"Urban transport systems based on a combination of rail lines, bus lines, bicycle pathways, and pedestrian walkways offer the best of all possible worlds in providing mobility, low-cost transportation, and a healthy urban environment." –Lester R. Brown, Plan B 4.0: Mobilizing to Save Civilization.
Chapter 6. Early Signs of Decline: Health Challenge Growing
Health challenges are becoming more numerous as new infectious diseases such as SARS, West Nile virus, and avian flu emerge. In addition, the accumulation of chemical pollutants in the environment is starting to take a toll. While infectious diseases are fairly well understood, the health effects of many environmental pollutants are not yet known.
Among the leading infectious diseases, malaria claims more than 1 million lives each year, 89 percent of them in Africa. The number of people who suffer from it most of their lives is many times greater. Economist Jeffrey Sachs, head of Columbia University’s Earth Institute, estimates that reduced worker productivity and other costs associated with malaria are cutting economic growth by a full percentage point in countries with heavily infected populations. 15
Although diseases such as malaria and cholera exact a heavy toll, there is no recent precedent of a disease affecting as many people as the HIV epidemic does. To find anything similar to such a potentially devastating loss of life, we have to go back to the smallpox decimation of Native American communities in the sixteenth century or to the bubonic plague that took roughly a fourth of Europe’s population during the fourteenth century. HIV is an epidemic of epic proportions that, if not checked soon, could take more lives during this century than were claimed by all the wars of the last century. 16
Since the human immunodeficiency virus was identified in 1981, it has spread worldwide. By the end of 2006, the number of people infected had climbed to 86 million. Of this total, more than 40 million have died thus far. Today 25 million HIV-positive people today live in sub-Saharan Africa, but only 1 million or so are being treated with anti-retroviral drugs. 17
Infection rates are climbing. In the absence of effective treatment, the areas of sub-Saharan Africa with the highest infection rates face a staggering loss of life. Countries like Botswana and Zimbabwe could lose more than a fifth of their adult populations within a decade. 18
The HIV epidemic affects every facet of life and every sector of the economy. Food production per person, already lagging in most countries in sub-Saharan Africa, is now falling fast in some as the number of field workers shrinks. The downward spiral in family welfare typically begins when the first adult falls victim to the illness—a development that is doubly disruptive because for each person who is sick and unable to work, another adult must care for that person. 19
Education is also affected as the ranks of teachers are decimated by the virus. With students, when one or both parents die, children are forced to stay home simply because there is not enough money to buy books and to pay school fees.
The effects on health care are equally devastating. In many hospitals in eastern and southern Africa, a majority of the beds are now occupied by AIDS victims, leaving less space for those with other illnesses. Already overworked doctors and nurses are often stretched to the breaking point. With health care systems now unable to provide even basic care, the toll of traditional disease is also rising. Life expectancy is dropping not only because of AIDS, but also because of the deterioration in overall health care associated with it. 20
The epidemic is leaving millions of orphans in its wake. Sub-Saharan Africa is expected to have 18 million “AIDS orphans” by 2010—children who have lost at least one parent to the disease. There is no precedent for millions of street children in Africa. The extended family, once capable of absorbing orphaned children, is now itself being weakened by the loss of adults, leaving children to bury their parents and fend for themselves. For some girls, the only option is what has come to be known as “survival sex.” Michael Grunwald writes from Swaziland in the Washington Post: “In the countryside, teenage Swazi girls are selling sex—and spreading HIV—for $5 an encounter, exactly what it costs to hire oxen for a day of plowing.” 21
The HIV epidemic in Africa is now a development problem, threatening not only to undermine future progress but also to eliminate past gains. It threatens food security, undermines the educational system, and dries up foreign investment. It is overwhelming governments, leading to more failing states. Stephen Lewis, when he was the U.N. Special Envoy for HIV/AIDS in Africa, said that the epidemic can be curbed and the infection trends can be reversed, but it will take help from the international community. The failure to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria, he said, is “mass murder by complacency.” 22
Writing in the New York Times, Alex de Waal, an adviser to the U.N. Economic Commission for Africa and to UNICEF, sums up the effects of the epidemic well: “Just as HIV destroys the body’s immune system, the epidemic of HIV and AIDS has disabled the body politic. As a result of HIV, the worst hit African countries have undergone a social breakdown that is now reaching a new level: African societies’ capacity to resist famine is fast eroding. Hunger and disease have begun reinforcing each other. As daunting as the prospect is, we will have to fight them together, or we will succeed against neither.” 23
While the HIV epidemic is concentrated in Africa, air and water pollutants are damaging the health of people everywhere. A joint study by the University of California and the Boston Medical Center shows that some 200 human diseases, ranging from cerebral palsy to testicular atrophy, are linked to pollutants. Other diseases that can be caused by pollutants include an astounding 37 forms of cancer, plus heart disease, kidney disease, high blood pressure, diabetes, dermatitis, bronchitis, hyperactivity, deafness, sperm damage, and Alzheimer’s and Parkinson’s diseases. 24
Nowhere is pollution damaging human health more than in China, where deaths from cancer have now eclipsed those from heart ailments and cerebrovascular disease. A Ministry of Health survey of 30 cities and 78 counties that was released in 2007 reveals a rising tide of cancer. Populations of some “cancer villages” are being decimated by the disease. 25
Jiangsu province, located on the coast just north of Shanghai, is both one of China’s most prosperous provinces and one of its most cancer-ridden. Although it has only 5 percent of the country’s population it has 12 percent of the cancer deaths. One river in the province was laden with 93 different carcinogens, most of them from untreated factory waste. 26
Pan Yue, vice minister of China’s Environmental Protection Administration, believes his country “is dangerously near a crisis point.” The reason, he believes, is that Marxism has given way to “an unrestrained pursuit of material gain devoid of morality. Traditional Chinese culture with its emphasis on harmony between human beings and nature,” he says, “was thrown aside.” 27
The new reality is that each year China grows richer and sicker. Although there are frequent pronouncements urging steps to reduce pollution, these official statements are largely ignored. There is not yet a real commitment in the Chinese government to control pollution. China’s Environmental Protection Administration has fewer than 300 employees, all located in Beijing. The U.S. Environmental Protection Agency (EPA), in contrast, has 17,000 employees, most of whom work in regional offices around the country where they can observe and monitor pollution at the local level. 28
Yet the United States is also still feeling the effects of pollution. In July 2005 the Environmental Working Group, in collaboration with Commonweal, released an analysis of umbilical cord blood from 10 randomly selected newborns in U.S. hospitals. They found a total of 287 chemicals in these tests. “Of the 287 chemicals we detected...we know that 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests.” Everyone on the planet shares this “body burden” of toxic chemicals, but infants are at greater risk because they are in the highly vulnerable formative stage of early development. 29
WHO reports an estimated 3 million deaths worldwide each year from air pollutants—three times the number of traffic fatalities. In the United States, air pollution each year claims 70,000 lives, compared with the country’s 45,000 traffic deaths. 30
A U.K. research team reports a surprising rise in Alzheimer’s and Parkinson’s diseases, and in motor neuron disease generally, in 10 industrial countries—6 in Europe plus the United States, Japan, Canada, and Australia. In England and Wales, deaths from these brain diseases increased from 3,000 per year in the late 1970s to 10,000 in the late 1990s. Over an 18-year period, death rates from these diseases, mainly Alzheimer’s, more than tripled for men and nearly doubled for women. This increase in dementia is likely linked to a rise in the concentration of pesticides, industrial effluents, car exhaust, and other pollutants in the environment. A 2006 study by the Harvard School of Public Health found that long-term low-level exposure to pesticides raised the risk of developing Parkinson’s disease by 70 percent. 31
Scientists are becoming increasingly concerned about the various effects of mercury, a potent neurotoxin, which now permeates the environment in virtually all countries with coal-burning power plants and many of those with gold mines. For example, gold miners release an estimated 290,000 pounds of mercury into the Amazon ecosystem each year, and coal-burning power plants release nearly 100,000 pounds of mercury into the air in the United States. The U.S. EPA reports that “mercury from power plants settles over waterways, polluting rivers and lakes, and contaminating fish.” 32
In 2006, 48 of the 50 states in the United States (all but Alaska and Wyoming) issued a total of 3,080 fish advisories warning against eating fish from local lakes and streams because of their mercury content. EPA research indicates that one out of every six women of childbearing age in the United States has enough mercury in her blood to harm a developing fetus. This means that 630,000 of the 4 million babies born in the country each year may face neurological damage from mercury exposure before birth. 33
No one knows exactly how many chemicals are manufactured today, but with the advent of synthetic chemicals the number of chemicals in use has climbed to over 100,000. A random blood test of Americans will show measurable amounts of easily 200 chemicals that did not exist a century ago. 34
Most of these new chemicals have not been tested for toxicity. Those that are known to be toxic are included in a list of nearly 650 chemicals whose discharge by industry into the environment must be reported to the EPA. The Toxics Release Inventory (TRI), now accessible on the Internet, provides information on a community-by-community basis, arming local groups with data needed to evaluate the potential threats to their health and that of the environment. Since the TRI was inaugurated in 1988, reported toxic chemical emissions have declined dramatically. 35
15. Deaths calculated from U.N. Population Division, World Population Prospects: The 2004 Revision (New York: 2005), and from WHO/ UNICEF, World Malaria Report 2005 (Geneva: 2005); Sachs from Center for International Development at Harvard University and London School of Hygiene and Tropical Medicine, “Executive Summary for Economics of Malaria,” at www.rbm.who.int, viewed 3 August 2005.
16. More deaths from AIDS than wars from Lawrence K. Altman, “U.N. Forecasts Big Increase in AIDS Death Toll,” New York Times, 3 July 2002.
17. Total deaths and historical estimates calculated using UNAIDS statistics in Worldwatch Institute, Signposts 2004, CD-Rom (Washington, DC: 2004) and in UNAIDS, AIDS Epidemic Update (Geneva: various years); sub-Saharan Africa from UNAIDS, 2006 AIDS Epidemic Update (Geneva: December 2006), p. 10.
18. UNAIDS, 2006 Report on the Global Aids Epidemic (Geneva: May 2006), pp. 2–6, 320, 488.
19. UNAIDS, 2004 Report on the Global Aids Epidemic (Geneva: 2004), pp. 39–66; FAO, “The Impact of HIV/AIDS on Food Security,” 27th Session of the Committee on World Food Security, Rome, 28 May–1 June 2001.
20. UNAIDS, op. cit. note 18, p. 95.
21. UNAIDS, UNICEF, and U.S. Agency for International Development, Children on the Brink 2004: A Joint Report on New Orphan Estimates and a Framework for Action (Washington, DC: 2004), p. 29; Michael Grunwald, “Sowing Harvests of Hunger in Africa,” Washington Post, 17 November 2002.
22. Stephen Lewis, press briefing, New York, 8 January 2003; Edith M. Lederer, “Lack of Funding for HIV/AIDS is Mass Murder by Complacency, Says U.N. Envoy,” Associated Press, 9 January 2003.
23. Alex de Waal, “What AIDS Means in a Famine,” New York Times, 19 November 2002.
24. Sarah Janssen, Gina Solomon, and Ted Schettler, Chemical Contaminants and Human Disease: A Summary of Evidence (Boston: Alliance for a Healthy Tomorrow, 2004); Geoffrey Lean, “ US Study Links More than 200 Diseases to Pollution,” Independent News (London), 14 November 2004.
25. Jonathan Watts, “ Beijing Blames Pollutants for Rise in Killer Cancers,” Guardian (London), 22 May 2007.
27. Pan Yue, “View: China’s Green Debt,” Daily Times (Pakistan), 1 December 2006.
28. Kent Ewing, “Behind the Hysteria About China’s Tainted Goods,” Asia Times, 18 July 2007; EPA, “About EPA,” at www.epa.gov, viewed 25 July 2007.
29. Jane Houlihan et al., Body Burden: The Pollution in Newborns (Washington, DC: Environmental Working Group, 2005).
30. Bernie Fischlowitz-Roberts, “Air Pollution Fatalities Now Exceed Traffic Fatalities by 3 to 1,” Eco-Economy Update (Washington, DC: Earth Policy Institute, September 2002), citing WHO, “Air Pollution,” Fact Sheet 187 (Geneva: revised September 2000); traffic accident deaths from WHO, “Estimated Total Deaths, by WHO Member State, 2002,” table downloaded from WHO Web site, “Burden of Disease Statistics,” www.who.int/healthinfo; U.S. deaths from Joel Schwartz, quoted in Harvard School of Public Health, “Air Pollution Deadlier Than Previously Thought,” press release (Cambridge, MA: 2 March 2000).
31. C. Pritchard, D. Baldwin, and A. Mayers, “Changing Patterns of Adult (45–74 years) Neurological Deaths in the Major Western World Countries 1979–1987,” Public Health, vol. 118, issue 4 (June 2004), pp. 268–83; Juliette Jowit, “Pollutants Cause Huge Rise in Brain Diseases: Scientists Alarmed as Number of Cases Triples in 20 Years,” The Observer (London), 15 August 2004; A. Ascherio et al., “Pesticide Exposure and Risk for Parkinson’s Disease,” Annals of Neurology, vol. 60, issue 2 (August 2006), pp. 197–203.
32. Global Environment Facility, U.N. Development Programme (UNDP), and United Nations Industrial Development Organization, “Removal of Barriers to the Introduction of Cleaner Artisanal Gold Mining and Extraction Technologies,” UNDP Global Mercury Project Inception Document GLO/01/G34 (Washington, DC: April 2002), p. 8; Ilan Levin and Eric Schaeffer, Dirty Kilowatts: America’s Most Polluting Power Plants (Washington, DC: Environmental Integrity Project, July 2007), p. 2; EPA, “EPA Decides Mercury Emissions from Power Plants Must Be Reduced,” press release (Washington, DC: 15 December 2000).
33. EPA, Office of Science and Technology, “National Listing of Fish Advisories: 2005–06 National Listing,” fact sheet (Washington, DC: July 2007); Kathryn Mahaffey, EPA, Methylmercury: Epidemiology Update, presentation at The National Forum on Contaminants in Fish, San Diego, CA, January 2004, at www.epa.gov/waterscience.
34. Anne Platt McGinn, Why Poison Ourselves? A Precautionary Approach to Synthetic Chemicals, Worldwatch Paper 153 (Washington, DC: Worldwatch Institute, 2000), p. 7; 200 chemicals in body from Pete Myers, plenary discussion on Emerging Environmental Issues, at USAID Environmental Officers Training Workshop, “Meeting the Environmental Challenges of the 21st Century,” Airlie Center, Warrenton, VA, 26 July 1999.
35. EPA, “Toxics Release Inventory (TRI) Program,” fact sheet, at www.epa.gov/tri, updated 9 June 2006; EPA, “EPA Issues New Toxics Report, Improves Means of Reporting,” press release (Washington, DC: 11 April 2001).
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