Five years after the Paris climate agreement to limit global temperature rise to “well below 2°C” the world observed a 1.2°C temperature rise above pre-industrial levels. In order to protect human health, it is imperative that efforts are made to reduce greenhouse gas emissions and keep the temperature targets agreed. The changing climate affects the conditions for human health, and the basic requirements for maintaining good health. Starting with the 2015 Lancet Commission on climate change and health that described tackling climate change as the greatest global health opportunity of the 21st century, the talk will give an overview of some health impacts covered in the Lancet Countdown and end by focusing on what the Lancet Countdown in 2020 called the often “unseen” impacts of climate change on human health – the mental health impacts.

Vaccines do much more than protect against the disease they are designed for. Watch this talk from TEDxAarhus 2018 by medical doctor and professor in global health Christine Stabell Benn and learn how hundreds of thousands of lives could be saved every year just by using the existing vaccines smarter. Christine Stabell Benn is a medical doctor and professor in global health. By studying real-life effects of vaccines in Africa, she has found that vaccines do much more than protect against the target disease; they have so-called non-specific effects. In most cases, they come with an added bonus of increased resistance against other infections than the target disease. If we take that into account, we can save hundreds of thousands of lives every year just by using the existing vaccines smarter. Christine argues that we should not only study vaccines' effects on the target infection, but also ask the often ignored question: what is the impact of vaccines on overall health?

Presentation by Stefan Swartling Peterson, Karolinska Institute, Sweden.
Tropical Medicine was the origin of today’s Global Health, which is now increasingly under debate. There is the “decolonize” debate, but also the failure to overcome the “implementation gap” - whereby a majority of maternal child deaths today could be prevented with existing knowledge. In this talk, Stefan Swartling Peterson will sketch the evolution of Global Health as a discipline, and share thoughts on what a transformation to “Glocal, Sustainable Health” could look like.

“By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births”
Professor Thorkild Tylleskär, CISMAC, CIH, University of Bergen

According to Tylleskär, there have been some improvements in the average levels of maternal mortality world-wide – enough that the topic is no longer being discussed as “high priority”. However, he stresses, this average value does not reflect the unacceptably high levels that remain in Low Income Countries (LIC). Thankfully, he points out that the issues is still included in the Economist’s recent list of “169 Commandments”.

In many LIC, Tylleskär says, a woman’s inherent value still lies in her ability to produce children. He showed a short film to underline the challenges that remain to be addressed. “Why did Mrs X die?” is produced by the WHO and addresses how maternal mortality is connected to the unjust situation of women in low income societies.

View “Why did Mrs X die?”: (2 versions, full and shortened)
Shortened version (~6 min) youtube.com/watch?v=R0mcQ-fF_MY
Full version (~15 min) youtube.com/watch?v=Ugg-ipHnj6U

By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
Professor Halvor Sommerfelt, CISMAC, CIH, University of Bergen

Sommerfelt underlined that the first 28-days – the neonatal period – are the most challenging for survival. In many Low Income Countries (LIC) neonatal mortality is 30-50 per 1000 live births. In addition, he stresses, this figure does not include stillbirths.

Sommerfelt is the Director of a Centre of Excellence (CISMAC) that is engaged in a number of very large intervention trials aiming to reduce the risk of death in mothers and newborns as well as equitably promoting the growth and development of children. Many of the mother and newborn deaths are preventable and do not require advanced technological solutions, or state-of-the-art facilities. Significantly improving maternal and neonatal health does not require large investments, but will provide significant returns in terms of less suffering and enhanced human capital.

By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
Professor Tehmina Mustafa, CIH, Haukeland University Hospital, University of Bergen

Mustafa began by pointing out that the UN Millennium Development Goals, which preceded the SDGs (Goal 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES), had only highlighted a few global communicable diseases. The SDGs continue to address the challenges of communicable disease epidemics, but have a widened focus to include a number of other important diseases. Also diseases that are not only pathogen caused.

Mustafa underlined that communicable disease epidemics highlight other global issues such as social injustice and social inequality. The years of life lost to these diseases is much higher in “hot-spots”, generally located in low- and middle-income countries.

According to Mustafa, the approaches included in the SDGs are more integrated than those of the MDGs and will be better able to lead to research directions that will help to alleviate the health and economic implications of communicable disease outbreaks.

By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
Professor Ingunn Maria S. Engebretsen, CIH, University of Bergen

Engebretsen explains that the Goal is ambitious, embracing everything that is “non-communicable”, it means everything that is not infectious. Her own research interests include diseases relating to nutrition and mental health. She noted that malnutrition, in particular, is a common factor for many poor health conditions.

Engebretsen highlighted a number of established theories (Forsdahl, Barker, Brenner) and newer theories linking genetics, epigenetics, environment and health, to argue that a lifestyle approach is needed to best tackle non-communicable diseases. She also mentioned how many of these diseases have significant socio-economic effects on society and many impact the health of future generations.

Finally, Engebretsen presented information about the importance of mental health, highlighting that this is a significant factor in disability-adjusted life years (DALYs) for young people (aged 15-24).

Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
Associate Professor Lars Thore Fadnes, Department of Global Public Health and Primary Care, University of Bergen

Lars Thore Fadnes explained that globally, disability-adjusted life years (DALYs) relating to substance abuse show that this is a significant factor reducing the lives of young people (ages 15-35). Perhaps because of the stigma and negative connotations, Fadnes feels that this area tends to be down-prioritised compared to other health issues. However, Fadnes argues that interventions are available for substance abuse and that it is both preventable and treatable, making it a good focus for an attainable SDG. He would like to see efforts increased in this area to reduce its global burden.

By 2020, halve the number of global deaths and injuries from road traffic accidents
Dr. Sven Young, University of Malawi, Haukeland University Hospital, CIH

Sven Young is part of a Norwegian Programme for Capacity Building in Higher Education and Research for Development (NORHED) project to educate surgeons in Malawi at Kamuzu Central Hospital in Lilongwe, Malawi. He has been very active in both educating Malawian surgeons and in building collaborations that will help to better equip and modernize Kamuzu Central Hospital.

In 2015 the global average for traffic deaths was 18 per 100 000 people. In Malawi, it is nearly double that, 35 per 100 000. Young says that low- and middle-income countries (LMIC) account for 90% of the global total of traffic fatalities, with only 50% of the global total number of vehicles. But, he underlines, accidents that end up with deaths are just the tip of the iceberg – 20 times more result in injuries, many of which permanently disable the victim, with the inherent catastrophic economic effects for the person and their families.

Action is needed. Long-term goals and actions need to be undertaken. Young says that he hopes that the “2020” on the target indicator is a typo for 2030, and calls on high-income countries for commitments to help reduce the impact of traffic accidents on LMIC countries.

By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
PhD candidate Andrea Melberg, CIH, University of Bergen

Melberg underlined that the things that the indicators for reproductive health are measuring are difficult to quantify. For example, the proportion of women with access to the family planning resources they need depends very much on a given woman’s status – married vs unmarried etc. She also highlighted that the process of defining indicators often impacts social processes, which then can become political issues, in turn generating social pressures.

Melberg stresses that concrete quantifiable data is lacking in this area, and measurements are not standardized. She concluded by mentioning the “elephant in the room – abortion”. Abortion is a significant cause of maternal deaths, but data is difficult to collect. She highlights the need to work towards gender equality and women’s health and rights.

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
Professor Bjarne Robberstad, CIH, CISMAC, University of Bergen

Robberstad began his presentation by stating that “universal” is a big word! Universality must be considered along several dimensions.

Robberstad used a visual model to explain the interaction between competing factors. He suggests that a box, or the WHO “cube”, is a useful framework for considering universal coverage. Population, or who is covered, is one dimension. Financing, or cost sharing, is a second dimension. The third dimension is which services are included – which are most essential?
The next step is to consider the size of the box. The largest box would represent a hypothetical situation, where everything is possible and covered for everyone. Boxes of smaller sizes represent the compromises that are necessary to design for the actual coverage possible within given budget constraints.

This is priority setting – the challenges of trade-offs and compromises in health-care service plans.

By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
Professor Magne Bråtveit, Occupational and Environmental Health, and Professor Bente E. Moen, CIH, University of Bergen

London’s lethal fog of 1952 was a result of coal burning and temperature inversions. It brought the issue of air pollution to public attention. It resulted in 12 000 deaths and 150 000 hospitalisations. As a result, Britain passed the Clean Air Act of 1956. Health complications due to air pollution make it among the 10 leading factors for death in most countries. It is responsible for about 1 in every 9 deaths around the world every year. It is listed as number 6 in the 10 leading risk factors posted by the Global Burden of Disease.

Air pollutions is due to chemicals, gases, particles or biological material in the atmosphere that lead to discomfort and undesirable health effects such as airway diseases, cancer, and cardiovascular diseases, all of which can lead to death.

This presentation introduces the Sustainable Development Goals (SDG), and discuss why development of sustainable tourism has become part of the global agenda. In continuation of this, we will discuss the global trends in tourism.

In this presentation, we will discuss the impacts of tourism on marine environment in Zanzibar. In continuation of this, we will discuss sustainable development challenges regarding small island environments. Among challenges are rapid growing populations, a constantly rising number of tourists, limited freshwater resources, and fragile marine ecosystem.

This presentation introduces the term “death by tourism” and discuss’ the impact of uncontrolled tourism on local communities. In continuation of this, we will discuss the importance of Certification of Sustainable Tourism and introduce the three types of Sustainability Certification schemes.

In this presentation, we will discuss how saltwater intrusion affects small islands freshwater supplies, and how tourism is a significant part of this. In Zanzibar fresh water for drinking and other purposes come from rain that replenishes the island’s groundwater reservoir and in many cases freshwater is a scarce resource. On top of this, the excessive pumping in groundwater for the tourist industry increases the risk of salt water seeping into the freshwater magazine from the sea, thereby destroying the freshwater resource.

In this presentation, we will discuss how tourism affects different local communities, including Zanzibar. A study from Zanzibar published in 2015 found that only 20 percent of the GDP generated by tourism occurred to local communities, so it seems possible to develop forms of tourism with greater benefits to the population of Zanzibar, including local population.

In this presentation we will discuss how tourism affects the daily water use in Zanzibar and how a significant water consumption, has the potential of undermining the sustainability of the tourist sector in Zanzibar. Zanzibar has a great water disparity with 15 times higher daily water use per tourist compared with local residents.

This presentation introduces the International Year for Sustainable Tourism for Development (2017). In continuation of this, we will present and discuss data from the World Tourism Organization.

In this presentation, we will discuss how tourism development affects the coral reefs and in continuation of this, we will examine the Crown-of-Thorn Starfish invasion around Zanzibar. Reefs sustain human society, such as fishermen's livelihood and they are also a key asset for the tourist industry. However, the reefs are also under pressure from a range of human induced stresses, including the expanding tourism.