Wealth and health in a sustainable future

By Ronald Macfarlane, CHASE Associate, September 2, 2020

Business as usual is not an option. Exponential economic growth that relies on increasing consumption of natural resources is not sustainable (Figure 1) and will not result in a healthy future for all. A green recovery that reduces emissions of greenhouse gases, invests in biodiversity, and decreases disparities has to be a priority. Even though these measures may not prove sufficient in the long-run, they will improve health, reduce health inequities, and set our economies onto a more sustainable path.   

Figure 1: Human pressures on wildlife, terrestrial and marine ecosystems: Source World Economic Forum (2020).

Income and Health

Income is a well established determinant of health – with higher income comes better health, while lower incomes are associated with a higher burden of disease and early deaths (Biciunaite 2014; Krisberg 2016; Statistics Canada 2020; WHO 2020). Life expectancy and incomes have increased rapidly over the last century (see Figures 2 and 3). However, this growth has come at the expense of the ecosystems we depend on for food, water, and materials for our needs such as shelter (Fritz & Koch 2016). How do we continue to improve health while living within the limits of the planet?

Figure 2: Change in world life expectancy between 1770-2019: Source www.ourworldindata.org (Accessed 2020-08-15).

Figure 3: Change in gross domestic product over time 1870-2016: Source www.ourworldindata.org (Accessed 2020-08-15).

National income and health

Since 1950 we have been experiencing the great acceleration – rising economic growth accompanied by rapid increase in both resource consumption and pollution (Steffen et al 2015). Our current development path is not sustainable (Cumming & von Cramon-Taubadel 2018; SRC 2018).

The Preston Curve (Figure 4) reinforced the idea that higher gross domestic product (GDP) leads to improved health. The gains at lower income levels are quite clear, but they taper off, and may even decrease at incomes above US$40,000 (purchasing power parity or PPP) (Biciunaite 2014).  How much of this relationship is causal continues to be debated. That said, higher national and household incomes increase access to other determinants of health such as health care, nutrition, safe drinking water, improved sanitation and education. 

Figure 4: Preston Curve in 2012: Source Biciunaite (2014).

As illustrated in Figure 5, some countries have better health than would be expected given their GDP and others less.  For example, life expectancy in Chile, Costa Rica and Cuba is higher than in the United States, while in Qatar, Saudi Arabia and the United States, it is lower than their peers (www.gapminder.org). This suggests that the distribution of GDP is also a factor that influences a country’s health (Biciunaite 2014).

Figure 5: Life expectancy in years compared to national GDP per capita (PPP) in 2011: Source www.gapminder.org (accessed 2020-08-14).

Health disparities in Canada

Disparities in life expectancy and health-adjusted life expectancy (HALE) continue to exist in Canada.  People with higher levels of education or a higher income have longer life expectancies and spend a greater portion of those years in good health compared with those with less education or with a lower income (Statistics Canada 2020). And these disparities were larger in 2011 compared to 1996. At age 25, men in the highest income group (top 20%) could expect to live nearly 8 years longer than men in the lowest income group (lowest 20%). The gap for women was smaller, at about 5 ½ years (see Figure 6). 

Figure 6: Life expectancy (years) at age 25 in Canada – 2011: Source Statistics Canada (Accessed 2020-08-15).

Ecological footprint and health

Estimating our ecological footprint is a way to assess our overall impact on the environment (Wackernagel & Rees 1996).  Earth Overshoot Day – the day when demand for ecological resources and services in a given year exceeds what Earth can regenerate in that year – is estimated at August 22 in 2020.[1] This means that our collective ecological footprint is 60% higher than the estimated carrying capacity of 1.7 global hectares per person (gha/p)(about 4 acres) (Global Footprint Network accessed 2020-08-14).[2]   We are living beyond the capacity of the planet to support us.  We would need 1.6 Earths to meet our current demands.

Economic development has improved health and well-being. However, when we look at the ecological footprint, only three countries are within the sustainable quadrant having both a high human development index (HDI)[3] and an ecological footprint of 1.7 gha/p or less: Jamaica, the Philippines and Sri Lanka (See Figure 7) (Global Footprint Network).[4] Canada, which has a high HDI of 0.92, has a large ecological footprint of 7.7 gha/p; Norway, with the highest HDI (0.95) has a smaller footprint, 5.5 gha/p. Under the current economic development paradigm, we can only achieve the social and economic targets of the 2030 Sustainable Development Goals (SDGs) by exceeding 8 of the 9 planetary boundaries (SRC 2018). 

Figure 7: Human development index and ecological footprint (2016): Source Global Footprint Network, 2019.

There are also disparities in greenhouse gas emissions. The richest 10% of people in the world are responsible for around 50% of global emissions (Oxfam 2015). Overall, average greenhouse gas emissions also increase with a country’s GDP (See Figure 8). In their analysis, Fritz and Koch (2016) concluded that only the lowest-income countries were within their carbon and ecological footprints. These countries are also the ones with poorer health status.

Figure 8: Economic development in GDP (PPP) per capita and associated emissions of CO2 (Credit: Aron Strandberg Lund University, 2016).

The environmental burden of disease

The World Health Organization (WHO 2016) estimates that nearly a quarter of global deaths, and over 20% of Disability Adjusted Life Years (DALYs)[5], are due to modifiable environmental factors, such as unsafe drinking-water and sanitation, indoor and outdoor air pollution, climate change and the built environment.[6] The main environment-related diseases are: stroke, ischaemic heart disease, diarrhoea  and  cancers. Ambient air pollution alone contributes to 25% of strokes, 23% of coronary heart disease, 14% of lung cancer and 7-8% of acute lower respiratory infections. Current levels of air pollution are reducing life-expectancy by 1.8 years on average globally (Figure 9). 

Climate change is expected to result in an increase in severity of extreme weather events including heatwaves and flooding. Over the 20 year period from 1998 to 2017, storms, extreme temperature, floods and drought were responsible for about 280,000 deaths worldwide with an estimated cost of USD 2171 billion (UNISDR 2018).

Figure 9: Average life-expectancy lost per person world-wide due to selected causes: Source Statista 2018 (accessed 2020-08-14)

Overcoming these ecological challenges

As the Club of Rome stated in their 1972 report Limits to Growth, it is not possible to expect the earth to sustain us if our numbers and use of resources continue to increase unabated. Can sustainable development be achieved by increasing resource productivity alone?

Several analyses suggest that it is still possible to get to net-zero carbon emissions by 2050 if a concerted effort is made to foster an energy transition. Project Drawdown suggests that this would possible if we make the best use of all existing climate solutions. A new report from the University of California at Berkeley concludes that, with appropriate policies in place, it would be possible for the US to achieve 90 clean electricity by 2035 (UC-Berkeley). Not only would the cost of this electricity be lower than what it is today, it would avoid $1.2 trillion in health and environmental damages in the US, including 85,000 premature deaths, through to 2050.

Jacobson and colleagues (2019) developed energy transition road maps for 143 countries with the aim of achieving 100% clean, renewable wind-water solar (WWS) energy by 2050 with at least 80% by 2030. Worldwide, such an approach would reduce energy needs by 57% and energy cost by 61% as well as increase employment, and human health and welfare. A 100% renewable energy portfolio for Canada is estimated to create health benefits of $37.78 billion per year (The Solutions Project 2015). The local health benefits of climate actions are substantial (Macfarlane & Perrotta 2019).

There are also benefits from protecting nature.  These include ecosystem services such as climate change mitigation, flood protection, clean water provision, and soil conservation (Campaign for Nature). Protected marine areas can help maintain fish stocks. The benefits of expanding protected areas to cover 30% of land and ocean surfaces is estimated to outweigh costs of doing so by at least five-times.

Figure 10: A possible 100% clean energy mix for Canada in 2050: Source https://thesolutionsproject.org/why-clean-energy/  (Accessed 2020-08-16).

The Stockholm Resilience Centre suggests that it is only possible to achieve the Sustainable Development Goals within planetary boundaries if the world adopts a transformative pathway (SRC 2018). Such a pathway would involve accelerated adoption of renewable energy, addressing the sustainability of food systems, adoption of new development models, focus on reduction in inequity, investment in education and promotion of gender equality. 

Time is running out

As Figure 11 shows, the longer we wait to take action to reduce greenhouse gas emissions, the faster and more challenging the transition will be, until it becomes practically impossible to ensure global warming is kept below 1.5C or even 2C.  Bologna and Aquino (2020) have estimated that at the current rate of resource use there is a high likelihood of unmitigated climate change and ecological collapse only a few decades from now.

Figure 11: Emission trajectories to limit warming to below 1.5C in the absence of net-negative emissions: Source Carbon Brief (2019).

Economic growth – the dilemma

Von Weizsäcker and colleagues (2010) have suggested that it is technologically possible to reduce resource use by a factor of five (i.e. 80%). Other researchers conclude that is not realistic to decouple resource use from GDP sufficiently to meet the 1.5°C or 2°C global warming targets with continuing economic growth (Parrique et al 2019; Vadén et al 2020a). To achieve environmental sustainability goals including net-zero carbon emissions, resource consumption would need to reduce by 40% and material efficiency increase 2.6-fold over the next 30 years (Vadén et al 2020b).

This is not to suggest that an energy transition and increased material efficiency are not important. They are essential, but decoupling on its own – focussing purely on resource intensity – will only buy us time. The obsession with continued economic growth based on production and consumption also needs to be addressed (Cumming & von Cramon-Taubadel 2018; Parrique et al 2019; Wiedmann et al 2020). “So the most effective way to increase our chances of survival is to shift focus from extreme self-interest to a sense of stewardship for each other, other species, and the ecosystems in which we find ourselves (Ahmed  2020).” Kate Raworth (2017) has proposed a conceptual model to guide living within planetary and social boundaries (See Figure 12). 

Figure 12: The Doughnut of social and planetary boundaries showing transgressions on both sides of the Doughnut’s boundaries (shortfall and overshoot). Source: https://ged-project.de/globalization/doughnut-economics-solving-inequality-ecological-degradation-with-a-new-economic-model/ (Accessed 2020-08-16)


[1] Earth Overshoot Day has been arriving earlier in the year. In 1970 it arrived on 29 December and in 2019 July 29. The COVID economic slowdown, has resulted in a later date in 2020.

[2] Only 63 of 184 countries have an ecological footprint of 1.7 or lower.

[3] The United Nations’ Human Development Index (HDI) tracks a country’s achievements in longevity, access to education, and income. An HDI higher than 0.7 is considered “high human development” (UNDP).

[4] Indonesia is on the borderline: HDI 0.69 and footprint of 1.69 gha/p.

[5] Disability-adjusted life year (DALY): a DALY can be thought of as one lost year of “healthy” life.

[6] WHO includes exposures occurring in workplaces, indoor environments and environmental tobacco smoke.

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