Opportunity knocks: health wins from action on global warmingBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4947 (Published 25 November 2009) Cite this as: BMJ 2009;339:b4947
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Editor –two weeks ago, on behalf of the BMJ, I interviewed Professor Ruhul Haque, Health Minister of Bangladesh about how rising greenhouse gas emissions are affecting health in his country. Bangladesh tops the 2009 climate risk index with threats from storms, floods, and falling food production. Crop yields in southern Bangladesh are already declining because of increased salinity due to rising sea levels. I asked the minister what doctors in Britain should be doing to draw attention to the plight of people in Bangladesh. He said that although poor people in Bangladesh are the victims the fault is mostly with the developed countries and that doctors should be “speaking in a common voice, in a loud voice so that the developed nations can understand and help the people who are suffering as a result of climate change.” He gave me his email address and mobile phone number in case I needed to contact him again on the issue.
Last week, the UK Health Minister Andy Burnham attended the launch of a series of articles in the Lancet about the health benefits of policies to reduce greenhouse gas emissions in areas such as food and transport. Cutting greenhouse gas emissions by reducing livestock production would reduce saturated fat intake and dramatically reduce rates of heart disease. Cutting emissions by reducing motor vehicle use, with more walking and cycling, would also have huge benefits with less heart disease, stroke, breast cancer, dementia and depression. In the short speech that he read out, Andy Burnham cited the DOH Change for Life Programme, a health promotion website supported by Tesco, McCain and other food industry partners, which exhorts obese people to move more and eat less, as an example of the win-win between climate change mitigation and health. Although the minister began by saying that the launch was the most important meeting he would attend this year, he did not stay to hear the presentation of the results, allowed only a few questions, and was rapidly ushered away by ministerial aides in the ministerial car. Later there was a brief political brouhaha because the Department of Health had not consulted the Department for Environment, Food and Rural Affairs about the implications for farming of reducing livestock production. According to the BBC, the Department of Health later withdrew its endorsement of the Lancet report and emphasised Burnham’s meat eating credentials.
Here were two health ministers a world apart. On the one hand, a health minister from a poor country whose people are suffering the health consequences of climate change, beseeching doctors in wealthy countries to put health and climate change on the international political agenda. On the other, a health minister from a wealthy country, whose people are suffering the health consequences of the over-consumption of fossil fuel energy and animal products (overweight and chronic disease), promoting limp public health policies and making empty public gestures.
Competing interests: None declared
liam donaldson claims that the nhs has a policy on climate change. Maybe so - but i wrote to our pct nearly 1 year ago asking what action they were taking to implement the new policy, and i am still waiting for a reply, despite numerous reminders. today i am working in our local hospital in Scunthorpe, which is overheated and ablaze with light. Electrical devices are rarely switched off and i have found rooms with heating turned high and fans on at the same time! The monthly electricity bill is over £70,000, which is an awful lot of carbon emissions. Under PBR - hospitals are paid for seeing patients in outpatients - but not for phone contacts or emails. Many patients travel many miles for perfunctory appointments. If the nhs is to significantly reduce carbon emissions, then action is needed, not just a policy.
Competing interests: i have children and i would like them to live until the end of this century
Roberts’ article  eloquently describes the health benefits of tackling climate change. In the same article, he also narrated how climate change is already affecting countries such as Bangladesh. This is worrying as it is becoming increasingly clear that the effects of climate change are likely to most adversely affect those communities in low- and middle- income countries that are least able to effectively mitigate against their effects.
The emergent threat of climate change is not new and neither is it imagined but the global community has been slow to react thus far. Climate change policy at present appears to be dictated by high income countries in temperate climes where the effects of climate change thus far have been muted and less obvious. This may contribute to the muted risk perception or indeed risk denial evident in these countries to date. We as health professionals are not without blame either - whilst we have talked the talk, we have not walked the walk.
In the face of the gargantuan challenges posed, it is easy to succumb to a degree of fatalism of the futility of individual action. But that is not true. Simple measures have been identified that health professionals can take that collectively can have a substantial impact. Similarly, it is also easy to defer individual responsibility to other agencies. It is important that health professionals appreciate that this is not an issue for public health practitioners alone, but for the entire health community.
Can the health community mount a substantial response to combat climate change? Recent experience of the energy, focus and drive demonstrated by the NHS in responding to the threat of swine flu suggests that the health community certainly has the capability to do so. What is required then is the political will, strong leadership and a preparedness to bear the costs as tackling climate change will have its attendant costs. For example, a considerable proportion of the NHS carbon footprint for example is due to building energy use (22% or 4.14 MtCO2). However, some NHS buildings have been built in recent years funded by private finance initiatives with long contractual arrangements in place spanning 20-25 years. Do local health authorities have the will to re-negotiate these terms to incorporate the climate agenda? And are they prepared or able to fund the contractual variations required especially in the coming years of austerity.
More broadly, there are legal instruments that can be utilised to respond to climate change. If climate change was declared an emergency by the UK government (and it would certainly fulfil the definitions of an emergency as set out in the act), the Civil Contingencies Act 2004 would place legal obligations on key agencies including health and local authorities, for the assessments of the risks and necessary plans to be made, but also confer powers to key agencies such as local authorities and primary care trusts to act to prevent, reduce or mitigate the effects of climate change.
Whilst climate change is a slowly evolving emergency (and likely in time to be a global disaster), it is easy to incorrectly assume that we have the luxury of time to react. It may already be too late. It is now time to turn words into action.
References 1. Roberts I. Climate change: Is public health up to the job? BMJ 2009; 339:b4947 2. Griffiths J, Rao M, Adshead F, Thorpe A, eds. The health practitioners guide to climate change. Earthscan, 2009. 3. Griffiths J, Hill A, Spiby J, Stoot R. Ten practical steps for doctors to fight climate change. BMJ 2008; 336:1507. 4. NHS Sustainable Development Unit (2008). Saving carbon, improving health – a draft carbon reduction strategy for the NHS in England. 5. Office of Public Sector Information. Civil Contingencies Act 2004. Available online: http://www.opsi.gov.uk/Acts/acts2004/ukpga_20040036_en_1 (Accessed 28/11/09)
Competing interests: None declared