What did you do about climate change Mum?
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7554.0-f (Published 08 June 2006) Cite this as: BMJ 2006;332:0-f
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear editor
We are delighted to see that the BMJ is taking a stand on and we commend
the actions you are taking on climate change. We the undersigned are a
group of public health professionals who believe that climate change is
posing a huge threat to human health. However we consider that there is
still time to reduce the threat. The reduction of carbon emissions by
countries, organisations and communities must become as legitimate a
priority for public health as tackling smoking. We believe that through
advocacy and influence, in our work and our personal lives, we can show
how much difference we can make. We have drawn up a manifesto to which we
are all signatories. Through this we are developing a practical programme
of work to make environmental sustainability centre stage within the NHS
and the broader public health world. We intend to:
• work with the English Department of Health and other Government
Departments, the Welsh Assembly Government, the Scottish Executive, the
Department of Health for Northern Ireland, to push for stronger government
action;
• take action, in partnership with others, to ensure that existing
opportunities to promote environmental sustainability are used to best
effect;
• take action nationally and locally to ensure that environmental
sustainability is reflected in public health workforce development ; and
• last but not least, to ‘practise what we preach’.
We will be encouraging our colleagues and our organisations to adopt
the manifesto and intend to take forward the actions we have set out. We
know we will be more influential working together than individually. If
you think you might be interested in becoming a signatory to the manifesto
please contact alison.hill@phru.nhs.uk
Competing interests:
None declared
Competing interests: No competing interests
Will the BMA and BMJ do their bit to save the forests by
1. Stop sending the print version of the journal to BMA members who
never open the plastic wrapper (many of my colleagues don't).
2. I and many of the members do not need the bmj careers either so
that will be some more trees saved.
3. Use only recycled paper to print the BMA newsletter and the annual
reports.
And in return for these a small discount in our BMA membership fees
would be great, thank you.
Competing interests:
I am a BMA member who forks out a fortune every year on membership fee
Competing interests: No competing interests
There will always be a few people who cling to their beliefs despite
overwhelming scientific evidence that they are wrong (for example, that
the MMR vaccine causes autism, or that HIV does not cause AIDS). With the
evidence we now have, it is very difficult not to conclude that global
warming is human-induced, and our ever-increasing energy use is wrecking
the planet.
The good (ish) news is that it may not be too late, if we all act now
and we all act decisively. There is much that each of us can do to reduce
our energy use, especially those of us who live in rich developed
countries. Read Mayer Hillman's article and excellent book. We must each
take individual responsibility for our impact on the environment, and stop
expecting the government, or the Americans, or anyone else, to sort this
problem out for us. We may have to accept that life will become a bit
more expensive or a bit less convenient, but that is surely a small price
to pay for securing the planet's future?
Competing interests:
None declared
Competing interests: No competing interests
This debate makes it crystal clear, how different minds interpret
same thing. I really appreciate the thinking and effort of the editor.
Editorials are meant to be thought provoking and intellectually
instigating. This piece certainly fulfills this criterion. It’s very easy
to criticize but criticisms should be after understanding the essence of
talk. Many of us raised fingers by giving so irrational reasons that it’s
hard to believe that they are health professionals (who live to serve the
humanity).
Mr. Cherry argued that if an asteroid is causing problem for mankind,
should this issue be raised in a medical journal. There is no comparison
between environmental change and an asteroid strike. This issue of
environment is raised in a medical journal because health professionals
are part of society and they can effectively contribute to solve this
problem by their individual efforts. Contrary to this in case of an
asteroid strike, nuclear war, drawbacks of WTO or nuclear proliferation,
there is hardly any thing which health professionals could do. You can not
ask Dr. Fiona Godllee to make a laser gun that could destroy the asteroid
in the air, but you can ask her to save electricity or prefer materials
that can be recycled.
Mr. Balaji Ravichandran argued that why should I do something when
others are not doing their part. I am sorry to say that this pathetic
thinking is the biggest obstacle in the progress of third world countries.
Change does not come all of a sudden, it takes years and decades. It will
not happen that one day you wake up and read the headline “2 million
people in USA and 1 million in UK have announced to cut their energy use
to save the environment”. Everybody must change its way individually
without caring what others do, then we might some day wake up and read the
headline “A study was conducted showing 2 million people in USA and 1
million in UK are doing efforts to save the environment”. Why we look at
others for examples? We should set good examples by taking the first step.
Somebody criticized that giving the ideas is not sufficient, give
suggestions how can we replace current air conditioning and heating
systems etc… My point is that, this is the stuff not to be asked to a
health professional and should not be published in a medical journal. It’s
true that engineers and scientists should answers these questions but
criticizing a health professional for not answering these questions in
quite unfair.
If you think that the same editorial in a newspaper will have the
same impact and credibility, then I am afraid you are wrong. Medical
journals are meant to provide credible information and journals like BMJ
are doing it responsibly. It’s the credibility of the journal/newspaper in
which the article is published that makes the real difference. I believe
all topics concerning human health directly or indirectly, about which
health professionals could do positive measures at individual levels must
be taken up in medical journals.
Competing interests:
None declared
Competing interests: No competing interests
The articles on climate change (BMJ 10-6-06) are a welcome, if
belated, addition to the wake-up calls we seem to need on this topic. As
in so many articles on this subject the emphasis is on personal behaviour
that leads to increased carbon emissions, and very important this is. But
there is scant reference to the other hugely important variable in the
equation – the growing world population (1). In 1955 the world population
was 2.8 billion. The current population of 6.5 billion is projected to
rise to 9 billion by mid-century (2), and unless this is recognised as
part of the problem our efforts to make modest cuts in domestic and travel
-related carbon dioxide production will fail to halt global warming, and
moreover will fail to halt the depletion of many other vital resources.
In Europe the total fertility rate (number of children per woman) has
fallen from 2.66 to 1.40 in the last 50 years. Without having introduced
draconian laws to limit family size, and without net inward migration, the
European population would now slowly decrease. Surely we should be aiming
for a steady reduction in world population so that each nation can be self
-sufficient in the key resources of food, water and energy. The United
Kingdom, with its very high population density (246 people per sq. km.
compared with Europe's 32 people per sq. km.) will be particularly
vulnerable to pressure on resources as world population increases. Rules
regarding trade in carbon allowances should be designed to encourage
countries to reduce their populations, by rewarding those countries that
succeed in doing so. Otherwise we are in danger of creating a perverse
incentive by which countries are encouraged to increase their populations
in order to obtain bigger allowances.
Health services will be crucial in providing incentives for
population reduction; universally free family planning services come to
mind, and no doubt good public health and child health services will play
important parts. There are enormous political and economic barriers to
achieving acceptably a sustainable population, and overcoming them is
probably the greatest challenge facing the human race today.
References:
1) Optimum Population Trust:
http://www.optimumpopulation.org/index.html
2) United Nations Department of Social and Economic Affairs;
Population Division: The 2004 Revision:
http://www.un.org/esa/population/unpop.htm
Competing interests:
None declared
Competing interests: No competing interests
Apologies to Mr Cherry for getting his title wrong, though he was
similarly mistaken with me. I too am a Mr, albeit of the non-surgical
variety- public health is now happily a multidisciplinary profession. Mr
Cherry is though right to compare climate change with concerns about AIDS
and nvCJD. In both instances the health establishment acted before there
was absolute scientific proof about the epidemiology of these diseases.
By erring on the side of caution, they helped to prevent, in this country
at least, a more severe health impact than would otherwise have been the
case. All we ask is that this same caution is applied to climate change
where the ultimate health impact could be much worse.
Competing interests:
I work for the UK Sustainable Development Commission
Competing interests: No competing interests
Editor: Thank-you for starting this important debate.
I want to contribute 4 comments to various threads.
One change that is simple to make and does have a measurable impact
on CO2 footprint (though is not in isolation a solution) is to switch to a
green electricity supplier. For example Good Energy (formerly
unit:e)guarantees that 100% of its supply is sourced from renewables.
This could also be done at organisational level and it would make a huge
impact if a large health or education organisation switched it entire
supply to a renewable. I suggest that those who can lobby their
organisation to do so!
Re: Dr Hayes - The Hardinian taboo - The BMJ does occasionally
publish debate on population/reproduction - see the reference below:
http://bmj.bmjjournals.com/cgi/content/full/315/7120/1441
I must admit, despite being convinced by the debate, I was persuaded
to be involved in producing 2 climate changers myself, which just goes to
show how difficult it is to make changes in accordance with one's
principles, despite the seriousness of the consequences.
Re: Carbon offsetting by tree planting - I dont claim to be an
expert, but my understanding is that the carbon dioxide cycle is
essentially carbon neutral; i.e. if you plant a tree today and cut it down
in 10-20 yrs (and decompose it in some way) - the carbon is released
again. In that sense off setting by planting trees could only work if the
trees are not cut down or decomposed for, say 100 years. Conversely, I
assume that agroforestry, that is using farmed trees to make paper, wood
products etc, is at worst carbon neutral. (Unlike cutting down virgin
rainforest).
So another small thing you can do is always use FSC certified products.
Re: Dr Reyes contribution - the point is that the majority of people
in the world DO use facilities that are unheated or uncooled, often
without electricity and usually without carparks too (though most probably
don't own a car). It is interesting that this has presumably changed for
some of the people in the Philippines, though not all I would guess.
The reason that this cannot change for everybody, is that the earth
cannot support air conditioning, heating, personal motor transport, TVs in
every room, etc etc for for every person on the planet.
Therefore this issue is vitally important because it is not just
about climate change, it is about social justice. Our present system is
obliged to maintain the poor living standards of the majority of the
world's population, unless the privileged minority in developed countries
and the elite of every country are prepared to accept a lower standard of
luxury than they currently enjoy so that the entire human race can
experience some of these benefits.
David
Competing interests:
Concerned about the planet.
Competing interests: No competing interests
It is with interest that the BMJ should select the topic of global
warming as a subject of an editorial with no immediate health
implications. One could argue that it is similar to public health
campaigns such as controlling smoking and drink driving which have had
measureable health outcomes. However global warming is disconnected even
further. Frankly I think it is a manifestation of a problem increasingly
facing doctors. The partial collapse of religion in the west and the
communities general disdain of politicians, suspicion of corporations and
other professional groups (eg lawyers) has resulted in us being expected
to comment about things other than medicine. Success in other health
campaigns and continuing advances in medicine only amplify this problem.
The responses to the editorial, however vigorous they are, highlight the
balanced nature of our profession and the increasing expectations society
places on us. Unfortunately though the subject of 'global warming' has
become hopelessly politicised.
As far as to the reality of 'global warming', we only need to look at
corporations central to it. Both Shell and BP have jumped the fossil fuel
lobby ship but whilst now recognising the problem have no clear plan on
what to do. Historcally they have behaved like the tobacco companies in
both denying the problem and obfuscate any effective debate. American oil
companies such as ExxonMobil continue to do so. There is a long term
liability issue here in that the insurance, agriculture, tourist and
finance industries have potentially a lot of money to lose and are
starting to make serious noise about much needed action on climate change.
Nuclear has raised its head in Australia but is not financially
viable without substantial government subsidies. Even the coal admits
there is a problem in that CO2 sequestration has been proposed but cannot
work commercially for at least ten years.
At an individual level its fairly easy to install a PV electricity
and solar hot water system on your roof (as we have done). This works well
in Australia. The difference in electricity you need can be purchased
carbon neutral. Most here though prefer to spend their money on 4x4 SUVs
and plasma TVs and buy cheaper electricity from coal fired power stations.
These are much sexier choices. It is also why Australia is almost as bad
as the USA in CO2 production per capita. This is what it comes down to
really, the needs and rights of the individual versus that of the group.
Competing interests:
None declared
Competing interests: No competing interests
I should have been disappointed not to have provoked controversy
with my tongue-in-cheek response, but Dr. Barnes has not got it quite
right: after all, I am a surgeon (and, by the way, I call myself “Mr.”,
not “Dr.”), so it’s not just a question of pills. In fact, though, as
regards my profession, my view is indeed that if there is no preventative
treatment, surgery or medication nor any possibility of palliation, then
it falls outside my area of interest. I stand by my criticism of the BMJ,
which I have made privately for a long time. The journal is supposedly a
medical publication. Now, an asteroid strike would have some pretty
serious consequences for public health, but I don’t expect a lapsed doctor
to write editorials about the possibility, seeing it as a topic for
astrophysical journals and thereafter for general public interest and
discussion. Of course, I may yet find a whole issue of the BMJ devoted to
asteroids, meteors and comets, and their potential effects on human
health, but I don’t think it would be a worthwhile exercise.
I think that Dr. Barnes’s rather predictable comments about middle
class elites are sad, and the bit about doctors committing themselves to
abide by ethical standards is patronising to the rest of society (not to
say middle class and elitist).
When it comes to waking me up, as Dr. Barnes so kindly puts it, I
suppose I shall have to declare my opinions about climate change,
irrelevant as they are, in my view, to medicine, otherwise Dr. Barnes’s
failure to understand my point (which was nothing to do with global
warming) may misrepresent my position. Here we go, then. First of all, I
think that human society is always under some form of major threat, and
that some people are naturally inclined to make more noise about it than
others who are naturally more optimistic. Thirty years ago, we were all
waiting for the planet to be polished off by an intercontinental ballistic
nuclear exchange followed by radioactivity and a nuclear winter. Twenty
years ago, we were waiting for decimation by AIDS (no, Dr. Barnes, I don’t
underestimate the seriousness of the situation in sub-Saharan Africa, and,
this being a medical problem, I do think it has something to do with my
professional work.) Fifteen years ago, it was going to be NVCJD (and
those working in the field still tell us it may be.)
I think climate change is happening, although perhaps faster, perhaps
no faster than it has done on other occasions within the last two hundred
years. Whether it really results from human activity, or can be altered
by changes in human activity, seems to me to be equivocal, but both are
certainly possible. When it comes to changing the “carbon footprint” of
hospitals in Britain, I doubt this will have much impact at all bearing in
mind the current and projected use of fossil fuels in the USA, India and
China. I believe, however, that we should in any case be reducing our use
of fossil fuels, because they are a finite resource and cause pollution.
There is no reason not to look for alternatives at present, and if such
action benefits the climate, excellent. The way for me to influence this,
however, is not to lecture society from my exalted position as a doctor (I
think even those who are not doctors have an interest in preserving the
human race), but to study, discuss, put forward ideas, and vote. And I’ll
cheerfully vote for any party which puts forward the following plan:
Build ten new nuclear power stations and use them to generate electricity
and hydrogen. Go for public and private vehicles fuelled by hydrogen,
biodiesel or bioethanol. Subsidise the fitting of solar panels to all
houses, and small wind generators to all chimneys. Invest in wave and
tide power, concentrating particularly on the areas undergoing rapid
coastal erosion at present.
But why put this forward in a medical journal? And what would be the
response if I did? Just as mixed as it has been to my earlier rapid
response, I suppose. Some at least would castigate me (as a doctor) for
wanting to use nuclear fission, and would assume (wrongly, as Dr. Barnes
was wrong in thinking I was not in favour of reducing fossil fuel usage)
that I don’t understand the risks. They would remind me of Windscale,
Three Mile Island, Chernobyl and the pollution of the Irish Sea, and
generally urge me to, er, wake up. The place for scientific articles
about climate change is in the relevant journals. The place for debate is
politics. The job of a medical journal is to disseminate research and
information about medicine. Which is where I came in, and where I still
stand. I shan't make any further response on this subject, you will all
be relieved to hear. Cheerio, chaps.
Competing interests:
I am in favour of reducing the use of fossil fuels and in favour of nuclear power generation
Competing interests: No competing interests
Carbon Columns in the Atmosphere- Availability and Useage
Our Carbon Footprint is often measured in terms of the number of
tonnes of CO2 we emit a year. It might be easier to visualise the damage
in terms of an area of ground and/or a volume of atmosphere 'filled'with
CO2, to a generally accepted upper limit (with regard to its greenhouse
gas effect). One way of doing this is to consider the number of Carbon
Columns of atmoshpere we 'fill' each year and the area of ground they
cover.
A Carbon Column is defined (by us) as the column of atmosphere
stretching up into space above 1 square metre of ground. Given the density
of air (1.225kg/cu metre) and mercury (13,593kg/cu metre) and an
atmospheric pressure of 0.76 metres of mercury, we can calculate that a
Carbon Column is 8433 metres high. (In fact, as we know, the atmosphere
strestches upwards for more than 100km but the density of course reduces).
Present CO2 levels are 378 parts per million (ppm). A generally
agreed (but debatable) upper limit is 450 parts per million. We can
therefore put an extra 72ppm in the atmosphere before catastrophe strikes
(we appreciate that a certain amount of CO2 will be reabsorbed). 72ppm
equates with 72cc of carbon dioxide in 1 cubic metre. 72cc of CO2 has a
mass of 0.14g and therefore a Carbon Column 8433 metres high can have an
extra 1.9kgs put into it before it is 'full'. For rough calculations 1
tonne of CO2 fills 838 Carbon Columns of atmosphere (at the present level
of 378ppm);this equates with the atmosphere standing on a square piece of
land with sides 29 metres.
In the UK we emit about 10 tonnes of CO2 a year each on average; all
60,000,0000 of us. We therefore 'fill' the atmosphere 'standing' on a
piece of land twice the area of the UK(and complain about rainforest
loggers). A car emitting 140g of carbon dioxide per km 'fills' a Carbon
Column every 8.433km that is driven. Most cars produce significantly more
than 140g of CO2 per km.
Given a world population of 6.6 billion and the fact that there are
5.1 x 10 to the fourteen Carbon Columns, it follows that there are about
77,000 Columns available to each of us.
We hope that this concept (which is probably open to a great deal of
refinement) may help people to visualise the limited atmospheric resources
available and how much they are using.
Competing interests:
None declared
Competing interests: No competing interests