Written on 10th December 2018
We are living through most trying times of our civilisation. The past 20 years have been amongst the 22 hottest years of the planet. 2018 has been a roller coaster of a year with record number of extreme climate change events across the globe. We are living through Dicken’s “It was best of times, it was the worst of times…” redux. Global capitalism is peaking in all spheres epitomized by urbanization, cars, air travel, consumerism, technological advancement, mobiles, telecommunication, internet, entertainment, energy use, etc. Parallelly we are paying a Faustian price for it in terms of global warming, drought, heatwaves, melting arctic and glaciers, storms, precipitation, flooding, wildfires, atmospheric and ocean pollution, sea level rise and extreme climate events.
Almost 200 countries are meeting in Katowice, Poland at COP24 to finalise the practical implementation of 2015 Paris Agreement. This meeting assumes significance especially in the wake of the recent IPCC special report on limiting global warming and US National Climate Assessment report. Like the preceding COP meetings hope of any magical solutions emerging from the current COP24 are receding fast with five days left. Few countries have not been very helpful in ironing differences led by US and Russia.
A slew of extreme climate events has been occurring with accelerating tempo over the past few years which now reinforces the rather despairing prognosis that we are possibly hurtling towards a climate collapse scenario much earlier. This was the most inconvenient truth[1] which all of us are refusing to face. Eventual climate collapse is like mass societal death which human beings do not like to contemplate. We are too busy in our materialistic lives never wanting to admit to ourselves about the impermanence of life.
Denial is the stock reaction of most people when confronted with the inevitability of climate change and collapse. Hence, it’s difficult to drum up sizeable support for climate change social groups. Psychoanalysts like Sally Weintrobe (Engaging with Climate Change) are trying to adopt a multidisciplinary approach to helping overcome denial and avowal.
In view of the bleak scenario where carbon and methane emissions are poised to rise further or at best stay stable till 2030, it is high time for us to plan and implement measures for coping with gradually worsening climate. It will be poor who will be most impacted by accelerating climate change. Percentage of people living in poverty ranges from 40% to 80% depending upon how we define poverty.
Health is a major area where society’s ability to cope with accelerating climate change will be most sorely tested. We are witnessing rise in death due the climate and environment factors like pollution, dwindling fresh and potable water, inadequate sewage systems, flooding, heatwaves, etc. Human stress is increasing especially among the poor. Stress is considered a major trigger[2] for several diseases like cardiovascular, asthma, obesity, diabetes, headaches, gastro-intestinal, common cold, etc. many of which are non-communicable.
There is already a strain on the existing healthcare systems. The better hospitals attract the best doctors and cater to the higher income groups. There is an urgent need for building up wide scale paramedical infrastructure with trained paramedical staff to treat those without medical insurance. India has launched recently a novel social healthcare for treating poorer sections of society “Ayushman Bharat Yojana Scheme”[3]. The rationale of the Scheme was that the existing primary health care were focused on reproductive, maternal, newborn, child and adolescent health and communicable diseases, while non-communicable diseases accounted for nearly 62% of deaths among men and 52% among women. The low-income earners had to pay high, sometimes catastrophic, out of pocket medical and hospitalization expenses often resulting in their penury and ruin.
The strategy behind rolling out the Scheme was to offer a comprehensive need-based health care package instead of the traditional sectoral and segmented based health service system. The Scheme’s objective was to spectrum of healthcare services at the primary, secondary and tertiary levels. The twin component of the scheme offers health protection covers up to Rs 500,000 per annum per family ($ 7,150) for poor and vulnerable sections. Some of the features of the Ayushman Scheme are portability across India, cashless benefits at any public or private empaneled hospitals. It has a strong IT platform which is paperless, cashless and even integrates with mobiles for capture of member information, etc. Once it stabilizes in India, it could be replicated in other places.
Though the Scheme is an innovative one, its success will depend on the passion with which it is implemented. Unfortunately, social health care systems have not succeeded in most of the poor parts of the world like Africa and Asia. In India too, the present primary health centres are not effective in meeting the complex healthcare needs. For serious and chronic health problems in rural areas they have to rely upon district level government hospitals or private nursing homes. Unless government hospitals are manned by better doctors and nurses, most of the poor have to bear higher expenses for medical treatment in private sector clinics.
In view of this, there is an urgent need to take a fresh look at social healthcare. Both the public and private sectors need to work hand in hand. Doctors and nurses as part of their career should be mandated to serve in rural areas and in government hospitals which cannot pay attractive emoluments as in the private sector. The private sector should be forced as part of their corporate social responsibilities to invest and spend in rural health care. Low cost hospitals should set up at all districts. Two private sector organisations, which have succeeded in India, Narayana Health and Health Care Global from Bengaluru by offering world class process driven medical services from their chain of hospitals should be the model health care systems.
In view of accelerating climate change there is a huge pressure to replicate these models in rest of India, South east Asia and Africa. In fact, the governments should make it statutory for all health care service providers to train their staff in climate disaster management also. Recently the state of Kerala in India was hit by an extreme cyclone event during which about 70% of the state was flooded for a week or so. With climate disasters increasing in frequency, role of health care is paramount. Society needs to set up corps of volunteers for handling these climate emergencies. At the earliest all social organisations right down to building, school, office levels need to be put through disaster management drills like that for fire.
As climate change accelerates, during the next the decade, there will arise the need to calm huge sections of population suffering from depression and hyper anxiety. This will not be in isolation. By then we will simultaneously experience further deterioration of the economies, financial system, law and order, communication, food scarcity, inflation, disruption of transportation and so on. Mass yoga, meditation, chanting, counselling and medical cannabis could be useful during these extraordinary times.
Propagation of concepts of Pralaya (end of the world) and Samadhi state (mind in its most concentrated state) will also help facing the ultimate reality. Euthanasia should be legalized in all societies in order to provide exit options with dignity. We need to do all to face and cope with the numbing truth and abyss towards which we are hurtling.
[1] An Inconvenient Truth: Documentary film directed by Davis Guggenheim on Al Gore’s campaign on global warming.
[2] Sopolsky, Robert: Why Zebras Don’t Get Ulcers
[3] https
://www.pmjay.gov.in/about-nha
