Health
How can the
threat of new and reemerging diseases and immune microorganisms be reduced?
[Challenge8]
Status of Women
How can the changing
status of women help improve the human condition? [Challenge11]
-- Brief overview --
Although the rate of population growth continues to slow and the efficiencies in resource deliveries from energy to food will increase, the sheer rising numbers of people and their demands will be difficult to meet over the next 50 years. People are living longer and are increasingly urban, and our numbers are growing fastest where people can least afford the necessities of life. The current population of 6.3 billion is forecasted to grow to 8.9 billion by 2050, 98% of whom are expected to live in the poorer countries. Almost 40% of the world lives in either China or India, where industrial growth is accelerating the use of resources and impacts on the environment. Nearly half the world lives in cities on 2% of the land, consuming about 75% of the resources and producing about the same percent of the pollution. About 3% of the world’s population are migrants.
Natural resources to support all this growth are shrinking. The UN Environment Programme estimates that nature’s current value to the global economy is about $36 trillion a year and that 40% of the economy of the developing world is directly based on biodiversity, yet these assets are being destroyed.
More than 1 billion people live in slums and squatter communities, 25 countries are facing food emergencies, and about one out of every three children under five (150 million) is malnourished. The urban population is growing at 60 million a year: in one generation, nearly 3 billion city dwellers will grow to 5 billion, making urbanization one of the most powerful trends today. There are 19 cities with 10 million or more people; by 2015 there could be 26 such megacities. Sufficient nutrition, shelter, water, and sanitation will have to reach people, or increased migrations, conflicts, and disease seem inevitable.
The UN estimates that by 2050 there will be more people over 60 than
children under 15. The number of people who are 60 or older is expected
to quadruple to 2 billion by 2050, putting stress on retirement and health
care systems worldwide, especially as life expectancy continues to increase
as medical and social advances are discovered. As of this year, no industrial
country has a fertility rate at or above the replacement level of 2.1 children
per woman. To reduce the economic burden on the younger generations, retirement
communities and individuals could experiment with Internet-based businesses
to earn income in the emerging knowledge economy.
The factors that reduced population growth in the developing world
still need to be reinforced. These include increased income, improved literacy,
diminished infant mortality, empowerment and education of women, urbanization,
improved and inexpensive contraceptives, and family planning.
FAO estimates that food production has to increase 60% over the next 20 years, irrigated land will have to increase by 22%, and water withdrawals by 14%. Better rain-fed agriculture and irrigation management, plus genetic engineering for higher-yielding, drought-tolerant crop varieties will be needed. Currently, agriculture uses 80% of arable land in developing countries, of which 20% is irrigated. Without serious water changes, 20% of developing countries will face water shortages within a generation, forcing mass migrations. The world demand for animal protein will accelerate as the middle class increases, triggering massive investments into genetically modified food, aquaculture, and stem cells for meat production. Water and energy strategies for the growing population are discussed in Challenges 2 and 13.
-- Brief oberview --
Rapid and unprecedented international cooperation to contain SARS in early 2003 constituted a step in the evolution of global systems necessary to address this question. However, silent, slower-acting diseases like HIV/AIDS have not generated the same systemic response. Over the past 30 years, AIDS has killed 22 million people. Today 42 million are living with HIV/AIDS. During 2002, 5 million more people were infected and 3.1 million people died of AIDS. Although AIDS is the leading cause of death in sub-Saharan Africa, it is now spreading more rapidly in Eastern Europe and Central/Southern Asia. The yearly cost of antiretroviral medicine available to some in developing countries has fallen to $500–700 per person, but Brazil uses a quarter of its budget to produce nelfinavir domestically and give it free to its citizens. Meanwhile, bioterrorism is emerging as a threat on a par with nuclear war.
Infectious diseases cause about 30% of deaths worldwide. In the last 20 years, more than 30 new and highly infectious diseases have been identified, such as Ebola, AIDS, and SARS; for many there is no treatment, cure, or vaccine. Furthermore, 20 known strains of diseases such as tuberculosis and malaria have developed resistance to antibiotics due to the widespread use and misuse of these drugs. And old diseases such as cholera, plague, dengue fever, meningitis, hemorrhagic fever, diphtheria, and yellow fever have reappeared as public health threats after years of decline. Immunization rates are declining in low-income and middle-income countries.
These developments are compounded by factors such as the rapid increase in international air travel and large populations who are malnourished and undereducated, living in unhealthy conditions. The globalization of trade, as well as recent changes in the production, handling, and processing of food and breeder stock, has heightened the risk of food-borne diseases. Activities such as deforestation, tourism, conflict, climate change, and migration into remote habitats have increased exposure to disease.
The response to SARS has shown that even without a vaccine it is possible to control a disease by preventing infection through early detection and accurate reporting, prompt isolation of those infected, and quarantine of those they contacted. Governments should increase their support for the World Health Organization (WHO) network of collaborating laboratories to create a global surveillance system and a rapid international medical deployment capacity to respond to outbreaks of infectious disease, and they should also help expand WHO’s vaccines program. Governments and donors have pledged more than $2.1 billion to the Global Fund to Fight AIDS, Tuberculosis & Malaria. The recent genomic sequencing of both Anopheles gambiae, a mosquito vector, and the Plasmodium falciparum organism could lead to a vaccine and cure.
AIDS awareness programs will have to change sex norms. Women’s rights
programs related to AIDS should be expanded. Funding should be increased
for safe water supply, advanced generations of antibiotics, understanding
the relationship among disease, ecology, and genetics, and applications
for tele-medicine and tele-health. In the future, according to a 2002 article
in The Lancet, strategies that target global disease indicators (childhood
and maternal underweight, unsafe sex, high blood pressure, tobacco and
alcohol use) can provide substantial and underestimated public health gains.
-- Brief overview --
Improving the status of women could be one of the most cost-effective strategies for addressing the other challenges in this chapter. Research has shown that improving the status of women has resulted in a host of benefits not only for women but also for their children, families, and nations. Increasing women’s education and access to resources and training improves economic development. Educated women have fewer children, as they tend to marry later and use contraceptives more. Their children are also healthier. Not only is mothers’ education inversely related to child mortality, but gains in women’s education actually made the single largest contribution to declines in malnutrition in the period 1970–95. In addition, over the last 20 years women’s own mortality rates have dropped 50% worldwide.
Better educated mothers have better educated children; unfortunately, two-thirds of the world’s 876 million illiterate people age 15 and older are female. Although the gender gap in school enrollment rates is decreasing in many regions, girls still lag behind boys in many parts of South Asia and sub-Saharan Africa. The World Bank confirms that investing in girls and women is one of the soundest social and economic anti-poverty strategies.
While 173 nation-states have ratified the Convention on the Elimination of All Forms of Discrimination Against Women, progress in the area of gender equality has been slow and uneven. According to UNIFEM, 90% of the 1.3 billion people who live on less than $1 per day are women. Throughout most of the world, women earn on average two-thirds to three-fourths as much as men for the same work. In the majority of countries in Latin America and Asia, 50% or more of the female nonagricultural labor force is in the informal sector, where earnings and social protection are far less secure.
Meanwhile, violence against females between 15 and 44 years old causes more death and disability than cancer, malaria, traffic accidents, and even war. Some 90% of 20 million unsafe abortions occur each year in the Third World. Rates of HIV/AIDS infection among women are also rapidly increasing, with females now constituting the majority of new infections in the 15–24 age group.
Future strategies aimed at enhancing the status of women should include increasing the percentage of women legislators (currently about 15%), guaranteeing the legal rights of women, and raising gender awareness in all departments of the government. Women’s access to resources such as credit, land, technology, training, health care, and childcare programs must be improved, as legal changes may not be enough to enhance women’s status. This is of particular importance to rural, migrant, refugee, internally displaced, and disabled women. UN Secretary-General Kofi Annan has pointed out that “full equality for women means more than the accomplishment of statistical objectives: the culture has to change.” Such an effort includes educating men to fully respect women and also directly working with the media, which too often perpetuates harmful gender stereotypes. Although discussions about the changing role of women are increasing, it may be necessary to explore sanctions against governments that do not guarantee the rights of women.
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