The health and about medicine. So to introduce myself, as I told you, I grew up in Upper Austria. I studied medicine and cultural anthropology. I worked for several years, first in Africa, then in Latin America. And then I worked for 29 years as a general practitioner and family physician in a rural area in Lower Austria. And after retiring from that, I started studying again. I started sustainable development because during my whole life, I was confronted with questions of sustainable development and I wanted to understand it in a better way. So therefore I start with a picture. I took this picture in Latin America. I was working there in an integrated project development program to save and guarantee basic human rights for Indian minorities, for indigenous people. It is the community of the Mbya Indians in Paraguay. And here you see displaced persons. And here you see displaced persons. I suppose you understand what it means. A displaced person is a refugee in his own country, according to UN definition. So if we were in an orla, I would like to ask you, what do you think? Why are they displaced? But we are not able to have long discussions now and therefore I just want to tell you you know that the indigenous people in Paraguay as in many places of the world they live in large territories they have a very sustainable economic system but there are other interests and this is just a photo for those who are interested in medicine. I was working a lot in fighting tuberculosis and this is one of the nurses I taught the so-called Tzildilson stent to diagnose tuberculosis. But what is the main problem behind is that there is an enormous deforestation all over Latin America. You might have heard about Brazil. The deforestation in Paraguay is not so well known in Europe, but it is the same problem. Large areas were sold to foreigners or to other land owners. You know, we are talking about thousands of hectares. And then in order to make business, the wood is burned down. And this is the end. This is how it looks like what once was an ice forest. So this was my first confrontation with climate change. As we all know, that the tropical and subtropical forests are very essential to maintain the climate on our globe. the climate on our globe. They are sinks for carbon and they have multiple functions in the ecological systems. So in short, and here I show you a picture, you see indigenous people and they here on this place they still can live the traditional way of living and what was so much impressive for me is that their life is actually a 100% sustainable lifestyle. But what I learned during my years in Latin America from 77 to 82, it's wrong here, it's not 79, it was from 77 to 82, is that land degradation and deforestation has an impact on climate change. It means loss of natural carbon sinks. It means, of course, an enormous loss of biodiversity. And it leads to social and economic destruction of a traditional society and a really sustainable society. As a doctor, I would like to say that climate change is only a symptom of the larger of change of our Western lifestyle. And what I learned later when I came back to Europe is that this enormous problem of deforestation deforestation as a cause for climate change. This is just about 20% of the climate change problem. You see that 65% of carbon dioxide, this is an overall view of greenhouse gases, but 65% is built by burning fossil fuels in cars, in the industry, etc. I guess you are familiar with the problem. And only about 11 percent is carbon dioxide from forestry and from other land degradation. And then we have the methane problem. You know about the permafrost and you know about the factory farming with cows, etc. And then we have smaller fractions of greenhouse gases. I suppose that most of you are familiar with this. But to give you a wider view, I would like to present you the so-called planetary boundaries, first formulated by Rockström. And maybe you know his circle. And he mentions climate change, novel entitis, the ozone problem, atmospheric aerosol loading, the acidification of oceans, biochemical flows, mainly eutrophication from artificial fertilizer or fields, freshwater problem, land system change, and biodiversity and biosphere integrity. So all this plays together and there are interactions between these problems. So it was the British economist Kate Roberts, maybe you have, here's a picture of her, maybe you have heard of her. She took this model of model of Rockström, this round model, in order to develop her visionary economic system, and she calls it the so-called donut economics. I was not very happy when I heard this first, but it is a ring like a donut. And therefore, but what is meant is that we have these problems and we have a big confrontation with having enough food. We have energy problems. We have job problems and social problems. And all these problems must be solved and organized in a way that they go together with the limits of our planet. therefore planetary boundaries. Of course, Kate Raworth was not the first economist to deal with this. You might have heard about all kinds of models of degrowth, of post-growth economies, or maybe of Herman Daly with steady state economy. So there are other models. But one thing is important. Our economy cannot continue as it is going right now, because this will have enormous negative effects on health and other also on global health. But that's not yet all. In addition to these aspects, we have to think about uneven distribution of wealth and of access to certain goods in our globe. There are a lot of social aspects of transformation. There is the problem of climate justice, and there is the problem of disarmament. After the change in Europe, we had hoped that now the world will disarm. It happened for a while, but now we have a new wave of armament. that now the world will disarm. It happened for a while, but now we have a new wave of armament. So these are serious problems. And when we talk, for instance, about the wars in Middle East, millions of people were killed in these wars for oil. And this oil is just a sign, you know, of our non-sustainable lifestyle. Now coming back to medicine, there are three main issues of climate change, which have several influences on global health and on human health. The first is rising temperature, the second is rising sea level, and the third is a high amount or increasing amount of precipitation. And this graph shows you the path of how it goes. Of course, when we have more storms and more flooding, the morbidity and mortality is increasing. We have more displacement and displacement, fleeing people is always related to bad health conditions. Heat, I will talk about this a little bit later. We have a change in vector biology. You know, malaria is coming, is arriving in Europe again. We have problems with air pollutants and, of course, with food supply. because of increasing yeast, the bigger the loss of arable land for our nutrition. And all this is connected with an enormous increasing danger of civil conflicts. I remember it was already in 2008 when then UN Secretary General Ban Ki-moon said we have to count with an enormous stream of migration from Africa towards the north out of the region, who will have to migrate when they lose their basic possibilities for living. And this is another old graph which shows you the interrelationship between human health and climate change diverse pathways, desertification and land degradation, freshwater decline, biodiversity and stratospheric ozone depletion. Here we are somewhat hopeful, you might know about the Montreal Agreement. But we have really serious problem and from a point of view of science it is fascinating that all these problems are interrelated to each other. You cannot simply speak about climate change because it is related to desertification and biodiversity is related to the way we do our agriculture, etc. So this is just a short overview of what you can hear and I think the newspapers are full of these aspects. we have to protect ourselves against the heat and the consequences of heat against extreme weather situations. That's all true. But if we only try to protect ourselves against the heat and the consequences, we are not really working right there where there are the roots of this problem. This is also already from 2008, the picture from a series of WHO calling the water problem these times. So as a doctor, I ask myself, how can we prevent the disease? I ask myself, how can we prevent the disease? And for instance, if we want to solve the problem of increasing heat with air conditions, we will not be able to solve it, as this is only a palliative therapy. You know, at the opposite, we need more energy for air conditions. And we cool inside, but we heat up outside. necessary. Think of Bangladesh. Think of the Nile Delta in Egypt. Of course, it might be necessary to protect people, but this is not a preventive action. This is only palliative. So, there are more aspects we have to think. How much energy do we really need? How could a circular economy work today? I think we can learn a lot of indigenous people. And it's interesting, those of you who are familiar with the Brundtland report of 1987, 1987. You might know that the report still speaks a lot about learning from indigenous people and says about the problem of armament and the necessity for disarmament. But these two aspects are often forgotten in today's discussion of sustainable development. So I guess you are familiar with mitigation curves. These one are from Robbie Andrew from Great Britain. I like them very much. You can find them in the internet. They are also movable. But you see clearly the longer we wait, the steeper we have to go down with our economy and with emissions. And it is clear that the question of decoupling is an essential question in this context. Can we really decouple carbon dioxide and other greenhouse gas production from GDP? And this is the curve for 1.5 degrees centigrade. And you see how steep it is. I mean, if we had started changing our economic system here around 2000 or maybe in 1980, it would have been easy, you know, just going down 2, 3, 4 percent, even here in 2000, going down 4 percent with carbon dioxide each year and we would have been able to solve but we have been waiting and our climate policy is absolutely non-working and therefore we are confronted with this enormous steep curve problem today. But now let's talk about the individual approach. Everybody of us is producing a carbon footprint. I mean, is producing a certain amount of carbon dioxide and other greenhouse gases. You know, they are measured in carbon dioxide equivalent. So where are they coming from? They come from housing. How we live. Do we heat with oil or do we have another more sustainable heating system? What do we consume? How are our consumer goods produced? Under which conditions? There are also a lot of social questions behind it, but also the question of the amount of greenhouse gas already in the upstream, produced already in the upstream processes. And the third chapter is, how is our transport? How do we move around? I personally think that the car is not I personally think that the car is not a vehicle which is compatible with a sustainable future. So let's talk a few words about nutrition first. By the way, in order to complete this, there is housing, consumption and transport and consumption is on the one side eating and on the other hand it is of course the consumption of all our goods, mobile, is, of course, the public footprint, all the public infrastructure, the highways, railways, universities, hospitals, etc. And the footprint of this public infrastructure is considerably high and we cannot easily have a direct influence on these footprints, whereas we have a certain direct influence on how we house, how we want to house, to live, and what do we want to consume and how we want to move around. So a few words about nutrition. Maybe you are familiar with the Harvard School healthy eating plate, and you see that mainly vegetables and fruits and enough liquids, whole grains and healthy protein, not necessarily of meat of course. And the sustainable questions, I guess you are all familiar with this, is the best food is the locally produced food with a low carbon footprint. Of course, mainly vegetarian or vegan nutrition, because meat footprint can be very high and in general is very high. Here you see a comparison of different fruits. On the right side, you see potatoes, carrots, legumes, rice. This food has very low footprints. And on the other hand, you see that beef, cheese, pork have very high footprints per amount of calories. What is interesting, and therefore I show you this graph from another study, is on top you have beef. And you see that even the footprint of beef varies a lot. This is the average. see that even the footprint of beef varies a lot. This is the average, but it can be much smaller if we do not factory farming. Here we also, we could learn something from Latin America. And in LAMP, it is similar. And here are the interesting things for those who are very much interested in biophysics. You see the nuts. And if we were in an open audience, I would ask you now, how is it possible that the nuts, which is a very good nutrient with very healthy proteins and also healthy fats, how can it be negative in the food? I tell you the answer. The answer is because if you produce nuts on trees or in the ground, but especially here we have in Europe, we have two kinds of nuts, walnut and hazelnut on trees. And you produce a certain amount of wood at the same time when you produce the nuts. And so as wood is a sink for carbon, the overall footprint of nuts can even be negative. So this just in short to give you an overview, I like to give two small examples. I like to give two small examples. Both elements, bread and potatoes, have a rather low carbon footprint. But even there you can see considerable differences. Let's think of bread. How is it produced? First, the wheat is planted in the fields. You need a machinery. If it is a non-organic agriculture, of course, they use herbicides and pesticides. They use artificial fertilizers. Then you need a harvesting machine which runs in a non-sustainable way. You need a transport to the miller, but the mill of today doesn't look anymore like the mill you see here. It needs also non-sustainable energy. You need another transport of the flour to the bakery, and the bakery doesn't look like this anymore today. that even bread already accumulates a certain considerable footprint, which is much higher than the footprint of mere potatoes or of vegetables you possibly grow in your own garden. And here you see myself at my solar cooker. If you cook this vegetarian food with solar energy, the overall footprint of this meal is close to zero. Just to understand what is behind our nutrition system, and of course the transport of our food plays an important role. Think what finally ends up in the supermarket. Think of the footprint of these goods. How many transport processes, how many industrial processes are upstream in the supply chain of the production of these goods. to transport and I have worked a lot of transport and published a lot about transport. I'm very sorry this graph I have only in German language, but this was the first useful data I used for my research in 2005. It shows the difference in the carbon footprints of various means of transport. And you see on top we have bicycle producing only one gram of carbon dioxide per kilometer. And the next is the Austrian railway with about 20 grams per kilometer, which are rather sustainable means of transport. By the way, the one gram is from the production of the bicycle. And on the other end we have car and plane, of course, which have very high footprints. This is a similar result from the Technical University of Graz. It's almost the same, but I want to, and it was in 1996, I was working that time as a family physician and general practitioner. And when I changed to use a bicycle instead of a car, I called this integrated cycling. I did a lot of research, a lot of experimenting. You can find my publications on my website. I cannot say details, but I learned a lot by this process. Now, cycling has a second advantage. It is very good for health because when you move around, it is very good for health because when you move around you are less likely to suffer from hypertension from cardiovascular diseases heart diseases yeah from diabetes from osteoporosis even breast cancer and colon cancer is less present among people who cycle or move a lot on a regular daily basis. And if you want to know more about this, go to the European WHO website and search for the so-called health economic assessment tool for cycling. I was very happy when I read about this as a lot of this data just confirmed my research data. So these are just examples and I state that when I cycle, when I use the bicycle instead of a car, it is not only good for my own health, it is also good for local health, for the health of my neighbors. Now you might say, I can't understand, how can it help your neighbor? Your neighbor might go to the pub and drink a lot of alcohol and smoke, and how can your cycling be good for your neighbor's health? But nevertheless, it is quite true that as long as we use the bicycle instead of a car, or we walk, or even if we walk and use the train, we produce less carcinogenic substances, less noise, we need less space. less noise, we need less space, and all this contributes enormously to the health, to the general health of the local population. But it also contributes to global health, because we produce less carbon dioxide, and therefore this has a diminishing effect on global health. You see, I show you this as it was published in the Austrian newspaper Standard in the year 2008. Climate change leads to hunger. You see, this is 13 years ago. So the problem was present. People knew about it. Why did politicians sleep? I published several papers during those years. consequences of climate change associated catastrophes in developing countries or in global south as we say today and you see that there is an enormous increase from the time of 75 to the time of now and this study goes up to 2004 but i can tell you I checked the data from food and agricultural organization and the values are even worse like now. So it is over 300 million people who are suffering in global south, suffering from negative consequences of climate change and the small very small black columns here this is the amount of people in industrialized countries who are suffering from the consequences of climate change though it's quite clear and this data are from United Nations, it is from the so-called Human Development Report of 2007 and 2008. So it's quite clear that OECD countries, rich countries are producing the problem, are creating the problem, but those who suffer are mainly people in the global south. And this is also from food and agricultural organizations. It shows that we were happy that we could reduce hunger at the global scale, but now it is increasing again slowly because of climate change. So to summarize, health from cycling has individual, local, and global positive effects. Now, some of you might say, yes, but isn't there an increased danger of accidents when you cycle? There are several studies. There were studies made. This is an older one. It's already from 2000. And it shows clearly that those countries who promote cycling very much, typically in Europe is Denmark and the Netherlands, you know, they have less traffic accidents overall. And this is another conclusion. So outweighing cycling benefits versus cycling risks. Of course, there are limits to cycling. I cannot tell you everything about cycling, but just a few important things. I do special presentations about bicycle cycling. There I bring many more examples and I talk about my experience, etc. But, you know, there are often prejudices. You cannot cycle when you have small children and this is just an example to counter tick then to show that this is not true or you cannot bicycle when you have a small child or you cannot bicycle for shopping you need a car or when it is raining your bicycle will not serve you and therefore I show I like to show this picture from Amsterdam it's raining the lady has a small child she goes shopping and it is possible with the bicycle. About 13 or 14 years ago I developed a game where you can learn about the so-called mobility game. I held many workshops. I received several awards and prizes for this. These are pictures from workshops with students, how to create more sustainable transport concepts, mobility concepts, but we do not have the time to explain the game right now. Even if you are handicapped, there are bicycle solutions, as you can see here. And even if you have more things to transport, there are bicycle solutions. I have been living without a car for many years and till now. So, I mean, it is a matter of creativity to live without the car. Your Christmas tree you can bring home on a bicycle. You don't need a car for that. And even in winter, I did a lot of patient visits even in winter on my bicycle, of course, you have to learn how to drive in winter. And I have a long experience with holidays, more than 40 years, holidays without car and plane with my wife. We visited many European countries without using car and plane on bicycle and train. and plane, on bicycle and train. This was on a lecture tour over Europe many years ago. So some other pictures. And when I was invited at Columbia University in New York to give a presentation and to hold a seminar there, and wanted to avoid flying so I used the transport on a container ship first I thought I should try to find a place on a sail ship but when I learned that the sailboat has a higher footprint than a seat in an airplane I found out that this is not the solution and so the lowest footprint solution is to go on a container ship and that's what I did when in 2014 and 15 I was at Columbia University here you see my folding bike on the rope in the in within the ship and this is in arriving in Chester near Philadelphia. And from there in four days, I cycled to New York. But now I want to come to the triple benefit principle as that's how I called my theory. But it is not a theory made in my room. It is a theory based on a lot of practical experience and a lot of experimenting. So, triple benefit principle means that you try to live a sustainable lifestyle. And a sustainable lifestyle means to keep your carbon footprint low. And I found out the bicycle is an ideal concept to do this. But you have to be creative in order to really be able to avoid car use. But it is not only about transport. You can also reduce your carbon footprint in nutrition and in the way you live in housing. Try to move towards a circular economy. Of course, there are factors we cannot influence because we have to buy certain goods and we do not have an overall influence on the production of these goods. So the first benefit is that you keep the carbon footprint low. Cycling stands here for a sustainable lifestyle Of course, it's also possible without the bicycle There are people who do not even need a bicycle If they have only very short distances to cover But I move around a lot And therefore I do a lot on bicycle I always move on bicycle And sometimes on bicycle and trains When the distance is too large. Now, the second benefit is, of course, the improvement of health. And I told you, individual, local and global health. But that's not enough. You save money if you live this way, but it is very important what you are doing with this money. Because if you say, oh, now I have saved money, I can buy other consumer goods, I can do an extra holiday, then you will produce exactly a new footprint in the holiday or in the consumer good you buy. And therefore, I used this money in order to invest in renewable energy. And after about 10 years, I had reached my so-called energy break-even point. So in that moment, this was around the year 2007, I was able to provide to the general public the same amount of gross energy that I need for my life. My energy consumption as a general practitioner living in the country was rather high. The Austrian average is at 45 kilowatt hours, 45,000 kilowatt hours per year. I could give you exact data. People are always surprised when I tell this because they only have in mind the electric current they need for the household. But the overall energy consumption per citizen or per inhabitant in Austria is extremely high. It is about 45,000 kilowatt hours per person. per person. And the overall carbon footprint per capita inland is about between eight and nine tons of carbon dioxide, but you have to add another four or even a little bit more tons because we import a lot of goods. And these are produced in other countries, but the footprint is for us. So this a little bit about triple benefit principle, I recommend you to see the film. Three years ago I was able to produce a short film. You can find it in the web. You just Google or DuckDuck my name and you will find links or you search for triple benefit principle and you will find this film. Now you might say, yes, but this is not the change of the whole system. This is only an individual action. Yes, it is absolutely true. And therefore, we have to fight for a really good climate policy, including a carbon tax. There are proposals. You might remember, in 1990, Sweden introduced the carbon tax. Then there was the European plan. The law was already prepared for a carbon tax all over Europe. Imagine 30 years ago, 29 years ago in 92. But the industry lobbies, strong lobbies in Brussels were against it. And the law didn't come out. Brussels were against it and the law didn't come out. Now there are more speakers, more voices for a carbon tax. And to compare carbon tax with my triple benefit principle, I can tell you, you know, the overall proposal or the average proposal for a carbon tax is taxed between 50 and 100 euro per ton of carbon dioxide. Here I show you my own results of saving. I started with about 1,000 euro in a year I could save only from from switching from car to bicycle in a year. But as my footprint was already smaller than average overall, so this is about 100 euros per ton of carbon dioxide. I invested it in the production of clean electric energy, wind energy and solar energy, mainly some other investments too. But then with improving my technology, with improving my strategy, I saved more and more. I could save 6,500 euros in a year and my footprint at the same time had shrunk down to 6.5 tons of carbon dioxide. So this was 1,000 euro per ton of carbon dioxide produced. So this is much higher than what the strictest economist demands as a carbon tax. This is to show you that the change, the transition is possible if we really want. Triple benefits principle is, let's say, a stone on the way. I, as an individual, I cannot introduce a carbon tax. It is a legislative problem. In order to make this more clear, I like to compare two facts. Norway is proud of having 50% electric cars, of new cars, of having 100% of electricity from water power etc but all this norwegian transformation has been financed by the exporting oil and gas and this appeared in 2019 nine years earlier 2010, I published an article in the Globalist Review, and allow me to quote myself. In 2010, I wrote, oil companies facing coming energy transition are about to extract and sell as much oil as possible in order to invest the assets in sustainable future projects. The consequences are catastrophes like in the Mexican Gulf, maybe you remember, and increasing greenhouse gas emissions. Triple benefit principle follows a different and a more effective path. It's just the opposite path. The immediate reduction of fossil energy consumption to a minimum and the investment of their achieved savings in the provision of renewable energy and in further carbon reducing or carbon binding projects. Through the targetless implementation of cycling, besides of ecological and economic benefits, there are large health gains for the common good. These gains can now be assessed by this heat for cycling I just told you before. So I hope you understand what I mean by the difference between these two policies. of investment is done, is made in fossil energy, as you might know, even in Austria. Yeah, you know about this data, I suppose, and you can find them easily. Of course, triple benefit principle can only be voluntary. benefit principle can only be voluntary. But here I want to show you again the differences between carbon tax and triple benefit principle. And for me, triple benefit principle is even valuable once carbon tax is introduced. And it has the big advantage if carbon tax one day really works for investment in sustainable instruments, then I have the money because I can use this money to pay my reasonable carbon tax. And I do not need anymore to invest privately in solar and wind energy. in solar and wind energy. So here I composed four reasons, but our time is ending. And therefore, I just want to give you short information. There is an interesting report from WHO about health impacts of circular economy. This is rather new from 2019. These are a few data from my own research. I will not explain you, but I want to show you that triple benefit principle is not only about cycling. You can find the same principle, for instance, in developing countries, when you provide clean stoves, you know, you need less energy for heating, you produce less health risks, so you have better health and you have lower cost. And I often ask my students when they write their seminar papers, try to search for this triple benefit principle. It is, there are many possibility. This is another possible illustration, open fire versus closed fire. And the same in meat eating, you know, less meat, less meat eating, less meat meats means less need of surface water, less greenhouse gas production. But at the same time, it is healthier because if we eat less meat, we have less cardiovascular diseases and less cancer, and it is cheaper. So you can find the same triple benefit principle in many places. Now, my last word is about the so-called green paradox. As in my very early years with triple benefit principle, I think it was around 2006 or 2007, I had already published some papers. I had a discussion with Heiner Flassbeck. And you know that some economists say, well, it is nice if you try to reduce your own carbon footprint. But what happens is that if less oil is consumed by industrialized countries, then the oil price will fall according to the law of economics, less demand, prices go down, and then just the developing countries and poor countries can afford more oil, and there we will produce more greenhouse gas. I agree that there is this danger, but this danger is embedded in our economic system. And here is the demand for a change. I'm sorry that I can't explain this deeper. I would like to recommend to see the 15-minute short film about the triple benefit principle. You find an English version and a version with German subtitles. You see the film received many awards in almost all continents of the globe. And with this, I thank you very much for your attention and I am open for discussion.