On May 18, 2022, the NTU RSPRC hosted the "Just Transition and Youth Lecture Series (1): Social Environment Changes and Health". Invited to this online lecture were Hsien-Ho Lin, Professor of Institute of Epidemiology and Preventive Medicine, National Taiwan University. Acting as the keynote speaker, Professor Lin talked about the relationship between the burden of disease on Taiwan's future social aging, labor force and health policy from the perspective of aging. Acting as a panelist to express the views of the young generation was Meng-Hui Lin, one of Youth Advisory Committee members in Executive Yuan. Lin is also a doctoral student in the International Degree Program in Climate Change and Sustainable Development, National Taiwan University.
Figure 1 Just Transition and Youth Lecture Series
Kuei-Tien Chou, Director of the RSPRC, served as the program host. He opened the forum by throwing in three major issues that this generation is facing, namely climate disaster, aging society, and pandemics. All of them have been causing huge impacts on our country and the whole world. From the perspective of just transition and the youth future action framework, these three issues of climate, aging, and pandemics were talked about in this forum. The three issues are internationally known as the Disruptive New Normal.
Under the theme of "The Enlightenment and Contribution of ‘Ethnic Burden of Disease and Health Risk’ to Health Policy and Aging Society Policy", Professor Hsien-Ho Lin shared his views on sustainable development from the perspective of public health and wellness. Talking about the great challenges facing today's society, Professor Lin said that all the issues of climate change, aging or pandemics belong to changes in the social environment in a broad sense. Judging from the background and the perspective of "Burden of Disease", a method to measure population health, he explored its impact on public health, influence and development, and the reflections brought about to the relevant policies.
Figure 2 How are diseases rated?
Professor Lin said that Taiwan has rich and diverse ethnic groups and different urbanization development, but how do we define whether agroup is healthy or not? Using only annual mortality statistics from the Ministry of Health and Welfare has its limitations, so a "Burden of Disease" method has been developed to measure population health. Some diseases do not cause immediate death, but bring disability or suffering to the patient itself. As “time” is a calculation unit that can be quantified and compared to everyone, the burden of disease method uses “time” for measurement. The two major dimensions of the burden of disease are the "burden of death" and the "burden of morbidity." The burden of death is the number of person-years lost to premature death due to a disease (e.g., diabetes), called "Years of Life Lost" (YLLs); the other dimension is the person-years lost due to illness and disability called "Years Lived with Disability" (YLDs), that is, the patient is surviving, but losing its healthy state. Adding these two numbers, you can get the overall Disability Adjusted Life Years (DALY) and use this common currency-like health indicator to compare Mr. A's stroke with Ms. B's schizophrenia and the overall population health effects.
Launched by scholars Alan Lopez and Christopher Murray of the Health Statistics Department of the World Health Organization (WHO), the Global Burden of Disease Project (GBD) not only evaluates the health of the world's population across countries, gender, and age but also analyzes their causes. There is Taiwan Burden of Disease Center, whose structure is similar to that of the GBD Project, so that we can further analyze and evaluate the health situation of our people through local data. In addition to cross-country comparisons, the center can also compare local groups across counties, cities, and towns. Take air pollution as an example, upstream risk factors of disease occurrence are used in the burden of disease study to calculate the disability-adjusted person-years and the impact of the financial burden. The health indicators database can be constructed according to the core structure of risk factor-disease-consequence. It provides an important reference for policy formulation and guidance.
It is found through age stratification that the overall disease burden occurs mainly in the population over 65 years old in Taiwan, and it is found through the gender analysis that men have more disease burden than women. Considering from the perspective that the labor force is mainly male, it is conceivable that the result will cause the labor force to shrink. As Taiwan is experiencing rapid population aging and is about to enter a super-aged society (that is, 20% of the total population is over 65 years old), the future trend is that the prime-age population will decrease, while the elderly population will increase.
Figure 3 Taiwan is facing an aging future
Thinking from the perspective of health or burden of disease will help Taiwan society achieve the Sustainable Development Goals (SDGs). The purpose of the GBD Project mentioned above is to establish an interactive website for the SDGs database so as to observe the sustainable development indicators related to health in countries around the world with those indicators converted into scores (0 to 100 points). You can find Taiwan’s scores and ranking on this website. Based on the objective and quantitative data on burden of disease, we can carry out trend assessment. The World Bank also proposes to use human capital as an indicator for evaluating national capital, of which "educational quality" and "national health" are two aspects that are often overlooked.
Therefore, Professor Lin evaluated Taiwan's sustainable development from the perspective of health and found that the healthy labor-force population aged 20 to 64 in 2040 and 2060 showed an opposite trend to the increase in the elderly population. He has thus predicted that Taiwan would face the long-term care and social burden issues in the future. Also, he said that localized data can be used to prevent risk factors and calculate the burden of disease; for example, localized data in different regions can be used to calculate the burden of disease of related diseases caused by PM2.5, such as heart disease, stroke, lung cancer, chronic obstructive pulmonary disease, and so on. Finally, Professor Lin mentioned that although it is difficult for individuals to choose the health impact caused by factors, they can prevent health costs through the analysis of National Health Insurance data if the benefits of moving towards sustainability or energy transition can be considered. He said that starting the journey by understanding specific risk factors and setting out to make a real change in lifestyle would eventually pay off to a certain degree.
As a panelist, Commissioner Meng-Hui Lin responded to the speaker that climate change has a wide range of impacts, including risks to health and other aspects that cannot be ignored. The contemporary generation needs to have a different innovative thinking than the past. In recent years, there is a term called "climate anxiety". For example, residents who have been greatly affected by the weather will have a psychological burden when they restore their homes after a disaster; young people tend not to raise children because of disasters caused by climate change, leading to population problems; climate change, extreme high temperature and heavy rain phenomenon tend to cause injuries to those working outdoors, and has climate change been considered in the long-term care system? Lin said, All of the above have caused varying degrees of anxiety among young generations. She continued to say that if the global net zero emission targets are not reached by 2050, the future generations would need to bear even more severe climate challenges, but at present, society has rarely made specific preparations or transition work for the anxiety and goals mentioned above.
What else can young people do? Their actions cannot be underestimated. Commissioner Lin mentioned that the rental program for environmentally friendly tableware was once implemented on the NTU campus and it promoted the lifestylestransition of the young generation ; the Sustainability Team of National Taiwan University Student Association (NTUSA) succeeded in persuading the NTU authorities to withdraw its investment from the high-carbon industries in early 2021; and Taiwan Youth Climate Coalition (TWYCC), an NGO representative group, not only took part in important international conferences to exchange views and opinions but also held the Taiwan Youth Climate March, so that the voices of young people could be heard by the government, enterprises and the general public.
What can be done for the youth? There are four things: listening to their needs, providing education, imagining together, and acting now. It is common to hear elders say, "By 2050, we may not be in this world anymore", but resources and power are not delegated to the youth. In the context of real needs of the youth, the imagination is made concrete by listening. To provide the youth with richer education through different flexibility and knowledge. For example, the speaker talked about assisting the Ministry of Education to develop climate change teaching materials for the public.
Finally, Commissioner Lin mentioned that Taiwan's Pathway to Net-Zero Emissions in 2050, released by the National Development Council on March 30, contains few elements of youth or generational justice. Therefore, the latest proposal by the Youth Advisory Committee, Executive Yuan, is to understand the needs of the youth under the net zero targets by using the "Youth Wishing Pool Platform" to collect young people's imaginations and opinions online. The information collected by this proposal will be compiled and passed to the various ministries for reference.
Figure 4 Youth Wishing Pool Platform
In the online interaction and feedback session, one participant raised a question about air pollution. Although the number of PM2.5 seems to have decreased in the central and southern Taiwan and in the long-term trend in recent years, it has also reminded everyone that in addition to PM2.5, the risk factors of air pollution also include the impact of high ozone concentration and the problem of average data in different towns; two other participants asked questions on "the impact of aging on the industry and its countermeasures" and "the government's perception and countermeasures for various crises".
Professor Lin replied that different industries have different labor types and age groups and thus, experts and scholars must be invited to discuss the relevant issues in the general direction of population structure, health impact, and then the connection with the relevant industry. With regard to how to respond to various crises, Professor Lin said that the Ministry of Science and Technology(MOST) project " Foresight 2050: Developing a decision support system for a Sustainability Transition of Taiwan ", which focuses on the policy implications, and hoping to provide his research data to the government for reference through the MOST.
Regarding the cooperation activities with the youth, Commissioner Lin mentioned that the Environmental Protection Administration has a subsidy program for environmental actions; various ministries also offer training programs to the youth; NTU has recently held an ESG proposal competition and so on. Director Chou responded that in the future, the industry, academia, and NGOs will need to have more dialogues with the youth or groups of different generations. Director Chou also said that the ruling party has at present proposed the structure for Net-Zero Emissions in 2050, but the actual pathway is not yet so clear. Chou continued to say that transition requires more discussion, momentum and ambition from all walks of life. Commissioner Meng-Hui Lin replied that there is currently an information gap in society, causing a big difference between the public's expectations and imaginations for the future. She encouraged young people to use every opportunity to speak out.
Director Chou finally concluded that our society needs to put more forward thinking and vision on urgent issues and told the audience to follow the next series of lectures and research discussions on the official RSPRC website.
The wonderful video and slideshow of this lecture are below.
0518 Just Transition and Youth Lecture Series (1): Social Environment Changes and Health session1
0518 Just Transition and Youth Lecture Series (1): Social Environment Changes and Health session2