healthier, happier and richer

 

• “The implications of climate change for a global population of 9 billion people threatens to undermine the last half century of gains in development and global health. The direct effects of climate change include increased heat stress, floods, drought, and increased frequency of intense storms, with the indirect threatening population health through adverse changes in air pollution, the spread of disease vectors, food insecurity and under-nutrition, displacement, and mental ill health.”
• “Any prioritisation in global health must therefore place sustainable development and climate change front and centre.”

Climate change is not just an environmental issue. It is a public health emergency. The two quotes above are from the Lancet Commission’s report Health and climate change: policy responses to protect public health, (see http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60854-6/fulltext) published on June 23rd. This Commission involved strong collaboration between many academic disciplines and organisations in Europe and China. It cannot be dismissed as western imperialism or tree-hugging romanticism.

Near the start, the report says that “the central finding from the Commission’s work is that tackling climate change could be the greatest global health opportunity of the 21st century.” In part this ‘opportunity’ is to avoid to dreadful consequences that uncontrolled climate change would bring, but the Commission does also identify ways in which public health could be improved from today’s situation. And they conclude – correctly in my view – that:

• “achieving a decarbonised 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 identification of potential public health benefits is probably an attempt to increase the traction of the report among policy makers. In 2009, a previous Lancet Commission on Managing the Health Effects of Climate Change called climate change “the biggest global health threat of the 21st century”. Unfortunately this did not have much impact on political debate: politicians hear enough doom and gloom from campaigners. So the academics are now combining warnings with promises, which could well prove more effective.

Health threats

However, the report retains some powerful warnings. It cites the 2014 World Health Organisation estimate of “at least an additional 250?000 potential deaths annually between 2030 and 2050 for well understood impacts of climate change.” This includes direct and indirect health effects:

• “Climate change significantly alters the probability of extreme weather, most often in directions that have dangerous health consequences.”
• “Floods…have long-term and short-term effects on wellbeing through disease outbreaks, mental health burdens, and dislocation.”
• “Rising temperatures and changes in precipitation pattern alter the viable distribution of disease vectors such as mosquitoes carrying dengue or malaria.”
• “Ground-level ozone…is more readily created and sustained in an environment with reduced cloudiness and decreased precipitation frequency, but especially by rising temperatures.”
• In China…the interactions between climate and a range of pollutants is especially acute.”

How many lives can be saved?

The report notes that extreme weather events kill many people: for example, there were “more than 6000 fatalities as a result of typhoon Haiyan in the Philippines in late 2013.” However, individual weather events cannot definitively be linked to climate change – there have always been typhoons, floods and droughts – and the commission also accepts that some warming is now unavoidable, so there will be more extreme weather. Hence the need for adaptation. Many lives could be saved by reducing extreme weather events, but it would not be credible to put a number on the number of premature deaths that could be avoided, and the commission sensibly does not do so.

The Lancet Commission does put numbers on the number of lives that could be saved by cleaning up air pollution. For example, it says that fine particulate air pollution was “responsible for 7 million additional deaths globally in 2012, mainly due to respiratory and cardiovascular disease.” Those of us living in Europe often see TV pictures of smogs in Chinese cities and are thankful that our air is cleaner. It is indeed cleaner, largely because of EU policies (see http://www.cer.org.uk/publications/archive/policy-brief/2014/green-benefits-britains-eu-membership). But it is not clean enough. London – where my children and I live – regularly breaches EU air quality standards. Most of the pollution comes from vehicles: a Conservative UK government banned the burning of coal in urban areas in the 1950s. And the EU has quite good pollution control standards for power stations. Nevertheless, such pollution still kills people. The Lancet report notes that:

• “In the UK, the associated burden of air pollution from the power sector is estimated to account for 3,800 respiratory related deaths per year.”

The report also cites a paper (West, JJ, Smith, SJ, Silva, RA et al, Co-benefits of global greenhouse gas mitigation for future air quality and human health, 2013. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051351/) in which the authors calculate that decarbonisation, and consequent reductions in air pollution, could avoid half a million premature deaths each year globally by 2030, and 1·3 million a year by 2050.

So what should be done?

The commissioners are not shy of saying what governments should do.

• “The dangerous impacts of coal on health from exposure to air pollution in the form of noxious particulates and heavy metals, the environmental degradation (eg, contaminating water courses and habitat loss) from the extraction and processing of coal, and the major contribution that burning coal and the release of GHGs has in changing the long-term climate almost certainly undermines the use of coal as a long-term fuel.”

They therefore call on governments to:

• “protect cardiovascular and respiratory health by ensuring a rapid phase out of coal from the global energy mix.” This would be “part of an early and decisive policy package which targets air pollution from the transport, agriculture, and energy sectors, and aims to reduce the health burden of particulate matter (especially PM5) and short-lived climate pollutants, thus yielding immediate gains for society”.

They are not enthusiastic about the prospects of cleaning up coal pollution through carbon capture and storage (CCS), though their concern is more about cost than about performance :

• “Whilst the use of technologies such as carbon capture and storage (CCS) are consistently cited in reducing the impact of coal-based power generation, at present, these technologies have many major unknowns and are without substantial government investment or the use of carbon pricing.”
• ”CCS suffers from similar problems to nuclear—ie, large unit sizes, potential regulatory concerns, and long lead times, which means weak and delayed learning once deployment has begun. But CCS’s additional disadvantage compared with nuclear and renewables is that while the latter decouple economies from the threat of future rising and volatile fossil fuel costs, CCS magnifies these threats. Even in the absence of carbon pricing, renewables and nuclear can be justified as a hedge against future increases in fossil fuel prices, whereas CCS cannot.”

Despite these comments, the commissioners conclude that, in order to deacarbonise:

• “Technologies that have the greatest decarbonisation potential include nuclear power, offshore wind, concentrated solar power (CSP), and CCS.”

How should we pay for the low-carbon transition?

The commissioners identify three sources of funding: establishing a global carbon price, redirecting subsidies away from fossil fuels and avoiding the health spending which is currently necessary due to poor energy efficiency and pollution.

A global carbon price is a familiar call from academics. The commissioners say that it should be “strong, predictable, and international”. This would avoid the weaknesses of the weak, unpredictable EU Emissions Trading System which has no influence outside Europe – and little influence inside it. (See http://www.cer.org.uk/publications/archive/policy-brief/2012/saving-emissions-trading-irrelevance). But it is not likely to happen any time soon.

The redirection of subsidies away from dirty energy towards clean energy has a greater chance of success. As the Lancet report says:

• “Globally, there is plentiful financial resource available, however much of it is still being directed towards the fossil-fuel industry.”

G20 leaders agreed in 2009 that they would phase out inefficient fossil fuel subsidies, since when little has been done. This should be the focus of international climate negotiations this year: money is more important than targets. (See http://www.cer.org.uk/publications/archive/policy-brief/2014/international-climate-negotiations-should-focus-money-not-tar).

The amount of money that could be saved through avoided health costs is enormous:

• “The European Commission has estimated that in the EU alone, reduced air pollution from policies to mitigate climate change could deliver benefits valued at €38 billion a year by 2050 through reduced mortality.”
• “With an increase to 36% renewables in global final energy consumption by 2030 (from 18% in 2010), IRENA calculates up to $230 billion of avoided external health costs annually by 2030.”
• “Improved housing in England alone could save the UK NHS more than €700 million per year in treatment no longer required.”

As noted above, the Commissioners say that the failure to decarbonise is not down to economics or technology but to politics. They are right.

Climate justice

The Lancet report is very strong on climate justice, and says that failure to decarbonise cannot be justified on economic development grounds:

• “Rapidly expand access to renewable energy in low-income and middle-income countries, thus providing reliable electricity for communities and health facilities; unlocking substantial economic gains; and promoting health equity. Indeed, a global development pathway that fails to achieve this expansion will come at a detriment to public health, and will not achieve long-term economic growth.”
• “Affordable renewable energy will also have huge benefits for the poorest. WHO found that in 11 sub-Saharan African countries, 26% of health facilities had no energy at all and only 33% of hospitals had what could be called “reliable electricity provision”, defined as no outages of more than 2 h in the past week. Solar power is proposed as an ideal alternative energy solution, providing reliable energy that does not harm cardiovascular or respiratory health in the same way that diesel generators do. Clean cookstoves and fuels will not only protect the climate from black carbon (a very short-lived climate pollutant), but also cut deaths from household air pollution—a major killer in low-income countries. Buildings and houses designed to provide better insulation, heating efficiency, and protection from extreme weather events will reduce heat and cold exposure, disease risks from mould and allergy, and from infectious and vector-borne diseases.”

The report highlights that some groups are more at risk from climate change than others:

• “Some population groups are particularly vulnerable to the health effects of climate change, whether because of existing socioeconomic inequalities, cultural norms, or intrinsic physiological factors. These groups include women, young children and older people, people with existing health problems or disabilities, and poor and marginalised communities. Such inequalities are often also present in relation to the causes of climate change: women and children both suffer the majority of the health impacts of indoor air pollution from inefficient cookstoves and kerosene lighting, and so mitigation measures can help to reduce existing health inequities such as these.”
• “Women’s and girls’ nutrition tends to suffer more during periods of climate-related food scarcity than that of their male counterparts, as well as starting from a lower baseline, because they are often last in household food hierarchies.”

Call to arms

The Commission ends with a powerful section calling on health professionals to speak out on climate change:

• “The health implications could and should be more effectively harnessed in efforts to build support for a stronger response to climate change. The health impacts of climate change discussed in this Commission are not well represented in global negotiations, but they are a critical factor to be considered in mitigation and adaptation actions.”
• “Doctors and nurses may be trusted more than environmentalists. They also bring experience of collating evidence and conducting advocacy to cut deaths as a result of tobacco, road traffic accidents, infectious disease, and lifestyle-related non-communicable diseases.”
• “A public health perspective has the potential to unite all actors behind a common cause—the health and wellbeing of our families, communities, and countries. These concepts are far more tangible and visceral than tonnes of atmospheric CO”
• “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.”

Indeed it must. And this excellent report is a good start.