Richard Horton: Sustainable Development Is about More than Global Health

October 11, 2016

“Sustainable development is about a universal concept of human improvement,” Richard Horton, editor-in-chief of The Lancet, asserted during his keynote speech at the Duke Global Health Institute’s 10th anniversary symposium last Wednesday. “It’s about the oneness of life. It’s saying that all life is important and interdependent.” Sustainable development, he said, is about the symbiosis between our human lives and all of the natural and physical systems of our planet. 

Horton believes that the global health community has failed to truly understand the meaning of sustainability. He argued for a new global world order that breaks out of the prevalent silo-based global health model that fails to address the complex, dynamic challenges of today’s world. 

Maternal and Adolescent Health Care among Unmet Challenges 

He cited maternal and adolescent health as two areas in which we’re failing to address the health needs of the world’s people. For example, while much progress has been made in reducing maternal mortality worldwide, 53 million women still do not have access to maternal health care, and shockingly, maternal mortality has been on the rise in the United States for the past decade. 

Horton also argued that investing in the health of the world’s 1.8 billion adolescents will result in astonishing dividends, as healthy adolescents grow into healthy adults and, in turn, produce healthy children. Addressing the dire health predicaments adolescents are currently facing—infectious disease, malnutrition, HIV, violence and mental health disorders, to name just a few—will require us to embrace the centrality of today’s adolescents to our future.

SDGs: 17 Goals, 17 Silos

Horton claims that the Sustainable Development Goals (SDGs) will perpetuate the verticality of our global systems and inhibit integration and communication across goals. 

“We’re not going to solve sustainable development by addressing those individual goals,” he said. “Sustainable development will be won at the intersection between those goals.” He cited connections between education and health and between healthy lives and gender equity, and he argued that the rule of law, peace and justice are essential elements in achieving health for all.

If not the SDGs, then what?

Horton explained that the current Anthropocene era has had a profoundly negative effect on biodiversity, a neglected contributor to human health. “The less biodiverse our environment, the weaker our ecosystems that support our species,” he said. “Biodiversity must be—if we believe in sustainability—part of a new vision of global health.”

To this end, Horton and 14 other leading academics and policymakers from institutions in eight countries served on a Planetary Health Commission formed by The Rockefeller Foundation and The Lancet. They advocated for a shift from a public health model to a planetary health model. 

In his talk, Horton defined planetary health as “the health of human civilization and the state of the natural systems on which it depends—the way we organize our political, economic, social, environmental and technological systems to address the predicaments we face.”

In July 2015, the Commission published a report, “Safeguarding Human Health in the Anthropocene Epoch.” 

Can planetary health help inform DGHI’s future strategy?

Horton proposed a new strategy for DGHI’s second decade and, in doing so, pulled three key words from DGHI’s current strategic plan: interdisciplinary, research and partnerships. To achieve sustainable development, he said, “we have to think about how we unite different disciplines to answer research questions in ways that we’ve never done before.” 

He warned, though, that interdisciplinary research currently receives limited support in the way of funding and publications, so this approach comes with its own set of challenges. In fact, this is one of the issues the Planetary Health Commission addressed in their report. 

Horton closed his talk with this declaration: 

“Global health is the science for humanity, and the opportunities that it gives us are enormous. But for that opportunity to be fully achieved, we have to re-vision, revise, radically transform the meaning of global health today; otherwise we will miss the opportunity, the prize that sits before us. I can’t think of an institution that’s better placed to seize that prize than Duke, but to have the courage to take that radical step into a different future is going to take brave leadership.”

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Richard Horton, editor-in-chief of The Lancet, gave the keynote address at the symposium.

Biodiversity must be—if we believe in sustainability—part of a new vision of global health.

Richard Horton, The Lancet editor-in-chief

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