Public Health Issue: climate change

Climate change related to global warming is the world's most urgent public health problem. Climate change is a major health threat and requires concerted action to mitigate it. Health professionals must set an example and advocate for contraction and convergence both locally and nationally. Around 60% of the ecosystems essential to sustain life are already damaged1 There are initiatives in raising the awareness among the medical community about the climate change and saving the planet.

Climate change poses grave risks to health. It threatens the essentials of life. It brings drought, floods, storms, and extremes of heat and cold that can lead to famine, homelessness, dislocation, destruction of communities, the spread of disease, and even mass migrations and armed conflict as people vie with each other for land, water, food, and energy. And let's not forget the effects on mental health of anxiety, insecurity, and a sense of powerlessness as we watch the grass wither and the ice-caps melt.

There are many ways in which Health community can contribute towards contraction and convergence policy. If medicine is about saving lives, not just by last ditch interventions but by trying to avert illness, then working to alter patterns of behaviour that contribute to climate change could arguably become a priority for clinicians—as an urgent preventive measure. Debating the health implications of climate change may also be the best way to get the general public to take the problem seriously. Concepts such as "sustainable development" and "global warming" can strike the average person as either too daunting to consider or too distant to concern them. But we can all relate to the idea of risks to health that may affect ourselves, our children, and grandchildren. So there are good reasons to put climate change at the heart of the health agenda.

Likewise, the climate change debate belongs at the heart of health service management. The institutions of health care have enormous power to do good or harm to the natural environment and to increase or diminish carbon emissions. This applies particularly to the NHS, with its sheer bulk—still growing year on year. In 2006-7 the annual NHS budget in England is expected to be £83bn ( 121bn, $156bn), with a total UK health expenditure of £97bn.w1 NHS purchasing power is estimated at £17bn a year.w2 It is one of the largest employers in the world, beaten only by the likes of Wal-Mart and the Chinese army. It employs more than 1.3 million peoplew3 and runs 259 NHS trusts.w4

Future development programme in the NHS must be directed toward concerns for unsustainable building. By 2010, about £11bn is expected to have been spent on 100 new hospitals and more than £1bn on new primary care buildings.w5 w6 The new hospitals’ car parks and energy intensive air conditioning, heating, and lighting must use more environmental friendly equipments. They should wary of costly demolitions of buildings and the use of construction materials from unrenewable sources.

The recent suggested policy for tackling global warming is contraction and convergence, developed by Aubrey Meyer of the Global Commons Institute Contraction and convergence is a carbon cap and trade policy designed to stabilise and then reduce carbon dioxide emissions, which are responsible for 70% of greenhouse gases. Industrial methane emissions, responsible for much of the rest, will reduce alongside carbon dioxide. Given the present global population, this amounts to 2 tonnes/person/year, five times less than the present UK average emission. Evidence from Mozambique suggests that this money will help trigger the latent entrepreneurial skills of the recipients.4

The financial implications of trading in carbon entitlements mean it will be in everyone's interest to minimise the amount of carbon we emit. Just as all of us strive to live within our financial means, we will strive to live within our carbon means, with the evident financial benefit this brings. The less carbon we emit, the better off financially we are, a major inducement to the global development of low carbon emitting societies.

The move to a low carbon society will encourage each of us to get the benefits of low carbon living. It will also enable the much more rapid uptake of measures to conserve energy, promotion of renewable fuels, building of carbon sequestering coal power stations, and a better informed debate on the need to build new nuclear power stations. However, no foreseeable technological change can compensate for all the energy we presently generate from fossil fuel. In a low carbon future, we will inevitably use more of our own human effort, prompting those of us living in rich industrialised societies to get much more exercise in our everyday lives. The psychological health benefits of exercise are substantial, and increasing the entire population's exercise levels is key to preventing atheroma, the leading cause of death in industrialised countries.

1. WHO. Ecosystems and human well-being: health systems. Geneva: WHO, 2005.
2. Simmons M. Twilight in the desert. Chichester: John Wiley, 2005.
3. Tooke M. Peak oil 2005. www.powerswitch.org.uk/downloads/pos.doc
4. Hanlon J. Is it possible just to give money to the poor? Dev Change 2004;35: 375-83

References w1-w6 and details of the NHS's ecological foot-print are on bmj.com

Extracts:
Bmj.com, Healthy response to climate change, R. Stott, Medact , 2006
Bmj.com, What health services could do about climate change, Sustainable Development Commission, A. Coote, 2006

related links:
(www.activetravel.org.uk)
(www.corporatecitizen.nhs.uk)
(www.carboncounter.org)