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Threats to human survival: a WIRE to warn the world
Comment
Threats to human survival: a WIRE to warn the world The response of most knowledgeable scientists to the south-Asian tsunami was quick and decisive: the world had to take this opportunity to create an earthquake early warning system for the Indian ocean.1,2 World leaders backed this proposal in Jakarta last week. The evidence on which their decision was based came not only from the scenes of tumultuous devastation in Indonesia, Sri Lanka, India, Thailand, and elsewhere. Equally compelling was the argument that since a warning system had been put in place for the Pacific ocean, where 80% of tsunamis occur, many lives had been saved. The key to success was a well-worked out procedure for risk assessment and communication. Such an alerting service for the Indian ocean could be in operation within 12 months, according to UN officials. A parallel case is also being made for a North Atlantic tsunami early warning system. Is this suggestion an overreaction? The historical evidence suggests not.3 Underwater earthquakes have caused tsunamis affecting Sicily (1693), Lisbon (1755), Calabria (1783), and Messina (1908). Underwater sediment slides and volcanic collapses, although rarer events, may also increase the likelihood of dramatic coastal floods and loss of life.2 Indeed, David King, the UK government’s chief scientific adviser, has gone further. He has argued that, although earthquake science is in its infancy,4 seismologists can pinpoint geographical regions predisposed to volcanic activity. And so, “in the aftermath of this disaster an intergovernmental panel of geophysical scientists should develop a global foresight programme to coordinate scientific knowledge and research programmes in the area of tectonic catastrophes, and to make recommendations for action. Along the lines of the Intergovernmental Panel on Climate Change, the work of this panel should be ongoing and wide-ranging, starting from relatively low-tech early warning systems to recommendations for government investment in further research to develop methods of reliably forecasting quake and volcanic activity.”
King is right to emphasise the value of a comprehensive international approach to earthquake risks. Rapid responses to the immediate effects of tsunami damage can save lives and limit morbidity, especially from trauma—as was shown after three tsunamis hit Papua New Guinea in July, 1998. 5–7 But now is also a unique moment to create a broader mechanism to measure and prioritise all major global threats to human survival. By doing so, some order would govern how the world deals with these extreme dangers. A piecemeal approach to determining human risks would be an understandably reactive but deeply flawed response to this latest natural catastrophe. www.thelancet.com Vol 365 January 15, 2005
High-mortality developing countries
Developed countries
Risk factor
% DALYs
Risk factor
% DALYs
Underweight Unsafe sex Unsafe water, sanitation Indoor smoke Zinc deficiency Iron deficiency
14·9 10·2 5·5
Tobacco Blood pressure Alcohol
12·2 10·9 9·2
Vitamin A deficiency Blood pressure Tobacco Cholesterol
3·7 3·2 3·1
7·6 7·4 3·9
3·0
Cholesterol Overweight Low fruit/vegetable intake Physical inactivity
2·5 2·0 1·9
Illicit drugs Unsafe sex Iron deficiency
1·8 0·8 0·7
3·3
Table 1: Selected risk factors and their contributions to burden of disease9
Heads of State need to be able to formulate domestic and foreign policies according to a total picture of the risks facing their populations. The difficulty for policy-makers is that there is a confusion of ways to assess prevailing threats. If one takes global estimates of mortality,8 for example, the priorities for tackling causes of death are very clear: ischaemic heart disease (7·2 million deaths in 2002), cancer (7·1 million deaths), cerebrovascular disease (5·5 million deaths), respiratory tract infections (3·9 million deaths), and HIV-AIDS (2·8 million deaths). These diseases can be calculated on a global, regional, or national basis, giving clear directions for political decision-makers. Or perhaps politicians should pay more attention to morbidity. Here the pattern would be very different: neuropsychiatric disorders (193 000 disability adjusted life years lost in 2002) and perinatal conditions (97 000 DALYs lost) top burden of disease measures by this criterion. Risk factors for the most important diseases give a still different picture (table 1).9 These estimates of risk all come from WHO. But governments may want to take a more inclusive approach to threats facing their country’s integrity. In an analysis of risks to the global economic outlook, for example, the World Economic Forum has devised a far more diverse range of predicaments (panel), grouped according to economic, geopolitical, societal, and environmental risks. Political leaders may wish to immerse themselves further in the detail of these arguments, preferring to consult with technical experts when there is disagreement over evidence. Bjorn Lomborg drew on such expert opinion in a process called the Copenhagen Consensus, which produced ten global challenges that, he argued, held promising opportunities for intervention.10 This list was devised with the help of a distinguished group of academic economists. 191
Comment
Panel: Global risk mapping by the World Economic Forum* Economic risks Oil prices/energy supplies Asset prices/excessive indebtedness US current account deficit Coming fiscal crises China growth Geopolitical risks Organised crime Current and future hot spots Israel/Palestine India/Pakistan Iraq Chechnya Korean peninsula Weapons of mass destruction
China/Taiwan Iran Saudi Arabia Failing states Resource-driven conflicts
Societal risks Radical Islam Coming religious wars Over-regulation Demographics (ageing, population loss, male surplus) Migration Poverty Pandemics Public responses to technology (eg, biotechnology) Environmental risks Ecosystem services and biodiversity Climate change Water supply Natural catastrophes/accidents Air pollution *Presented at a seminar in London on Oct 20, 2004.
The final ten challenges included climate change, communicable diseases, conflicts and arms proliferation, access to education, financial instability, governance and corruption, malnutrition and hunger, migration, sanitation and access to clean water, and subsidies and trade barriers. A final overall ranking of risks and opportunities yielded encouraging avenues for potential policy development (table 2). But Lomborg’s methods and conclusions, while superficially plausible, have been seriously questioned.11 What is clear is the profound complexity of any effort to assess risk rationally. To make matters worse, many of the judgments about risks are strongly contested. For example, Lomborg claimed, against the emerging consensus, that an early warning system for the Indian ocean “may not be our best first priority”.12 Instead of “focusing on the issues with the most buzz”, the world’s resources would be better spent on communicable diseases, malnutrition, and drinking water, he suggested. 192
Even popular writers have joined the debate about global risks. In State of Fear, Michael Crichton concludes his sceptical 500-page novel on global warming by commenting in an unusual “author’s message” that “We can’t ‘assess’ the future, nor can we ‘predict’ it. These are euphemisms. We can only guess. An informed guess is just a guess.”13 Crichton castigates “the interminable yammering of fearmongers”. This is the level of discussion about global risks to which we have sunk. It is pretty depressing. We need a different approach. Yet the institutions that exist today cannot deliver that new approach. The UN has no single technical agency devoted to global risk assessment. The World Bank, International Monetary Fund, G8, and World Trade Organization are all inappropriate repositories for impartial analysis of global threats. Independent foundations may offer more neutral forums for risk judgments. But even foundations, such as that run by Bill and Melinda Gates, identify challenges from their own particular perspectives, producing solutions biased by their own specific ideologies. What is the answer? In one respect, Michael Crichton is correct. We do need a “non-partisan, blinded funding mechanism to conduct research to determine appropriate policy”. The power of independent technical evidence is consistently undervalued. For instance, global policies towards child health have changed because of new data derived from sound epidemiological and experimental science.14 The case for putting science at the centre of development policy-making has been made before.15 It received renewed support last week from the task force on science, technology, and innovation, part of the UN Millennium Project. Calestous Juma, the task force report’s author, argued that: “Economic advice will always be important in guiding policy makers on development matters. But in a knowledgebased economy, leaders and governments increasingly need science advisors to make effective use of emerging technologies.”
And, one might add, in determining how to respond to prevailing risks. In sum, we need a World Institute for Risk Evaluation— WIRE. This new institute would be an independent research-based agency, mandated to assess and adjudicate global risks. Evidence would be systematically gathered and peer-reviewed, risks would be quantified and prioritised, and issues would be targeted prospectively rather than responded to retrospectively. WIRE’s work would take place in open forums. Its advisers would represent a wide range of disciplines. WIRE would not—it could not—make judgments about the economic benefits, political feasibility, or public acceptability of risk reduction strategies. WIRE would be a global risk monitor rather than a regulator. Regulation would remain a matter for elected governments. But WIRE www.thelancet.com Vol 365 January 15, 2005
Comment
would provide a view on what is known about a given risk, the likely size of that risk, the precision of such an estimate, areas of uncertainty that required resolution, and data supporting interventions to limit the effects of that risk. WIRE would set the global agenda on threats to human survival. It would aggregate the evidence and make its conclusions available to all. Given the terrible effects of the south-Asian tsunami, The Lancet has proposed an International Commission on Global Responses to Complex Emergencies.16 This commission would ensure that pre-planned protocols were in place to deal with crisis situations. But the corollary of any response mechanism is a means to identify risks that need preventive or curative actions. That would be the function of WIRE. Taking these risks seriously is about nothing less then species survival. As Jared Diamond writes,17,18 “When people are desperate, undernourished, and without hope, they blame their governments which they see as responsible for or unable to solve their problems. They try to emigrate at any cost. They fight each other over land. They kill each other. They start civil wars. They figure that they have nothing to lose, so they become terrorists, or they support or tolerate terrorism . . . We need to realise that there is no other planet to which we can turn for help, or to which we can export our problems.”
But we should also be humble about what science might achieve. The effectiveness of WIRE would depend on two intangible variables. The first is the political environment in which risks are debated and communicated. Only in open societies where individuals feel free to raise concerns about risks can human survival be protected to the full. Where traces of repression or censorship remain, there can never be effective risk reduction. Second, whatever the quality of risk assessment and irrespective of the response mechanism, risk reduction ultimately depends on the capriciousness of human behaviour. After the May, 1960, earthquake off the coast of Chile, a tsunami hit Hawaii. A siren on the island gave 10 hours of warning, yet 61 people died and hundreds were injured. In a post-tsunami survey of survivors,19 it became clear that early warnings were seen as highly ambiguous. Although 95% of islanders heard the siren, only 41% evacuated the island. The alert meant different things to different people. No clear advice was given as to what the right behavioural response should be. Some islanders believed they should escape. Up to half thought they should await further information. This uncertainty proved fatal. Hawaii’s experience provides a salutary lesson. Whatever early warning systems are implemented, whatever measures are taken to diminish global risks, and whatever signals are communicated to those at risk, the way that individuals react will be neither entirely predictable nor completely rational. The science of risk is important and its value underestimated, but science alone can only do so much. www.thelancet.com Vol 365 January 15, 2005
Likelihood of success
Risk
Opportunity
1. Communicable diseases 2. Malnutrition and hunger 3. Subsidies and trade 4. Communicable diseases
Control of HIV/AIDS Providing micronutrients Trade liberalisation Control of malaria
5. Malnutrition and hunger 6. Sanitation and water 7. Sanitation and water 8. Sanitation and water
New agricultural technologies Community managed services Small-scale water technology for livelihoods Research on water productivity in food production Lowering costs for starting new businesses
Very good
Good
9. Governance and corruption Fair 10. Migration 11. Malnutrition and hunger 12. Communicable diseases 13. Malnutrition and hunger
Lowering barriers to migration for skilled workers Improving infant/child nutrition Scaled-up basic health services Reducing prevalence of low birthweight
14. Migration 15. Climate change 16. Climate change 17. Climate change
Guest worker programmes for the unskilled Optimal carbon tax Kyoto protocol Value-at-risk carbon tax
Bad
Table 2: Lomborg’s ranking of global risks and opportunities10
Richard Horton The Lancet, London NW1 7BY, UK 1 2 3 4
5
6 7
8 9 10 11 12 13 14
15 16 17 18 19
McGuire B. We need a warning system too. Guardian Dec 30, 2004: 18. King D. Just suppose it was us . . . Independent on Sunday Jan 2, 2005: 17. Dawson AG, Lockett P, Shi S. Tsunami hazards in Europe. Env Internat 2004; 30: 577–85. Nanayama F, Satake K, Furukawa R, et al. Unusually large earthquakes inferred from tsunami deposits along the Kuril trench. Nature 2003; 424: 660–63. Taylor PRP, Emonson DL, Schlimner JE. Operation Shaddock—the Australian Defence Force response to the tsunami disaster in Papua New Guinea. Med J Aust 1998; 169: 602–06. Holian AC, Keith PP. Orthopaedic surgery after the Aitape tsunami. Med J Aust 1998; 169: 606–09. Asari Y, Koido Y, Nakamura K, Yamamoto Y, Ohta M. Analysis of medical needs on day 7 after the tsunami disaster in Papua New Guinea. Prehosp Disaster Med 2000; 15: 81–85. World Health Report 2004: Changing history. Geneva: World Health Organization, 2004. World Health Report 2002: Reducing risks, promoting healthy life. Geneva: World Health Organization, 2002. Lomborg B, ed. Global crises, global solutions. Cambridge: Cambridge University Press, 2004. Sachs JD. Solving global crises: economists alone are not enough. Lancet 2004; 364: 2087–88. Lomborg B. Remember, Asia’s old stealthy killers claim more. Sunday Times Jan 2, 2005, 14–15. Crichton M. State of fear. London: HarperCollins, 2004. El Arifeen S, Blum LS, Hoque DME, et al. Integrated management of childhood illness (IMCI) in Bangladesh: early findings from a cluster-randomised study. Lancet 2004; 364: 1595–602. Horton R. The case for a Global Development Organisation. Lancet 2002; 360: 582–83. Editorial. One world, one response—needed, but not yet forthcoming. Lancet 2005; 365: 95–96. Diamond J. Collapse: how societies choose to fail or survive. London: Allen Lane, 2005. Diamond J. Disasters waiting to happen. Guardian G2 Jan 6, 2005: 4–6. Lachman R, Tatsuoka M, Bonk WJ. Human behavior during the tsunami of May 1960. Science 1961; 133: 1405–09.
193
Threats to human survival: a WIRE to warn the world The response of most knowledgeable scientists to the south-Asian tsunami was quick and decisive: the world had to take this opportunity to create an earthquake early warning system for the Indian ocean.1,2 World leaders backed this proposal in Jakarta last week. The evidence on which their decision was based came not only from the scenes of tumultuous devastation in Indonesia, Sri Lanka, India, Thailand, and elsewhere. Equally compelling was the argument that since a warning system had been put in place for the Pacific ocean, where 80% of tsunamis occur, many lives had been saved. The key to success was a well-worked out procedure for risk assessment and communication. Such an alerting service for the Indian ocean could be in operation within 12 months, according to UN officials. A parallel case is also being made for a North Atlantic tsunami early warning system. Is this suggestion an overreaction? The historical evidence suggests not.3 Underwater earthquakes have caused tsunamis affecting Sicily (1693), Lisbon (1755), Calabria (1783), and Messina (1908). Underwater sediment slides and volcanic collapses, although rarer events, may also increase the likelihood of dramatic coastal floods and loss of life.2 Indeed, David King, the UK government’s chief scientific adviser, has gone further. He has argued that, although earthquake science is in its infancy,4 seismologists can pinpoint geographical regions predisposed to volcanic activity. And so, “in the aftermath of this disaster an intergovernmental panel of geophysical scientists should develop a global foresight programme to coordinate scientific knowledge and research programmes in the area of tectonic catastrophes, and to make recommendations for action. Along the lines of the Intergovernmental Panel on Climate Change, the work of this panel should be ongoing and wide-ranging, starting from relatively low-tech early warning systems to recommendations for government investment in further research to develop methods of reliably forecasting quake and volcanic activity.”
King is right to emphasise the value of a comprehensive international approach to earthquake risks. Rapid responses to the immediate effects of tsunami damage can save lives and limit morbidity, especially from trauma—as was shown after three tsunamis hit Papua New Guinea in July, 1998. 5–7 But now is also a unique moment to create a broader mechanism to measure and prioritise all major global threats to human survival. By doing so, some order would govern how the world deals with these extreme dangers. A piecemeal approach to determining human risks would be an understandably reactive but deeply flawed response to this latest natural catastrophe. www.thelancet.com Vol 365 January 15, 2005
High-mortality developing countries
Developed countries
Risk factor
% DALYs
Risk factor
% DALYs
Underweight Unsafe sex Unsafe water, sanitation Indoor smoke Zinc deficiency Iron deficiency
14·9 10·2 5·5
Tobacco Blood pressure Alcohol
12·2 10·9 9·2
Vitamin A deficiency Blood pressure Tobacco Cholesterol
3·7 3·2 3·1
7·6 7·4 3·9
3·0
Cholesterol Overweight Low fruit/vegetable intake Physical inactivity
2·5 2·0 1·9
Illicit drugs Unsafe sex Iron deficiency
1·8 0·8 0·7
3·3
Table 1: Selected risk factors and their contributions to burden of disease9
Heads of State need to be able to formulate domestic and foreign policies according to a total picture of the risks facing their populations. The difficulty for policy-makers is that there is a confusion of ways to assess prevailing threats. If one takes global estimates of mortality,8 for example, the priorities for tackling causes of death are very clear: ischaemic heart disease (7·2 million deaths in 2002), cancer (7·1 million deaths), cerebrovascular disease (5·5 million deaths), respiratory tract infections (3·9 million deaths), and HIV-AIDS (2·8 million deaths). These diseases can be calculated on a global, regional, or national basis, giving clear directions for political decision-makers. Or perhaps politicians should pay more attention to morbidity. Here the pattern would be very different: neuropsychiatric disorders (193 000 disability adjusted life years lost in 2002) and perinatal conditions (97 000 DALYs lost) top burden of disease measures by this criterion. Risk factors for the most important diseases give a still different picture (table 1).9 These estimates of risk all come from WHO. But governments may want to take a more inclusive approach to threats facing their country’s integrity. In an analysis of risks to the global economic outlook, for example, the World Economic Forum has devised a far more diverse range of predicaments (panel), grouped according to economic, geopolitical, societal, and environmental risks. Political leaders may wish to immerse themselves further in the detail of these arguments, preferring to consult with technical experts when there is disagreement over evidence. Bjorn Lomborg drew on such expert opinion in a process called the Copenhagen Consensus, which produced ten global challenges that, he argued, held promising opportunities for intervention.10 This list was devised with the help of a distinguished group of academic economists. 191
Comment
Panel: Global risk mapping by the World Economic Forum* Economic risks Oil prices/energy supplies Asset prices/excessive indebtedness US current account deficit Coming fiscal crises China growth Geopolitical risks Organised crime Current and future hot spots Israel/Palestine India/Pakistan Iraq Chechnya Korean peninsula Weapons of mass destruction
China/Taiwan Iran Saudi Arabia Failing states Resource-driven conflicts
Societal risks Radical Islam Coming religious wars Over-regulation Demographics (ageing, population loss, male surplus) Migration Poverty Pandemics Public responses to technology (eg, biotechnology) Environmental risks Ecosystem services and biodiversity Climate change Water supply Natural catastrophes/accidents Air pollution *Presented at a seminar in London on Oct 20, 2004.
The final ten challenges included climate change, communicable diseases, conflicts and arms proliferation, access to education, financial instability, governance and corruption, malnutrition and hunger, migration, sanitation and access to clean water, and subsidies and trade barriers. A final overall ranking of risks and opportunities yielded encouraging avenues for potential policy development (table 2). But Lomborg’s methods and conclusions, while superficially plausible, have been seriously questioned.11 What is clear is the profound complexity of any effort to assess risk rationally. To make matters worse, many of the judgments about risks are strongly contested. For example, Lomborg claimed, against the emerging consensus, that an early warning system for the Indian ocean “may not be our best first priority”.12 Instead of “focusing on the issues with the most buzz”, the world’s resources would be better spent on communicable diseases, malnutrition, and drinking water, he suggested. 192
Even popular writers have joined the debate about global risks. In State of Fear, Michael Crichton concludes his sceptical 500-page novel on global warming by commenting in an unusual “author’s message” that “We can’t ‘assess’ the future, nor can we ‘predict’ it. These are euphemisms. We can only guess. An informed guess is just a guess.”13 Crichton castigates “the interminable yammering of fearmongers”. This is the level of discussion about global risks to which we have sunk. It is pretty depressing. We need a different approach. Yet the institutions that exist today cannot deliver that new approach. The UN has no single technical agency devoted to global risk assessment. The World Bank, International Monetary Fund, G8, and World Trade Organization are all inappropriate repositories for impartial analysis of global threats. Independent foundations may offer more neutral forums for risk judgments. But even foundations, such as that run by Bill and Melinda Gates, identify challenges from their own particular perspectives, producing solutions biased by their own specific ideologies. What is the answer? In one respect, Michael Crichton is correct. We do need a “non-partisan, blinded funding mechanism to conduct research to determine appropriate policy”. The power of independent technical evidence is consistently undervalued. For instance, global policies towards child health have changed because of new data derived from sound epidemiological and experimental science.14 The case for putting science at the centre of development policy-making has been made before.15 It received renewed support last week from the task force on science, technology, and innovation, part of the UN Millennium Project. Calestous Juma, the task force report’s author, argued that: “Economic advice will always be important in guiding policy makers on development matters. But in a knowledgebased economy, leaders and governments increasingly need science advisors to make effective use of emerging technologies.”
And, one might add, in determining how to respond to prevailing risks. In sum, we need a World Institute for Risk Evaluation— WIRE. This new institute would be an independent research-based agency, mandated to assess and adjudicate global risks. Evidence would be systematically gathered and peer-reviewed, risks would be quantified and prioritised, and issues would be targeted prospectively rather than responded to retrospectively. WIRE’s work would take place in open forums. Its advisers would represent a wide range of disciplines. WIRE would not—it could not—make judgments about the economic benefits, political feasibility, or public acceptability of risk reduction strategies. WIRE would be a global risk monitor rather than a regulator. Regulation would remain a matter for elected governments. But WIRE www.thelancet.com Vol 365 January 15, 2005
Comment
would provide a view on what is known about a given risk, the likely size of that risk, the precision of such an estimate, areas of uncertainty that required resolution, and data supporting interventions to limit the effects of that risk. WIRE would set the global agenda on threats to human survival. It would aggregate the evidence and make its conclusions available to all. Given the terrible effects of the south-Asian tsunami, The Lancet has proposed an International Commission on Global Responses to Complex Emergencies.16 This commission would ensure that pre-planned protocols were in place to deal with crisis situations. But the corollary of any response mechanism is a means to identify risks that need preventive or curative actions. That would be the function of WIRE. Taking these risks seriously is about nothing less then species survival. As Jared Diamond writes,17,18 “When people are desperate, undernourished, and without hope, they blame their governments which they see as responsible for or unable to solve their problems. They try to emigrate at any cost. They fight each other over land. They kill each other. They start civil wars. They figure that they have nothing to lose, so they become terrorists, or they support or tolerate terrorism . . . We need to realise that there is no other planet to which we can turn for help, or to which we can export our problems.”
But we should also be humble about what science might achieve. The effectiveness of WIRE would depend on two intangible variables. The first is the political environment in which risks are debated and communicated. Only in open societies where individuals feel free to raise concerns about risks can human survival be protected to the full. Where traces of repression or censorship remain, there can never be effective risk reduction. Second, whatever the quality of risk assessment and irrespective of the response mechanism, risk reduction ultimately depends on the capriciousness of human behaviour. After the May, 1960, earthquake off the coast of Chile, a tsunami hit Hawaii. A siren on the island gave 10 hours of warning, yet 61 people died and hundreds were injured. In a post-tsunami survey of survivors,19 it became clear that early warnings were seen as highly ambiguous. Although 95% of islanders heard the siren, only 41% evacuated the island. The alert meant different things to different people. No clear advice was given as to what the right behavioural response should be. Some islanders believed they should escape. Up to half thought they should await further information. This uncertainty proved fatal. Hawaii’s experience provides a salutary lesson. Whatever early warning systems are implemented, whatever measures are taken to diminish global risks, and whatever signals are communicated to those at risk, the way that individuals react will be neither entirely predictable nor completely rational. The science of risk is important and its value underestimated, but science alone can only do so much. www.thelancet.com Vol 365 January 15, 2005
Likelihood of success
Risk
Opportunity
1. Communicable diseases 2. Malnutrition and hunger 3. Subsidies and trade 4. Communicable diseases
Control of HIV/AIDS Providing micronutrients Trade liberalisation Control of malaria
5. Malnutrition and hunger 6. Sanitation and water 7. Sanitation and water 8. Sanitation and water
New agricultural technologies Community managed services Small-scale water technology for livelihoods Research on water productivity in food production Lowering costs for starting new businesses
Very good
Good
9. Governance and corruption Fair 10. Migration 11. Malnutrition and hunger 12. Communicable diseases 13. Malnutrition and hunger
Lowering barriers to migration for skilled workers Improving infant/child nutrition Scaled-up basic health services Reducing prevalence of low birthweight
14. Migration 15. Climate change 16. Climate change 17. Climate change
Guest worker programmes for the unskilled Optimal carbon tax Kyoto protocol Value-at-risk carbon tax
Bad
Table 2: Lomborg’s ranking of global risks and opportunities10
Richard Horton The Lancet, London NW1 7BY, UK 1 2 3 4
5
6 7
8 9 10 11 12 13 14
15 16 17 18 19
McGuire B. We need a warning system too. Guardian Dec 30, 2004: 18. King D. Just suppose it was us . . . Independent on Sunday Jan 2, 2005: 17. Dawson AG, Lockett P, Shi S. Tsunami hazards in Europe. Env Internat 2004; 30: 577–85. Nanayama F, Satake K, Furukawa R, et al. Unusually large earthquakes inferred from tsunami deposits along the Kuril trench. Nature 2003; 424: 660–63. Taylor PRP, Emonson DL, Schlimner JE. Operation Shaddock—the Australian Defence Force response to the tsunami disaster in Papua New Guinea. Med J Aust 1998; 169: 602–06. Holian AC, Keith PP. Orthopaedic surgery after the Aitape tsunami. Med J Aust 1998; 169: 606–09. Asari Y, Koido Y, Nakamura K, Yamamoto Y, Ohta M. Analysis of medical needs on day 7 after the tsunami disaster in Papua New Guinea. Prehosp Disaster Med 2000; 15: 81–85. World Health Report 2004: Changing history. Geneva: World Health Organization, 2004. World Health Report 2002: Reducing risks, promoting healthy life. Geneva: World Health Organization, 2002. Lomborg B, ed. Global crises, global solutions. Cambridge: Cambridge University Press, 2004. Sachs JD. Solving global crises: economists alone are not enough. Lancet 2004; 364: 2087–88. Lomborg B. Remember, Asia’s old stealthy killers claim more. Sunday Times Jan 2, 2005, 14–15. Crichton M. State of fear. London: HarperCollins, 2004. El Arifeen S, Blum LS, Hoque DME, et al. Integrated management of childhood illness (IMCI) in Bangladesh: early findings from a cluster-randomised study. Lancet 2004; 364: 1595–602. Horton R. The case for a Global Development Organisation. Lancet 2002; 360: 582–83. Editorial. One world, one response—needed, but not yet forthcoming. Lancet 2005; 365: 95–96. Diamond J. Collapse: how societies choose to fail or survive. London: Allen Lane, 2005. Diamond J. Disasters waiting to happen. Guardian G2 Jan 6, 2005: 4–6. Lachman R, Tatsuoka M, Bonk WJ. Human behavior during the tsunami of May 1960. Science 1961; 133: 1405–09.
193