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Battlefront: Challenging a climate of inaction

Health issues are inextricably linked with climate change, and by tackling health concerns we automatically challenge climate change.

This is the message from Dr Ilan Kelman of University College London’s Institute for Risk and Disaster Reduction (IRDR) and co-author of the 2015 Lancet Commission report on health and climate change.

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Dr Ilan Kelman, IRDR

Dr Kelman’s mandate is to bring together health and disaster research, integrating climate change into each area and covering such aspects as disability and disaster, casualties in disasters, mental health impacts of climate change, disaster diplomacy and health diplomacy.

“Climate change exacerbates already existing medical conditions,” Dr Kelman emphasises to the Medical Independent (MI). “We already know that many countries are not taking care of their health services properly and not focusing fully on preventative health measures and are often under-funding a lot of very simple and straightforward approaches that would improve the health of communities and individuals.

“Climate change is one more factor that will exacerbate many of the problems we are experiencing, as well as drawing resources away from some of the fundamentals regarding healthcare and health systems.”

The other dimension, he says, is that actions taken by countries to achieve better health outcomes and healthier lifestyles can be undermined by the impact of climate change and not dealing appropriately with its dangers.

 “A lot of the measures which are promoted to do with climate change are also promoted for good health. A very good example is what is called ‘active transport’ — rather than simply getting into one’s private vehicle all the time, it means more walking and more cycling, and providing the infrastructure to avoid conflicts on the road and to support walking and cycling. That’s good for health, that’s good for lifestyle, that also helps with climate change and many of these measures also work simultaneously for health and for addressing the challenges and impacts from climate change.”

‘This is an invitation to anyone working in the medical field to recognise that the combination of dealing with health and dealing with climate change and dealing with disasters all result in a common agenda’

Some countries are making progress in dealing with these health impacts, but others are slower to do so, he suggests. “When we look at both health and climate change there are some positive and negative aspects. In many cities around Europe, they have done wonderful jobs in terms of promoting different forms of transport that are not dependent on fossil fuels and that’s very good for health and that’s very good for climate change.

“We see a lot of measures from small island states such as Tongo, in the South Pacific, and in cities like London and Dublin, where people are recognising that we have to deal with climate change and are putting measures in place to try and think long-term about what this means for rising sea levels, for more intense heatwaves and coldwaves — this is not just about climate change, this is about healthy and safe living.

“Climate change will increase the number of heatwaves in Europe, so putting measures in place is good for health by reducing heatwave deaths. There’s progress being made in some ways but we still have a long way to go. A lot of it is very much about the fundamentals of good health and good lifestyles. We see cycle lanes, for example, increasing in London but we still see a lot of car and bicycle conflicts.”

Investment

Dealing with climate change — and its impact on health — saves lives and brings economic benefits, Dr Kelman outlines. “It’s not so much a cost as an investment. The work we’ve done [in the Institute for Risk and Disaster Reduction] shows that investing in measures to reduce disaster risk can have a payback of between four times and all the way up to 50 or 60 times as much as the money invested.

“So even if one’s ideology were that everyone should take care of themselves and we shouldn’t really care about helping people, if we want to save money we would invest in measures to reduce disaster risk, and it’s the same with health.

“We know that in many countries around Europe, health systems are underfunded and overburdened. Medical practitioners are being hit in many ways by government policies that seem almost designed to support privatisation. But there are a lot of costs associated with public healthcare. If we promote healthier lifestyles, if we recognise that there are ways in which people could enjoy their lives much more and be healthier for it, we are going to save so much money from the health systems and from taxes.

“So fundamentally, we prefer to say this is about life, lifestyle, livelihood, health, good living, safe living and if people want the economic argument, the numbers are absolutely there. Dealing with health and dealing with climate change saves a lot of money.”

Still, the world’s most powerful leader appears to be ignoring such arguments. US President Donald Trump came to office pledging to cancel US commitments to support UN climate programmes and dismissed global warming as a hoax “created by and for the Chinese in order to make US manufacturing non-competitive”.

However, it’s not just the US that needs to take the problem more seriously, says Dr Kelman. He emphasises that all world leaders need to be doing far more. “The Paris Agreement [in 2016 on emissions reductions] was mainly voluntary. Even if all voluntary measures were implemented 100 per cent, we still wouldn’t have the impact on climate change that we need.

“The Paris Agreement is just one mechanism among many that people are pursuing for climate change. We’ve now had a generation of these conferences going back to Kyoto (in 1992), and now we have Paris and we still do not have a substantive legal international agreement. I think it is time to move beyond these processes and do what we know is effective. What we know is effective is coming out of the Lancet Commission that says by tackling health concerns, we automatically tackle climate change.

“So where there is hesitation, where there is scepticism on climate change, maybe what we need to do is say, ‘Do you want a healthy lifestyle?  Do you want a safer environment? Do you want a more fulfilling life?’ And if we can get agreement on those, and people start making decisions about their health and the health of those around them, not only will we have a healthier system, not only will we be spending much less money on health-related conditions, not only will we be spending much less money on disaster-related responses in construction, by definition we are also going to be tackling climate change, irrespective of the Paris Agreement.”

Dr Kelman stresses that medical practitioners have a key role to play. “This is an invitation to anyone working in the medical field to recognise that the combination of dealing with health and dealing with climate change and dealing with disasters all result in a common agenda, which is all about safe and healthy communities and lifestyles.

 “To me, both climate change and health are human issues. We know that a lot of it is about attitude and behaviour and values that then lead to certain health outcomes. Climate change is one input among many into that. In some circumstances, it’s the biggest one; in some circumstances, it’s not that relevant. So we have to recognise what are we are trying to do in the long term. In the long term, for me, it really is about individual community and environmental health. Climate change impacts on that but if we tackle only climate change in its own silo, we may or may not resolve the fundamental issues. Conversely, if we tackle the fundamentals of health, then by definition we resolve climate change.”

Cardiovascular disease

Dr Blánaid White, Lecturer at Dublin City University’s School of Chemistry and Principal Investigator in the university’s Water Institute, also underlines that climate change has a major impact on a range of medical conditions, like cardiovascular disease and COPD.

“In Ireland, we are expecting wetter, damper winters and hotter, drier summers and if you look at diseases here like cardiovascular disease, the additional heat stress, even a couple of degrees during these increased drier periods are going to lead to additional stress,” Dr White tells MI. “If you add in the additional stress and all the factors that are impacting health, the cumulative impact of these different components is what leads to an event like a heart attack. Additional heat from climate change is another one of those factors.

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Dr Blánaid White, DCU

 “Additional heat stress is going to affect your hydration levels, for example, so if you think about all the medical conditions where hydration is very important, this is going to impact across the board if you’re a more vulnerable patient. If you don’t have cardiovascular disease, then climate change is not going to give it to you, but if you do have it, then climate change could promote and accelerate it.”

Climate change also means that plants are starting to arrive earlier. This is having repercussions not just for the environment, but also for people’s health and wellbeing. “Where traditionally some plants might be expected not to arrive until March or April, we’re now beginning to see them in February or March. Some of that is within normal variability, but some of it is being driven by climate change and when you change the seasons of plants and their cycles you are affecting plant and animal interactions.

“Pollens are around for longer periods so for those suffering with airway conditions like hay fever, prolonged exposure to different pollens can make them feel very miserable. Pollinating in the past that mightn’t have been until May, you’re now seeing at the end of April and you’re getting that longer window where you can be exposed to pollens that can drive your hay fever crazy.”

The other aspect to consider is the repercussions from increased dampness in winter. “You see increases in mould, so people in Ireland who suffer from COPD or airway illnesses are now more vulnerable.”

She also cites the growing threat to people’s health from tick-borne diseases. “The increasing incidence of Lyme disease, a typical tick-borne disease, is directly related to precipitation. Because northern Europe is predicted to experience increased precipitation, this is going to influence tick distribution and shift exposure patterns of tick-borne disease. All that increases the possibility of outbreaks of those diseases.

“We don’t want to frighten people unduly or give cause for alarm but a vector for the dengue fever virus has been seen in southern Europe over the last decade, and this raises the possibility of dengue outbreaks [in that region],” Dr White cautions.

Are we doing enough here in Ireland to raise awareness of climate change and counter its effects on our health? “I go back to the idea that the effects are cumulative and this is one of those issues on which, as a society, we can have an impact.”

The medical profession is cognisant of the impact that climate change will have on its patients, says Dr White.

“For example, in the case of cardiovascular disease, working with patients to improve their diet and increase their fitness — all those things are going to increase their resistance to increased heat stress as well, so a lot of the steps that patients are advised to take to improve their general health will increase their resistance to the impact of climate change. I think the medical profession is very well aware of what those increased stresses are going to do to their patients.”

While the impact of climate change in Ireland may never be as dramatic as in other parts of the world, it will exacerbate existing conditions. “While people sometimes view climate change and its health impacts in terms of those who die from famine or from drowning caused by floods, our own health and the health of our population is also going to be impacted in smaller ways by climate change by exacerbating existing conditions that people might have.

“The likelihood of Ireland being suddenly turned into a desert and having months of no rain and not enough food and having a famine are hopefully miniscule, but people should realise that even small temperature changes and increased precipitation are going to impact the health of the population.”

Prof Ivan Perry, Head of the Department of Epidemiology and Public Health, Faculty of Medicine and Health, University College Cork, tells MI that climate change has an impact on health at every level.

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Prof Ivan Perry, UCC

“Climate change affects such a wide range of factors, all of which at some level impact on health. Climate change impacts on agriculture in different parts of the world. It impacts on forestry, water resources, sea levels, coastal areas and species and biodiversity — all are important in themselves but they also have impacts on health.

“The main effects of climate change that we are already seeing is the increase in number and intensity of extreme weather patterns in terms of floods and hurricanes and heatwaves, which can cause suffering and death and devastation. During the 2003 Paris heatwave, for example, in the space of about 10 days there were close to 1,000 extra deaths in August beyond what you would expect for that period.”

Prof Perry also stresses that rising global temperatures are going to influence the transmission of a wide variety of vector-borne diseases. “Malaria and dengue fever would be two major ones, not for us but globally, these are massively important issues. The effects of vector-borne diseases are likely to be trivial [in Ireland] but when you have a rise in average temperatures, vulnerability to diarrhoeal diseases like salmonella also increases. Even in wealthy, developed countries, temperature does influence rates of diarrhoea.”

Sounds like a plan: 10 ways of tackling climate change

Responding to climate change could be the greatest global health opportunity of the 21st Century, according to the 2015 report by The Lancet Commission on Health and Climate Change. To help drive a transition to a low-carbon economy, the Commission recommends that governments:

Invest in climate change and public health research, monitoring and surveillance.

Scale-up financing for climate-resilient health systems worldwide.

Protect cardiovascular and respiratory health by ensuring a rapid phase-out of coal from the global energy mix.

Encourage a transition to cities that support and promote lifestyles that are healthy for the individual and for the planet.

Establish the framework for a strong, predictable and international carbon pricing mechanism.

Rapidly expand access to renewable energy in low-income and middle-income countries.

Support accurate quantification of the avoided burden of disease, reduced healthcare costs and enhanced economic productivity associated with a low-carbon economy.

Facilitate collaboration between ministries of health and other government departments, empowering health professionals and ensuring that health and climate considerations are thoroughly integrated in government-wide strategies.

Agree and implement an international agreement that supports countries in transitioning to a low-carbon economy.

To help drive this transition, the 2015 Lancet Commission will develop an independent Countdown to 2030: Global Health and Climate Action report, designed to monitor progress on the implementation of climate change policies that promote health over the next 15 years.

(Source: The Lancet)

Food

Another aspect of climate change is its effect on food supply. “The impact on food supply in terms of droughts, famines, refugee crises and civil conflict will loom larger and larger in the future, particularly conflicts over water. It has the potential to set back (healthcare) progress in many countries but especially in poorer countries that are already grappling with major health and economic issues.”

Prof Perry says Ireland has a major role to play in responding to such global health crises, and in terms of dietary changes at home that would leave this country less dependent on the consumption of meat.

“All countries are interdependent in the modern world and Ireland must play its part in terms of the overall global response,” he stresses. “We must be prepared to take measures with our food production in the dairy sector as regards the issue of methane gas. For both climate change and health reasons, we must move away from a diet heavily dependent on meat and dairy produce.

“Many of the changes that would help deal with climate change we should be making anyway for the sake of our health and wellbeing. The efforts to tackle obesity and climate change go hand-in-hand. We cannot separate them. Everything we do as regards controlling our calorie intake, including calories from meat and dairy, and increasing our walking and cycling, and so on, will have a profound effect on our health and wellbeing in terms of heart disease and cancer and it will also reduce our carbon footprint. So it’s a win-win scenario between health and climate change.”

The year 2016 was the hottest on record for the third time running. Prof Perry warns that “we may be nearer than we realise to some sort of a tipping point, so there is perhaps a greater level of urgency than we imagine”.

A properly-functioning public health infrastructure is also critical. “This is the capacity to detect when things are going wrong and to respond quickly. It is disaster preparedness so that if there is a major outbreak of an infectious disease or a major catastrophic weather event, we have the health intelligence and resources to respond.”

The World Health Organisation has sounded a chilling warning. It estimates that between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.

In Prof Perry’s words: “Now is the time to act.”

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