Diarmid Campbell-LendrumI,*; Manjula Lusti-NarasimhanII
IDepartment of Public Health and Environment, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
IIDepartment of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
Climate change and population, taken individually, are among the most contentious issues in public policy; bringing the two issues together is a recipe for controversy. The paper by Bryant et al. (852-857) in this issue1 points towards a more constructive approach to addressing these linked concerns.
For all of its complexities, the basic challenge of climate-change policy is the apparent conflict between the drive to maximize short-term individual or national gains (increasing per capita GDP through use of cheap fossil fuel energy) and the need for long-term protection of shared benefits (reducing climate change and minimizing global damage to natural and human systems).
Closely tied to this is the issue of fairness. Those populations that have contributed least to past emissions of greenhouse gases are most vulnerable to the impacts of climate change, including on population health.2,3 The governments of developing countries are therefore reluctant to commit to limits on greenhouse gas emissions to help solve a problem that has, so far, been created elsewhere. For their part, the governments of richer countries generally acknowledge their responsibility to take a lead in combating climate change, but hesitate in implementing policies that they consider may harm short-term economic growth and hamper their competitiveness against rapidly developing economies.
Some aspects of this debate find analogies in discussion of population policy. Again, there is a potential tension between the immediate rights of individuals (to control their own fertility) and a longer-term, population-level concern (that rapid population growth could potentially overstretch natural and socioeconomic resources, hamper development and lay conditions for conflict).
These two issues are also closely linked, but discussing them together has often generated more heat than light. Although the major driver of greenhouse gas emissions remains the consumption patterns of richer populations, human population is also a fundamental determinant of this trend. However, even stating the fairly obvious fact that an individual's number of children makes a major contribution to their "legacy" of greenhouse gas emissions4 has sparked outraged reaction in some quarters.
Population growth is also fastest in developing countries, leading to suggestions that this should be the starting point to reduce climate change. In response, developing countries point out that per capita emissions of children born in poor countries are, and are likely to remain, much lower than those in richer countries, and claim that they are being stigmatized for "profligate reproductive behaviour" as a negotiating position over greenhouse gas commitments.5
Can these issues be discussed constructively? The best approach is probably to choose the least controversial entry point - identifying where human rights, health, environmental and equity objectives converge, rather than conflict. This can be framed around the fact that, in developing countries, approximately 200 million women express an unmet need for family planning services.6 Meeting this need is supported by the following arguments.
First, control over reproduction is an individual right, supported through the landmark Programme of Action of the 1994 International Conference on Population and Development. Improved access to reproductive health services is also a Millennium Development Goal. Second, it provides major public health benefits; systematic reviews across multiple countries show that increasing birth spacing from less than 18 to more than 36 months correlates with a two-thirds drop in childhood mortality.7 Third, reducing local overpopulation decreases vulnerability to near-term environmental and other stresses. Fourth, over the long-term, it relieves climate change and other pressures on the global environment.8
Other studies have already identified improved access to reproductive health services as one of several "win-win" interventions that can both improve individual well-being and reduce climate change.9-11 The paper by Bryant et al., however, is the first to provide strong support for the third point - showing that the majority of the least-developed countries cite population pressure as an important determinant of their vulnerability to climate change. The fact that the affected countries themselves identify this as a local priority avoids the conflict that comes from framing population regulation as a way of reducing global greenhouse gas emissions.
When developing this case, the order of the arguments is critically important. Individual rights come first, with the population health, local and global environmental benefits as welcome and important co-benefits. In contrast, using the need to reduce climate change as a justification for curbing the fertility of individual women at best provokes controversy and, at worst, provides a mandate to suppress individual freedoms.
This new paper is an important contribution in its own right. It is also a reminder that, although the case for family planning services should be self-evident, it needs to be carefully constructed and sensitively handled.
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8. Millennium Ecosystem Assessment. Ecosystems and human well-being: health synthesis. Geneva: World Health Organization; 2005.
9. O'Neill BC. Cairo and climate change: a win-win opportunity. Glob Environ Change 2000;10:93-6. doi:10.1016/S0959-3780(00)00013-3
10. Guzman JM. Climate change and population growth. Lancet 2009;374:450. PMID:19665643 doi:10.1016/S0140-6736(09)61449-5
11. Smith KR, Balakrishnan K. Mitigating climate, meeting MDGs, and moderating chronic disease: the health co-benefits landscape. Commonwealth Health Ministers' Update. London: Commonwealth Secretariat; 2009.