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Latin America and the Caribbean countries need to spend more and better on health

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Health spending in Latin America & the Caribbean (LAC) was about USD 1,000 per person in 2017, only ¼ of what was spent in OECD countries (adjusted for purchasing power). At the same time, health systems’ capacity is also considerably lower, including the ability to provide access to services of good quality to the most vulnerable groups. In addition, much is left to to be done to improve efficiency, effectiveness and targeting of health spending. While the LAC region is struggling to respond to the major challenges of the COVID-19 pandemic, a serious reflection is needed not only on how to secure more funding but also on how to spend resources better, according to a new joint OECD – World Bank report, the first Health at a Glance publication entirely dedicated to the LAC region.


Health at a Glance: Latin America & the Caribbean 2020 says that total health expenditure across LAC countries is 6.6% of GDP, lower than the 8.8% in OECD countries. Spending varied from 1.1% in Venezuela to up to 11.7% in Cuba and 9.2% in Uruguay in 2017.


Government spending and compulsory health insurance represent an average of 54.3% of total health spending in LAC, significantly lower than the 73.6% in the OECD. This  shows that health systems in the LAC region are heavily dependent on out-of-pocket expenditures or supplemental private insurance from households. Honduras, Haiti and Guatemala have the highest proportions of private spending, while Cuba and Costa Rica have the lowest.


Health systems in LAC have fewer resources and less capacity than OECD countries to confront the COVID-19 pandemic. The LAC region has an average of two doctors per 1,000 population, and most countries stand well below the OECD average of 3.5, with only Cuba, Argentina and Uruguay having more. The average number of hospital beds in LAC is 2.1 per 1,000 population, that is less than half of the OECD average of 4.7. Barbados, Cuba and Argentina have more hospital beds than the OECD average, whereas the stock is below one hospital bed per 1,000 population in Guatemala, Honduras, Haiti, Venezuela and Nicaragua. Moreover, according to data gathered just before the COVID-19 pandemic started, there were just 9.1 Intensive Care Unit (ICU) average beds per 100,000 population in 13 LAC countries, which is much lower than the 12 ICU average beds per 100,000 population found in OECD countries. Brazil, Uruguay and Argentina are above the LAC average, while the lowest ratios are observed in Costa Rica and El Salvador.


Health at a Glance: LAC 2020
highlights that poor allocation of health spending is slowing down, if not halting, progress towards universal health coverage in LAC. For example, weak health information systems are a major impediment. Across 22 LAC countries, an average of 10% of all deaths are never reported in public mortality databases. This means a reliable picture of population health is often missing. According to the Global Corruption Barometer, 42% of respondents across 12 LAC countries considered that there were corruption problems in the health sector. Most LAC countries have parallel health sub-systems with multiple and overlapping mechanisms of governance, financing and service provision, making it hard to steer resources to where they are most needed in an efficient way.


The report also highlights how quality of care in LAC is often poor. Twelve out of the 33 LAC countries fall short of attaining the minimum immunisation levels recommended by the WHO to prevent the spread of diphteria, tetanus and pertussis (90% of the target population) and 21 out of 33 fail to meet this target for measles (95% of the target population). This indicates the difficulties that countries are likely to have in making a future COVID-19 vaccine available for the whole population. Among six LAC countries with available data, women with early diagnosis for breast cancer had a 78% probability of surviving at least five years, while in adults with colon cancer it was 52% and for rectal cancer it was 46%, which are all much lower than the 85%, 62% and 61% survival rates observed in OECD countries.


Finally, the publication identifies key critical risk factors for poor health in LAC. Eight percent of children under the age of 5 and 28% of adolescents are overweight. This figure increases to over 53% among adult men and to more than 61% among adult women. Obesity increases the risk of chronic disease, and can also lead to complications and death in patients infected by COVID-19. Moreover, nearly one in four men and close to one in ten women aged 15 and above smoke daily. Smoking rates among children aged between 13 and 15 years old are 15% for boys and 12% for girls. Although average alcohol consumption in LAC is lower than in the OECD, it has increased by 3% between 2010 and 2016. Almost 35% and 22% of road traffic accidents among men and women, respectively, can be attributed to alcohol consumption.

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Finance

Why financial institutions are banking on sustainability

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Eric Usher’s day planner is filled with meetings with the heads of some of the world’s biggest banks. And while he has years of experience working with the financial industry, his mission isn’t profit. It is to support and challenge banks and other financial institutions to lay the foundation for a more sustainable future.

Usher is the head of the United Nations Environment Programme Finance Initiative (UNEP FI), a partnership between UNEP, banks, insurers and investment companies that has established among the most important sustainability frameworks for the sector. Its aim is to align private money with the UN Sustainable Development Goals that aim to shift our economy to clean energy, eliminate hunger, foster gender equality and achieve more than a dozen other social and environmental targets.

In his role, Usher has worked with financial institutions to put sustainability at the heart of their business strategy.

“If we want to meet global sustainability challenges, we absolutely need the support of the private sector,” said Usher recently. “There just isn’t enough public money out there, especially in the wake of COVID-19, to finance the massive structural changes our societies desperately need.”

The Organization for Economic Cooperation and Development estimates it will cost $6.9 trillion annually through 2030 to finance the sustainable development goals.

Usher’s comments came just ahead of the United Nations Climate Change Conference of Parties, known as COP26. The gathering came with the planet slipping dangerously behind the goals of 2015’s landmark Paris Agreement and already experiencing the effects of a changing climate. Progress towards the other Sustainable Development Goals has also been uneven.

Origins of a movement

UNEP FI was born out of a group of six banks that met on the sidelines of 1992’s Rio Earth Summit, considered by many as one of the most important environmental gatherings of the last three decades.

Nearly 30 years later, more than 450 financial institutions are members of what is the UN’s largest partnership with the finance industry.

In the past year alone, member banks have given 113 million vulnerable customers access to financial services and advised over 15,000 companies on their climate strategies.

Not only is that work helping people and the planet, it’s also securing the future of financial stability. The burgeoning green economy is creating a host of new investment and lending opportunities. Institutional investors and retail banking customers are increasingly demanding that financial institutions uphold environmental standards. And, perhaps most importantly, a growing number of financial institutions have realized that financing fossil fuels, and other projects that harm the environment, is bad for their long-term future.

“I truly believe that the next 30 years of our economy and our society, can’t be like the last 30 years,” said Guy Cormier, CEO of Desjardins Group, one of Canada’s largest financial services companies. “The activities of a financial institution can make a real difference in the lives of the people and also in the environment.”

Becoming more environmentally sustainable requires banks, insurers and investors to redesign their business models, says Usher.

“Traditional risk (in the financial sector) looks at what failed in the past,” said Usher, “With climate change that doesn’t work. Now it’s about forecasting the future, which isn’t easy and therefore is an area that we work with our members to develop the norms and standards needed to respond.” 

The latest Intergovernmental Panel on Climate Change , released in September, finds that nearly every corner of the world has been touched by climate change. UNEP’s Emissions Gap Report 2021 found that, even with new national climate pledges and mitigation measures, the world is still on track for a global temperature rise of 2.7°C by the end of the century, which could lead to catastrophic climate impacts. To keep global warming below 1.5°C this century, the aspirational goal of the Paris Agreement, countries would need to halve annual greenhouse gas emissions in the next eight years.

With this as a backdrop, Usher says the work of the UNEP FI has never been so important.

“There really is no time to waste,” said Usher. “The current decade is critical to determining the future of our species and our planet.”

Guiding principles

To shepherd the financial industry towards sustainability, UNEP FI has unveiled a series of guiding frameworks including:

These industry frameworks have attracted widespread support among financial institutions. Some 80 per cent of the investment industry has committed to the Principles for Responsible Investment while 260 banks, representing $70 trillion in assets, have signed onto the Principles for Responsible Banking.

The Principles [for Responsible Banking] are very much hinged on the Paris Agreement as well as the Sustainable Development Goals,” said Siobhan Toohill, Group Head of Sustainability, Westpac. “It’s clear that climate change is a really significant factor that banks need to address… and there are areas of impacts that we need to give closer attention to, such as biodiversity.”

A progress report, released in October, highlights the accomplishments of the responsible banking principles initiative. Among other things, it found that signatories have mobilized at least $2.3 trillion in sustainable financing. What’s more, 94 per cent of banks identify sustainability as a strategic priority.

The industry frameworks developed by UNEP FI help financial institutions embed sustainability into all aspects of their business. But with more than US$100 trillion required to transition the global economy to net-zero emissions by 2050 – and US$32 trillion of that over the next decade – there is an urgent need to focus financing on helping to achieve that goal.

Three UNEP FI-convened groups are working with more than 170 investors, banks and insurers to develop the tools and science-based guidance to use with their customers and the companies they invest in to decarbonize their businesses. The financial institutions are setting targets every few years and making their progress public via annual reporting to ensure that their work can be measured and scrutinized, and that they keep their commitments on track.

The large number of financial institutions involved and the near-term action that has been committed to, have left Usher optimistic about the future.

“There’s no question we have a lot of work to do to make our societies more sustainable,” he said. “But in the private sector, the desire for real change is growing and that makes me hopeful.”

UNEP

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Energy News

Colombia’s energy districts: an example for the region

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image: UNIDO

An energy district is a local institution that leads, implements and accelerates a locally-owned, inclusive and clean energy transition. In the process, energy districts create local jobs and retain and grow wealth, while simultaneously reducing carbon emissions and air pollution.

Colombia is a pioneer South American country in the promotion of this approach. Beginning in 2013, the United Nations Industrial Development Organization (UNIDO), together with Switzerland’s State Secretariat for Economic Affairs (SECO), has been implementing an energy districts project in cooperation with the Ministry of Environment and Sustainable Development (Minambiente) and the public utility of the city of Medellín (Empresas Publicas de Medellín – EPM).

In its second phase, beginning in 2019, the project has been working closely with national and city-level authorities and stakeholders to improve and implement national and sub-national policy and regulatory frameworks to promote further development of energy districts; reinforce knowledge and capacities for energy districts of all market players; and provide technical assistance to some 10 selected cities so that they can include energy districts in their urban planning and support the realization of two-three near-future mature projects.

From the 17-19 November, the UNIDO project and partners, ACAIRE (Colombian Association for Refrigeration and Air Conditioning) and CIDARE, the Centre of Research and Development in Air Conditioning and Refrigeration hosted the Third International Conference for Energy Districts, a virtual event bringing together national and international experts from industry and academia, and representatives from the public sector and international organizations.

Carlos Eduardo Correa, Colombia’sMinister of Environment and Sustainable Development, stated that the conference was the ideal scenario to show the achievements of the country in the implementation of district energy as a contribution to the Sustainable Development Goals.

“All of our actions, plans, projects and regulations, are geared towards the achievements of the Nationally Determined Contributions, the reduction of greenhouse gas emissions, and, at the same time, the contribution of low-carbon development. Here, Colombia has an important experience and is an example for the region,” he stated.

The progress of district energy in Colombia and the region, the importance of their implementation in urban planning, energy maps and clean energy transition, the mechanisms to finance these projects and the use of renewable energies in their execution, were some of the main topics addressed by more than 30 national and international speakers during the three days of discussions.

“The implementation of the project has, as a main component, the sustainability of knowledge and capacities in Colombia. That is why the support and work with academia are fundamental to strengthen the capacities of all the actors in the value chain and promote the education of professionals in the areas of sustainability and energy efficiency, among others,” noted Alex Saer, Director of Climate Change and Risk Management at the Ministry of Environment and Sustainable Development.

The conference was also the opportunity to celebrate the awards of the Second Competition for Universities in District Energy, with the objective of designing a business model for the sale of thermal energy applied to residential users.

The contest, which had the participation of eight universities from Colombia, awarded the first-place winner team with  fully funded attendance to the International District Energy Association Campus Energy in Boston in February 2022.

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Tech News

193 countries adopt the first global agreement on the Ethics of Artificial Intelligence

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All the nations members of the UN Educational, Scientific and Cultural Organization (UNESCO) adopted on Thursday a historical text that defines the common values and principles needed to ensure the healthy development of AI.

Artificial intelligence is present in everyday life, from booking flights and applying for loans to steering driverless cars. It is also used in specialized fields such as cancer screening or to help create inclusive environments for the disabled.

According to UNESCO, AI is also supporting the decision-making of governments and the private sector, as well as helping combat global problems such as climate change and world hunger.

However, the agency warns that the technology ‘is bringing unprecedented challenges’.

We see increased gender and ethnic bias, significant threats to privacy, dignity and agency, dangers of mass surveillance, and increased use of unreliable AI technologies in law enforcement, to name a few. Until now, there were no universal standards to provide an answer to these issues”, UNESCO explained in a statement.

Considering this, the adopted text aims to guide the construction of the necessary legal infrastructure to ensure the ethical development of this technology.

“The world needs rules for artificial intelligence to benefit humanity. The Recommendation on the ethics of AI is a major answer. It sets the first global normative framework while giving States the responsibility to apply it at their level. UNESCO will support its 193 Member States in its implementation and ask them to report regularly on their progress and practices”, said Audrey Azoulay, UNESCO chief.

AI as a positive contribution to humanity

The text aims to highlight the advantages of AI, while reducing the risks it also entails. According to the agency, it provides a guide to ensure that digital transformations promote human rights and contribute to the achievement of the Sustainable Development Goals, addressing issues around transparency, accountability and privacy, with action-oriented policy chapters on data governance, education, culture, labour, healthcare and the economy.

One of its main calls is to protect data, going beyond what tech firms and governments are doing to guarantee individuals more protection by ensuring transparency, agency and control over their personal data. The Recommendation also explicitly bans the use of AI systems for social scoring and mass surveillance.

The text also emphasises that AI actors should favour data, energy and resource-efficient methods that will help ensure that AI becomes a more prominent tool in the fight against climate change and in tackling environmental issues.

“Decisions impacting millions of people should be fair, transparent and contestable. These new technologies must help us address the major challenges in our world today, such as increased inequalities and the environmental crisis, and not deepening them.” said Gabriela Ramos, UNESCO’s Assistant Director General for Social and Human Sciences.

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