Climate Change and Health Seminar: "Climate change, cities, and health: advancing solutions through systems-based research

July 29, 2021

Information

July 16, 2021

Dr. José Siri, Senior Science Lead for Cities, Urbanization, and Health at the Wellcome Trust's Our Planet, Our Health Programme

Dr. José Siri joined YCCCH for this special seminar to discuss his work in urban and planetary health, climate change, and systems thinking.

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To CiteDCA Citation Guide

00:00<v ->Okay.</v>
00:03It's time to get started. I'm Robert Dubrow.
00:05I'm the faculty director of the
00:07Yale Center on Climate Change and Health.
00:09I know most of you, but maybe not everyone.
00:12And it's a great pleasure today to introduce Jose Siri,
00:18who is speaking to us from London.
00:22And since 2019,
00:24he's been the senior science lead for
00:27Cities, Urbanization and Health for the Wellcome Trust's
00:30Our planet, Our Health Programme.
00:33Some of his previous positions have included
00:36being a research fellow in Urban Health for the
00:39UN University International Institute for Global Health.
00:43He's been a research scholar for the
00:45International Institute for Applied Systems Analysis,
00:49and he got his PhD in Epidemiology with a concentration
00:54in infectious disease epidemiology
00:57from the University of Michigan.
00:59So without further ado, I'll let Jose start his talk.
01:06<v ->Great!</v>
01:07Many thanks, Robert. Can you hear me? Thumbs up?
01:11Great, great.
01:13So it's great to be with you today.
01:14Thanks again to Robert.
01:15Thanks to the Yale Center on Climate Change and Health,
01:19and thank you to you all for joining.
01:22Today, I'm gonna talk about
01:23the central role that cities play
01:24in climate change and health and how systems-based research
01:28can contribute to the solutions.
01:29And I hope that you'll see or you'll agree with me
01:32why we need this type of approach to compliment
01:34traditional public health research.
01:36So I want to start with a few concrete examples.
01:41Just this past month,
01:43we saw one of the most intense heat events in history
01:46in the Western North American heat wave.
01:49So starting in late June,
01:50the Pacific Northwest and Western Canada
01:52saw maximum temperatures up to 19 degrees Celsius
01:55above normal, lasting through early July.
01:59This is a map showing temperature anomalies on June 27th,
02:03compared to the typical average for the same day
02:05in different years.
02:07The heat caused power outages,
02:09it destroyed infrastructure,
02:11it buckled roads across the region,
02:13it spoiled crops, and damaged trees,
02:16some places saw major water quality declines
02:18because of fish kills,
02:20and of course, it sparked wildfires,
02:23which continue to be a major concern in the region.
02:26Some places even saw serious flooding from snow melt.
02:29So the drought, excuse me, the fire had a whole range,
02:32excuse me, the heatwave,
02:34had a whole range of complex consequences.
02:37And we still don't know the full health impacts,
02:40but there've been estimated 700 plus excess deaths so far.
02:45There was a significant rise in hospitalizations,
02:48and there was morbidity, not just from the heat,
02:50but also from cascading events
02:52like smoke inhalation from wildfires,
02:55major mental health impacts, of course, for those effects.
02:59In this context, impacts were much worse because this region
03:02has a low uptake of air conditioning,
03:04and it hadn't prepared in other ways for this level of heat.
03:07So in other words, they're not adapted.
03:10A preliminary attribution study has estimated
03:12that this is about a one in 1,000 year event
03:15in today's climate,
03:16but that it would have been 150 times rarer
03:19without human-induced climate change.
03:21Under two degrees Celsius warming,
03:23which is the minimum goal for the Paris Climate Agreement,
03:26an event of this magnitude might happen
03:28every five to 10 years.
03:30Of course, we know that cities amplify heat waves
03:32because of urban heat island effects.
03:35Cities can be significantly hotter than surrounding areas,
03:37especially at night.
03:40In the left figure below,
03:42you see how climate change might shift
03:44the distribution of hot days.
03:45Now, to the right.
03:47In the right, you see the additional shifts
03:49from urban heat islands.
03:50And the message from from this figure is that
03:52even small rises in average heat
03:55can lead to large increases in extreme heat
03:57at the leading edge of the distribution,
03:59especially in cities where you have
04:01the additional amplifying effects.
04:04So let's cross the world to South Africa,
04:07and three years earlier.
04:09In 2018, after three consecutive years of low rainfall,
04:13Cape Town had one of the worst water crises
04:15ever recorded in the major city.
04:18Early that year, officials estimated that the water system
04:21would actually fail on a so-called "day zero" in April.
04:25In other words, they projected that water levels
04:26would be too low for any withdrawals
04:28and the city would essentially have to shut the system down.
04:32The chart you see here is a measure of water storage
04:35for the city over the five proceeding years.
04:37The black lines at the bottom
04:39show have the minimum levels needed to allow withdrawals.
04:42Now,
04:43in this case, the city averted the crisis,
04:46but not before it drew up security plans
04:48to protect emergency water supplies.
04:50Water was severely rationed.
04:52Citizens were challenged and in some cases, even shamed,
04:56into conserving and consumption was reduced
04:58by more than half, which allowed the city to survive
05:00until the rains came.
05:03But even though the crisis was averted,
05:05it sort of highlighted some of the severe inequities
05:08and conflicts related to water in the city.
05:11Now for example,
05:11informal settlements in Cape Town
05:13received less than 4% of the water supply,
05:16even though they represent 20% of the population.
05:19There were conflicts over the use of water for public health
05:23versus for agricultural priorities.
05:26And again,
05:27this is a situation where the systems
05:29that the city of Cape Town had put into place
05:32just weren't designed for the conditions they encountered.
05:34They weren't well adapted.
05:37As for the Western American heat wave,
05:40this was a quite rare event,
05:42perhaps 0.7% per year in today's climate,
05:46but made five and a half times more likely
05:48because of human-induced climate change.
05:51In an intermediate warming scenario,
05:53the probability of a drought as bad as this or worse
05:56could rise to 25% per year by the end of the century.
06:00In a high warming scenario, it could rise to 80%.
06:03So you would see this kind of drought most years,
06:05essentially.
06:08Again, cities amplified drought risks
06:10because they concentrate massive amounts of people
06:13in a small area,
06:15they impact health directly,
06:16but also through loss of livelihoods,
06:19impacts on agriculture,
06:20and sometimes even increased infectious disease risks.
06:24So for example,
06:25where hygiene suffers because of lack of water.
06:28As with almost all climate risks,
06:30the greatest impacts are on the poor and marginalized.
06:35So coming back to the U.S. now,
06:37one year earlier than that.
06:38In 2017,
06:40Hurricane Harvey dumped as much as five feet of water
06:43on parts of Texas.
06:45Over a hundred people died,
06:4730,000 people were displaced,
06:49and the storm caused $125 billion worth of damage.
06:54Aside again, from the direct health impacts
06:56and environmental exposures,
06:58many, many people suffered mental trauma from the disaster
07:01and from the losses of their homes or their livelihoods.
07:04Again, impacts felt disproportionately on Black
07:07and poor residents.
07:09This was another extremely rare event,
07:13perhaps one in 2,000 years in today's climate,
07:15I've seen as low as one in 9,000 years.
07:18But again, the rainfall totals were made more than
07:20three times as likely, like human-induced climate change,
07:23and the risk might increase to one in 100
07:26by the end of the century.
07:29In Houston itself, within the city,
07:31modeling suggests that the urban environment
07:33not only exacerbated the flooding,
07:35because of impervious services and channeling the water,
07:39but the urban environment actually increased local rainfall,
07:42through interactions with meteorological system,
07:44making the observed flooding,
07:46the observed water levels 21 times more likely.
07:51So,
07:52it's not hard to find material unfortunately
07:55for climate and health.
07:57There are hundreds of other examples
07:59that I could have used here.
08:01All of these have connections to adaptation
08:03because they speak to the need to plan for such impacts,
08:07but they're also intimately linked to mitigation
08:09because all of them were made much more likely
08:11by human greenhouse gas emissions.
08:14So these events really illustrate that climate change
08:16is not just the concern for the future,
08:18we're already seeing serious impacts today.
08:21They show how cities mediate and modify
08:24both overall climate impacts and the distribution of impacts
08:27across society.
08:29They show how much human-induced climate change
08:32has already increased health risks,
08:35and how these health risks may increase in the future.
08:38And they tell us or they show us really,
08:40the cities are critical part of solutions
08:43for climate mitigation, adaptation, resilience.
08:47So for the rest of my talk,
08:48I'm gonna be discussing why cities are critical
08:51for climate and health impacts and solutions,
08:54what challenges we face in implementing
08:56healthy climate action in cities and beyond,
08:59why we should see many climate and health challenges
09:01in cities as systems problems,
09:04and how a systems-based research agenda can help catalyze
09:08solutions.
09:10So, first of all,
09:11why are cities critical for climate and health impacts?
09:15First of all, cities are where we mostly live.
09:19And this is a fairly new situation.
09:21Most of us tend to think of, for example,
09:23the Industrial Revolution
09:25as the time of massive urbanization as I do.
09:28But the population of England in 1800
09:30was maybe just 10 to 20% urban.
09:33Urban population growth began to overtake rural
09:36about half a century ago.
09:38And according to the UN,
09:39we became majority urban around 2007,
09:42where you see these two curves cross.
09:45Today, the UN estimates that we're about 55%,
09:48and by 2050, two-thirds of us will live in cities.
09:52Now it's worth mentioning that these numbers are quite
09:54uncertain.
09:55We actually can't measure who lives in city
09:59and how many people live in city directly.
10:01We've tended to use national definitions for urban,
10:04whatever they are.
10:06But in Norway or Sweden, a city with 200 people
10:09is considered urban.
10:10In Japan, you have to have 50,000 people
10:12to be considered urban.
10:14So cross country comparisons are quite difficult.
10:17There have been a few efforts to apply
10:19a single standard everywhere.
10:21One effort using a construct called degree of urbanization,
10:23puts the global urban share of the population
10:27at about 75 to 80%.
10:29Most of the increase coming from Asia and Africa.
10:33There's some controversy over that definition.
10:35There's other efforts, but whatever method you use,
10:38the take home message is that we're mostly urban
10:41and we'll be adding billions of more city dwellers
10:43over the course of the century.
10:45So,
10:46given that we're mostly urban species today
10:50from the standpoint of an ecologist,
10:51cities are our dominant habitat
10:53and they've profoundly affect our health.
10:56And I like to think of the analogy of a fish tank.
10:59So if you buy a fish tank,
11:01you have to supply it with fresh or salt water,
11:03depending on the kind of fish,
11:04you need to add light and heat,
11:06gravel, hiding places for the fish,
11:09you have to regularly add food, you need a filter,
11:12and so on and so forth.
11:14If you imagine building an ideal habitat for a human being,
11:18it probably wouldn't look too much like modern cities,
11:21that some are better than others.
11:23This list here is from Stephen Boyden's seminal work
11:26on human ecology in Hong Kong.
11:28And I love that this includes not just physical,
11:31but psychosocial needs.
11:33So, of course,
11:34cities should supply clean air, water and food,
11:37but it's equally important that they supply
11:39emotional support, and variety, and a sense of purpose.
11:44But again, the key is that cities, in many ways,
11:47determine the health of the human species.
11:51Virtually, every urban system affects health
11:53in familiar ways,
11:55but also along pathways that we may not be aware of,
11:58or when we think about, excuse me.
12:03Urban transport systems affect physical activity,
12:07they affect the air pollution and exposure to air pollution,
12:10mental health and opportunities for social interaction.
12:15For women, in some contexts,
12:16they also can seriously affect safety
12:18or perceptions of safety.
12:20Housing affects exposure to extreme temperatures,
12:23infectious vectors, toxic pollutants,
12:26but it can also influence a sense of belonging
12:28and variety and daily experience.
12:31Cultural systems have impacts on creativity, of course,
12:35but also on loneliness,
12:37and even on infectious disease transmission
12:39as we've seen in lots of examples during COVID-19.
12:43And I'm sure I've left relevant systems off this list.
12:47I won't go through them all,
12:48but I just really want to emphasize the point that cities,
12:51through their complex integrated dynamic systems,
12:54are among the main drivers of our health and wellbeing.
12:58Now, importantly, for what we're discussing today,
13:01cities affect virtually all the pathways along which
13:03climate change affects health.
13:06So you have direct impacts, for example, through storms,
13:09drought, flooding, and heat.
13:10And as we've seen,
13:12these are all modified and sometimes amplified by cities
13:15in urban systems.
13:17You have indirect impacts,
13:18might mediated through ecological systems.
13:21These are also affected by cities.
13:23So for example, cities drive deforestation,
13:25increasing the likelihood of zoonotic disease transmission
13:28when previously separated species come into contact.
13:33They can cause food system disruptions when they grow over
13:36or expand over productive agricultural land,
13:38which is quite common.
13:40Indirect impacts can also be mediated
13:42through social processes like migration or trade.
13:46And of course, cities are the primary driver
13:48and destination of those processes as well.
13:52Cities are also where most mitigation and adaptation actions
13:56either are implemented or are the driving force behind it.
14:03Perhaps most importantly,
14:05cities emit about three-quarters of all greenhouse gases
14:08from final energy use.
14:10They use more than three quarters of all natural resources.
14:13They produce about half of all the waste
14:15that humanity produces.
14:17And the graph on the left shows
14:20global greenhouse gas emissions by economic sector.
14:24Electricity and heat production, transportation, buildings,
14:28and to some extent, industry,
14:29are important sources of urban emissions
14:32as you might imagine.
14:33But even emissions that happen in rural
14:36or undeveloped areas,
14:38so for example, from agriculture or forestry,
14:41are mostly the result of urban demand
14:43for goods and services.
14:46On the right,
14:48the figure shows two common ways of accounting for emissions
14:51and the bluer circle towards the top,
14:54shows all emissions arising from goods and services produced
14:57within the city,
14:58whether they're consumed there or exported somewhere else.
15:01That's the usual way that we measure emissions.
15:04The greener circle shows all emissions
15:06arising from goods and services consumed by the city,
15:09wherever they're produced.
15:11And in fact, especially in wealthy cities,
15:14a high percentage of emissions are from imported goods
15:17and services.
15:18So, you buy your iPhone,
15:19and you don't have any emissions from that,
15:21but emissions are produced in China or somewhere else
15:24or where that phone is produced.
15:27We've done a lot less well at documenting
15:29so-called consumption-based emissions.
15:31For example, they're not generally included
15:33in net-zero commitments,
15:34which are pledges to reach a state of carbon neutrality
15:38by a certain date.
15:40There are efforts underway to change that,
15:42led by groups like C40 Cities,
15:44which is a network of the world's largest
15:47and most influential cities.
15:50So,
15:51just as urban populations are growing,
15:54so too our urban extents.
15:56The amount of land that we devote to cities is projected
15:59to increase dramatically over the century.
16:03In fact, many analysts suggest
16:06that we're more than double total urban land extents.
16:10I believe Karen Seto, who I think is with us here,
16:13has estimated that 60% of all of the urban infrastructure
16:16that we're going to need has yet to be built.
16:22Under some scenarios of fossil fuel development,
16:25as you see on the right graph here,
16:27models have projected that we could have as much as
16:29six times as much urban land by the end of the century
16:32as we have now.
16:34More than two-thirds of the expansion in urban land
16:37will happen in Africa and Asia.
16:40And so,
16:40you can imagine that this is a tremendous opportunity
16:43to rethink how we design our fish tank,
16:46how we make our cities healthier places,
16:48both for people and for the planet.
16:53So,
16:54I've highlighted some troubling trends and statistics here,
16:58but I really want to emphasize that
16:59cities can be forces for good.
17:02It's really important to remember that.
17:03These two pictures are before and after shots of a place
17:07in Seoul, South Korea,
17:08called Chonggyecheon.
17:10I'm positive, I'm butchering the pronunciation, but I try.
17:15From the late 1950s to the mid-1970s,
17:18this was a site of major industrialization
17:21and really a perfect example of car dependency.
17:24You can see in the upper picture that the site included
17:27an elevated highway.
17:29This was constructed over the bed of a former river.
17:33In 2003, the then mayor of Seoul initiated a project
17:37to remove the highway and restore the river.
17:39It was highly controversial.
17:41It was expected to lead to terrible congestion
17:43and other consequences,
17:45but actually it's become a showcase for the city.
17:48The new watercourse, which you see in the lower picture,
17:52led to locally cooler temperatures,
17:55by some measures an increase in biodiversity,
17:57less traffic congestion,
17:59less pollution,
18:00more tourism,
18:02and cultural and economic revitalization.
18:05And cities everywhere are taking actions like this,
18:08and trying experiments like this.
18:10Now, we saw a host of new experiments in public space
18:13and infrastructure,
18:14and working in mobility during COVID-19
18:18in cities around the world.
18:20Cities are also taking the lead on net-zero commitments,
18:24and adaptation matters,
18:25and on integrating all these activities
18:27under one-governance structure.
18:29So the city of Amsterdam, I believe,
18:32is taking an explicit Doughnut Economics Approach
18:34to their development, where they both mitigate
18:39the excesses of growth,
18:41but also provide all the social needs for the population.
18:44So really important that we see cities not as problematic,
18:48but as a source of solutions.
18:51So now,
18:53I want to talk a little bit about some of the challenges
18:55to implementing healthy climate action in cities.
18:59Many of these things that I'll talk about, of course,
19:01apply to climate and health more broadly.
19:05One challenge is that we just don't know where we're going
19:08in terms of emissions pathways.
19:10This figure shows annual growth,
19:12global greenhouse gas emissions under different scenarios.
19:15If we do nothing, we're up in this pink gray area,
19:18and we're probably looking at
19:19more than four degrees Celsius of warming,
19:22which would be catastrophic.
19:24But fortunately, we are already doing something,
19:26and under current policies, we're probably in this tan space
19:30in the middle and looking about three degrees of warming,
19:33which would still be extremely serious.
19:36Our current pledges and targets under the Paris Agreement,
19:39get us down to about 2.4,
19:41and if we were able to take the urgent massive action
19:44that we need to take,
19:45we might still be able to hold a warming to two degrees
19:48or even 1.5.
19:51But it's important to remember that all the climate impacts
19:53that we're seeing today are just
19:561.1 or 1.2 degrees of warming.
19:59So even 1.5,
20:00even if we meet the goals of the Paris Agreement,
20:03we're looking at significantly more serious health impacts
20:05and other impacts.
20:08Now, of course, not knowing what to adapt to,
20:11makes it quite difficult for cities to plan effectively.
20:14It also makes it quite difficult and challenging
20:16to project impacts.
20:19So,
20:21a second issue is that we don't know enough
20:23about tipping points.
20:26A tipping point is a set of conditions
20:28where small changes can lead to abrupt shifts
20:31in the state of a complex system.
20:33Most often, we hear about climate change tipping points.
20:37So for example,
20:38there's a hypothesis that if the Greenland ice sheet melts
20:41too quickly,
20:42the influx of cold water could shut down
20:44the circulation of the North Atlantic Ocean currents
20:47and that would cause a very rapid shift in global climate.
20:51So that's one climate tipping point.
20:53There are many other potential climates tipping points,
20:55but tipping points aren't limited to climate systems.
20:58So you can have ecological tipping points,
21:01and socio-economic tipping points as well.
21:04So to give an example of an ecological tipping point,
21:07drier conditions can cause less vegetation growth,
21:10which leads to less evapotranspiration, even less rain,
21:14and eventually leads to rapid desertification.
21:17And there's evidence that that may have
21:20already started happening in some areas.
21:23In terms of socioeconomic tipping points,
21:26sea-level rise, or sustained drought
21:27can lead to sudden abandonment of settlements
21:30and out-migration.
21:31Imagine if the Cape Town drought
21:33had gone on a couple more years.
21:36Importantly, tipping points can also be positive.
21:39We might see a sudden transition to renewable energy
21:42when a critical mass and cheaper technology
21:44leads to universal adaption.
21:46We've seen that kind of rapid spread for mobile phones
21:49and social media, for example.
21:52But deep uncertainty about the likelihood, magnitude,
21:55and timing of tipping points is another factor that
21:57complicates city planning and even global climate planning
22:01and policy discourse.
22:05We don't have enough information
22:07about the limits of adaptation or its effectiveness.
22:11The figure here shows frequency of adverse impacts
22:14from some event on the Y-axis
22:17and intensity of adverse impacts on the X-axis.
22:22So when frequency or intensity are very low,
22:25when they're in the blue,
22:26we don't worry about them.
22:27They're acceptable risks.
22:29Beyond some limit of acceptable risk,
22:31which is shown here by the curve line at the lower left,
22:35we adapt to the risk,
22:36but there are limits to what's possible or feasible.
22:39A limit to adaptation is a point at which an actor
22:42can no longer secure valued objectives
22:45from intolerable risk through adaptive action.
22:49So the point at which your adaptive action can't secure
22:52what you need to secure.
22:54Above the limits of adaptation,
22:56which is the second curve line in this figure,
22:58to the upper right, risks are so severe
23:00that we have to try to avoid them or mitigate them.
23:03And you may have heard the phrase,
23:05"Adapt to what you can't avoid, avoid what you can't adapt."
23:10Barriers to adaptation can be physiological.
23:14So for example, where heat and humidity go beyond
23:17the human body's capacity to cool itself,
23:19they can also be ecological, social,
23:21cultural, physical infrastructural, or technological.
23:25I'm sure there are other things that they can be.
23:28So we need to have a much better understanding of the limits
23:31to adaptation.
23:34One second.
23:37In terms of effectiveness,
23:39we have lots of projections and sort of modeled estimates of
23:43the effectiveness of potential actions,
23:45but far fewer measurements of performance of adaptation
23:49in reducing health or climate impacts or risks.
23:52So,
23:54as things become more and more implemented in the world,
23:56we need evaluations of those projects.
24:00Even when we know adaptation has been effective,
24:02it's hard to separate out
24:03the effects of personal behavioral change,
24:06changing contextual factors, and specific interventions.
24:09So we need a theory that helps us
24:11disentangle those patterns.
24:14Another challenge,
24:15and this is a really important one,
24:17from my perspective, is that existing research
24:20doesn't reflect non-patterns of risk.
24:23The figure above is from a preprint of a new review.
24:26They used machine learning approaches
24:28to evaluate about 16,000 climate and health studies.
24:32And if you notice the scale, there is a log scale,
24:34so keep that in mind.
24:36Notice where the studies are concentrated.
24:39The second figure below shows the locations of heat wave
24:43and health research over close to half a century.
24:46It's even a starker pattern,
24:47and that's for one specific risk,
24:49but you can do that for any different climate analysis.
24:53In both cases, there's a significant lack of research
24:55in countries and cities that will experience
24:58serious climate and health impacts.
25:01That includes Latin America, Africa,
25:04the Middle East, Central Asia and Oceania.
25:08And lots of research in the U.S. and Europe,
25:11India and China, but much of the rest of the world
25:13needs a lot more.
25:16We still don't have nearly enough evidence
25:18on how cities interact with modify and mediate
25:20climate health relationships.
25:22And because we haven't done the research,
25:24we especially have limited information about
25:26how these interactions are already affecting residents
25:29of informal settlements, secondary cities,
25:32cities in the Global South,
25:34or how they'll affect in the future.
25:37We don't have enough evidence on impacts
25:38on marginalized groups or intersectional impacts,
25:42even in high-income countries.
25:44And we don't have enough evidence on impacts
25:46mediated via complex indirect pathways,
25:49which I'll talk a little bit more about later.
25:53And of course we've seen the climate change
25:55will push our infrastructure beyond the tolerances
25:58that it was designed for.
26:00That was something in several of the examples that I gave.
26:03We need much more information on how our infrastructure
26:06would respond to and what we do to fix it.
26:11So another issue is that we have systematically incomplete
26:15information on how to catalyze climate action.
26:18And some of you may be familiar with this picture.
26:21This picture represents a story from World War II.
26:25Bombers were being regularly shot down
26:27when they went out on raids,
26:29and the U.S. Military was trying to figure out
26:30what to do about it.
26:32So when the bombers came back, they systematically mapped
26:34the bullet holes in planes returning from combat,
26:37and they proposed to add armor to the parts
26:39that had the most holes.
26:41But a statistician named Abraham Wald,
26:44pointed out the solution was the exact opposite
26:47because these were the planes that had survived.
26:49So the military should armor the parts with no bullet holes,
26:52because any plane that got hit in those places
26:54didn't make it back.
26:56This type of effect has been called survivorship bias,
27:00and it's really common.
27:02In the context of climate change,
27:04we're beginning to have many collections of implemented
27:06mitigation adaptation and co-benefits actions.
27:09And often these collections try to pull out and identify
27:12the salient shared features of success.
27:15But we have far less information on interventions
27:17that failed during implementation.
27:20Almost no information at all on actions that were rejected
27:23during ideation or planning.
27:26Actions that were proved and never implemented.
27:29In this context, survivorship bias can arise
27:32to drawing conclusions only from successful climate action.
27:36So we need to look at the failures.
27:40Another challenge is that research policy and practice
27:42tend to operate in silos.
27:45In other words, people tend to engage, primarily,
27:47with the concepts, people, problems and actions
27:51that relate to their own specific area of work or interest.
27:55Obviously, this challenges effective communication,
27:57the challenges are believed to integrate
27:59research policy and practice,
28:01and it challenges the coherence of the actions
28:04that we implement.
28:06One thing that I and many others have observed is that
28:09health has actually, often particularly,
28:12separated from other sectors.
28:14And maybe this is because of deference to the health sector,
28:17maybe it has something to do with specialization,
28:19maybe it's because health is life and death,
28:21and so occupies a sort of a different place.
28:24But the result is that in many cities,
28:27just to give one example,
28:28urban and transport planners have little or no contact
28:31with the health department,
28:32even though their actions have huge implications
28:35for health and wellbeing, and obviously for climate.
28:40Another challenge is that the pace of the required change
28:43of what we have to do is getting faster and faster.
28:47Every year that we delay action,
28:49the climate challenge becomes greater.
28:51As of 2019,
28:53we would have had to cut emissions by 7.6% each year,
28:56globally,
28:57to meet the goals of the Paris Agreement.
28:59And just for perspective, in 2020 with COVID-19,
29:03we had just a 6.4% drop in emissions.
29:07So that starts to give you a sense of the scale
29:09of what we need to do every year.
29:12The figure here shows how the pace and trajectory
29:15of the needed emissions reductions changes
29:16with the year when they begin.
29:18So if they had started in 2000,
29:21it would have been a much shallower
29:22reduction that we would have had to have.
29:24Now it's much deeper.
29:26Not only do we have to move faster than ever,
29:28but we have to do more than ever before.
29:31So our goal can't be just to reduce emissions,
29:34but we also have to meet all the other goals
29:36to sustainable development.
29:37We have to the end poverty and hunger,
29:39provide education and equality,
29:42and all of the other SDGs.
29:48The figure on the left
29:51just shows how health is intimately linked
29:53with all of those goals.
29:55And on the right,
29:55we have countries plotted, excuse me,
29:57on the right we have countries plotted with respect to their
29:59ecological footprint per capita on the Y-axis,
30:03and their human development index on the X-axis.
30:05So the further to the right on this chart,
30:08the better your standards of living.
30:10The lower down, the more sustainable you are.
30:14The shaded square at the bottom right
30:15defines the space within which countries
30:17have high human development
30:19and live within the world's limits.
30:22And you can see that there are very few countries
30:24in that space, and we need to get everyone there
30:26quite quickly.
30:28So one last challenge is that we have lots of commitments,
30:32but actual implementation lags far behind.
30:35Here, we see cities and regions that have pledged
30:37a net-zero emissions target,
30:39and we also have the percentage of national populations
30:41that are covered by these targets.
30:43As of 2020, 126 countries and 51% of global emissions,
30:47As of 2020, 126 countries and 51% of global emissions,
30:50excuse me, of the global population had net-zero goals,
30:53either formerly adopted, announced, or under consideration.
30:57But pledging and implementing are far different things,
31:00politically and practically.
31:02So we need to keep an eye on this
31:03and we need mechanisms for accountability.
31:08So I want to shift gears here and talk about
31:11the systemic nature of many urban challenges,
31:13including those related to climate and health,
31:15and why we should think of them as systems problems.
31:19So, first of all, what do I mean by systems problems?
31:23Systems problems arise from the interactions of networks
31:26of interconnected elements or systems.
31:29They tend to have various features,
31:31detailed complexity, so they have lots of variables,
31:34there's lots of things going on.
31:36Dynamic complexity.
31:38Cause and effect can be hard to define in these systems.
31:41The outcomes of interventions aren't obvious.
31:45They usually have multiple stakeholders acting on
31:47incomplete information, often with conflicting motives.
31:51They operate across multiple scales and sectors.
31:54They're often resistant to change or sometimes
31:56they'll change very suddenly and unexpectedly.
31:59And they're usually related to other problems.
32:04So the defining feature of systems problems is feedback,
32:07which can be reinforcing or balancing.
32:10Reinforcing feedbacks lead to exponential growth decline,
32:14balancing feedbacks lead to stable values.
32:17So remember the example of desertification before,
32:20where less rain went to less vegetation,
32:23went the less rain and so on,
32:24that's a reinforcing feedback loop.
32:27Your thermostat in your house operates
32:29on the principle of balancing feedback.
32:31When the gap between the room temperature
32:34and your thermostat setting gets large,
32:36it turns on the furnace and the room heats up.
32:38When the gap becomes smaller,
32:41it turns off the furnace so the temperature stays close
32:43to the desired temperature.
32:46So an important observation here is that you can have
32:49a valid causal relationship between A and B,
32:52perfectly valid, but still see all sorts of different
32:54behavior in the real world,
32:56depending on other connections in the system.
32:59System behavior can be explained endogenously
33:01in terms of feedbacks, delays, stocks, flows,
33:04and parameters within the system.
33:07That means that the way the system behaves
33:09depends on the way the elements of the system are connected.
33:13Simple system structures,
33:15or combinations of feedback loops and delays,
33:17give rise to characteristic patterns of behavior.
33:22Sometimes, we see these called systems archetypes.
33:26So seeing a certain pattern suggests a certain relationship
33:29between the elements in a system.
33:31So just to give a couple of examples,
33:34the top example here,
33:35you have a balancing feedback loop with a delay
33:38and that gives dampening oscillations.
33:40So if your thermostat is slow to react,
33:43you'd see this kind of pattern.
33:45The second example,
33:46a reinforcing loop tied to a balancing loop
33:50can give you a typical logistic growth curve.
33:52So,
33:54in the second diagram, we have population growth
33:56with an ecological carrying capacity.
33:58At low populations, the reinforcing loop dominates
34:01and growth is exponential,
34:02and at high populations, the balancing loop dominates,
34:05so growth slows until the population equals
34:08the carrying capacity.
34:10There are many other well-established systems archetypes,
34:13and of course, these relationships can be expressed
34:15mathematically and modeled.
34:19Simple systems structures combined into broader systems
34:22in constant dynamic flux.
34:25And this is where conventional approaches really struggle.
34:28So when you have health needs and risk factors
34:31and diseases and health resources that are all fluctuating
34:34constantly over time,
34:36it's hard to develop valid conclusions.
34:41Earlier, I mentioned silos,
34:42here's where they really become relevant.
34:45So when dealing with a system virtually, everyone sees,
34:47tends to see their own part,
34:49the part most related to their own work, or their own ideas,
34:52or their own community.
34:54So climate scientists tend to look at climate variables,
34:58city planners look at urban variables,
35:00health professionals tend to look at
35:01direct health relationships.
35:03Now, of course,
35:05there's intentional reaching across the boundaries.
35:08Health scientists certainly look at the impacts of variables
35:11in other parts of the system,
35:13but it's rare that anyone is able to perceive
35:15the whole system and the way things co-vary
35:17and interact at the same time.
35:20So an important guideline and systems thinking
35:23is that you can't understand
35:24the behavior of that whole system
35:25by understanding the behavior of individual parts.
35:29This is especially true in critical feedback loops,
35:32especially if feedback loops that have delayed action
35:36when they cross silo boundaries.
35:38And under those circumstances,
35:39it's very common for decision-makers to be surprised
35:42by the counter-intuitive outcomes
35:44or the failure of policies or interventions.
35:49Now,
35:50practitioners of systems analysis and systems thinking
35:52have developed heuristics about when and how to intervene
35:56in a system to have greatest impact.
35:59These are so-called leverage points,
36:01and some of them are more effective than others.
36:03So the lowest value leverage points are parameters.
36:06So for example, the rates of flow into or out of stocks.
36:11Higher up on leverage scale are physical system structures
36:15like buffers and material stocks and flows.
36:18Even higher are control structures.
36:21The structures that control of the working
36:22in the system, feedback loops,
36:24information flows and rules.
36:27The highest leverage points are those that allow
36:29the system structure or the goals to change,
36:32so if you can add feedback loops or remove them.
36:36And if you look at the very peak are interventions to change
36:38the paradigm out of which systems arise.
36:41In a real sense, that's what we're trying to do
36:43in the context of climate change
36:45and sustainable development.
36:47We want to shift our shared understanding of the goal
36:50of the human system, of humanity's place in the world.
36:56In the meantime,
36:58systems thinkers tell us
37:00that most of what we do to solve problems
37:03of the options that we look at,
37:06tend to rely on low value leverage points,
37:09and that we often, after we've identified them,
37:11push them in the wrong direction.
37:13So the systems approaches offer an opportunity
37:15to identify higher quality actions.
37:20Many urban climate and health challenges have features
37:23or show behaviors that we associate with systems problems.
37:26There are processes that we see replicated again and again
37:30in cities around the world.
37:32Urban sprawl, traffic congestion, gentrification,
37:35slum formation, air pollution,
37:37patterns of consumption growth.
37:39All of these are processes that resist change,
37:43that involve multiple stakeholders, and so on.
37:46We also see persistent why they replicated social patterns
37:50like prejudice and denialism.
37:53And this should be no surprise.
37:55Cities are the most complex systems
37:57that human beings have ever created.
37:59And all of this suggests that we need
38:01a systems-based research agenda to address
38:04these and other climate and health issues.
38:08Now, what I mean by a systems-based research agenda
38:10is not a replacement of traditional epidemiological
38:12or public health approaches.
38:14I think those are absolutely critical.
38:17And we have to make sure that we don't disrupt
38:20traditional science.
38:21What I rather mean is a program of work
38:23that complements traditional methods,
38:26that frames them within a systems context,
38:28and that draws on them to map complex problems,
38:32and identify solutions.
38:34A systems agenda would include components
38:36that apply methods to understand complexity
38:38and that engage broadly across disciplines,
38:41and especially beyond science.
38:44Now, this could be more or less expensive,
38:46but I've mapped out some of the components
38:48that I think are necessary.
38:50And these include conceptual mapping,
38:53systems-based case studies,
38:55simulation modeling,
38:56systemic analysis of governance planning and policy,
38:59and transdisciplinary research.
39:01And I'll talk about each of these just briefly.
39:06At the most basic level,
39:07concepts mapping can help organize information.
39:10I know this doesn't look very organized to you,
39:12but it actually helps a lot.
39:15It allows for exploration and hypothesis generation.
39:19This particular diagram is a causal process diagram
39:22for droughts and mental health from a systematic review.
39:25Now, the numbers that you see in brackets
39:27are the number of papers meeting the search criteria.
39:30So, you can see that this gives a sense of the state
39:32of knowledge across the system,
39:34and suggests where more research may be needed.
39:37And then there's the area of the shaded in green here,
39:41gives a sense of how this whole system diagram can be used
39:43to identify subsystems of interest.
39:46In this case, between drought, agricultural productivity,
39:49workloads and the health of the economy.
39:52Conceptual diagramming of this sort can also help identify
39:55potential co-benefits or co-risks between climate actions.
40:01On a more applied level,
40:03place-based, systems-based case studies can help,
40:06can also help with hypothesis generation
40:08and problem diagnosis.
40:10They can also play an important role in communication
40:12and advocacy because they provide a common language
40:16that cuts across silos,
40:17the language of feedback and stocks and flows.
40:21This is a case study series from a research project
40:24that I led a few years ago at UNU, it was called,
40:27Systems Thinking in Place-Based Methods for Healthier
40:30Malaysian Cities, SCHEMA for short.
40:32Don't ask me about the acronym.
40:37The case studies were produced in
40:38iterative cycles of engagement between a systems thinker,
40:42who provided technical knowledge and encourage
40:44thinking about dynamic processes,
40:46and a set of urban stakeholders who supplied
40:48local relevant knowledge,
40:50and evaluated the options, the structural options
40:53that were given to them by the system figure.
40:56In the end,
40:57the local stakeholders made all the decisions
40:59about the final model.
41:02This particular model explores how to assure safe food
41:04in school cafeterias, but the series covered a wide range
41:07of sustainability and health issues.
41:10There's lots of different methodologies
41:11for producing this kind of study
41:12and it could be done quite easily,
41:14so I think it's actually also a really useful tool
41:16for education and systems they need.
41:19On an even more applied level, of course,
41:21you have simulation models.
41:24Treat these with caution,
41:25absolute prediction is difficult,
41:27but they can provide useful insights to the system behavior,
41:31the probable outcomes of different scenarios,
41:33and potential unintended consequences.
41:36Simulation models can also be used to design
41:38and assess interventions,
41:40which is especially important for interventions
41:42with long time horizons.
41:44This particular model is of climate population
41:47and water supply.
41:49The agents here,
41:49which include households,
41:51and the water utility manager,
41:53make decisions based on their own attributes
41:55and rules for behavior,
41:56but also based on the current state of water system.
42:00Agent-based models are especially useful
42:02for looking at issues with distributional impacts,
42:05but there are many other classes of simulation model.
42:11Analysis of urban governance policy and planning
42:14is another really crucial element
42:15of the system-based agenda,
42:18just because these are the information
42:19and control structures for urban systems.
42:22So these are potentially high leverage points.
42:25This particular chart,
42:28maps different modes of urban climate governance
42:30against mitigation sectors.
42:33So for example, for transport,
42:35it distinguishes self-governing like procuring
42:38energy-efficient vehicles for the government fleet,
42:42governing through enabling like educational campaigns,
42:46governing by provisions, such as
42:48the provision of public transport,
42:50and governing by regulation such as road user charges.
42:56I don't want to go through this in detail,
42:58but just to make the point that understanding
42:59how each of these modes functions and practice,
43:02and how they themselves are connected in feedback systems
43:06and hierarchies.
43:08It again offers opportunities for problem diagnosis,
43:11hypothesis generation, and advocacy.
43:14One of the things that this kind of mapping does
43:16is it allows for documentation of the early stages
43:19of policy and planning to reduce the survivorship bias
43:22that I talked about earlier.
43:25And finally,
43:29transdisciplinary research is increasingly recognized
43:32as an important modality for resolving complex
43:35societal challenges.
43:37This is an OECD report that I helped coordinate in 2020,
43:41because recommendations for universities,
43:43research funders, researchers,
43:45and international organizations,
43:47are looking to foster this kind of work.
43:49Transdisciplinary research,
43:50which is across the boundary between science and society.
43:54That's the defining characteristic.
43:56It involves non-stained stakeholders and co-design,
43:59blending knowledge and creating new theory
44:01in search of common goals.
44:03It generally involves cycles of conceptualization,
44:06implementation and evaluation.
44:08It takes longer.
44:10It's usually more difficult.
44:11It's almost always more messy than traditional research,
44:14but well-designed and this is where research can generate
44:18scientific breakthroughs and local solutions
44:20at the same time.
44:22And that's something that's really important at this moment
44:24when we have to act at the same time as we learn.
44:28And just to give an example of transdisciplinary research,
44:32through my program at Wellcome,
44:33we fund a research partnership called RISE,
44:36Revitalizing Informal Settlements and their Environments.
44:39And this is a randomized control trial,
44:41The complex, nature-based water and sanitation
44:44and intervention in informal settlements
44:46in Indonesia and Fiji.
44:49The intervention itself has core features.
44:51It's based on a nature-based approach to sanitation,
44:54but ultimately an intervention is tailored
44:56to each community.
44:57Community stakeholders make the final design decisions.
45:01RISE measures a wide range of health
45:03and environmental outcomes,
45:05and scientifically, its generated knowledge,
45:08not only about the intervention,
45:09but about community engagement,
45:11and the capacity involving the informal settlements.
45:15So for the study communities,
45:16it's generated livelihoods, ownership and agency
45:19beyond the benefits of the intervention.
45:22And I think that we need much more of this type of research
45:24to tackle the challenges of climate and health
45:27in cities and beyond.
45:29So that brings me to the end of my presentation.
45:33I think that we're at a time when we need to harness
45:36the brilliance and the exuberance of cities
45:38to meet the needs of people in the planet.
45:40And I think that systems thinking is critical
45:42to that effort.
45:43So thank you for listening.
45:46I'm glad to take any questions.
45:52<v ->Well, thank you, Jose.</v>
45:53I could start with a question to get things started.
45:58So you gave a number of examples of conceptual diagrams
46:03of systems models that, you know, were hard,
46:08obviously hard to digest deeply, you know,
46:12given the timeframe, which, but my question is,
46:17do you see a role for more quantitative systems models
46:21in doing this kind of work?
46:24<v ->Yeah, I absolutely do.</v>
46:26And I, when I was talking about simulation modeling,
46:29I was more talking about quantitative models.
46:32I think that you do get into difficulties
46:35when you try and get into that exact prediction.
46:38We've seen, for example, with COVID-19,
46:40how difficult it is to predict the exact behavior
46:43of a system,
46:44but we are actually quite good at predicting
46:46the general shape.
46:48So we may not be able to say that the people come now,
46:50but we can say that there will be a peak.
46:53So certainly, all sorts of climate and health questions
46:58in cities and beyond are amenable
47:00to that kind of quantitative model, yeah.
47:04Rafael?
47:06<v ->Yes.</v>
47:06Thank you for a very insightful presentation, Jose.
47:10And my question is about, first of all,
47:13And my question is about, first of all,
47:17realizing through your presentation
47:20and the work that some of us are doing with food systems,
47:23how it is important to not fear complexity,
47:28that at the end of the day,
47:30we have to deal with it
47:33the way it is in reality on the one hand,
47:36and we can come up with very wonderful
47:39spaghetti-like diagrams,
47:41like some of the ones you showed us to
47:43all the innumerable factors and subsystems
47:47that are interconnected,
47:50explaining the problem that we have.
47:52But then, I think for decision making, for policy making,
47:57at the end of the day,
48:00the secret sauce is in actually breaking down
48:03those systems into subsystems,
48:06that we can really understand in a reasonable way,
48:09that we can really understand in a reasonable way,
48:12and that we can actually come up with very specific policies
48:17or interventions to address them
48:19versus trying to do everything at the same time.
48:22So,
48:24what is your take with regards to not fearing complexity,
48:25what is your take with regards to not fearing complexity,
48:29but at the same time embracing simplicity to try to address
48:34the humongous problems that we face?
48:38<v ->Yeah.</v>
48:39So first of all,
48:40I think that you're right about spaghetti diagrams.
48:43There's a diagram,
48:44a famous diagram on obesity
48:47and the factors that lead to obesity,
48:48and called, I think the framework shift model,
48:51which is so crazy that I decided I didn't want to show it.
48:55And those sorts of diagrams actually,
48:59I think can lead to paralysis.
49:01So they're not useful in that sense,
49:03but they are useful in constructing them
49:06to think about the subsystems and to learn about the things
49:08that were not, you know,
49:10you didn't consider it to be related and actually are.
49:12But I agree with you,
49:13that pulling out the subsystems is really where you get more
49:16interesting and applicable results.
49:19I did some work with a colleague at ANU
49:21that made the argument that low order systems models.
49:24So five variables or less are really useful
49:27for influencing policy makers if you can get them
49:30to engage with the process.
49:32I have another talk.
49:35I remember where actually, I was at a meeting
49:39and there was a policy maker speaking.
49:40She had been, I think deputy director
49:42of the city of Lens in France,
49:44and someone asked her, you know,
49:46how do you get policy makers to engage with
49:48systems thinking?
49:49And she said, don't ever use the word system.
49:51Once you've used the word system, they've checked out.
49:55So you do have to find ways to express these things in ways
49:59that are more palatable and more understandable
50:01for the audience.
50:03But I think that that's part of the challenge.
50:04And I don't think it's, I don't think,
50:06I mean, I don't think it's daunting.
50:08I think it's actually really exciting that there's this
50:11whole area of space that maybe we haven't spent enough time
50:14thinking about, but that we can,
50:17especially sort of in mapping the government structures
50:19and the barriers that come about
50:20through the structure of governments.
50:24<v ->Thank you.</v>
50:36<v ->Are there any other questions?</v>
50:38Feel free to speak up.
50:40While you're thinking, I'll ask another question.
50:44So,
50:46I guess the question is,
50:48what are the limitations of cities'
50:53city-level policy in a context where you don't have a
50:57coherent, you know, good national policy around
51:02climate change or climate change and health?
51:07<v ->That's a good question.</v>
51:08I think that, well, for one thing,
51:10it depends on the context.
51:12There's some places where there will be more importance
51:15to have coherence or not depending on the climatic factors,
51:18depending on social factors.
51:21I think that in general, cities are a good unit to use
51:24because they can, you know,
51:28they can take action at a large enough scale
51:30to affect people, and they're close to people.
51:33National policy makers often have less understanding
51:36of the issues than city policy makers.
51:38I think where you really do have to have coherence between
51:40cities and countries is in finance,
51:44because cities don't have the finance to be able to take
51:47the kinds of actions that they need to take.
51:49So for example,
51:50there's a group called the Coalition for Urban Transitions,
51:54which I believe is funded by Bloomberg.
51:56It's sort of a partner to the C40 Cities program,
52:00which advocates and provides evidence for governments
52:03to fund climate action through cities.
52:06But,
52:07yeah, so in general, I think the cities are a good unit.
52:11Obviously, it's much better if you can coordinate
52:13city action with national action.
52:15And that's something that we don't see enough of.
52:17In the United States, you have huge disparities
52:19between city climate action and national climate action,
52:22but hopefully that's changing for the better.
52:31So I see a question here. Why don't I read it out?
52:35Based on your research,
52:36do you see a potential role for environmental lawyers
52:39in overcoming the silos you mentioned
52:41and perhaps addressing the need for accountability
52:43and meeting commitments pledged by national governments?
52:47So, first of all, I see a role for everybody.
52:50You know, we're having the silos that I mentioned,
52:52so lawyers, architects, urban planners, engineers,
52:58public policy makers, civil society, everybody has a role.
53:01But specific to the role of law, that's actually,
53:04that's something that we're thinking about
53:06at Wellcome, right now,
53:08because we're designing a whole new strategy
53:10that includes climate and health
53:12as one of the three fundamental areas that we'll fund
53:14for the next several decades.
53:17And one of the elements in there,
53:19is how do we design funding for,
53:22to produce the kind of research that lawyers
53:24will be able to use in holding governments
53:27and other players accountable.
53:29So you'll have seen, or you may have seen that recently
53:32there was a judgment in Holland against
53:35the Shell oil company that said,
53:38that basically, it was liable for not having a policy
53:41that basically, it was liable for not having a policy
53:44that did enough to curb emissions.
53:47And we hope that we're gonna see many, many more judgments
53:50like that.
53:50Not just against the oil companies,
53:52but really against all sorts of players
53:55that are not taking appropriate climate action.
53:57So I think the role of lawyers is actually quite critical
54:00in all of this.
54:13<v ->Okay. One last chance.</v>
54:15Any other comments?
54:17Feel free to either put it in the chat
54:19or just speak right up.
54:24Okay, well,
54:25thank you very much, Jose, for a wonderful seminar,
54:30it was very comprehensive and...
54:35<v ->Thanks, Robert. It's great to be here.</v>
54:37And if anyone has any questions,
54:38I'm very glad to answer it so,
54:42you know, just write me.
54:44<v ->Okay.</v>
54:45So, bye everyone.