Confronting the health challenges of climate changeRoyal Society of Medicine Trustee Professor Linda Luxon examines the role health professionals are playing in tackling the defining public health challenge of the 21st century: climate change.
In January 2021, the UN Development Programme in partnership with the University of Oxford published the results of The Peoples’ Climate Vote, the largest survey of public opinion on climate change ever conducted.
1.2 million people spanning 50 countries responded to the survey. Approximately half a million of respondents were under the age of 18. The results show that 69 per cent of those aged 14-18 considered that there is a climate emergency. 58 per cent of those aged over 60 agreed. The UK, which is hosting the UN Climate Conference (COP26) later this year, is one of two countries with the highest level of public belief in the climate emergency.
Much of the media coverage of climate change centres on causation, including fossil fuel usage, deforestation, urbanisation, population growth and farming practices; and the deleterious planetary effects, including air and water pollution, climatic extremes with floods, forest fires, melting ice caps, rising sea levels, loss of plant and animal habitats and food and water insecurity.
However, the impact of climate change on health and wellbeing has had a lower profile, despite the World Health Organization highlighting in 2015 that it is the greatest threat to global health in the 21st century, with former WHO Director General Margaret Chan reporting: “The evidence is overwhelming; climate change endangers human health. Solutions exist and we need to act decisively to change this trajectory.”
Given this warning, healthcare professionals have a crucial role to play in mitigating climate change and adapting health systems. Across the world, they are leading groups advocating for health to have a higher profile within the broader climate change debate, while closer to home, the UK Health Alliance on Climate Change represents more than 700,000 healthcare professionals, with a primary aim of mitigating climate change to improve health and wellbeing.
Last October, the UK NHS became the world’s first national health system to commit to become carbon net zero, backed by clear deliverables and milestones. At the time Sir Simon Stevens, CEO of the NHS in England, said: “2020 has been dominated by Covid-19 and is the most pressing health emergency facing us, but undoubtedly climate change poses the most profound long-term threat to the health of this nation.”
Strengthening the government approach, in December 2020 the UK announced its Nationally Determined Contribution (NDC) to decarbonization, committing to reduce greenhouse gas emissions by at least 68 per cent by 2030, compared to 1990 levels. NDCs are required five yearly as part of the Paris Agreement signed by 196 countries in 2015. Against these aims Glasgow will host COP26 in November and health will be a high priority on the agenda.
The evidence is overwhelming; climate change endangers human health. Solutions exist and we need to act decisively to change this trajectory.
The emergence of climate change as a health issue
Weather and climate change have been known to affect human health since the time of Hippocrates. Human societies have had long experience of naturally occurring climatic events, with disasters and disease outbreaks often occurring in response to the extremes of climatic cycles.
In 1969, extraordinary images of the Earth from the Apollo 11 space mission transformed the world view of the biosphere and its limits and emphasised the need to preserve ecological and physical systems for the future of life on Earth. But by the early 1970s, it was clear that population growth and associated increased economic activity was driving climate change at an exponential rate, putting these systems in danger.
Global population health, which depends on the conservation of the biosphere to ensure adequate supplies of food and water, freedom from pollution and excess infectious disease, and physical safety from floods, droughts and heat waves, is now under threat.
The health issues at stake today
The direct impact of air pollution on respiratory disorders is one of the better known and discussed topics in the climate change debate. However, there are many other, less recognised health detriments.
Extreme temperatures cause heat exhaustion and hyperthermia. Floods, hurricanes, tornados and forest fires cause air and water pollution, injury, population displacement, mental health disorders and death.
Environmental and ecosystem changes cause shifts in the patterns of disease-carrying mosquitos and ticks and the risk of waterborne diseases. They can also lead to the emergence of new pathogens causing infectious diseases, which has been raised as a possible factor in the current pandemic.
Indirect health impacts mediated through societal systems include undernutrition arising from altered agricultural production and food insecurity. Mental illness is associated with the stress of fires, floods, draughts and violent conflict caused by population displacement, from, for example, rising sea levels.
The evidence indicates that poor and disenfranchised groups will bear the most risk and, globally, the greatest burden will fall on poor countries, particularly on poor children who are most affected today by climate-related diseases such as malaria and water borne infections.
But the diverse and global effects of climate change are now common in affluent countries too, with extreme weather events causing forest fires in California and Australia, heatwaves across Europe and recent repeated flooding in the UK. All are associated with increased morbidity and mortality.
Impact on the ground
Healthcare professionals in the developed world are already witnessing at first hand the health impact of climate change. Obstetricians see an increase in low birth weight babies and miscarriages. Respiratory physicians see children with impaired lung growth due to air pollution, while dermatologists observe exacerbations in inflammatory skin disease such as eczema and psoriais caused by allergy, heat and air pollution. Cardiovascular specialists see symptoms aggravated in patients with pre-existing medical conditions and there are reported excess cancer deaths related to climate change.
Populations in low-income countries suffer more from all these health effects of climate change, but especially from the results of extremes of climate and lack of water and soil security leading to outbreaks of infectious diseases including cholera and E.coli, quite apart from malnutrition and reduced life expectancy.
Health systems and climate change
Regrettably, while healthcare networks are a key resource in the management of climate change induced health hazards, they are a significant contributor to the global carbon footprint.
In England, the NHS is responsible for an estimated 4 per cent of the country’s carbon footprint and before the pandemic was producing more carbon emissions annually than all the planes taking off from Heathrow every year.
The NHS England report ‘Delivering a ‘Net Zero’ National Health Service‘, launched by Sir Simon Stevens in October 2020, sets out two clear and feasible targets:
- For the emissions the NHS controls directly (the NHS Carbon Footprint), net zero by 2040, with an ambition to reach an 80 per cent reduction by 2028 to 2032
- For the emissions the NHS can influence (the NHS Carbon Footprint Plus), net zero by 2045, with an ambition to reach an 80 per cent reduction by 2036 to 2039.
There are government plans to meet these ambitious targets, as noted above, but the report makes clears that all healthcare professionals working in the NHS have a role in delivering a net zero health service.
What action healthcare professionals can take
Individual healthcare professionals can lead from the front and ‘walk the talk’. They can encourage their professional bodies and trusts to adopt sustainable polices and practice, from simple measures such as reducing paper use and using recycled paper to promoting active transport through cycling schemes for employees and installing automatic light switches. They can press for more ambitious policies for sustainable procurement, a reduction of transport and built environment energy consumption, together with optimal use of technology to deliver efficient clinical and administrative services. Examples include the novel use of drones to deliver medicines and the introduction of zero emission emergency ambulances.
Individually, healthcare professionals can make changes in their own practice and discipline, with medical royal colleges and organisations including the NHS Sustainable Development Unit providing case studies online to disseminate good practice.
Young doctors instigating change
The Duke of Cambridge has emphasised that young people are ‘shining lights’ in the urgent need to address climate change and its damaging effects on the planet.
A number of medical schools have introduced educational initiatives on environmental sustainability into the curriculum and trainee doctors are often the instigators of change. The establishment of Sustainability Fellowships is a major strategic development to disseminate knowledge, good practice and engage more young healthcare professionals and to ensure that the required transformation of the health service across all disciplines and at all levels takes place.
Influential healthcare leaders around the world are actively engaged in contributing to the climate change and health debate on social media and many will be speaking in the Royal Society of Medicine’s climate change series, alongside their younger colleagues.
Climate change will be the defining public health challenge of the 21st century. In the immediate future, the single most important step that can be taken is to accelerate awareness of the issues which will affect all continents, countries, people and patients to ensure the development of public health strategies, sustainable healthcare systems and medical interventions to reduce the present burden of disease related to climatic conditions.
This article was first published by the Royal Society of Medicine as part of its launch of a new 10-part series focusing on climate change. Each episode positions health and well-being at the centre of the climate change debate. All episodes include input from leading experts in their fields discussing the latest evidence and information followed by an in-depth discussion into the clinical consequences of climate change and what can be done to mitigate these.
Skin in a warming world – Episode 3 – Dermatology
April 13 (18:00 – 19:00 BST)
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This third episode will explore the impact of climate change on dermatological health. International experts will cover how warming temperatures impact skin health, looking at topics including inflammatory skin disease, infectious diseases, cancer, and UV radiation.
Key speakers include: Professor Antony Young, Emeritus Professor of Photodermatology, King’s College London, Member of Environmental Effects Assessment panel of the UN, Dr Mark Dennis P Davis, Vice Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA Chair of the Climate Change Committee of the International Society of Dermatology, Professor Eleni Linos, Professor of Dermatology and Epidemiology, Stanford University Medical Centre, USA Deputy Editor, British Journal of Dermatology, Kate Lawlor, Specialty Registrar, Cardiff, and Misha Rosenbach, Associate Professor, Dermatology & Internal Medicine, Program Director, Dermatology Residence, University of Pennsylvania.
Hazardous temperatures and cardiac health – Episode 4 – Cardiology
April 27 (18:00 – 19:00 BST)
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This fourth episode of the Health emergency of climate change series will explore the links between climate change and cardiovascular health. This episode will cover the scale of this cardiovascular crisis, the range of conditions affected, and the groups who are most at risk. It will also outline the implications for health professionals treating these diseases, their role in communicating with patients about these health threats, and the benefits of a healthy, sustainable lifestyle.
Key speakers include: Professor Annette Peters, Helmholtz Centre Munich, Research Centre for Environmental Health, Munich Heart Alliance, Centre for Cardiovascular Research, and Dr Leslie Cho, Chair of Preventive Cardiology for Cleveland Clinic.
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