Tuberculose: um retorno mortal - Bjorn Lomborg

The Return of a Forgotten Killer

In the last two centuries, tuberculosis has claimed more lives than any other disease: an unprecedented and unsurpassed death toll of one billion. And, despite a compelling economic and moral case for investing more in controlling the disease, it has quietly resumed its position as the world’s leading infectious killer.

Bjørn Lomborg

 Project Syndicate, Praga – 21.2.2018

Prague  - In the last two centuries, tuberculosis has claimed more lives than any other disease: an unprecedented and unsurpassed death toll of one billion. And, despite a compelling economic and moral case for investing more in controlling the disease, it has quietly resumed its position as the world’s leading infectious killer.

 Thanks to the advent of a vaccine and cheap drugs, TB kills very few people in the developed world nowadays. So it has quickly been forgotten in rich countries – thought of as a relic from the Victorian era.

TB not only gets scant attention, but also a fraction of health funding. Around 3.4% of total development assistance for health is devoted to TB, compared to 27.7% for maternal and child health and 29.7% for HIV in 2015.

Such complacency is dangerous. Despite a compelling economic and moral case for investing more in controlling the disease, it has quietly resumed its position as the world’s leading infectious killer, claiming more lives than either HIV or malaria. Data for 2016, the latest available, show that 6.3 million new cases of TB were reported (up from 6.1 million in 2015) and almost 1.7 million people died.

Researchers from the University of Sheffield and London School of Hygiene & Tropical Medicine (LSHTM) estimate that in 2014, approximately 1.7 billion individuals were latently infected with TB – just under one-quarter of the global population. Roughly 10% of latent cases turn into active TB. Nearly 100 million children already carry a latent TB infection.

Even if all TB transmission were somehow stopped tomorrow, the researchers find that the current pool of latent infections alone will prevent the number of TB cases from falling to the World Health Organization’s global targets for 2035

In research for the Copenhagen Consensus Center, which I direct, Anna Vassall of LSHTM has made the case for greater investment in global TB control. “TB treatment is low cost and highly effective, and on average may give an individual in the middle of their productive life around 20 additional years of life,” she concludes. What’s more, investment in TB disproportionately helps the world’s poorest people.

TB control in poor countries is highly vulnerable to fluctuations in attention from rich-country donors, on which low-income governments depend for almost 90% of their response. While international funding reached $1.1 billion in 2017, this was recognized to be $1.5 billion short of what is needed to enact the Global Plan to End TB.

Treatment reduces the spread of dangerous and expensive multi-drug resistant TB, and the WHO recommends providing preventive treatment in high-risk populations. But while treating most TB cases costs just $21 per person for drugs, this does not account for the cost of improving detection of TB and other aspects of the health system. The disease can be difficult to diagnose, and many programs rely on sick people to report to hospitals. As a result, nearly one-third of active TB cases go unrecognized.

Globally, Vassall concludes that every dollar spent investing in TB control would generate benefits to society worth around $43. Those are outstanding returns, and a panel of Nobel laureates that studied the United Nations’ new Global Goals determined that controlling TB is one of 19 phenomenal development investments that should be given high priority globally.

In high-prevalence countries, there can be no argument that governments and donors need to focus more on TB. A panel of development and economic experts that examined policy options for Bangladesh last year found that TB control should be the highest national priority.

In Bangladesh, one in 11 deaths is caused by TB. Every hour, nine people die from a disease that we know how to treat effectively and cheaply. Almost half of the cases are never detected. Investment in TB is not only important from a health perspective, but also for poverty reduction, because loss of income forces those with TB further into destitution.

A 95% reduction in TB deaths and a 90% reduction in new cases in 20 years’ time is achievable in Bangladesh for about $300 million a year. This would give each patient another 25 years of life, on average. Treating one person prevents at least one new case from developing, and every dollar spent on TB returns $21 in benefits to society.

These research findings were part of the reason the Bangladeshi government increased its health investments in its 2017-18 budget. But Bangladesh is just one of 20 high-prevalence countries that, together, account for 83% of the global total.

Unlike diseases like Ebola or Zika, TB seldom makes headlines. It should. Given all that we know about how to prevent and treat TB, and a powerful economic case for investing in eradication efforts, there is no excuse for the heavy toll that it continues to take.

Bjørn Lomborg, a visiting professor at the Copenhagen Business School, is Director of the Copenhagen Consensus Center, which seeks to study environmental problems and solutions using the best available analytical methods. He is the author of The Skeptical Environmentalist, Cool It, How to Spend $75 Billion to Make the World a Better Place and The Nobel Laureates' Guide to the Smartest Targets for the World, and was named one of Time magazine's 100 most influential people in 2004.

Ambientalismo Imoral - Bjorn Lomborg (WSJ)

Apresentação apenas (quem tiver acesso ao artigo completo de Bjorn Lomborg, favor postar aqui ou me enviar).

‘Immoral’ Environmentalism
BY JAMES FREEMAN
“Climate aid” is the latest fad among rich countries as they shift billions of dollars of foreign assistance away from health and nutrition programs and into carbon reduction. “In a world in which malnourishment continues to claim at least 1.4 million children’s lives each year, 1.2 billion people live in extreme poverty, and 2.6 billion lack clean drinking water and sanitation, this growing emphasis on climate aid is immoral,” writes Bjorn Lomborg in today’s Journal.

Not surprisingly, the people who need help didn’t ask for this change. Mr. Lomborg notes that “in an online U.N. survey of more than eight million people from around the globe, respondents from the world’s poorest countries rank ‘action taken on climate change’ dead last out of 16 categories when asked ‘What matters most to you?’” Better health is a higher priority and Mr. Lomborg adds that “just $570 million a year—or 0.57% of the $100 billion climate-finance goal—spent on direct malaria-prevention policies like mosquito nets would reduce malaria deaths by 50% by 2025, saving an estimated 300,000 lives a year.”
(...)

This Child Doesn’t Need a Solar Panel

Spending billions of dollars on climate-related aid in countries that need help with tuberculosis, malaria and malnutrition.

Bjorn Lomborg

The Wall Street Journal, Oct. 21, 2015  In the run-up to the 2015 U.N. Climate Change Conference in Paris from Nov. 30 to Dec. 11, rich countries and development organizations are scrambling to join the fashionable ranks of “climate aid” donors. This effectively means telling the world’s worst-off people, suffering from tuberculosis, malaria or malnutrition, that what they really need isn’t medicine, mosquito nets or micronutrients, but a solar panel. It is terrible news.

(para ler a íntegra, só com assinatura do jornal, o que eu não tenho. Mas quem tiver acesso, agradeceria receber o artigo completo...)
Paulo Roberto de Almeida 

Meio Ambiente: o ambientalista cetico e a conferencia de Durban

Global Warming and Adaptability

Any carbon deal to replace Kyoto would have a negligible impact on climate in coming decades.

By BJØRN LOMBORG

The Wall Street Journal, December 12, 2011

The Durban pit-stop in the endless array of climate summits has just ended, and predictably it reaffirmed the United Nations' strong belief that the most important response to global warming is to secure a strong deal to cut carbon emissions.

What is almost universally ignored, however, is that if we want to help real people overcome real problems we need to focus first on adaptation.

The Durban agreement is being hailed as a diplomatic victory. Yet it essentially concedes defeat, leaving any hard decisions to the far end of the decade when other politicians will have to deal with it. For nearly 20 years, the international community has tried to negotiate commitments to carbon cuts, with almost nothing to show for it.

Even most rich countries don't want to cut fossil fuels, because the alternatives are considerably more expensive. China, India and other emerging economies certainly do not want to, because putting the brakes on growth means consigning millions to poverty.

But even if such intractable issues could be magically resolved, any deal would have a negligible impact on climate. Even if we were to cut emissions by 50% below 1990-levels by 2050—an extremely unrealistic scenario—the difference in temperature would be less than 0.2 degrees Fahrenheit in 2050.

This goes against everything that carbon campaigners tell us. When Hurricane Katrina or other weather disasters devastate communities, we're told by advocates such as Al Gore that the effects of climate change are already being felt and it's time to commit to drastic carbon cuts.

Getty Images

It is worth noting that often these arguments are exaggerated for effect. Since Hurricane Katrina, the global accumulated cyclone energy index has declined to almost the lowest level since we started measuring such phenomena in the early 1970s. Global warming will probably make hurricanes slightly stronger but slightly less frequent, leaving the overall impact murky.

What we can say clearly is that if we want to help New Orleans or other at-risk areas, cutting emissions will have virtually no impact for many decades. Bolstering hurricane defenses through improved levees and wetlands could, however, make a world of difference.

This is even more true for hurricane impacts in Third World countries. When Hurricane Andrew hit Florida, it cost 10% of the state's GDP and killed 41 people. But when the similar-sized Hurricane Mitch hit Honduras, it cost the country two-thirds of its GDP and killed more than 10,000. Tackling hurricane impacts in developing countries is not about cutting carbon but about adaptation and economic growth to improve resilience.

This is true whether we look at hurricanes or at other problems exacerbated by global warming. It is often—correctly—pointed out that global warming will hit developing countries hardest. Malaria cases, for instance, will increase along with mosquito populations, while food production in many developing countries will decrease.

But getting an emissions deal in any of the future Durban meetings will do nothing to help either of these problems. Even if we halted global warming by the end of the century, we could expect to avoid only about 3% of world-wide malaria cases by 2100. What the billions afflicted by malaria in the world today need is access to treatment and better prevention through bed-nets and indoor spraying. This is adaptation.

When it comes to access to food, global warming is expected to be responsible for a 7% yield decrease in the developing world and a 3% yield increase in the developed world over this century. Yet this needs to be seen in the context of total developing world food production rising by about 270% over the same period.

Do we better help the developing world by making drastic carbon cuts today that might—in an ideal world—avoid a 7% yield drop, or by making higher-yielding varieties of crops available that could potentially generate drastic yield increases? These are questions we have to answer if we are to adapt to the reality of global warming in this century.

The first step in focusing on adaptation is measuring it. The Global Adaptation Institute, led by former World Bank Managing Director Juan Jose Daboub, publishes the Global Adaptation Index, which shows how vulnerable countries are to global warming and how prepared they are to tackle it. The challenge lies not merely in reducing vulnerability but also in getting the structures in place so governments and investors can tackle adaptation in the most effective manner possible. The good news is we can improve lives today while building the crucial infrastructure needed for tomorrow.

The climate will continue changing throughout this century. And we do need to fix carbon emissions smartly through technological innovation. But if our concern is with saving lives and helping the planet's most vulnerable populations, then we need to focus first on how we can build more resilient, adaptable communities.

Mr. Lomborg is the author of "The Skeptical Environmentalist" and "Cool It." He directs the Copenhagen Consensus Center and is an adjunct professor at Copenhagen Business School.