Mary Robinson addresses graduating students at Harvard School of Public Health in May 2018. (Credit: Jonathan Levine)
On 23 May, Mary Robinson delivered the Convocation address to graduating students at the Harvard Chan School of Public Health, highlighting the challenge posed by climate change to global public health. She also lamented the “national scandal” of 28 million Americans not having health insurance coverage but noted with optimism what she called the “unstoppable momentum” for universal health coverage in the United States.
I am honoured and delighted to address the graduating class of 2018 at Harvard School of Public Health. I must say, I was very moved yesterday when I went along to the awards ceremony, and I heard something I’ve never heard before. And it was really, really well done. Thirteen students took the preamble to the Universal Declaration of Human Rights, and spoke that preamble in 13 languages. And I gather you do this each year. It’s a wonderful example. After the preamble is Article 1 of the Universal Declaration, and the first sentence of Article 1 captures for me what human rights means: “All human beings are born free and equal in dignity and rights.”
I also want to note the way in which you made space at the very beginning of this Convocation ceremony for a voice on behalf of indigenous peoples and to honour the land. That too is something I haven’t heard at convocations or commencement ceremonies. So, well done, the Harvard Chan School of Public Health!
As I see it, you are in the right place at the right time. And you have the talent, the training, the commitment and the expertise to meet the challenges ahead.
But more about that later.
Allow me a nostalgic moment, as I reflect on having been, 50 years ago, part of the class of 1968 graduating with my master’s from Harvard Law School. I have often referred to the positive impact which that year at Harvard had on me. Many of my American contemporaries were critical of what they viewed as an immoral war in Vietnam. They were heading not for the lucrative Wall Street law firms but to tackle racial discrimination and to work on poverty programs in the south of this country. We mourned the assassination of Martin Luther King in April that year, and were further shocked by the assassination of Robert Kennedy just after we graduated. What impressed me most of all was that young people in Harvard were prepared to take on responsibility, to show leadership and to be determined to make great changes in society. And that was different from the Ireland I had grown up in, where young people were told to wait, wait your turn. Wait. Now you’re in your 30s—wait a bit longer. Now you’re in your early 40s—wait a bit longer. It was different.
It seems to me that you are graduating at a similar time of deep uncertainty but of great potential for a better future.
The international community faces a great challenge in stabilizing the climate. We need to reach zero carbon emissions by 2050 in order to have the best possible chance of keeping warming well below 2°C above pre-industrial levels and hopefully stabilizing at 1.5°C. However, the commitments made by countries to date in their Nationally Determined Contributions (NDCs)—national targets for curbing climate-altering greenhouse gases—leave a considerable gap between the commitments pledged and the action needed. If we continue with business as usual we are on track to at least a 3.5°C warmer world compared with pre-industrial levels. This would lead to extreme and potentially irreversible impacts on natural ecosystems and on human health. Basically, it would be catastrophic, and that is what we are headed for unless we can bend the curve and change.
President Trump’s decision to pull the United States out of the Paris Agreement—although it cannot take full effect until 4th November 2020—was a severe blow to climate action. I do note that your next presidential election is the 3rd of Nov 2020—so maybe things can change. And in fact, that decision to pull out of the Paris agreement was met by two positive responses: every other country committed to staying the course; and in the United States a broad alliance of states, cities, business, philanthropy, universities and civil society adopted a declaration called ‘We are still in,’ which concludes as follows:
“It is imperative that the world know that in the U.S., the actors that will provide the leadership necessary to meet our Paris commitment are found in city halls, state capitals, colleges and universities, investors and businesses. Together, we will remain actively engaged with the international community as part of the global effort to hold warming to well below 2ºC and to accelerate the transition to a clean energy economy that will benefit our security, prosperity, and health.”
Climate change is not just an issue of atmospheric science; it is also about human rights. Climate change undermines the enjoyment of the full range of human rights—from the right to life, to food, to shelter and to health. The situation is particularly acute for people living in vulnerable situations owing to geography, gender, age, race, poverty, disability or social status. It is an injustice that the people who have contributed least to the causes of the problem suffer the worst impacts of climate change.
The impacts of climate change on the right to health are now well understood. The 2015 Lancet Commission on Health and Climate Change documents the direct impacts of heat stress, droughts, floods and increased frequency of intense storms on human health; as well as the indirect impacts on health caused by air pollution, spread of disease vectors, food and nutrition insecurity and mental illness among others. The central finding of the 2015 Lancet Commission is “that tackling climate change could be the greatest global health opportunity of the 21st century.” So acting on climate change makes sense for health reasons as well as environmental and economic reasons.
We are the first generation to understand how serious the climate crisis is and the last generation to be able to do something about it.
The 5th assessment report of the Intergovernmental Panel on Climate Change published in 2014 states with high confidence that global warming has exacerbated health problems which already exist in our world. As this century continues, the IPCC expects climate change to lead to increases in ill health in many regions, as compared to a planet without the impacts of climate change. Examples include greater likelihood of injury, disease, and death due to more intense heat waves and fires; increased likelihood of under-nutrition resulting from diminished food production in poor regions; risks from lost work capacity and reduced labour productivity in vulnerable populations; and increased risks from food- and water-borne diseases.
The report also clarifies that while people all over the world are vulnerable to the impacts of climate change, the poor and marginalized are the most vulnerable. With this in mind, I believe that the world needs to respond with a climate justice approach to shape a global response that is rights-based in its actions to lower emissions and build resilience.
All too often, it is women who are most at risk from the impacts of climate change on health. The report of Working Group II of the IPCC reveals that vulnerable groups, including women, will experience adverse effects on their health due to the impacts of climate change.
It finds that regions of Africa with little financial resources, inadequate public health and health care systems, insufficient access to safe water and sanitation, food insecurity, and poor governance will be most affected by climate-induced health issues. Poor populations in rural areas are most vulnerable to climate-induced health issues, and factors that increase vulnerability include inadequate or no mosquito protection and limited access to healthcare facilities offering effective diagnostic testing and treatment.
That is the global health challenge. But let me now come nearer to home and address the most fundamental issue facing the health and wellbeing of the American people—your country’s failure to achieve universal health coverage.
Universal health coverage means that everybody receives the health services they need without suffering financial hardship. It is a key target within the Health Sustainable Development Goal. All countries, including the US, signed up to the Sustainable Development Goals at a UN Summit in September 2015.
Promoting UHC is one of the key priorities for The Elders, the group of independent former leaders founded by Nelson Mandela of which I have the honour to be a member. We believe that health is a human right, and that no-one should be denied that right or forced into poverty to access the healthcare they need. In this hall and across this country you are blessed with talented medical professionals, world-class hospitals and research institutes, and an almost unparalleled capacity for technological innovation. Yet at least 28 million of your fellow Americans do not have any health insurance coverage, despite health costs taking up 17.1 percent of this country’s Gross National Product.
As my dear friend and fellow Elder President Jimmy Carter wrote last year, this is a national scandal. What makes it all the more unacceptable is that all other wealthy nations have achieved UHC and there are plenty of successful models for you to follow. You need only look to your northern neighbors in Canada, or across the Atlantic to Western Europe to see reliable, efficient and affordable public health systems that cover the whole population and enjoy deep-rooted popular support.
Here’s the basic question: Why should Americans not enjoy the same health rights as citizens of other countries around the globe? Why does the US have a lower life expectancy than Costa Rica (which has UHC), and a higher maternal mortality rate than Kazakhstan? Why should healthcare costs remain the biggest cause of bankruptcy in the US, thwarting the hopes and ambitions of hardworking families?
I am sure that I am preaching to the converted here when I tell you that the reasons are of course grounded in politics rather than medical practice. Americans desperately need leaders who have the courage and resilience to tackle the vested interests of the healthcare industry, pharmaceutical companies and insurance companies, and extend health coverage to those who need it most.
And I am heartened to see that this conversation is vigorously underway in the United States. Last November, The Elders convened a meeting at the Bellevue Public Hospital in New York to bring together doctors, politicians and media to share best practice and support bold leadership. This summer we will organize a similar event in California, another state that is blazing a trail for UHC.
I believe that despite the hyper-partisan arguments in Washington, momentum for universal health coverage is unstoppable in the United States.
This is why you graduate at such a key moment for global health and for the achievement of universal health coverage here in the United States. Looking at your bright young faces, knowing you have had the privilege of being educated at the Harvard School of Public Health, I have every confidence that you will meet the challenges head on! You are in the right place at the right time! I congratulate you, and wish you every success and deep fulfilment in your lives.