COVID-19 Narratives

Exploring the biodiversity-climate-health nexus

February 12, 2023/0 Comments/in COVID-19 Narratives

This narrative was written up by Mihika Acharya, Communications Officer at 4SD and David Nabarro, Strategic Director, at 4SD Foundation, Geneva, Switzerland. It is based on presentations by David Nabarro at the Prince Mahidol Award Conference in Bangkok January 2023 on ‘Setting a new health agenda at the nexus of climate change, environment and biodiversity.’

The importance of biodiversity for people’s health and wellbeing

As humanity grapples with worsening climate change, successive COVID-19 waves, and deepening inequalities, it has become increasingly evident that many interconnected challenges threaten the well-being of people and the planet. It is vital that damage to nature and loss of biodiversity are included in efforts to secure equitable and sustainable futures .

Biodiversity provides humanity with food, water, medicine, a stable climate, and economic growth. Over half of global GDP is dependent on nature, and more than one billion people rely on forests for their livelihoods. But nature is in crisis. Accelerating climate change and the continuing destruction of nature threaten to undo the last fifty years of progress in development, global health, and poverty reduction, and to widen existing health inequalities between and within populations.

Climate change and damage to nature are affecting the lives and livelihoods of an increasing number of people, especially those on the lowest incomes, through increasing volatility and uncertainty around weather patterns and the loss of natural resources. As systems disturbances accelerate, they bring additional threats to poorer people everywhere, especially for those who have least agency and respurces. They are especially vulnerable.

For example, climate change and damage to nature amplify existing gender inequalities and pose unique threats to the lives and livelihoods of women and girls. Changing weather patters reduce access to clean water: this leads to reduced yields of food crops and adds to the challenges faced by women. Lack of water increases the challenges with management of menstrual hygiene. School-going girls may feel unsafe, and some may not feel able to access education: this impacts on the power and agency of women and girls in communities.

Climate change is affecting the behaviours of ecosystems, leading to changes in patterns of infectious disease and increasing risks to people’s health. Pathogens in the natural environment can spill-over to humans with potentially serious consequences: there are constant reminders of humanity’s vulnerability to outbreaks of zoonotic diseases such as those caused by Ebola and coronaviruses. SARS-CoV-2, the coronavirus associated with COVID-19, has caused the death of well over six million people since 2020. These vulnerabilities remind us that the human species is a part of nature’s world, and that nature needs to be treated with care and respect. Taking more than we give back, and not making space for species of animals and plants that preceded humans, creates an imbalance of resources on which people depend for life and livelihoods.

Recognizing that humanity is dependent on the resources of the planet , and that this relationship has a direct impact on the health of both, underpinned recent negotiations towards a sustainable agenda for the world. These were initiated in 2012 and the outcome was agreed by world leaders in 2015. This 2030 Agenda for Sustainable Development (and its 17 Sustainable Development goals, or SDGs), acknowledged that the challenges faced by people and planet are layered, interlinked and universal. They must be faced not only in lower- and middle-income countries but in high-income nations too. They affect all aspects of our lives, including people’s physical health, emotional well-being, and livelihoods.

Applying living systems approaches to the 2030 Agenda

The 2030 Agenda for Sustainable Development, with its SDGs has a broader set of objectives across a wider spectrum of socio-economic dimensions than its predecessor agreement, the millennium declaration, and the Millennium Development Goals (MDGs) of 2000. It is far more ambitious, recognizing that global challenges are universal and are interconnected. For example, the goal for health and well-being (SDG3) is linked with that for gender equality (SDG5), decent work (SDG8), and sustainable cities and communities (SDG11). In this way, the 2030 Agenda is a reminder that people are integral parts of all living systems. Splitting up global challenges and working on them separately, in siloes, is not the way to go. A focus on biodiversity targets alone, for example, might risk negative outcomes for people if human rights, sustainability, and equity are not adequately considered.

The ways in which national Governments and community organizations respond to agreements reached by world leaders in global forums (like the United Nations General Assembly), have impacts on the lives of people everywhere, particularly those who are most vulnerable. Effective local and national responses depend on scientists, specialists and community actors making their voices heard in every possible avenue. They seek to ensure that decisions are driven through people’s engagement, with constant attention to re-generating and safeguarding nature in the face of climate change. People’s behaviour, beliefs, and willingness to act, together, all influence the prospects for people’s future wellbeing. It is more important than ever that people are at the centre of development efforts and no one is left behind.

A ‘living systems’ approach offers a holistic way for all involved to work together when navigating complexity and negotiating contested issues. It helps groups to work for transformational change through including all groups of people as partners, acknowledging power asymmetries and encouraging exploration of embracing perspectives. Such an approach is helpful when addressing the consequences of COVID outbreaks, widening conflicts, accelerating climate change and damage to nature for the realization of the SDGs. Tens of millions of households are now experiencing the greatest cost-of-living crisis in a generation, and it is vital that responses reflect the expressed needs of those who are hardest hit, as well as an appreciation of what the the crisis means for them, and the support they need for health and livelihood security.

The navigation of power asymmetries reqires an understanding of the political context from the perspective of the people themselves and the political realities that they encounter. This is vital if people who feel disempowered are to acquire greater agency. External experts may seek to position themselves as politically neutral, but most find that, in practice, they must pay attention to how their actions reflect the interests of those with the greatest influence.

Living systems leaders become comfortable operating within this deeply political realm. They learn to be able to work with those who are making use of relatively limited power. They realize that people’s potential sources of power are not always the most obvious.  They accept that working within political processes may appear messy to those focused on specific outcomes: systems transformation is not a straightforward process. Negotiations may not immediately lead to clarity – indeed, being explicit about the choices to be made can lead to greater tensions, to suspicions, and to outright discord. 

One challenge faced by everyone is the tendency for all of us to share our perspectives with those with whom we expect to align.  This helps us build our own sense of community. However, we are more likely to succeed if we can work with all who are involved in an issue even if they have views which differ from ours – connecting with those with whom we have not worked with before. This can create the potential for the emergence of renewed energy and enthusiasm for unexpected and potentially effective new collaborations.

Focusing on those most vulnerable so as to leave no one behind

The health of all people is a recognized priority in public health and development, features strongly in the SDGs, and is an important focus within responses to outbreaks. It must be taken seriously when the well-being of populations is a central feature of national policies.

To approach the SDGs with a people-centred and equity focus, with an emphasis on the interplay within living systems, requires seeing people as the primary actors in responses to public health challenges. It calls for the engagement of the many stakeholders that have an interest. For example: food systems are more likely to transform if the full range of stakeholders can connect, engage, and explore options in a systematic way. Attention needs to be paid to the identities of, relationships among, and sharing between stakeholders as this increases the likelihood that they will trust each other and act together in a meaningful way.

Responses to COVID-19 outbreaks have laid bare the necessity for a collaborative science-based living-systems-thinking. Such responses take account of the synergies across different issues: they help change the nature of the trade-offs that are faced when choices are made. Inter-disciplinary science and multi-sectoral working are essential and not an optional extra.

It is important that the values adopted by all who are engaged in such collective approaches are made explicit: they are most likely to advance if those involved all acknowledge and respect human rights agreements, draw on multi-disciplinary science, appreciate the need to act across sectors, and approach health as an inclusive, whole of society, issue. It is important to promote and protect the engagement, voices and interests of people with the least agency and greatest vulnerability when decisions are made. This consideration applies especially to women, indigenous people, young people, older people, smallholder farmers, labourers and more.

Enabling health workers to lead for systems change

Health workers have unique opportunities to lead by highlighting the challenges that are faced by people especially when their agency is limited. They can serve as advocates, making authoritative use of their experience and expertise. They can also be effective change agents, recognizing the importance of being authentic and accountable to those they serve. They are accountable when they engage openly with those they serve, taking stock and learning from what has been done, at all levels: it contributes to trust and impact.

Their impact is increased if they widen their circles of engagement beyond the health sector and communicate in ways that reflect on where people really are. Honest, open, and consistent communication is essential and has proved to be especially helpful when partnering with people on responses to outbreaks of disease and other threats.

All groups in society have parts to play. Those with the responsibility to govern, for example, are expected to respond to the knowledge, experiences, and challenges of all in society including those at the frontlines of crises, especially women and indigenous peoples. When they lose their sources of income or are forced to evacuate their homes by extreme weather, they are at risk of becoming more marginalized and experiencing multiple forms of violence. Inclusive, multilateral, equitable actions will ensure that all within communities are able to access the resources they need, and that the most vulnerable are in a position to use them.

There is a unique leadership opportunity for health workers of all kinds to lead n the health consequences of climate change and biodiversity loss. Lasting change starts and ends with alliances being built within communities, and the deepening of trust between people and those who serve them. It is more likely to happen when people perceive they are partners in change, being listened to and perceiving that they are able to impact on the decisions made about them.

It is vital that all decision-makers are constantly reminded, by those they serve, that the biodiversity-climate-health nexus does not affect everyone equally. Who people are matters. Where they are matters. Whether they are able to engage in decision-making matters. Whether they can participate as decisions are made, despite asymmetries in relative power, positions, and expertise, matters. It is important that climate change and biodiversity are included in conversations on health. It is at least as important that, as decisions about health and well being are made, there are accessible spaces in which people and their communities can engage in the decisions about health action.

Tackling the emerging complexities that abound in our world, especially at the biodiversity and climate nexus, is extremely challenging. Navigating them in ways that optimise the health and well-being of those who have the least agency, power, and resources, is even more so. Health workers have a vital and central role to play. They are counted on to help maintain the structures, spaces, and opportunities for inclusive engagement, dialogue, exploration, and accountability.

Mental Health, Climate Change and COVID-19

July 1, 2022/0 Comments/in COVID-19 Narratives

Based on a speech given by David Nabarro at a ‘Mental Health Advocacy and Action’ workshop with ‘NCD Child’ and ‘The George Institute for Global Health’, on 23rd June 2022, this narrative was written up by Mihika Acharya, Communications Officer at 4SD.

We are currently in the middle of the largest cost-of-living crisis seen in at least a generation exacerbated by conflict, climate change and COVID. In addition, one in 20 of those who get infected by COVID have been left with lingering problems affecting their heart, respiratory system, and their general well-being. Many people have lost their jobs because of COVID. Politicization of responses to this difficult virus has led to the stigmatization of groups of people and a lack of trust in authority. COVID has also caused anxiety to those with chronic non-communicable illnesses not being able to access healthcare.

Society re-opening has led to more visceral fears- not just of catching COVID-19, but also of the fear of passing it on to a loved one, the stress of being faced with new realities of working from home, unemployment, home-schooling of children, or the lack of physical contact with other family members, friends, and colleagues. All these factors along with system disruptions caused by climate change and conflict are drivers of social and health inequalities, having the greatest effect on those most vulnerable.

Without meaningful interventions, an even greater burden will be placed on our health and on our health systems, only further deepening inequalities. How we deal with it now can either strengthen our societies or set us back in the progress that we need, to make our societies equitable and durable. And that means we need a global response that focuses on the needs of those most vulnerable. We need all people to be protected, and we need to prepare all our systems and all our communities to be more resilient.

To assist with the challenge of the conflation of crises including COVID, conflict, cost, and climate change, the United Nations set up the ‘Global Crisis Response Group on Food, Energy and Finance’ to help decision-makers mobilize collective solutions. At the same time to address the mental well-being of individuals and communities, the World Health Organization released a report on Climate Change and Mental Health at the Stockholm + 50 conference. More recently, the ‘Grantham Research Institute on Climate Change and the Environment’ of Imperial College London, put together a comprehensive document on the impact of climate change on mental health and emotional well-being. The publication shows the relationship between increased temperatures and number of suicides and gives evidence for severe distress following extreme weather events. It goes on to show how climate change amplifies mental distress, particularly among young people, even for individuals who are not directly affected (e.g. ‘eco-anxiety’).

With the help of these initiatives, governments everywhere are urged to include mental health in their response to the climate crisis, to develop community-based approaches to reduce vulnerabilities and close the large funding gap that exists for mental health and for psychosocial support.

50% of mental health problems are established before children are aged 14, and 75% before adolescents are 18. Children and adolescents are particularly vulnerable to negative mental health impacts of climate change, and they do need to be equipped with knowledge and skills to be able to steer themselves through this, to be able to lead their communities, their organizations, and to make their voices heard in their spheres of influence.

Advocacy by young people is particularly important in moving the needle for systems leadership. For interconnected crises, interconnected solutions are needed. Systems leaders know how to weave the different issues together. They understand the need for whole system responses while still being able to focus on their components.

Young people can bring awareness and drive behaviour change by engaging with systems from multiple perspectives at the same time. They can appreciate the relationships between systems and their environment. They can feel the pace and rhythm of systems and assess their readiness for change. They are more likely to meet people where they are, rather than where they would like them to be. Young people are ready to make these changes and provide the systems leadership that is needed for the future, but they can only do so if they are able to function at the interface between climate and health.

In summary, climate change combined with food shortage and conflict on top of COVID is having an extreme impact on the mental health and well-being of people everywhere particularly those that are poor or vulnerable. This is manifested in the interconnected problems that we see today, and they need systems solutions and leaders who are systems thinkers and practitioners. The mounting pressures and increasing triggers for mental ill health need collective attention now. Community-based approaches to provide mental health and psychosocial support to all people particularly those who are hard to reach, poor, and those who are vulnerable, needs to be the centre of our attention now.

Communicating Science with Policymakers: From Stats to Stories

May 6, 2022/0 Comments/in COVID-19 Narratives

Based on a presentation given by David Nabarro at an Imperial College seminar on 21 February 2022 on ‘Communicating Science to Policymakers’, this narrative was written up by Mihika Acharya, Communications Officer at 4SD.

COVID-19 is an infectious disease caused by a virus that is easily transmitted between people. Outbreaks of COVID-19 are contained by preventing the virus from moving from person to person. As efforts are made to reduce the risks to populations, ways to encourage specific behaviours are considered. In some settings, mandates for vaccination, wearing masks, physical distancing, and isolation, are being considered. Yet decisions about the control of COVID-19 are never straightforward. The virus is new and there is much that is not known both about its behaviour in populations and its impact on people. What we do know is that the people worst affected by the virus are those who are vulnerable and the poor.

When decisions are made about how best to minimize threats posed by the virus, decision-makers need to know how it moves within populations, the risks and consequences associated with infection, and the effectiveness of preventive measures. This is the focus of efforts among scientists in different countries: their efforts are analysed by the World Health Organization (WHO) and used to develop the WHO’s recommendations.

Collaboration between scientists and policymakers

Responses to infectious disease outbreaks are best devised and delivered through public health systems that function well and adapt to changing circumstances. The underlying values of public health should always be explicit. In my view these are about enabling all people to be as healthy as possible throughout their lives through offering health care that responds to their needs, with a focus on people who are hardest to reach and on leaving no-one behind. This means connecting and partnering with those who have differing perspectives on how best to contribute as the pandemic is continuing to advance, wave by wave, across the world.

Multi-stakeholder collaboration with scientists and specialists can make the act of influencing policies more effective when they ensure that the well-being of all people is their central concern. Specialists may seek to position themselves as politically neutral, but most find that this is, in practice, just not possible. Understanding the political context and navigating power asymmetries is vital in working towards restoring agency to persons who feel diminished or seeking to examine issues that have been set aside.

Specialists and decision-makers interact best for public health when they ensure that people are kept at the centre of all decisions. For me there are six words that illustrate what this might mean in practice: cadence, consistency, connection, credibility, contracts, and conviction.

Cadence

Specialist advisers and decision-makers work best when they are adept at feeling into the pace and rhythm of their work, sensing whether things are ready to move or not. This means that – when they are together – they should seek to meet each other where they are and be comfortable with holding contradictory points of view.

Consistency

Being consistent when given a chance to communicate doesn’t mean maintaining a fixed opinion when it is not warranted. It does, however, mean making a point of being transparent, offering reasons for changes in position, and providing evidence to support them.

Leaders make difficult decisions every day. They have to balance people’s health and well-being, the state of the economy, and the political space for shifting position. This will diminish when there is fatigue with responding but making quick decisions is part of the process and leaders must be vigilant and ready to re-evaluate and adapt those decisions if they notice things are not going to plan.

Connection

The steps involved in implementing public health directives are never straightforward: the implications of the directive must be spelt out clearly to make it understandable for different audiences. This is where it may be difficult to combine the approach of the scientist and the belief systems of different groups of people. If belief systems are influenced by ideology the interaction between science and politics can emerge as an issue: it is important that all who communicate are authentic. This is where narrative and stories can help: they may better connect science and people than statistics and charts. The narratives help with putting issues into context. Here are some narratives which I use now:

1. When looking ahead, it is important to protect the vulnerable, prevent transmission and prepare for surges: This is a virus that is affecting everyone everywhere. It is a global issue. When thinking of public health policies, equity matters.

As with any kind of infectious disease, the starting point is to prevent people from being infected. We know that Public Health Social Measures prevent the transmission of the virus. Face-masking in closed or crowded spaces, frequent handwashing, ventilation, and fewer social interactions help prevent people from being infected.

The second is to protect those who are exposed from being seriously ill and dying. Vaccines have separated disease from death and help protect vulnerable populations. Immunity from vaccines seems to wane after six months or earlier depending on the person’s age or the type of vaccine they received. Keeping up to date on being vaccinated helps protect people from more severe symptoms, and even death.

Thirdly, surges seem to occur every three or four months. The window of time between surges is a moment to be used to prepare by putting systems into place at local, regional and global levels. During this time, listen to health workers who know what is happening and where it may lead. Bring together all stakeholders so they are well-integrated around a shared plan. Engage the people in their communities, connecting with them where they are, and to fill gaps in the response.

2. When planning responses, everyone involved should remember that the virus is the problem, and the people are the solution: Transmission starts and ends in communities. Responses should be locally integrated with central direction based on expertise and experience.

3. As the pandemic evolves all people are called on to be partners in the response: There are bound to be people with diverging perspectives. Avoid stigmatizing and demonizing any group even if they are a small number. Stigmatizing only pushes people further away and undermines social cohesion.

Credibility:

Scientists and policymakers need to earn people’s trust to be effective.

When dealing with COVID, the first part of being authentic is being clear that this virus is not going away anytime soon and threatens all of humanity. It is global and encompassing and we must ensure that no one is left behind.

People need to respond to COVID in a holistic way. The truth cannot be arrived at by only viewing its separate elements. Mandates and lockdowns on all people everywhere have had catastrophic effects in some cases and has had a knock-on effect on a vast spectrum of communities economically, politically, and also psychologically.

Thirdly scientists and policymakers need to avoid making any false promises or pledges. They need to be honest with people, and this matters when seeking to build trust. As the pandemic has evolved the world is faced with an infodemic. Misinformation has generated mistrust between people, as well as between people and governments.

Fourthly, the virus is new and there is so much that is not known. There is uncertainty about what variants are going to come next, or how they will behave. Being humble about this virus – acknowledging that there is so much which is not known and that scientists have to collaborate across national boundaries to help societies work their way through it.

Finally, being hopeful matters. My personal hope is that humanity will emerge from this pandemic a lot better, with a greater understanding of how to deal with multiple threats – including destruction of nature, mass migration, violent conflict, and more. Much ingenuity is needed for people to tackle them together, especially in poorer settings.

Contracts

Professionals involved in responding to COVID need to be clear with different audiences on what is at stake and what is important. The pandemic is still advancing. The virus itself is changing. It is affecting people, businesses, governance, and nations. It is causing massive suffering. It is not going away anytime soon. After infection or immunization, individuals have some immunity but this fades over time. People should act in ways that prevent transmission and keep the virus at bay. Concerted investment in a worldwide response is of vital importance, now more than ever: fragmented responses are less effective.

Multistakeholder platforms are established to inform integrated, people-centred responses. Interdisciplinary scientists are welcome because their engagement permits deeper connections among diverse actors and stakeholders, especially if they focus on people as well as disease, and on connecting science with decision-making. This can strengthen the ‘contract’ between society and the State and take trust and partnership to a new level.

Conviction

We have come a long way since the coronavirus was first discovered. We have adopted good habits to protect ourselves and to shield others. We have gathered tools and know what is required to fight this virus. We have seen communities come together and we have seen people connect with each other in beautiful ways.

There is hope for us to emerge from this as a more unified collective, and it all depends on how we manage this problem together with a concerted effort to increase levels of both political engagement and global investment.

The consequences that the pandemic has had on all other systems will only start to become apparent in about ten years’ time. The failure for concerted economic and political investment in an equitable response would leave us cleaning up the pieces for not just one decade but more realistically, for closer to two decades. Part of the learning curve of working in the science-policy interface involves finding out that we have made mistakes and then finding ways to do better. To do better, sometimes, it is necessary to think about the context within which scientific expertise is being offered.

I urge every scientist and specialist who has the opportunity to work with decision-makers, to make their voices heard in every possible avenue. It is still not too late for putting people back in the centre of the context. It is people – how they behave, what they believe, and what they are prepared to do together- that could make all the difference. Only with people as partners can we protect those who are most vulnerable, prevent transmission of what is a dangerous virus, and prepare our systems for further surges, after all, it is the virus that is the problem, and people that are the solution.