{"id":38160,"date":"2017-01-20T12:17:25","date_gmt":"2017-01-20T11:17:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=38160"},"modified":"2017-01-20T12:22:13","modified_gmt":"2017-01-20T11:22:13","slug":"colin-d-butler-regional-overload-and-the-consequences-it-has-on-public-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/01\/20\/colin-d-butler-regional-overload-and-the-consequences-it-has-on-public-health\/","title":{"rendered":"Colin D Butler: Regional overload and the consequences it has for health"},"content":{"rendered":"

\"\"Almost 1% of the world population, mostly children, is forcibly displaced (including 11.7 million Syrians), an increase of over 50% from 2011. [1]\u00a0Here I propose that the public health catastrophe in Syria\u00a0be conceptualized as a canary case of \u201cregional overload,\u201d relevant to the emerging public health sub-specialty of planetary health. [2,3,4]<\/p>\n

In 1990, King warned, in a prominent article in the health literature, of \u201cdemographic entrapment.” [5] Soon after, leading epidemiologist McMichael wrote of \u201cplanetary overload.” [6] Both concepts are related to Malthusian thought, and thus to the theory of evolution, which accepts, as fundamental, competition for finite resources, often between co-operating groups. [3,7]<\/p>\n

Demographic entrapment is argued to occur in extreme cases when population growth outpaces that of development, triggering population \u201cchecks\u201d including from conflict, famine, epidemics, and out-migration. [5]\u00a0Examples include in Ireland (mid-19th<\/sup> century), Rwanda (1994), and, arguably South Sudan and Syria today. [6]<\/p>\n

Planetary overload posits that the human impact on Earth is non-sustainable. [3,7]\u00a0Planetary overload is unlikely to be homogenous; some regions will be overloaded before others. Plausible contemporary examples of regional overload include Yemen, the Sahel and Bangladesh; here I focus on Syria, given the magnitude of its current situation.<\/p>\n

Two key papers have reviewed substantial evidence to conclude that climate change has aggravated the recent Syrian drought, unprecedented in severity, and, in turn, this contributed to food price shocks, rapid internal migration, and ultimately its civil war and population displacement crisis. [8,9]\u00a0Analysts in support of the link between environmental stressors and conflict stress violence emerges in a \u201cmilieu\u201d whose elements in Syria include rivalry, grievance, inequality and outside interference. Importantly, this is not \u201cenvironmental determinism,\u201d as some critics have asserted. Instead, climate change acts as a \u201cthreat multiplier\u201d of conflict. [3,10]<\/p>\n

The total fertility rate in Syria before the war was falling, but far above replacement. [2]\u00a0High Syrian population growth reduced the \u201cdemographic dividend,\u201d which helps to promote economic and human development in low-income settings with high population growth. A consequence of Syria\u2019s high fertility rate was growing youth unemployment, reported as 48% in 2011, a five-fold increase from 2000. [2]\u00a0Large numbers of young, underemployed, under-fulfilled men (\u201cyouth bulges\u201d) often accompany high population growth, and have long been linked to violence. The need for economic growth to reduce Syrian poverty, accelerated depletion of groundwater, another key resource. [8,9]<\/p>\n

The Planetary Health Commission argued that many health gains are achieved by eroding Earth\u2019s natural systems that provide essential services \u201con which human civilisation depends\u201d. It suggested that if populations attain health by exploiting the environment unsustainably then this is likely to be at the expense of other populations, now or in the future. [4]<\/p>\n

Although humans have always modified nature, today, too many humans are feasting on the ecological underpinnings of global and planetary health. Those with ample \u201cfeed\u201d thrive, but at an increased cost to others, including many of the Syrian population, whether killed, living in fear, or displaced.<\/p>\n

I have argued that the population displacement from Syria can be conceptualised as a form of regional overload, in turn related to planetary health. But not all causes of regional overload are from overconsumption by the rich. Conditions in Syria, much of the Sahel, Burundi and elsewhere will be greatly improved by education, human rights, slower population growth, and greater scientific acknowledgement of these imperatives.<\/p>\n

The problems besetting planetary health are formidable. Scientists and medical practitioners cannot, themselves, alter human destiny, yet have a duty of care to be as accurate and dispassionate as possible. A proper diagnosis may yet enable the remedies which can alleviate much future human suffering.<\/p>\n

Colin<\/span>\u00a0Butler<\/span><\/strong>\u00a0is an adjunct professor of Public Health at the University of Canberra, Australia, and co-founder of the NGOs\u00a0BODHI<\/a>\u00a0and\u00a0BODHI Australia<\/a>. He is founding co-chair of\u00a0Health Earth<\/a>\u00a0and lead author for the section on health in the forthcoming flagship Global Environmental Outlook report of the United Nations Environment Programme, called\u00a0Healthy Planet, Healthy People<\/a>.<\/em><\/p>\n

Competing interests<\/strong>:\u00a0I own stocks whose value should increase with greater action to counter climate change. I have received and anticipate future reimbursement for travel expenses, both as a speaker and co-author at writing workshops. I receive occasional book royalties (as an editor) and other author\u2019s fees. I am a past recipient of an Australian Research Council grant. Most of my writing, speaking and the grants I have received or am applying for is relevant to the subject of this blog\/opinion piece. <\/span><\/p>\n

Not commissioned, Peer reviewed.<\/p>\n

References:\u00a0<\/strong><\/p>\n

    \n
  1. UNHCR. Global Trends Report. Forced Displacement in 2015: UNHCR 2016.<\/li>\n
  2. Taleb ZB, Bahelah R, Fouad FM, et al. Syria: health in a country undergoing tragic transition. International Journal of Public Health<\/em> 2015;60(1):63-72. doi: 10.1007\/s00038-014-0586-2<\/li>\n
  3. Butler CD. Planetary overload, limits to growth and health. Current Environmental Health Reports<\/em> 2016;3(4):360-69.<\/li>\n
  4. Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation\u2013Lancet Commission on planetary health. The Lancet<\/em> 2015;386:1973\u20132028. doi: 10.1016\/S0140-6736(15)60901-1<\/li>\n
  5. King M. Health is a sustainable state. The Lancet<\/em> 1990;336:664-67.<\/li>\n
  6. McMichael AJ. Planetary Overload. Global Environmental Change and the Health of the Human Species. Cambridge: Cambridge University Press 1993.<\/li>\n
  7. Butler CD. Human carrying capacity and human health. Public Library of Science Medicine<\/em> 2004;1(3):192-94.<\/li>\n
  8. Gleick P. Water, drought, climate change, and conflict in Syria. Weather, Climate, and Society<\/em> 2014;6:331\u201340. doi: 10.1175\/wcas-d-13-00059.1<\/li>\n
  9. Kelley CP, Mohtadi S, Cane MA, et al. Climate change in the Fertile Crescent and implications of the recent Syrian drought. Proceedings of the National Academy of Sciences (USA)<\/em> 2015;112(11):3241-46. doi: 10.1073\/pnas.1421533112<\/li>\n
  10. Schleussner C-F, Donges JF, Donner RV, et al. Armed-conflict risks enhanced by climate-related disasters in ethnically fractionalized countries. Proceedings of the National Academy of Sciences<\/em> 2016;113(33):9216-21. doi: 10.1073\/pnas.1601611113<\/li>\n<\/ol>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Almost 1% of the world population, mostly children, is forcibly displaced (including 11.7 million Syrians), an increase of over 50% from 2011. [1]\u00a0Here I propose that the public health catastrophe […]<\/p>\n

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