Opinion: Global health is at risk. Sustainable infrastructure will help

The global health system has long been under assault and recent drastic cuts to foreign aid budgets around the world reinforce the trend. Official development assistance for health from advanced economies reached a 13-year low in 2021 and, despite a brief surge during the pandemic, has continued on a downward trajectory. Such global health divestment will leave vulnerable populations without critical resources to combat rising temperatures, extreme weather events, and emerging diseases. The COVID-19 pandemic highlighted the extent of underinvestment in global health, particularly in basic health care, as well as pandemic preparedness and response. Add to this the escalating threats to health from climate change, environmental degradation, and biodiversity loss. Now is not the time to defund global health, and novel approaches are required to address the growing financing gap. The threats to global health put at risk the remarkable achievements of previous decades. Almost inconceivable improvements in life expectancy and quality of life — such as the near-eradication of polio through immunization or preventing waterborne diseases by improving clean water access — came on the back of massive investments through national development aid and philanthropic contributions. Few if any areas of development assistance can show similar impressive results. A new report from the Asian Infrastructure Investment Bank, “Infrastructure for Planetary Health,” documents these increasingly interrelated threats and highlights how sustainable infrastructure development could help reverse the threats to public health by considering the significant climate, nature, and health co-benefits. The “new” threats are already major killers globally. Deaths from climate change are increasing, with the World Health Organization estimating that climate intensified natural disasters are expected to result in 15 million deaths by 2050. Air pollution is the largest environmental cause of disease and premature death, alone causing over 8 million deaths every year. Add to this antimicrobial resistance, or AMR; chemical hazards; and extreme weather events, and we see catastrophic effects on life expectancy and general health. Human health and the health of our planet are now intimately linked. Recent academic research also emphasizes the importance of biodiversity for human health. During the Indian Vulture Crisis, over 95% of the vulture population was wiped out due to the introduction of anti-inflammatory drug use in cattle. This resulted in a public health emergency as animal carcasses, once scavenged, were left to rot — providing a breeding ground for diseases. Indirectly, this resulted in 100,000 additional human deaths per year. The populations of low- and middle-income economies — particularly women, children, and those living in poverty — are disproportionately affected by these health impacts. People with more resources can afford to reduce risks through private means, such as flood prevention and air conditioning. These solutions, however, are not available to the masses. To protect society as a whole, it is imperative that we look to stop the threats at source. Planetary health infrastructure is about addressing the escalating threats from climate change and how nature degradation forces us to think in new ways about how to achieve health impact. We should not only focus on the health sector but also a range of infrastructure investments to address the new threats. Investments in energy, transport, water, and digital infrastructure should be guided by health impacts. Our proposed approach includes measures on controlling air pollution; mitigating the impact of water- and vector- borne diseases in LMICs; using green and nature-based infrastructure to adapt to extreme heat; and investing in effective antimicrobial resistance prevention and control measures. “Only by considering climate and nature in global health investments can we hope to decrease the burden on underfunded health care systems.” --— Investing in nature as infrastructure can help improve health outcomes through a wide range of ecosystem services. For instance, mangroves can protect against tidal waves and storm surges, provide valuable protection for fish spawning — and also deliver major health benefits. Wetlands and parks can help cool and clean the air in cities. Nature, after all, is our most important infrastructure in sustaining life on this planet. The economic toll of not making such investments is staggering. It results from health-related issues exacerbated by climate change, including AMR, mental health challenges, and productivity losses. AMR-related costs alone are projected to reach $13 billion in Indonesia, $20 billion in Brazil, $82 billion in India, and $85 billion in China by 2050. By focusing infrastructure investments on the nexus between health, climate change, and nature, we could unlock billions of dollars in additional funding for health from climate financing agencies, climate-affected countries, philanthropies, and the private sector — and vice-versa. In fact, the health impact of environmental degradation, not least air pollution, has arguably been the strongest driver of climate and nature action in places where most improvements have been recorded. Investments in health need to consider climate and nature as means for prevention, and target those who are most vulnerable. Only by considering climate and nature in global health investments can we hope to decrease the burden on underfunded health care systems and find additional resources for restoring degraded ecosystems. Investing in infrastructure that combats climate change and reverses nature loss is no longer merely an imperative for the future of the planet, but for the future of humanity.