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Confronting the health challenges of climate change

Next month His Royal Highness The Prince of Wales will give the opening address at The health emergency of climate change, the opening event in a new 10-part RSM series that will position health and wellbeing at the centre of the climate change discussion. In this article RSM Trustee Professor Linda Luxon highlights the role health professionals are playing in tackling the challenge of climate change head-on.

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% of those aged 14-18 considered that there is a climate emergency. 58% 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 decarbonisation, committing to reduce greenhouse gas emissions by at least 68% 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 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.

View of Earth taken by Apollo 11 crew members. Image courtesy of NASA.

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 under nutrition 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.

Courtesy of American Public Health Association.

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% 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 (1).

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% 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% 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 RSM 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.

The health emergency of climate change webinar will take place on Tuesday 16 March at 6pm.

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