Unsustainability and Pandemics: Exploring the relationship and finding the crucial underlying factor
The year 2020 has started on a perilous note for human civilization. Earlier we had Australian bushfires which led to burning up of flora and fauna of unprecedented magnitude and which is regarded as a colossal environmental tragedy attributable to climate change (global warming). Presently the world is coping with COVID-19 pandemic. Since long environmental activists and scientists have been raising the issues of climate change, deforestation, biodiversity loss, pollution and other related issues but to no purposeful response.
In September 2015 'United Nations General Assembly' adopted the ambitious 2030 agenda of "Sustainable Development Goals (SDGs)" and UN Member States pledged to ensure that "no one will be left behind" and to "endeavour to reach the furthest behind first". The SDGs agreed upon are "No poverty, Zero hunger, Good health and well-being, Quality education, Gender Equality, Clean water and sanitation, Affordable and clean energy, Decent work and economic growth, Industry, innovation and infrastructure, Reduced inequality, Sustainable cities and communities, Responsible consumption and production, Climate Action, Life below water, Life on land, Peace, Justice and Strong Institutions, and Partnerships for the Goals". 
Needless to state that health has a significant place in the 2030 agenda (via SDGs). Indeed, human health is integral to all activity and indispensable for sustainable development. World Health Organization (WHO) has recently delineated 10 threats to Global Health in 2019 which include Air pollution and climate change, Non-communicable diseases, Threat of a global Influenza pandemic, Fragile and vulnerable settings (such as regions affected by drought and conflicts), Antimicrobial resistance, Ebola and higher threat pathogens, Weak primary healthcare, Vaccine hesitancy, Dengue and HIV.  All these Sustainable Development Goals and global health hazards are inextricably interlinked and affect human wellbeing.
COVID-19 Pandemic and Sustainable Development Goals (SDGs)
Besides having a devastating effect on Global Health, the COVID-19 pandemic has adversely affected almost all the SDGs. In order to contain the pandemic, various countries have gone for lockdown affecting economic activity. Though everybody is feeling the pinch of a tottered economic activity, the people from lower socio-economic strata are finding it very hard and unaffordable. As the situation is today, hunger, unemployment and inequality stand exacerbated. Children and youth are getting deprived of quality education due to the closure of schools and colleges. The reports of domestic violence against women are on the rise. Significantly women constitute major chunk of the healthcare workforce, working on the frontline and fighting COVID-19, as such they stand the maximum risk of getting infected (in-spite of the precautions which they take while attending the patients). The documented reports point out that present pandemic could lead to about 7 million unintended pregnancies as a large number of women are unable to gain access to family planning measures due to lockdown. The vulnerable regions of the world, conflicts infested areas, drought regions and areas sheltering refugees; are experiencing shortage of food and clean drinking water (due to impediments in food supply chains), inadequate sanitation and erratic electric power supply. The high population density and inadequate medical facilities make such areas more prone to COVID-19 infection. The reports of COVID-19 patients developing secondary bacterial infections, leading to increased use of antibiotics and consequently the development of antibiotic resistance are the cause of concern. Apart from the above, the recent pandemic has caused a shift of focus from other Global Health threats to COVID-19 with almost the whole of the research activity and action centred on issues related to COVID 19 pandemic. [3-5]
Inadequacy of Health Care Sector in 'Global South'
Though much progress has been made in improving the healthcare sector throughout the world in the last few decades yet a large chunk of the global population has no access to affordable healthcare. The health system in many regions of the world, especially in 'global south countries', are experiencing unprecedented strain due to limited resources, lack of investment, and shortage of healthcare personnel. Needless to say that the healthcare sector in 'global south countries' is inadequate to cater to the needs of an ever-growing population and the fall out of it is often reported violence against healthcare professionals besides poor health outcomes.  Though many measures have been lately envisaged to improve the health delivery system during the present pandemic, these have been implemented in emergency mode and are essentially reactionary. The prospects of enhanced government investment in the healthcare systems after the pandemic may get constrained by economic recession of global dimensions. However, to be on a positive note, the COVID-19 pandemic has sharpened the focus of the governments on the healthcare systems besides providing a reason and argument for strengthening and rebuilding faith in the public health care systems and in health workers, especially in 'Global South'.
Unsustainable Practices and Pandemics
Evidence points out that pandemic COVID - 19 is zoonotic and has started with unusual human-animal contact. With progressively rising biodiversity-loss and deforestation to cater to ever-growing human population needs and profit-driven aspirations; such as creating more space for economic activity, generating additional resources to sustain livelihoods and using more wild animals to feed more people, having unrestricted unusual human-animal interfaces; the frequency of occurrence of pandemics is bound to increase. To substantiate this assertion, it is worthwhile to note that one of the likely reasons behind Amazon forest fires was the encroachment of wild habitats for an increase in economic activities including food production for consumption of humans.
The wet markets selling living wild animals for consumption are located in many areas of Asia and Africa and millions of people are dependent on these markets for their livelihood. Such actions can potentially lead to the opportunity for the pathogens to jump from wilderness to the livestock and humans. Even previous epidemics such as Ebola, Zika virus, SARS and West Nile virus had originated from the animals. Further, UNEP (United Nation Environment Programme) has reported that up-to 75% of emerging infectious diseases are zoonotic and are linked to destruction of ecosystems, loss of biodiversity and over-exploitation of species. The assault on environment and ecosystems has shown no signs of deceleration with over-exploitation of resources, CO2 emissions and rate of biodiversity loss now being higher than ever before.
Human Population Overgrowth - Gateway to Unsustainability and Pandemics
The fact goes without denying that frequency and severity of pandemics have an inverse relationship with sustainability. Unsustainability/unsustainable practices lead to more epidemics/pandemics. On the other hand, the pandemics result in increased unsustainability and may wipe-off the effect of constructive initiatives already taken in the direction of achieving the Sustainable Development Goals (SDGs). Further, a strong correlation exists between the risk and severity of the pandemic and human population density. Hundreds of millions of people around the globe live in poverty, depravation and hunger in areas with high population density. Though many countries especially India and China have been able to lift an impressive number of their people above the poverty line, still much more needs to be done. There is an urgent need to check unsustainable growth of human population lest whatever is achieved may ultimately get lost.
An unsustainable population growth leads to flaring up of economic and social disparities, results in unplanned/rapid urbanization, and poses threat to the environment and aids to the spread of infectious and non-communicable diseases. If the growth rate of population is allowed to go unchecked, the expansion in quality education and healthcare facilities may lag behind the need; vulnerability of the people to disease and epidemics may increase, unemployment and related issues may surface, with society becoming conflict prone and social injustice may increase.
One notes with concern that the progress so far made, in direction of achieving objectives of 'Agenda 2030 of United Nations' has been tardy and uneven across countries with many sectors worsening instead of improving. One of the underlying important reasons is that the sustainability efforts have not kept pace with the rapidly increasing human population. [9,10] Since sustainability is central to all the '17 Global goals' and the world is adopting sustainable options in various sectors; it needs be realized that among all sustainable options, sustainable human population growth is one vital factor which when combined with other efforts may provide desirable results in the years to come.
The efforts to achieve sustainability cannot be limited to controlling the population alone and these have to be multi-sectorial with trans-disciplinary perspectives and international cooperation (Science diplomacy) playing their role. In the context, it needs hardly be stressed that robust science advisory system may be put in place, right from local to national level in all countries, with participation of scientists, physicians, professionals and policy-makers for making evidence-based policies and for monitoring their implementation.
To summarize, human health is inextricably linked to environment, ecosystems and biodiversity which in no case be allowed to get spoiled. It has become all the more imperative that in order to achieve SDGs, a population growth which is sustainable and which goes well with our environment, biodiversity and ecosystems be determined and defined. The international bodies, governments and experts need to deliberate on this issue and guide the policymakers based on credible scientific evidence. Needless to add that to achieve Sustainable Development Goals, bold evidence-based policies and actions is required which are not influenced by traditions, personal beliefs, and conflicts of interest. Till that the road to sustainability and a better world is going to be a bumpy one.
1. Sustainable Development Platform Outcome document—Open Working Group on Sustainable Development Goals. http://sustainabledevelopment.un.org/focussdgs.html Date: 2014 (Accessed May 4, 2020).
2. Ten threats to Global Health in 2019.https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019 Date: 2019 (Accessed May 4, 2020.
3. Implications of COVID-19 for Public Health and the SDGs. https://www.unsdsn.org/covid-19-webinar Date: 14 April 2020 (accessed May 4 2020)
4. Why we cannot lose sight of the Sustainable Development Goals during coronavirus https://www.weforum.org/agenda/2020/04/coronavirus-pandemic-effect-sdg-un-progress Date: 23 April 2020 (accessed May 4 2020)
5. COVID-19 could lead to millions of unintended pregnancies, new UN-backed data reveals. https://news.un.org/en/story/2020/04/1062742 Date: 28 April 2020 (accessed May 4 2020)
6. COVID-19 reveals gaps in health systems: WHO Briefing. https://www.weforum.org/agenda/2020/05/covid-19-reveals-gaps-in-public-health-system-who-briefing/ Date 6 May 2020 (accessed May 7 2020)
7. Scientists warn worse pandemics are on the way if we don't protect nature. https://www.weforum.org/agenda/2020/05/scientists-pandemics-coronavirus-nature-covid19-health/ Date: 4 May 2020 (accessed 5 May 2020)
8. Coronavirus isn't an outlier; it's part of our interconnected viral age. https://www.weforum.org/agenda/2020/03/coronavirus-global-epidemics-health-pandemic-covid-19/ Date 4 th March 2020 (accessed 5 May 2020)
9. The World and the UN Must Reduce Population Growth. https://www.project-syndicate.org/commentary/new-sdg-dampen-population-growth-by-frank-gotmark-and-robin-maynard-2019-09?barrier=accesspaylog 10 th September 2020 (accessed 4 May 2020)
Dr Paramdeep Singh, MD is an Academic Physician (Associate Professor) working at the University Hospital of Baba Farid University of Health Sciences (BFUHS), Faridkot (Punjab), India and is working on the forefront in tackling the COVID 19 pandemic.
Disclaimer: The views expressed in the above article are solely those of the author/agency in his/her private capacity and DO NOT represent the views of Medical Dialogues.