The human problem on Earth

Anne Marie Chomat

BCG

StreptomycinSulfa

Vaccine

PCN

VaccinePCN

United States

“Biomedical interventions” vs. “The environment”

Significant variation WITHIN countries

Significant variation BETWEEN countries

HDR 2005

Achieving the MDGs ???

State of the world’s health

• 1/2 million/yr women die from pregnancy/childbirth (hemorrhage > infection > other causes)

• Child mortality = 9.2 million/yr (1/2 due to diarrheal illness, 2/3 from underlying malnutrition)

• 195 million children < 5 are stunted (1/3 developing world children)

• 1 billion people undernourished

• Malnutrition responsible for >36 million deaths/yr

• 0.8 billion without clean water access

• 2.5 billion without sanitation

• Land degradation, deforestation, falling water table levels, climate change, risk of decreasing crop productivity

UNICEF 2009FAO 2009

WHO 2009Von Glebmer 2010

Risk to cyclones, floods, earthquakes, landslides

Threat to human water security and biodiversity

Loss of annual net primary productivity 1991-2003Child Mortality

Prevalence of undernourished

Prevalence of people without sanitation

Poverty

Poor humanhealth

Poor environment

alhealth

Health solutions & unintended consequences

Malnutrition in Guatemala

Poor governan

ce

Fuel insecurity

Erosion

Malnutrition

Poor agricultur

e yields

Heavy rains

Flooding

Poor sanitation

Food insecurity

Land Overuse

Poverty

High fertility rate

Climate change

Droughts

↑morbidity

↑mortality

Free Market / Global Economy

Infections

↑ food/fuel

prices

Export/Import

pressures

↑cash crops

Altered livelihoods

↓subsistence

agriculture

Indigenous

ethnicity

Overpopulation

No education

Poor health care access

Difficult travel/transp

ort

Economic security

Water security

FarmingProduction

costsYields

Social capitalCommunity

cohesion

Physical securitySocial support

KnowledgeFood security

Nutrition status

New exposures to infectious diseases

Sanitation

VulnerabilitySusceptibility to illness/infection

Population pressures

LivelihoodsAccess to resources

ClimateEnvironment

GlobalizationLocal

economics

Health

Underlying health/illnessSocial determinants of

health(wealth, education, gender, age,

ethnicity, rural/urban)

Local governanceLocal resources

Local infrastructure

Determinants of health