WHO/Dominic Chavez

The impact of global crises on health: money, weather and microbes

Dr Margaret Chan
Director-General of the World Health Organization

Mr Silberberg, Secretary of State, members of parliament, members of the scientific community, representatives of industry and civil society, colleagues in public health, colleagues from sister organizations of the UN, ladies and gentlemen,

First and foremost, I would like to thank the organizers for the kind invitation to address this audience.

The world is in a mess, and much of this mess is of our own making. Events such as the financial crisis and climate change are not quirks of the marketplace, or quirks of nature. They are not inevitable events in the up-and-down cycle of human history.

Instead, they are markers of massive failure in the international systems that govern the way nations and their populations interact. They are markers of failure at a time of unprecedented interdependence among societies, capital markets, economies, and trade.

In short, they are the result of bad policies. We have made this mess, and mistakes today are highly contagious.

As the economists tell us, the financial crisis is unprecedented because it comes at a time of radically increased interdependence. Its effects have moved rapidly from one country to another, and from one sector of the economy to others.

The contagion of our mistakes shows no mercy and makes no exceptions on the basis of fair play. Even countries that managed their economies well, did not purchase toxic assets, and did not take excessive financial risks will suffer the consequences. Likewise, the countries that have contributed least to greenhouse gas emissions will be the first and hardest hit by climate change.

The financial crisis and climate change are not the only markers of bad policies and failed systems of governance. The gaps in health outcomes, seen within and between countries, are greater now than at any time in recent history. The difference in life expectancy between the richest and poorest countries now exceeds 40 years. Globally, annual government expenditure on health varies from as little as US$ 20 per person to well over US$ 6000.

Medicine has never before possessed such a sophisticated arsenal of tools and interventions for curing disease and prolonging life. Yet each year, nearly 10 million young children and pregnant women have their lives cut short by largely preventable causes.

Something has gone wrong.

Collectively, we have failed to give the systems that govern international relations a moral dimension. The values and concerns of society rarely shape the way these international systems operate. If businesses, like the pharmaceutical industry, are driven by the need to make a profit, how can we expect them to invest in R&D for diseases of the poor, who have no purchasing power?

In far too many cases, economic growth has been pursued, with single-minded purpose, as the be-all, end-all, cure-for-all. Economic growth, as many believed, would cure poverty and improve health. This did not happen.

Globalization was embraced as the rising tide that would lift all boats. This did not happen. Instead, wealth has come in waves that lift the big boats, but swamp or sink many smaller ones.

Greater market efficiency, it was thought, would work to achieve greater equity in health. This did not happen.

Trade liberalization was put forward as a sure route to prosperity for developing countries. But trade liberalization slashed tariff revenues and brought no alternative source of finances for public services, including health care. This has meant a disaster for health and social protection in the many countries where most labour is concentrated in the informal sector and the tax base is small.

User fees for health care were put forward as a way to recover costs and discourage the excessive use of health services and the over-consumption of care. This did not happen. Instead, user fees punished the poor.

WHO estimates that, each year, the costs of health care push around 100 million people below the poverty line. This is a bitter irony at a time when the international community is committed to poverty reduction. It is all the more bitter at a time of financial crisis.

Ladies and gentlemen,

We are at the start of what the experts say could be the most severe financial crisis and economic downturn seen since the Great Depression began in 1929.

Last week, the World Bank issued an assessment of the impact the crisis is having on developing countries. The assessment was far worse than just two months ago, and it predicted more grim news to come. In affluent countries, people are losing their jobs, their homes, and their savings, and this is tragic. In developing countries, people will lose their lives.

We are also in the midst of the most ambitious drive in history to reduce poverty and reduce the great gaps in health outcomes. No one wants this momentum to slow.

But between the need and the good intention falls the reality. What happens if the enormous financial bailouts break the bank? What happens if the money simply is not there to continue domestic health programmes or finance health development abroad? At the individual level, what happens if people simply cannot afford to take care of their health?

In a sense, the Millennium Declaration and its Goals operate as a corrective strategy. They aim to ensure that globalization is fully inclusive and equitable, and that its benefits are more evenly shared.

They aim to give this lopsided world a greater degree of balance: in opportunities, in income levels, and in health. The underlying ethical principle is straightforward: those who suffer or benefit least deserve help from those who benefit most.

In other words, the Millennium Development Goals aim to compensate for international systems that create advances and advantages, yet have no rules that guarantee the fair distribution of these benefits.

As last week’s World Bank report clearly states, financial conditions facing developing countries have deteriorated sharply, the delivery of essential social services is in danger, and the implications will be long-term.

The likelihood of achieving the Millennium Developing Goals, and benefitting from their corrective strategy, is now in jeopardy. What happens if the financial crisis kills our best chance ever to transform this world towards greater social justice?

The world desperately needs a corrective strategy. The current huge gaps, in income levels, opportunities, and health outcomes, are a precursor for social breakdown. A world that is greatly out of balance in matters of health is neither stable nor secure.

Let me be clear. I am not against free trade. I am not in favour of protectionism. I am fully aware of the close links between greater economic prosperity, at household and national levels, and better health.

But I do have to say this: the market does not solve social problems.

The policies governing the international systems that link us all so closely together need to look beyond financial gains, benefits for trade, and economic growth for its own sake. They need to be put to the true test.

What impact do they have on poverty, misery, ill health, and premature death? Do they contribute to greater fairness in the distribution of the benefits of socioeconomic progress? Or are they leaving this world more and more out of balance, especially in matters of health?

I would argue that equitable access to health care, and greater equity in health outcomes are fundamental to a well-functioning economy. I would further argue that equitable health outcomes should be the principal measure of how we, as a civilized society, are making progress.

This world will not become a fair place for health all by itself. Economic decisions within a country will not automatically protect the poor or guarantee universal access to basic health care.

Globalization will not self-regulate in ways that favour fair distribution of benefits. Corporations will not automatically look after social concerns as well as profits. International trade agreements will not, by themselves, guarantee food security, or job security, or health security, or access to affordable medicines.

All of these outcomes require deliberate policy decisions.

Health had no say in the policies that led to the financial crisis or made climate change inevitable. But the health sector will bear the brunt of the consequences.

Ladies and gentlemen,

Countries at all levels of development are concerned about the impact of the financial crisis on health.

Officials are worried that health in their own countries may worsen as unemployment rises, safety nets for social protection fail, savings and pension funds erode, and spending on health drops.

They are also concerned about mental illness and anxiety, and a possible jump in the use of tobacco, alcohol, and other harmful substances. This has happened in the past.

They are concerned about nutrition, and rightly so. Recent dramatic changes in the world food supply make this economic downturn different in terms of health threats arising from poor nutrition. Food production has become highly industrialized, and distribution and marketing have a global reach.

When times are hard, processed foods, high in fats and sugar and low in essential nutrients, become the cheapest way to fill a hungry stomach. These foods contribute to obesity and to diet-related chronic diseases, and they starve young children of essential nutrients.

And there are other threats to health that we need to anticipate. In times of economic crisis, people tend to forego private care and make more use of publicly financed services. This trend will come at a time when the public health system in many countries is already vastly overstretched and underfunded.

In many low-income countries, more than 60% of health spending comes in the form of direct out-of-pocket payments. Economic downturn increases the risk that people will neglect care, with prevention falling by the wayside. Less preventive care is particularly disturbing at a time when demographic ageing and a rise in chronic diseases are global trends.

We know, too, that women and young children are among the first to be affected by a deterioration in financial circumstances and food availability. Women are among the last to recover when times get better.

Health officials are also worried that current levels of financing for international health development may not be maintained. The assessment issued last week by the World Bank fully justifies these concerns. The consequences will be dire.

Well over 3 million people in low- and middle-income countries are now receiving life-prolonging antiretroviral therapy for HIV/AIDS. Their lives have been rejuvenated. Families and communities have been revived. Treatment is, of course, lifelong. Can we, ethically and morally, cut back spending in this area?

Dire consequences can also be contagious. Interruptions in the supply of drugs, especially for diseases like AIDS, TB, and malaria, contribute to preventable deaths in high numbers. Such interruptions also accelerate the development of drug resistance.

Drug-resistant forms of disease can quickly spread internationally. We are seeing this, right now, with the rise of multi-drug resistant TB, and the even more alarming rise of extensively-drug resistant TB. This form of the disease is virtually impossible to treat, with fatality rates approaching 100%.

Its further international spread could take us back to the treatment era that pre-dates the development of antibiotics. Can the world really afford another risk of this magnitude?

Surveillance for emerging diseases contributes to global security. If basic surveillance and laboratory capacities are compromised, will health authorities catch the next SARS, or spot the emergence of a pandemic virus in time to warn the world and mitigate the damage?

We know that external assistance for health has more than doubled since the start of this century. Despite this trend, around half of the world’s countries do not have the capacity to finance even the most rudimentary “survival kit” of basic health services.

Reduced external financial assistance will truly be a killer.

Globally, around 1 billion people are already living on the margins of survival. It does not take much to push them over the brink. This can happen because of the financial crisis. This can also happen because of climate change.

Ladies and gentlemen,

The scientific evidence is overwhelming. The climate is changing. The effects are already being felt.

The warming of the planet will be gradual, but the increasing frequency and severity of extreme weather events, like intense storms, heat waves, droughts, and floods, will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, food, and water.

I am fully aware that I am speaking to an audience in a country that has been at the vanguard of environmental protection, and the cutting edge of technology development and application. In this regard, let me pay my deep personal respects to the government of Germany and its citizens.

I also thank this country for its strong support for health development and for the work of WHO, including support from your scientists, epidemiologists, laboratories, and renowned research institutes.

Several consequences for health have been identified with a high degree of certainty. Malnutrition will increase, as will the number of deaths from diarrhoeal disease. More storms and floods will cause more deaths and injuries, and cholera outbreaks will occur with greater frequency.

Heat waves, particularly in large cities, will cause more deaths, largely among the elderly. Finally, climate change could alter the geographical distribution of disease vectors, including the insects that spread malaria and dengue.

All of these health problems are already huge, largely concentrated in the developing world, and difficult to control.

Although climate change is, by its nature, a global phenomenon, its consequences will not be evenly distributed. Scientists agree that developing countries will be the first and hardest hit.

According to the latest projections, Africa will be severely affected as early as 2020. A decade from now, crop yields in some parts of Africa are expected to drop by 50%. By 2020, water stress could affect as many as 250 million Africans.

Imagine the impact on food security and malnutrition. Imagine the impact on food aid. In many African countries, agriculture is the principal economic activity for 70% of the population. Among Africa’s poor, 90% depend on agriculture for their livelihoods. There is no surplus. There is no coping capacity. There is no cushion to absorb the shocks.

Women and young girls in parts of Asia currently spend from six to nine hours collecting water each day. What will this burden be when water scarcity increases, as is happening right now?

We also need to consider what these changes mean for the international community. More disasters, more floods and famines mean greater demands for humanitarian assistance. These demands for help will come at a time when most countries are themselves stressed by climate change.

The international community will also have to cope with a growing number of environmental refugees. If land is parched or salinated, if coastal and low-lying areas and small island nations are under water, these people cannot simply go home. Environmental refugees thus become a new wave of settlers, possibly adding to international tensions.

Anything we can do now to reduce existing burdens of disease will increase national and international capacity to cope with the new stresses that come with climate change. This gives us another very good reason to remain steadfast in our pursuit of the health-related Millennium Development Goals.

Up to now, the polar bear has been the poster child for climate change. We need to use every politically correct and scientifically sound trick in the book to convince the world that humanity really is the most important species endangered by climate change.

Can the health sector give a human face to the other problems we see in this big mess of a world? Is the health sector in a position to bring a moral dimension, to introduce a value system to the policies that govern our international systems?

Given my current job description, I will definitely say yes. But I have some solid reasons to back up this view.

Ladies and gentlemen,

Let me turn to a third issue: global crises that arise from the constantly changing microbial world. This issue is different from the financial crisis and climate change.

It is different because the health sector is in the lead. The health sector makes the policy, and implements governance through the International Health Regulations. We do not have to compete against economic interests. In fact, the tables are turned.

Emerging and epidemic-prone diseases are considered threats to international security precisely because of the tremendous economic and social disruption they can cause.

Public health has very few estimates that come even close to the multi-billion dollar financial bailouts we seem to hear about every week. But according to the latest World Bank estimate, the next influenza pandemic could easily cost the global economy US$ 3 trillion.

World leaders tell us that the financial crisis is so severe and unpredictable because it is the first such event under the unique conditions of the 21st century.

SARS, which emerged in 2003, was the first severe new disease of the 21st century. Like the financial crisis, it emerged at a time of radically increased interdependence.

SARS was the first disease to move rapidly around the world along the routes of international air travel. It put every city with an international airport at risk. It closed airports, businesses, schools, and some borders. It paralysed economies, and paralysed the public with fear.

But never forget: the response to SARS was a deliberate effort to prevent this new disease from becoming permanently established in this world, to keep it from joining the league of killer diseases like AIDS, TB, and malaria.

This was one severe global contagion that was quickly ended. WHO and its partners stopped SARS, dead in its tracks, within four months.

The health sector was prepared. Surveillance, alert, and response mechanisms were in place. We managed the risks. And this crisis did not spiral out of control.

From the beginning of the outbreak, the world’s top scientists set aside competition and worked together, in a virtual laboratory, around the clock. They identified the virus within a month.

This is the brighter side of globalization. This is an example of collaboration and solidarity before a shared threat.

We see this same international solidarity in support for the drive to eradicate polio, including humanitarian support from Rotary International, and support from several enlightened governments, including Germany.

Concern for health can also motivate ethical behaviour in industry, as when pharmaceutical companies dramatically cut prices for AIDS medicines. Concern for health can persuade the international community to agree on the control of harmful, yet profitable products, like tobacco.

There is hope.

If we have to rethink the way this world works, and overhaul some of our international systems, I personally believe that health deserves careful consideration for a leading role.

Our policies are guided by scientific evidence, and not by vested interests. We have the power and the objectivity of the scientific method on our side. The health sector has humanity’s best interests at heart, a strong moral dimension, and a strong set of social values among its many stars.

Let us all continue to provide the hope this world so badly needs at a time of severe crises – and transformation.

Thank you.


HIV-related TB deaths higher than past estimates 1.37 million new TB cases in 2007 among HIV-infected people, says new global TB control report

Patients of the Tuberculosis (TB) center in Khayelitsha, on the south-western coast of S. Africa, wait to see doctors.

24 MARCH 2009 | RIO DE JANEIRO – Ventilation and sunshine reduce tuberculosis risks in hospitals and prisons, two strongholds of the contagious lung disease, the World Health Organisation said.

In its latest Global Tuberculosis Control report, released on Tuesday, the United Nations agency also doubled its estimate of how many HIV-infected people catch and die from tuberculosis, and warned especially deadly strains are continuing to spread in all corners of the world. These are the hardest to treat tuberculosis and they spreading around the world.

The total number of new tuberculosis (TB) cases remained stable in 2007, and the percentage of the world’s population becoming ill with TB has continued the slow decline that was first observed in 2004, according to a new report released by WHO today.

However, the 2009 global TB control report also reveals that one out of four TB deaths is HIV-related, twice as many as previously recognized. .HIV and TB go hand-in-hand. In 2007, there were an estimated 1.37 million new cases of tuberculosis among HIV-infected people and 456 000 deaths. This figure reflects an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years.

“These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases,” said Dr Margaret Chan, Director-General of WHO.

Sharp increase in HIV testing

The report reveals a sharp increase in HIV testing among people being treated for TB, especially in Africa. In 2004, just 4% of TB patients in the region were tested for HIV; in 2007 that number rose to 37%, with several countries testing more than 75% of TB patients for their HIV status.

Because of increased testing for HIV among TB patients, more people are getting appropriate treatment though the numbers still remain a small fraction of those in need. In 2007, 200 000 HIV-positive TB patients were enrolled on co-trimoxazole treatment to prevent opportunistic infections and 100 000 were on antiretroviral therapy.

“We have to stop people living with HIV from dying of tuberculosis,” said Mr Michel Sidibe, Executive Director of UNAIDS. “Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives.”

Greatest challenges

TB/HIV co-infection and drug-resistant forms of tuberculosis present the greatest challenges, the report says. In 2007 an estimated 500 000 people had multidrug-resistant TB (MDR-TB), but less than 1% of them were receiving treatments that was known to be based on WHO’s recommended standards.

Given the current financial crisis, the report documents concerns over an increasing shortage in funding. Ninety-four countries in which 93% of the world’s TB cases occur provided complete financial data for the report. To meet the 2009 milestones in the Stop TB Partnership’s Global Plan to Stop TB, the funding shortfall for these 94 countries has risen to about US$ 1.5 billion. Full funding of the Global Plan will achieve its aim of halving TB prevalence and deaths compared with 1990 levels by 2015.

“We have made remarkable progress against both TB and HIV in the last few years. But, TB still kills more people with HIV than any other disease,” said Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “The financial crisis must not derail the implementation of the Global Plan to Stop TB. Now is the time to scale-up financing for effective interventions for the prevention, treatment and care of TB worldwide.”

The release of the report today coincides with World TB Day and a 1500-strong gathering at the 3rd Stop TB Partners’ Forum in Rio de Janeiro. Next week health leaders and ministers will gather in Beijing in a meeting organized by WHO, the Ministry of Health of the People’s Republic of China and the Bill & Melinda Gates Foundation with the aim of securing commitments to actions and funding for drug-resistant TB.

LiveScience.com, March 23, 2009, by Robert Roy Britt — Researchers in the UK plan to make what’s being hailed as an unlimited supply of blood for transfusions using discarded stem cells found in human embryos, according to news reports.

They’ll test embryos discarded from in vitro fertilization (IVF) treatments to find those with embryonic stem cells that will make O-negative blood, which is the one type that can be transfused into anyone without being rejected.

An adult has about 4–6 liters of blood (which transports oxygen through the body), white blood cells to fight infection, and platelets that clot to heal wounds. Many patients died of transfusions before 1901, when the Austrian Karl Landsteiner discovered the human blood types. Landsteiner found that antibodies against donor blood can cause deadly clumping.

Still, supplies of blood available for life-saving transfusions are limited. Local and regional pleas for blood by the Red Cross, owing to critically low levels, have become routine in the past decade. There’s more to it all than just giving blood. There are a host of tests that must be run on donor blood to make sure it is free of infection. And blood has a limited shelf life. Blood stored for 29 days or more (nearly 2 weeks less than the current standard for blood storage) is more likely to cause infection in transfusion patients, a study last year found.

Embryonic stem cells have the ability to become all the cells of the body. The idea is that harnessing their power would allow infinite production of what’d being termed “synthetic” blood that would be free of any infections that sometime plague blood supplies.

“In principle, we could provide an unlimited supply of blood in this way,” said team member Marc Turner, director of the Scottish National Blood Transfusion Service.

This is no backwater laboratory effort. It’s also being supported by NHS Blood and Transplant and the Wellcome Trust, the world’s biggest medical research charity, according to The Independent.

In 2004, researchers at the University of Minnesota published research explaining the conditions under which blood cell development occurs from embryonic stem cells. But embryonic stem cell research has been somewhat stifled in the United States owing to restrictions on federal funding that were lifted earlier this month by the Obama administration. There may be time to catch up to the UK effort.

“We should have proof of principle in the next few years, but a realistic treatment is probably five to 10 years away,” Turner said.

FDA Approves Test to Inject Embryonic Stem Cells into Humans

The FDA has approved the first study by a company that will use human embryonic stem cells injected into a human.

The Geron corporation announce the approval today. The therapy used in the study is designed to treat spinal cord injuries by injecting stem cells — which are able to transform into the many different types of cells we need in our bodies — directly into the patients’ spinal cords.

The U.S. Food and Drug Administration (FDA) granted clearance of the company’s application for the clinical trial of GRNOPC1 in patients with acute spinal cord injury.

“This marks the beginning of what is potentially a new chapter in medical therapeutics – one that reaches beyond pills to a new level of healing: the restoration of organ and tissue function achieved by the injection of healthy replacement cells,” said Geron’s president and CEO. Dr. Thomas B. Okarma.

“The neurosurgical community is very excited by this new approach to treating devastating spinal cord injury,” said Dr. Richard Fessler, a professor of neurological surgery at the Feinberg School of Medicine at Northwestern University.

“Demyelination is central to the pathology of the injury, and its reversal by means of injecting oligodendrocyte progenitor cells would be revolutionary for the field,” Fessler said in a statement released by Geron. “If safe and effective, the therapy would provide a viable treatment option for thousands of patients who suffer severe spinal cord injuries each year.”

Neuroscientist Ole Jensen models the Donders Institute\’s MEG machine. With the help of the machine, Jensen, Ali Mazaheri (now at UC Davis) and colleagues found that a distinct alpha-wave pattern occurred in the brains of people taking an attention-demanding test. Credit: Donders Institute

Neuroscientist Ole Jensen models the Donders Institute’s MEG machine.

With the help of the machine, Jensen, Ali Mazaheri (now at UC Davis)

and colleagues found that a distinct alpha-wave pattern occurred in the

brains of people taking an attention-demanding test.

Credit: Donders Institute

LiveScience.com, March 23, 2009 — About a second before mistakes are made, brain wave patterns predict the looming blunder, a new study finds.

Researchers hooked 14 volunteers up to a non-invasive brain-wave recording machine that employs magnetoencephalography (MEG). Then they administered really boring tests sure to trigger mistakes.

During a half-hour test sitting at a computer, a random number from 1 to 9 flashes onto the screen every two seconds. The object is to tap a button as soon as any number except 5 appears.

The test is so monotonous that even when a 5 showed up, the subjects spontaneously hit the button an average of 40 percent of the time, explained study leader Ali Mazaheri at the University of California, Davis.

By analyzing the recorded MEG data, the research team found that about a second before these errors were committed, brain waves in two regions were stronger than when the subjects correctly refrained from hitting the button. In the back of the head (the occipital region), alpha wave activity was about 25 percent stronger, and in the middle region, the sensorimotor cortex, there was a corresponding increase in the brain’s mu wave activity.

“The alpha and mu rhythms are what happen when the brain runs on idle,” Mazaheri explained in a statement. “Say you’re sitting in a room and you close your eyes. That causes a huge alpha rhythm to rev up in the back of your head. But the second you open your eyes, it drops dramatically, because now you’re looking at things and your neurons have visual input to process.”

The work is part of a broad effort to read the mind.

In separate research last year, scientists found that some mistakes can be predicted by changes in brain blood flow 30 seconds before an error. A study earlier this month showed that brain scans can read memories with surprising accuracy. Researchers at Tufts University, meanwhile, are developing ways for a computer to tell if you are overworked, under-worked or not working at all.

The team also found that errors triggered immediate changes in wave activity in the front region of the brain, which appeared to drive down alpha activity in the rear region, “It looks as if the brain is saying, ‘Pay attention!’ and then reducing the likelihood of another mistake,” Mazaheri said.

It shouldn’t take too many years to incorporate these findings into practical applications, Mazaheri said. For example, a wireless EEG could be deployed at an air traffic controller’s station to trigger an alert when it senses that alpha activity is beginning to regularly exceed a certain level.

It could also provide new therapies for children with ADHD, he said. “Instead of watching behavior — which is an imprecise measure of attention — we can monitor these alpha waves, which tell us that attention is waning. And that can help us design therapies as well as evaluate the efficacy of various treatments, whether it’s training or drugs.”

The research is published online today by the journal Human Brain Mapping. The work was supported by the Netherlands Organization for Scientific Research (NWO) and BrainGain Smart Mix Program of the Netherlands Ministry of Economic Affairs.


Medical experts to discuss stem cell research – Event to feature patients’ success stories

Sun-Herald.com, March 20, 2009, by Jason Witz — Carol Petersen realizes umbilical stem cells can’t cure genetic conditions like blindness or cerebral palsy.

Yet the Port Charlotte woman has seen firsthand how the treatment improves quality of life.

Now residents will get a chance to hear those success stories.

On Sunday, medical experts will descend on Gilchrist Park as part of a reunion designed to raise awareness of the research. It will take place from 1 p.m. to 5 p.m.

The event will feature testimony from children who have experienced drastic improvements in their conditions since undergoing the procedure.

Petersen, herself, has become an advocate of stem cell research since witnessing the progress of her grandson, Cameron.

The 2-year-old suffers from optic nerve hypoplasia, a leading cause of blindness in children. The condition causes underdevelopment of the optic nerve and can lead to permanent blindness.

Cameron traveled overseas in August 2007, as part of a case study to treat his blindness.

The procedure consisted of four stem-cell infusions to Cameron’s arm and the lumbar region of his spine. By the third treatment, he was standing on his own and crawling toward objects — simple tasks he couldn’t do before.

Petersen said Cameron can now see at least 8 feet, and is attending school.

“The people who had these treatments want you to know it’s not wishful thinking,” Petersen said.

Ophthalmologist Dr. David Klein will be one of the guest speakers.

The local doctor plans on visiting China in late May as part of a fact-finding mission at one of the top stem cell facilities in the world.

Klein has treated several patients who have undergone stem cell infusion overseas.

At this point, he remains “cautiously optimistic” about the effectiveness of the treatment, although he said it seems to help.

“I’ve seen people improve,” Klein said.

Sunday’s event is free and open to the public.


Dr. Joseph Romm is the editor of Climate Progress and a Senior Fellow at the Center for American Progress. He was Acting Assistant Secretary of Energy for Energy Efficiency and Renewable Energy during the Clinton Administration where he directed $1 billion in research, development, demonstration, and deployment of clean energy and carbon-mitigating technology. He holds a Ph.D. in physics from MIT. In 2008, Romm was elected a Fellow of the American Association for the Advancement of Science for “distinguished service toward a sustainable energy future and

Joe Rommfor persuasive discourse on why citizens, corporations, and governments should adopt sustainable technologies.

In 2008, TIME magazine named Climate Progress one of the “Top 15 Green Websites,” writing that “Romm occupies the intersection of climate science, economics and policy…. On his blog and in his most recent book, Hell and High Water, you can find some of the most cogent, memorable, and deployable arguments for immediate and overwhelming action to confront global warming.” In March 2009, The New York Times’ Tom Friedman wrote that Romm is “a physicist and climate expert who writes the indispensable blog climateprogress.org.”

An Introduction to Global Warming Impacts: Hell and High Water

By Joseph Romm BA, PhD. MIT

I will examine the key impacts we face by 2100 if we stay anywhere near our current emissions path. I will focus primarily on:

· Staggeringly high temperature rise, especially over land — some 15°F over much of the United States

· Sea level rise of 5 feet, rising some 6 to 12 inches (or more) each decade thereafter

· Widespread desertification — as much as one-third of the land

· Massive species loss on land and sea — 50% or more of all life

· Unexpected impacts — the fearsome “unknown unknowns”

· More severe hurricanes — especially in the Gulf

Equally tragic, as a 2009 NOAA-led study found, these impacts to be “largely irreversible for 1000 years.”

The most important finding concerns the irreversible precipitation changes we will be forcing on the next 50 generations in the U.S. Southwest, Southeast Asia, Eastern South America, Western Australia, Southern Europe, Southern Africa, and northern Africa (see also US Geological Survey stunner: SW faces “permanent drying” by 2050 and links below)

Here is the key figure
Figure: Best estimate of expected irreversible dry-season precipitation changes, as a function of the peak carbon dioxide concentration during the 21st century. The quasi-equilibrium CO2 concentrations shown correspond to 40% remaining in the long term as discussed in
the text. The yellow box indicates the range of precipitation change observed during typical major regional droughts such as the ”dust bowl” in North America [except, of course, this Dust Bowl lasts 1000 years, not 10 to 20, which is what some people might call a desert (see Australia faces the “permanent dry” — as do we)].

The single biggest failure of messaging by climate scientists (until very recently) has been the failure to explain to the public, opinion makers, and the media that business-as-usual warming results in impacts that are beyond catastrophic. For these impacts, terms like “global warming” and “climate change” are essentially euphemisms. That is why I prefer the term “Hell and High Water.”

Business-as-usual typically means continuing at recent growth rates of carbon dioxide emissions, which we now know would take us to atmospheric concentrations of carbon dioxide greater than 1000 ppm (see U.S. media largely ignores latest warning from climate scientists: “Recent observations confirm … the worst-case IPCC scenario trajectories (or even worse) are being realised” — 1000 ppm). We are at about 8.5 billion metric tons of carbon a year (GtC/yr) and, until the recent global economic recession, were rising about 3% per year.

What is less well understood is that even a very strong mitigation effort that kept carbon emissions this century to 11 GtC a year on average would still probably take us to 1000 ppm — a little noted conclusion of the 2007 Intergovernmental Panel on Climate Change (IPCC) report

The scientific community has spent little time modeling the impacts of a tripling (~830 ppm) or quadrupling (~1100 ppm) carbon dioxide concentrations from preindustrial levels. In part, I think, that’s because they never believed humanity would be so stupid as to ignore the warnings and simply continue on its self-destructive path. In part, they low balled the difficult-to-model amplifying feedbacks in the carbon cycle.

So I pieced together those impacts from available studies and from discussions with leading climate scientists for my book, Hell and High Water. But now as climate scientists have sobered up to their painful role as modern-day Cassandra’s, the scientific literature on what we face is much richer. Let me review it here.


Two of the best recent analyses of what we are headed towards can be found here:

· M.I.T. joins climate realists, doubles its projection of global warming by 2100 to 5.1°C

· Hadley Center: “Catastrophic” 5-7°C warming by 2100 on current emissions path

As Dr. Vicky Pope, Head of Climate Change Advice for the Met Office’s Hadley Centre explains on their website.

Contrast that with a world where no action is taken to curb global warming. Then, temperatures are likely to rise by 5.5 °C and could rise as high as 7 °C above pre-industrial values by the end of the century.

That likely rise corresponds to roughly 10°F globally and typically 50% higher than that over inland mid-latitudes (i.e. much of this country) — or 15°F.

Based on two studies in the last few years:

By century’s end, extreme temperatures of up to 122°F would threaten most of the central, southern, and western U.S. Even worse, Houston and Washington, DC could experience temperatures exceeding 98°F for some 60 days a year. Much of Arizona would be subjected to temperatures of 105°F or more for 98 days out of the year–14 full weeks.

Yet that conclusion is based on studies of only 700 ppm and 850 ppm, so it could get much hotter than that.

And the Hadley Center adds, “By the 2090s close to one-fifth of the world’s population will be exposed to ozone levels well above the World Health Organization recommended safe-health level.”

The Hadley Center has a huge but useful figure which I will reproduce here:

A 5.5°C warming would likely lead to the mid- to high-range of currently projected sea level rise — 5 feet or more by 2100, followed by 10 to 20 inches a decade for centuries. The best recent study is

· Startling new sea level rise research: “Most likely” 0.8 to 2.0 meters by 2100

Needless to say, a sea level rise of one meter by 2100 would be an unmitigated catastrophe for the planet, even if sea levels didn’t keep rising several inches a decade for centuries, which they inevitably would. The first meter of SLR would flood 17% of Bangladesh, displacing tens of millions of people, and reducing its rice-farming land by 50 percent. Globally, it would create more than 100 million environmental refugees and inundate over 13,000 square miles of this country. Southern Louisiana and South Florida would inevitably be abandoned. And salt water infiltration will only compound this impact (see “Rising sea salinates India’s Ganges“). As will hurricanes..

The scientific literature has been moving in this direction for a couple of years now — too late for the IPCC to consider in its latest assessment. For instance, an important Science article from 2007 used empirical data from last century to project that sea levels could be up to 5 feet higher in 2100 and rising 6 inches a decade (see Inundated with Information on Sea Level Rise)!

Another 2007 study from Nature Geoscience came to the same conclusion (see “Sea levels may rise 5 feet by 2100“). Leading experts in the field have a similar view (see “Amazing AP article on sea level rise” and “Report from AGU meeting: One meter sea level rise by 2100 “very likely” even if warming stops?“).

Note: Since global warming deniers and delayers like to hide behind the IPCC’s 2007 sea level estimate — even though they really don’t believe most of what the IPCC says or most of the scientific literature on which it bases its conclusion — you’re going to be hearing the IPCC estimate for another several years, until the IPCC does a new report and puts in a more realistic estimate. That said, while the delayers never acknowledge it, even the 2007 IPCC report “was the first to acknowledge that the melting of the Greenland ice sheet from rising temperature [which would raise the oceans 23 feet] could result in sea-level rise over centuries rather than millennia,” as the NYT put it (see “Absolute MUST Read IPCC Report: Debate over, further delay fatal, action not costly“).

· US Geological Survey stunner: Sea-level rise in 2100 will likely “substantially exceed” IPCC projections


Then we have desertification of one third the planet and moderate drought over half the planet, plus the loss of all inland glaciers that provide water to a billion people.

“The unexpectedly rapid expansion of the tropical belt constitutes yet another signal that climate change is occurring sooner than expected,” noted one climate researcher in December 2007. A 2008 study led by NOAA noted, “A poleward expansion of the tropics is likely to bring even drier conditions to” the U.S. Southwest, Mexico, Australia and parts of Africa and South America.”

In 2007, Science (subs. req’d) published research that “predicted a permanent drought by 2050 throughout the Southwest” — levels of aridity comparable to the 1930s Dust Bowl would stretch from Kansas to California. And they were only looking at a 720 ppm case! The Dust Bowl was a sustained decrease in soil moisture of about 15% (”which is calculated by subtracting evaporation from precipitation”).

A NOAA-led study similary found permanent Dust Bowls in Southwest and around the globe on our current emissions trajectory (and irreversibly so for 1000 years). And as I have discussed, future droughts will be fundamentally different from all previous droughts that humanity has experienced because they will be very hot weather droughts (see Must-have PPT: The “global-change-type drought” and the future of extreme weather).

I should note that even the “one-third desertification of the planet by 2100″ scenario from the Hadley Center is only based on 850 ppm (in 2100). Princeton has done an analysis on “Century-scale change in water availability: CO2-quadrupling experiment,” which is to say 1100 ppm. The grim result: Most of the South and Southwest ultimately sees a 20% to 50% (!) decline in soil moisture.


In 2007, the IPCC warned that as global average temperature increase exceeds about 3.5°C [relative to 1980 to 1999], model projections suggest significant extinctions (40-70% of species assessed) around the globe. That is a temperature rise over pre-industrial levels of a bit more than 4.0°C. So a 5.5°C rise would likely put extinctions beyond the high end of that range.

And, of course, “When CO2 levels in the atmosphere reach about 500 parts per million, you put calcification out of business in the oceans.” There aren’t many studies of what happens to the oceans as we get toward 800 to 1000 ppm, but it appears likely that much of the world’s oceans, especially in the southern hemisphere, become inhospitable to many forms of marine life. A 2005 Nature study concluded these “detrimental” conditions “could develop within decades, not centuries as suggested previously.”

A 2009 study in Nature Geoscience warned that global warming may create “dead zones” in the ocean that would be devoid of fish and seafood and endure for up to two millennia (see Ocean dead zones to expand, “remain for thousands of years”).


If we go to 800 ppm — let alone 1000 ppm or higher — we are far outside the bounds of simple linear projection. Some of the worst impacts may not be obvious — and there may be unexpected negative synergies. The best evidence that will happen is the fact that it is already happened with even a small amount of warming we have seen to date.

“The pine beetle infestation is the first major climate change crisis in Canada” notes Doug McArthur, a professor at Simon Fraser University in Vancouver. The pests are “projected to kill 80 per cent of merchantable and susceptible lodgepole pine” in parts of British Columbia within 10 years — and that’s why the harvest levels in the region have been “increased significantly.”

As quantified in the journal Nature, “Mountain pine beetle and forest carbon feedback to climate change,” (subs. req’d), while just looks at the current and future impact from the beetle’s warming-driven devastation in British Columbia:

… the cumulative impact of the beetle outbreak in the affected region during 2000–2020 will be 270 megatonnes (Mt) carbon (or 36 g carbon m-2 yr-1 on average over 374,000 km2 of forest). This impact converted the forest from a small net carbon sink to a large net carbon source.

No wonder the carbon sinks are saturating faster than we thought — unmodeled impacts of climate change are destroying them:

Insect outbreaks such as this represent an important mechanism by which climate change may undermine the ability of northern forests to take up and store atmospheric carbon, and such impacts should be accounted for in large-scale modelling analyses.

And the bark beetle is slamming the Western U.S. and Alaska, too (see “Oldest Utah newspaper: Bark-beetle driven wildfires are a vicious climate cycle“).

The key point is this catastrophic climate change impact and its carbon-cycle feedback were not foreseen even a decade ago — which suggests future climate impacts will bring other equally unpleasant surprises, especially as we continue on our path of no resistance.


Even if we don’t see an increase in the worst hurricanes hurricanes, the rising sea levels alone would put a growing number of coastal cities below sea level. Such cities are particularly hard to protect from major hurricanes as we saw with New Orleans. And that suggests in the second half of this century, we will be increasingly reluctant to rebuild cities devastated by major hurricanes.

That said, the literature suggests we will see an increase in severe hurricanes (see “ Hurricanes ARE getting fiercer — and it’s going to get much worse“). A 2008 Nature studied concluded:

The team calculates that a 1 ºC increase in sea-surface temperatures would result in a 31% increase in the global frequency of category 4 and 5 storms per year: from 13 of those storms to 17. Since 1970, the tropical oceans have warmed on average by around 0.5 ºC. Computer models suggest they may warm by a further 2 ºC by 2100.

Well, actually, those are the old computer models running old scenarios of emissions without much consideration of amplifying carbon cycle feedbacks. On our current emissions path, key parts of the tropical oceans are likely to warm considerably more than 2°C by century’s end.

For a longer discussion of why future hurricanes in the Gulf of Mexico are likely to become far more dangerous in the future, see (Why global warming means killer storms worse than Katrina and Gustav, Part 1 and Part 2).


We can’t let this happen. We must pay any price or bear any burden to stop it.

And let me make one final point. I think it is increasinly clear the “middle ground” scenarios are unstable in that once you hit 500 ppm (or possibly lower), the amplifying feedbacks kick in: These feedbacks include:

· The defrosting of the permafrost

· The drying of the Northern peatlands (bogs, moors, and mires).

· The destruction of the tropical wetlands

· Decelerating growth in tropical forest trees — thanks to accelerating carbon dioxide

· Wildfires and Climate-Driven forest destruction by pests

· The desertification-global warming feedback

· The saturation of the ocean carbon sink

As Dr. Pope puts it, “If the climate turns out to be particularly sensitive to increases in greenhouse gases and the Earth’s biological systems cannot absorb very much carbon then temperature rises could be even higher.”

Indeed, some of the best research on this has come from the Hadley Center, since it has one of the few models that incorporates many of the major carbon cycle feedbacks. In a 2003 Geophysical Research Letters (subs. req’d) paper, “Strong carbon cycle feedbacks in a climate model with interactive CO2 and sulphate aerosols,” the Hadley Center, the U.K.’s official center for climate change research, finds that the world would hit 1000 ppm in 2100 even in a scenario that, absent those feedbacks, we would only have hit 700 ppm in 2100. I would note that the Hadley Center, though more inclusive of carbon cycle feedbacks than most other models, still does not model most of the feedbacks above or any feedbacks from the melting of the tundra even though it is probably the most serious of those amplifying feedbacks.

So we must stabilize at 450 ppm or below — or risk what can only be called humanity’s self-destruction. Since the cost is maybe 0.11% of GDP per year — or probably a bit higher than that if we shoot for 350 ppm — the choice would seem clear. Now if only the scientific community and environmentalists and progressives could start articulating this reality cogently.