Health as a global public good – An essential reframing for poverty measurement and a more balanced view on sustainability

By: Jieling Liu and Franz Gatzweiler

1. The flawed and antiquated international poverty line

We have learnt from COVID-19 that the key is to ‘flatten the curve’ and many have thereby appreciated a slower pace of life. The same lesson is valuable for the sustainability discourse in the post-COVID era. We need to flatten the development curve and decelerate. The current pandemic, climate impacts, and resource scarcity are all entangled in the global development bottleneck. Similar to the inadequacy of GDP measurement, development economists have long argued that the current $1.90 international poverty line is flawed and antiquated. Understanding and measuring poverty is more about distribution and access to opportunities than reaching a monetary threshold. Despite the emergence of numerous improved wellbeing indicators in the last three decades, such as the Human Development Index (HDI) by Amartya Sen, the multidimensional approaches to poverty, the Gini coefficient, other alternative approaches such as the Happpiness index and the human rights-based approaches, the overly simplified international poverty line is still being used to compare the progress of nations. Behind this phenomenon is the view that money can create wealth and buy wellbeing. The $1.90 poverty line is too low, and most success in eliminating poverty globally is due to China’s contribution. A multidimensional system of indicators, including health, to improve poverty measurement, is needed.

Transit Centre for Migrants that are being sent home in Agadez, Niger
UNICEF/VII Photo, Ashley Gilbertson (2018)

In the Anthropocene, or what Daly refers to as a ‘full world’, alleviating poverty also means internalizing the externalities produced by the free-market driven system. Poverty is no longer about having too little, but rather, suffering too much from poor quality food. In essence, it is the inappropriate application of a neoliberal institutional system globally. The issue of public goods has long been in critical political and economic debates and with a systemic shock like COVID-19, we urgently need to address this issue. There is no wealth for anybody if the health of the planet is not safeguarded. Health is a public good and needs to be ‘economised’ and institutionalised as such.

The growth delusion is a problem hardly harmonisable with climate change, environmental or health goals. Continued growth in a business-as-usual style is only possible if we advance technology faster than population growth and exceed planetary boundaries. The problem is that once people are given the idea of ‘freedom’, it is difficult for them to understand that more regulation or civilised freedoms are not only an option but a necessity.

2. Between doomsday climate narrative and SDG sustainability merrymaking

Therefore, we need a more nuanced understanding of what can be achieved by both the centralised regulatory and the decentralised free-market system. This is critical for a better understanding of the macrolevel origin of climate change and environmental sustainability issues. For these issues, we have so far developed two responses oddly on the two ends of the spectrum. One is the doomsday climate change narrative, and the other is the colourful merrymaking of the Sustainable Development Goals (SDG).

The doomsday climate change narrative is increasingly ineffective. The numerous scenes of a looming Armageddon in recent years, from wildfires to extreme heatwaves, rising sea levels to blooming algae, became increasingly incapable of bringing humanity closer. On the contrary, the doomsday narrative has made many people feel hopeless, and hopelessness in psychological term refers to the state of being ‘cognitively impaired’, that means the brain’s limbic system becomes activated. An activated limbic system could reduce people’s capacity for strategy, foresight, collaboration and tolerance, which deviates and demotivates them from acting towards a pre-set goal. On the one hand, the doomsday climate change narrative portraits human beings as victims of climate impacts with inevitable suffering. On the other hand, the present data-based scientific evidence on climate impacts makes the issue highly time pressing and yet largely lacks the social and policy components necessary for steering willingness for behavioural and institutional change.

The SDGs built on the flawed barometers like the International Poverty Line is in the other end of extreme – a scene of colourful merrymaking that is misleading in three ways. First, it is celebrated as if we were on track to achieve the SDGs by default. Second, it is rolled out without critical reflections on the barometers and regional contextual subtleties. Third, the SDGs are established based on the current liberal, consumption-driven economy (e.g., Goal 8, which literally calls for an increase of GDP in low-income countries of 7% by 2030). The goal is in itself paradoxical to the overall goal of the SDGs – to live more sustainably upon the finite resources on planet Earth.

Furthermore, we need to acknowledge the 2nd law of Thermodynamics and the limit of sustainability to which we could achieve. The higher complexity and better human lives, more energy will be consumed. We need deeper reflections on sustainability regarding 1) the tools: the standards and benchmarks set upfront; 2) legitimacy of the means: is it based on a business-as-usual approach? And 3) realisticness of the ends: is it realistic to end all poverty by 2030? Even the UN Secretary-General has admitted that progress toward sustainable development is seriously off-track. In between a doomsday climate narrative and the SDG festival, we need to be more critical of the new tools and lens, seek a more nuanced narrative with a greater acknowledgement of Earth as our precious common property, and hold the attitude of awe.

3. COVID19 as the potential turning point for sustainability

The current pandemic, climate impacts, and resource scarcity are all entangled in the global development bottleneck. The same lesson of ‘flatten the curve’ from COVID-19 is valuable for the sustainability discourse in the post-COVID era: we need to flatten the development curve and decelerate. To identify and establish the right tool for assessment, we need a new lens to reframe ‘what is a public good’. There is no wealth for anybody if planetary health is not safeguarded. Human health is closely related to planetary health; and yet, the planet can be healthy without us. Environmental and climate health are essential public goods that need to be ‘economised’ and institutionalised. As the Greek root ‘eco’ or ‘oikos’ indicates ‘house’ or ‘household’, if our common house – the Earth – is on fire, which it is, no one is omitted from loss, rich or poor. Currently, poverty, insecurity and ill-health are in a locked-in vicious cycle. Therefore, we need to frame poverty eradication and sustainability in the context of fundamental human rights, to which health belongs. The lessons learnt from COVID-19 and a new framing on health as global public goods could support a direly needed systemic transformation towards sustainability.

Jieling Liu is pursuing her doctorate degree in the interdisciplinary program in Climate Change and Sustainable Development Policies at the Institute of Social Sciences, University of Lisbon. She is also Visiting Scholar at the Ostrom Workshop in Political Theory and Institutional Analysis at Indiana University Bloomington between 2019-2020. Besides, Jieling is Lead Guest Editor for the journal Cities & Health special issue – Asian City Futures: Spatial form and health. She has an academic background in Political Sciences and Journalism.

Dr Franz W. Gatzweiler is a Professor at the Institute of Urban Environment, Chinese Academy of Sciences, and Executive Director of the International Council for Science’s global program on “Urban Health and Wellbeing: a Systems Approach”. His current research focus is the science of complex systems, and urban and global health. Before joining the Chinese Academy of Sciences in 2014, he was a senior researcher at the University of Bonn’s Center for Development Research (ZEF).


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