global increase in the earth’s surface temperature of more than 1.5°C compared to pre-industrial levels will have devastating and irreversible effects on the environment, food supply and human health.
For more than a decade the private sugar mill operated by Gangakhed Sugar and Energy Private Limited (GSEPL) in Parbhani, Maharashtra, has regularly released untreated effluent into a nearby lake and irrigation canals. This has caused a such a significant loss of aquatic life in Mannath lake that the fisherfolk dependent on this lake have lost their livelihoods. The untreated effluent from the sugar mill also polluted irrigation canals with a detrimental impact on the crops and soil on nearby farms. For a decade fisherfolk and farmers have struggled to end this pollution. For a decade the food industry has been undermining food security.
Soon after GSEPL started its operations in 2010, the mill released untreated effluent into Mannath Lake and irrigation canals during the sugarcane crushing season. Fisherfolk filed a case with the National Green Tribunal (Western Zone) Bench, Pune, against the company for “polluting the water in Mazalgaon Right canal and Mannath lake, causing water pollution and thereby causing a threat to human health, fishery yield and ecology.” The case referred to pollution caused by “industrial waste molasses and chemical mixed water”.
Despite this, the mill again released untreated effluent into the lake in the 2013-2014 sugarcane crushing season.
When fisherfolk and farmers made complaints about this pollution, GSEPL management responded with violent attacks, threats and intimidation. The company also took legal action against fisherfolk and farmers, forcing many of them to abandon their livelihoods and migrate.
The extent of this brutality is reflected in the private prison operated by the mill to punish indebted farmers and critics. This was described in 2012 as follows:
On 30/04/2012 around 11 am, the goons of the mill management came into the UCO bank branch Gangakhed, kidnapped and took V. to the privately owned prison in the factory premises. Mill management was maintaining their own prison for assaulting farmers, workers and everyone who was raising the questions against mill management. According to V. that place was in dark, smoky and unhygienic. When he entered the custodial room there were around 34 detainees were already present. While held here he assaulted many times. All these detainees were kept their [sic] like slaves without any basic amenities and food. Mill management released him the next day around 5 pm.
A public demonstration against the GSEPL mill management on 18 October 2013 led to the demolition of the private prison. Yet the violent attacks on fisherfolk and farmer leaders continued.
While water pollution was damaging the ecology, destroying livelihoods and undermining food security (in the prevailing fear of private prisons and violence), the conglomerate Shree Renuka Sugar bought sugar from the GSEPL mill. One of the leading customers of Shree Renuka Sugar at that time was Hindustan Coca-Cola Beverages Private Limited (HCCBPL). Even after the case was filed in the Green Tribunal and the media reported on these violent attacks on the community, Shree Renuka Sugar made several more purchases from GSEPL. This environmental pollution, human rights abuse and food insecurity ran from Mannath lake through the supply chain of Coca-Cola in India.
While water pollution was damaging the ecology, destroying livelihoods and undermining food security, GSEPL successfully registered as an emission-reduction project under the Kyoto Protocol’s clean development mechanism. The UNFCCC’s Clean Development Mechanism (CDM) Executive Board assigned Project No.4816 to Gangakhed Sugar & Energy Private Ltd (GSEPL) 30 MW Bagasse Based Co-generation Power Project. Despite several reviews over 10 years, the CDM ignored the large-scale pollution of Mannath lake and surrounding farmlands. Even when the Green Tribunal ruled in July 2014 that GSEPL had extensively polluted Mannath lake and must pay to replace its water, the company continued to be a green project under the Kyoto Protocol.
After a decade the fisherfolk union, Godavari Magasvargiya Matsya Vyavsay Sahakari Sanstha (GMMVSS), continues to struggle for compensation for their lost livelihoods and to end the pollution that has destroyed the ecology of Mannath lake. They seek an end to an unsustainable food industry and to regain their right to food security.
Hidayat Greenfield, IUF Asia/Pacific Regional Secretary
There can be no doubt that the COVID-19 pandemic and the prolonged crisis we face for the next decade exposes the vulnerability and weaknesses of the prevailing political and economic system. It also exposes how our values have been displaced: individualism over collectivism; economic growth over social justice; consumption over environment. But in most cases, it simply means there are no values at all. Over the last 45 years the fundamental tenets of neoliberalism have gone from anti-establishment ideas and ‘radical’ policy to become the everyday logic within which virtually everything is decided.
In 2020 we saw so clearly how neoliberalism created the vulnerabilities that allowed a zoonotic disease to become the worst global health crisis in 100 years and the most severe economic decline since the 1930s. Yet in 2021 we see international and national policies on health and recovery still operating within the iron cage of neoliberalism. We cannot save lives and livelihoods unless it is profitable. We cannot provide health care and social protection unless it is a commodity. The universal human rights to food and nutrition, housing, health care and education exist only as an individual right to participate in the market – to buy these as commodities. It is a product in the economy, not a service to society.
Even what appears as public and free now (COVID-19 vaccines) is simply an instalment plan. The costs are added to the national debt to be paid by future generations.
In the OECD countries, governments borrowed USD 18 trillion from financial markets in 2020 in response to the COVID-19 pandemic. This is a 61% (USD 6.8 trillion) increase over 2019. It is the highest single increase in government borrowing in history. In 2021, this government borrowing will reach USD 19 trillion.  However, 25% of the money borrowed in 2020 will mature before the end of 2021, requiring even more borrowing. With an average term to maturity of 7.7 years, the rest will be repayable just as we are trying to come out of the 10-year global recession.
Combining this government debt with private sector debt, the pandemic response in 2020 led to increased borrowing of USD 24 trillion, with total global debt now at USD 281 trillion. This 355% more than the total dollar value of all goods and services created (i.e., the total sum of global GDP). This is not an argument against public spending in a time of crisis, but the basis for concern about the debt cycle and more structural adjustment in future. We should also expect another financial crisis in Europe and Asia-Pacific, including the impending banking and mortgage crisis in China.
The repeated cycle of debt, crisis and structural adjustment is already familiar for less developed countries. This occurred in the context of a massive shift in wealth from South to North – from developing to developed countries. A new study quantifies this shift in wealth at USD 62 trillion from 1960 to 2018. If lost growth is included, the amount is USD 152 trillion. The biggest shift in wealth occurred during structural adjustment under the neoliberal policies of the IMF and World Bank in the 1980s and 1990s.
The same structural adjustment forced the privatization and commercialization of hospitals and health care, water, everything. Now these countries are also borrowing to finance health care and to order patented vaccines.
The pharmaceutical companies praised for their COVID-19 vaccines are today fighting against moves by governments the remove of patent protection and allow the generic, mass production of vaccines. These vaccines are a commodity to be sold for profit, not a public good. Governments can buy them and make them available to citizens for free. But they cannot manufacture them to make them freely available to all.
So today we are not seeing a restoration of public health care and public services through government spending after 20 years of privatization and commercialization. We are seeing the costs nationalized spread out over the next 20 years of debt repayment. The financial markets are cashing in on human suffering on a massive scale.
The UNCTAD Trade and Development 2020 report warns that if we maintain austerity policies (meaning the neoliberal policies that do not allow public spending on social protection and public goods and services), then we face “a lost decade” from now until 2030. Increased global unemployment, reduced social spending and social protection, and declining real wages risks “… a transfer of income from workers to profit earners of approximately USD 40 trillion by 2030”.
Preventing such a massive transfer of income from workers to profit earners is surely our most important political task, alongside tackling climate change and preventing the next pandemic.
To stop this massive shift in income from workers to profit earners, we need to restore public goods and services; increase social protection and increase government spending and public investment, including in the IUF sectors. To do this governments need to cancel national debt and restore the tax base. At a minimum this requires and end to tax havens and tax holidays, restoring corporate taxes, and re-introducing a capital gains tax and regulatory instruments such as the Tobin tax.
A significant part of this public spending and investment must be used to tackle climate change and biodiversity loss. This can be done in the context of addressing the disease drivers (which includes unsustainable agriculture and food systems). We could develop organizing and collective action on both climate and biodiversity and preventing the next pandemic. This is the COVID-19 era in which the next pandemic is already taking shape. Nothing has been done yet to tackle the human-mediated disease drivers that will cause the next pandemic. So it is not a matter of if, but when.
 Reasserting collective rights and taking collective social action in the COVID-19 era – IUF Asia/Pacific (iufap.blog) 27 August 2020, vulnerability, insecurity and the future of work – IUF Asia/Pacific (iufap.blog) 16 October 2020.
 As Dee Hock, former chief of the Visa bank-card operation, observed: ”It’s not that people value money more but that they value everything else so much less – not that they are more greedy but that they have no other values to keep greed in check. They don’t know what else to value.” Quoted in “The money society”, Fortune, July 6, 1987.
 In turning the academic ideas of Friedrich Hayek and Milton Friedman into a political program, Thatcher and Reagan were considered radicals within their respective political parties. Now it is mainstream thinking today, even within the social democratic and labour left.
 OECD, Sovereign Borrowing Outlook for OECD Countries 2021, OECD, 2021.
 Institute of International Finance, Global Debt Monitor COVID Drives Debt Surge—Stabilization Ahead, 27 February 2021.
 Hickel, J., Sullivan, D., Zoomkawala, H., “Plunder in the post-colonial era: Quantifying drain from the global South through unequal exchange, 1960-2018”, New Political Economy, 30 March 2021.
 UNCTAD, Trade and Development Report 2020: From Global Pandemic to Prosperity for All – Avoiding Another Lost Decade, UNCTAD, 2020
 UNEP, Preventing the Next Pandemic – Zoonotic diseases and how to break the chain of transmission, UNEP, July 2020. The seven human-mediated factors identified as “disease drivers” are related directly and indirectly to activities in the IUF sectors: 1) increasing human demand for animal protein; 2) unsustainable agricultural intensification; 3) increased use and exploitation of wildlife; 4) unsustainable utilization of natural resources accelerated by urbanization, land use change and extractive industries; 5) increased travel and transportation; 6) changes in food supply; 7) climate change.