"Urban transport systems based on a combination of rail lines, bus lines, bicycle pathways, and pedestrian walkways offer the best of all possible worlds in providing mobility, low-cost transportation, and a healthy urban environment." –Lester R. Brown, Plan B 4.0: Mobilizing to Save Civilization.
Chapter 6. Early Signs of Decline: Health Challenge Growing
Health challenges are becoming more numerous as new infectious diseases such as SARS, the West Nile virus, and avian flu emerge. In addition, the accumulation of chemical pollutants in the environment is starting to take a toll. While some infectious diseases, such as malaria and cholera, have been around a long time and are diseases with which health authorities are quite familiar, the health effects of many environmental pollutants are only now being determined.
Among the leading infectious diseases, malaria claims more than 1 million lives each year, 89 percent of them in Africa. The number who are infected, and often suffer from it most of their lives, is many times greater. Economist Jeffrey Sachs, head of Columbia University’s Earth Institute, estimates that reduced worker productivity and other costs associated with malaria are cutting economic growth by a full percentage point in countries with heavily infected populations. 16
Although diseases such as malaria and cholera exact a heavy toll, there is no precedent for the number of lives affected by the HIV epidemic. To find anything similar to such a potentially devastating loss of life, we have to go back to the smallpox decimation of Native American communities in the sixteenth century or to the bubonic plague that took roughly a fourth of Europe’s population during the fourteenth century. HIV should be seen for what it is—an epidemic of epic proportions that, if not checked soon, could take more lives during this century than were claimed by all the wars of the last century. 17
Since the human immunodeficiency virus was identified in 1981, this infection has spread worldwide. By 1990, an estimated 10 million people were infected with the virus. By the end of 2004, the number who had been infected climbed to 78 million. Of this total, 38 million have died; 39 million are living with the virus. Twenty-five million HIV-positive people today live in sub-Saharan Africa, but only 500,000 or so are being treated with anti-retroviral drugs. Seven million live in South and Southeast Asia, with over 5 million of them in India alone. 18
Infection rates are climbing. In the absence of effective treatment, the parts of sub-Saharan Africa with the highest infection rates face a staggering loss of life. Adding the heavy mortality from the epidemic to the normal mortality of older adults means that countries like Botswana and Zimbabwe will lose half of their adult populations within a decade. 19
The HIV epidemic is not an isolated phenomenon. It is affecting every facet of life and every sector of the economy. Food production per person, already lagging in most countries in sub-Saharan Africa, is now falling fast as the number of field workers shrinks. As food production falls, hunger intensifies among the dependent groups of children and the elderly. The downward spiral in family welfare typically begins when the first adult falls victim to the illness—a development that is doubly disruptive because for each person who is sick and unable to work, another adult must care for that person. 20
The massive loss of young adults to AIDS is already beginning to cut into economic activity. Rising worker health insurance costs in industry are shrinking or even eliminating company profit margins, forcing some firms into the red. In addition, companies are facing increased sick leave, decreased productivity, and the burden of recruiting and training replacements when employees die. 21
Education is also affected. The ranks of teachers are being decimated by the virus. In 2001, for instance, Zambia lost 815 primary school teachers to AIDS, the equivalent of 45 percent of new teachers trained that year. With students, when one or both parents die, more children are forced to stay home simply because there is not enough money to buy books and to pay school fees. Universities are also feeling the effects. At the University of Durbin in South Africa, for example, 25 percent of the student body is HIV-positive. 22
The effects on health care are equally devastating. In many hospitals in eastern and southern Africa, a majority of the beds are now occupied by AIDS victims, leaving less space for those with other illnesses. Already overworked doctors and nurses are often stretched to the breaking point. With health care systems now unable to provide even basic care, the toll of traditional disease is also rising. Life expectancy is dropping not only because of AIDS, but also because of the deterioration in health care. 23
The epidemic is leaving millions of orphans in its wake. Sub-Saharan Africa is expected to have 18.4 million “AIDS orphans” by 2010—children who have lost at least one parent to the disease. There is no precedent for millions of street children in Africa. The extended family, once capable of absorbing orphaned children, is now itself being decimated by the loss of adults, leaving children, often small ones, to take care of themselves. For some girls, the only option is what has come to be known as “survival sex.” Michael Grunwald of the Washington Post writes from Swaziland, “In the countryside, teenage Swazi girls are selling sex—and spreading HIV—for $5 an encounter, exactly what it costs to hire oxen for a day of plowing.” 24
The HIV epidemic in Africa is now a development problem, a matter of whether a society can continue to function as needed to support its people. It is a food security problem. It is a national security problem. It is an educational system problem. And it is a foreign investment problem. Stephen Lewis, the U.N. Special Envoy for HIV/AIDS in Africa, says that the epidemic can be curbed and the infection trends can be reversed, but it will take help from the international community. The failure to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria, he says, is “mass murder” by complacency. 25
Writing in the New York Times, Alex de Waal, an adviser to the U.N. Economic Commission for Africa and to UNICEF, sums up the effects of the epidemic well: “Just as HIV destroys the body’s immune system, the epidemic of HIV and AIDS has disabled the body politic. As a result of HIV, the worst hit African countries have undergone a social breakdown that is now reaching a new level: African societies’ capacity to resist famine is fast eroding. Hunger and disease have begun reinforcing each other. As daunting as the prospect is, we will have to fight them together, or we will succeed against neither.” 26
While the HIV epidemic is currently concentrated in Africa, air and water pollutants are damaging the health of people everywhere. A joint study by the University of California and the Boston Medical Center shows some 200 human diseases, ranging from cerebral palsy to testicular atrophy, linked to pollutants. Other diseases that can be caused by pollutants include an astounding 37 forms of cancer, plus heart disease, kidney disease, high blood pressure, diabetes, dermatitis, bronchitis, hyperactivity, deafness, sperm damage, and Alzheimer’s and Parkinson’s diseases. 27
In July 2005, the Environmental Working Group in collaboration with Commonweal released an analysis of umbilical cord blood from 10 randomly selected newborns in U.S. hospitals. They detected a total of 287 chemicals in these tests. “Of the 287 chemicals we detected… we know that 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests.” Everyone on the planet shares this “body burden” of toxic chemicals, but infants are at greater risk because they are in the highly vulnerable formative stage of early development. 28
WHO reports an estimated 3 million deaths worldwide each year from air pollutants—three times the number of traffic fatalities. A study in Lancet concluded that air pollution claims 40,000 lives per year in France, Austria, and Switzerland, half of them attributable to vehicle emissions. In the United States, air pollution each year claims 70,000 lives, nearly double the 40,000 traffic fatalities. 29
A U.K. research team reports a surprising rise in Alzheimer’s and Parkinson’s diseases and in motor neuron disease broadly in 10 industrial countries—six in Europe plus the United States, Japan, Canada, and Australia. In England and Wales, deaths from these brain diseases increased from 3,000 per year in the late 1970s to 10,000 in the late 1990s. Over an 18-year period, death rates from these dementias, mainly Alzheimer’s, more than tripled for men and nearly doubled for women. This increase in dementia is linked to a rise in the concentration of pesticides, industrial effluents, car exhaust, and other pollutants in the environment. 30
Horror stories of the health effects of uncontrolled industrial pollution in Russia are commonplace. For example, in the industrial town of Karabash in the foothills of the Ural Mountains, children routinely suffer from lead, arsenic, and cadmium poisoning. This translates into congenital defects, neurological disorders, and cancer. Pollutants also impair immune systems. 31
Scientists are becoming increasingly concerned about the various effects of mercury, a potent neurotoxin, which now permeates the environment in virtually all countries with coal-burning power plants and many of those with gold mines. Gold miners release an estimated 200,000 pounds of mercury into the Amazon ecosystem each year, and coal-burning power plants release over 100,000 pounds of mercury into the air in the United States. The U.S. Environmental Protection Agency (EPA) reports that “mercury from power plants settles over water ways, polluting rivers and lakes, and contaminating fish.” 32
In 2004, 48 of the 50 states in the United States (all but Alaska and Wyoming) issued a total of 3,221 fish advisories warning against eating fish from local lakes and streams because of their mercury content. EPA research indicates that one out of every six women of childbearing age in the United States has enough mercury in her blood to harm a developing fetus. This means that 360,000 of the 4 million babies born in the country each year may face neurological damage from mercury exposure before birth. In a 2005 study by the Mt. Sinai Center for Children’s Health and the Environment, a team of doctors calculated that lower I.Q. levels as a result of mercury exposure in the womb cost the United States $8.7 billion a year in lost earnings potential. 33
No one knows exactly how many chemicals are manufactured today, but with the advent of synthetic chemicals the number of chemicals in use has climbed to over 100,000. A random blood test of Americans will show measurable amounts of easily 200 chemicals that did not exist a century ago. 34
Most of these new chemicals have not been tested for toxicity. Those that are known to be toxic are included in a list of 667 chemicals whose discharge by industry into the environment must be reported to the EPA. The Toxic Release Inventory (TRI), now accessible on the Internet, also provides information on a community-by-community basis, arming local groups with data needed to evaluate the potential threats to their health and that of the environment. Since the TRI was inaugurated in 1988, reported toxic chemical emissions have declined steadily. 35
Although we have been hearing about the carcinogenic effects of pesticides since Rachel Carson launched the environmental era with her book Silent Spring, we are not yet adequately dealing with this threat. Since then we have learned a great deal about the health effects from chemicals released into the environment, particularly the endocrine disruptors described by Theo Colborn and her colleagues in Our Stolen Future. This family of chemicals disrupts the reproductive and developmental processes not only in humans but in many other species as well. 36
16. WHO/UNICEF, World Malaria Report 2005 (Geneva: 2005); Anne Platt McGinn, “Malaria’s Lethal Grip Tightens,” in Worldwatch Institute, Vital Signs 2001 (New York: W.W. Norton & Company, 2001), pp. 134–35; Sachs from Center for International Development at Harvard University and London School of Hygiene and Tropical Medicine, “Executive Summary for Economics of Malaria,” www.rbm.who.int/docs/abuja_sachs2.htm, viewed 3 August 2005; malaria deaths calculated from United Nations, op. cit. note 1, and WHO/UNICEF, op. cit. this note.
17. More deaths from AIDS than wars from Lawrence K. Altman, “U.N. Forecasts Big Increase in AIDS Death Toll,” New York Times, 3 July 2002.
18. UNAIDS, AIDS Epidemic Update (Geneva: December 2004), p. 1; UNAIDS, op. cit. note 1, pp. 189–207; total deaths and historical estimates calculated using UNAIDS statistics in Worldwatch Institute, Signposts 2004, CD-Rom (Washington, DC: 2004); anti-retroviral treatment in sub-Saharan Africa from WHO, “Access to HIV Treatment Continues to Accelerate in Developing Countries, but Bottlenecks Persist, Says WHO/UNAIDS Report,” press release (Geneva: 29 June 2005).
19. UNAIDS, op. cit. note 1, pp. 39–66, 191.
20. AIDS and food security in UNAIDS, op. cit. note 1, pp. 39–66; FAO, The Impact of HIV/AIDS on Food Security, 27th Session of the Committee on World Food Security, Rome, 28 May–1 June 2001.
21. “Strategic Caring: Firms Strategize About AIDS,” The Economist, 5 October 2002; UNAIDS, op. cit. note 1, pp. 39–66.
22. EFA Global Monitoring Report Team, op. cit. note 6; UNAIDS, op. cit. note 1, pp. 39–66; Prega Govender, “Shock AIDS Test Result at Varsity,” Sunday Times (Johannesburg), 25 April 1999; “South Africa: University Finds 25 Percent of Students Infected,” Kaiser Daily HIV/AIDS Report, 27 April 1999.
23. UNAIDS, op. cit. note 1, pp. 39–66.
24. UNAIDS, UNICEF, and U.S. Agency for International Development (USAID), Children on the Brink 2004: A Joint Report on New Orphan Estimates and a Framework for Action (Washington, DC: July 2004),
p. 29; Michael Grunwald, “Sowing Harvests of Hunger in Africa,” Washington Post, 17 November 2002.
25. Stephen Lewis, press briefing (New York: 8 January 2003); Edith M. Lederer, “Lack of Funding for HIV/AIDS is Mass Murder by Complacency, Says U.N. Envoy,” Associated Press, 9 January 2003.
26. Alex de Waal, “What AIDS Means in a Famine,” New York Times, 19 November 2002.
27. Sarah Janssen, Gina Solomon, and Ted Schettler, Chemical Contaminants and Human Disease: A Summary of Evidence (Boston: Alliance for a Healthy Tomorrow, 2004); Geoffrey Lean, “US Study Links More than 200 Diseases to Pollution,” Independent News (London), 14 November 2004.
28. Jane Houlihan et al., Body Burden: The Pollution in Newborns (Washington, DC: Environmental Working Group, 2005).
29. Bernie Fischlowitz-Roberts, “Air Pollution Fatalities Now Exceed Traffic Fatalities by 3 to 1,” Eco-Economy Update (Washington, DC: Earth Policy Institute, September 2002), citing WHO, “Air Pollution,” Fact Sheet 187 (Geneva: revised September 2000); N. Künzli et al., “Public-Health Impact of Outdoor and Traffic-related Air Pollution: A European Assessment,” Lancet, 2 September 2000, p. 795; traffic accident deaths from British Red Cross, “May 8 Spotlight on the Millions Injured and Disabled by Road Accidents,” press release (London: 9 May 2001); 70,000 American deaths from Joel Schwartz, quoted in Harvard School of Public Health, “Air Pollution Deadlier Than Previously Thought,” press release (Cambridge, MA: 2 March 2000).
30. C. Pritchard, D. Baldwin, and A. Mayers, “Changing Patterns of Adult (45–74 years) Neurological Deaths in the Major Western World Countries 1979–1987,” Public Health, vol. 118, issue 4 (June 2004),
pp. 268–83; Juliette Jowit, “Pollutants Cause Huge Rise in Brain Diseases: Scientists Alarmed as Number of Cases Triples in 20 Years,” The Observer (London), 15 August 2004.
31. Sharon LaFraniere, “Mother Russia’s Poisoned Land,” Washington Post, 22 June 1999.
32. “Mercury Poisoning Disease Hits Amazon Villages,” Reuters, 4 February 1999; mercury emissions from U.S. coal plants in U.S. Environmental Protection Agency (EPA), Office of Air Quality Planning and Standards and Office of Research and Development, Mercury Study Report to Congress Volume II (Washington, DC: December 1997),
p. ES-4; Patricia Glick, The Toll from Coal (Washington, DC: National Wildlife Federation, 2000), p. 9; EPA, “EPA Decides Mercury Emissions from Power Plants Must Be Reduced,” press release (Washington, DC: 15 December 2000); Ilan Levin and Eric Schaeffer, Dirty Kilowatts: America’s Most Polluting Power Plants (Washington, DC: Environmental Integrity Project, 2005).
33. EPA, Office of Water, “2004 National Listing of Fish Advisories,” EPA Fact Sheet (Washington, DC: September 2005); Kathryn Mahaffey, EPA, Methylmercury: Epidemiology Update, presentation at The National Forum on Contaminants in Fish, San Diego: January 2004, at www.epa.gov/waterscience/fish/forum/2004/presentations/monday/mahaffey.pdf; Leonardo Trasande, Philip J. Landrigan, and Clyde Schechter, “Public Health and Economic Consequences of Methyl Mercury Toxicity to the Developing Brain,” Environmental Health Perspectives, vol. 13, no. 5 (May 2005).
34. Anne Platt McGinn, Why Poison Ourselves? A Precautionary Approach to Synthetic Chemicals, Worldwatch Paper 153 (Washington, DC: Worldwatch Institute, November 2000), p. 7; 200 chemicals in body from Pete Myers, plenary discussion on Emerging Environmental Issues, at USAID Environmental Officers Training Workshop, “Meeting the Environmental Challenges of the 21st Century,” Airlie Center, Warrenton, VA, 26 July 1999.
35. EPA, “Toxics Release Inventory (TRI) Program,” fact sheet, at www.epa.gov/tri, updated 17 May 2005; EPA, “EPA Issues New Toxics Report, Improves Means of Reporting,” press release (Washington, DC: 11 April 2001).
36. Rachel Carson, Silent Spring (Boston: Houghton Mifflin Company, 2002); Theo Colborn, Dianne Dumanoski, and John Peterson Myers, Our Stolen Future (New York: Dutton Publishing, 1996).
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