Climate change, equity, and health

It is important that we all play our part

The evidence gathered by the Intergovernmen? tal Panel on Climate Change (IPCC) leaves us in no doubt (although a range of scenarios exists) that the earth's climate is changing—largely because of the accumulation of carbon dioxide in the atmosphere through the burning of fossil fuels.¹

On p 408, Hartog describes how current patterns of energy and resource use are far from evenly distributed.² The footprints of people living in northern countries weigh far heavier than those living in the south. In general, there is a ten-fold difference in energy consumption per person between rich and poor countries.³

In developed countries the most disadvantaged groups, with least choice about where to live and what to eat, suffer the short term impacts most. In developing countries the future impacts of climate change will adversely affect the poor. Climate change threatens the ability of countries, particularly in low lying coastal areas, to meet basic human needs of adequate food, clean water, a healthy environment, and safe shelter.⁴

Action to redress global inequity needs to proceed alongside action to control and reduce energy consumption in the north. Debt cancellation, an increase in the proportion of gross domestic product (GDP) allocated as development aid, and measures to encourage developing countries to participate in international organisations would be a start.

However, the IPCC claims that significant reductions in net greenhouse gas emissions could be possible through policy measures and technologies focused on changes to energy supply—for example, through switching to renewable sources rather than fossil fuels—and by responsible land management— such as forest restoration. The Kyoto protocol, the international treaty intended to provide the framework for much of this to happen, has been severely weakened since it was first proposed. Earlier this year the US government rejected the protocol as “fatally flawed.” Following intense negotiations it seems possible that the treaty could be ratified in the near future, but only if Japan agrees to proceed.

While international governments debate crucial details there is a danger of apathy setting in. Delay may leave the world poorly prepared to deal with adverse changes and increases the possibility of irreversible or very costly consequences.

In addition, the underlying pressure causing climate change—the unsustainable pattern of consumption in the world's rich countries—also has other, more immediate consequences. Changes in technology, social organisation, and lifestyles that have accompanied the changes in consumption are associated with chronic diseases, including coronary heart disease, diabetes, respiratory disorders, and osteoporosis. Unfit, obese populations with a high prevalence of coronary heart disease are a product of the same unsustainable consumption that drives climate change.⁵ Health workers have an opportunity as advocates to explain the ways that current unsustainable activities underlie both climate change and much ill health. Policies aimed at reducing the impact of climate change will also help to prevent illness in the short and intermediate term.

Transport is a crucial area for action. About a quarter of Britain's production of carbon dioxide comes from vehicle exhaust.⁶ At a policy level we need to create integrated transport systems, emphasising walking, cycling, and public transport, and rerouting commercial freight from road to rail. Locally, measures to make walking and cycling safer will make these modes of transport more acceptable and increase social capital as people return to the streets. They will also help to counter current trends of increasing obesity and low levels of physical activity, reducing the population's risk of coronary heart disease and type II diabetes. Less polluted urban environments will reduce the adverse health impacts of heart and lung disease. Health workers can contribute to local authorities' local transport plans and support NHS trusts to develop and implement green transport plans.⁷

There is a huge potential to replace fossil fuels with “clean” renewable energy sources, such as wind or solar power. It is estimated that wind power could supply Britain's current electricity needs three times over and will account for one tenth of the global energy market by 2020. Wind and, particularly, solar power need substantial investment to compete economically with conventional forms of energy. Environmental organisations are trying to increase the pace of change with schemes to encourage consumers to switch to energy suppliers who are investing in renewable energy.⁸

Agriculture is another important area for action on climate change. We should move towards a more locally based agriculture, encouraging retailers to stock locally sourced food and develop links between growers and consumers. This will reduce “food miles” and promote healthier eating. We should promote climate friendly land management as trees and shrubs absorb and recycle carbon dioxide, as well as stabilising ecosystems

What else can we all do as individuals? Lots of things. We can turn lights off when we leave a room, starting now. Lower heating or air conditioning controls. Insulate the home. Walk, cycle, or use stairs where we can. Wash hands in cold water. Next time we renew a light bulb or an appliance, make sure it is the most energy efficient we can afford. Choose a car for maximum fuel economy, not maximum power to impress. Recycle what you can. Refuse unnecessary packaging. Don't buy canned drinks. Buy recycled goods. Use things till they wear out. Repair anything that can be repaired. Don't trash anything that someone else could make use of.⁹

And leave a message in a (biodegradable) bottle to tell your great grandchildren what you understood and what you did about it.

Cathy Reid, specialist registrar in public health, Sheffield
Email: cathy-reid@sheffieldsw.pct.nhs.uk


studentBMJ 2001;09:399-442 November ISSN 0966-6494

1. Intergovernmental Panel on Climate Change. Summary for policymakers to climate change 2001: synthesis report of the IPCC third assessment report. www:ipcc/ch
2. Hartog M. Overconsumption and health. studentBMJ 2001;9:408?9.
3. McMichael AJ. Planetary overload: global environmental change and the health of the human species. Cambridge: Cambridge University Press,1993.
4. www.ipcc.ch/press/COP6.5
5. Read C, Stott R. Climate change—thinking widely, working locally, acting personally: health workers have a crucial role. BMJ 1997;315:758?9.
6. Department of the Environment. Climate change: UK programme. London: Department of the Environment,1997.
7. Health Education Authority. Making the links: integrating sustainable trans? port, health and environmental policies: a guide for local authorities and health authorities. London: Health Education Authority, 1999.
8. www.greenpeace.org.uk
9. Harrison P. The third revolution: environment, population and a sustainable world. London: I B Tauris, 1992.