Call for emergency action to limit global temperature increases, restore biodiversity, and protect health
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1734 (Published 06 September 2021) Cite this as: BMJ 2021;374:n1734Linked News
Climate crisis: Over 200 health journals urge world leaders to tackle “catastrophic harm”
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,
How urgent is an "emergency"? The word usually implies that immediate action is needed, but in the two years since the declarations of a climate emergency by many national and local administrations following the 2019 street protests, there has been little effective action. In some countries, e.g. the UK, fossil fuel use has even been encouraged by measures such as further road building. It is all a long way from the "rapid and far-reaching transitions", taking just a few years, that was envisaged by the IPCC SR15 report of 2018 [1], which sparked the street protests.
We can quantify the urgency of the climate emergency in terms of the residual carbon budget - i.e. how much more CO2 can be dumped into the atmosphere without a major risk of exceeding 1.5°C global warming - and how soon this budget will be used up at current emission rates. It turns out that the UK's fair share of the global carbon budget will be used up in 3.3 years. The maths are simple, but this timescale of 3.3 years is so far from what is being discussed, even in your editorial, that it is worth explaining the calculations in detail, as follows, so that readers can check for themselves.
The 2021 IPCC AR6 report [2] (Table SPM.2 p38) gives 400 billion tonnes CO2 as the global carbon budget to keep global warming to less than 1.5°C with 67% confidence. This is from the start of 2020. With a world population close to 8 billion, and using an assumption of global equity, this is 50 tonnes per person on the planet as a lifetime limit. The UK's current CO2 emissions are around 10 tonnes per person per year, according to a WWF report [3] (Figure 21, p46). So the UK's 50 tonnes per person will be used up in 5 years from January 2020, i.e. in December 2024, which is 3.3 years from now.
This should not come as a surprise to people in the UK since similar calculations were done by the Tyndall Centre after the 2018 SR15 report, and are readily available for each UK local authority [4]. These typically give a fair share of the global carbon budget as running out in 7 years from 2020 at current emission rates - the period is 7 rather than 5 years since the local authority data provided by BEIS is incomplete in not including emissions that are embedded in imports. Despite being so readily available, these reports have been almost completely ignored.
Why is the need for radical change (emission cuts of double digit percentages per year) not common knowledge? Firstly, the UK Government promotes its Net Zero 2050 plan [5] as a satisfactory solution, but the Government is not being sufficiently transparent that emissions from aviation, shipping and imports are excluded, or about the implications of the commitment to global equity, or about the feasibility of the implied technological solutions. Many commentators repeat the Government's claims without challenge, but youth climate activists see through them and are speaking up about the deceits [6][7]. Secondly, for various reasons, many climate scientists and many NGOs are self-censoring about the size and urgency of the changes needed [8] - it is easier to campaign against the expansion of a particular airport than to explain the blunt truth that any leisure flying using fossil fuels is incompatible with a lifetime personal carbon budget of 50 tonnes CO2, since a reliable food supply and keeping warm are much higher priorities.
Yet another COP may help, but what is really needed is for everyone to tell the truth about the climate emergency so that it is treated as an emergency, and to call out misinformation and deceits whoever makes them (however uncomfortable that is), as is advocated by Scientists for Global Responsibility in their Science Oath [9]. It is clear that we cannot rely on governments to take the right decisions by themselves, however much they are urged to. It is up to citizens to be much more involved in policy making, and health professionals with their independence and their experience in making and explaining tough choices are well placed to make a major contribution to this.
[1] https://www.ipcc.ch/site/assets/uploads/2018/11/pr_181008_P48_spm_en.pdf
[2] https://www.ipcc.ch/report/ar6/wg1/downloads/report/IPCC_AR6_WGI_SPM_fin...
[3] https://www.wwf.org.uk/sites/default/files/2020-04/FINAL-WWF-UK_Carbon_F...
[4] https://carbonbudget.manchester.ac.uk/reports/
[5] https://www.theccc.org.uk/publication/sixth-carbon-budget/
[6] https://climateemergencyeu.org/
[7] https://twitter.com/GretaThunberg/status/1385165197350952961
[8] https://www.sgr.org.uk/resources/turning-delusion-climate-action-prof-ke...
[9] https://www.sgr.org.uk/projects/science-oath-climate-text-and-signing
Competing interests: No competing interests
Dear Editor,
The biggest environmental impact we have seen was due to Covid itself. The planetary carbon emissions significantly reduced due to transport freeze - no planes or cars or buses etc. This was not man-made (as far as we know). It was an event of nature. Such an environmental "Covid Effect" if it were sustained should bring about some significant change. An intervention of this scale is required it seems to offset the progressive destruction outlined in your editorial. This will not happen because human nature doesn't change its spots. People will keep doing what they are doing as long as they get away with it. To change human behaviour, (and this is what we are speaking about), a powerful deterrent or stimulus is needed. A recent editorial in Science discusses the Will to Fight and shows that it correlates with deeply held convictions and commitments usually of a spiritual, cultural or patriotic hue.[1] It also shows that success in an venture requires cohesion and unity of purpose in the group.
Where are these features in your suggestions to halt temperature rise? The big carbon emitters are either absent or underrepresented in your journal listing - USA, China. You cannot cool the planet if fires are burning wildly in several big countries. Such editorials are aspirational and naive and like arranging the proverbial deckchairs on the Titanic. Something far more courageous, honest and powerful is needed. A force of nature similar to the Covid Effect is needed. Maybe when the White House spontaneously combusts due to soaring heat, or when Tiananmen Square gets flooded due to sea level rise we might see change?
1. The will to fight.SCOTT ATRAN. SCIENCE..3 Sep 2021:Vol 373, Issue 6559; p. 1063. DOI: 10.1126/science.abl9949
Competing interests: I object to human bashing and overpopulation being trotted out as the cause of all woes. Northern Hemisphere under-population is the real issue.
Dear Editor,
An interesting commentary published in Nature (Mallapaty, 2021) reports that a vast proportion (40%) of white-tailed deer (Odocoileus virginianus) from North-Eastern USA were proven to harbour anti-SARS-CoV-2 antibodies in their blood serum.
This implies two important things, namely that:
1) the aforementioned deers had been previously exposed to the virus;
2) these deer, once having acquired the infection - most likely from SARS-CoV-2-infected humans - were (most likely) able to transmit the virus to their conspecifics living in close proximity with them.
Based upon the above, white-tailed deer add themselves to the (already) long list of SARS-CoV-2-susceptible animal species, either naturally or experimentally, including - among others - cats, dogs, racoon dogs, lions, tigers, snow leopards, pumas, ferrets, hamsters, otters, gorillas and mink (Di Guardo, 2020; Di Guardo, 2021a).
Within such context, the viral-host interaction dynamics occurring in mink appear to be of special concern, provided that - once acquired from infected humans - SARS-CoV-2 was shown to evolve into a peculiar "variant of concern" (VOC) named "cluster 5" inside the body of mink, which were additionally proven to be able to re-transmit the mutated virus to humans (Di Guardo, 2021a). This has been repeatedly documented, more than one year ago, in intensely reared/bred mink from The Netherlands and from Denmark, where approximately 17 million mink had to be killed as a consequence of the public health hazard posed by them.
In this respect, based upon the fact that the "artificial, man-made gregarious appearance" characterizing intensive mink herds (paradoxically) shares a number of features in common with the ecological behaviour of white-tailed deer, living together in more or less large groups of animals, there are plausibly more chances - for both species - of acquiring and transmitting SARS-CoV-2 infection to their conspecifics in close proximity to them.
This is additionally supported by the primary sequence similarities existing between the viral ACE-2 receptor of white-tailed deer and mink, on one side, and the human one, on the other, as also reported by us for a number of cetacean species inhabiting the Western Mediterranean (Audino et al., 2021).
What does all this mean in terms of "SARS-CoV-2 infection's evolutionary dynamics"?
We know there are almost 8 billion people living on Earth and that the "official numbers" of the SARS-CoV-2 pandemic show that the virus has thus far (at the date of September 08, 2021) infected approximately 220 million humans, with a death toll of nearly 4.6 millions worldwide (World Health Organization/WHO, 2021). We also kmow that the vast majority (over 70%) of people vaccinated against SARS-CoV-2 live in no more than 15 Countries, with the so-called "herd immunity level" (which is now estimated to be reached when around 85-90% of the human population will have received a full vaccination, as a consequence of the widespread circulation of the "Delta VOC") having been achieved, thus far, in none of these Countries, to the best of my knowledge. We additionally know that young people, who may still become infected quite easily, tend to display the clinical features of SARS-CoV-2 infection much less frequently than older adults and elderly people (many of whom are now fully vaccinated, luckily!), with many SARS-CoV-2-infected youngsters showing either no symptom(s) or very mild CoViD-19-associated/related clinical signs. While this is undoubtedly good news, on the "other side of the coin" there is an increased risk of viral transmission posed by asymptomatic, SARS-CoV-2-infected young people, with special reference to unvaccinated, older adults and "fragile" elderly patients.
Furthermore, by circulating "undetected" in young patients - many of whom are getting vaccinated in Italy as well as in other Countries - the chances for the virus to evolve into additional VOC and/or "variants of interest" (VOI), such as the recently described "Kappa", "Lambda" and "Mu" variants, will most likely get increased by far.
This appears to be true also for unvaccinated people and, most plausibly, also for a number of SARS-CoV-2-susceptible animal species, as clearly demonstrated for mink in relation to the "cluster 5 VOC" in The Netherlands and in Denmark.
With this in mind and in tight agreement with the One Health principle, mutually linking "human, animal and environmental health" to each other, I believe we should take into serious account the possibility/opportunity to vaccinate (also) SARS-CoV-2-susceptible animals, both domestic and wild ones (the latter ones not only from a health but also from a conservation perspective), against SARS-CoV-2 (Di Guardo, 2021a).
Indeed, of the many lessons this dramatic pandemic has taught us, the most important one is that we need a "holistic, multi-interdisciplinary strategy" to properly counteract and, most hopefully, prevent similar catastrophes in the years to come.
This is totally different, of course, from the "anthropocentric" and, consequently, "hospitalocentric" approach seen until now, which - albeit important - is by definition a "losing approach" if everything rotates around it.
Notwithstanding the above, it makes me very sad to remark - as a veterinary pathologist and past university professor for almost 20 years at an Italian veterinary medical faculty - that not even one single veterinarian sits yet on the "Italian CoViD-19 Scientific Committee" (popularly known with the acronym "CTS"), after more than 19 months since its official institution (Di Guardo, 2021b)!
References
1) Audino T., et al. (2021) - Animals.
2) Di Guardo G. (2020) - Journal of Comparative Pathology.
3) Di Guardo G. (2021a) - Veterinary Record.
4) Di Guardo G. (2021b) - BMJ.
5) Mallapaty S. (2021) - Nature.
Competing interests: No competing interests
Dear Editor
One of the actions that must be taken to reduce the climate disaster is often omitted for political and economic and other reasons.
That action is the reduction in human population size, which is almost 8 billion and still rising. Human population growth and parallel increases in consumption are the root cause of climate change.
Population growth can easily and cost effectively be addressed through free access to contraception and financial incentives for smaller families. The resulting stability of population would result in less construction and deforestation and have a huge impact on climate change.
As health professionals I hope you acknowledge and promote this.
Competing interests: No competing interests
Dear Editor
With the concurrence of climate change and Covid-19, human beings are witnessing two simultaneous cataclysmic pandemics for the first time in modern history. Both are existential threats not just to human beings but to the collective species that inhabit our planet.
Human beings are the most dominant animals on this planet. We can, via intellect and tools, literally change the face of the earth, and we have done so. The world community has been slow to acknowledge the negative consequences of our actions. This is not now possible; we now face two simultaneous pandemics, Covid-19 and climate change. For the most part, Covid-19 has been more ostensibly abrupt and brutal and climate change has been more insidious. Climate change and Covid-19 may at first appear to be disparate events, which by chance are occurring simultaneously. Upon closer scrutiny, this is not true.
There are commonalities of cause and effect (with one brief and unsustainable window of counterbalance). Both have anthropogenic roots. Both incur massive costs with respect to economies and human health, and for both, the initial victims of these costs are, disproportionately, those with fewer resources and fewer options; there is an increasing divide between the ‘haves’ and the ‘have-nots.’ This divide could in turn have social and economic consequences yet unseen. Our power to change the planet has given us the responsibility to be its custodians. We can only hope that the devastation being caused by these concurrent pandemics will raise awareness to the point that we can be more proactive and do a better job of protecting the house that we live in.
Reference:
1. Joshi M, Caceres J, Ko S, Epps SM, Bartter T. Unprecedented: the toxic synergism of Covid-19 and climate change. Curr Opin Pulm Med. 2021 Mar 1;27(2):66-72. doi: 10.1097/MCP.0000000000000756. PMID: 33394750; PMCID: PMC7924924.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924924/
Competing interests: No competing interests
Dear Editor,
Climate change has now turned into a crisis. Typically an acute-on--chronic problem, the exacerbation is now persistent and appears unending.
The impact of the Corona Pandemic, unabating and casting economy breaking effecs, on Global Health cannot be underestimated and should be expected to bring about a change in thought and approach to issues environmental. At the UN, rich nations should do more, and there should be equity - the vaccine global maldistribution is an example of what should not happen. The combined and collective effort on the part of two hundred world Health editors deserves appreciation, carrying as it does the importance of necessary emergency action. Optimism is a must, but this could be a major start.
Dr Murar E Yeolekar, Mumbai.
Competing interests: No competing interests
Dear Editor
This call for a rapid emergency response could not have come at a better time (UN COP26), especially as pre COP discussions have made no progress. The IPCC 6th assessment said that "unless there are immediate, rapid and large-scale reductions in greenhouse gas emissions, limiting warming to close to 1.5°C or even 2°C will be beyond reach" (9 August 2021 IPCC press release). However the record of inaction shows this will not happen unless governments, in short order, terminate fossil fuel subsidies and incentives and charge the fossil fuel industry the full costs of fossil fuel pollution. This is a must for rapid global emissions decline mitigation, adaptation and for the development of safe direct air capture of CO2. As these two long delayed indispensable measures are not in the Call for Emergency measures..., the world and our future needs a follow up statement urging governments to implement these for the UN COP26.
Sincerely
Dr. Peter Carter
Competing interests: No competing interests
Re: Call for emergency action to limit global temperature increases, restore biodiversity, and protect health
Dear Editor,
We congratulate your collective initiative demanding urgent action against climate change.[1] However, despite citing many useful strategies, you only made a passing mention about production and distribution of food1 without touching in any depth on the paramount importance of our eating habits to human and planetary health. For instance:
• We agree with you that the destruction of nature[1] must be stopped for the sake of all the living creatures in this Planet. But let’s clarify that one of the greatest drivers of habitat destruction is our meat consumption: cattle production alone causes 40% of deforestation globally.[2] Our food system constantly converts natural habitats into farmland and reduces biodiversity.[3] Consequently, the biomass of humans and of livestock far surpass that of wild mammals. The same applies to birds where the biomass of domesticated poultry is about three times higher than that of wild birds.[4]
• We agree with you that heating is contributing to declines in the yields of major crops.[1] But according to the Food and Agriculture Organisation of the United Nations (FAO), 33% of croplands are used for livestock feed production.[5] If we add that animals take large amounts of feed to produce 1 kg of meat (cattle take 25 kg, mutton 15Kg, pork 6.4Kg, and poultry 3.3Kg of feed to produce 1 kg of meat),[6] it does not make much sense to use our limited resources in this manner.
• We agree with you that our health is affected by the rapid changes in climate we are experiencing. However, while 9.43% of all deaths have been associated with non-optimal temperatures,[7] dietary risk factors caused 22% of all deaths in 2017. These deaths were mostly due to noncommunicable diseases[8,9] which in turn cause 71% of all deaths[9] and can be prevented by tackling the root of the problem, our diet.
• We agree with you that the greatest threat to public health is the failure of world leaders to keep the average temperature rise below 1.5°C and to restore nature.[1] But clinicians have also failed at helping patients change the unhealthy diets that drive the destruction of nature and are a major source of greenhouse gas (GHG) emissions (animal-based foods corresponds to 57% of the global GHG emissions from food production compared to 29% from plant-based foods).[10]
If you truly recognise that more can and must be done and that only fundamental changes will reverse our situation,[1] then let’s talk about our eating habits: the fundamental actions everyone can take to do what’s vital for the planet while enhancing their own vitality. In fact, individuals have been changing their diets already due to health and environmental concerns[11,12] However, to fight climate change, sustainable diets must become generalised and clinicians are uniquely placed to encourage patients to make this transition.
As you say, clinicians must do all they can, and they should proactively contribute to prevention of further damage and act on the root causes of the crisis.[1] Since human nutrition is at the crux of the problem, they should educate and empower their patients to change their diets towards less processed and more plant-based foods.
Some clinicians may argue they lack training to provide dietary advice, but if they often recommend their patients to stop smoking without being specialised in pneumonology, why can’t they recommend dietary changes that are known to improve healthcare outcomes and help fight climate change as the EAT-Lancet Commission explained so well?[13] At this point, it comes down to honouring the Hippocratic oath and its “First do no harm” concept by stopping to neglect the power nutrition has over health and sustainability. And if they consider they lack training, they can resort to the many resources available to clinicians, such as:
• The American College of Lifestyle Medicine provides extensive online and in-person resources for different types of clinicians up to Board certification in Lifestyle Medicine:
o https://www.lifestylemedicine.org/ACLM/Education/ACLM/Education/Overview... [14]
o https://www.lifestylemedicine.org/ACLM/Certification/Approved_CME [15]
• Plant-based Health Professionals UK in association with the University of Winchester offer the first University-based course on plant-based nutrition in the UK along with a many other resources throughout their website:
o https://plantbasedhealthprofessionals.com/pbn-course [16]
• The Physicians Committee for Responsible Medicine offers many resources for clinicians including CMEs:
o https://www.pcrm.org/good-nutrition/nutrition-for-clinicians
• Harvard University provides several online nutrition courses for clinicians:
o https://online-learning.harvard.edu/subject/nutrition [17]
• A new white paper by Food+Planet that “provides a road map of how we might meaningfully close the gap so that we can create a movement among nutrition professionals to catalyse change within the food system”, downloadable here:
o https://foodandplanet.ck.page/ [18]
As we all know, climate change is already disturbing societies worldwide and drastic changes should be implemented at all levels to protect our children’s legacy. The large-scale dietary changes towards predominantly plant-based patterns that clinicians should lead can make a great impact to stabilise Earth’s climate, protect nature, and improve human health and productivity.[13,19] So, instead of hoping we develop technologies to remove GHG from the atmosphere, let’s reduce the methane and all the other GHG produced by animal farming by switching from animal to plant protein sources now.[19]
COVID-19 demonstrated that global action and unprecedented funding can be implemented very quickly. It also showed that after eons of evolution we still follow a fight versus flight behaviour. But if we are the most intelligent beings in this planet, let’s behave as such instead of as the worst invasive species in history. After all the amazing progress we have achieved, now we face the ultimate challenge to evolve beyond our primal inclinations by learning to eat to live and thereby reach the best version of ourselves, physically, mentally, and ethically.
To summarise, in a situation where we need to do everything possible, we should invest our limited time on the exponential effect of drastically changing the actions every human does many times daily: eating and drinking. We can be sure we’ll all die someday, but what if we can give our children healthier lives and fight climate change at the same time? It sounds like the right thing to do.
REFERENCES
1. Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. The Lancet. 2021;398(10304):939-941.
2. Pendrill F, Persson M, Godar J, Kastner T. Deforestation displaced: Trade in forest-risk commodities and the prospects for a global forest transition. Environmental Research Letters. 2019;14.
3. Benton T. G. BC, Harwatt H., Pudasaini R., Wellesley L. Food system impacts on biodiversity loss. 2021.
4. Yinon M. Bar-On RP, Ron Milo,. The biomass distribution on earth. PNAS. https://www.pnas.org/content/115/25/6506#sec-6. Accessed 23/09/2021.
5. Food and Agriculture Organization of the United Nations. Livestock and Landscapes. http://www.fao.org/3/ar591e/ar591e.pdf. Published 2012. Accessed 18/09/2021.
6. Alexander P, Brown C, Arneth A, Finnigan J, Rounsevell MDA. Human appropriation of land for food: The role of diet. Global Environmental Change. 2016;41:88-98.
7. Zhao Q, Guo Y, Ye T, et al. Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study. The Lancet Planetary Health. 2021;5(7):e415-e425.
8. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2019;393(10184):1958-1972.
9. World Health Organization. Noncommunicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Published 2021. Accessed 18/09/2021.
10. Xu X, Sharma P, Shu S, et al. Global greenhouse gas emissions from animal-based foods are twice those of plant-based foods. Nature Food. 2021;2(9):724-732.
11. McCarthy J. DS. Nearly One in Four in U.S. Have Cut Back on Eating Meat. https://news.gallup.com/poll/282779/nearly-one-four-cut-back-eating-meat.... Published 2020. Accessed 18/09/2021.
12. European Consumer Organisation (BEUC). One bite at a time: consumers and the transition to sustainable food. https://www.beuc.eu/publications/one-bite-time-consumers-and-transition-.... Published 2020. Accessed 18/09/2021.
13. Willett W, Rockstrom J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet (London, England). 2019;393(10170):447-492.
14. ACLM. Lifestyle Medicine Education. https://www.lifestylemedicine.org/ACLM/Education/ACLM/Education/Overview.... Published 2021. Accessed 24/09/2021.
15. ACLM. American College of Lifestyle Medicine Resources for Certification. https://www.lifestylemedicine.org/ACLM/Certification/Approved_CME. Published 2021. Accessed 24/09/2021.
16. Plant-based Health Professionals UK. Plant-based Nutrition Course. https://plantbasedhealthprofessionals.com/pbn-course. Published 2021. Accessed 24/09/2021.
17. Harvard University. Online Nutrition Courses. https://online-learning.harvard.edu/subject/nutrition. Published 2021. Accessed 24/09/2021.
18. Vogliano C. G, K., Chou, S., Palmer, S. . Empowering Nutrition Professionals to Advance Sustainable Food Systems [White Paper]. 2021.
19. Harwatt H. Including animal to plant protein shifts in climate change mitigation policy: a proposed three-step strategy. Climate Policy. 2019;19(5):533-541.
Competing interests: Dr. Rojido declares no conflicts of interest Dr. Kassam is the founder of Plant-Based Health Professionals UK and co-founder of Plant-Based Health Online Dr. Katz is the founder and CEO of Diet ID, Inc, a company working to include objectively measured diet quality among vital signs