Introduction
Recently the world has been going through the most critical phase with the aftermath of COVID-19, conflict, and aberrant climate (3C) converging into a helpless decline in social conditions especially in the low-and-middle-income group of countries (LMIC). The progression that unfolded, nearly approximating the marks of SDG goals, faded away inadvertently under the dark cloud of job loss, lockdown, and closure of offices, institutions, shops, and markets, affecting millions especially so, in the context of poverty elimination and health upliftment of the marginalized societies. This endeavour tries to discuss and deliberate the effects of 3C on global health and development and suggest suitable remedial measures.
Discussion
Magnitude of problem
Deaths directly and indirectly attributable to the coronavirus reached nearly 7 million by mid-December 2023 wiping out hard-earned progress in poverty elimination with severe disruption of essential health services.1 Moreover, since 2020, some 147 million students missed over half of their in-person instructional sessions. COVID-19 is still active around the world with India reporting 2311 cases on 21 December 2023 having the highest no. in the state of Tamil Nadu and the US harbouring nearly 1.1 million active cases projecting a cause of concern.1 Strict surveillance may help avert the unfortunate slithering of an outbreak, but the brewing of the wicked virus around the nook and corner is a real threat to development and humanity.
The world has seen a series of massive setbacks to stability in regions across the world - from Asia and Africa to Latin America and the Caribbean, and more recently in Eastern Europe. The high cost impinged by the Russian invasion of Ukraine, the damage caused to hospitals and healthcare organizations in Ukraine and the mental/physical impact of the war on health workers and citizens have been unprecedented. Tigray war in Ethiopia, a military upheaval cast the longest and worst black hole in history that had shut off deliveries of food, fuel, medicines, essentials, and public services culminating into a humanitarian calamity with large-scale food shortage and mass starvation since November 2020. A peace treaty has been signed between the involved countries and federal autonomy for the Tigray has been restored since 02 November 2022. 2, 3, 4 Two on going conflicts - Russia - Ukraine and Israel - Palestine involve nuclear-weapon states that could be devastating on solitary strike. Longstanding bulwark of nuclear stability, such as the New Strategic Arms Reduction Treaty between the United States and Russia, is barely functional. North Korea and Iran proudly campaign their prowess of nuclear ambitions and could join the power-greedy to ravage needless plunder. And China has grown and modernized its nuclear strike capability behind the shadow to join the global command contest.5
The world is on the brink of climatic catastrophe where billions are suffering from the consequences of global warming and eerie extreme weather. Energy-related CO2 emissions rose by six percent in 2022, reaching the so-called highest level ever - completely wiping out pandemic-related declines from industrial lockdowns and setbacks. To surpass the dreadful effects of climate change, global greenhouse gas emissions must peak before 2025 and then decline by 43 percent by 2030, falling to net zero by 2050. Instead, under the current Nationally Determined Contributions (NDC) to climate action, greenhouse gas emissions are set to surge by nearly 14 percent over the next decade. We may fall short of the goal set by the Paris Climate Agreement - keeping temperature increase to no more than 1.5°C above pre-industrial levels. Over and above, an estimated 17 million metric tons of plastic entered the ocean – a number that is expected to double by 2040.6
A worsening climate crisis threatened many countries often getting spells of multiple catastrophes like floods, forest-fires, quakes, and cyclones simultaneously. Rising conflict, the corroding climate and after effect of the pandemic together led Doomsday Clock stuck at 90 seconds to midnight since January 2023, remains the closest to the global collapse that the world has ever experienced in the recent past possibly indicating the impending cataclysmic annihilating apocalypse since its creation in 1947.5 However, this end-of-the-world-prognostications may not be the last thread-not-torn till date, but there are ways and means to stall the warrant at the micro and macro levels to make a difference.
The Fall-outs
Humanitarian crisis, long-drawn-out emergencies, food scarcity, refugee displacement, political insecurity, ineffective governance, and failure of health and social services because of 3Cs engendered countries/regions as Fragile-Conflict affected-Vulnerable (FCV) ones having its susceptibility to higher risk of death and diseases that merit utmost attention for action and immediate cessation. It has been estimated that around 20 million people are subsisting in extreme poverty in countries affected by FCV since the onset of the COVID-19 pandemic and by 2030, around 59% of the extremely poor will conglomerate in FCV regions defeating the purpose of sustainable development and poverty elimination in entirety.7 Severe food scarcity is estimated to affect over 240 million people until 2027 - may even be twice as common in FCV countries. In fragile and war-ridden areas, average per-capita income is expected to decline by 2024.7 The conflict in Ukraine has been unsettling general livelihoods, disturbing energy and commodity availability furthering stresses on health and social services. About 103 million people were forcefully displaced by mid-2022 – post-Ukraine war resulting in the fastest-growing refugee crisis in Europe. Around 74% of 32.5 million refugees were hosted in low and middle-income countries.7
The concurrent multidimensional onslaught capsizing human civilization into the unceasing death spiral needs to be brought to a halt through united and innovative efforts to bend the arch of dictatorial supremacy to a peaceful, healthy and sustainable world. Majority of the global citizens want to live in a world free of war, where the members can avail most meaningful satisfying employment, feed and nourish their children and enjoy easy access to essential healthcare and public beneficiary services including competent schooling, training and job engagement.
Conflict is potentially easy to break off, but the quest for peace is often deceptive as wars are characterized by the never-ending effect of untoward aggressive escalations and destructive fall-outs on civic life and communities in the absence of dialogue for peace and cooperation for harmony (Figure 1). Diplomacy for peace is a complex entity with the neighbouring countries, fostering peaceful mutual co-existence that needs to be achieved through business, sports, cultural activities, academia and other forms of ties. Keeping the dialogue open even during dissidence or threat of aggression can help avert escalation. Political stability and strong social solidarity in the involved countries often build a resilient international milieu for sturdy mutual co-existence. Peace plants all dimensions that include positivity, hope and a prospect of good faith in our societies ultimately weaving the strong social fabric. Peace accords good health and prosperity promoting the society with long-lasting health for the future. For the healthcare and social workers, the humanitarian collaborators working at the field level, aggression makes things exponentially harder and sometimes even impossible. Health and peace can nurture humanitarian corridors leading to progress and prosperity without any doubt.
The policy response to COVID-19 may lead to a reduction in local income levels especially so in LMIC countries and in turn increase the chance of social unrest and localized tension.8 The pandemic could lower the value of natural and physical resource exploitation and in turn, reduce the economic benefit of seizing control of these resources. 9 Furthermore, disruptions of global food supply chains may lead to increasing food prices and in turn, increased conflict. 10 The Ukraine war has prompted the swirling refugee crises of enormous dimensions of the modern era. Over 100 million people were fiercely displaced from their shelter and 11.5 million had to move to other destinations within Ukraine itself. The crunch caused prices of common commodities like food, fuel, fodder and fertilizer to pitch to newer heights crushing the supply chains and global trade, churning national economy and financial institutions ultimately crushing the international food security system, pushing mankind towards the darkest.6
The Call for
Peace is elemental for the progression of health, and development while extenuating the trial of conflict, climate crisis and COVID-19. Therefore, the first and foremost need is to open a new dialogue around health, harmony, and peaceful coexistence. Humanitarian avenues need to be provisioned so that every citizen can avail of bare essentials, like nutritious food, fuel, education, employment and health services, and to that effect, no hospital is targeted by military aggression. The UN agencies, World Bank, civil societies, sports organizations, academia, and business houses are required to commit to this peace initiative to be part of an overall peace-building effort that would help the people at the highest risk of disease and death.
The contemporary up-to-the-minute Millennium Declaration - chronicled at the turn of the century - underscored the link between peace, security, development and health and the same was enunciated in SDG 2015. The cloud of conflict and crisis relinquished the orchestrated effort against healing the world from the effect of the COVID-19 pandemic into something like an impasse battle-fire but the deadlock needs international cooperation to resolve soon and move forward. And even in a highly carved-up world of part, progress in health is possible. The Globe experienced the coordinated work of the US and USSR in unison to accomplish smallpox eradication even in the odd face of the Cold War, a truly existential challenge of the recent past.
Although discussions on war predominantly influence the mindset of the political leaders and the ever-glittering media currently, COVID-19 is literally not eradicated and seeking a chance to strike back with a higher punch. While the virulence and infectiousness of COVID-19 are inversely associated, however, a cocktail of novel mutations in the future manifesting with the superior power of both traits could be most devastating for human existential assurance. Wise recognition of under-the-carpet viral threat and working with national agencies to track, isolate and eliminate the virus by boosting the immunity of populations with 70% vaccination coverage would be the most favorable at this cross-road undoubtedly.
Strengthening prevailing health systems at this crucial juncture is of paramount importance so that countries can progress on many health issues and National Health Programs that remained unattended and lagged in performance along with preparation for future variants of concerns and possibilities of potential new outbreaks. Many prosperous nations are gearing up to ‘second booster’ – fourth dose effectively – while few of them are aberrant and non-adherent also. The pandemic-related challenges like supply chain chaos, oxygen and bed availability still pose a threat to health as well as peace and security in many LMICs.
The climate crisis necessarily reflects the dark impending survival peril of the current date that merits explicit attention. A searing environment in general is bad for health, with millions of people dying due to breathing polluted bad air. Countries are now keeping the air of their citizens’ breath under close surveillance and supervision. Convincingly, populations are endowing funds in newer technology to detect the amount of pollutants in the air; and feel certain about the need for a metamorphic reform to move away from fossil fuels, which for human survival must be left under-ground with rapid switch-over to renewable energy.
Scientific innovation and commitment saved lives and protected health systems as was evident from the recent pandemic but the same need an universal accessibility and availability for all especially in LMNCs. That’s even applicable to climate control because it’s vital to make plans now so that newer strategies and technical know-how can be shared efficiently and successfully to turn away climatic calamity.
Conflict management needs commitment, communication, conflict resolution and camaraderie of the National Leaders, their advisors, mediators and negotiators to halt any crisis and bring back peace and harmony. Dictatorship is a strong deterrent to any peace process and harmonized international peace commitment can ward off such disincentive altogether.
Conclusion
Conflict, climate crisis and COVID-19 are causing enormous price rises in bare necessities, food and fuel including escalation of the cost of living culminating in non-accessibility to health services being experienced by the common. Peace initiatives, scientific innovations, renewable energy and universal health coverage in the ambit of Primary Health Care would be indisputably rewarding to sustain the growth and development of humanity on this planet. Global catastrophic threats are nebulous, complex and overwhelming. With just a few dots and two hands, the Doomsday Clock depicts the sense of urgency for individualistic, collective and international actions. There are better and more actionable ways to assess risk. A handful of countries, for example, conduct national risk assessments. These are formal and regular processes by which governments assess a range of threats to the country, prioritizing them on a quantitative scale and building response plans for the highest risk to follow when imminent. More nations should conduct an assessment of such precarious issues peculiar to their countries, communities, and contextual perspectives, and be sure to catalogue them honestly in the global catastrophic threat inventory seeking international aid and assistance in the offing.
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