Climate change: a public health emergency?

07 June 2018

An unhealthy planet means unhealthy people too, with high impact predictions on health for all unless everyone takes action. Environmental journalist Mary Griffin reports.

Climate Change

Climate change has been labelled ‘the greatest health threat of the 21st century’ (Costello et al, 2009) and without immediate global action, the predictions for the coming years are undeniably bleak.

Since the industrial revolution, humans have been emitting increasing amounts of carbon dioxide into the earth’s atmosphere, and heat-trapping greenhouse gases are now warming the planet at an alarming rate (NASA, 2018a; 2018b). In fact 16 of the 17 warmest years on record have occurred since 2001 (NASA, 2017). To put it another way, our climate has been described as now absorbing four Hiroshima atomic bombs worth of heat every second (Cook, 2014; Nuccitelli et al, 2012). As a result, people around the world, including in the UK, are already feeling the health impact, with far worse predicted to come if nothing is done.

Ahead of the 2009 climate summit in Copenhagen, The Lancet and University College London (UCL) produced a report acknowledging that during this century, earth’s average surface temperature rises are likely to exceed the safe threshold of 2°C above the pre-industrial average temperature (Costello et al, 2009).

The report outlined major threats to global health through changing patterns of disease, water and food insecurity, extreme climatic events and population migration, warning that climate change will put the lives and wellbeing of billions of people at increased risk in the coming decades.

Three years ago, ahead of the 2015 Paris climate summit where 194 countries committed to limit the impact of global warming (before Donald Trump withdrew USA support), The Lancet and UCL again formed a Commission on Health and Climate Change, bringing together scientists, geographers, engineers, economists and health professionals to focus on the policy response to the health impacts of climate change.

The report’s findings led commission co-chair Professor Hugh Montgomery to warn: ‘Climate change is a medical emergency. It thus demands an emergency response’ (Watts, 2015).

In other words, we need to take action now. And rather than viewing climate change as a future issue that can still be dodged in the nick of time, the message now is that the effects of climate change are unavoidable. Instead the aim is to reduce the effects by preventing climate change from becoming even worse.


What's the damage?

Speaking to Community Practitioner, Professor Montgomery’s advice is stark: ‘The most important thing is that people do something to stop it happening. The impact of climate change is that there is no future for human civilisation by the end of the century so there’s no point in discussing how we adapt to treat increased cases of asthma if we don’t first ask how we stop this [climate change from worsening]. The key message is: it’s coming. So the first thing we have got to do is lower our carbon footprints and drive everyone else to do the same.’

On a positive note, experts say that tackling climate change immediately improves global health and also is an opportunity to improve public health (Figueres, 2017). But what’s the current forecast? By the year 2030, WHO says 250,000 additional deaths are projected due to climate change - from heat exposure in elderly people, diarrhoea, malaria and childhood undernutrition (WHO, 2014). While this is global, it includes the UK (climate modelling is notoriously difficult so country-specific modelling is generally not used).


Air pollution

Last year, a study by The Lancet Commission on pollution and health found that diseases caused by pollution were responsible for an estimated nine million premature deaths in 2015 – 16% of deaths worldwide (Landrigan et al, 2017). Most of the deaths linked to air pollution globally are caused by non-infectious diseases such as heart disease, stroke 
and lung cancer.

However, researchers at the University of Birmingham have found evidence suggesting an association between sudden infant death syndrome and exposure to air pollution in the form of airborne pollutants (PM10), as well as nitrous dioxide (Litchfield et al, 2018). ‘Certain groups of the population are more vulnerable to ambient air pollution than others,’ explains lead author Dr Ian Litchfield. ‘And children figure predominantly among them due to the fragility of their immune system and the ratio of their lung capacity to their size… However, government policies appear slow to react.’

Since most of the air pollution we create comes from burning fossil fuels to produce electricity and power our vehicles, a shift to electric and hybrid vehicles is a healthier, greener path. And despite their expensive reputation, electric cars may now be cheaper to run (Palmer et al, 2018). However, lower total cost of ownership may largely apply to high-mileage vehicles. Vitally, manufacturers must consider that unless electric vehicles are powered by renewable energy, the full benefits will not be felt. In practice this means buying the electric car if you need one but using active transport when you can, and lobbying your MP in the meantime (see page 34 for more steps you can take to fight climate change).

Just meeting climate change targets can cut air pollution by half, right across the UK


Extreme weather

The Intergovernmental Panel on Climate Change’s report (Field et al, 2012) confirmed that climate change can result in extreme weather and climate events.

The World Meteorological Organisation’s report, The global climate 2001-2010: a decade of climate extremes (WMO, 2013), found a 20% increase in lives lost in extreme weather events compared with the previous decade.

And The Lancet countdown (Watts et al, 2018) found that between 2000 and 2016, the number of vulnerable people exposed to heatwave events globally increased by about 125 million.

In the UK, the effect of climate change on weather means preparing for wetter winters, stronger storms, and more extreme floods and heatwaves. The UK Health Alliance on Climate Change (UHACC), estimates that 2000 people die from heat-related illness each year in the UK, which is expected to more than double by the 2050s as a result of climate change (UHACC, 2018b). And more frequent and intense storms put health services under extreme stress (UHACC, 2018b). It also means local health services need to develop plans so that they can adequately respond to climate change.

In the UK, as spring comes earlier we can also expect the pollen season to last longer. A recent study claims to be the first to quantify the consequences of climate change on pollen allergy in humans (Lake et al, 2016). Measuring ragweed allergy, it found that higher pollen concentrations and a longer pollen season may increase the severity of symptoms. Researchers concluded that ragweed pollen allergy will become a common health problem across much of Europe, and that sensitisation to ragweed will more than double, to 77 million people by 2060.


Infectious diseases

Another possible consequence of long-term change to the UK climate is that species which transmit infectious disease-causing pathogens could move to British shores.

A 2015 parliamentary briefing (Bunn, 2015) on climate change and infectious diseases in humans warns that species of concern for the UK include mosquitoes (which can be a vector for malaria, dengue fever and chikungunya virus) and ticks (which can cause Lyme disease).


What can you do?

‘Climate change is very serious for health professionals in three ways, says UHACC director Laurie Laybourn-Langton. ‘Firstly, it’s already happening – most likely, more than many people know. Secondly, it’s going to happen more in the future and professionals need to prepare now to become more resilient. And thirdly, Britain has a global role, a global reach and a global impact so it’s incumbent on Britain and its health professionals not only to take a lead but also to highlight the problem and help people to prepare.’

UHACC formed in March 2016, and aims its message at three main audiences: health professionals, the public and the government. ‘We are particularly interested in nurses because there are so many of them and they are in constant touch with patients and the community.’

The alliance raises awareness of climate change among health professionals and amplifies their voices to lobby politicians for change.

The alliance focuses on three key aspects of health where climate change mitigation and adaptation can have the greatest impact: air pollution, physical activity and food and nutrition.

Laurie says: ‘As food systems are increasingly disrupted by climate change and extreme weather events, that has an impact on our ability to provide the nation with enough nutritious food and increases the chance of war and the spread of disease.’

Although the NHS has been slowly reducing its relative carbon footprint in line with targets, it remains the largest public-sector emitter of greenhouse gases in the UK, every year producing the same amount of carbon as over 800,000 space shuttle launches, according to a report by the RCP (2018). But small pilot schemes at NHS trusts could add up to big change if multiplied.

For instance: 

  • At Newcastle Upon Tyne Hospitals NHS Foundation Trust, the disposal of rigid yellow containers for medical waste accounted for 30% to 40% of the trust’s incineration bill (HM Government, 2013). A trial replaced them with 96% paper bio-bins, which produce less harmful gases when incinerated and are 50% lighter, reducing transport emissions as well.  
  • NHS West Suffolk (2017) encouraged local residents to hand back NHS equipment no longer needed – in one month over 8500 items were returned, including crutches (£12.70 per pair) and air mattresses (£1650 per mattress).
  • NHS Lanarkshire trialled a reusable sharps system which, after being collected by the clinical waste contractor, was emptied, heat-treated and returned for re-use. Each one can be used up to 500 times as opposed to the traditional single-use containers (NHS Scotland).
  • And 10 hospitals in England are currently recycling PVC devices such as anaesthetic masks, oxygen masks and tubing. It’s believed UK hospitals could recycle 2250 tonnes of PVC if the scheme was rolled out nationwide (SDU, 2018).

The Public health in a changing climate report (Button and Coote, 2016) found that where public health departments were taking climate action, this was often driven by individuals championing initiatives rather than strategy. It also found that cuts to local authority budgets and the long-term nature of climate change mean that climate change is seldom regarded as a priority.

Crucially, though, the report’s authors stress that many of the measures that could be taken in order to mitigate and adapt 
to climate change have ‘co-benefits’ in terms of health and wellbeing. They state: ‘Well-insulated and ventilated homes, active travel (walking/cycling), flood- and heat-resilient green space, strong social cohesion, a sustainable health and social care system, a sustainable food system and diet, as well as a reduction in air pollution, can all have positive health benefits.’ UHACC also promotes this notion of co-benefits through its member institutions.


How you can take action

Tackling climate change is personal, professional, political and economic. Here’s how you can act on all four fronts: 

Everything you use or buy has an energy footprint, which mostly comes from fossil fuels. One litre of bottled water, for example, requires just over one-third of a litre of oil to make 
it and ship it. Switch to tap water. 




You can switch to a supplier who provides energy from 100% renewable sources, such as Good Energy. Share this with friends, colleagues and employers. 



To tackle waste, the priority is: Reduce - Reuse - Recycle. Recycling materials demands energy, as do manufacturing products in the first place. So the most important step is to use less. 




Politicians believe that if they tackle climate change they’ll lose votes. Businesses believe that if they go green without a level playing field they’ll be disadvantaged. But politicians and businesses will respond to societal pressure, so vote with your purse – as well as your ballot paper.



Swap your car for active transport such as walking, cycling or public transport (which usually involves some walking), even if it’s just for one day each week. If your employer doesn’t already, suggest to them that they add cycling and walking mileage to expenses claims. You could not only save money but make money by leaving the car behind.



Just as businesses and politicians are influenced by consumer and voter power, people power also influences professional bodies and employers. Union members and staff councils pressing for action can and do bring about change. Talk to your colleagues and employers. Be vocal on social media with the hashtag #2020DontBeLate



Cut down on meat, even if you simply start with meat-free Mondays. Some scientists have claimed that giving up red meat can reduce your carbon footprint more than giving up your car (Pierrehumbert and Eshel, 2015). Suggest your workplace offers vegetarian catering in the canteen and for conferences and events to lead by example.




A bright idea: Workplace energy audit

Professor Montgomery, director of the UCL Institute for Human Health and Performance, shows how small differences add up: ‘At the hospital where I work, I asked the head of security to take me round all outpatient areas with a clicker counter on a Friday night. We found there were over 700 light bulbs staying on all weekend. You could add up those energy savings and run a lottery system incentivising all staff – or the lowest paid – to switch off, knowing every three months one of them will win the money saved that quarter.’


Cause for optimism?

Future predictions may seem grim, but Laurie believes there is cause for hope. ‘For the younger generation, climate change can seem almost unremittingly bleak. But it’s also electrifying and terrifically exciting. We either fail to sort these problems out and head towards disaster, or we sort it out and create a better world than we could ever have imagined.

‘To mitigate climate change, we’ll have to radically reshape our society, how we build cities, feed people, and look after people’s health. But in doing so we will unlock health benefits that we can hardly even imagine now.’

Another Lancet countdown study (Williams et al, 2018) found that just meeting climate change targets can cut air pollution by half, right across the country, with reductions of up to 70% in London. The resulting benefits to health are enormous.

Laurie stresses that community practitioners should not underestimate the power they have to influence change. ‘Individual health professionals must always feel confident that they can do their bit towards tackling climate change, whether it’s taking a leading role and telling the story to a much bigger audience, or spreading the message on a person-by-person basis. For a client, acting on climate change can be as simple as going for a walk instead of driving the car.

‘The individual’s voice here is much more powerful than in other sectors because of how strong the individual health benefit is as well as the health and environmental benefits to society and the planet as a whole.’    





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Picture Credit | Denis Carrie

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