WHO Manifesto for a healthy recovery from COVID-19

Prescriptions for a healthy and green recovery from COVID-19

26 May 2020

"The pandemic is a reminder of the intimate and delicate relationship between people and planet. Any efforts to make our world safer are doomed to fail unless they address the critical interface between people and pathogens, and the existential threat of climate change, that is making our Earth less habitable."

WHO Director-General Dr Tedros Adhanom Ghebreyesus. Address to the 73rd World Health Assembly.   May 18^th 2020.

What we have learned from COVID-19

COVID-19 is the greatest global shock in decades.   Hundreds of thousands of lives have been lost, and the world’s economy likely faces the worst recession since the 1930s.   The resulting loss of employment and income will cause further damage to livelihoods, health, and sustainable development.

Societies need to protect themselves, and to recover, as quickly as possible.   But we cannot go back to the way we did things before.   Increasing numbers of infectious diseases, including HIV/AIDS, SARS and Ebola, have made the jump from wildlife to humans - and all available evidence suggests that COVID-19 has followed the same route. Once human-to-human transmission of COVID-19 began, national and international surveillance and response systems were not strong or fast enough to completely halt transmission.   And as infections spread, a lack of universal health coverage has left billions of people, including many in rich countries, without reliable and affordable access to medical treatment.   Massive inequalities have meant that deaths and loss of livelihoods have been strongly driven by socioeconomic status, often compounded by gender and minority status.

Attempting to save money by neglecting environmental protection, emergency preparedness, health systems, and social safety nets, has proven to be a false economy – and the bill is now being paid many times over.   The world cannot afford repeated disasters on the scale of COVID-19, whether they are triggered by the next pandemic, or from mounting environmental damage and climate change. Going back to “normal” is not good enough.

In adversity, the crisis has also brought out some of the best in our societies, from solidarity among neighbours, to the bravery of health and other key workers in facing down risks to their own health to serve their communities, to countries working together to provide emergency relief or to research treatments and vaccines. The “lockdown” measures that have been necessary to control the spread of COVID-19 have slowed economic activity, and disrupted lives - but have also given some glimpses of a possible brighter future. In some places, pollution levels have dropped to such an extent that people have breathed clean air, or have seen blue skies and clear waters, or have been able to walk and cycle safely with their children - for the first times in their lives.   The use of digital technology has accelerated new ways of working and connecting with each other, from reducing time spent commuting, to more flexible ways of studying, to carrying out medical consultations remotely, to spending more time with our families. Opinion polls from around the world show that people want to protect the environment, and preserve the positives that have emerged from the crisis, as we recover.

National governments are now committing trillions of dollars, in a matter of weeks, to maintain and eventually resuscitate economy activity.   These investments are essential to safeguard people’s livelihoods, and therefore their health.   But the allocation of these investments, and the policy decisions that will guide both short- and long-term recovery, have the potential to shape the way we live our lives, work and consume for years to come. Nowhere is this more important than in their effects on environmental degradation and pollution, and particularly on the greenhouse gas emissions that are driving global warming and the climate crisis.

Decisions made in the coming months can either “lock in” economic development patterns that will do permanent and escalating damage to the ecological systems that sustain all human health and livelihoods, or, if wisely taken, can promote a healthier, fairer, and greener world.  

Prescriptions for a healthy, green recovery

1) Protect and preserve the source of human health: Nature.

Economies are a product of healthy human societies, which in turn rely on the natural environment - the original source of all clean air, water, and food. Human pressures, from deforestation, to intensive and polluting agricultural practices, to unsafe management and consumption of wildlife, undermine these services. They also increase the risk of emerging infectious diseases in humans   – over 60% of which originate from animals, mainly from wildlife. Overall plans for post-COVID-19 recovery, and specifically plans to reduce the risk of future epidemics, need to go further upstream than early detection and control of disease outbreaks. They also need to lessen our impact on the environment, so as to reduce the risk at source.

2) Invest in essential services, from water and sanitation to clean energy in healthcare facilities.

Around the world, billions of people lack access to the most basic services that are required to protect their health, whether from COVID-19, or any other risk. Handwashing facilities are essential for the prevention of infectious disease transmission, but are lacking in 40 % of households. Antimicrobial-resistant pathogens are widespread in water and waste and their sound management is needed to prevent the spread back to humans. In particular it is essential that health care facilities be equipped with water and sanitation services, including the soap and water that constitutes the most basic intervention to cut transmission of SARS-CoV-2 and other infections, access to reliable energy that is necessary to safely carry out most medical procedures, and occupational protection for health workers.

Overall, avoidable environmental and occupational risks cause about one quarter of all deaths in the world. Investment in healthier environments for health protection, environmental regulation, and ensuring that health systems are climate resilient, is both an essential guardrail against future disaster, and offers some of the best returns for society.   For example, every dollar that was invested in strengthening the US Clean Air Act has paid back 30 dollars in benefit to US citizens, through improved air quality and better health.  

3) Ensure a quick healthy energy transition.

Currently, over seven million people a year die from exposure to air pollution – 1 in 8 of all deaths. Over 90% of people breathe outdoor air with pollution levels exceeding WHO air quality guideline values.   Two-thirds of this exposure to outdoor pollution results from the burning of the same fossil fuels that are driving climate change .

At the same time, renewable energy sources and storage continue to drop in price, increase in reliability, and provide more numerous, safer and higher paid jobs. Energy infrastructure decisions taken now will be locked in for decades to come. Factoring in the full economic and social consequences, and taking decisions in the public health interest, will tend to favour renewable energy sources, leading to cleaner environments and healthier people.

Several of the countries that were earliest and hardest hit by COVID-19, such as Italy and Spain, and those that were most successful in controlling the disease, such as South Korea and New Zealand, have put green development alongside health at the heart of their COVID-19 recovery strategies. A rapid global transition to clean energy would not only meet the Paris climate agreement goal of   keeping warming below 2C,   but would also improve air quality to such an extent that the resulting health gains would repay the cost of the investment twice over.

4) Promote healthy, sustainable food systems.

Diseases caused by either lack of access to food, or consumption of unhealthy, high calorie diets, are now the single largest cause of global ill health. They also increase vulnerability to other risks - conditions such as obesity and diabetes are among the largest risk factors for illness and death from COVID-19.

Agriculture, particularly clearing of land to rear livestock, contributes about ¼ of global greenhouse gas emissions, and land use change is the single biggest environmental driver of new disease outbreaks. There is a need for a rapid transition to healthy, nutritious and sustainable diets. If the world were able to meet WHO’s dietary guidelines, this would save millions of lives, reduce disease risks, and bring major reductions in global greenhouse gas emissions.

5) Build healthy, liveable cities.

Over half of the world’s population now lives in cities, and they are responsible for over 60% of both economic activity and greenhouse gas emissions. As cities have relatively high population densities and are traffic-saturated, many trips can be taken more efficiently by public transport, walking and cycling, than by private cars. This also brings major health benefits through reducing air pollution, road traffic injuries – and the over three million annual deaths from physical inactivity.

Many of the largest and most dynamic cities in the world, such as Milan, Paris, and London, have reacted to the COVID-19 crisis by pedestrianizing streets and massively expanding cycle lanes - enabling “physically distant” transport during the crisis, and enhancing economic activity and quality of life afterwards.

6) Stop using taxpayers money to fund pollution.

The economic damage from COVID-19 and the necessary control measures, is very real, and will place huge pressure on Government finances. Financial reform will be unavoidable in recovering from COVID-19, and a good place to start is with fossil fuel subsidies.

Globally, about US$400 billion every year of taxpayers money is spent directly subsidizing the fossil fuels that are driving climate change and causing air pollution. Furthermore, private and social costs generated by health and other impacts from such pollution are generally not built into the price of fuels and energy. Including the damage to health and the environment that they cause, brings the real value of the subsidy to over US$5 trillion per year-   more than all governments around the world spend on healthcare – and about 2,000 times the budget of WHO.

Placing a price on polluting fuels in line with the damage they cause would approximately halve outdoor air pollution deaths, cut greenhouse gas emissions by over a quarter, and raise about 4% of global GDP in revenue. We should stop paying the pollution bill, both through our pockets and our lungs.

A global movement for health and the environment

The COVID-19 crisis has shown that people will support even difficult policies if decision-making is transparent, evidence-based, and inclusive, and has the clear aim of protecting their health, their families and their livelihoods - rather than serving special interests.

This needs to be reflected in the way that policy is made. In most countries, Finance Ministries will take the lead in defining COVID-19 economic recovery packages. Given the integral connection between the environment, health and the economy, it is also important that health leaders, such as Chief Medical Officers, are directly involved in their design, report on the short- and long-term public health repercussions that they may have, and give their stamp of approval.

Most fundamentally, protecting lives, livelihoods and the environment depends on the support of the people. There is widespread public support for policies that do not seek only to maximize GDP, but to protect and enhance wellbeing, and for governments to combat climate change and environmental destruction with the same seriousness with which they are now fighting COVID-19. It is also shown by the millions of young people who have mobilized to demand action not only on climate and biodiversity - but also for the right to breathe clean air, and for their future on a liveable planet.

The health community is increasingly an ally in this goal. Healthworkers are the single most trusted profession in the world. Their skill, dedication, bravery and compassion has saved countless lives during the COVID-19 crisis – raising them to even higher levels of respect in their communities. Health professionals from around the world have shown that they are also strong supporters of action to protect the environment – and thereby the health of the populations that they serve. They are ready to be champions for the green, healthy and prosperous societies of the future, as evidenced in a recent open letter to G20 leaders, in which health professionals from around the world called for a healthy recovery from COVID-19.