In 1987, governments from across the world came together and ratified the Montreal Protocol. You may never have heard of it, but it was a truly momentous accomplishment. The protocol aimed to protect the Earth’s ozone layer by eliminating the use of chlorofluorocarbons (CFCs) across the globe. Think hair sprays and freon. As a result of CFC use, a hole in the ozone layer larger than the continental U.S. had formed above Antarctica.
For those of us who were alive in the 1980s, it has been a while since anyone has talked about the ozone layer. The Montreal Protocol is the reason why.
Many experts have argued that the Montreal Protocol saved our planet from unfettered ultraviolet radiation. Skin cancer would be commonplace. Our skins, if unprotected, would burn within minutes of sun exposure. The global agriculture industry is devastated. Indeed, a world without an ozone layer would have likely been uninhabitable. Game over.
The Montreal Protocol—which is expertly covered in the documentary The Ozone Hole—was the first international treaty to reduce global pollution. It represents a worldwide, highly coordinated effort by governments of hundreds of countries to act in the best interests of the human species writ large.
But perhaps most importantly, the Montreal Protocol was a shining example of coordinated action. Action without certainty. It sought to install stringent precautionary measures (at an economic and social cost) before the scientific evidence of the impact of a depleted ozone layer and its root cause was clear. In some ways, governments across the globe leapt without looking. And we are all better off for it.
Doomed to the Past
“Those who cannot remember the past are condemned to repeat it.” – George Santayana
It has been 33 years since the Montreal Protocol. As the world combats the COVID-19 virus, we seem to have forgotten the lessons of the past. These lessons are especially relevant to the United States. We need only look at two domains deeply intertwined with the pandemic – preventative healthcare and emergency preparedness – to see how the past is haunting us.
The United States spends the most per capita on healthcare in the world. It is not even close. The United States spends more than $10,000 per person on healthcare. That is 50%+ more than the next highest country — Norway — spends. But despite our luxurious spending, our health outcomes – mortality rate, obesity rates, child mortality rates, etc. – lag most developed nations. We spend more to get less. That simply doesn’t make any sense. Especially now when a deadly virus is spreading throughout the nation and disproportionately impacting the poor and minorities.
Upstream vs. Downstream
Take a closer look at the nature of our healthcare spending and the answer reveals itself. The allocation of our healthcare dollars matters just as much, if not more, than the total amount. A primary reason why our healthcare ROI is abysmal is because so much of our spending goes to address acute and chronic conditions. Conditions such as heart disease, chronic obstructive pulmonary disease (COPD), obesity, and diabetes. We spend a preponderance of healthcare budget on prescription drugs, surgeries, testing, and other treatments for the sick.
Other developed countries allocate their spending differently. Other OECD countries spend more (if not most) of their health care dollars upstream, on prevention and wellness. They invest in reducing obesity by ensuring supermarkets with fruits and vegetables in low-income areas. They invest in improving diets by educating children on nutrition and providing subsidies for healthy meals. They invest in reducing chronic stress by providing affordable housing and job guarantees. In the end, these governments and societies spend less and get better health outcomes for their citizens by focusing on prevention instead of treatment.
And while I will not dare unravel the ridiculous complexity of the U.S. healthcare system in this post, I will state that our approach to preventative healthcare is not unique. We tend to favor “treatment” over “prevention” as a norm. As a society, we tend to focus on the immediate problem. We prefer firefighting. It’s far simpler and tangible than addressing the (potential) cause. We adore the heroes who ride in and save the day. We ignore those behind the scenes that prevented the fire to begin with. Not surprisingly, our government (and the public who elects them) favors firefighting. Critically, this mindset pervades how our elected officials prioritize their agendas and how we allocate our budgets.
Overcoming Structural Limitations
The Strategic National Stockpile — a store of essential supplies, medications, and equipment – has been in the news a lot lately. More specifically, the emptiness of the stockpile has been in the news lately. But the state of the stockpile is only the canary in the coalmine. Despite warnings and prior pandemic scares, the U.S. government failed to adequately prepare for COVID-19.
Part of the challenge is bureaucratic. The administration of emergency services often gets stuck within the byzantine maze of federal, state, and local government “coordination.” Determining who is accountable and who is responsible is always a challenge. One need only look at Hurricane Katrina to see all the finger-pointing ex-post.
The same challenges of ownership and control among governments apply to preventative measures as well. Which agency is responsible for assessing the risk the levees will be breached? Which level of government is accountable for maintaining the levees? Who makes sure the buildings in the French Quarter are up to code? Which group owns the process of moving citizens to safe housing if New Orleans is flooded? On and on.
Part of the challenge is budgetary. The upstream, downstream challenge of healthcare rears its ugly head with emergency preparedness as well. Between 2011 and 2014, the federal government spent $3.2 billion fixing damage from disasters. But it only spent a little more than $200 million preparing for them. It has been argued that $1 of prevention is worth many dollars of reconstruction avoided. But who spends based on the hypothetical when there are real challenges today?
The Precautionary Principle
No congressperson or governor is going to win votes by spending an already limited budget on “preparedness” or “prevention.” Fictitious disasters are hard to conceive. Emergencies fade from our memories quickly. The public moves on to binge-watch the next Netflix special. After all, there are far more urgent needs that deserve our attention and our money.
There is a concept in the policy world known as the “precautionary principle.” It asks at what point does one act in the face of insufficient evidence. After all, in most cases, by the time you have definitive evidence (a category 5 hurricane that has breached the levees), it is too late to prevent a problem. Enter cleanup and recovery. In those cases, the financial cost and societal impact of not acting is definitely severe but manageable. In aggregate, we recover from a lack of prevention.
We won’t always be so lucky.
Defeating a Prophecy
The Ozone Hole documentary dramatically ends by showing the viewer two very different charts of the future (2030 onward) – each representing a reality on earth. One shows the “world expected.” It depicts a world where the ozone layer is slowly repairing itself. UV radiation is under control. The other shows the “world avoided.” It is a barren wasteland where humans can barely venture outside without protection from the sun. The “world avoided” is pure speculation because it never happened. Thank goodness we prevented it. It is terrifying.
As I touched upon in a prior post, making the “world avoided” visible – to decision-makers, to policymakers, and to the public – may actually help us avoid it from happening. t is analogous to a “self-defeating” prophecy. The “world avoided” is a prediction of the future that prevents what it predicts from happening because it was predicted. A real-time traveling mind-bender, huh?
Envisioning a New Montreal Protocol
As we look to the future, the next prophecy that needs to be defeated is a world devastated by climate change. You have read about all the possible doomsday scenarios. Uncontrollable rising sea levels put most major metropolises underwater. Huge swaths of desert take over much of Africa, Asia, and North America. Access to clean water is severely restricted. Basic food staples can no longer be grown at a pace to sustain the growth of human life. On and on.
The good news is that the Montreal Protocol provides a blueprint for governmental action at a global scale. We can do it. The past shows us the way. Acting today is paramount. If there is even a 1% chance that climate change will unleash the type of carnage some forecasters have indicated, we cannot delay. We must accept minor pain today in exchange for avoiding extreme pain in the future. The risk-reward is so obscenely imbalanced that even the smallest of probabilities deserves real attention and focus. After all, we may never know with certainty what inaction around climate change will bring… and that’s exactly what we want to happen.
Wagish Bhartiya is a GovLoop Featured Contributor. He is a Senior Director at REI Systems where he leads the company’s Software-as-a-Service Business Unit. He created and is responsible for leading a team of more than 100 staff focused on applying software technologies to improve how government operates. Wagish leads a broad-based team that includes product development, R&D, project delivery, and customer success across state, local, federal, and international government customers. Wagish is a regular contributor to a number of government-centric publications and has been on numerous government IT-related television programs including The Bridge which airs on WJLA-Channel 7. You can read his posts here.