Monthly Archives: October 2023

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Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency

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This posting is a reposting of an editorial published in JAMA      (Journal of the American Medical Association).

The editorial  was published in over 200 health journals this past week – that is how seriously the global health community sees this issue.
Just as importantly, the global health community sees the issues as being intertwined which requires a systems based solution.
They recognize that seeing the two topics as separate challenges is “a dangerous mistake.”
Tim
The Editorial follows:
Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency

Kamran Abbasi; Parveen Ali; Virginia Barbour; Thomas Benfield; Kirsten Bibbins-Domingo; Stephen Hancocks; Richard Horton; Laurie Laybourn-Langton; Robert Mash; Peush Sahni;Wadeia Mohammad Sharief; Paul Yonga; Chris Zielinski

Over 200 health journals call on the United Nations, political leaders, and health professionals to recognize that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.

The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. The research communities that provide the evidence for the 2 COPs are unfortunately, largely separate, but they were brought together for a workshop in 2020 when they concluded that “Only by considering climate and biodiversity as parts of the same complex problem…can solutions be developed that avoid maladaptation and maximize the beneficial outcomes.”1

As the health world has recognized with the development of the concept of planetary health, the natural world is made up of one overall interdependent system. Damage to one subsystem can create feedback that damages another—for example, drought, wildfires, floods, and the other effects of rising global temperatures destroy plant life and lead to soil erosion and so inhibit carbon storage, which means more global warming.2 Climate change is set to overtake deforestation and other land-use change as the primary driver of nature loss.3

Nature has a remarkable power to restore. For example, deforested land can revert to forest through natural regeneration, and marine phytoplankton, which act as natural carbon stores, turn over 1 billion tons of photosynthesizing biomass every 8 days.4 Indigenous land and sea management has a particularly important role to play in regeneration and continuing care.5

Restoring one subsystem can help another—for example, replenishing soil could help remove greenhouse gases from the atmosphere on a vast scale.6 But actions that may benefit one subsystem can harm another—for example, planting forests with one type of tree can remove carbon dioxide from the air but can damage the biodiversity that is fundamental to healthy ecosystems.7

The Impacts on Health

Human health is damaged directly by both the climate crisis, as the journals have described in previous editorials,8,9 and by the nature crisis.10 This indivisible planetary crisis will have major effects on health as a result of the disruption of social and economic systems—shortages of land, shelter, food, and water, exacerbating poverty, which in turn will lead to mass migration and conflict.

Rising temperatures, extreme weather events, air pollution, and the spread of infectious diseases are some of the major health threats exacerbated by climate change.11 “Without nature, we have nothing,” was UN Secretary-General António Guterres’ blunt summary at the biodiversity COP in Montreal last year.12 Even if we could keep global warming below an increase of 1.5 °C over preindustrial levels, we could still cause catastrophic harm to health by destroying nature.

Access to clean water is fundamental to human health, and yet pollution has damaged water quality, causing a rise in water-borne diseases.13 Contamination of water on land can also have far-reaching effects on distant ecosystems when that water runs off into the ocean.14 Good nutrition is underpinned by diversity in the variety of foods, but there has been a striking loss of genetic diversity in the food system. Globally, about a fifth of people rely on wild species for food and their livelihoods.15 Declines in wildlife are a major challenge for these populations, particularly in low- and middle-income countries. Fish provide more than half of dietary protein in many African, South Asian, and small island nations, but ocean acidification has reduced the quality and quantity of seafood.16

Changes in land use have forced tens of thousands of species into closer contact, increasing the exchange of pathogens and the emergence of new diseases and pandemics.17 People losing contact with the natural environment and the declining loss in biodiversity have both been linked to increases in noncommunicable, autoimmune, and inflammatory diseases and metabolic, allergic, and neuropsychiatric disorders.10,18 For Indigenous people, caring for and connecting with nature is especially important for their health.19 Nature has also been an important source of medicines, and thus reduced diversity also constrains the discovery of new medicines.

Communities are healthier if they have access to high-quality green spaces that help filter air pollution, reduce air and ground temperatures, and provide opportunities for physical activity.20

Connection with nature reduces stress, loneliness, and depression while promoting socialinteraction.21 These benefits are threatened by the continuing rise in urbanization.22 Finally, the health impacts of climate change and biodiversity loss will be experienced unequally between and within countries, with the most vulnerable communities often bearing the highest burden.10Linked to this, inequality is also arguably fueling these environmental crises. Environmental challenges and social/health inequities are challenges that share drivers and there are potential co-benefits of addressing them.10

A Global Health Emergency

In December 2022 the biodiversity COP agreed on the effective conservation and management of at least 30% of the world’s land, coastal areas, and oceans by 2030.23 Industrialized countries agreed to mobilize $30 billion per year to support developing nations to do so.23 These agreements echo promises made at climate COPs.

Yet many commitments made at COPs have not been met. This has allowed ecosystems to be pushed further to the brink, greatly increasing the risk of arriving at “tipping points,” abrupt breakdowns in the functioning of nature.2,24 If these events were to occur, the impacts on health would be globally catastrophic.

This risk, combined with the severe impacts on health already occurring, means that the World Health Organization should declare the indivisible climate and nature crisis as a global health emergency. The 3 preconditions for WHO to declare a situation to be a Public Health Emergency of International Concern25 are that it (1) is serious, sudden, unusual, or unexpected; (2) carries implications for public health beyond the affected State’s national border; and (3) may require immediate international action. Climate change would appear to fulfill all of those conditions. While the accelerating climate change and loss of biodiversity are not sudden or unexpected, they are certainly, serious and unusual. Hence we call for WHO to make this declaration before or at the 77thWorld Health Assembly in May 2024.

Tackling this emergency requires the COP processes to be harmonized. As a first step, the respective conventions must push for better integration of national climate plans with biodiversity equivalents.3As the 2020 workshop that brought climate and nature scientists together concluded, “Critical leverage points include exploring alternative visions of good quality of life, rethinking consumption and waste, shifting values related to the human-nature relationship, reducing inequalities, and promoting education and learning.”1 All of these would benefit health.

Health professionals must be powerful advocates for both restoring biodiversity and tackling climate change for the good of health. Political leaders must recognize both the severe threats to health from the planetary crisis as well as the benefits that can flow to health from tackling the crisis.26 But first, we must recognize the crisis for what it is: a global health emergency.

ARTICLE INFORMATION

Published: October 25, 2023. doi:10.1001/jamanetworkopen.2023.44081

Open Access: This is an open access article distributed under the terms of the CC-BY License.©2023 Abbasi Ket al. JAMA Network Open.

Corresponding Author: Chris Zielinski, University of Winchester ([email protected]).

Author Affiliations: Editor-in-Chief, BMJ (Abbasi); Editor-in-Chief, International Nursing Review (Ali); Editor-in-Chief, Medical Journal of Australia (Barbour); Editor-in-Chief, Danish Medical Journal (Benfield); Editor-in-Chief,JAMA (Bibbins-Domingo); Editor-in-Chief, British Dental Journal (Hancocks); Editor-in-Chief, The Lancet (Horton); University of Exeter, UK (Laybourn-Langton); Editor-in-Chief, African Journal of Primary Health Care & Family Medicine (Mash); Editor-in-Chief, National Medical Journal of India (Sahni); Editor-in-Chief, Dubai Medical Journal (Sharief); Editor-in-Chief, East African Medical Journal (Yonga); University of Winchester, UK (Zielinski).

Conflict of Interest Disclosures: Dr Benfield reported that his institution received funds from Novo Nordisk, Simonsen Foundation, Lundbeck Foundation, Kai Foundation, Eric and Susanna Olesen’s Charitable Fund, GSK, Pfizer, Gilead Sciences, and MSD; he received funding to conduct trials for Pfizer, Boehringer Ingelheim, Gilead Sciences, MSD, Roche, Novartis, and Kancera; served on an advisory board for GSK, Pfizer, Gilead Sciences, MSD,Pentabase, Janssen, and AstraZeneca; received consulting fees from GSK and Pfizer; received payment for lectures from GSK, Pfizer, Gilead Sciences, Boehringer Ingelheim, AbbVie, and AstraZeneca; and received trial medication from Eli Lilly. Dr Hancocks reported receiving compensation for hosting webinars from Procter & Gamble. Dr Mash reported receiving a grant from VLIR (Belgium) to study primary health care and climate change in Africa. Dr Yonga reported serving as a principal investigator for a COVID-19 antiviral for Atea Pharmaceuticals; receiving honoraria for lectures, presentations, and educational events from bioMerieux and Pfizer; serving on an advisory board for Pfizer and NHLBI; and serving on committees or panels for the European Society of Clinical Microbiology and Infectious Diseases. No other disclosures were reported.

Note: This Editorial is being published simultaneously in multiple journals. For the full list of journals see https://www.bmj.com/content/full-list-authors-and-signatories-climate-nature-emergency-editorial-october-2023.

REFERENCES

  1. Otto-Portner H, Scholes B, Agard J, et al. Scientific outcome of the IPBES-IPCC co-sponsored workshop on biodiversity and climate change. June 2021. doi:10.5281/zenodo.4659159
  1. RippleWJ,Wolf C, Lenton TM, et al. Many risky feedback loops amplify the need for climate action. One Earth.2023;6:86-91. doi:10.1016/j.oneear.2023.01.004
  1. European Academies Science Advisory Council. KeyMessages from European Science Academies for UNFCCC COP26 and CBD COP15. August 2021. Accessed October 1, 2023. https://easac.eu/publications/details/keymessages-from-european-science-academies-for-unfccc-cop26-and-cbd-cop15
  1. Falkowski P. Ocean science: the power of plankton. Nature. 2012;483:S17-S20. doi:10.1038/483S17a
  2. Dawson N, Coolsaet B, Sterling E, et al. The role of Indigenous peoples and local communities in effective and equitable conservation. Ecol Soc. 2021;26. doi:10.5751/ES-12625-260319
  1. Bossio DA, Cook-Patton SC, Ellis PW, et al. The role of soil carbon in natural climate solutions. Nat Sustain. 2020;3:391-398. doi:10.1038/s41893-020-0491-z
  1. Levia DF, Creed IF, Hannah DM, et al. Homogenization of the terrestrial water cycle. Nat Geosci. 2020;13: 656-658. doi:10.1038/s41561-020-0641-y
  1. Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. BMJ. 2021;374:n1734. doi:10.1136/bmj.n1734
  1. Atwoli L, Erhabor GE, Gbakima AA, et al. COP27 climate change conference: urgent action needed for Africa and the world. BMJ. 2022;379:o2459. doi:10.1136/bmj.o2459

10 WHO, UNEP, Convention on Biological Diversity. Connecting Global Priorities: Biodiversity and Human Health: A State of Knowledge Review. 2015. Accessed October 1, 2023. https://www.cbd.int/health/SOKbiodiversity-en.pdf

  1. Magnano San Lio R, Favara G, Maugeri A, Barchitta M, Agodi A. How antimicrobial resistance is linked to climate change: an overview of two intertwined global challenges. Int J Environ Res Public Health. 2023;20(3):1681. doi:
  2. Jelskov U. “Without nature, we have nothing”: UN chief sounds alarm at key UN biodiversity event. UN News.December 6, 2022. Accessed October 1, 2023. https://news.un.org/en/story/2022/12/1131422
  1. World Health Organization. State of the world’s drinking water: an urgent call to action to accelerate progress on ensuring safe drinking water for all. October 2022. Accessed October 1, 2023. https://www.who.int/publications/i/item/9789240060807
  1. Comeros-Raynal MT, Brodie J, Bainbridge Z, et al. Catchment to sea connection: impacts of terrestrial run-off on benthic ecosystems in American Samoa. Mar Pollut Bull. 2021;169:112530. doi:10.1016/j.marpolbul.2021.112530
  1. IPBES. Assessment report on the sustainable use of wild species. August 2022. https://www.ipbes.net/sustainable-use-assessment
  1. Falkenberg LJ, Bellerby RGJ, Connell SD, et al. Ocean acidification and human health. Int J Environ Res Public Health. 2020;17(12):4563. doi:10.3390/ijerph17124563
  1. Dunne D. Climate change “already” raising risk of virus spread between mammals. April 28, 2022. AccessedOctober 1, 2023. https://www.carbonbrief.org/climate-change-already-raising-risk-of-virus-spread-betweenmammals/
  1. Altveş S, Yildiz HK, Vural HC. Interaction of the microbiota with the human body in health and diseases. Biosci Microbiota Food Health. 2020;39(2):23-32. doi:10.12938/bmfh.19-023
  1. Schultz R, Cairney S. Caring for country and the health of Aboriginal and Torres Strait Islander Australians. Med J Aust. 2017;207(1):8-10. doi:10.5694/mja16.00687
  1. Macguire F, Mulcahy E, Rossington B. The Lancet Countdown on Health and Climate Change: policy brief forthe UK. 2022. Accessed October 1, 2023. https://s41874.pcdn.co/wp-content/uploads/Lancet-Countdown-2022-UK-Policy-Brief_EN.pdf
  1. Wong FY, Yang L, Yuen JWM, Chang KKP,Wong FKY. Assessing quality of life using WHOQOL-BREF: a crosssectional

study on the association between quality of life and neighborhood environmental satisfaction, and the mediating effect of health-related behaviors. BMC Public Health. 2018;18(1):1113. doi:10.1186/s12889-018-5942-3

  1. Simkin RD, Seto KC, McDonald RI, JetzW. Biodiversity impacts and conservation implications of urban land expansion projected to 2050. Proc Natl Acad Sci U S A. 2022;119(12):e2117297119. doi:10.1073/pnas.2117297119
  1. Secretariat of the Convention on Biological Diversity. COP15: Nations Adopt Four Goals, 23 Targets for 2030 In Landmark UN Biodiversity Agreement. December 12, 2022. Accessed October 1, 2023. https://www.cbd.int/article/ cop15-cbd-press-release-final-19dec2022
  1. Armstrong McKay DI, Staal A, Abrams JF, et al. Exceeding 1.5°C global warming could trigger multiple climate tipping points. Science. 2022;377(6611):eabn7950. doi:10.1126/science.abn7950
  1. WHO guidance for the use of Annex 2 of the International Health Regulations. 2005.World Health Organization. Accessed October 1, 2023. https://www.who.int/publications/m/item/who-guidance-for-the-use-ofannex-2-of-the-international-health-regulations-(2005)
  1. Australian Government Department of Health and Aged Care. Consultation on Australia’s first National Health and Climate Strategy. July 26, 2023. Accessed October 1, 2023. https://www.health.gov.au/news/consultation-onaustralias-first-national-health-and-climate-strategy

JAMANetwork Open | Editorial Treating Climate and Nature Crisis as a Global Health Emergency

JAMA Network Open. 2023;6(10):e2344081. doi:10.1001/jamanetworkopen.2023.44081 (Reprinted) October 25, 2023 4/4

Downloaded From: https://jamanetwork.com/ on 10/29/2023

Open Access. This is an open access article distributed under the terms of the CC-BY License.

https://jamanetwork.com/journals/jama/fullarticle/2811131

 

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The Necessity, Responsibility, and Right to Repair

I have three functional and operational VCRs. I understand that this opening statement is not something one could, or should, normally brag about in the world of digital streaming, but the VCRs work. And I have dozens and dozens of VHS recordings that I still enjoy. I will also confess that three of the five TVs in the house have yet to need or require a transformation to digital flat screen device. It’s not that I can’t do those things, I just don’t feel the need to make the change. I mean really, how large, how sharp, how clear, how color improved do I need a commercial about toenail fungus to be?

And upgrading the terminology so that I can be told that I have CVD*, Amblyopia, and Diplopia does not alter the reality of a lifetime of dealing with red/green color blindness, a lazy eye and double vision (without my glasses). I understand the model of continuous improvement in nature. I know that change can happen slowly. I know that change can be massive and quick – like the day the asteroid hit the earth and began the phase out of the dinosaurs, or the moment that we went from a world without Covid to a world which marked time with phrases like, before Covid, during Covid, and after the pandemic.

What annoys me, angers me, and has caused me to stop purchasing certain brands… are forced changes that seem to have no functional value to me. There is a software I have used for over a decade to do my federal taxes. A couple of years ago, the software started to require an update of my computer to the newest version of its operating system. Taxes are annoying on their own. Upgrading the software is a bother. Then finding out that the new operating system means that I can no longer use certain apps and other software is hyper-problematic. I have lost data and files because of issues of non-compatibility. Previously all the programs I used were collaborative. To do my job, I did not need the required upgrade of my operating system. With the upgrade, I lost hours of productivity translating old files into functional files.

It also turned out that between the new tax software and the updated operating system, I could no longer ‘look back’ at previous filings if I had questions. The upgrade had so “improved” everything that I was dependent upon paper printouts to complete the tax filing. To use the current edition of that tax software, I would need to buy a new computer. Not going to happen. I feel that forced obsolescence of technology is a form of consumer abuse.

All the above brings me back to the four VCRs in the garage that are not currently operational.

I suspect that the VCRs could be fixed. I would not be surprised to find that a minor repair would restore those devices to full functionality. But that is not an option. I had a VCR that stopped working while under warranty and was informed by the salesperson that it was simply easier and cheaper to give me a new VCR, than to fix the one I brought into the store.

Common logic suggests that the smart move for me would be to throw the old VCR away. And as I start to think of the VCRs as trash or waste, I get hit with a transcendental mind shift.

By definition waste is1:

  • Verb: use or expend carelessly, extravagantly, or to no purpose.
  • Adjective: (of a material, substance, or byproduct) eliminated or discarded as no longer useful or required after the completion of a process.
  • Noun: an act or instance of using or expending something carelessly, extravagantly or to no purpose.
  • Noun: material that is not wanted; the unusable remains or byproducts of something.

And the material that comprises the VCR are none of those things. The VCR is made up of the primary raw materials of Planet Earth. It is a collection of atoms and molecules currently configured as metals, ceramics, wires, chemicals, circuits, and plastics into the shape of a VCR.

Why would we want to waste such finite and important entities? Why would we not want to reuse those ingredients?

By definition repair means2:

  • Transitive verb; to restore to a sound and healthy state: renew.

Do we realize how silly it sounds to say we can fix a house, but cannot repair a VCR? Or that we can fix a car but cannot repair a printer? Is this really the logical model for a prosperous future?

Humans are currently deeply entrenched in a linear economy in which resources are converted to waste through commerce. Nature, the environment, and the planet run on a circular/cyclical, no waste, resource economy. One of these models has worked brilliantly for 3.7 billion years, if not longer. The other model supports waste, pollution, global income disparity, the depletion and degradation of the resource base, and the collapse of communities and civilizations. One of these models will survive us. The other model is us until we decide that thriving and existing is more beneficial than the restricted and limited distribution of short-term financial gains.

The right to repair is a recognition that modeling our societies and economies on the fundamental process of how Nature operates is the strongest foundation we can create to have a verdant and viable future.

“Don’t waste.                                                                                                                   Don’t waste Anything.                                                                                                Don’t waste Electricity. Don’t waste Food. Don’t waste Water.       Treat the natural world as though it’s precious, which it is.                Don’t squander those bits that we have control of.”                                      Sir David Attenborough

Our future will be determined by our willingness, ability and commitment to support, protect, repair, renew and regenerate the natural environment upon which our lives depend.

Tim

*Color Vision Deficiency

1 https://www.google.com/search?client=safari&rls=en&q=waste+defined&ie=UTF-8&oe=UTF-8

2 https://www.merriam-webster.com/dictionary/repair

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A Clear and Present Danger

To many, my desk is a cluttered mess or a jigsaw puzzle of disconnected pieces that can never be assembled into a coherent picture.  To me, my desk is a highly organized panorama of easily accessible tools of my craft interspersed with remembrances and waypoints of travels, adventures, people, places, joys, sorrows, hopes, philosophies, beliefs, and responsibilities.

I was looking at one of these waypoints, a piece of scrimshaw when the phrase “full and best use” came to mind.  It is a phrase I seldom hear used these days, and even then, not in its original context.

My history with the term stems from one’s obligation to honor what had been taken from Nature.  If you took a deer or a rabbit, or collected seashells, or dug fossils from the riverbank, how did you honor the find or the gift?  The notion may seem quaint or irrelevant in today’s world of rapid commodification, manufactured obsolescence, and mindless disposal of the no-longer-popular.  But “full and best use” is a question we need to ask and a lesson we need to relearn and practice for the sake of our future welfare and happiness.

In the example of the deer, it was not enough to kill the deer and take the meat.  You were also responsible for the “full and best use” of the fur, the bones, the sinew, and all the other parts that made up the living animal.  You were not supposed to waste any part of that which you had taken, and you were to repair any harm you had done in the process of acquiring the gift you sought.   You were also supposed to say thank you to, and for, the deer.

 Last week my thank-you was for the miss.  Hurricane Idalia blew by the community in which I live.  She was nearly 200 miles to the west, but still triggered storms, winds, and waves that flooded and closed roads, eroded beaches, knocked out power, and closed schools and businesses.  She got her name when she became a tropical storm.  Having lived through both tropical storms and major hurricanes, one can become overly complacent.  When I first saw her on a weather map, she was far enough away that she became a thought to remember, not an action to be taken.  A couple of days later, she was a Category 1 hurricane with a vague cone of uncertainty about her future movements. But then Hurricane Idalia did something to remind me that today’s hurricanes are NOT the hurricanes of my youth.  As Idalia became better organized and as I looked at the data for surface water temperatures in the Gulf of Mexico, it was clear that she was not going to stay a Category 1 storm.  There was too much heat upon which she could feast. And feast she did while rapidly intensifying. She was Category 3 when she came by us, grew to a Category 4, then came ashore as a Category 3. Hurricane Idalia completely decimated some old and treasured coastal towns.

Today, Hurricane Lee is toying with us as he decides when, or it, he will take a right-hand turn and hit the east coast of the US or swing farther out to sea – the hurricane equivalent of shouting BOO or GOTCHA after worrying/scaring 10s of millions of people.

Of course, while we focused on our own local emergency, we paid little attention to the historic wildfires in Greece, or the floods in Peru, Ecuador, Brazil, and China.  Nor did we give much time to the simultaneous droughts and famine in Africa.  There were also heat waves in Asia, Africa, Australia, Europe, and South America.  And almost nobody mentioned the marine heat wave in the Pacific, or the rapid glacier melt in Antarctica or the spike in ice melt in Greenland.

There was a time, when for years, decades, even generations, one could reasonably consider weather ‘anomalies’ as separate and independent from each other.  But these are NOT those times.

When we personally, socially, and economically forgot the obligation of “full and best use” and accepted pollution as an externality of doing business, we put ourselves on track to generate global warming which is the trigger of the climate change and extreme weather events that we are now suffering from.

WE have warmed the planet.  WE have heated the atmosphere and the oceans.  WE have given birth to the common cause of the weather, floods, fires, droughts, heat, glacier melt, hurricanes, cyclones, and typhoons we do not like or want.  WE have caused the loss of habitats and biodiversity and the ever-growing expense of invasive species.

It does not matter that this is not what WE intended to do.  WE did it.  WE (people, businesses, governments) can no longer think as we did in 1950 or 1970 or 1990 that these events are isolated, separate, short-term, and surprise emergencies that WE occasionally need to do something about.

WE have created a set of laws, policies, and processes which ensures that these events will reoccur on a regular basis and on a growing scale of harm and cost to citizens, businesses, governments, and the environment.

WE need to plan and prepare to provide significantly more aid and more timely support to the victims.  The financial impact of these events can no longer be regarded as an externality to national, provincial, and local budgets.  But most importantly, WE must understand that the manifestations of the disasters are only symptoms, not causes.  WE need to end the harm WE are causing.

“The environment can be humanity’s greatest friend or,                             if poorly managed, our most implacable foe.”                                             Achim Steiner                                                                                              Administrator of the United Nations Development Programme, Vice-Chair of United Nations Sustainable Development Group.

“Making peace with nature is the defining task of the 21st century.      It must be the top, top priority for everyone everywhere.”          Antonio Guterres                                                                                                      United Nations Secretary-General

After all, Nature always wins.  So perhaps WE should play with the winning side, not against it.

Tim