Climate Changes May Eradicate 50 Years Of World Health Progress (In Depth)

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“Recent decades have witnessed dramatic progress in global health,” says the US Agency for International Development. Smallpox has been eradicated within the past half century. In all but three countries (Afghanistan, Nigeria, and Pakistan), polio has been wiped out. Use of modern methods of contraception has increased from 10% in 1965 to more than 50% in 2013. Child deaths from diarrhea have been cut in half since 1990. Malaria deaths have fallen by more than a quarter globally since 2000. Only half as many mothers died in live childbirth in 2010, compared to 20 years earlier. Unheard of 50 years ago, HIV/AIDS has now transited from certain death to a chronic ailment.

Developed and developing photo, from Costello et al, 2009  (

But climate change could quickly wipe out the past 50 years of world health progress.

Thanks to the power of the internet and the tenacity of a commission formed years ago under the auspices of The Lancet (one of several world-recognized medical journals), however, the world has just gained a comprehensive and forward-looking, reliable perspective on the subject of human health and climate change—a force that could impact our lifestyles more than any individual actions (exercise, diet, purchasing an umbrella, etc.) that we might pursue. This new report from leading world experts on environmental health begins:

“Climate change is one of the defining challenges of the century, and increasingly recognised as a public health priority. Research in this field is increasing, but is comparatively undeveloped in view of the complexity of the issue and the potential magnitude and range of health consequences. For example, the average annual number of articles published in PubMed-indexed journals that referred to ‘health’ and either ‘climate change’ or ‘global warming’ more than doubled between the early 1990s and the middle of the current decade.”

The report compares in scope and ambition to the Fifth Assessment Report from the United Nations Intergovernmental Panel on Climate Change, which will form the scientific basis for the proposed international agreement at COP21 in Paris this December, or the US National Climate Assessment. The difference: the 2015 medical study from The Lancet holds a current snapshot of all human knowledge about how changes in climate—especially the anthropogenic changes of the past two centuries around energy use—may play out for the health of the entire human race on Earth.

Greenhouse gas emission effects on health (
Greenhouse gas emission effects on health (

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The Lancet initially formed an initial multidisciplinary international Commission on Health and Climate Change, with strong collaboration among academic centers in Europe and China. Its purpose: “to map out the impacts of climate change, and the necessary policy responses, in order to ensure the highest attainable standards of health for populations worldwide.” The Lancet and University College London, UK, produced the first Lancet Commission report (Costello et al.) in London in May 2009.

It sets out how climate change over the coming decades will be the biggest global health threat of the 21st century. In fact, it could have a disastrous effect on health across the globe.

Potential tipping points in climate systems from Costello et al, 2009  (
Potential tipping points in climate systems from Costello et al, 2009 (

“Effects on health of climate change will be felt by most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, the earth’s average surface temperature rises are likely to exceed the safe threshold of 2°C above pre-industrial average temperature.”

The first report outlines all the major threats—both direct and indirect—to global health from climate change. These derive from changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population migration. The report presents these results in four sections:

  • The physical basis.
  • Health impacts of climate change.
  • Non-linearities, interactions, and unknown unknowns.
  • Health co-benefits of emissions reduction.

To emphasize the multiple health co-benefits, the authors have created a magnificent graph (see pdf) showing which major mitigation techniques are allied with them. It also charts dozens of interrelationships.

The report concludes from 175 references that a new advocacy and public health movement is needed urgently to bring together governments, international agencies, nongovernmental organizations, communities, and academics from all disciplines to adapt to the effects of climate change on health.

The World Health Organization has also worked proactively on the subject. WHO held the first-ever global conference on health and climate in Geneva last August. It brought together over 300 participants—government ministers, heads of UN agencies, urban leaders, civil society leaders, and leading health, climate, and sustainable development experts–and paved the way toward the UN Climate Summit organized by Secretary-General Ban Ki-moon in September. WHO concluded then that measures to adapt to climate change would ensure that communities are better prepared to deal with the impacts of heat, extreme weather, infectious disease, and food insecurity. Through careful planning, these efforts could save lives around the world.

In the US, the point agency for state and city health departments to prepare for specific health impacts of climate change is the Climate and Health Program of the Centers for Disease Control and Prevention. Its missions:

  • Lead efforts to identify populations vulnerable to climate change.
  • Prevent and adapt to current and anticipated health impacts.
  • Ensure that systems are in place to detect and respond to current and emerging health threats.
Indian Ocean coastline of Phuket, Thailand, before and after the 2004 tsunami, from Costello et al, 2009  (
Indian Ocean coastline of Phuket, Thailand, 2004 tsunami, from Costello et al, 2009 (

Fast forward to Monday, June 22, 2015—the day the Lancet Commission publishes its long-awaited second major report: Health and climate change: policy responses to protect public health, from Nick Watts et al. In it, the internationally respected team lays out the policy responses necessary to ensure the highest attainable standards of health for populations worldwide in the face of projected climate alterations.

Naturally, many will find the unknowns and some of the science terrifying. However, the central finding from the Commission’s work is that tackling climate change could present the greatest global health opportunity of the 21st century.

The text is also informed by a section on generic barriers. Opposing national (and vested) interests, clashing views of what constitutes fair distribution of effort, and a model of economic growth that is tied to current fossil fuel use can all impede progress. The decades-old UNFCCC process has been stymied at one time or another, and is still held up, by all of these. The Commission cites Hulme, 2009, on a few specific barriers:

  • Uncertainty and complexity.
  • Psychological distance along four dimensions—temporal, social, geographical, and degree of uncertainty. (People tend to connect more easily with issues that are close in time, space and social group, and about which there is little uncertainty. All these dimensions interact with each other and tend to dampen concern and willingness to act.)
  • Enormous lock-in to current economic patterns, e.g., addiction to fossil fuels and/or the services they provide.
  • Active promotion of misinformation, motivated by either ideology or vested economic interests. A major study of the Climate Change Counter Movement in the US identifies funding of around $900 million annually.

The Commission also offers a useful look at the influence of public opinion. “Ultimately, effective actions by local and national governments, and by businesses, are unsustainable without supportive public opinion.” Public support for stronger action on climate change is a necessary, albeit far from sufficient, factor that is essential for behavioral change to contribute to solving the problem.

Cross-national studies suggest that most people view climate change as a threat, although its degree can vary significantly among regions. As of 2013, over 60% of people in parts of Europe (Greece, Spain, Italy), Lebanon, Tunisia, Uganda, South Korea, Japan, the Philippines, and most of South America see climate change as a major threat. Belief in climate change as a major threat is only held by 40% of US citizens in this tabulation, about the same as in China, although fewer Chinese consider it not a threat than Americans. Canada, Australia, the UK, and Russia all think climate change is a worse threat than US citizens do. Only Egypt, Jordan, Israel, Pakistan, and the Czech Republic (torn by dissension for centuries) view it as less of a major threat, and they have more immediate problems.

The Commission’s writers go on to state that public understanding of climate change is shaped by broader knowledge, religious convictions, and political belief systems. They make the point that effective communication about climate change requires trust. However—and this is odd in the context of last week’s encyclical from Pope Francis—they neglect the power of the pulpit and religious gatherings, citing only “family and friends, environmental groups, scientists, and the media” as the most trusted sources. Local and city-level authorities may provide an important conduit for information, the writers say. However, to engage effectively with the public, scientists need communication skills radically different from those of academia. They must convey a big picture of climate change for the public to engage and internalize for future discussions of new scientific results and their consequences.

Here’s what else the second report includes.

Climate change and exposure to health risks. Reexamines causal pathways between climate change and human health. Offers up-to-date estimates of exposure to climate health risks in the coming decades.

Direct and Indirect effects of climate change on health and wellbeing (

Action for resilience and adaptation—measures that must be instituted to lessen unavoidable health impacts. Adaptation strategies will reduce human vulnerability and enhance resilience. Institutional and decisionmaking challenges exist related to uncertainty, multicausal pathways, and complex interactions between social, ecological, and economic factors. The section also reveals tangible adaptations that provide clear no-regret options and co-benefits related to food insecurity, human migration and displacement, and dynamic infectious disease risks.

Transition to a low-carbon energy infrastructure. Immediate analyses needed: epidemiology, options for scaling up low-carbon technologies and responses, measures required to facilitate their deployment, health implications of various mitigation options, with particular attention to actions that both promote public health and mitigate climate change.

Financial, economic, and policy options for decarbonization. Mitigation policy should be to reduce cumulative and annual greenhouse gas emissions in order to delay climate disruption. It will also reduce the overall cost of abatement by avoiding drastic and expensive last-minute action. Immediate action offers more technological options, allows economies of scale, promotes learning, will reduce costs over time, and holds the window of opportunity open for longer so that new technologies can develop, be commercialized, and deploy.

Delivering a healthy low-carbon future. The authors examine the political processes and
mechanisms that might play a part in delivering a low-carbon economy here. They consider multiple levels, including the global response (UNFCCC), national and subnational (cities, states, and provinces) policy, and the role of individuals, with emphasis on the interaction between these levels and lessons learned from public health.

Bringing the health voice to climate change. The Commission proposes forming an international Countdown to 2030: Global Health and Climate Action. An international, multidisciplinary coalition of experts should monitor and report on the following:

  • Malnourished child suckling, from Costello et al, 2009  (
    Malnutrition and disease, from Costello et al, 2009 (

    Health impacts of climate change,

  • Progress in policy to reduce GHG emissions and synergies used to promote and protect health; and
  • Progress in health adaptation to reduce population vulnerability, build climate resilience and to implement climate-ready low-carbon health systems.

The Countdown process would complement rather than replace existing IPCC reports and would bring the full weight and voice of the health and scientific communities to this critical public health challenge.

The Commission also offers 10 underlying recommendations to accelerate action within the next 5 years. The timeline corresponds exactly with the UN’s 2015-2020 scenario. Many international players view this stage of preparations as inadequate. Here are the Commission’s recommendations.

The report begins by stating that effects of climate change are being felt today, and that future projections represent an unacceptably high—and potentially catastrophic—risk to human health. The Commission recommends that over the next 5 years, governments:

  • Invest in climate change and public health research, monitoring, and surveillance.
  • Scale up financing for climate-resilient health systems worldwide, including strengthening health systems in low-income and middle-income countries that will ultimately play into overall health.
  • Protect cardiovascular and respiratory health by ensuring a rapid phaseout of coal from the global energy mix. Over 2000 coal-fired plants are currently proposed for construction worldwide that will damage health unless we find cleaner energy alternatives, the Commission reports. Transitioning to renewable energy will require a cautious use of natural gas (presumably also its withdrawal).Connections between global energy system and health impacts (
  • Encourage a transition to cities that support and promote lifestyles healthy for the individual and for the planet. Develop highly energy-efficient building stock, low-cost and easy transportation, and more access to green spaces.

The Commission points out that achieving a decarbonized global economy and securing the public health benefits it offers is no longer primarily a technical or economic question. It is now a political one. The authors recommend that over the next 5 years, governments:

  • Establish a framework for strong, predictable, and international carbon pricing.Carbon pricing schemes as of 2015 (
  • Rapidly expand access to renewable energy in low-income and middle-income countries. This will provide reliable electricity for communities and health facilities, unlock substantial economic gains, and promote health equity. A global development pathway that fails to expand here will come at a detriment to public health and long-term economic growth.Health expenditures related to national GDPs  (
  • Support accurate reporting of avoided burdens of disease, reduced healthcare costs, and enhanced economic productivity associated with climate change mitigation.

Because the health community has a vital part to play in accelerating progress to tackle climate change, the Commission recommends that over the next 5 years, governments:

  • Adopt mechanisms to facilitate collaboration among government departments. This will empower health professionals and ensure that climate and health are thoroughly integrated in government-wide strategies. “A siloed approach to protecting human health from climate change will not work.” Additional global environmental changes like deforestation, biodiversity loss, and ocean acidification must be addressed.
  • Agree and implement an international agreement that supports countries in transitioning to a low-carbon economy. This recommendation should be pursued in the international agreement expected in Paris this December. It will replace the Kyoto Protocol. The Commission adds: “While the negotiations are very complex, their goals are very simple: agree on ambitious and enforceable global mitigation targets, on adaptation of finance to protect countries’ rights to sustainable development, and on the policies and mechanisms that enable these measures. To this end, international responsibility for reducing greenhouse gas emissions is shared: interventions that reduce emissions and promote global public health must be prioritized irrespective of national boundaries.”

To help drive the transition, the 2015 Lancet Commission on Health and Climate Change will develop a new, independent Countdown to 2030: Global Health and Climate Action. This program will both provide expertise in implementing policies that mitigate climate change and promote public health, and monitor progress over the next 15 years. The Commission will report in The Lancet every two years on a range of indicators in global health and climate change.

A very important contribution of this week’s Lancet Commission report is its excellent discussion of “tail risks,” a concept difficult to understand (even for the experts) but critical to any analysis of potential effects of climate change.

Tail risks  (

Health as percentage of gdp ( interesting: Vulnerability, adaptation, and resilience; decarbonization pathways in the IK and China; social costs; health as a percentage of GDP; high-impact mitigation techniques; total external costs of burning fuels (formula and explanation); and heatwave, flooding, and drought scenarios. The study ends with a section called “Optimism” that explains why people should not approach the phenomenon of climate change with fear. Paraphrase being inadequate, we quote it here.

“We should draw considerable strength in the face of the challenges of climate change from the way in which the global community has addressed numerous other threats to health in the recent past.

Although the threats are great and time is short, we have an opportunity for social transformation that will link solutions to climate change with a progressive green global economy, reductions in social inequalities, the end of poverty, and a reversal of the pandemic of non-communicable disease. There are huge opportunities for social and technological innovation. We have modern communications to share successful local learning. At the highest levels of state, there are opportunities for political leaders to grasp the global challenge with transformative climate initiatives of a scale and ambition to match the Marshall plan, the Apollo and Soyuz space programmes, and the commercial success of mobile telephony.

Scalable, low-carbon, and renewable energy technologies require billions of dollars of new investment and ideas. In cities, municipal governments are already bringing energy and innovation to create connected, compact urban communities, better buildings, managed growth, and more efficient transport systems. In local communities transformative action creates greater environmental awareness and facilitates low-carbon transition. And within local government, civil society, and business, many people aim to bring about social and economic transformation.

All of us can help cut GHG emissions and reduce the threat of climate change to our environment and health. At every level, health must find its voice. In health systems we can set an example with scale up of renewables, combined heat and power generation in health facilities, decentralisation of care and promotion of active transport, and low-carbon healthy lifestyles.

But time is limited. Immediate action is needed. The Countdown to 2030 coalition must begin its work immediately.”

Pillars of climate/health policy ( Commission’s new report offers an almost bewildering amount of information to digest at one time. People not closely involved in the science or medicine may profit from the discussion in VOX (“Why climate change is increasingly seen as an urgent health issue”) and the review stack presented there.

Additional resources from The Lancet

Reduce short-lived climate pollutants for multiple benefits. Noah Scovronick, Carlos Dora, Elaine Fletcher, Andy Haines, Drew Shindell.

Achieving a cleaner, more sustainable, and healthier future. Margaret Chan.

Tackling climate change: the greatest opportunity for global health. Helena Wang, Richard Horton.

Action to protect human health from climate change: an African perspective. Kesetebirhan Admasu, Kare Debessa.

Perspective: Peng Gong: remote sensing of near climate change (Fascinating tidbit. Professor Peng Gong, Director of the Centre for Earth System Science at Tsinghua University in Beijing, China, is one of the Co-Chairs of the Lancet Commission on Health and Climate Change. As such he’s had a key role in compiling its new report. But had it not been for a chance decision made some 35 years ago by an anonymous Chinese bureaucrat, he would almost certainly be working in some other branch of science.) Geoff Watts.

Health and climate change: a roadmap for applied research. Diarmid Campbell-Lendrum, Roberto Bertollini, Maria Neira, Kristie Ebi, Anthony McMichael.

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