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Editor's Choice

Memo to COP26 leaders: abandon your hubris, politics, and pride and see the future through young people’s eyes

BMJ 2021; 375 doi: (Published 28 October 2021) Cite this as: BMJ 2021;375:n2607
  1. Kamran Abbasi, executive editor
  1. The BMJ
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

“Don’t let anybody else decide your future,” Barack Obama urged young people this week. “Imagine a better future and help make it real.” In fairness, young people aren’t the problem. The future, unfortunately, is controlled by their parents and grandparents, too many of whom see the future as an only slightly less rosy version of the past. Yet the multiverse of crises we face today won’t magically disappear with the click of a superhero’s fingers.

Growing numbers of doctors, young and old, are becoming climate activists, joining groups such as Extinction Rebellion to bring about climate policies that will preserve the planet for future generations (doi:10.1136/bmj.n2565).1 The political will to agree and implement those policies will be tested at the 2021 United Nations Climate Change Conference (COP26) in Glasgow from 31 October to 12 November. Any attempt to water down commitments on climate will be greater “acts of criminality” than the non-violent protests of climate activists.

Evidence for the effects of climate change on health continues to mount. An ingenious study by Canadian researchers supports a direct relation between particulate air pollution, in the form of PM2.5 concentrations, and death (doi:10.1136/bmj.n2368).2 Five year mortality in people who moved from highly polluted to less polluted areas fell by up to 13%. The reverse effect was seen in people who moved to more highly polluted areas. The study isn’t a randomised controlled trial, nor does it have perfect observational design; but, with high quality data collection and propensity score matching in a large population, this is the best answer to the question yet and may be hard to improve on (doi:10.1136/bmj.n2561).3

Most people, however, are unable to choose the adaptive option of moving house, which increases the onus on COP26 to find urgent solutions to reduce PM2.5 levels. Many places in the world with the highest PM2.5 levels are also urban areas vulnerable to the health risks of extreme heat (doi:10.1136/bmj.n2467).4 Even in Europe the heatwave of 2003 resulted in 70 000 excess deaths; and heat related deaths, primarily from “urban heat islands,” will increase by a factor of 50 by 2100 (doi:10.1136/bmj.n2438).5

Regions of high particulate air pollution and extreme heat are also affected by vaccine injustice—the gross inequity worldwide in vaccine supply and manufacture. Responsibility again rests with leaders of rich countries, to release vaccine technology transfer from the firm grip of corporations and national interests. If countries that make vaccines will inevitably think of themselves first, then the only solution is to ensure that manufacturing capability exists in as many countries as possible in each region (doi:10.1136/bmj.n2375).6

Inequalities lie at the heart of crisis after crisis, and tackling them must be a priority—for example, in the response to pressures on the UK’s NHS (doi:10.1136/bmj.n2456),7 a crisis that politicians seem intent on downplaying just as frontline professionals and patients see the service falling apart (doi:10.1136/bmj.n2590; doi:10.1136/bmj.n2572; doi:10.1136/bmj.n2594).8910 Nor do politicians seem willing to fully accept the role of covid-19 (doi:10.1136/bmj.n2606; doi:10.1136/bmj.n2597; doi:10.1136/bmj.n2573),111213 and the urgent actions now needed to limit its effects (doi:10.1136/bmj.n2595).14 A new modelling study projects up to 60 000 deaths from covid-19 over the winter unless vaccine boosters are delivered to vulnerable populations and people older than 50 and transmission is controlled ( Indeed, a recent government expert review supports the role of airborne transmission and the benefits of mask wearing and improved ventilation (

It’s little wonder, then, that by ignoring its own science on covid measures and launching a misguided, ill timed, and damaging war on GPs the government seems to be living in its own “multiverse of madness” (doi:10.1136/bmj.n2570; doi:10.1136/bmj.n2584; doi:10.1136/bmj.n2587).171819 How can young people rescue the future from this distressing reality? It’s precisely this logic that leads health professionals to non-violent activism and dissent. It’s the same activism that helped women win the vote and Gandhi create a nation. The onus on world leaders gathering in Glasgow is to abandon their hubris, politics, and pride and instead see the future through young people’s eyes.