Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Climate of misunderstanding
- John D McLean (10 November 2006)
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C&C References
- Aubrey Meyer (11 November 2006)
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Re: Climate of misunderstanding
- Bryan A G Cebuliak (11 November 2006)
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Pie in the sky
- Godfrey G Hill (11 November 2006)
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Is “contraction and convergence” equitable?
- David C Taylor-Robinson (12 November 2006)
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Doctor's Climate Change Leadership?
- William T Stevenson (13 November 2006)
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Time for action
- Ian R Campbell (18 November 2006)
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What should we do about climate change?
- John GUILLEBAUD (21 November 2006)
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Can health care workers be believed? – Nov 22 2006
- Phillip J. Colquitt (22 November 2006)
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Condoms for Africa
- Mark Struthers (23 November 2006)
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Re: What should we do about climate change - simple measures always work best.
- Robert J Carr (28 November 2006)
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Re: Climate of misunderstanding
- Amanda Root (28 November 2006)
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Psychological Consequences of the Birmingham Tornado: Lessons for the London tornado
- Catherine A Meads, Michael Stewart, Nicholas Owen, Paul Sampson (4th Year Medical Students, University of Birmingham) (14 December 2006)
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Global climate change and health
- Alan Maryon-Davis, Ian Gilmore, Patricia Hamilton (23 November 2007)
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John D McLean, Analyst Melbourne, Australia, 3000
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Would you, as a medical professional, start complex treatment without a clear and relatively certain diagnosis of a cause? That is what this article is urging you to do because evidence simply does not support the diagnosis that is presented. Earth's near-ground temperatures may have risen 0.6 degrees since 1976 but the temperature at heights lower than commercial aircraft, instead of warming in accordance with the "greenhouse" theory, are oscillating at no more than 0.4 deg C. Both the near-ground temperatures and the lower tropospheric temperatures have still not exceeded their 1998 values despite all the additional carbon dioxide. The evidence from proper analysis indicates that higher temperatures contribute to greater carbon dioxide concentrations and that the additional carbon dioxide has no discernible effect on temperature. Fears of an expansion of tropical diseases are very largely without merit. Malaria was common in Sweden and Russia in the 1800s and the issue was not temperature but the lack of common hygiene. Never mind what the politicians are saying, nor the eco-political organisations. Look to the evidence presented by data. On current figures the world will be cooler this year than last. It's a grave pity that heads are not cooler also. Competing interests: None declared |
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Aubrey Meyer, Climate Change Policy Research GCI E17 9LY
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The article refers to Contraction and Convergence [C&C].
GCI would encourage readers of it to refer to: -
www.gci.org.uk/briefings/ICE.pdf
for a C&C definition statement and
http://www.unep.org/pdf/ourplanet/op_english_17v2.pdf
for a recent description in a UN publication and
http://www.gci.org.uk/images/CandC_model_context_animation.swf and
http://www.gci.org.uk/images/CandC_model_context_animation.swf
for C&C materials used at the recent RIBA conference and the currect UN climate negotiations in Nairobi.
Aubrey Meyer
GCI
Competing interests: None declared |
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Bryan A G Cebuliak, General Practitioner Brisbane Queensland Australia 4122
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I thank the “analyst”, Mr McLean, for his concern about the medical profession. However, I fear it is perversely misguided if not disingenuous. His “analysis” reeks of propaganda rather than true statistical analysis. For his edification regarding the current and future effects of climate change on world health I suggest he read the following reference in the article. http://www.who.int/globalchange/climate/summary/en/ He will find it is more comprehensive than his “analytic” technique of setting up a straw horse, ie malaria in Sweden, to knock it down thereby implying that climate change will not effect global health. Regarding his leap to conclusions based on a shallow discussion of the relation of temperatures to global climate change, I point him to some expert discussion on this topic: http://www.realclimate.org/index.php/archives/2005/01/global-temperatures- continue-to-rise/ Competing interests: The future of my children. |
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Godfrey G Hill, Retired HP4 1HN
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What on earth will you come up with next? In the first place there is no universal consensus that carbon emissions are the main cause of global warming and secondly what possible good will stem from whatever minute amount you might save by this hare-brained scheme. And if you do manage to raise any money most of it will be pocketed by politicians in the "yet to be industrialised world". Competing interests: None declared |
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David C Taylor-Robinson, Specialist Registrar in Public Health Liverpool Primary Care Trust
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Editor – Stott advocates “contraction and convergence” to reduce global carbon emissions and redistribute wealth from rich to poor counties(1). I am concerned that this solution may not be radical enough. Identifying methods for distributing scarce resources, on a planet where widespread entrenched health inequity exists in and between countries, represents a major challenge for policy makers and for public health in the 21st century. The tools and philosophies used to address these issues are likely to have important effects on health and demand careful discussion. In order to address the problems of global social and environmental injustice that exist, should we not be challenging the current consumerist, market driven paradigm? The mechanism for “contraction and convergence” is to allocate an equal but gradually reducing entitlement of the carbon budget to every citizen and then to let the global market do the rest, allowing rich consumers to buy unused carbon allocation from the poor. This puts great faith in the current global economic system to sort things out when it is arguably the cause of the problem in the first instance(2). In their editorial Stott and Godlee advocate that health professionals should be articulating their concerns about the public health effects of climate change and “contraction and convergence” is suggested as a favoured option for dealing with the problem(3). One of the central tenets of current public health approaches is an emphasis on equity. This requires, as Aristotle put it, treating equals equally, and unequals unequally, in proportion to the relevant inequality(4). Allocating equal (rather than equitable) carbon entitlements and letting the market do the rest, in a grossly unequal world may not have the desired effect. References 1. Stott R. Healthy response to climate change. BMJ. 2006 Jun 0;332(7554): 1385-7. 2. Crawford F, Craig P. The Full English: the full picture. BMJ. 2006 Nov 11;333(7576):1022 3. Stott R, Godlee F. What should we do about climate change?: Health professionals need to act now, collectively and individually. BMJ. 2006 Nov 11;333(7576):983-984. 4. Gillon R. Philosophical medical ethics. 1986. Wiley Medical publications. Competing interests: None declared |
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William T Stevenson, Consultant Radiologist Royal Lancaster Infirmary LA1 4RP
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It is both egotistical and unwarranted to presume that doctors are more, or indeed less, caring for the planet than individuals with similar disposable incomes. When I atttended my hospital this morning there were three other cars in the on-call car park- all huge gas guzzling monstrosities: Land Rover, Mercedes and Volvo. Consultants generally have huge and/ or ridiculous cars such as Porsches, 4 wheel drives and so on, and only the ones deemed terminally eccentric or Anaesthetists are seen (God Forbid!)cycling to work. I suspect GPs are similarly inclined, particularly following the new contract, and I feel doctors in particular and the NHS in general are in no position to lecture others on 'carbon footprints'. Hospitals are almost all Electric Company Financial Directors' dreams, with unheeded lights lit all weekend, radiators jammed on next to open windows and all the other eco-vandalisms we have been familiar with for decades. The NHS says 'Sod the Planet, Jack, I'm alright', and it's right.. for a few years at least. Cease this self delusion! As regards the position of McLean in his response and George W Bush that Climate Change is an unproven speculation: because we can't all summon the expertise or the time to critically appraise the arguments, we're going to have to trust the real scientists. The heavyweight opinions are good enough for me. Competing interests: None declared |
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Ian R Campbell, Medical statistician I C Statistical Services, Wirral CH48 8BP, www.iancampbell.co.uk
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Clearly, we must do something: every individual, every organisation and every government must do something. The steady increase in carbon use is not sustainable, and has already lead to massive public health issues around the world. It is only a matter of time before mankind will reduce its use of carbon - it is far better that this happens now while the planet is still habitable, than leave the problem to grow and become an overwhelming burden for our children and grandchildren. Doctors are the most trusted profession, and a group of concerned health care professionals will achieve more by acting together, and speaking out together than by acting as individuals. Count me in. Competing interests: None declared |
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John GUILLEBAUD, Emeritus Professor of Family Planning and Reproductive Health Elliot-Smith Clinic, Churchill Hospital, Oxford OX3 7LJ
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Editor- Your leading article was excellent - but why no mention of contraception? Scratch the surface of almost any environmental problem and you find population as the great multiplier.1,2 Climate change depends on the number of climate changERS: mean per-person production of carbon dioxide is multiplied by the number of persons. World population now exceeds 6600 million, increasing mainly in the developing world by a billion every 12 years. A city for one million persons is required, somewhere, every 5 days. Each new city or slum not only impacts worryingly on adjoining croplands and forests and habitats for other species, but also means a million new makers of greenhouse gases, every 5 days. Poverty cannot be alleviated anywhere without energy, as India and China are demonstrating. They use nowhere near as much per- person as we who live in the affluent world of course, hence we absolutely must do everything mentioned in your article - I am not talking ‘either- or’ here but ‘both-and’. As a medical student, back in 1959, I attended a lecture on world population (then ‘only’ 3000 million) given by the biologist Colin Bertram. This talk established the direction of my career. For an environmentally-aware doctor I decided there could be no more appropriate medical specialty than contraception. Our success in reducing death-rates through public health measures starting in the 19th century, without enough government or medical concern then or since about a balancing reduction in birth-rates, had been the fundamental cause of the unprecedented 6-fold increase in human population that predictably followed. A sin of omission which health care professionals still urgently need to share in correcting, but always “wisely, compassionately and democratically”, in Jonathon Porritt’s words3 . The omission is doubly unfortunate, given that “more than 120 million couples have an unmet need for modern contraception and an estimated 80 million women have unintended or unwanted pregnancies, with 45 million ending in abortion annually” 4 . It is a paternalistic myth that in Africa, for example, there is no desire for correct information and the practical means to manage one’s fertility. I confirmed this only last month at an enthusiastic meeting for couples about family planning in Rwanda, the country of my upbringing - where all those killed in the tragic 1994 genocide have now been replaced and projections indicate at least a doubling of population by 2050; and in discussions with the Minister of Health and with the CEO of Urunana (the Rwandan radio ‘soap’ modelled on ‘the Archers’ which conveys reproductive health education messages within its story-lines). Indubitably, there is unmet need for family planning. Yet there is no unmet need anywhere for reducing affluence and energy consumption…. Rich or poor, our starting-point is that we want more. So is not the ending of the deafening silence on population with proper resourcing of voluntary contraception the most relevant, effective and do-able thing - by a country mile – for the medical profession? I offer myself (again) for consideration as a member of the BMJ’s carbon council. John Guillebaud 1 McMichael A J, Guillebaud J & King M. Contrasting views on human population growth. BMJ 1999;319: 931-2. 2 www.optimumpopulation.org 3 www.ecotimecapsule.com 4 www.who.int/reproductive-health/publications/srh_lancetseries.pdf Competing interests: None declared |
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Phillip J. Colquitt, Technician/RN Independent Comment
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Long experience with mercury abatement in health care[1], shows me that occupational health issues such as leaking mercury sphygmomanometers, which expose health care workers every day to mercury, tend to get camouflaged by health care workers[HCWs], and so appear to be “environmental” issues. The attitude could be put this way……… “…..oh yes it’s terrible that pregnant women have to avoid eating swordfish because of the methylated mercury in the environment, but we did a literature review of hazards related to elemental mercury leaking from sphygmomanometers, and we found there was little evidence, and the risk to nurses(women) was low…..etc etc” Can one believe HCWs when they start with environment issues? I don’t. I think health care workers have short memory syndrome. The HCWs I tend to believe are the ones who say they are human just like the rest of us, since they are more likely to be expected to be compliant with a mercury ban, and hence other environmental initiatives. In September this year, ophthalmologists demonstrated they don’t need mercury for ocular decompression devices[2], and we wait for the humble GP to phase out his sphygmomanometer – one of the largest reservoirs of mercury in the environment[3]. Further, I think there is a tendency for enviro-pollitical agencies[eg Greenpeace] to “go easy” on mercury use in health care, indicating the powerful HCW “professions” may be more feared rather than respected. [1]European countries ban sphygmomanometer. Online transcript from Australian Broadcasting Corporation’s TV program 7.30 Report 15/2/2000. Accessed on Wednesday, 22 November 2006. http://www.abc.net.au/7.30/stories/s100543.htm [2] Gayer S, Denham D, Alarakhia K, Bernal A, Cardenas G, Duncan R, Parel JM. Ocular decompression devices: liquid mercury balloon vs the tungsten powder balloon. Am J Ophthalmol. 2006 Sep;142(3):500-1. [3]Woroniecki RP, Flynn JT. How are hypertensive children evaluated and managed? A survey of North American pediatric nephrologists. Pediatr Nephrol. 2005 Jun;20(6):791-7. Epub 2005 Apr 5. Competing interests: None declared |
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Mark Struthers, General Practitioner Bedfordshire, mark.struthers@which.net
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John Guillebaud in his cogent response (What should we do about climate change? 21 November 2006) wonders why there was no mention of contraception in this otherwise excellent article. Professor Maurice King, Honorary Research Fellow at the University of Leeds, devotes the final chapter of his book ‘Primary Mother Care and Population’ to the ‘population demons’ and the current taboo of world population problems – a taboo which is stealthily maintained by the world’s only superpower. http://www.leeds.ac.uk/demographic.disentrapment/Chapter29Demons.htm A community is demographically trapped, according to Maurice King, “if it exceeds the carrying capacity of its local ecosystem (too many people and not enough land), - and there is nowhere for people to go, - and the economy produces too few exports to exchange for food and other essentials. What happens then is abject poverty, stunting, starvation, and population-driven violence.” In 1948, George Kennan at the US Department of State said, “We have 50% of the world’s wealth but only 6.3% of its population…. In this situation we cannot fail to be the object of envy and resentment.” The US citizen burns twice as much fossil fuel as the European and at least 20 times as much as anyone in the developing world. Of course, Americans resent criticism of their energy consumptive lifestyle - and religiously guard their freedom to consume, now and forever - and won’t discuss Africa’s disentrapment – because it is taboo. But we’re all in it together, in one world, North and South, East and West – and the US too. Disentrapment in the South can only take place as part of a campaign for sustainable lifestyles and reduced resource consumption in the North. The South has to reduce its fertility and the North has to play ball on resources. The South needs condoms and the North needs a kick in the butt – or as Maurice King more eloquently puts it, “Genu robustum ad inguen gentes superantium acerrime applicandum” or, ‘The current superpower needs a bloody good knee to the geopolitical crotch’ I would like to join Maurice King (and John Guillebaud) in kicking American ass … on behalf of Africa. "Rare is the felicity of the times, when you can think what you like, and speak what you think". This quotation by Tacitus starts chapter 29, 'The Population Demons' of Maurice King’s compelling book. Competing interests: I was born and spent my early years in Uganda |
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Robert J Carr, Consultant in Health Protection Shropshire and Staffordshire Health Protection Unit
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Dear Editor I read your BMJ editorial on 11 Nov with interest and would broadly support the policy option of contraction and convergence. I also agree that health professionals should play an exemplary leadership role for others in reducing carbon emissions. An article in the Times just over a week ago highlighted the enormous contribution that air travel makes to global emissions. The author gave a powerful example to illustrate this point. The contribution of an average passenger, taking a single return trip to New York was stated as broadly comparable with the domestic emissions (through heating, lighting etc) due to that same individual for a whole year! Since air travel is such a significant contributor to carbon emissions, surely one of the most simple and effective measures the BMA, and indeed the medical profession more widely, could take would be to reduce our personal air miles. A good starting, indeed exemplary, measure would be to seek to reduce the emissions contributions due to the widespread support of international medical conferences, for instance by promoting a greater use of teleconferencing facilities. Yours sincerely Dr Rob Carr
Competing interests: None declared |
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Amanda Root, Principal Lecturer School of Health and Social Care, Oxford Brookes University OX3 OFL
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This debate is fascinating because it reveals how some scientifically trained people refuse to believe trends and changes about which there is overwhelming scientific evidence and consensus. What we see here disproves the Enlightment myth that people are swayed by rational argument. (Our friends the climate change deniers prefer their own analysis to that of the eminent panel of about 2,000 scientists who constitute the Intergovernmental Panel of Climate Change, or to the conclusions of systematic reviews of peer reviewed climate change journal articles, for instance). We need to debate how we can move forward without being permanently derailed by these doubters. If we let policy-makers wait for everyone to be consensual about the need for action, we will have a long wait... Would changing the curriculum for health care professionals help? We need to teach more about risk and the limitations of science, and examine what - other than scientific evidence - structures fundamental beliefs so that future generations do not waste so much precious time trying to reason non-rational beliefs away. Competing interests: None declared |
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Catherine A Meads, Lecturer Department of Public Health and Epidemiology, University of Birmingham, Birmingham, B15 2TT, Michael Stewart, Nicholas Owen, Paul Sampson (4th Year Medical Students, University of Birmingham)
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The incidence of natural disasters in the UK is increasing (1) and their positive correlation with global warming is well documented (2). The long lasting psychological effects on human populations that such catastrophes can induce are increasingly coming to the attention of the medical profession and governments alike (3). At 11am on Thursday the 7th of December, a tornado injured six people and damaged up to 150 houses in the Kensal Rise district of north-west London. The financial and psychological fallout of the London tornado is yet to be quantified but London does have a precedent on which to base its management of this natural disaster. In July 2005, a tornado caused extensive damage to both residential and commercial areas of south-east Birmingham and affected several thousand homes. This was the strongest tornado recorded in the UK in nearly 30 years and figures from the Association of British Insurers estimate that the damage caused to buildings by the 130mph twister was £25 million (4). Of the most affected areas (Kings Heath, Moseley, Balsall Heath, Sparkbrook) the Sparkbrook district is the second most deprived area of Birmingham scoring 3.2 on the Townsend scale (5). Effective psychological management of the tornado victims is essential in the early months following a disaster as there is evidence that natural disasters have a detrimental effect upon mental health (6). Here we present further evidence of the existence of a relationship between natural disasters and increased mental health difficulties. To assess the impact of the Birmingham Tornado on the psychiatric health of the local population we used a scaled version of the General Health Questionnaire (GHQ-30) and questions regarding changes in self-report smoking, drinking and GP consultation rates. The questionnaires were completed on a door-to-door basis on four evenings during February 2006 across three streets affected by the tornado (cases) and three matching streets just outside the path of the tornado (controls). Questionnaire distribution was deferred until February 2006 to allow secondary stressors to take effect. Seventy-four cases and 94 controls were questioned. Of the cases, 70.3% scored above 12 using the GHQ questionnaire (the threshold associated with “psychiatric caseness”) compared to only 9.6% in the controls. Significantly increased GHQ scores were observed in cases (mean=14, SD=7.0) compared to controls (mean=7, SD=3.4, p<0.001). A significant increase in the GP consultation rates and alcohol consumption (as perceived subjectively by the respondents) in the six month period following the tornado was also observed (p<0.001 and p<0.001), although no significant increase in levels of smoking was observed (p=0.248). Our study demonstrates that natural disasters like the Birmingham tornado, which may be deemed “small-scale” still have the potential to cause significant mental health problems in the affected community. This morbidity may stem from the primary event itself or secondary stressors such as housing issues (7). Disadvantaged socio-economic groups are also more vulnerable to the impact of these stressors, not least in the Birmingham districts affected where 50% of the victims had inadequate home insurance (8). Birmingham City Council and has already spent in excess of £4.3 million making the area safe and addressing the most urgent community issues and hopes to put together a £260 million regeneration program over 10 years from public and private sectors. The council has also able to contribute £100,000 to a “hardship fund” (9) and residents have also relied on a relatively small Birmingham Tornado Relief Fund raised by local donations and charities (10). With the mounting evidence of natural disaster-induced mental illness, it is possibly time for central government to implement proactive measures to provide financial aid and counselling services that could greatly improve the mental health outcomes for the victims. References: 1. Parliamentary Office of Science and Technology. 267 – Adapting to climate change in the UK. POSTnote July 2006. 2. “Natural Disaster and Disaster Reduction Measures – A desk review of costs and benefits”. Review by Department for International Development (DFID), http://www.dfid.gov.uk/pubs/files/disaster-risk- reduction-study.pdf 3. McMichael A. & Woodruff R. Climate change and risk to health. BMJ 2004; 329: 1416-1417. 4. Statement by Malcolm Tarling, spokesman for the Association of British Insurers (ABI), quoted on BBC website http://212.58.226.19/2/hi/uk_news/england/west_midlands/4137456.stm 5. NHS Heart of Birmingham Teaching Primary Care Trust. Annual Public Health Report. October 2006. 6. Reacher M, McKenzie K, Lane C, Nichols T, Kedge I, Iversen A, Hepple P, Walter T, Laxton C, Simpson J. Lewes Flood Action Recovery Team. Health impacts of flooding in Lewes: a comparison of reported gastrointestinal and other illness and mental health in flooded and non- flooded households. Communicable disease and public health 2004; 7(1): 39- 46. 7. Davidson JR, McFarlane AC. The extent and impact of mental health problems after disaster. Journal of Clinical Psychiatry, 2006. 67 suppl 2; 9-14 8. Paul Farrow. Tornado lifts lid on risks of going without insurance. Article in the Telegraph, 9th August, 2007 9. “Tornado One Year On”. Press release from Birmingham City Council, 28 July 2006. http://www.birmingham.gov.uk/GenerateContent?CONTENT_ITEM_ID=86561&CONTENT_ITEM_TYPE=9&MENU_ID=276 10. Birmingham Tornado Relief Appeal. http://www.birminghamtornadorelief.org.uk/ Competing interests: None declared |
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Alan Maryon-Davis, President Faculty of Public Health, 4 St Andrew's Place, London NW1 4LB, Ian Gilmore, Patricia Hamilton
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The Editor BMJ BMA House Tavistock Square London WC1H 9JR 20 November 2007 Dear Madam Global climate change and health There is now virtually complete consensus that human production of greenhouse gases is driving global warming – more quickly than anticipated. In its latest summary of the scientific evidence,1 the Intergovernmental Panel on Climate Change suggests that the earth will warm by 2.0oC by 2030 – the tipping point at which warming may lead to more warming (melting ice means less reflected heat, warming oceans hold less CO2, dying forests sequester less, and soil organisms release more). Temperatures may rise by as much as 6.4oC this century. At the beginning of December in Bali, world leaders will attempt to agree on how to limit this rate of rise. It is imperative that they do. The IPCC predicts increased deaths and injury due to heatwaves, floods, storms, fires and droughts. Cardio-respiratory disease will be driven by increases in ground-level ozone concentrations. Freshwater and saltwater flooding will also impact on human disease: by 2002, the World Health Organisation was already ascribing 2.4% of worldwide cases of diarrhoea in some areas to climate change.2 Elsewhere, by 2100, the population exposed to malaria-prone temperature ranges may rise by more than one third. Water availability will suffer. Subsistence agriculture will fail regionally, through prolonged changes in temperature or rainfall, increased weather instability, altered growing seasons, and ecosystem collapse. Hunger, migration and war may also be driven by economic collapse similar in scale to those associated with world wars.3 As physicians concerned with the future health of the human race we urge the leaders to consider the health implications of such a rise, and act now to prevent it. The health effects are predictable and will affect first those members of the population who are the most vulnerable: poor mothers and children living in developing countries. It is predicted that there will be 175 million children afflicted every year over the next decade by the kind of disaster brought about by climate change, and by 2010 there will be 50 million displaced people, most of whom will be women and children.4 We consider this to be the greatest public health disaster facing us today and one which requires action at local, national and international level. We are calling on all health professionals, wherever they are, to unite in urging their colleagues, employers and institutions to reduce their carbon footprint, and to set an example in their own personal lives. We are also examining the work of our own Colleges to become carbon neutral as soon as possible. Above all we call on the world’s leaders to take radical action to reduce CO2 emissions as a matter of extreme urgency. Only by firm and decisive action right now, can we, as a global community, hope to avert or mitigate an impending public health catastrophe of immense proportions. Yours sincerely Professor Alan Maryon-Davis, President, UK Faculty of Public Health Professor Ian Gilmore, President, Royal College of Physicians of London Dr Patricia Hamilton, President, Royal College of Paediatrics and Child Health References 1. Intergovernmental Panel on Climate Change. Synthesis report: risks and rewards of combating climate change. Valencia 2007. http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr_spm.pdf 2. World Health Organization. World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: WHO, 2002. 3. Stern J. The Economics of Climate Change: The Stern Review. Cambridge: Cambridge University Press, 2007. 4. Save the Children. Legacy of Disasters. The Impact of Climate Change on Children. London: Save the Children, 2007. Competing interests: None declared |
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