1. Is the Path to Human Well-being Inevitably Unsustainable? Daniel Rainham McLaughlin Centre for Population Health Risk Assessment, Ottawa and Environmental Sciences, Dalhousie Ian McDowell (Ottawa), Rory Cantwell (McGill)

2. June 2, 20082 / 12 Overview Prevailing Objective: wealth = health Issues with the prevailing objective Consumption and health Biocapacity and consumption Resource inequalities ~ global health inequalities? Evidence Limitations Reframing health in the context of sustainability

3. June 2, 20083 / 12 Wealth = Health Mathers et al. BMC Public Health 2004 4:66 doi:10.1186/1471-2458-4-66

4. June 2, 20084 / 12 Issues with wealth = health Humans appropriate ~30-50% of the present net primary production in the biosphere (Pauly & Chrisensen, 1995) Global per capita GDP (US$) has doubled since 1960 Income gap between the fifth of the world’s richest people and fifth of the poorest has increased form 3:1 in 1820 to 74:1 in 1997 (UNDP, 2000) An estimated 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors (~ 35% in very poor regions like sub-Saharan Africa) (Smith et al, 1999; WHO, 2006)

5. June 2, 20085 / 12 Generating wealth – is this normal? Fowler & Hobbs. Is humanity sustainable? Proc Royal Soc London B: Biol Sci 2003; 1533:2579-2583.

6. June 2, 20086 / 12 Generating wealth – is this normal? Sources: UNDP, 2002; Wackernagel et al., 2002; WWF, 2004; World Resources Institute, 2004. Ecological Footprint Life Expectancy Infant Mortality Living Planet Index GDP

7. June 2, 20087 / 12 Distribution of Natural Capital Appropriation Sources: UNDP, 2002; Wackernagel et al., 2002; WWF, 2004; World Resources Institute, 2004.

8. June 2, 2008 The Worsening Scientific Consensus “Human activity is putting such a strain on the natural functions of the Earth that the ability of the planet’s ecosystems to sustain future generations can no longer be taken for granted.” (MEA, Living Beyond Our Means, 2005)

9. June 2, 20089 / 12 Relationship: HALE and Ecological Footprint (Global) Rainham D, McDowell I. The Sustainability of Population Health. Population & Environment 2005; 26: 303-24.

10. June 2, 200810 / 12 Relationship: HALE and Ecological Footprint (Canada) Premature death High blood pressure (%) Infant mortality Circulatory disease BMI (%)

11. June 2, 200811 / 12 Limitations Indicators: crude measures of population health; consumption heavily weighted to energy use; no accounting for stock flows; health effects from contaminants; issues with country-level data Correlational evidence; crude analysis Other determinants at play: governance, trade, culture, etc. Assumption that equitable access to resources is optimal – does this make me a socialist?

12. June 2, 200812 / 12 The Take Home Messages All human activities (development) are dependent on natural capital and functions of natural systems Global trends in human development are currently unsustainable Focus on wealth generation for population health improvements may be misguided – how to achieve health sustainably? Resources to support health, globally & nationally, are not shared equitably (leading to health inequalities?) The most healthy populations are the most resource hungry and unsustainable Directions for improvement? Learn from the outliers: Sweden, Costa Rica, Cuba, etc.