Climate change, ill health, and conflict
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1819 (Published 05 April 2011) Cite this as: BMJ 2011;342:d1819
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"I'm torn between the desire to create and the desire to destroy." So
says Lucy to Charlie Brown as she builds snowmen then stamps on them.(1)
This same dilemma is glimpsed under the surface of the oil and water
editorial where medicine and militarism apparently unite to face a common
foe. I would challenge this conceptualisation.
The editorial is welcome in that it includes broad thinking and sees
the links between climate, medicine and militarism. Reductionist thinking
sees every problem in fragmented detail but loses the interrelations and
big dynamic picture so this "fundamental interconnectedness of all
things"(2) approach offers a fruitful alternative way of thinking. I
would add further players to the three way interaction, namely the arms
industry and politicians.
The close and destructive influence of the arms industry and war as a
business was set out by Major General Smedley Butler(3) and then the
wisely timed farewell address of Eisenhower on the dangers of a Military-
Industrial Complex.(4) In an Orwellian realm(5) we now have perpetual and
profitable conflict with Minipax waging perpetual war, Minitru spreading
the 45 minute spin to frighten the population into acquiescence and
Miniluv running Guantanamo. Warfare needs energy; principally oil. Some
argue that many recent conflicts were carbon resource wars from the first
British excursions into Iraq to secure battleship fuel in WWI, through
WWII Axis attempts to reach oilfields and latterly Kuwait, Iraq again and
Libya.(6)
Militarism is profitable to corporations and steals resources from
natives with the plunder fuelling rich nations. The by products of this
exchange being limbless soldiers, refugees and yet more rich GDP growth
with planet destabilising emissions and climate chaos, famines and
drought. Militarism is not the answer, except for the oppressors; it is
part of the problem.
The corrective action must be to end military spending on aggressive
resource wars and invest in green technology at home. Thus tridents become
train lines, cruise missiles-cycle lanes, stealth bombers- solar panels
and tomahawks-turbines. If we cut our domestic energy demand we will not
only cut carbon dioxide emissions, become fitter through active transport
but also end death and destruction from fuelling conflicts. It is time to
beat our swords into ploughshares.(7)
Jon Orrell
1) The Complete Peanuts. Charles M Schultz, Canongate Books Ltd
2) Dirk Gently's Holistic Detective Agency, by Douglas Adams, Pan
Macmillan;
3) War is a Racket: The Antiwar Classic by America's Most Decorated
Soldier by Smedley D. Butler,
Feral House
4)
http://www.americanrhetoric.com/speeches/dwightdeisenhowerfarewell.html
5) 1984 Nineteen eighty-four. George Orwell. Penguin
6) A Century of War: Anglo-American Oil Politics and the New World
Order,
William Engdahl, Pluto Press.
7) Isaiah 2 verse 4.
Competing interests: Chairman Transition Town group Weymouth and Portland. A community group making the transition to a low carbon future.
This worthy editorial would benefit from two explications: first, the
relationship between climate change, conflict and ill health; second, the
nature of suggested collaboration between medical and military
professions, despite the editorial's subtitle.
There is consensus that climate change will harm health.1 Direct
health impacts such as from heat stress and those consequences mediated by
ecological changes including altered vector behaviour (secondary effects)
are accepted. However less understood are ways that political, economic,
and cultural changes due to climate and associated ecological change will
manifest and interact with health. These effects, including conflict, have
been classed as "tertiary health effects".2 Indeed, conflict, triggered in
part by resource scarcity and underlying political and social environments
due to climate change, and resultant social instability and migration may
prove the most harmful effect in this class, exceeding even that of famine
and rising food prices.
Climate change cannot be prevented, but its ultimate extent and
effects can still be lowered, as heroically recognised by the UK
government. It is not obvious how medical and military professionals can
collaborate for this purpose, but this jointly published editorial is an
excellent start. However, complicating this collaboration, the military is
a major emitter of greenhouse gases. The military also uses large amounts
of non-renewable resources and causes substantial environment
contamination.3 Reducing the military contribution to greenhouse gases
would demonstrate a commitment to averting climate change and thus the
related risk of conflict.
The medical and military professions both have high levels of public
esteem and influence. Thus, proposed collaboration between these groups to
advance the global public good of climate change mitigation and conflict
prevention is innovative and encouraging.
1. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al.
Managing the health effects of climate change: Lancet and University
College London Institute for Global Health Commission. Lancet
2009;373:1693-733.
2. Butler CD, Harley D. Primary, secondary and tertiary effects of
the eco-climate crisis: the medical response. Postgraduate Medical Journal
2010;86:230-34.
3. Barnett J. The meaning of environmental security: ecological
politics and policy in the new security era. London: Zed Books Ltd., 2001.
Competing interests: No competing interests
Please note the conference executive have decided to postpone this
event until 17 October 2011.
For the latest information please visit
http://climatechange.bmj.com
Competing interests: No competing interests
Many socio-political decisions relate to perceptions of lifestyles
and expectations that have tended to focus on economic growth and
consequently further exploitation of natural systems and resources. At the
same time, we seek ways to mitigate our actions, for example, in tackling
anthropogenic climate change. Whilst the concepts and practices of public
and environmental health are long-established, we must remember that like
all other living organisms we change the environment. Our health and well-
being, our lifestyle choices and the condition of the natural systems of
our environment are all inextricably linked.
The links between climate and health policies are clear. For example,
the health benefits of reduced dependency on the car: reducing greenhouse-
enhancing gas emissions, and reducing chronic disease from increased
physical exercise1. Emissions reductions targets and action plans should
be part of a wider strategy in which health professionals should play an
essential role2. However, to achieve significant emissions reductions to
mitigate climate change and, in effect, decarbonise a country presents an
enormous challenge because of the very radical societal and economic
changes required3.
In planning change we must consider ourselves as part of the
environment, not somehow separate from it because of our technological
mastery. A key issue concerns our impact on the natural ecosystems that
provide us with benefits on which we are all dependent. Ecosystem
services is the term used to describe these collective benefits. Four
categories of ecosystem services are recognised: provisioning, such as the
production of food and water; regulating, such as the control of climate
and disease; supporting, such as nutrient cycles and crop pollination; and
cultural, such as spiritual and recreational benefits.
The Millennium Ecosystem Assessment concluded that the health effects
of ecosystem disruption are evident in many parts of the world4. The
dramatic decline in biodiversity we are witnessing as a result of the
increase in the human population could increase or decrease transmission
of infectious diseases in humans5. Evidence suggests that preserving
endemic biodiversity should reduce the presence of infectious diseases6.
Possible environmental-public health issues for the future include:
genetically modified organisms, nanotechnology, 'artificial life', new
pathogens and invasive species (resulting from climate change)7.
Alongside these potential threats we run the risk of forgetting the
importance of atmospheric pollution (particulates, ozone, nitrogen
dioxide, sulphur dioxide and carbon monoxide) if we over-focus on carbon
management, especially at a global scale.
Some ecosystem change is inevitable and the damage to human health
caused by these changes may be mitigated through strategies that reduce
the driving forces of consumption, population increase, and inappropriate
technology use. This has echoes of 'Limits to Growth'8: the growth of the
ecological human 'footprint' being as small as possible whilst increasing
human welfare. This can be in the form of consumption, not least in the
form of fossil fuels for private transport1; access to family planning as
a priority in the context of population growth and climate change, and
with a call for doctors to put family size into the arena of environmental
ethics9. The debate about the appropriateness of geo-engineering options
to mitigate climate change and their potential impact on people and the
planet is on-going 10.
In a socio-economic context, inequalities in earnings and incomes are
high in Britain compared with other industrialised countries and compared
with thirty years ago11. There remain deep-seated and systematic
differences in economic outcomes between social groups across all of the
dimensions and reinforced across the life cycle as expressed in mortality
rates in later life. Health inequalities result from social inequalities,
and to address the former requires action across all the social
determinants of health11. Among the proposed policy objectives to reduce
health inequalities is to create and develop healthy and sustainable
places and communities11. Greater equality will achieve sustainability
and enhance the quality of life through reduced consumerism and the
development of a more cohesive sustainable community. The desired outcome
does not necessarily involve sacrificing quality of life12.
A key issue relates to behaviour change sought through marketing
strategies, the latter being most suitable for small-scale or painless
lifestyle changes. It has been argued that mainstream approaches to
tackling environmental threats do not question the dominance of
individualistic and materialistic values13. The tendency, therefore, is
to miss the mark in so far as more systemic and structural changes are
concerned13. Further, we must avoid a temptation to give everything a
monetary value. In the current debate, health and the environment
constitute moral and political questions and not just economic ones14.
A fundamental point is that we cannot live without clean water,
protection from flooding, carbon storage (in soils) and other services
provided by the natural environment. We must protect natural ecosystems
and recognise that we are part of nature and dependent on ecosystem
services. Controlling population growth may be a controversial issue for
doctors and health professionals to address. However, policies and
practices aimed at addressing inequalities to achieve positive health and
environmental outcomes indicates pivotal roles for both health and
environmental professionals. This builds on programmes such as the Healthy
Communities Programme (www.idea.gov.uk) and it will be increasingly
important to see a sustained, evidence-based, broad approach as public
health and provisioning services adjust to their new landscapes. We need
work on policies aimed at systemic and radical change.
1. Roberts, I., Stott, R. Doctors and Climate Change BMJ 2010;
341:c6357.
2. Haines, A., McMichael, A. J., Smith, K. R., Roberts, I., Woodcock, J.,
Markandya, A., Armstrong, B. G., Campbell-Lendrum, D., Dangour, A.,
Davies, M., Brice, N., Tonne, C., Barrett, M., Wilkinson, P. (2009) Public
health benefits of strategies to reduce greenhouse-gas emissions: overview
and implications for policy makers The Lancet, 2009; 9707: 2104 - 2114.
3. Pielke, R. The Climate Fix: What Scientists and Politicians Won't Tell
You About Global Warming, 2010, Basic Books, New York.
4. Chopra K., Leemans, R., Kumar, P., Simons, H. (Eds.) Ecosystem and
Human Well-being: Policy Responses, Millennium Ecosystem Series, 2005,
Island Press.
5. Mace, G. M., Masundire, H., Baillie, J. E. M. in Ecosystems and Human
Well-being: Current State and Trends: Findings of the Condition and Trends
Working Group Vol. 1, Ch. 4: 2005, Millennium Ecosystem Series, Island
Press.
6. Keesing, F., Belden, L. K., Daszak, P., Dobson, A., Harvell, D., Hplt,
R. D., Hudson, P. ,Jolles, A., Jones, K. E., Mitchell, C., Myers, S.,
Bogich, T. Ostfeld, R. Impacts of Biodiversity on the Emergence and
Transmission of Infectious Diseases, Nature, 2010: 468; 647-652.
7. www.defra.gov.uk/environment/biodiversity/documents/201009space-for-
nature.pdf
8. Maclean, N. Twenty-five key questions in ecology, in N Maclean (ed)
Silent Summer - The state of wildlife in Britain and Ireland, 2010,
Cambridge University Press, Cambridge.
9. Meadows, D. H., Randers, J., Meadows, D. L. Limits to Growth: The 30
Year Update, 2004. Chelsea Green Publishing.
10. Guillebaud, J., Hayes, P. Population Growth and Climate Change BMJ
2008; 337:a576.
11. Edenhofer, O. IPCC Yet to Address Geoengineering, Nature: 2010: 468;
508.
12. Marmot, M., Allen, J., Goldblatt, P., Boyce, T., McNeish, D., Grady,
M., Geddes, I. Fair Society, Healthy Lives: The Marmot Review of Health
Inequalities. An Anatomy of Economic Inequality in the UK, Report of the
National Equality Panel, 2010, Government Equalities Office.
www.marmotreview.org
13. Wilkinson, R. G., Pickett, K. E., de Vogli, R. BMJ 2010; 341:c5816.
14. Crompton, T. WWF-UK report 'Weathercocks and signposts: The
environment movement at a crossroads', 2008.
http://assets.wwf.org.uk/downloads/weathercocks_report2.pdf
15. Reith Lectures 2009: A new citizenship: Professor Michael Sandel
Lecure 1: Markets and Morals. Transmitted 9 June 2009, BBC Radio 4.
Competing interests: No competing interests
To the Editor:
With great change of climate in the 21st century, this influence on
human health has been observed globally. Of note, industrial gas waste
is blamed for the increase of temperature and is toxic to human beings.
Recently, a number of review articles were published for addressing the
relationship between cardiovascular disease including myocardial
infarction and stroke and air pollution.1, 2 As is known, the severity of
air pollution is inversely associated with colder temperature, and less
windy and rainy weather.3 Previously, a number of population-based studies
have demonstrated that cardiovascular events are more common in winter and
on colder days, independent of season.4,5 The mechanisms underlying acute
vascular events may reflect a cold-induced hypercoagulopathy status for
thrombus propagation and is related to the hazardous effect of wintertime
respiratory infection.6 Accordingly, an interaction of air pollution and
cold temperature should be emphasized in the subtropical area with a
paradoxical change in temperature. In this regard, Keatinge and Donaldson
used multiple regression analysis of mortality for middle-aged persons on
weather factors and pollutants (SO2, CO and smoke) in London.3 They found
that cold weather is associated with 2.77 excess deaths per million during
24 days following 1 Celsius degree fall for 1 day, but no net excess
deaths with the concentrations of pollutants.3 Therefore, change of
climate may lead to up and down of the cardiovascular events worldwide
beyond the conventional factors. With the warm-up of the earth, the issue
of a rise of infectious disease has been emerged. However, a further
ecological study should focus on the interactions among climate change,
air pollutants and cardiovascular disease.
Reference
1. Nawrot TS, Perez L, K?nzli N, Munters E, Nemery B. Public health
importance of triggers of myocardial infarction: a comparative risk
assessment. Lancet. 2011 ; 377: 732-740
2. Mateen FJ, Brook RD. Air pollution as an emerging global risk factor
for stroke. JAMA. 2011; 305:1240-1241.
3. Keatinge WR, Donaldson GC. Mortality related to cold and air pollution
in London after allowance for effects of associated weather patterns.
Environ Res. 2001; 86:209-216.
4. Marchant B, Ranjadayalan K, Stevenson R, Wilkinson P, Timmis AD.
Circadian and seasonal factors in the pathogenesis of acute myocardial
infarction: the influence of environmental temperature. Br Heart J.
1993;69:385-387
5. Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of
acute myocardial infarction in the second National Registry of Myocardial
Infarction. J Am Coll Cardiol. 1998; 31:1226-1233.
6. Woodhouse PR, Khaw KT, Plummer M, Foley A, Meade TW. Seasonal
variations of plasma fibrinogen and factor VII activity in the elderly:
winter infections and death from cardiovascular disease. Lancet.1994;
343:435-439.
Competing interests: No competing interests
Why did the authors miss an opportunity to discuss the one, easy ,
cheap thing which the medical profession can do yet continually refuses to
discuss?
We must break the taboo on discussing responsible reproduction.
There are 1 million more humans on the planet every 5 days yet only a few
of us will dare to suggest that having more than 2 children per couple,
provided that that couple has access to education and contraception, is
increasingly irresponsible and unfair.
Watch Sir David Attenborough's speech to the RSA
We do not hesitate to promote other aspects of healthy living yet it
is obvious that lack of resources and the resultant conflicts is about to
have massive health impacts for all of us. I believe that GPs,
obstetricians, midwives and health visitors have a duty to discuss family
size at every relevant opportunity.
Competing interests: Trustee of Population Matters
We are trapped in an unsustainable economic system based on growth,
consumption and debt that has brought the world to the brink of
bankruptcy. This unsustainable system is propped up, to a large extent, by
"cheap" fossil fuel. In this situation, authorities in many parts of the
world seem more interested in having meetings to decide the agenda for
meetings on climate change or implementing "schemes" for mitigation that
protect the worst polluters, rather than actually confronting its reality.
Our children and grand-children are our most important and most
vulnerable citizens. Some of the consequences of burning carbon for energy
that we know are real because they are already happening include -
1. For every dollar's worth of carbon-based energy that we use the
real cost is about $3. The other $2 represents environmental damage and
ecological destruction that will be passed on to our children.
This is deeply immoral and will certainly damage their health. Moreover,
as supplies of oil dwindle and existing conventional electricity
infrastructure proves increasingly inadequate, dollar costs of carbon-
based energy continue to rise.
2. Sea levels are rising. As this continues, hundreds of millions of
people will be displaced creating a refugee nightmare for all the world's
children. And the health of the most vulnerable children will be the most
affected.
3. "Natural" disasters like floods, fires and droughts are becoming
more frequent and more severe. The cost of the recent Queensland floods
alone, that will have economic consequences well into the future, would
buy a great deal of clean energy. Certainly, those floods may have
happened anyway but risk is probability multiplied by severity and having
a La Nina Southern Oscillation (not carbon-based) coincide with the
hottest Pacific surface temperatures ever, increased both probability and
potential severity. We insure houses against destruction, even though the
probability of it happening to any one house is low, because of the
magnitude of the possible consequences. As predicted by complex system
science, so-called "one in a hundred year" disasters are now occurring
with ever increasing frequency.
4. As it gets hotter and, on average, drier, water will become
increasingly scarce and costly (in spite of our temporary surfeit in parts
of Australia, costs are rising inexorably). Our children's generation will
need more water to live, and to grow food that requires very large
quantities of water (current unrest in the North Africa is said to be, in
part, due to food scarcity and rising prices).
5. We see the migration of tropical diseases that will undoubtedly
endanger our children's health.
Doctors and their surgeries are hubs in the complex network that is
society. They frequently treat children who come with their mothers for
treatment, vaccinations and advice. We have a moral obligation to treat
them well; to fail to do so would constitute negligence and this is our
responsibility. I suggest that organizations like the British Medical
Association should consider sending a poster to all UK surgeries with a
request that it is displayed prominently and that surgery staff be asked
to be prepared to answer relevant patients' questions. The poster could
contain something like the above 5 points as a compact "bundle" such as we
are becoming familiar with in combating adverse events in hospitals.
Doctors, as the hubs of social networks, are in a unique position to
distribute this kind of message. Moreover, we have a moral and clinical
responsibility to do our best to ensure a healthy future for those young
patients. It is time for us to "stand up and be counted". Perhaps
organizations like the BMA could consider sending this message to their
counterparts in other countries and to other network hubs. For example,
veterinary surgeons are well aware of the ecological destruction
perpetrated by burning fossil fuels. Perhaps dental surgeons would
consider coming on board as might the churches of many religious
organizations.
It seems obvious that increasing the cost of fossil fuels would go at
least some way to repaying our children and grandchildren for the debt we
are incurring on their behalf, provided the money is used wisely. At the
same time more costly fossil fuel energy would encourage more careful use
and support the production of "clean" energy as well as allowing the
market to replace producers who refuse to modernize. At the very least, we
need carbon taxes to achieve these objectives.
Competing interests: A very similar paper is to appear in the forthcoming edition of Australian Medicine, a publication of the AMA. I have been advised by its editorial staff that it is not improper to submit this material as a rapid response.
Re: Climate change, ill health, and conflict
The history of planet earth dates back to millions of years. It has survived destructive forces of nature that are unimaginable. Still quite amazingly has life not only originated in such uninhabitable extremes, but diversified through the eons on such an evolutionary scale that baffles conventional wisdom. The entry of mankind in this epochal timeline is very brief.
In this context we, despite all our imaginative and critical scientific frame of mind somehow manage to remain so brazenly oblivious to the forces of nature both in this planet and beyond. By some unseen hand acting on our wisdom has so deeply indoctrinated us regarding the anthropogenic causes of global warming, and to a far greater extent so convinced our collective belief that we can effectively battle the forces of nature that we seem to be privy to performing the greatest act of folly in the name of science. Simply put, one needs to answer the following questions for the sake of veracity.
1. Can we harness the forces of the sun (solar flares,solar spots, magnetic storms) by all that we are proposing as the necessary preventive measures to combat global warming?
2. Can we overcome the forces of nature such as volcanic eruptions and earthquakes and their extensive aftermaths by offering the distorted claim of anthropogenic cause of global warming?
3. If for the sake of pure argument one wishes to consider our contribution to this deliberate creation of gloom and doom, can we stop or even hope to prevent natural calamities such as forest fires and man made effects of war with its preconceived scorched-earth policy by use of weapons of mass destruction?
I wish the proponents of anthropogenic global warming can answer these simple questions.
In the absence of any succinct line of reasoning, the powers that be are not only restricting the the right of survival of ordinary inhabitants of the world under the pre-fabricated yoke of legislations and punitive measures, but are also asphyxiating third world countries of their economic growth and potential. Restrictions imposed by the likes of the IPCC have only made lives of the poor more miserable and allowed the flow of billions through coercion and force into one gigantic slush fund that has curiously created millionaires overnight. When a formidable population of the world survives a hand-to-mouth existence, what right do we have to impose one restriction after another to make them suffer even more.
There is this talk of green energy as the key to the survival of our kind that makes this issue more open to ridicule. It has been proved without a doubt that any form of so-called green energy cannot by any stretch of imagination provide a miniscule of practical energy requirements for our needs. Solar and wind options have already proved to be impractical both in terms of the magnitude of energy created and the financial drain it has imposed upon growing economies vis a vis production of energy through conventional means. Spain is a glittering example of the utter failure to implement green energy with the associated fiscal fallout due to its implementation.
We share a collective responsibility to provide if not a better life, at least the hope of survival and promise of basic health care needs of the society rather than to impose restrictions on the basic rights of people across the globe for whom the basic needs of survival are more overwhelming than preconceived folly of anthropogenic global warming.
If doctors can effectively manage and treat the sick rather than preoccupying themselves with the fanciful conceit of calming the forces of nature or their effects on health thereof, they would not be doing any disservice to humanity.
Competing interests: No competing interests