Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Climate Change and Health
- Gerry C Silverstein, Burlington, Vermont-USA 05405 (26 January 2008)
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More CO2 - another undesired side-effect of EWTD
- Stephan Dalchow (28 January 2008)
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Climate change only a symptom
- Dominic C Horne (29 January 2008)
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You don't need permission to act on climate change!
- Chris Chung (30 January 2008)
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The role of doctors and health workers in response to climate change
- Emily Y Chan, Sian M Griffiths, William B Goggins (30 January 2008)
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The NHS must use its muscle
- Alan Maryon-Davis (30 January 2008)
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Medicine's contribution to climate change
- John J. Byng-Hall (31 January 2008)
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Gyms as energy sources
- Phillip J. Colquitt (31 January 2008)
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Hospitals and Climate Change
- David C Taylor-Robinson, Rachael Gosling, Public Health Specialist Trainee (1 February 2008)
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WANTED! A Green NHS
- Rachel C Stancliffe, Mahmood Bhutta, Medical Fair and Ethical Trade Group, BMA (19 February 2008)
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Global warming as money goes out of the window
- Barrie Smith (2 June 2008)
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Gerry C Silverstein, Emeritus Lecturer in Health Sciences University of Vermont, Burlington, Vermont-USA 05405
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In "Climate change-permission to act", Fiona Godlee refers to Margaret Chan sharing her belief that climate change will be the defining issue for public health in the 21st century. It goes without saying that climate change will have a dramatic impact on health.... personal, global, and planetary. Yet I would disagree that climate change is the defining issue for public health in the 21st century. The world's population reached 1 billion in 1804. During the next 200 years, another 5 billion people were added. If Total Fertility Rates (TFRs) fall as predicted by health demographers, the global population in 2050 will be approximately 9 billion (if their predictions are incorrect, global population could easily reach 12 billion by 2050). Africa, a continent with some of the poorest health outcomes in the world, is expected to grow by 1 billion people between now and 2050. What will life be like for an additional 1 billion people in Africa in 2050, especially if the continent's healthcare system, agricultural output, and access to clean water and sanitation do not improve? And even if overall quality of life does improve, the increase in energy consumption associated with an additional one billion people will likely exacerbate global warming via increased greenhouse gas production (both carbon dioxide and methane). What can be done to promote sustainable population growth? Obviously reducing poverty, eliminating gender equalities, and increasing access to education and family planning are essential. The diversity of these endeavors teaches us about the need to employ a multi-disciplinary perspective when addressing population growth. Failure to achieve sustainable population growth by concerted action will lead to population policies such as those implemented by China. The one child per family policy, draconian though it was, resulted in 400 million less people in a country whose current economic growth (driven in large part by the needs of the 1.3 billion people currently living in China) is causing enormous environmental harm. Had the one child per family policy not been implemented, one can only imagine the greater negative impact that 400 million additional people in China would have had on individual health and on the environment (and not just in China; pollutants released into the atmosphere by coal burning plants in China travel around the world) Margaret Chan is to be applauded for raising the consciousness of the global community to the relationship of climate change and health. Yet population growth and demographics demand that the consciousness of the global community be raised to at least a similar degree as regards the impact of an increasing world population on personal, global and planetary health. Gerry Silverstein, PhD University of Vermont Burlington, Vermont USA gsilvers@uvm.edu Competing interests: None declared |
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Stephan Dalchow, SPR Western Infirmary Glasgow G11 6NT
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The introduction of the European Working Time Directive to medical training in almost all specialties in the UK has had a number of adverse effects. Continuity of care for 24 hours has been interrupted and has led to the introduction of more hand-overs, where important information may be lost. Less time for training is already resulting in a deterioration in technical skills and a loss of clinical experience. Another aspect has been disregarded completely: The increased number of shifts leads to a significant increase in the number of travels between home and work-place and therefore CO2- and other emissions. Further Centralisation of clinical services means longer travels for staff, patient and relatives resulting in a similar effect. More discussion should hopefully lead the drivers of decision-making in the NHS to two consequences: 1. Together with a review of MMC/MTAS a review of the implications of EWTD with individual consideration of each specialty. 2. The reversal of the decision to centralise clinical services in order to keep them local and accessible to deprived communities and reduce individual traffic, particularly where these decisions where based on flawed and out-dated evidence from other countries. Competing interests: None declared |
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Dominic C Horne, GP Locum Westfield Walk Surgery, Leominster, Herefordshire HR6 8HD
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Is climate change the defining issue for public health in the 21st century? How can it be when it is only a symptom of a far more sinister underlying pathology? Global capitalism is the evil bringing misery to the world's population and sadly it appears that things will only continue to get worse for the forseeable future. The WHO has predicted that depression will become the world's second- highest cause of disability by 2020, eclipsing cancer, respiratory disease and infection (including HIV and malaria). Inequality continues to increase, both within and between nations, and ironically it is the very same victims of capitalism who suffer the most as a result of climate change. The single-minded obsession with creating ever-greater profit for an ever-smaller minority is destroying our planet and rendering mankind physically and mentally ever more sick. Fiona Godlee is quite right to say that 'The risks of inaction and the benefits of action make tackling climate change part of the doctor's role.' However, as good clinicians we must look to tackle the malignancy itself rather than focus on just one of its many unpleasant symptoms. Unless we have resigned ourselves to a terminal prognosis and are content to provide merely palliative care. Competing interests: None declared |
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Chris Chung, Registrar New Zealand
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About time! I have been caring for the environment for over 15 years since I watched a program on it as a teenager. I am not at all surprised at the cost savings that can be achieved with energy efficiency. The wastage of energy in any hospital is shocking: computers left on all night, photocopiers left on all night, tungsten bulbs in unused broom cupboards on all day and night, huge entrance doors blasting out heat, no reliable public transport leading to staff having to drive to work. I've written to my MSP about this and I got a letter back from the hospital I wrote about saying that they take the issue seriously. Well, I hope so, because every pound of wasted energy is a pound less for patient care. If doctors want more money for the NHS,then switching off unused lights and computers for a start is an easy way to help. If the Government is serious about companies cutting carbon emissions, it must lead the way with the NHS. Tax spent on the NHS is for patient care not for paying an electricity bill due to careless wastage. The US Department of Energy is making US hospitals more energy efficent (http://www.distributedenergy.com/de_0401_more.html). The NHS can do the same. Competing interests: None declared |
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Emily Y Chan, Assistant Professor Chinese University of Hong Kong, Sian M Griffiths, William B Goggins
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Heat wave related mortality is one of the direct human health effects of climate change. We have studied the health impact of heat waves in 3 urban Chinese cities and have identified significant associations between socio-geographical characteristics, temperature and mortality. Specifically for our Hong Kong analysis, we find that high temperatures have a greater impact on increasing daily mortality in more socially deprived areas. This variation might be attributable to factors such as lower socioeconomic status or population density or to other features related to city planning such as building heights and construction material which may lead to the ‘heat-island’ effect. Other studies have shown that risk factors such as extremes of age, immobility, use of tranquilizers, underlying cardiovascular or respiratory problems, mental illness, alcoholism, residence in the upper floors in multistory buildings and lack of access to air-conditioning facilities predispose individuals to higher mortality patterns in a community. Given the increasing climatic variations, our findings together with these other studies in urban settings highlight the need for greater awareness among healthcare workers of the higher risks of these population groups, particularly those living in urban cities which are characterized by densely populated districts. Whilst more research is needed to establish the risk profiles of different areas which may vary because of factors such as culture, climate and acculturation, we believe healthcare workers have important roles to play in protecting their community from the associated health risks as evidence supports the effectiveness of community based interventions in reducing the impact of heat waves. 1. Haines, A., R.S., Kovats, Campell-Lendrum, D. & C. Coralan. Climate change and human health: impacts, vulnerability, and mitigation. Lancet 2006: 357: 2101-2109 2. Basu R, Samet JM. Relations between elevated ambient temperature and mortality: A Review of the Epidemiologic Evidence. Epidemiologic Reviews 2002;24:190-202. 3. Kalkstein LS. Health and climate change: direct impacts in cities. Lancet 1993;342:1397–9. 4. Argaud, L., Ferry, T., Le, Quoc-Hung, Marfisi, A., Clorba, D., Achache, P., and Ducluzeau, R., Robert, D. Short-and Long-term Outcomes of Heatstroke Following the 2003 Heat wave in Lyon, France. Arch Intern Med. 2007: 167(20) Competing interests: None declared |
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Alan Maryon-Davis, President, UK Faculty of Public Health Faculty of Public Health, 4 St Andrew's Place, London NW1 4LB
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As one of the major organisations which will have to deal with many of the consequences of climate change, the NHS must use its unique position of power and influence and lead by example in taking immediate action to promote sustainable development and tackle climate change. The NHS is the largest single organisation in the UK, holder of one of the largest property portfolios in Europe and one of the biggest employers in the world. Its annual budget alone makes it ideally placed to harness its vast purchasing power to make a real difference. There are many positive things happening within the NHS to reduce carbon emissions, but there is much more it can do. And, because it is directly responsible for the health of the population, it can provide a powerful example for other organisations to follow. A practical guide just published by the UK Faculty of Public Health (FPH), Sustaining a healthy future – taking action on climate change,1 shows the many ways – including quick wins and longer term goals – in which the health and healthcare community in general, and the NHS in particular, can become more sustainable, and how we can help create a healthier, low-carbon future. It also shows that prioritising action on climate change and sustainable development makes good business sense. 1. Downloadable from the FPH website: www.fph.org.uk Competing interests: None declared |
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John J. Byng-Hall, Retired Child Psychiatrist Hampstead, NW3
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Godlee points out that our professional duty is to tackle climate change. We are doubly duty bound because medicine has been a major contributor to climate change through stimulating a massive escalating global population explosion by discovering how to prevent and treat many illnesses. That was an uncomfortable and unanticipated side effect. But we are also continuing to contribute to the population expansion. Saving and lengthening life is our mantra and the press never allows us to forget it. We need it to be established that we can assist those who wish to die when it is appropriate and not take us into many years of unwanted suffering through prolonging life. Before this a psychiatrist must see them first for any treatable depression. We should stand up as doctors for human well being against such forces as pressure of escalating litigation, compensation, exposure to limelight and certain religious beliefs for their own particular reasons. We should also put limiting the birth rate, which our profession knows a lot about, high on our agenda. Competing interests: None declared |
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Phillip J. Colquitt, Technician/RN Independent Comment
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Much energy is wasted when people attend health clubs. The various cycling and rotating machines could be "hooked up" to act as an electricity generation method. As it is the machines actually use electricity to create resistance, which resistance is potential electricity. How much better would obese and out of condition people feel if they were rated as to their energy production, not merely their KCal energy use. Competing interests: None declared |
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David C Taylor-Robinson, Clinical Lecturer in Public Health University of Liverpool, L69 3GB, Rachael Gosling, Public Health Specialist Trainee
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To the editor We read with interest the editorial on health and climate change. We have been involved in implementing public health strategies at the Cardiothoracic Centre (CTC) and the Royal Liverpool Children’s Hospital (RLCH) in Liverpool. The strategies aim to improve the health of hospital staff, patients and the wider community. Hospitals treat ill health, but can also address the wider determinants of health by influencing the social, physical and economic environment. A key theme of the strategies includes corporate social responsibility and the environment. Promoting public health in acute settings can be a useful vehicle for raising the corporate citizenship agenda and putting in place clear and achievable goals. Doctors can have an important role in leadership around these issues, but a multidisciplinary approach is needed, involving key partners in human resources and estates management. Part of the process of engaging people has been to clearly outline the links between what NHS staff see and experience on a daily basis and the bigger picture. For example, local purchasing can both reduce carbon emissions and revitalize local economies. This in turn plays a part in redressing social inequalities in health, which we know accounts for a significant proportion of hospital admissions. We have been struck by the enthusiasm and excitement that has been generated within these Trusts on these issues. The time is right for all healthcare providers to take on board the public health/corporate citizenship agenda – the effect on population health and the environment could be impressive. Competing interests: None declared |
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Rachel C Stancliffe, Director, The Campaign for Greener Healthcare Summertown Pavilion, Middle Way, Oxford, OX2 7LG, Mahmood Bhutta, Medical Fair and Ethical Trade Group, BMA
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We welcome and commend the BMJ for its latest issue on climate change, which comes not a moment too soon. As the articles in this issue detail, there are extremely pressing reasons for all of us, both personally and in our professional capacities, to take immediate action to cut our resource use, for the health of the planet and the health of its human inhabitants. McMichaels et al (1) suggest some strategies that health professionals can take to tackle this threat to health, including public education, surveillance and forecasting of health risks and adaptation strategies, and Roberts (2) rightly stresses the significant co -benefits to health of reducing carbon emissions. But we need more than this. The title question was “Climate change: what can doctors do?” There is a pressing need for health professionals to adopt more than a role of public health engagement, there is a need for them to lead by example in their own practices and in that of their organisations. In the BMJ Career Focus section, Cole (3) details six laudable green initiatives in various Trusts which are excellent isolated examples of what can be done. However, these will be drops in the ocean (carbon sequestration pool?) unless these and similar initiatives are shared across all NHS institutions in a more systematic way. Ray Furlong, (4) noted in a recent BBC programme called “NHS: A long way from being green” that the NHS lags far behind other sectors. The UK National Health Service emits one million tonnes of carbon every year and has an annual energy bill of approximately £400 million. Although the UK government has committed £100 million to improving energy efficiency in the NHS, and is committed to reducing carbon emissions significantly over the next decade, NHS carbon emissions rose by 11% between 2000 and 2005 as the number of buildings expanded. We are aware of several valuable papers and policy level initiatives by the government; companies such as The Carbon Trust and WRAP are beginning to look seriously at the NHS (5) and (6); and we welcome the recent announcement that the NHS Sustainable Development Unit will be created. However, greening the NHS has long been on the agenda (7) and (8) and the NHS MUST make more urgent efforts to implement fine words if targets for a reduction in UK carbon emission are to be achieved, and patients’ health safeguarded. We are aware that in the healthcare sector fair and ethical trade is also threatened by increasing emphasis on short-term fiscal policies, but are encouraged by the ongoing collaboration of the British Medical Association and the NHS to tackle such issues (9). We are convinced of the importance of a social, economic and environmental approach to sustainability and argue that fair and ethical trade is a vital component of this. The Campaign for Greener Healthcare started earlier this month with the mission of providing the NHS with active support in achieving sustainability in all areas of purchasing and provision. The campaign will work with government, the NHS, patients and relevant industries to provide services to improve sustainability. With the creation of ‘green teams’ the campaign will support action programmes based on examples that have already worked within the NHS and support specified targets for reduction of waste in all areas. Its activities will include research on the evidence base, consulting services, practical handbooks and toolkits, conferences and pulling together all the currently disparate information on attempts to green the NHS into one place. We hope that healthcare professionals will support and be supported by this initiative. We invite your readers to visit www.greennhs.org and to make one change for the better today. Rachel Stancliffe
Mahmood Bhutta
1 McMichaels AJ, Nyong A, Corvolan C. Global environmental change and health: impacts, inequalities, and the health sector. BMJ 2008;336;191- 194 2 Roberts I. The economics of tackling climate change. BMJ 2008;336;165-166 3 Cole A. How many doctors does it take to turn off a light bulb? BMJ Career Focus 2008;336:27-28 4 Furlong, R. BBC News: NHS: A long way from being green. http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7109163.stm 5 http://www.carbontrust.co.uk/carbon/publicsector/nhs/ accessed 30th January 2008 6 http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Estatesandfacilitiesmanagement/Sustainabledevelopment/DH_074290 accessed 30th January 2008 7 Gray M, Keeble B. Greening the NHS. BMJ 1989;299;4-5 8 May C. Climate change – the need for health leadership. In Improving health for the world's poor: what can health professionals do?.2007 London: BMA p27-33 www.bma.org.uk/ap.nsf/Content/Improvinghealth 9 Bhutta,M, Fair Trade for Surgical Instruments BMJ 2006;333;297-299 Competing interests: None declared |
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Barrie Smith, Retired physician Birmingham
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Dear Editor The Editorial staff of the BMJ are to be congratulated on repeatedly returning to the topic of measures to combat climate change, and encouraging doctors to take an interest in the issues. Preventing unnecessary fuel usage is important not only in combating global warming but it also leads to financial gains. On February 28th. I paid a visit to a local general hospital (500 beds plus) to count the number of open windows in all areas– there were 358. The building is some 30 years old. Most of the original windows were replaced with double glazed ones some years ago. I have difficulty in working out how effective is this double glazing when the said windows are open! On Good Friday (March 21st.) I visited a friend in a surgical block at another hospital – on one face of the block I counted 40 open windows. At yet another hospital on Easter Monday, a particularly chilly day, there were 208 open windows – some were high up in corridors and I suspect that they had been open for years. In hospitals there are various occupants – lightly clad largely inactive patients who may have to become undressed; also lightly clad active nurses and other staff who may find the ambient temperature oppressive, as may well-clad visitors – so windows get opened. Windows are also opened to clear unpleasant smells. Domestics need to dry off wet- mopped surfaces. People who open windows rarely close them –there are other preoccupations, staff have moved on to work in other areas, it is no one’s job, someone else is paying the heating bill, “fresh air is good for you isn’t it?” – and (as with shops with open doors) the system simply belches out more heat, so no one feels cold! Yours sincerely Barrie Smith Competing interests: None declared |
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