This is a joint post with Kristof Decoster

In an “end of the year world” mood, David Hercot and Kristof Decoster share their view on which “health post- Millennium Development Goal” should replace the current health MDGs. Although you might smile at some points in the text, they are dead serious.


The MDGs have no doubt been a unique political window of opportunity to align a large number of actors behind ambitious global public good goals. The world has changed a lot since the early 2000s. Provided our cozy planet  is still there tomorrow, we hope that the post-MDG discussion will again seize the opportunity to raise awareness on the challenges of today’s world in the coming months and years.

Despite all its shortcomings, the United Nations are still the most democratic global institution we have. So if the solution for humankind’s current predicament has to come from somewhere else than street riots  – although we fully understand the  appeal of smashing windows of “Too Big to  Fail” banks and corporate headquarters – then New York is probably your safest bet, whether Fox News anchors like it or not. So far, it doesn’t look good, though. Post-MDG discussions like the sustainable development discussions currently underway seem to miss THE health goal of our times. To paraphrase a former US president: it’s about the survival of the human species, stupid! And if global health is not about “survival” of human beings then we didn’t understand anything of it.  So we global health people are well placed to say a word or two about the survival of mankind.

Indeed, it is the first time in history that a species is able to cause its own extinction and apparently hell-bent on doing so. We don’t even need aliens or UFOs for destroying our very own habitat. In fact, at this moment, aliens from the planet Zorb are probably looking at us with a mixture of unbelief and horror. The question now is: can our leaders still avoid a catastrophic ecological scenario and will they do so?  Don’t count on it. Many scientists have warned repeatedly that the time to act is now and that major shocks are looming just around the corner. For many years, scientists have warned that our economic model of infinite growth is not fit for a world with finite resources. Not that anyone with real power is paying attention. How can we change this?

Perhaps  the next time the IPCC publishes a report on climate change, scientists could (a) be surrounded by bodyguards showcasing AK47s  – that might impress the Putins of this world  (b) or they could spread a very soothing “everything is fine” message. As the world is gradually collapsing around us, the ‘Comical Ali’ effect of such a comforting message might actually have more impact on public opinion than a more traditional ‘alarming’ message.  (c) A last  option is to screen ‘Mad Max’ or ‘The road’ before every press conference, to focus the minds of the journalists present on the world that is in store if we don’t act now.

Let’s face it, the post-MDGs discussions are a “once in a generation” opportunity to help ensure the survival of mankind.  Singing for the climate – a happy pastime in our country – and turning the light off for one hour a year aren’t solutions. They are what they are: awareness raising campaigns. We need more than awareness raising campaigns and in depth-analyses of the impact of climate change on health. We need – asap – bold measures that will address the major challenges of our future as a human species: a warming world, a foreseeable decrease in food productivity and a failing global market mechanism of which the growth addiction is causing huge damage to the entire planet as well as to 99% of the people living on this planet. If the A team still existed, we would call on them right now. No less than a warlike response is needed.  In fact, many would say nature is already wreaking havoc upon us. The new MDGs should start from this analysis. And then do something about it.

As global health experts we obviously support the right to health of all 8 billion citizens that will live on earth by 2030. But we should also think about the generations after them and frame the challenges of our time the way they are: as a fight for the survival of human kind, a fight to turn the earth into a place where humans can live in peace with themselves, their neighbors and the entire earth, a home that Deepak Chopra, Eckhart Tolle, Kumi Naidoo, Oprah Winfrey ànd Michael Moore can be proud of.  We need to reduce the footprint of human kind on earth. We need to actively manage the impact of an overcrowded and over-industrialized planet on the earth ecosystem. Luckily, as Gill and Stott have put it, “overall, what is good for tackling climate change is good for health”.

There aren’t many “high impact interventions” global health experts can promote that directly affect our chances to survive as a species in the long term. Still, we should embrace them. In parallel, we should  adapt health systems to a changing world.

We see two global health priorities that can more directly help mitigate the impact of human beings on the planet: Firstly, we need to do everything we can to provide those who want it with the right and the means to use birth spacing measures including policies that are friendly to households willing to limit their size. This will directly affect  global population growth. Let’s hope Melinda Gates can push decision makers to open their pockets a bit more. As for the ones who think they’re only fully human if they raise a whole football team of kids, we have been told castration works well.

Secondly, we have to push the richest one or two billion of people to adopt a diet that is both healthier and less demanding in terms of planetary resources. In both richer and emerging economies, many people are consuming excessive amounts of meat and processed food high in saturated fat. On the other end of the economic spectrum, almost a billion people are starving because they just can’t afford food.  To do something about this, we will need something more than daily op-eds by Jeffrey Sachs. Some real men seem required here to get the job done. Would be great if George Bush and Al Gore could team up and take up this cause as their ultimate contribution to global health. Only then we can rest assured that no prisoners will be taken and the mission accomplished.

Now, if we manage to survive today’s “end of the world” party, you bet the world will still face some deeply disturbing changes in the medium and long term. To prepare and adapt health systems to a changing planet, we see two priorities. Firstly, we should strive for more equitable health systems that ensure fair access to the services people need. We are not the first ones to advocate for equitable health services, but it is more than likely that in a context of runaway climate change,  the need for rationing will only become more urgent and the challenge to do so in an equitable way more daunting. This will no doubt require a lot of diplomatic skills. A schmoozer like Bill Clinton could come in handy here. Secondly, as we can expect more and more climate chaos and extreme weather events in the coming decades, when the world will increasingly resemble a “hell on earth”, health policy makers and researchers should as soon as possible include “emergency preparedness” in their thinking and policy plans, to boost resilience of their countries’ citizens. Humankind needs to become far more resilient – if we have to go down, let us at least do it in slow motion and with dignity, like Willem Dafoe in Platoon.

Not all these priorities need to become post MDG goals and not all these bigshots need to be hired. But if we do have to formulate one overall health goal for the post-MDG framework, it would have to be this one, as it captures the great challenge of our time: Current and future citizens of this world have the right to live a healthy life in a healthy world.

And now, bring on the aliens!


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