“Climate change is the biggest global health threat of the 21st century.” (1) I first saw this quote from the Lancet-UCL Commission in 2010 when an older student gate-crashed an anatomy lecture to further alarm medical students in their third week of university. Nine years on and I have quoted this report thousands of times, because, whilst there is now a continuous flow of evidence of the health effects of climate change, the message is still the same, indeed it now carries an even stronger sense of urgency.
The 2018 Report of the Lancet Countdown: Tracking Progress on Health and Climate Change warns us that climate change is already affecting the health of people world-wide through changes in heatwaves, vector-borne diseases, weather-related disasters and food security. (2) In 2017, 157 million more vulnerable people were exposed to heatwaves and 62 billion more hours of labour were lost due to heat compared with 2000. (2) Over half of global cities surveyed expect climate change to seriously compromise their public health infrastructure. (2) What’s more, 30 countries are now experiencing downward trends in agricultural yields, which reverses decades long trends in improvements. (2) Humanitarians working for Médecins Sans Frontières are also documenting these trends in their field work in locations all around the world. (3)
On the other hand, responding to climate change presents the opportunity to improve public health, with well-designed climate change mitigation policies providing health co-benefits. (4) Ceasing combustion of fossil fuels for energy, heating, cooking and transport reduces air pollution, which currently causes 7 million premature deaths annually. (5,6) Poor diets and physical inactivity are two of the biggest lifestyle factors contributing to burden of disease. Switching from cars to cycling and walking as forms of transport and decreasing meat and dairy consumption can reduce incidence and prevalence of type two diabetes, stroke, ischaemic heart disease, breast cancer, colorectal cancer, dementia and depression. (7–10)
The health community plays a crucial role in responding to this public health emergency: to ensure there is widespread understanding of climate change as a public health issue; to lead action within the health sector; and to work with policy makers to take the necessary measures in primary, secondary and tertiary prevention. Indeed, there are already many examples of individuals, institutions and organisations taking action that the global health community can learn from. I’ll outline four areas in which the health community are already making a change in health and climate change.
Formal education on the interlinkages of health and climate change in university curricula and medical training programs is still lacking. The International Federation of Medical Students’ Associations (IFMSA) is working to address the knowledge gap, creating a Training Manual on Health and Climate Change (11) and setting a vision to have an element of climate-health included in the curriculum of every medical school by 2020 and to have an integration of climate-health in all aspects of medical school life by 2025. (12)
The provision of health services can carry a large environmental footprint. To mitigate this, the UK’s Sustainable Development Unit was formed, reducing GHG (greenhouse gas) emissions of the UK National Health Service by 18.5% from 2007 to 2017, whilst clinical activity increased by 27.5% over the same time period. (13) Over 4000 hospitals around the world have committed to the Global Green and Healthy Hospitals Agenda, which includes 10 interconnected goals for the health sector to address and promote greater sustainability and environmental health. (14) In addition to this, 175 institutions, representing the interests of over 17000 hospitals and health centres heave joined the Health Care Climate Challenge to commit to decarbonising their own energy supply. (15)
Health professionals are also becoming political. Health organisations led the push for Canada to commit to a total coal phase-out (16,17) and the formation of the Powering Past Coal Alliance, which now comprises of 30 national governments, 22 sub-national governments, and 28 businesses or organisations committed to phasing out coal. (18) Many leading health organisations in the United States have opposed threats to roll back environmental protection under the Trump Administration. (19–22) The Australian Climate and Health Alliance has developed a Framework for a National Strategy on Climate, Health and Well-being for Australia, outlining policy directions to be taken at the federal, state/territory and local level that meet Australia’s obligations of the Paris Agreement and protect the health of Australians. (23) Health organisations published briefings alongside the 2018 Report of the Lancet Countdown, directed at policy makers of the European Union and of countries including China, India, Brazil and Spain. (24) With President Bolsonaro posing a threat to the Amazon and climate change, the health voice in Brazil has been particularly strong. (25,26)
Health institutions have also joined the divestment movement, moving their money out of investments in fossil fuels. Commitments have been made by the American Medical Association, the British Medical Association, the Canadian Medical Association, the Royal Australasian College of Physicians, the Royal College of General Practitioners and the New Zealand Nurses Organisation. (27) The total number of organisations and institutions from across all sectors that have committed to fossil fuel divestment is almost 1000, with an approximate value of US$7 trillion. (28)
In its Special Report on Global Warming of 1.5 oC, the Intergovernmental Panel on Climate Change cautions of the increased health risks even with 1.5 or 2 oC of warming by 2100. (29) However, we are currently far off track from achieving either of these goals, with the gap between how much greenhouse gas emissions have been reduced and where they should be widening, with a threat of warming of 3 or 4 oC (30) which risks human civilisation as we know it. (31)
The health community is rising to the challenge of climate change and there are many examples of action already happening all around the world. However, a much greater response is required in order to divert from our current trajectory. We need urgent action from the health community and all sectors of society to address the public health emergency of climate change and ensure improved health for all.
Dr. Alice McGushin, MBBS BMedSci (Hons) MScPH
Consultant, Lancet Countdown: Tracking Progress on Health and Climate Change, Vice Chair, World Organization of Family Doctors Working Party on the Environment, Junior Medical Doctor