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Action on Climate Change Is Good for Public Health

Patricio V. Marquez's picture



Pachamama 
or Mother Earth, revered by the indigenous people of the Andes to this day, is considered to be a benevolent deity that presides over planting and harvesting and who, through her creative power, sustains life.  This belief system also holds that when people damage Mother Earth, problems arise because her life cycles are affected. 

Rapid climate change—caused by the injurious impact of man-made actions on the environment—has become a priority issue in the 21st century since it has the potential to negatively impact the economic and social development of countries across the world. While solid scientific evidence on climate change has led to heightened awareness about this challenge in recent years, policy action at the international level has not lived up to expectations.  

Uncontrolled, man-made carbon emissions, which climbed to a new record of 30 billion tons worldwide in 2010, are at the core of the climate change threat. Curbing this trend is not only a daunting task that requires sophisticated technical solutions, but its complexity is intensified by disagreements among countries on the size of the problem and what to do about it.  In large measure, entrenched political and economic interests are behind these disagreements, which have slowed down progress to address this global challenge.

Climate change should matter to all of us. Changing weather patterns, including more frequent extreme climate events (e.g., the 13 warmest years on record have been in the last 15 years), sea level rise (e.g., while global sea level rose about 17 centimeters in the last century, the rate in the last decade  is nearly double that of the last century), and natural disasters (e.g. in some regions the number of particularly large hurricanes has increased), negatively impact the lives, health conditions, and well-being of people—the raison d’être of economic and social development.

A landmark 2009 report by The Lancet Commission documented how climate change over the coming decades could have a disastrous effect on health conditions across the world. There are both direct and indirect health threats through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration.  But, as this report highlighted, while vector-borne diseases will expand their reach and death toll as a result of climate change, the indirect effects on potable water, food security, and extreme climatic events are likely to have the biggest negative effect on health conditions.
 
If the negative impacts of climate change are not mitigated, they will only exacerbate existing global health inequities, particularly affecting the poorest and less developed countries, such as those in sub-Saharan Africa.  This will help perpetuate poverty across generations, increase malnutrition and ill health, and cause premature mortality, undermining competitiveness, employment and wealth creation across countries.  And this, in turn, has the potential to aggravate social tensions and increase the risk of political unrest. 
 
Call for Policy Action

Not everything is bleak however.  As documented in a recent World Bank report, Climate-Smart Development, prepared in advance of the U.N. Secretary General’s Climate Summit in September 2014, if public policies and market- based approaches that reduce emissions and other short-lived climate pollutants are implemented, they can have clear and measurable economic, health, and other social benefits. 
 
Case studies prepared for the report simulate benefits to be realized from the application of key measures in six regions or countries (the United States, China, the European Union, India, Mexico, and Brazil) and the impact on global GDP. These studies show that regulations, taxes, and incentives to stimulate a shift to clean transport, improved industrial energy efficiency, and more energy-efficient buildings and appliances would generate annual benefits by 2030 that include an estimated GDP growth of between $1.8 and $2.6 trillion.  
 
The report also estimates that approximately 94,000 premature pollution-related deaths could be avoided, and that these measures would avoid production of 8.5 billion metric tons of carbon dioxide-equivalent (CO2e) emissions and save almost 16 billion kilowatt-hours of energy—a savings roughly equivalent to taking 2 billion cars off the road.
 
It should be clear, therefore, that action on climate change — and control of its potential negative health consequences — will require  adoption and adaptation of multisectoral approaches, coupled with participation, collaboration, and consensus among  governments, communities, individuals, businesses, and international organizations. Such collaboration should result in policies and market-based approaches aimed at reducing carbon emissions and other heat-trapping gases that we are adding to the atmosphere, particularly in fast-growing cities, which account for two-thirds of energy demands and emissions.

Public Health Platforms
 
In the health sector, it is imperative that we move beyond biological and medical concepts of health and disease and focus on the social determinants of health to better understand the health risks associated with climate change and the possible response of the health sector to this phenomenon.
 
We should also be ready to collaborate on multi-sector economic analysis to better illustrate, for example, the environmental and health benefits of shifting behaviors to use public transport systems and advanced cook stoves, and to walking and cycling, by adopting road safety measures to protect the safety of pedestrians and bicycle riders on city roads. 
 
To help reduce vulnerability and build resilience in countries, it is important that institutions such as the World Bank , working in tandem with other agencies such as the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC) and the European Center for Disease Prevention and Control (ECDC), redouble  support to countries to develop and strengthen essential public health platforms (e.g. surveillance systems and epidemiological intelligence capacity) to anticipate, prevent, and deal with adverse health outcomes associated with climate change.

Although tackling climate change often seems to be an insurmountable challenge, we should be optimistic that the tide will turn, much as we witnessed in the last decade in relation to HIV/AIDS.
 
With committed political leadership at the highest level of government, active social movements pressing for action, new scientific and technological developments adapted to local realities, and sustained allocation of resources for action over the medium term, it will be possible to modify human activity which is contributing to global warming and its negative impact on public health and development.  
 
And if we succeed, Mother Earth will begin to be cured, and the natural course of climate restored.
 
Follow the World Bank health team on Twitter: @worldbankhealth
 
Related
 
The Lancet Commission: Managing the Health Effects of Climate Change (2009)
 
World Bank Report: Climate-Smart Development

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Comments

Submitted by Kremlin Wickramasinghe on

Thank you for this blog. I cannot see "moving towards sustainable healthy diets" as one of the policy options in the list. Is there any reason for not to include it in the report ? It would help to reduce emissions and prevent diet-related diseases.

Submitted by Patricio V Marquez on

Many thanks for your comment. Your point is well taken. Indeed, as noted by the American Public Health Association (APHA), with the increase in the relative importance of non communicable diseases (NCD), including obesity and diet-related NCD chronic disease rates such as CVDs, and the rising antibiotic resistance; increasing attention needs to be planced on the interaction between chemicals and pathogens contaminating our food, air, soil and water; depletion of natural resources; and climate change. These threats have enormous social and economic costs which affect all of us and are related to food—what we eat and how it is produced. So, as advocated by APHA and other institutions, action on climate change also need to be geared to support the development of sustainable food systems that provide not only healthy food to meet current food needs but also that help maintain healthy ecosystems and prevent further environmental destruction.

Submitted by Terry Snitheens on

It's true as you say that diseases can spread more when climate changes. There is also the threat from increasing ice, just reported two days ago. Average global temperatures are now at a standstill for 17 years, notincreasing notwithstanding the rapid accumulation of CO2 emissions. The models are being adapted so CO2 lags temperature as it did historically. That probably explains the record growth of ice. http://www.dailymail.co.uk/news/article-2681829/Global-warming-latest-Amount-Antarctic-sea-ice-hits-new-record-high.html

is the health system prepared for coninuing trend like this? This wll have high adapting costs and health costs. Ice reduces availlable drinking water directly and also reduces food availability because oj lower yields. Fall in nutrition wll lead to worse population health, as the author pointsout. Specifying the timeframes for these profound changes is important. I hope the World Bank can shed light on the timeframes so health system investments are made accordingly and especially with a view toward Universal Health Coverage by goal for 2050.

Submitted by Patricio V Marquez on

Thanks for your comments and sharing the link on the newspapter article. Perhaps the key point to keeep in mind is the statement in the article attributed to Prof. Judith Curry, Head of Climate Science at the Georgia Institute of Technology in Atlanta. She said the arguments were not convincing, adding that "We do not have a quantitative, predictive understanding of the rise in Antarctic sea ice extent.’

Submitted by Terry Snitheens on

That is exactly the point to make. We need more knowledge of the factors driving the observed changes in ice and temperatures and other manifestations of climate change. When the model does not fit the data we need to always change the model and not ignore observations and knowledge.

What is interesting is human collective reactions to observations and knowledge. I find this on common herd behaviors gives pause. Charles Mackay provided historical evidence for the peculiar behavior and beliefs of large crowds in his 1841 book, Extraordinary Popular Delusions and the Madness of Crowds. It contains an insightful account of the “Tulipomania” craze of the mid-1600s. When considering the current climate change craze, reflect upon Mackay’s observation that:

"We find that whole communities suddenly fix their minds upon one object and go mad in its pursuit; that millions of people become simultaneously impressed with one delusion, and run after it, till their attention is caught by some new folly more captivating than the first.”

Maybe the should be less concern with climate in the coming centuries and more investment in health in the next several decades, at the margin. That is withthe timeframes I proposed in earlier post. How much can we truly care about the grandchildren of our grandchildren by payng to improve their wellbeing? I believe we care about them less than about our children, and this was the case even before the trend in global temperature of the last 17 years became apparent.

Submitted by Patricio V Marquez on

Thanks again for sharing your views on this matter. Besides The Lancet Commission Report mentioned in the blog, recent research funded by the respected US National Science Foundation -National Institutes of Health Ecology and Evolution of Infectious Diseases Program and published in the journal Science, points out that there is a direct risk for human health from pathogens like dengue, malaria and cholera, which are all linked to warmer temperatures, and from increasing parasitism. And that significant indirect risk also exists in threats to agricultural systems and game species that are crucial for subsistence and cultural activities.

See attached link: http://www.nsf.gov/news/news_summ.jsp?org=NSF&cntn_id=128617&preview=false

As you advocate, added attention and investment to strengthen the capacity of health systems is indeed a pressing need, particularly to strengthen much neglected and underfunded essential public health infrastructures such as disease surveillance systems, with strong laboratory capacity and epidemiological know how for data collection, reporting, assessment, policy making, program design, implementation, and impact evaluation. If this is done on a sustainable manner, the predictions on the intersection between infectious diseases and climate change could help provide valuable inputs for the design and implementation of actions that could be taken in a health system and across sectors to minimize or control climate change-related direct and indirect health risks and outbreaks of disease.

As the authors of the Science article suggest, those actions might involve more monitoring and surveillance, adjusting the timing of vector control measures and adopting new management measures.

The good news for people like you and me that care about health investments is that with the growing attention across the world placed on Universal Health Coverage that includes financial protection to minimize the impoverishment impact of ill health, premature death and disability on individuals, families and communities; expansion of access to quality health services when needed; and coordinated multisectoral action for health promotion and disease prevention, there is now an unprecedented opportunity to advance the health agenda and contribute to the improvement of the health status of the population and hence to overall social wellbeing in the years to come.

Thanks for the blog, and for citing our report on Climate Smart Development. The medical and climate science communities are both beginning to see the inter-connectedness of climate change and health. For the first time the fifth assessment report of the Inter-governmental Panel on Climate Change (IPCC) this year devoted a chapter to this topic, acknowledging a high level of confidence in adverse climate-health impacts in the future. They highlight three basic pathways of impact: i) Direct impacts, which relate primarily to changes in the frequency of extreme weather including heat, drought, and heavy rain; ii) Effects mediated through natural systems, for example, disease vectors, water-borne diseases, and air pollution; and iii) Effects heavily mediated by human systems, for example, occupational impacts, undernutrition, and mental stress. On the medical side the WHO is getting increasingly active on this agenda. The World Health Assembly (WHA) comprising 193 countries passed a landmark resolution on climate and health in May 2008 calling for (i) strengthening the evidence base; (ii) building health system capacity to help countries address both gradual changes and sudden shocks; and (iii) scaling up outreach and advocacy. In August 2014, the WHO will convene a first-ever Climate and Health summit, at which Ministries or Health and a diverse range of public and private stakeholders will be represented. Within the World Bank, we have also been increasing looking at climate-health linkages. Most of the work has been in the form of analytical products. We are now beginning to see operational demand for support from client countries.

Submitted by Patricio V Marquez on

Many thanks Sameer for your comments and information. In the new era of the Global Practices, we, at the WBG, now have a golden opportunity to add value in the support that we provide to countries by working as multidisciplinary and multisector teams geared to help address problems and their social and economic determinats. The time to move beyond individual sector issues and projects has arrived!

Submitted by Albert Figueras on

Climate change, health consequences and the implications of these new scenario in medicines use and consumption...

It seems plausible that in the forthcoming years (or decades), there will be an increase in the incidence of cancer, respiratory diseases, skin disorders, (new) infections, and also an increase in psychiatric disorders associated with the growing incertitude and the evolution of the present social model. So, new anticancer drugs, antibiotics and medicines for psychiatric and neurological disorders will be necessary... At the same time, the drug companies' pipelines seem to be almost empty (except for the new biological products). Additionally, these new available options are extremely expensive.

An interesting and worrying topic, that of the consequences of the climate change on public health. Sometimes I ask myself if it would be possible to disentangle the World's present complexity in order to come back to Pachamama's simplicity. Of course, this is not easy to solve, and perhaps some solutions would be inconvenient in many aspects. What seem clear is that we have to analyze the problem and face it!

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