Intended for healthcare professionals

Spotlight Spotlight: Climate Change

Contraction and convergence: the best possible solution to the twin problems of climate change and inequity

BMJ 2012; 344 doi: (Published 19 March 2012) Cite this as: BMJ 2012;344:e1765
  1. Robin Stott, co-chair of the Climate and Health Council1
  1. 1c/o BMJ Publishing Group, Tavistock Square, London WC1 H9JR
  1. Correspondence to: stott{at}
  • Accepted 24 February 2012

“Philosophers have only interpreted the world; the point is to change it.” Karl Marx, 1845

Much is now known about anthropogenically induced climate change, its impacts on the planet’s species, and the need for urgent action to avoid catastrophe.1 2 The unequal distribution of resources between the materially rich and the materially poor amplifies the multiple adverse effects of climate change, so disrupting ecosystems, reducing agricultural productivity, and displacing populations.3

The consequences differ for rich and poor populations. In poor countries, life expectancy may be only 40 years (Swaziland and Mozambique), infant mortality as high as 180 in 1000 (Angola), and the lifetime risk of dying in childbirth 1 in 16 (sub-Saharan Africa). In rich countries, life expectancy can exceed 82 years, infant mortality can be as low as 4 in 1000, and the lifetime risk of dying in childbirth is less than 1 in 3000. But, having reaped the health benefits of wealth, these countries now face the diseases of excess. In the United States 30% of the population is obese, for example, and in urban Samoa a staggering 70%, and with obesity comes an increasing prevalence of diabetes, cardiovascular disease, musculoskeletal problems,4 and rocketing healthcare costs. And despite their affluence, over 10% of many rich populations are on antidepressants.5

Despite these different disease patterns, most early deaths and many disabilities are preventable. We know what to do: improve the conditions in which people are born, grow, live, work, and age. This improvement entails tackling the structural drivers of these conditions: inequities in power, money, and resources.6 Fortunately, many of the measures needed to improve global health are the same as those needed to make the required 80% reduction in global greenhouse gas emissions. What is good for tackling climate change is good for health, and …

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