Gabriele Messori

The United Nations’ climate negotiations usually gain the press spotlight once a year, when the big Conference of the Parties (COP) meeting takes place. However, the process of designing a global climate agreement is ongoing, and additional meetings are scheduled throughout the year. 

One such meeting is currently taking place in Bonn. The meeting addresses a broad range of topics, among which mitigation, adaptation, climate equity and climate finance. All of these are crucial for minimizing the social and economic impacts of climate change, and all can reduce the severe health footprint that a changing climate inevitably has.

There is a wide consensus that time is running out and the meeting’s co-chair, Mr. Runge-Metzger, warned that if no decisive action is taken we could be looking at a 4 ˚C warming by the end of the century. This would spell catastrophe for the most vulnerable countries, such as small island states and least developed countries,

Because of this, the least developed and developing countries are demanding that the developed countries step forward and take the lead, both in terms of national plans to reduce emissions and in providing climate finance. As eloquently stated by the Philippines, “In our delegation we do not speak of support... finance is a commitment by developed countries, not support.”

In line with the feeling that the time is ripe for decisive action, it was decided to establish a formal negotiation group, called “contact group” in UN jargon, to continue the work on a global climate treaty. This decision will come into effect in June, when the parties will meet again to proceed with the negotiations. This is a distinct step forwards from the informal consultations that have taken place for the last two years.

Besides this, however, the meeting in Bonn has had few concrete outcomes. The talks have been plagued by clashes over procedural and organizational issues, which have often overshadowed the central point of the negotiations, namely climate change.

With time running out and the aim to have an ambitious global climate treaty in place by 2015, every second of negotiating time is precious. Today is the final day of meetings here in Bonn, and we all hope it will end on a positive note, preparing the ground for the next round of talks in June.

Gabriele Messori and Izzy Braithwaite

Adapted from a blog post at http://climatesnack.com/2014/01/30/cough-for-coal-at-cop19/#more-1673

Neither of us had imagined we’d end up carrying a pair of giant pink lungs in front of the Polish Ministry of Economy on a cold November morning.  

Why were we there?  It’s a long story…

We were in Warsaw for COP19, the annual UN climate talks (COP = Conference of the Parties).  The aim of the talks is to reach a global deal to tackle climate change in 2015, which will come into force in 2020.  We went as part of a delegation of students from Healthy Planet UK, a small, student-led group which seeks to raise awareness about the links between climate and health, and to advocate for UK policy that benefits both health and the environment.

As students, researchers and young people, our motivation was the growing body of evidence that climate change poses a major threat to global health, and that sustainable development presents major opportunities for public health.  Examples of such climate-health synergies (sometimes called health ‘co-benefits’) can be found across energy, transport, housing and food policy – and quite possibly elsewhere too.

Air pollution – bad for health, bad for the climate

We know that greenhouse gas emissions affect health indirectly through their contribution to climate change, via changing temperatures and rainfall patterns. Although carbon dioxide has no direct health effect except at high concentrations, it is often, if not invariably, produced alongside other air pollutants. These include substances such as particulate matter, ozone, nitrogen and sulphur oxides, which are emitted both in energy production and motorised transport.  Some are greenhouse gases themselves, and all are harmful to our health with myriad effects on our lungs, blood vessels and even cancer risk. The cumulative impact of chronic exposure shortens lives and exacerbates a range of other medical conditions.

Around the world, man-made outdoor air pollution accounts for an estimated 2.5 million excess deaths every year.  Indoor air pollution (much of it from inefficient cookstoves) accounts for at least as many again, which means that overall air pollution is one of the leading killers globally.

Lessons about how politics works…

Given the clear evidence that air pollution from burning fossil fuels is so bad for health, combined with the urgency of tackling climate change, you might think governments would be rushing to capitalise on those win-wins. This is where the inflatable lungs come in. Whilst some countries are already taking the kinds of steps that we need, cutting emissions and simultaneously reducing air pollution, over the course of the talks it became fairly clear that some others are working very hard to promote a fossil-fuel dependent future.

Almost all of the conference sponsors were fossil-fuel intensive industries. Even more astonishingly, just one day after a summit on climate change and health, organised by the newly-formed Global Climate and Health Alliance, the Polish Ministry of Economy hosted an “International Coal and Climate” summit in parallel with the COP. Feeling that this was outrageous, our team joined many other groups to take part in ‘Cough4Coal’: a public action staged outside the Coal Summit.  The stunt involved a series of scenes alternating with speakers from Poland, the Philippines and the UK – one of our team – with the impressive accompaniment of a 7m tall pair of lungs. This was intended to be a visual symbol of the direct health impacts of burning fossil fuels, but also of the less direct health impacts of climate change.

Tip of the iceberg

Climate change has been described as “the greatest global health threat of the 21stCentury” by the leading medical journal The Lancet. A 2012 analysis by the DARA Climate Vulnerability Monitor arrived at a total of 400,000 climate-related deaths annually by 2010, the greatest burden within this being due to hunger and diarrhoeal disease.  However, it is by no means clear that it is accurate to simply extrapolate the future burden due to climate change from the impacts seen so far. These may well be the tip of the iceberg, given that we’ve only seen limited warming relative to what is projected for the coming century.

What are the main health impacts of climate change? They range from increased heat exposure, a particular problem among older people and manual labourers, to extreme weather events (which can often affect mental health particularly severely). Changes in the distributions of infectious diseases, and malnutrition and/or starvation due to effects on food production, are equally important. The indirect impacts, such as exacerbation of poverty, migration, and conflict, are both harder to attribute to climate change and significantly harder to forecast. Such impacts are likely to be non-linear and could well be very large indeed – especially with the levels of warming scientists are currently projecting in business-as-usual scenarios. For those interested in finding out more about the health impacts of climate change, we've compiled a summary here.

Bridging the gap

There may also be pragmatic reasons for framing climate change as a health threat; namely that it connects to people’s own lives and the things they value. In a 2012 study by Teresa Myers and colleagues, a test audience was presented with articles that discussed climate change from a range of different perspectives.

Right across audience segments, the articles emphasising the health frame were more likely to elicit strong support for mitigation and adaptation policies than those focusing on the environment or national security. The second working group of the Intergovernmental Panel on Climate Change (IPCC)’s fifth assessment report will include a substantial chapter on human health, which could present a useful opportunity for more public communication about climate change using the health frame.

It is clear that the stakes are high for health if we continue on our current path.  The evidence that action on climate change can benefit public health in all regions is strong – and growing.  Emphasising the health implications of climate change can be a powerful way to engage a wider audience in the issue, and everyone with an interest in human health, or just the future of our planet, has a role to play.  Not to suggest that you’d need to carry any giant lungs in front of government departments – though by all means get in touch if you’d like to…

It has been quite an experience being out in Warsaw for the climate summit so far, both good and bad - and very tiring!  The first week at COP19 was spent mostly finding our feet in Warsaw and at COP19 (the national stadium is a maze!), getting our heads around the negotiations - and just how visible the corporate influence is, with sponsors ranging from coal to car and aviation companies, taking the term greenwashing to an entirely new level (could be a strong case for something similar to Article 5.3 of the WHO's Framework Convention on Tobacco Control here, we think!)   We've also had the chance to meet and talk to members of the UK government delegation, from both DECC and the Foreign and Commonwealth Office, thanks to our friends over at UKYCC, which was particularly interesting.

And we found ourselves in shock - and anger - after the irresponsible moves backwards on climate domestically by both Australia and Japan, especially coming just after the Philippines' lead negotiator Yeb Saño's historic and very moving speech about the devastation wrought by Typhoon Haiyan and his  announcement that he was going on hunger strike for the duration of the talks unless there was meaningful progress.

On Monday, we took part in 'People Before Coal', a protest action outside the Ministry of Economy who were - outrageously - hosting a 'Coal and Climate' Summit during the second week of COP19.  Perhaps 'coal versus climate' would have been more accurate if you take a look at the World Coal Association's 'Warsaw communique'... 

Although the fact that the summit was taking place at all is a travesty, the demonstration was a colourful and exciting gathering of people from all over the world; speakers from Poland via the UK to the Philippines and many participants from all over Europe, gathered to highlight the health impacts of coal, on both people and the planet - with these amazing giant inflatable, breathing lungs (!) which were made by #Cough4Coal.

There were three scenes in total, showing that the dirty energy future the coal industry's lobbyists are trying to sell us with their Coal Summit is not the clean, healthy future we want.   As Christiana Figueres put it at the Summit, "we now know there is an unacceptably high cost (from burning coal) to human and environmental health".

Along with some of our friends from the International Federation of Medical Students' Associations (IFMSA), we took up the role of young health professionals enthusiastically, with one of our delegation speaking in the gap between two of the scenes about how coal impacts health - both through the air pollution it creates, and through the health impacts of climate change.  Some of our photos from the stunt are on the right, with more here; there's also a great blog from 350.org here.

One of the best things about COP19 has been the chance to connect up with and talk to other young people from around the world, many of whom have gone to great lengths to fundraise to come and overcome immense obstacles in their fight for climate justice - although our backgrounds and organisations are different, we share a common cause.  And it is clear that our governments are currently making nowhere near enough progress towards a binding deal that will keep the planet below dangerous temperatures which would pose a major threat to health. 

The last few days are likely to focus mainly on Loss and Damage, but - as Yeb Sano has eloquently reminded us - it is essential that we don't lose sight of the ultimate point of the UNFCCC, which is to avoid dangerous anthropogenic climate change.  At present, the vested interests that rear their heads through 'fossil-friendly' governments like those backing down on climate ambition, are still succeeding in delaying that process for as long as possible.

Climate ethics and climate justice are subjects which hide in the background of COPs and treaties, rarely given any limelight of their own. In fact, the most common appeal to climate justice within negotiations are false ones, nations setting out their stall while grasping furiously for some foundations to stand it upon.

Because, while the neoliberal hegemony of self-interested actors fails miserably to encompass the breadth of human social relations, it is demonstrably accurate on an international level. Powerful nations may appeal to political theory and forms of justice to back up their positions, but you can bet that their move went outcome first, evidence second, and not the other way around.

For example, in the early 2000s while America was resisting becoming party to the Kyoto Protocol, the Bush administration argued furiously that the Annex 1 countries were being unfairly asked to mitigate a crisis which, all things considered, it looked like other countries had a lot more to lose from than themselves.

Slowing anthropogenic climate change will cost us a packet and only benefit Tuvalu, how unjust!

 It did not matter, of course, that this claim is justified only by a philosophy so libertarian that no US president (Nixon included) has ever come close to it. No, much more important to scream “injustice!” and hope nobody really notices that the argument doesn’t stack up.

Thus climate ethics has been sullied and debased by negotiators wanting a transcendent justification for their greed. It’s time to put it back at the heart of a global climate regime.

Here is just one such attempt. It’s not perfect but I think it reveals a few key things we are looking for from a global climate treaty, and provides the beginnings of a move away from pragmatism and towards justice.

Hold tight, here comes the theory.

(If you’re not interested in the theory in isolation, jump straight to part two where climate change comes back onto the scene).

When we discuss distributive justice of any kind, the first thing to be argued over is what’s called the “metric” – what exactly it is we should be distributing. Let’s narrow our gaze to egalitarianism – that equality is, for some reason, at least partially good – as it is now almost universally accepted across the liberal democracies.

There are two traditional camps in the metric debate: resourcists and welfarists. As their names give away, resourcists believe justice includes a focus on equalising the amount of stuff people have, whereas welfarists prefer a focus on the wellbeing or happiness people get from that stuff. It’s the classic means/ends debate.

This division has been standing for hundreds of years, splitting radical feminists from their traditional colleagues and communists from conservatives. This impasse however was, I believe, broken in 1979 when Amartya Sen – a heterodox development economist from Bangladesh – gave his Tanner Lecture entitled ‘Equality of What?’.

In this lecture Sen dismantled both metrics, each with a simple thought experiment, asking whether what each model was forced to conclude sounded much like justice or not.

Number one. Take two agents: one able-bodied and another with a severe disability needing round the clock care. Equalise resources. After covering their care expenditure, the disabled agent has far less resources than the able bodied agent to increase their wellbeing with.

Similarly other divides – gender, social position, country of birth, etc. – reach the same conclusion: that a resource egalitarian looks to be saying that justice permits, or even requires, that wellbeing is determined by factors of luck. Ask yourself: does that sound much like justice?

Number two. Brian is a plumber living in the city of London and Vikram works as a dabbawalla, distributing Tiffins to the workforce of Mumbai. Brian, from any objective standpoint, enjoys a far higher standard of living than Vikram yet it is certainly conceivable that Vikram is the happier of the two. Empirically, what’s called “hedonic adaptation” shows us that as our income increases so too can our expectations, resulting in no greater happiness.

So say Vikram is the happier of the two because he expects less, and we have some spare resources to distribute. We must be persuaded to give the extra to Brian. Justice? To say a poor person has no claim to extra resources because their expectations are lower doesn’t sound much like justice to me.

So what does Sen suggest? Justice, he claims, is found in neither resources nor welfare, but some function between the two, some measure of how we can translate resources into welfare. The correct metric for distributive justice is a person’s capabilities or, to be specific, the capability to achieve particular substantive human functionings. Say what?

Put simply, what justice demands is equalised are the real and tangible freedoms that humans can possess. It doesn’t matter how much income a person has, if they have no access to healthcare then they are not being served by justice. It does not matter how happy a person is, if they cannot access education then that is a failure of justice.

Although the language of capabilities was introduced by Sen, it was American theorist Martha C. Nussbaum that developed it into a robust philosophical doctrine.

Borrowing from the young Marx, Nussbaum claims that justice provides entitlement to a plurality of values that are both non-aggregable and non-fungible. In other words, we cannot serve justice by simply giving all a certain amount of a certain thing – say, money – and then leaving them to make choices as to how they trade it.

Rather, we must concentrate on fulfilling a range of indicators that are distinct and cannot be traded off against each other. Simplistically, one could not for example be compensated for an inadequate life expectancy by being allocated more political rights. This stands explicitly against classical and neoliberal theories of development, relying on GNP to assess the growth of a nation and the wellbeing its peoples.

What’s more we do not have to earn these entitlements. They are derived from our entitlement to “the respect and dignity of a life that is fully human”. We possess them, therefore, merely due to our species membership.

(Nussbaum also holds that it is likely many other species are similarly entitled to various capabilities, but for now we can just consider our entitlements on account of our being human.)

That’s all well and good, but what on earth does it have to do with climate negotiations?

Lots, actually.

Part two focuses on bringing climate change back into the picture, and putting justice back at the heart of a global climate regime.

Alistair Wardrope, Healthy Planet Sheffield                               Originally posted here


Would anyone dispute that healthcare systems ought to put their patients first?  The mantra has a near-unassailable status in discussions of the best foundations for healthcare.  The UK’s General Medical Council makes it first amongst the Duties of a Doctor; it provides the title of the Department of Health’s response to the findings of the Francis Report; and it lies (in its more-theorised form, ‘patient-centred care’) at the core of Don Berwick’s recent report into safety in the NHS.  No politician, of any political stripe, would see fit to enter into a debate on health without it taking pride of place in their rhetoric.  I’ve used it myself, campaigning for the priority of “patients before profits”.  Nonetheless, I’ve long had qualms about it.  It took a work of fantasy to figure out exactly why.

During a recent and all-too-brief summer break, I decided to read China Miéville’s Perdido Street Station. I had harboured the vague intent of doing so for several years,  but a fortuitous alignment of stars and an inability to access the books I was supposed to read in the university library meant I finally did.  As a (somewhat lapsed) devotee of speculative fiction, I’d always expected to find more than simple escapism between its covers; however, I did not expect it to form the nucleus around which those nagging worries about patient-centred care would crystallise.


The passage that set me thinking is little more than an aside, one of the short conversational detours the novel is littered with.  It concerns a society of nomadic bird-people, the Garuda of Cymek.  Garuda society is founded on the moral and political primacy of individual freedom. Their legal code admits but one crime – depriving another Garuda of choice; their ethical code, only one vice – disrespect.  So far, so Tea Party.  But the Garuda take these principles in an altogether different direction.

Their interpretation of individualism rests on a particular understanding of what the individual is: the ‘concrete’ individual. As Ged, the autodidact librarian-priest, states:
You are an individual inasmuch as you exist in a social matrix of others who respect your individuality and your right to make choices. That’s concrete individuality: an individuality that recognizes that it owes its existence to a kind of communal respect on the part of all the other individualities, and that it had better therefore respect them similarly.

With the individual understood in these terms, disrespect becomes at heart a crime of ‘abstraction’: isolating one’s own individuality from the network of social interactions by which it and other persons are constituted and so losing the symmetry between them in which equal status is grounded.

The Garuda share their ‘concrete’ understanding of the individual with a strong line of philosophers and political theorists.  In his influential essay ‘Atomism’, the communitarian thinker Charles Taylor describes the individual as existing only when grounded in a society that affords the material, psychological and social resources for them to develop into freely-choosing agents, and provides the range of options necessary to make such choices meaningful.  

Respect for such individuals, therefore, is inseparable from respect for the social conditions underpinning their individuality.  This is in stark contrast to the ‘atomism’ of the title, a charge he levels against the libertarian individual, whose values and preferences are interpreted and realised independently of others, and the protection of whose choices sets the boundaries of an acceptable social contract.

These ideas are developed upon in recent work in feminist philosophy on ‘relational’ conceptions of autonomy.  Traditionally, medical ethics has employed a rather thin understanding of autonomy – interpreted in the doctrine of informed consent, for example, as little more than decision-making capacity.  Relational theorists argue that this ignores the role played by our emotions and attitudes towards ourselves and others – and their attitudes towards us – in developing and maintaining our capacities for autonomy.  

Consider an individual who, after a lifetime of oppression, comes to adopt those oppressive values as his own; the individual who does not have the necessary self-respect to consider herself worthy to make her own; or the individual who, like Aesop’s fox rejecting the inaccessible grapes as sour, comes to view certain ways of living as undesirable only because they are not realistic options available to them.  In each case, the individual may be in full possession of the faculties that constitute mental capacity, but faces more subtle, relational, threats to their autonomy.

The concrete individualism of the Garuda – and the work of communitarian and relational theorists – captures my concerns about patient-centred care.  For in many interpretations of the term, the idea of the patient upon whom care is being centred is what the Garuda would consider an abstract individual. When patient-centredness merely means enhancing patient choice, increasing medical consumerism or a way to promote marketisation of health services, we present the patient as the isolated, rational ‘chooser’ that is the subject of Taylor’s ‘atomism’ critique.  More generally, an interpretation of patient-centred care focussed solely on the clinical encounter – where it concerns only the interactions between health professionals and the individuals who come to them at the point of clinical need – risks leaving out other individuals and important aspects of care.

When care is centred on the patient, who or what falls into the periphery?  It seems to me that many who fall into the margins of this picture are those who are already most marginalised.  Most obviously entering into this group are those who need health care but are unable to access it: ‘patient-centred’ care, focused on the abstract patient, has nothing to say about caring for those who – through legal, economic, social or psychological barriers to access – are unable even to become patients.  But, even setting aside the tremendous injustice and inequity – where the most vulnerable communities, such as vulnerable migrants, refugees and asylum seekers, poor and oppressed groups, are done further harm –ignoring these groups is a public health disaster.

Perhaps this could be remedied by defining ‘patients’ according to their need for health care rather than their ability to access it; but this picture still sees those patients as abstract individuals, and so has little room for public and global health concerns that make no sense in individualistic terms.  Infection control, mitigation of climate change and its health impacts, social and political action on the social determinants of health: all are relational public goods.  They are not focussed toward, or done in aid of, any individual patient, and only make sense at a population level.

In the current political climate in the UK – where attempts are being made to limit access to healthcare for migrants, and such care is increasingly conceived of as a service provided to individuals for individual benefit – the rhetorical use of patient-centredness emphasises only the abstract patient, with the attendant dangers to public health sketched above. But the good news is that, when the individual is understood in concrete terms, these dangers are not just brought back into the fold – they become a central component of patient-centred care. The reason why is simple: the health of the individual simply cannot be considered in isolation from that of the population.  As Sir Muir Gray writes, “personalised and population medicine are interwoven like warp and woof.”  A healthcare intervention is never solely for a single, isolated patient; it is simultaneously a public health measure.

So when the International Association of Patient Organisations puts patient involvement in social policy, universal access to health care, and attention to education, employment and family issues at the core of its definition of patient-centred care, it is not adding these in as an additional ingredient to aiding execution of the interests and desires of individual patients in the clinical setting.  Rather, it acknowledges the former as a core component of the latter. And protecting and extending access to healthcare for migrants – economic, asylum seeker or undocumented – is not a good to be weighed against the health needs of a nation’s citizens, but an integral part of serving those needs.

In meeting the challenges of shaping more environmentally sustainable health systems – able to meet the needs of people today without sacrificing those of future generations – we need not marginalise or ignore current patient’s interests; as elsewhere in healthcare improvement, “the greatest untapped resource in healthcare is the patient.”  Such work on sustainable healthcare – the focus of this September’s CleanMed Europe conference in Oxford – is a re-interpretation of what patient-centred care could be, modelled on a more comprehensive understanding of what it means to be a patient.

It turns out, then, that my concern is not primarily with putting patients first, or with patient-centred care – at least, not with what those ideals could and should mean. The problems arise only when the individual is considered in isolation from their social and political context and the environment around them.  Given the fundamentally relational nature of health and disease, this isolation is intellectually and ethically untenable; patient-centred care makes sense only when we listen to the lesson I was taught by a fictional society – to view patients (ourselves included) as concrete, inherently social, individuals.

Emily Collins, medical student at Keele University

If you’ve seen the news recently, you’ll probably have heard many loud opinions battling to have their say on fracking.  Fracking is a process that is unfamiliar to most of us, but which could have big effects on our world, depending on who you listen to.  

So what is it?  And why is it such an important issue?  

Fracking (hydraulic fracturing) is a feat of engineering aimed to increase the yield of natural gas gleaned from the earth, in order to be used as fuel. As a fossil fuel, formed when marine plankton and ancient plants trapped sunlight energy and carbon over millions of years, natural gas is an unsustainable energy source and burning it produces carbon dioxide.  Drills dig deep into the earth, vertically then horizontally, while pumping in water and chemicals at high pressures to open up fissures in the shale rocks way down deep: this frees trapped gases. These are then captured and piped off at the earth’s surface, ready to use as fuel (helpful video: http://www.bbc.co.uk/news/world-us-canada-23320540.)  

Having been widely used across the US, the government has recently announced the lifting of a temporary ban of fracking throughout the UK which has sparked controversy and protests, such as those in Balcombe and elsewhere.

Why the enthusiasm?

Hard to reach oil and gas can be accessed by fracking.  It has been estimated that there is as much as 1,300 trillion cubic feet of shale gas underneath the UK – a tenth of which, if extracted, would be the equivalent of 51 years’ gas supply. (1)  There are two main possible benefits: first, UK gas prices could be driven down, as they have been in the US.  This could be a big boost in the days of our troubled economy, where many families struggle with meeting the rising cost of energy bills – but as this letter to the FT from a senior (republished here) explains, even using very optimistic assumptions only investors in the extraction companies and the Exchequer are likely to benefit, unless gas imports are penalised.  At the same time, the cost of solar panels has dropped 80% due to a surge in Chinese production.  Is it really just a coincidence that Osborne’s father-in-law is an oil and gas lobbyist?

From an environmental perspective, electricity can be generated from natural gas at half the CO2 emissions of coal (potentially at least) so, compared to coal it could plausibly be a step in the right direction.  But there are big question marks on wheter this is true – see below – and is coal really the benchmark we should be using in 2013?

Another potential benefit of fracking – especially in the context of today’s record unemployment - is the creation of jobs in Britain.  David Cameron claims that as many as 74,000 jobs could be supported by the growth of this industry (1).  If true, this would be hard to overlook, although many of them would be temporary.  But the job creation argument applies just as strongly to investment in the green economy, as the Green Is Working campaign and this report from the Green Alliance  show.

Even if realised, the benefits of fracking come with big risks, and could cause lasting damage to our planet and our health.

Water usage and chemical contamination

Fracking uses huge amounts of water – just one site requires millions of gallons of water. This will compete with water resources in areas which are already prone to and experiencing shortages, areas which are also expected to increase with climate change.  Transport of these large volumes of water to and from fracking sites will also have environmental impacts.  In addition, there is serious public health concern about the risk of water quality being affected, with a concern that carcinogenic chemicals such as benzene, toluene, xylene etc among many others, used in the water will leak and contaminate groundwater around the site.

Earthquakes

There are concerns that fracking can cause earth tremors.  In 2011, two small earthquakes occurred in Blackpool following exploratory fracking.  Several reports have been conducted into the matter and it remains possible that future fracking will lead to some tremors. However, a recent report from the Department for Energy and Climate Change claimed that the risks of structural damage from these tremors remain low, and the process has been given the green light, albeit with stringent regulations.

Climate change

The science is telling us that we really need to keep most remaining fossil fuels in the Earth if we want to avoid catastrophic climate change, as highlighted by Bill McKibben's Do The Math talk (coming to the UK this Autumn in a 'Fossil Free' tour coordinated by People and Planet!)  In that context, is fracking just a distraction from developing renewable sources of energy?   

Cameron, like Osborne, says ‘we’re not turning our back on low carbon energy’ - just using fracking to help meet our energy needs – but we could do that with sustainable energy too.  Does the move just encourage continued dependence on fossil fuels, ‘one last fix’ before we change?  

As Friends of the Earth’s Head of Campaigns, Andrew Pendleton, said in reaction to the 2013 Budget: "This is yet another fossil-fuelled Budget....  Our economy desperately needs new ideas, but George Osborne is a 19th century Chancellor, using 20th century tools to fix 21st century problems".

Natural gas is mostly methane – which is over 20 times more potent as a greenhouse gas than CO2 – and it has been found to leak from fracking sites in quantities much larger than originally thought.  Burning fracked natural gas is only a greener alternative to coal burning so long as gas leakages into the environment are kept to a minimum, specifically below 2%.  Studies predict, however, that leakages may be significantly higher, with a recent study in Utah finding a leakage rate of 9%. A New Scientist article published yesterday cites that if rates are around 10%, at the top end of estimates for the US, then the escaped gas would increase global warming until the mid 22nd century.  The climate is a very complex thing: the same article also notes that side-products of burning coal, sulphur dioxide and black carbon, actually cool the climate to some degree and offset some of the warming created by the production of greenhouse gases – although they also have negative health effects.

There’s a lot to consider when it comes to the debate about fracking.  What damage to our planet is too much?  Will fracking really be the solve-all economic miracle the government is claiming?  The debate is open – what do you think?

Izzy Braithwaite

From a BMJ Blogs series for the upcoming CleanMed Europe Conference - edited version at:  http://bit.ly/13EBL8D

The concept of sustainable healthcare and – related to that - how environmental change affects health are not generally taught in medical schools, but I was lucky enough to take part in a student-led national programme on the topic in my first year.   I had long been interested in global health and the environment, so was keen to find out more and get involved in this area.

The focus of my work has been with the Sustainable Healthcare Education (SHE) Network, for example contributing to a set of downloadable teaching resources and subsequently helping to collate a set of case studies on existing student-selected components.  I’ve also been involved in the most recent project on curriculum learning outcomes, organised in response to a request from the GMC, which has been a multi-stage consultation process. The three overarching learning outcomes proposed on the basis of the consultation are to be published online soon and cover: the relationship between the environment and health; the environmental sustainability of health systems; and the ethical and policy-related issues that arise from understanding these two topics, such as how the duty of a doctor to protect health applies to future generations.

As I‘ve read more about our impacts on the environment, climate science and the extent to which human health depends on ecosystems and climate stability, I’ve been surprised and concerned by how little of this information seems to reach the general public, including medical students.  To help change that, I’ve been running workshops and campaigns with a student group called Healthy Planet UK, in partnership with a larger network called Medsin.

Medical educators, students and clinicians wishing to set up more teaching in their medical school often encounter objections that there's not enough space in the curriculum or that these topics aren't relevant.  Yet the evidence shows that climate change is an increasingly important threat to global public health, and I think the scope for health professionals to help shift political narratives around environmental issues is often underestimated.  If my cohort of future doctors needs to know about tobacco or antibiotic resistance, then surely we also need to understand how changes to weather patterns and ecosystems are affecting, and predicted to affect, health.  Equally importantly, we need to be aware of the growing evidence base around the opportunities, termed 'co-benefits', to deal with burgeoning public health problems such as obesity and poor mental health in a way that's synergistic with the goals of sustainable development.

Given some of the details I had to learn in pre-clinical medicine, the argument that there's not enough space in the curriculum suggests it’s an issue of priorities.  Do we really think enabling tomorrow's doctors to tackle what may well be a bigger health threat than tobacco - especially considering the complete inadequacy of the political response so far - matters less than learning, for example, all the steps of the Krebs cycle?  My learning in this area has influenced the way I think about the rest of my education, and I think I'll be a better doctor for it; better able to understand the macro-scale influences on patients' lives, and to contribute to discussions about how health services could be better for both patients and the environment.  

To create lasting change - whether in sustainable healthcare, climate policy or other public health issues – tomorrow’s doctors require an understanding of the issues, to have had the freedom to discuss them and try out their ideas, and the skills for effective collaboration, including inter-sectorally.  Through the SHE network, we are seeking to create this space for students to learn, reflect and debate about the issues, and to develop the skills to help lead the transition to sustainable healthcare.


The fourth CleanMed Europe conference takes place at the Oxford Examination Schools from 17th-19th September, and Izzy will be talking about the SHE Network and Healthy Planet's activities during the conference.

Jake Campton, UWE

""Dense plumes of methane over a thousand meters wide" have been discovered leaking from the permafrost around northern Russia following continued warming in the region - and the rate of release has been accelerating. Why does this matter?  Methane is a potent greenhouse gas with 20 times the warming potential (heat-retaining ability in the atmosphere) of carbon dioxide.  

That makes it extremely problematic.  The total amount of methane beneath the Arctic is calculated to be greater than the overall quantity of carbon locked up in global coal reserves, meaning a planetary time bomb is currently ticking in northern latitudes. It is not only the scale of these outflows that is unprecedented; it is also the alarming frequency at which they are occurring.  Dr. Semiletov’s research team that made the discovery found hundreds of these plumes, similar in scale, over “a relatively small area”.

Our planet’s weather has been thrown into disarray in recent years; the last decade has witnessed more weather records broken than the entire last century!  The more we continue to heat the Earth, the quicker the permafrost will melt, increasing the rate methane can escape its icy prison; a positive feedback effect (Arctic ice is not the only one either, there are a lot in action - see this page for info on a few others). We will eventually become locked in by this effect, with heating leading to more rapid heating, accelerating the whole process further still.  Add in the reduced albedo effect from the rapidly receding glaciers of Greenland and surrounding area and the danger we are in becomes clear.

We are in trouble.  It doesn't take too much time reading up on climate science - as described in a World Bank report just out - to work that out.  What's more, it's not just an issue for the polar bears; it's a health issue too.  Humans are reliant on the environment and most critically, a stable climate to provide food; it doesn't magically appear on our supermarket shelves (even if that's what many kids now seem to think!) The last few years have seen intense droughts ravage vast swathes of the planet, including the major grain producing nations: Russia, Australia and the U.S. among others.

By mid-2012, the U.S only held enough grain for just 21 days.  The increased scarcity of its staple crops caused sharp price spikes too - corn reached $8.39 a bushel by August 2012, an all-time record.  Farmers were forced to cull large numbers of livestock as they suddenly became too expensive to feed.  Are these the sorts of trends we should expect to continue looking forward?  Grains becoming so expensive that meat is affordable only for the richest?  And what about the poorest nations?  What will the implications for malnutrition and food security be if the main exporting nations are unable to meet export demands?  In 8 out of 13 recent annual harvests, global consumption has exceeded production, eating away at our grain buffers. A few more volatile growing seasons, and we could all be in real trouble. No nation is safe from a perturbed Gaia…

I blame a lot of people for this current mess.  Not enough people care.  That fatalistic idea, 'I'm one person, nothing I does matters' is, frankly, crap. 65 million UK inhabitants doing their bit, and I don't mean just recycling here, would make a substantial difference.   If we were also to factor in 700 million Europeans and 300 million+ Americans - not to mention a billion plus Chinese and others - you can see the potential for drastic, meaningful, global change.  

You see, you are not just one person; you are every environmentalist that plays their part in this conundrum.  You are hundreds of millions of people.  That is where our power to change lies; in sheer numbers. Industry is changing, albeit reluctantly, now society must change, too. My biggest fear is that most people won't act.  It's a failure of our education system, a neglect of our moral responsibility - and it could be a catastrophe for humanity.  

I realise we have had many decades of industrial pollution before us, but they weren't aware of the implications of their actions - and they were also far fewer in number, each consuming much less.   If current trends continue, things could become truly and irreversibly messed up within a couple of decades and that terrifies me. It will be this generation and our immediate predecessors, the ones that peered into the precipice, who will be blamed. We could still make a meaningful impact on the current situation but I worry that we won't. We could have a great future ahead of us, but many forget that humanity and the environment are inherently intertwined. Until we recognise Earth as the delicate, dynamic and precious entity that she is, and treat her with the respect she requires, we will continue unabated along this perilous path. The bridge is out up ahead, we need to change paths.

I sometimes worry that the window for action has already closed, it’s something I feel bitter about, something that angers me greatly. There are people out there who are particularly responsible, who keep ignoring the problem, and their negligence is literally costing the Earth.  I believe that if more people shared my sense of impending danger more would get done.  I’m not sorry if this offends you, it's probably because you are the sort of person I am referring to.  If my words are intrusive in to your way of life, maybe your way of life is part of the problem. When something so big is at stake, I think you have to ruffle a few feathers - feel free to comment if you wish to discuss anything further, I’ll gladly respond.

I know its complex, and it can feel like whatever you do is a drop in the ocean -sometimes it's difficult not to feel frustrated and concerned - but there is lots you can do.  Start off by educating yourself; there's a lot of information out there - but always be critical.  Outspoken anti-climate behemoths like the Koch brothers, use political and monetary leverage to fund anti-climate change ‘research’ and spokespeople to help maintain the status quo for their incredibly irresponsible and selfish gains.  Be wary…

Below are some ways I try to reduce my impact on the environment.  They're small steps that don't require much effort - why not give some of them a go?

Eating less meat - I can't understand why people assume it's a right and a necessity to eat meat every day, but this is one of the most effective ways you can reduce your burden, as well as making yourself healthier in the long run.  We have molars for a reason; we are omnivores, not carnivores.  Cycling and walking wherever you can is another great step - driving a few miles down the road is a missed opportunity to stay fit, a pointless waste of petrol and needless emission of carbon.   I realise some people can't - fair enough, but most could. I bike everywhere, I feel great because of it and I’m very fit as a by-product.

You could shower instead of filling a bath, turn off plug sockets at the wall to avoid appliances ‘ghosting’ electricity, wash your hands with cold water instead of hot to save energy, boil the exact water you need when making tea, by cloth bags for shopping trips and avoid plastic, use LED light bulbs; expensive but they can last over 30 years and use just 10% of the electricity of halogen/filament bulbs!  Wear an extra jumper instead of cranking up the heating in colder times, turn down the brightness on your laptop to reduce energy consumption and there are many more.  These may sound like small things, but, when added up and multiplied by the efforts of millions of others, cumulatively, we can drastically reduce our strain on Earth and preserve the environment for future generations, as is our responsibility.

Things you do in your daily life matter, and - imperceptibly - help start to shift the norm.  However, we need political change too, and contacting your MP and MEP, signing petitions or even getting involved or setting up local campaigns isn't actually as hard as it can seem - Google is your friend here.

Anyway, rant over - you're all free to act as you see fit of course, but what I'd really like to say, and excuse my French, is that you personally don't screw it up for future generations because you can't be bothered to act responsibly.  

Acting together, we have a chance to change our future for the better.  There’s no I in team, but there is in humanity.  Share yours. 

Dalvir Kular

With conservative estimates forecasting a population of around 9 billion people by 2050, the question of whether the world food system’s production capacity can keep up with increasing demand is a very important one.  How it can do so in a world increasingly influenced by climate change is an even tougher question.

Imagine if 2013 were the year where we started to take real action on climate change. The year where we changed our course to end malnutrition, for good.

I choose to be optimistic.

In the global north we have warped our basic need for food into a multi-billion pound industry in which it’s not so much about nutrition but luxury…at least as long as you have the money.  In the global south, the losers of our success are driven further into poverty, due to injustices in the political decisions of the global north.

The lack of regulation, commodity speculation, inequitable trade policies and climate change combined are helping to send food prices through the roof for the poor.

The recent launch of the ‘Enough Food For Everyone IF‘ campaign hammered home the truth that for now, there is enough food available to feed everyone on Earth, but the real problem is how to ensure that people have sufficient access to ensure their food security.

Unsustainable energy use and agriculture are fueling a warmer climate, which is resulting in unpredictable and increasingly frequent natural disasters such as floods and droughts.

The problems described above – and the increasing shadow of climate change – are directly and indirectly impacting on access to food for the world’s poor; and climate science tells us there’s more to come.

Safety nets and speculation 

According to the United Nations global food reserves are at their lowest levels in nearly 40 years, meaning that there’s a much smaller margin for those already food insecure.

If the cost of staples goes up 170%, people either increase their expenditure for the same amount of food, you change your diet to a cheaper and often less nutritious one or you eat less.  If you’re poor, ie. when the food required to be secure represents a reasonable proportion of your income, the first option may not be open to you, and there is much less scope to adapt.

Rapid urbanisation in the developing world creates the opportunity of greater inequality of livelihoods and income in a higher population density.  This give rise to possible future food security issues and a need for safety nets to help city dwellers cope when food prices may be volatile in the future.

Helping farmers to adapt to the impacts of climate change can defend food supplies.  Laws to prevent speculation have been largely opposed by the big players.  Barclays is the biggest UK operator in food commodity markets, making up to an estimated £500m from speculating on food prices in 2010 and 2011.

Legislation to limit commodity speculation was backed by the EU in early 2013.  Germany’s fourth largest bank, DZ Bank, has announced it would no longer speculate on food prices.

Agriculture – especially large-scale, intensive farming of livestock – contributes heavily to greenhouse gas (GHG) emissions, which in turn are a big part of the reason why we’ve been seeing crop failures all around the world, from Africa to the USA to Russia.

Agriculture needs to be part of the solution – and with an increase in investment and better policies, sustainable agriculture technologies and practices may be adopted to improve food security and sovereignty for farmers and consumers in the global South, and to reduce emissions and preserve biodiversity.

The recent extremely successful UK-based Fish Fight campaign, spearheaded by the food writer Hugh Fearnley-Whittingstall, is proof that people power – assisted by the internet and social media – can bring real change.  It coordinated its supporters to send emails to MEPs in all the official languages of the EU, with more than 120,000 sent within 24 hours in a, successful, effort to ban fish discards.

We need similar political momentum to set a more ambitious 40% emissions reduction target for Europe.

The Common Agricultural Policy (CAP), which receives nearly 40% of the EU budget must be reformed along the lines advocated by the ‘Enough food for everyone IF’ campaign.  It suggests stopping food from becoming fuel for cars, a false economy when it comes to tackling climate change. Certainly we in Europe should pressure our MEPs to lobby for sustainable agriculture in the context of the CAP reform being carried out this year.

The idea of a low GHG diet – more domestic, home grown foods, seasonal, local, and including less red meat and dairy – is far from new, but it’s one of the ways that people can make the biggest difference to their carbon footprint.

The really good news is that it isn’t only more sustainable, but also often healthier too.

Izzy Braithwaite

Originally published at: http://www.rtcc.org/2013/05/27/comment-health-overlooked-in-our-response-to-climate-change/

The protection of human health and wellbeing is a central rationale for the emissions reductions called for in the very first article of the UN Framework Convention on Climate Change (UNFCCC). Yet, somehow, the issue is missing from many parts of the UN talks.

The growing body of research and evidence in the area over the past couple of decades hasn’t really translated into a broader understanding of how climate change and health are related, beyond a relatively small community of academics and health professionals.

Knowledge about the links between climate and health among the public, climate negotiators and environmentalists is often limited and quite superficial. It typically doesn’t stretch far beyond the more direct impacts, such as heatwaves, vector-borne diseases or extreme weather events such as flooding.

Indirect effects on health are rarely considered, and both the media and the public tend to frame the impacts of climate change in terms of the risks to ecosystems and species or economic losses; very rarely in terms of its other impacts on people and their health.

Perhaps this is part of why climate mitigation and adaptation measures fail to get the levels of both political and financial support they need to tackle climate change and to protect and promote health in the face of it: current levels of adaptation finance, much like current emissions reductions pledges, are grossly inadequate.

As a glance at any newspaper or polls about the relative political importance of different topics make clear – most of us are concerned about our own health and the health of those we care about, including that of our children and grandchildren and less visible problems like climate change, which are also delayed in time, often feature far below this on the agenda.

Climate change will dramatically affect the health of today’s children and young people, and more than that, policies to promote the health ‘co-benefits’ of sustainability and climate action could greatly improve health.

Surely those messages, if communicated more effectively, could be a strong driver to help us achieve the sort of rapid, meaningful changes we need in order to avoid catastrophic climate change - couldn’t they?

In the UK, several thousand health professionals have joined the Climate and Health Council to add their voice to a global climate and health movement which already has strong voices in Australia, Europe and the US, along with several other regions, and they are starting to connect up, for example with the Doha Declaration.

Doubt is their product...

At the same time, communication with negotiators, the mainstream media and the wider public around what’s known about climate and health clearly hasn’t yet been very effective, and has been compounded by the confusion that biased and inaccurate media such as Fox News and the Murdoch empire seek to create.  This is very much like the 'merchants of doubt' phenomenon that emerged among tobacco companies as the evidence of tobacco's health risks came to light.

One of my friends recently asked me when he saw this video, “if climate change is really such a big health threat, then why don’t most people know that, and why isn’t it mentioned more in the news?”

I’m convinced by the evidence that it is – some of it is collected in our resources section– but I found it hard to answer his question.  Have we all, consciously or subconsciously, decided that it’s too depressing so we don’t want to know, do the media decide it’s not worth broadcasting, is it related to the success of fossil fuel companies and their PR and lobbying teams, or is it something else?

I don’t have the answers, but I think there are many reasons: for one, picking out long-term trends to ascertain what health impacts are attributable to climate change is no easy task, and – especially when it comes to modelling future health impacts which are often highly dependent on socioeconomic factors too – the science is far from simple.

Predictions, of necessity, depend on various assumptions and on multiple interacting factors. As with climate change in general, the real-world effects are highly uncertain: not because scientists think health might be fine in a world four or six degrees hotter, but because it’s very hard to work out exactly how bad the impacts may be.

Even the World Bank now explicitly recognises that this is what we’re currently on course towards, that it’ll be far from easy to adapt to, and that such a temperature rise would conflict greatly with its mission to alleviate poverty.

The dangers of ignoring Black Swans

As George Monbiot pointed out in characteristically optimistic style last year, mainstream global predictions for future food availability in the face of climate change may be wildly off – because they’re based only on average temperatures rather than the extremes.  A fatal error if this is true that the extremes – droughts, wildfires and so on – could become the main determinant of global food production, interacting with other changes to affect in ways that, like Taleb's 'Black Swan' events, are almost impossible to predict.

If this does turn out to be the case, it’s likely that by far the biggest health impact of climate change will be malnutrition, as argued by Kris Ebi, lead author of the human health section of the last IPCC report.  Inadequate food intake not only increases vulnerability to infectious diseases such as malaria, TB, pneumonia and diarrhoeal disease, but also kills directly through starvation.

Food insecurity, in turn, can force people to migrate just as something more obvious like sea-level rise can, and this can be a driver of civil conflict.  Both migration and conflict of course have major physical and health impacts, but their extent and distribution depend on numerous other things; climate is one driver among many.  Like any give extreme weather event, it’s hard to attribute indirect effects of climate change such as these to climate change, given how strongly it interacts with other contextual factors. But that doesn’t mean it’s not a causal relationship.

As the Millennium Ecosystem Assessment showed in 2005, our health and wellbeing ultimately depends on ecosystem functioning and stability, at levels from local to global. How ecosystems and in turn health are being – and will be – affected by climate change is unavoidably complex. That makes it hard to communicate and hard to use to change policy, but we cannot allow this to stop effective advocacy and action.

The fossil fuel industries and the many dubious institutions and individuals they fund will not wait: with billions made from the sale of coal, oil and gas, they are much better organised and resourced than us at present, and they will use every opportunity to maintain doubt, prolong inaction and ensure that our future isn’t allowed to compromise their sales.

In order to extend a sense of the importance of climate action beyond the environmental community and to secure broad and deep consensus on the need for concerted action, health must play a much bigger role in decision-making at all levels.  Both impacts and health co-benefits need to feature more centrally in national mitigation and adaptation plans, and in our discussions around climate change more generally.

That shift won’t happen on its’ own, and with the Bonn UNFCCC intersessionals coming up in June, it strike me that health should be a priority.  Better resourcing and a comprehensive work programme including capacity-building, education and raising public awareness on subjects specific to climate and health would be a tangible and positive way to protect and promote health and to reduce the impacts of climate change on the most vulnerable.