Image edited, retrieved from Unsplash
Guest: Peter Furu
Introduction
In this interview, I am speaking with Peter Furu, my academic mentor, Associate Professor at Department of Public Health UCPH, course leader for the new “Planetary Health Dynamics” course and above all, a global health professional who has been working in the field for over 40 years.
While sharing the history of the ever-evolving global health landscape, Peter also emphasises the puzzles that still remain unresolved. Why are certain regions more vulnerable to climate disasters than others, and how can climate change effects result in more health inequity? Together, we explore how a planetary health approach could enhance our understanding of potential health risks for all living beings, as humanity is transcending the planetary boundaries.
You have been working as a global health professional for over 40 years. How have you seen the landscape changing in all these years? How did you experience the shift towards the approach of planetary health?
I have seen big changes in the health sector since I started, back in the early 80s. Disease control programs focused on a vertical disease approach, which means focusing on one disease at a time. I was employed doing disease control for the National Schistosomiasis Control Program in Mali, back in 1983-1984, which was very vertical. In the same area, there were similar, separate programs for malaria and other vector-borne diseases.
Later, healthcare workers realised that more integrated and intersectoral approaches to disease control should be prioritised. From this derived a more holistic approach of health, coined ‘Eco Health’, later supplemented by ‘One Health’. Through these new approaches, professionals were trying to cross disciplines and sectors. One Health paved the way towards Planetary Health which was officially established as a new health concept and movement in 2015.
So yes, I have definitely seen changes over the past 40 years.
What was your initial reaction to these new developments in the field?
Well, I thought it made a lot of sense. When I worked together with the World Health Organization, we saw how important it was to break down walls between different sectors, thereby allowing intersectoral collaboration for health.
We tried to convey the message that health is not only the responsibility of the health sector. It is a joint responsibility across all sectors. Ill health does not originate within the health sector. Instead, disease or injuries arise in other sectors, which perform unhealthy and unsafe practices. For example, harmful working conditions or polluted natural environments result in bad health outcomes.
So, all of these newer terms managed to create bridges between different sectors. I’m hearing a lot of different concepts: Eco Health, One health, Planetary Health. Is Global Health a field in constant transition or should we view different health themes through differently categorised lenses?
I see planetary health more like an umbrella, which reaches above and includes the other approaches and concepts.
In the beginning, I felt that it was somehow confusing to suddenly introduce a new concept [in the classroom]. First, I had to introduce Ecohealth and One Health, and now Planetary Health. However, I feel that viewing health through systems, the Planetary Health approach, makes a lot of sense. We have to review natural systems, and the way they interact with human systems, to fully grasp the complexity of health and disease .
I see it as a positive development that new concepts are evolving. We are realising now more than ever that the planet Earth is also like a “patient”, who needs treatment and care.
I mean, in public health and in medicine, we deal with vulnerable groups and patients, right? But the planet itself suffers. The planet is ill. That’s why we have to treat this patient as well. To me, it makes sense to talk about planetary health. It creates an understanding of how much people really depend on the state of the environment and the planet.
When we are speaking of planetary health, we often talk about climate change and its adverse health outcomes. Which health impacts are you particularly concerned about in the context of climate change?
Well, there are so many potential impacts of climate change on health, it’s difficult to choose one thing I am particularly concerned about.
For over 40 years, I have worked with vector-borne diseases, and they are very sensitive to climate change. Transmission may spread to new areas, so it’s an important group of diseases to be concerned about. However, I am becoming increasingly concerned with food security and the associated malnutrition that you see. Now, for example, we see tremendous malnutrition emergencies in East Africa, due to loss of crops, which is most likely related to climate change. Droughts, but also floods, can cause a lot of harm to people’s livelihoods and ability to grow sufficient crops for subsistence and for cash.
Lastly, I feel like mental health is highly relevant in the context of climate change. The uncertainty of the future can create a lot of thinking, negative thinking, across all generations, but in particular for younger generations. You see that climate anxiety is becoming an increasingly more important issue.
Would you also say that there are disparities across different demographic groups or contexts for health outcomes impacted by climate change?
Yes definitely. There is a lot of inequality in the way that climate change affects countries and populations. We know, for example, that the continent of Africa accounts for only about 4% of the global carbon dioxide emissions. Nevertheless, they face the biggest challenges in terms of the health consequences. So there are a lot of inequities and injustice in vulnerability among different population groups and their ability to cope with and adapt to the climate challenges.
We’re often speaking about inequity in planetary health, often caused by colonial histories. Would you say that the developments around planetary health could provide new opportunities to connect the world?
I see it as an attempt to unite people somehow. We all have a common agenda, namely, to save the planet, and thereby also safeguard human health in the long run. Whether we come from the north or the south, we all have that obligation.
However, we often find these more extreme health inequalities in fragile states with weak health systems, who have difficulties in dealing with the additional burden of threats that we see from our unhealthy planet. Fragile states, with weak governance or weak infrastructure for health, result in certain countries or areas being more sensitive to disasters. This translates to more people being affected, and more people being seriously affected. It’s a bit of a combination between geographical position and availability of resources. It is both a lack of financial means- to actually invest in proper infrastructure that can prevent disasters- but also a lack of human resources, meaning healthcare and humanitarian personnel, to actually deal with the additional pressure when there is a disaster.
Furthermore, we are excessively exploiting the natural resources – certain geographical regions [e.g. ours] extensively more than others. Our consumption patterns are going in the wrong direction, with a focus on growth, rather than degrowth.
These inequalities have to be considered and acted upon. I mean, in the end, the money lives with us [in Northern Europe]. Consequently, we should make money more available for settings with less opportunities or less resources. We need educated, trained, people who can not only repair the damage, but also have a role in prevention and preparedness.
You can say that there are also some positive spin-off effects with disasters. As people, during disasters, may be more exposed to the more severe consequences such as fatalities and an increase in injuries and disease, it could create more awareness at some levels – hopefully leading to more climate action within communities and at a policy level.
Touching upon your own experiences of working in many different regions and countries, how are you seeing the shift of focus to climate change challenges? If you compare research in the 80s, versus now, do you think that climate change becomes more important or less important?
Well, definitely. Over the years, I’ve seen an increasing focus on climate change as an important determinant of human health. In the early 90s, climate change became an agenda point. However, my first educational activities in Copenhagen regarding climate change and health was in 2008. Before that, climate change was more referenced as one of many important risk factors that influences health. Later on, it became a stand-alone theme. We started to cover it more broadly and more comprehensively.
Along with climate change, of course, we should not forget that there are other issues of relevance to human health, defined by the nine so-called planetary boundaries. Biosphere integrity, as one example of the planetary boundaries, is another major issue. The fact that annually we are losing thousands of insect species becoming extinct is alarming, because of their role in nutrient cycling and pollination – a loss that may affect our ability to grow crops, and thereby also serve populations in terms of nutrition. In order to gain a fuller understanding of [human] health outcomes, we have to understand how our civilisation and all these planetary boundaries are interrelated, beyond just climate change.
Obviously, we are here in Denmark, which also has a certain level of vulnerability to climate change. However, as Denmark has a strong healthcare system and resources for climate change preparedness, individuals most likely will not be at risk for severe climate change health risks. So, what is our role as global health professionals?
Education and communication are important factors. Having climate change and planetary health, for example, as topics in our curriculum is very important for our next generation of health professionals. Communication is also important… communicating new knowledge, new learnings about potential health outcomes of climate change to different audiences, at a policy level, but also targeting educators and the general population.
Do you think it’s an easy message to communicate? As everything is so interconnected, it might be difficult to convey one clear message that encompasses the complexity all together, right?
It is very difficult. When thinking about the planetary boundaries, which are nine well-defined processes, ranging from ocean acidification to biosphere integrity, we try to work on them individually. However, we need to work on them as a whole, as they inevitably influence each other, and view them as interconnected systems.
Through communication and education and strong collaboration, we can shift to this holistic approach to improving health.
As a final question, what do you think the future of health will look like?
Where do you think the global health field will go? And are we heading towards a more all encompassing notion of health, that connects human health to planetary health?
It’s a difficult question, because it’s about your ability to predict what will happen in the future, but you can try to do qualified and informed guessing. This demands that you are up to date with existing knowledge and existing evidence on how things are interacting. However, in the end, of course, there’s still a lot of uncertainty, which means that a lot of research is still needed to clarify and understand the problem.
So one of the ways forward is to increase research output, trying to fill out those gaps in knowledge, because that will make us even better at guessing what the future will look like.
Models can help us, but models are only as good as the data that goes into it. So it’s a matter of being good at collecting and using data in the right way. In today’s world, with a lot of fake news, and a lot of artificially generated data, we should also be concerned about being critical towards the data we’re using.
The biggest thing we need to overcome is the inequality challenges – the fact that we don’t all have the same opportunities. Our resilience to future changes are very different across the world. Education, is one way to actually tryout if we can distribute those opportunities better,
However in the end, I’m quite confident that as human beings, we are able to overcome some of these challenges, and do the right thing.
Are there some final perspectives or recommendations that you would like to share with new, young global health or planetary health professionals?
[Changing the landscape] will demand or need activism and energy. You, as the next generation of global health professionals, you have the drive, you have the energy to actually do something about it.
And it’s quite rewarding to see that there’s actually quite a lot going on. It’s up to you to convince the old generation about the importance [of planetary health], because it’s still the older generations that possess the [decision-making] power. So it’s only through a change in mindset of the old generation that you can actually do something.
We are only at the beginning, I want to say, if we’re talking about Planetary Health it’s a very young and quite new way of thinking, but I think it’s increasing in its momentum.
I think that it is very exciting that there’s still space to explore. To younger students, sometimes entering the global health arena, it feels like a lot is already set and decided. It’s really exciting to be part of something that’s more new, and creates a space to be curious.
That’s exactly the approach I want young people like you to take. Use your curiosity.
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