On June 22, 2023, World Bank president Ajay Banga shared the stage with Barbados Prime Minister Mia Mottley at the Global Citizen Concert in Paris. Attended by 20,000 people, this was part of the Power The Planet event organised alongside the Summit for a New Global Financing Pact, chaired by French President Emmanuel Macron
Calling for justice to countries vulnerable to climate change, the eloquent yet assertive Mottley declared: “Action cannot be taken in some far-off future. In fact it cannot even wait for tomorrow—we need to do this today.” She underscored the urgency of this by highlighting the imminent danger posed to her own country by Tropical Storm Bret. Ajay Banga responded by announcing that the World Bank would implement a “debt pause” for countries suffering the effects of a natural disaster. “It gives governments and leaders like Mia a break from repaying their debts so that they can focus on recovery—they should not be worried about paying the bills.”
Even more significantly, Banga redefined the mission of the World Bank. In 1973, the then World Bank president, Robert McNamara, stated the mission of the multilateral development bank was to “accelerate economic growth and to reduce poverty”. Even now, the two goals listed on the bank’s website are: End extreme poverty and promote shared prosperity in a sustainable way.
The preoccupation of the bank with increasing prosperity—with only some attention to reducing extreme poverty—led to an almost exclusive focus on the economic indicators of national and global development, with scarce attention to the social and environmental indices of human and planetary well-being. Dangerously, it also gave licence to private sector activities which were detrimental to the health of the environment and people. National governments, too, became obsessed with chasing economic growth, unmindful of the damage to natural ecosystems and the finely balanced physiological systems of the human body.
In Paris, Banga declared that henceforth, the bank’s vision would be to “create a world free of poverty on a liveable planet”. Earlier, they focused only on extreme poverty. Now, they say they will tackle all levels of poverty and not restrict action only to extreme poverty. Commitment to actions aligned with environmental protection came strongly in the affirmation of “a liveable planet” as the existential imperative for all of humanity.
What is a “liveable planet”? While Banga did not describe its qualifying features, he prefaced his statement by listing some of the problems faced by the world at present. An unnecessary war in Ukraine was identified upfront. Lack of schools, “decent healthcare” and roads were listed as factors thrusting entire communities into a cycle of poverty. Extreme weather events like floods, droughts and hurricanes were mentioned. He declared that the urgency of the moment demands an immediate response.
The world would have to transcend present challenges and insulate itself against the recurrence of such dangers in the future if the planet is to be deemed “liveable”. However, the bank’s vision has to be expanded to include a clearer and stronger commitment to the promotion and protection of health at the population level, besides and beyond “decent healthcare” for individuals with disease. Population health is the best summative indicator of success across the 17 Sustainable Development Goals. The goal can relate to poverty reduction, protection against hunger and provision of nutrition security, promotion of education and gender equity, etc., but there is always an intimate and often bidirectional relationship to human and animal health.
Given this understanding, it would be appropriate for the bank to expand its goals to include “increase in healthy life expectancy of all populations in the world and of all socio-demographic groups within each population”, apart from eliminating poverty and increasing shared prosperity. Healthy life expectancy is a measure of disease- and disability-free survival and is the best development dividend that nations can gift to their populations. By elevating this to an overarching goal, we can address and assess progress in shaping the many social, economic, environmental and commercial determinants of health.
By doing so, we will set the right priorities for development at global and national levels, and give precedence to climate change mitigation and adaptation measures over deforestation and polluting industries. We will invest more resources in climate-smart and climate-resilient food and agriculture systems, health systems and urban development designs. We will ask ourselves how self-destructive it is to squander 3.5 mn hectares of arable land on growing a water- and pesticide-intensive killer crop like tobacco even as the world faces threats to nutrition security from climate change. We will introspect on why ultra-processed food products and sugar-sweetened beverages (like colas) are using up our precious agricultural produce and potable water—only to ultimately harm both human and planetary health.
Development of well-resourced, digitally enabled primary healthcare systems will promote population health, bring comprehensive and continuous healthcare services home or close to home, be energy-efficient by reducing the need for advanced care and long commutes, while also promoting employment opportunities for women and youth. Promoting local agriculture and food production will be environment-friendly and encourage women’s involvement in farming. The long supply chains in healthcare and food systems must be cut short as their contributions to greenhouse gas emissions are high. Multilateral development banks must support such transitions.
Humanity has already crossed seven planetary boundaries, as described by the Stockholm Resilience Institute. Vis-à-vis the eighth boundary, air pollution, we are dangerously close to the precipice. It is time we make protection and promotion of human and planetary health well-being the highest priority in global development. While doing so, the World Bank may wish to consider not only a debt pause for responding to immediate climate emergencies but providing support to long-term debt relief measures so that countries can invest in developing climate-smart and climate-resilient systems for agriculture, food production, health service delivery, and rural and urban development. The climate crisis calls for a corrective response, not just a coping response.
(Views are personal)
Dr K Srinath Reddy
Cardiologist, epidemiologist and Distinguished Professor of Public Health, PHFI