self-care
Self-care proved essential during the height of the COVID-19 pandemic, when millions of people around the world took testing and their health into their own hands to ease the strain on overwhelmed healthcare systems.

BERLIN, Germany — Last week, the World Health Summit in Berlin brought together experts, civil society, politicians, and international organizations from around the world to brainstorm solutions to the many threats facing healthcare systems today. 

Climate change, the looming health workforce crisis, and the increasingly distant goal of universal health coverage were all on the agenda. Panels and plenaries debated solutions like artificial intelligence, innovative financing mechanisms for global health, and the use of pharmaceutical innovation and digital technologies to further equity.

Yet the oldest solution in the book, self-care, received little attention. A panel organized by the Global Self-Care Federation (GSCF) and the World Health Organization (WHO), in a small conference room on the outskirts of the summit, was the only event to make it a focus.

That needs to change. Amid a widening health workforce crisis and a lack of universal health coverage for half the world, a broad alliance of public and private stakeholders are urging governments to recognize and develop self-care as a critical component of health systems. Their call is backed by a new joint statement on self-care launched at a World Health Summit, and signed by the WHO and three other UN agencies.

Formal care is only the tip of the iceberg

The global and economic value of self-care in data.

“When I think about the whole health continuum, I see an iceberg,” said Jurate Svarcaite, Director-General of the Association of the European Self-Care Industry, speaking on the panel. “The formal health system is what you see above the water, and self-care is what’s under. This invisible part of the iceberg is very difficult to visualize until you have the figures – and the numbers are really staggering.”

The self-care that people provide themselves and their families is essential to keeping even the most advanced healthcare systems afloat. Without it, the EU would need an additional 120,000 GPs, at a cost of $34 billion per year. Self-care allows physicians to focus on acute care by saving them nearly 1.8 billion hours per year globally, according to GSCF, a non-profit based in Geneva.

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective. 

Advances in over-the-counter medicines mean pharmacists can now empower patients by providing advice and treatment for a wide range of minor illnesses, such as coughs, colds, and skin conditions. This can help to reduce the burden on GPs and hospitals.

“Even in countries that have well-equipped and well-resourced health systems, I’ve never heard of a health system saying they have too many resources or too many healthcare professionals,” said Goncalo Sousa Pinto, Lead for Practice and Developmental Transformation at the International Pharmaceutical Federation.

“It is impossible to have sustainable health systems unless you revamp and you really invest in and strengthen primary health care – and self-care is really a way of responding to that challenge,” said Pinto. “It’s about prevention, it’s about early diagnosis, and it’s about reducing pressure on health systems so that patients that require more time in their health system can benefit from high-quality care.”

Self-care savings 

The COVID-19 pandemic demonstrated the essentiality of self-care in times of crisis. Healthcare systems would have collapsed, not just struggled, if millions of people around the world had not taken matters into their own hands.

“COVID really dropped the pin – all of us had to self-care,” said Svarcaite. “We were asked to stay home if we were sick, even if we caught COVID we just had to go to the pharmacy to get paracetamol for whatever symptoms we were feeling.” 

“We had to try not to go into the formal health system because it was caring for really, really sick people that needed the full attention of healthcare professionals,” Svarcaite added.

Self-care, enabled by enhanced health literacy, over-the-counter medicines, devices, and preventive care, can enable people to manage their health conditions and improve their productivity by up to 40.8 billion days globally, she said, referring to a 2022 report on self-care’s social and economic value. It is also often the only option for the nearly 4 billion people who do not have access to essential health services.

“There was not one country which had its health system saying ‘Hooray! We are ready, we can do the COVID, bring us more,’” said Svarcaite. “All health systems struggled, and it just shows that self-care is part of health system resilience.”

Self-care is not new, but it presents one of the highest impact ceilings and cost-benefit ratios to deal with some of the most intractable health problems of the future, such as climate change, conflict, displacement, and the health workforce crisis.

“We need to find new ways to deliver health and healthcare services,” Bente Mikkelsen, director of Noncommunicable Diseases at WHO, earlier told another World Health Summit panel focusing on the healthcare workforce. “For me, that can be the recommendation of self-care information.”

Self-care: A lifeline for sexual and reproductive health

Inequalities continue to be a fundamental challenge to global efforts to achieve universal health coverage, particularly for sexual and reproductive health and rights, according to the UN joint statement.

“Nowhere is the need for self-care more urgent than in sexual and reproductive health, where inequalities run deep,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual and Reproductive Health and Research. 

Nearly 800 women die every day from preventable causes related to pregnancy and childbirth. 164 million women of reproductive age worldwide have an unmet need for contraception, one in three face sexual violence in their lifetimes, and over 1 million newly sexually transmitted infections are acquired every day. 

Self-care interventions, such as self-testing for pregnancy diagnosis, self-sampling for HPV and other infections, and self-management of medical abortion, can help to reduce these inequalities and empower women to make informed and independent choices.

“In so many places around the world, pregnancy self-tests are not available,” said Dr Manjuula Narasimhan, who leads WHO’s Sexual Health and Well-Being Unit. “If it’s not available at the pharmacy, it’s not available to that adolescent young girl asking ‘Am I pregnant? How do I find out?’”

WHO’s Sexual Health and Well-Being Unit Dr Manjuula Narasimhan speaks at the World Health Summit.

Pregnancy self-tests are a common and accessible means of contraception in high-income countries, but they are often unavailable or inaccessible to women in low-income countries. This can pose a significant barrier to women’s health and well-being, as early knowledge of pregnancy is essential for accessing timely and appropriate care.

In many low-income countries, pregnancy self-tests are not available in pharmacies or other retail outlets. They may only be available through health facilities, which can be difficult or impossible to reach for women who live in remote areas or who face stigma or discrimination.

“If the only way she can find out is to go to a clinic and do a blood test — likely in the local clinic where everybody knows her, and are wondering why she’s coming in — then that is a problem of equity,” said Narasimhan. “It is a problem of people having that ability, that agency, to be able to make informed decisions about their health.”

Health literacy: an essential pillar of self-care

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective.

Self-care can reduce the burden on healthcare providers. But self-care can only be effective when health literacy is well-integrated into health system strategies.

“Self-care is intrinsically patient-centric,” said Pinto. “But for these interventions by patients to be effective and to be the best options for patients, the pillar of health literacy and self-care literacy needs to be there. 

But health literacy is more than handing out pamphlets. It requires tailored awareness campaigns targeting the needs of local populations.

“Literacy is not just giving up a pamphlet and a brochure that they can read and many populations actually can’t read either,” said Dr Téa Collins, Platform Lead for Global NCDs at the WHO. “We need to be aware of the diversity of countries and the diversity of healthcare systems, knowing they are not all equipped to do things a certain way.

“There are also very different value systems because in different cultures there are different ways of managing health and disease,” Collins added. “We need to really consider and be culturally sensitive.”

A paradigm shift

Self-care panel underway at the World Health Summit in Berlin.

A shift towards self-care would require a paradigm shift in modern health systems, which are still largely based on top-down approaches to patient care.

“When we are talking about the medical model of care, particularly for those of us trained in this system, we are still gravitating towards this top-down approach,” said Collins.

A shift towards self-care would require a more collaborative approach to healthcare, with patients and healthcare providers working together to develop and implement care plans that are tailored to individual needs. It would also require a greater investment in health literacy and self-care literacy programs.

Self-care is not a magic bullet, but it is a critical part of the solution to the health workforce crisis and the broader challenges facing healthcare systems today.

A new joint UN statement recognizes the potential of self-care

The joint statement was issued at the World Health Summit by the World Health Organization and three other UN agencies.

As a next step, GSCF and its partners are calling on the World Health Assembly to adopt a resolution on self-care. The adoption of such a resolution would be a landmark moment for the advancement of self-care as a pillar of health systems.

“Self-care is an indispensable solution for realising Universal Health Coverage by 2030 and should be integrated into future health and economic policy, with a focus on affordability and access,” said Judy Stenmark, head of GSCF, which has been working in collaboration with WHO to advance self-care in policy agendas.

“A WHO Resolution on Self-Care would provide a comprehensive framework for governments, stakeholders, and the international community to strengthen self-care policies and interventions and would put us on a pathway to better health, well-being, and sustainable development,”  Stenmark noted.

The joint statement, released at the World Health Summit by WHO, the United Nations Development Programme (UNDP), the UN Population Fund (UNFPA) and the World Bank, outlines five priority areas for strategic investment and coordination, including:

  • Financing: We must implement innovative funding models that reduce costs, enhance efficiency, and build a more equitable system.
  • Expanding the health workforce: We need to expand the competencies of the health workforce to provide user-centred self-care options as part of high-quality primary care.
  • Fostering broad-based political will: We need to foster broad-based political will and accountability for integrating self-care across policies, programs, and sectors.
  • Strengthening regulatory systems: We need to strengthen regulatory systems to assure the safety and quality of self-care interventions.
  • Generating robust evidence: We need to generate robust evidence on the health economics and social impacts of self-care while respecting patient preferences.

“The statement represents a watershed moment,” said Allotey. “We really, really have a lot of work to do.”

Image Credits: Annie Spratt, CC.

The unequal distribution of vaccines between countries at the height of the pandemic manifested “as a global system privileging those former colonial powers to the detriment of formerly colonised states and descendants of enslaved groups,” according to the UN Committee on the Elimination of Racial Discrimination.

For centuries, colonialism has shaped global healthcare, leaving behind a legacy of disparities and injustices between the Global North and Global South that continues to exert a profound influence on the health and well-being of marginalised and indigenous populations across the globe.

Today, colonialism’s legacy is being challenged by a growing movement to decolonise the healthcare sector by shifting power to marginalised communities and empowering them to design and deliver their own care.

At a recent panel discussion hosted by the Global Health Centre of the Geneva Graduate Institute, in collaboration with Medicus Mundi, experts from across the health spectrum discussed practical steps to decolonise global health governance and give marginalised communities a greater voice and agency in their own healthcare systems.

“We are speaking about localisation, shifting powers and decolonising,” said Hafid Derbal, Co-Desk for Sexual and Reproductive Health and Rights (SRHR) and Co-Program Coordinator for Zimbabwe, South Africa and Mozambique, Terre des Hommes Schweiz. “Who is ultimately benefiting from our work and these changes? It must be the people we work with – the local organisations and civil society.”

One example of this approach is community-based healthcare initiatives, which tailor services to the specific needs and preferences of the local population. 

“Participative urbanism is a concept that we came up with to bring the voice of the marginalised as part of the mainstream public policy,” said Danny Gotto, founder and executive director of Innovations for Development (I4DEV), Uganda.

“We created a space for people in so-called slums to voice their concerns based on their context, based on their cultures, based on their interests, based on their aspirations,” Gotto said. “Then, we created a space for dialogue between policymakers and the common people to ensure that they decolonise urbanism because the context of urbanism, as borrowed from the West, is that the poor all live on the fringes.”

On a broader scale, collaborations are emerging to support countries with limited resources to manage specific health conditions. For example, the African Centers for Disease Control and Prevention (Africa CDC) is dedicated to building Africa’s capacity to confront healthcare challenges.

“Because many national health organizations lack the capacity and resources to represent what’s going on, the African Union’s creation of the Africa Center for Disease Control and Prevention has great potential,” said Ravi Ram of the Kampala Initiative and co-chair of the WHO Civil Society Commission.

Colonial legacies often resulted in the suppression of indigenous healing traditions and the imposition of Western medical paradigms. Ongoing efforts are underway to decolonize global health education by revising curricula to encompass diverse perspectives and local knowledge and experiences.

Dr Agnes Binagwaho.

“First, we educate students to amplify the voice of the marginalised and vulnerable people in the country, the region, the societies, the communities, and families,” Agnes Binagwaho, a former minister of health in Rwanda and the retired vice chancellor of the University of Global Health Equity, told the panel.

“We educate our students inside the communities the most in need in the country. Normally, medical schools are in cities and in the richest part of countries, not where the most needs are for health professionals. On top of that, we put our students in direct contact with local, national, and regional leaders,” Binagwaho said.

However, the idea that decolonisation is only about the Global North versus the Global South was challenged during the panel discussion. Power imbalances in global health extend beyond former colonial powers, reaching into emerging economies where this disconnect poses challenges for policymakers and healthcare organisations.

“India has also been following, in many ways, a colonial mentality toward its development programs,” said Kampala Initiative’s Ram. “We saw that in COVID, where protectionism overruled their public commitment toward sharing vaccines.”

“Brazil is doing the same work in Latin America, using its regional dominance, trade, and other economic factors to dominate smaller states, even within Brazil,” Ram added. “Much of the general and Afro-Brazilian populations have been excluded from the formal health system.”

WHO
Proposals to include intellectual property waivers for vaccines during the next pandemic in a potential Pandemic Treaty have run up against sharp resistance from the pharmaceutical industry and rich countries.

The inequities of the COVID-19 vaccine rollout exposed the deep inequities in global health, leading to calls for a decolonisation of the sector and negotiations on international legal instruments like the World Health Organization’s (WHO) Pandemic Treaty.

The WHO’s “zero-draft” treaty proposes that 20% of pandemic-related products, such as vaccines, diagnostics, protective equipment, and therapeutics, be allocated to the organisation, which can then ensure equal distribution.

But the increasing monopolisation of entire economic sectors and various forms of profiteering are threatening to derail the Pandemic Treaty. Vaccine inequity was not solely shaped by perceived colonial division, but also the increasing monopolisation of the healthcare sector by private companies, the panelists said. 

“We’ve seen that member states and international organisations won’t necessarily be representing a national interest in the sense of the public. They’ll be representing a corporate interest,” said Ram. “I want to call attention to what’s happening here in Kenya, where a lot of health service delivery is being increasingly encroached upon by Indian corporates, where the Indian private sector is probably one of the most privatised in the Global South.”

Binagwaho echoed this concern, adding: “Money is controlled by the people who don’t want to change because they benefit from the system they have created over decades, and they’re resisting a lot.

“They have to give up a little, but to change that, we must change the world’s economic structure.”

Image Credits: CC, US Mission Geneva.

Trucks carrying humanitarian aid wait to cross into Gaza from Egypt through Rafah border point – some 74 have now passed but WHO says its not nearly enough.

The World Health Organization has issued its most forceful statement to date calling for the immediate release of some 200 Israelis and foreigners, including health workers and children, abducted by Hamas and other armed groups from Israel on 7 October during a deadly rampage of 22 Israeli communities that left about 1300 other people dead.   

Meanwhile, WHO’s Eastern Mediterranean Regional Office (EMRO) issued a fresh appeal for the entry of fuel supplies as well as more medicines  to Gazan overburdened hospitals, struggling to cope with a rising toll of casualties from unprecedented Israeli air raids. Since Saturday, Israel has the allowed entry of  74 trucks of food, water and medical aid. But it has barred fuel deliveries to the besieged enclave in an effort to stem the blitz of missiles being fired on Israeli cities by Hamas, and deplete its fuel reserves while staging the initial phases of a promised ground incursion into Gaza.  US President Joe Biden, a staunch supporter of Israel in the conflict, has admitted that the Gaza aid deliveries aren’t getting in “fast enough.”

WHO hostage statement

Outside of UN Headquarters in Geneva, demonstrators call for the release of some 222 Israeli and foreign hostages held by Hamas. In the past week, families have also met with the heads of WHO, the ICRC and the UN High Commissioner for Human Rights.

The WHO appeal on the hostages came late Wednesday evening following a meeting between WHO Director General Dr Tedros Adhanom Ghebreyesus and members of an Israeli civil society group representing families of those abducted. 

WHO is “gravely concerned by the humanitarian and health situation facing approximately 200 people, including health workers and up to 30 children, abducted from Israel by Hamas and other armed groups on 7 October 2023,” the statement said. It called for “the immediate release of all the hostages, along with urgent access to each of them and delivery of medical care.” 

Said Tedros, “We met today with families of people abducted from southern Israel on 7 October and heard firsthand the tragedy, trauma and suffering they are facing. There is an urgent need for the captors of the hostages to provide signs of life, proof of provision of health care and the immediate release, on humanitarian and health grounds, of all those abducted.”

Elderly, children and people with chronic health conditions

Two of the estimated 30 Israeli children taken hostage by Hamas at demonsration outside of the UN Headquarters in Geneva Sunday, calling for their release. Some families met with the heads of WHO, ICRC and the Office of the UN High Commisioner for Human Righs (OHCHR)

“Many of the hostages, including children, women and the elderly, have pre-existing health conditions requiring urgent and sustained care and treatment. The mental health trauma that the abducted, and the families, are facing is acute and psychosocial support is of great importance,” Tedros said.

The captives were taken after several thousand Hamas gunmen broke through an Israeli security fence separating Palestinian Gaza from pre-1967 Israel in the early morning of 7 December. Fanning out to some 22 Israeli villages and small towns nearby, the gunmen forced their way into hundreds of homes, and set others on fire. Survivors reported seeing neighbors and family members shot or bludgeoned to death, while a few were led away on foot,  motorcycles or in pickup trucks. 

So far, only four of an estimated 224 hostages have been released – including two elderly women, aged 85 and 79 on Monday, whose husbands remain in captivity.  Among the hostages are people of some 25 nationalities, including many Israelis with dual citizenship, but also Nepalese agriculture students and Thai caregivers who were working in the Israeli communities near Gaza.  A handful of the Israeli captives are Beduin Muslims, who live and work in the area.  

Since being taken captive, hostage families have launched a diplomatic campaign in Europe, North America and at UN institutions.  Last week some hostage family members also met in Geneva with the president of the International Committee of the Red Cross and Volker Turk, UN High Commissioner for Human Rights, on a tour that has also taken some families to Brussels and around European capitals as well as to the UN Security Council meeting in New York.   

WHO Eastern Mediterranean Office issues fresh appeal for Gaza fuel supplies 

Displacement of Palestinian families from northern Gaza to one of the UNRWA schools in Gaza City to escape the ongoing Israeli airstrikes on Gaza since October 7, 2023.

Meanwhile, WHO’s EMRO office warned again that more Gazan hospitals are facing collapse, due to the lack of fuel and the collapse of the electricity grid.

“In addition to the hospitals that have had to close due to damage and attacks, six hospitals across the Gaza Strip have already shut down due to lack of fuel, said the WHO/EMRO statement. 

“Unless vital fuel and additional health supplies are urgently delivered into Gaza, thousands of vulnerable patients risk death or medical complications as critical services shut down due to lack of power. These include 1000 patients dependent on dialysis, 130 premature babies who need a range of care, and patients in intensive care or requiring surgery who depend on a stable and uninterrupted supply of electricity to stay alive.” 

Since last Saturday, some 74 trucks carrying food, water and medicines have been allowed by Israel to pass into Gaza through Egypt’s Rafah, with 12 trucks crossing in the latest relay, on Thursday. 

However, UN Refugee Works Agency (UNRWA) officials say that is only about one-tenth of the aid that used to cross into the besieged Gaza strip, before the war broke out – and bereft of fuel.

WHO statements coincide with intense diplomatic activity on hostages and  de-escalation 

Palestinian man walks across a pile of rubble in Gaza, whish has seen the heaviest bombing attacks ever by Israel.

The WHO meeting and statements coincided with a UN Security Council debate Tuesday and Wednesday on the Israel-Gaza conflict, which ended in a veto by Russia and China of a proposed US resolution calling for a humanitarian “pause” in hostilities but also condemned Hamas and affirmed Israel’s right to defend itself. A competing Russian resolution that also called for a pause and condemned Hamas, but omitted language about Israel’s right to self-defense, failed to get the required 9 Security Council votes. 

While there have also been reports that Hamas is negotiating with mediators in Qatar, Egypt and elsewhere for the release of more Israeli captives, the hostage mission is vastly complicated by repeated Israeli threats to enter Gaza and remove Hamas altogether from power.  

The Hamas attacks on wide swathes of southern and central Israel, as well as from the northern Lebanese border, have led to the displacement of some 200,000 Israelis. Some of the Gaza-area Israeli villages that were the scenes of massacre on 7 October, are now mere burnt out ruins. 

But that is nowhere near the level of destruction now being seen in densely populated Gaza – where average people lack access to the network of shelters that Israel has built for its civilian population against missile attack – not to mention its “Iron Dome” air defense system. Around one half of Gaza’s 2.3 million Palestinian inhabitants have reportedly been displaced.  

Gaza reports soaring casualties 

A Palestinian boy with his cat salvaged from an apartment bombed by Israel.

Gaza’s Hamas-run Health Ministry released Thursday a detailed report on 7,028 Palestinian casualties, including 2,913 minors as a result of the conflict. Although US President Biden has expressed scepticism as to whether the numbers indeed are that high, WHO and UN sources, say that the Hamas figures have usually been reliable, bearing up to post-war scrutiny.  The Hamas toll, however, does include some 471 people reported to have been killed in the explosion at Al Ahli Hospital, which French and US intelligence agree was an errant missile fired from Gaza. It also does not separate military from civilian deaths. 

Regardless, Palestinian casualties appear to now outpace the combined Gaza toll of all of its major conflicts with Israel since in 2008. And there is no doubt that Palestinian deaths far outpace the losses seen by Israel, which has lost 1,400 people, including 380 soldiers.   

And irregardless, Israel’s air raids on Gaza, some of the heaviest ever seen on an urban area anywhere in the world, have thrust average Palestinians deep into crisis – overcrowding hospitals, as well as schools and refugee centers. Israel also has called for the evacuation of most of northern Gaza, while it takes aim at the huge labyrinth of underground tunnels created by Hamas as refuge for its fighters and high-ranking officials. 

The fuel war 

Some Gaza facilities, like Nasser Hospital in Khan Yunis, now have solar power capacity – but PV cannot fill the energy gap left by fuel shortages.

Already two weeks ago, Gazan health officials warned that hospital fuel supplies would run out in days. Fuel is also  critical for powering Gaza’s desalinization plant to produce clean water, UN and relief workers stress, in light of the heavy salt-water encroachment and pollution of Gaza’s wells and underground aquifers. And it is essential to bakeries, producing bread, a critical staple food. 

As of this week, fuel reserves hadn’t yet entirely been exhausted. On Monday, WHO reported its delivery of  34,000 liters of fuel to ambulance services and four major hospitals in southern Gaza.  But “this is only enough to keep ambulances and critical hospital functions running for a little over 24 hours,” WHO warned. 

Meanwhile, Hamas has continued to strike out against southern and central Israel, hitting homes in the city of Rishon Le Zion Wednesday night, and at Tel Aviv on Thursday, even if the pace of attacks was slackening noticeably from as hundreds of rockets a day, fired at the beginning of the incursion. to around 100 a day.  Precisely because of that, Israel remains adamant about allowing fuel convoys  into Gaza – which they say could be filched by Hamas.  

In the past few years, more Gazan hospitals have also been fitted with large PV rooftop solar installations, as part of a major initiative by UNDP, as well as WHO and bilateral donors – to cope with chronic interruptions in electricity grid supply that were a problem even before the war. But PV solar capacity is still under development, and clearly cannot meet the needs of flooded hospitals now. Moreover, one of the hospitals with one of the biggest and newest PV installations, the Palestinian Red Crescent’s Al Quds Hospital, is located in the northern Gaza strip, which Israel has called to evacuate. 

–Updated Friday 27.10.2023 with further details of the death toll in Gaza, as reported by the Hamas-controlled government.

Image Credits: E. Fletcher , © UN Photo/Eskinder Debebe, E. Fletcher/HPW, WHO/Eastern Mediterranean Region , Care International , UNRWA, WHO, 2019.

A new report by the United Nations University warns that climate change is a major factor in pushing the world towards multiple tipping points, which will cause rapid and fundamental change to the planet.

Human activity is pushing the world towards multiple tipping points that will cause rapid and fundamental change to the planet, according to a new report by the United Nations University Institute for Environment and Human Security (UNU-EHS).

The Interconnected Disaster Risks report, released on Wednesday, identifies six key tipping points: accelerating extinctions, groundwater depletion, mountain glacier melting, space debris, unbearable heat, and an uninsurable future.

These tipping points are defined in the report as the moment at which a given system is no longer able to buffer risks and provide its expected functions. 

Once a tipping point is reached, it is irreversible and can lead to cascading failures of other systems. For example, the loss of mountain glaciers could lead to water shortages and mass migration, while unbearable heat could make some areas uninhabitable.

The report also highlights the interconnectedness of the tipping points, warning that they could trigger each other in a vicious cycle. For example, the loss of biodiversity could make ecosystems more vulnerable to climate change, which could lead to more extreme weather events and further biodiversity loss.

Running out of time

The report’s authors say that humanity is running out of time to avert disaster. They call for urgent action to reduce greenhouse gas emissions and protect ecosystems.

“These tipping points have either passed or are about to happen,” said Dr Jack O’Connor, lead author of the report and a senior export at UNU-EHS. 

“Depending on where you are in the world, you might have a little bit more time,” said O’Connor. “But you should be looking at what is happening in other places of the world because we are all interconnected, and the impacts of tipping points passing in other places will eventually affect you.” 

The report comes a month before representatives from all countries will meet at the annual UN Climate Conference, COP28, in Dubai.

Chain reactions are already underway 

Extinctions are already happening at an alarming rate. Animals are running out of places to feed and reproduce as humans take over more and more land, while climate change is making it harder for threatened species to survive. This loss of biodiversity is increasing the risk of a chain reaction of extinctions, which could have devastating consequences for ecosystems and human societies alike.

“Recent research has shown that the way that ecological networks have formed means that as we lose biodiversity, we increase the risk of this chain reaction of extinctions in an ecosystem,” said O’Connor. “Extinctions could accelerate at a much faster rate in the future.”

Depleting groundwater is another major tipping point that is already having real-world impacts, threatening food security in many parts of the world. Groundwater is essential for agriculture, providing a reliable source of water during droughts and other periods of water scarcity. 

Yet, in many parts of the world, groundwater is being extracted faster than it can be replenished. This is due to a combination of factors, including population growth, climate change, and unsustainable agricultural practices. 

Farmers who are already facing the vagaries of fluctuating rainfall can no longer rely on groundwater to make up the shortfall. Some countries, such as Saudi Arabia, have already surpassed the groundwater risk tipping point, while others, like India, are not far behind.

Impacts of today in the future

Rising space debris is becoming a major issue as more and more satellites are launched into low Earth orbit (LEO), the region of space closest to Earth that is already crowded with satellites. By 2030, as many as 100,000 satellites could be in orbit, posing a significant risk to other spacecraft and missions. 

“Communities and individuals can influence the other tipping points on the list … [but] I think this is the one where individuals probably have the least agency,” said Dr Zita Sebesvari, another lead author of the report and deputy director of UNU-EHS.

New research from the University of British Columbia’s Outer Space Institute echoes Sebesvari’s concerns, estimating that as many as one million satellites may be headed into orbit.

“By treating orbital space as an unlimited resource, humanity is creating serious safety and long-term sustainability challenges to the use of low Earth orbit (LEO), including science conducted from space and the ground,” the study said.

“If even a portion of these million satellites are actually launched, national and international rules will be needed to address the associated sustainability challenges, like collision risks, light pollution, and reentry risks,” Andrew Falle, lead author of the study, told Space.com.

Transformative change needed

The report provides two categories of solutions for each of the problems: avoid solutions and adapt solutions. Avoid solutions target the root drivers of the tipping points, while adapt solutions help prepare for or better address the negative impacts.

In the case of unbearable heat, the report suggests halting greenhouse gas emissions and driving society towards low-carbon ways of living as an avoid solution. An adapt solution would be to help install more air conditioners in places that need them the most.

The report emphasizes that current solutions are only working to delay the onset of the tipping points, not to avoid them altogether. While some work is being done on transformative solutions, these need to be scaled up significantly, the authors say.

“Real transformative change involves everyone,” Sebesvari said. “The report serves as a timely reminder before the UN Climate Conference that we must all be part of the solution.”

Two girls sit together after receiving their HPV vaccinations at their primary school in Masaka, Rwanda. Young girls who receive HPV vaccines can hope for a future free of cervical cancer. / Credit: UNICEF

Nigeria, Africa’s most populous country has introduced the human papillomavirus (HPV) vaccine into its routine immunization system, aiming to reach 7.7 million girls – in the continent’s largest-ever vaccination drive against the virus that causes nearly all cases of cervical cancer. 

Girls aged 9–14 years will receive a single dose of the vaccine, which is highly effective in preventing infection with HPV types 16 and 18 that cause at least 70% of cervical cancers,  WHO and Nigerian health ministry officials announced on Tuesday. 

Africa is one of the regions with the largest burden of cervical cancer deaths, due to a dearth of prevention, screening and treatment services.

In 2020 – the latest year for which data is available – Nigeria recorded 12,000 new cervical cancer cases and 8,000 deaths, making it the third most common cancer and the second most frequent cause of cancer deaths among women aged between 15 and 44 years.

“The loss of about 8,000 Nigerian women yearly from a disease that is preventable is completely unacceptable,” said Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare. 

“Cervical cancer is mostly caused by HPV, and parents can avoid physical and financial pain by protecting their children with a single dose of the vaccine. 

In November 2020, the WHO launched the “90/70/90” global initiative to eliminate cervical cancer as a public health problem. The strategy aims to vaccinate at least 90% of girls against HPV by the age of 15 years; screen 70% of women by age 35; and treat at least 90% of identified precancerous lesions and invasive cancers. 

Still, nearly half of LMICs have been unable to introduce HPV vaccinations, as many countries cannot still afford the vaccine at the $4,50 per dose procurement price negotiated by global health agencies, according to a 2023 article in BMC Public Health. 

Rwanda was the first sub-Saharan African country to introduce HPV vaccination in 2011. Uptake since has been slow with only a few other African countries integrating the vaccine into their routine basket of services, peaking in 2019 with six new countries: The Gambia, Liberia, Côte d’Ivoire, Kenya, Malawi and Zambia.  

UNICEF has recently launched a major initiative to bolster HPV immunization. In 2023, the agency is supplying some 36 million vaccine doses to 52 low- and middle-income countries worldwide. Some two dozen African countries have received some form of support for HPV vaccinations, whether or not they are yet integrated into the routine basket of immunizations. 

Image Credits: UNICEF.

“The transition to clean energy is happening worldwide and it’s unstoppable,” said IEA Executive Director Fatih Birol.

The International Energy Agency (IEA) has projected that global demand for oil, coal, and gas will peak by 2030, but that demand for fossil fuels is set to remain “far too high” to keep the Paris Agreement Target of 1.5C within reach.

The IEA now says that the transition to clean energy is happening worldwide and is “unstoppable”, according to its annual World Energy Outlook report, released on Tuesday. It credits the record growth of key clean energy technologies, such as solar PV and electric cars, for this shift.

“It’s not a question of ‘if’, it’s just a matter of ‘how soon’ – and the sooner the better for all of us,” said IEA Executive Director Fatih Birol. “Taking into account the ongoing strains and volatility in traditional energy markets today claims that oil and gas represent safe or secure choices for the world’s energy and climate future look weaker than ever.”

The IEA predicts a surge in renewable technologies will underpin this green transformation of the global economy. By 2030, renewable energies such as solar, wind, and hydropower could provide nearly 50% of the global electricity mix, up from around 30% today. The number of electric cars on roads worldwide is projected to increase 10-fold.

“Peak” does not mean “decline”

The IEA projects that oil and gas demand will remain constant until at least 2050, as consumption increases in developing economies and decreases in advanced economies

For the first time in over 150 years, the global economy is poised to reach peak demand for fossil fuels – but charts in the IEA report show that “peak” does not mean “decline”.

While demand for coal – the dirtiest fossil fuel of which 55% is already sold at below market rates globally – will drop off sharply after 2030, demand for natural gas and oil will remain around 2030 “peak” levels until at least 2050. The IEA projects oil and gas demand will be buoyed by increases in consumption in developing economies which will offset expected decreases in advanced economies. 

The IEA also warns that governments are not doing enough to support the transition to clean energy. It recognized investments in fossil fuels will remain “essential” to keep the global energy mix balanced, but said that investments in fossil fuels are currently too high. Global fossil fuel subsidies surged to a record $7 trillion in 2022. 

“As things stand, demand for fossil fuels is set to remain far too high to keep within reach the Paris Agreement goal of limiting the rise in average global temperatures to 1.5C,” the report said. “This risks not only worsening climate impacts after a year of record-breaking heat, but also undermining the security of the energy system, which was built for a cooler world with less extreme weather events.”

Projections at the mercy of political shifts on green energy

Three times as much investment will go into new offshore wind projects than into new coal- and gas-fired power plants by 2030, the IEA projects.

The IEA’s assessment is based on current policies already implemented by governments and could change – for better or for worse – depending on whether governments backtrack or double down on major climate pledges. 

Former US President Donald Trump has already signalled he will try to repeal the Inflation Reduction Act, the largest package of green investment in US history, if re-elected in 2024. UK Prime Minister Rishi Sunak has also made a habit of backtracking on his country’s net-zero pledges, pushing ahead with plans to “max out” the UK’s fossil fuel reserves.

China, the world’s largest consumer of fossil fuels, is also a key factor. The country accounts for half the world’s coal use and has driven two-thirds of the growth in global oil demand over the past decade. China’s commitment to harnessing its green energy dominance to reshape its dependence on fossil fuels is essential to the IEA’s projections.

The fossil fuel industry has different ideas

Oil cartel OPEC supplies over half of the world’s oil and controls over 80$ of proven oil reserves.

The IEA assessment is in stark contrast to the views of the fossil fuel industry, which has long insisted that oil and gas will continue to play a major role in the global energy mix. The Organization of the Petroleum Exporting Countries (OPEC), the global oil cartel that supplies 51% of the world’s oil and controls 81% of proven oil reserves, said in its annual report earlier this month that it expects oil demand to increase by 17% by 2045.

The OPEC report called for expectations of what green energy can deliver to be more “pragmatic and realistic”, reflecting language used by the United Arab Emirates presidency ahead of the upcoming Un Climate Conference in Dubai, which will kick off in late November.

OPEC Secretary General and Kuwaiti oil executive Haitham Al Ghais wrote in the foreword of the report: “Calls to stop investments in new oil projects are misguided and could lead to energy and economic chaos.”

The bullish projections of OPEC are shared by American fossil fuel giants ExxonMobil and Chevron, who both announced plans to buy smaller shale producers in the United States a combined total of over $100 billion.

The International Energy Agency (IEA) has a mixed track record in forecasting fossil fuel demand. In 2016, the agency incorrectly predicted that China’s coal demand had peaked, while it had previously underestimated the rapid growth of renewable energy sources such as solar power.

Thousands of aid trucks are waiting to enter the Rafah crossing

A third convoy of 20 aid trucks with food, water and medical aid entered Gaza on Monday via Egypt’s Rafah crossing, in line with a  reported US-Israeli deal Sunday evening to keep desperately needed humanitarian aid flowing to the war-torn enclave. But no fuel has been allowed into the territory, and hospital generators are expected to run out by Wednesday, according to relief agencies.  

Israel is blocking fuel from entering Gaza as it claims Hamas will hijack fuel supplies to continue its missile attacks on Israeli cities, ongoing since the 7 October surprise incursion by Hamas gunmen into 22 Israeli communities, killing more than 1300 people, mostly civilians.  Israel has since cut off Gaza’s access to water and electricity from its grid, and bombarded the enclave at an unprecedented level of intensity.   

Now, the lives of Palestinian patients – including 130 premature babies dependent on hospital incubators – are at risk as fuel runs out, according to the UN Office for the Coordination of Humanitarian Affairs in the occupied Palestinian Territory.  Gaza’s desalinization plant is also dependent on fuel supplies to backup generators to produce clean water, since Israel cut off access to its electricity grid.  

Dr Tamer Al-Shaer, head of shelters in southern Gaza for the United Nations Relief Agency for Palestine (UNRWA), described the situation as “catastrophic” on Monday.

Nearly 420,000 people are sheltering in 93 UNRWA shelters in Middle, Khan Younis and Rafah areas, an increase of 14,000 (3.5%) in the past 24 hours, the UNRWA reported late Monday. 

This includes 3190 pregnant women and 18,000 with chronic conditions who need medical support, said al-Shaer.

Shelters are operating at 2.57 times their designated capacity, according to the relief agency.

Over 5,000 people have been killed in Gaza in the past two weeks, 40% of whom are children, according to Gaza’s Ministry of Health.

Meanwhile, UNRWA reported on Monday that 35 of its staff have been killed in Gaza since 7 October when Hamas first attacked Israel, unleashing an aerial bombardment of the territory by Israel in response.

The entry of the third convoy of trucks Monday means that 54 aid trucks have so far entered the territory from Egypt, in line with a deal on humanitarian aid reached with Israel during US President Joe Biden’s recent visit. But this is a drop in the ocean of need for an estimated 1.6 million Palestinians who are trapped and unable to leave the territory, UN officials say.

Before the 7 October conflict, 100 trucks delivered aid to the territory every day as almost a third of Gaza residents were food insecure even then.  

Five United Nations (UN) agencies, including the World Health Organization (WHO) and UNICEF, warned over the weekend that water production was at 5% of normal levels, food was running out and hospitals were overwhelmed with casualties.

“With so much civilian infrastructure in Gaza damaged or destroyed in nearly two weeks of constant bombings, including shelters, health facilities, water, sanitation, and electrical systems, time is running out before mortality rates could skyrocket due to disease outbreaks and lack of health-care capacity.

“We call for a humanitarian ceasefire, along with immediate, unrestricted humanitarian access throughout Gaza to allow humanitarian actors to reach civilians in need, save lives and prevent further human suffering. Flows of humanitarian aid must be at scale and sustained, and allow all Gazans to preserve their dignity,” said the statement, which made no reference to the fate of over 200 Israeli hostages held by Hamas along with foreign students and workers.

Meanwhile two more Israeli hostages, Nurit Cooper, 79 and Yocheved Lifshitz, 85, were released late Monday night to the Red Cross making four hostages to be freed over the past four days. They were among the 222 people originally seized, including young children and older people, during the 7 October deadly rampage by Hamas gunmen in 22 Israeli communities near Gaza. 

There has meanwhile been an escalation in violence in the West Bank. Some 95 people have reportedly been killed, mainly in confrontations between armed Palestinians and Israeli troops, but also in clashes with Israeli settlers. On Sunday, an Israeli airstrike hit al-Ansar Mosque inside Jenin Refugee Camp, according to UNRWA. Israeli said it was targeting a Hamas and Islamic Jihad compound under the mosque being used to organize an imminent attack, a claim that could not be independently verified. 

-Updated 24.10 with news of the latest hostage releases

Image Credits: Eskinder Debebe/ UN.

Dr Gaya Gamhewage, WHO Director of the Prevention of and Response to Sexual Misconduct (PRS) team and Lisa McClennon, Director of the WHO Office of Internal Oversight Services.

The vast majority of sexual misconduct complaints have been made in the World Health Organization’s (WHO) Africa region, while the majority of abusive conduct complaints originate in the Eastern Mediterranean Region (EMRO), which comprises mainly of countries in North Africa and the Middle East.

This is according to the WHO’s dashboard on investigations into sexual misconduct.

Abusive conduct refers to all misconduct, excluding sexual exploitation, abuse and harassment (for example, discrimination and bullying).

Acknowledging that “culture change” is hard, Dr Gaya Gamhewage, WHO Director of the Prevention of and Response to Sexual Misconduct (PRS) team said that “more personnel are speaking up” and the number of allegations and disciplinary action was increasing.

Soon every duty station and every person who works with and for the WHO will understand how to prevent and respond to sexual misconduct, Gamhewage told a media briefing on Monday.

Describing the WHO’s accountability framework as “the most detailed” across UN agencies, Gamhewage said that “everyone who works with or for WHO, including senior leadership all the way up to the Director General, now has very distinct accountabilities for both preventing and responding to sexual misconduct”. 

“It’s intended to clarify for every member of the organisation, from me to the driver in Malawi, their individual accountabilities for both prevention and response,” she told a media briefing on Monday.

Every country office is also obliged to run a risk assessment for sexual misconduct and come up with a mitigation plan.

“That’s how we can be sure that we quantify and qualify the risks of sexual misconduct at every single duty station. So the mitigation plans are important and they have to be suited to each context. So far this year, nearly 40 countries have completed this and this allows us really to be targeted and contextualised in our work,” said Gamhewge.

Lisa McClennon, the newly appointed director of the WHO’s Office of Internal Oversight Services (IOS), reported that the investigative team has received 287 allegations of sexual misconduct, of which 120 have been investigated and 38 have been substantiated so far. 

“Since 2021, we have entered the names of 25 alleged perpetrators of sexual misconduct into the UN Clear Check database to prevent future employment within the UN system,” added McClennon.

Open-door sessions

To encourage openness, Gamhewge said she was hosting monthly “open-door virtual sessions” and monthly workforce surveys of the workforce. 

Almost 10,000 people have taken part in PRS webinars and open-door sessions this year, and more than 60,000 others have taken their courses and training. 

“I’ve personally met with nearly 200 of our 407 Country focal points. We openly talk about issues. We address concerns staff have and staff are proposing ideas for our culture to change so that, not only do we respond, but we prevent sexual misconduct from happening in the first place. “

The PRS will host a stakeholder review at the end of November to “further calibrate the actions we need to take, going into year two [of the WHO’s  three-year 

“The global event will focus on acknowledging and identifying best practices for addressing sexual misconduct across the system and looking at the joint challenges that we all continue to face,” she added.

A man with diabetes checking his blood sugar level with a glucometer

World Health Organization (WHO) member states should include personal-use glucose monitoring devices in their vitro diagnostics (IVD) lists to help people with diabetes, according to the global body’s 2023 Essential Diagnostics List (EDL) released this week.

Diabetes caused 1.5 million deaths in 2019, and including personal glucose testing devices “could lead to better disease management and reduced negative outcomes”, said the WHO.

Another first for the list is the inclusion of three tests for hepatitis E virus (HEV), including a rapid test to aid in the diagnosis and surveillance of HEV infection, an under-reported disease which causes acute liver failure in a small number of people.

The list offers guidance rather than being prescriptive, with the aim of increasing patients’  access to diagnostics and better outcomes.

“The WHO Essential Diagnostics List is a critical tool that gives countries evidence-based recommendations to guide local decisions to ensure the most important and reliable diagnostics are available to health workers and patients,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

Other new tests added to the list include those for endocrine disorders, reproductive, maternal and new-born health and cardiovascular health:

The recent World Health Assembly  resolution on strengthening diagnostics capacity urges member states to consider the development of national essential diagnostics lists, adapting the WHO model list of essential in vitro diagnostics.  

Regulatory considerations for AI

The WHO also raised issues for consideration when regulating artificial intelligence (AI) for health this week.

With the increasing availability of health care data and the rapid progress in analytic techniques – whether machine learning, logic-based or statistical – AI tools could transform the health sector. 

WHO emphasizes the importance of establishing AI systems’ safety and effectiveness, rapidly making appropriate systems available to those who need them, and fostering dialogue among stakeholders, including developers, regulators, manufacturers, health workers, and patients.

“Artificial intelligence holds great promise for health, but also comes with serious challenges, including unethical data collection, cybersecurity threats and amplifying biases or misinformation,” said Dr Tedros.

“This new guidance will support countries to regulate AI effectively, to harness its potential, whether in treating cancer or detecting tuberculosis, while minimising the risks.” 

In response to growing country needs to responsibly manage the rapid rise of AI health technologies, the publication outlines six areas for regulation of AI for health:

  • transparency and documentation, such as through documenting the entire product lifecycle and tracking development processes.
  • risk management, including addressing issues including human interventions, training models and cybersecurity threats
  • externally validating data and being clear about the intended use of AI
  • commitment to data quality,
  • understanding the scope of jurisdiction and consent requirements, in service of privacy and data protection.
  • fostering collaboration between regulatory bodies, patients, healthcare professionals, industry representatives, and government partners.

 

Image Credits: Dischem.

Pollution levels are rising in India’s capital, Delhi.

There have been some gains in the past decade, but peak pollution is still 30 times WHO’s safe limit. Top Delhi government advisor Reena Gupta speaks with Health Policy Watch about progress and obstacles.

Come October and millions of people in and around Delhi brace for a sharp rise in pollution in the last quarter of the year and on cue, the level of PM 2.5, a critical microscopic air pollutant that is usually the best measure of air quality, has already tripled from a month earlier. 

It’s been 10 years since the World Health Organization (WHO) deemed the city to be the most polluted in the world – even worse than Beijing whose air was notorious at the time. 

Although there has been progress, Delhi is still often labelled as the most polluted capital in the world. Back then, the annual average of PM 2.5 was 149 micrograms per cubic metre. Now it’s about 100, an improvement of a third. But between October and December 2022, the average was almost 160, which is over 30 times the WHO’s safe limit. This year could be worse, experts warn.

Reena Gupta, the national spokesperson of Delhi’s governing party, Aam Aadmi Party.

To understand why pollution is still so bad, Health Policy Watch spoke with Reena Gupta, the national spokesperson of Delhi’s governing party, Aam Aadmi Party (‘common person’s party’). She represented the state government at the United Nations (UN) Climate Week in mid-September in New York and has previously worked at the World Bank as a Natural Resource Management Specialist. As a top advisor to the government on environmental and air pollution matters, she recently held a meeting with experts and civil society representatives. 

Dirty industries shift out of Delhi’s jurisdiction

Delhi is doing its bit, according to Gupta – even at the cost of losing revenue to reduce pollution. She cites a recent study which shows only about a third of the pollution sources are within the megacity’s boundary. 

“In Delhi, we have converted all the industry to clean (sic) and natural gas. Why has that not happened in Gurgaon and Ghaziabad [which border Delhi]?

“Also what has happened is, because we are so strict in the industrial areas of Delhi, the industries actually move to Gurgaon and Ghaziabad. They move just outside Delhi because they want to be outside the control of Delhi Pollution Control Board and they set it up on the outskirts of Delhi and continue to pollute the air shed of Delhi. So we lost the revenue but our airshed didn’t get cleaned.”

The responsibility for cleaning the air in Delhi and its neighbouring areas rests with a statutory body called the Commission for Air Quality Management (CAQM). It is headed by a retired bureaucrat and has the authority to direct over a hundred officials, including police across this vast region with a population of over 70 million.

“It’s a bureaucratic body,” says Gupta, who describes it as “very ineffective”.

“You don’t have any politicians there. The people in CAQM will continue to draw their salaries whether the air pollution improves or doesn’t improve. However, if you had a body where you had ministers who were accountable to the people, then you would see more action.” 

Gupta advocates for an air quality centre that is parallel to India’s Goods and Services Tax (GST) Council, where the centre can play the leading political role. 

Led by India’s finance minister, the GST Council includes finance ministers from the states and meets frequently to jointly administer the landmark regime which helped unify India as a single market for most goods and services. 

The council’s work may have its critics but its continued existence is seen as an example of how India’s federal structure can work in an otherwise very divisive political landscape. 

“In the GST Council, at least you have all the finance ministers and everybody comes and gives their opinion because they know that they have to go back and be accountable to the people. CAQM is not accountable to anybody,” AAP’s national spokesperson says. The AAP and the Bharatiya Janata Party (BJP) , Prime Minister Modi’s party, are bitter political rivals. 

Another alternative for the centre, she says, is to do what China did – incentivise city authorities. 

“In China you had these regional bodies which set targets for cities and for so, for example, the Central government was to tell Delhi, Gurgaon, Noida, Ghaziabad, any cities that it thinks of, to reduce your PM2.5 by 10% in the next two to three years and an additional 1,000 crore rupees (10 billion rupees) can be given from an environment fund.”

‘Can’t shut schools, can’t cut Metro fares’

There are questions over the Delhi government’s own strategy to speedily reduce air pollution in its jurisdiction. 

Why, for instance, aren’t schools closed when air pollution turns hazardous? Children can be seen walking into school when PM 2.5 levels are well over 100-200 micrograms. This toxic pollutant is linked to inhibiting the development of young lungs and cognition apart from causing respiratory diseases. 

Why aren’t fares to the metro train service slashed specially during high pollution times? This could incentivise many to move away from private vehicles as vehicular pollution is significant – contributing around 41% of air pol;ution, according to one study.

But Gupta says her government doesn’t have the authority to cut fares even though they wanted to. 

“The Metro right now is very, very expensive for people, for 70% of the population of Delhi. So we wanted to decrease the metro fares. That was rejected by the Central government. Because of Delhi’s complicated structure, some of these reforms are very difficult for us to implement.” 

Delhi is a union territory not a state and, as such, the Central government, led by the rival BJP, has overriding powers over Delhi despite the city having its own elected legislature and government.

If cutting metro fares is out, so is closing schools. Gupta explains this doesn’t make sense because most of the kids – 70-80% she reckons – live in “one-room” houses. 

“Those parents want the kids to come to school because their argument is that it’s not as if at home they have air purifiers, it’s not as if at home they have any better air quality. So they would rather have their children in school. Whereas the rich of the city probably feel that their kids are more protected at home and sitting with air purifiers. And as a government we found that there is not that much of a difference in terms of the air quality at homes or in schools.”

Private vehicles priority over public transit?

There are, however, deeper questions about AAP’s focus on public transit. For decades better public transit has been linked to air quality. AAP has been continuously in power in Delhi since 2015 and boasts of constructing 27 new flyovers and widening roads. The city now has the most road space in its land use plan amongst Indian cities. 

Yet it has been slow in adding buses despite a Supreme Court order, made in 1998, for 10,000 more buses to purchased to improve air quality. Twenty-five years later,  the population has grown and some estimate over 20,000 buses are now needed. 

 Currently, although there’s a plan to rapidly add more electric buses, there are still fewer than 8,000 buses for the entire city of almost 33 million residents. 

Gupta, however, denies that her government’s priorities are misplaced. 

“I disagree. The focus is on public transport. The focus is on increasing the metro connectivity, the focus is on increasing the last mile connectivity because unless we improve that, we will not be able to get the rich people to leave their cars.” 

She blames the opposition for complaining about the procurement which delayed the process. 

Too many plans, too many cooks?

The capital’s air crisis invariably makes the headlines this time of year, and often draws the attention of India’s top court and recently even the Prime Minister’s Office. 

Delhi Chief Minister Arvind Kejriwal, announced a 15-point programme to reduce air pollution in the capital. Some involve direct action against pollution sources, such as monitoring over a dozen “hotspots” and deploying 600 teams to stop the burning of garbage. 

There is also an app where the public can post complaints and a “war room” set up by the government. However, experts point out, enough isn’t being done to actually stop sources of pollution. 

Some of the other measures raise questions of implementation and impact. The plan includes planting ten million saplings, although the ideal time do so was a few months ago mid-monsoon; a ban on fireworks, which has repeatedly failed in the past couple of years; hundreds of ‘smog guns’ and sprinklers to spray water in a bid to suppress pollutants, the efficacy of which has been questioned; almost 400 teams to check pollution-under-control certificates (PUCs) for vehicles, but this doesn’t check for PM 2.5 even though vehicles can contribute to about a third or more of Delhi’s PM 2.5 pollution. 

Apart from the state government, there is also central government’s Graded Response Action Plan (GRAP) overseen by the CAQM. Each time the Indian air quality index deteriorates and crosses certain benchmarks, the CAQM orders tighter controls. For example, ‘GRAP 1’ is implemented when the air quality index (AQI) crosses 201. 

GRAP has been a dynamic programme although further studies are needed to show whether this is conclusively reducing pollution. 

For the last two years it’s been implemented since 1 October, perhaps to have protocols in place for quicker reaction as pollution spikes from mid-October. This is when multiple factors – including cooler temperatures and low wind speed which trap pollutants, crop stubble being burnt and festive firecrackers – make the air extremely hazardous to breathe. 

Several studies have linked even short term exposures to PM 2.5 pollutants to strokes, heart attacks and respiratory problems. Incidentally most of the stubble fires that affect Delhi are in Punjab, where Gupta’s party is in power. The state promised to halve the number of fires compared to last year but at the time of writing this the number had already exceeded last year’s count.

Significant changes

A significant change has been to base action on Air Quality Index (AQI) forecasts in Delhi rather than waiting for pollution to worsen and then take action. 

Other changes this year included a complete ban on diesel generators – only for this to be eased two days before imposition; a ban on burning coal and firewood in all restaurants, at the very first stage of GRAP unlike earlier; “strict restrictions” for the first time on certain types of vehicles operating on old fuel standards (which largely follow the Euro standards.) 

For all the political tension between the AAP and the BJP,  there is commonality in their pollution-control plans. Both back the ban on firecrackers, both press for planting more trees and drivers turning off vehicles at a stop light. Neither explicitly links the closure of schools to rising pollution but tacitly permits this when the pollution hits the “Severe” or “Severe +” benchmarks, levels that are extremely high even by Delhi’s poor record. 

Fireworks ban a mega-fail

The firecracker ban, specially during Diwali but also in other festive occasions, has failed repeatedly, despite having the official concurrence of the central and state governments, the Supreme Court and even the city police. 

“The regional issue comes into play, right? You have a firecracker ban in Delhi but you don’t have a ban in (next-door) Noida, how is it going to be effective?” asks Gupta.

“If the crackers are sold, people will buy and they will burst it. So I think in this also, we as citizens need to take ownership. How many policemen can you actually have on the ground that day to say that crackers should not be burnt?”

Banning firecrackers on Diwali also tends to be politically contentious. The BJP protested that this can hurt “religious sentiments” but their protest was overruled by the Supreme Court. 

No help for poor migrants burning biomass to cook

AAP’s Gupta points out another source of pollution: impoverished migrants coming to Delhi for better prospects, and burning biomass to cook food. 

“Some of the surveys that we did showed us that, because of poverty rates going up, a lot of migration is happening to Delhi right now,” said Gupta.

“So we looked into this whole idea that is it possible for the Delhi government at least to give subsidised (cooking gas) cylinders to some of our people who are living in the slums. We went very deep into it, but it would have been very difficult to implement because it would have been almost impossible to figure out who is a resident of Delhi and operationally it would have been very difficult. So we gave up that idea.”