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The ticking time bomb in health is being ignored

HealthThe World Health Organisation (WHO) estimates that 140 000 people die annually as a direct result of the climate change that has occurred since the 1970s. As the earth’s temperature continues to rise, we will fast reach a tipping point where the climate will be the most dominant influence on human health and our health systems, far outstripping current drivers such as the aging population and lifestyle related diseases.

By 2050, climate change will contribute to doubling the number of people living in water-stressed basins; halving rain-fed agriculture in some African countries by 2020; increasing the number of people at risk of malaria (170 million by 2030) and dengue (2 billion by 2080); as well as increasing exposure to coastal flooding by a factor of 10, and extreme drought by a factor of 10-30 (WHO).

In addition, a 40 cm rise in sea level is expected to increase the average annual numbers of people affected by coastal storm surges from less than 50 million at present to nearly 250 million by 2080.¹

If this happens, the impact of heat stress conditions and upper respiratory tract ailments, as well as drought and hunger, will be profound. Our health systems are currently struggling to cope with the influx of chronic diseases  that our lifestyles and aging are creating…what chance do they have when the true impact of ‘climate disease’ hits them?

In the here and now, our densely populated cities, especially those which experience an urban heat island effect, already face extreme heat and degraded air quality. In New York City, each single degree (Celsius) increase in summertime surface temperature has been associated with a 2.7–3.1% increase in same-day hospitalisations due to respiratory diseases, and an increase of 1.4–3.6% in hospitalisations due to cardiovascular diseases.² In Hong Kong, there is a daily broadcast of what the pollutant index is and on some days, it’s recommended that parents don’t let their kids play outside. Coupled to this, food and waterborne infections show a direct correlation to rising temperatures.

Put simply, we’re headed for trouble and a changing climate will soon magnify the already significant effects of extreme weather on our public health system.

HealthOur current hospitals and health systems are not designed to cater for climate disease. And while the predicted wave of climate disease is still a way off, hospitals are presently being designed with little regard to how they will adapt. Adaptability in healthcare design is probably the most forward thinking strategy our health departments and hospital designers can implement.

As yet, no one seems to have done the maths around the impact climate related health diseases place on our current burden of disease globally, and what this burden may become if the world were to become 2 degrees (Celsius) warmer. Arguably, there will be a need for different models of intervention and treatment, with new research and innovation to address climate disease.

When it comes to health, ‘Salutogenics’ has become fashionable i.e. an increasing focus on factors that support human health and well-being, rather than on factors that cause disease. But, in focusing on designing the built environment to support human health, we’ve forgotten that if we do not start to design for wellness of the planet, there is little point in designing for wellness of the body.

It’s time for health leaders to become climate leaders . If we want to see lasting and measurable change, health departments will have to heed the climate debate and then start synthesising what this will mean to the design of the facilities they are delivering now. We will have to start investigating how our health systems would cope with this changing disease cohort and start asking the question: “How will our facilities and health system adapt?”

The leaders of our health systems need to understand that there is an intrinsic inter-relationship between human health and sustainability that exceeds any cursory green agenda. We have to take being green seriously. For health practitioners, it must move beyond merely being environmentally responsible to actually protecting human health, which is in truth the very foundation of the Hippocratic Oath.

Deciding that sustainability measures are unaffordable and treating ‘environmental sustainability’ as if it is an issue that is an adjunct to building design has to cease. Our design of health facilities today, and indeed all facilities, has to be capable of changing drastically. If environmental sustainability is directly linked to human health, we may need to spawn the concept of ‘health credits’ instead of ‘carbon credits’ and start to value those credits differently, given the potential to reduce the cost of healthcare in future.

Back in 2000, the WHO predicted that ‘climate related health diseases’ could have a significant impact on our burden of disease, yet our health departments and health operators are blind to the biggest risk to our health systems: the environment.

There is an innate link between the environment we live in and human health. We cannot afford to wait another 15 years to start asking what role the designers, the private health industry, and the general public can play in changing our course.

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¹ Climate Change, Sustainable Development, and Human Security, Dhirendra K. Vajpeyi, 2013
² Lin et al, 2009

21 replies »

  1. There is one very simple solution for climate change, and that’s to stop eating meat.

    If everyone moved to a vegetarian or vegan diet we could reduce our CO2 emissions by over 50%, we would also see a large reduction in CH4 (methane) which is about 80 times more destructive than CO2. Add to that we would have cleaner waterways and no longer need to chop down forests to make way for feed stocks, we would have so much spare lane we could happily go planting forests to makeup for all the ones we have chopped down already.

      • That data looks to be based on the livestock only, once you take into account the food they require you will find they account for over 50% of all greenhouse gas emission’s. Another little known fact is that over 90% of the deforestation of the Amazon rainforest is due to increasing land to be used for livestock food production.

        Another aspect is the water used with about 56% if the fresh water usage in the US being for growing livestock feed.

    • Hi Richard – it is impossible to reduce the worlds CO2 emissions by over 50% though vegetarian or vegan diets. The Agriculture, Forestry, and Other Land Use is responsible for an estimated 24% of the worlds GHG emissions. Greenhouse gas emissions from this sector come mostly from agriculture (cultivation of crops and livestock) and deforestation. This estimate does not include the CO2 that ecosystems remove from the atmosphere by sequestering carbon in biomass, dead organic matter and soils, which offset approximately 20% of emissions from this sector. Some stats agricultural emissions (2011 figures):
      • enteric fermentation accounted for 39% of the sectors GHG emissions in 2011. Emissions from enteric fermentation increased 11 percent between 2001 and 2011.
      • the application (does not include the manufacture) of synthetic fertilizers accounted for 13% of GHG emissions, and are the fastest growing emissions source in agriculture, having increased some 37% since 2001.
      • biological processes in rice paddies that generate methane make up 10% of total agricultural emissions, while the burning of savannahs accounts for 5%.

      Promoting vegetarian diet as the solution to climate change is a very simplistic approach that ignores the complexities of the agricultural system from production to consumption.

      • Hi Liza, Richard, Colmac

        It’s a wicked problem, with no simple solutions.

        But it’s a problem that can’t be ignored.

        My question is why it doesn’t get more attention from our health leaders on the ground.

        By ‘humanising’ the threat to one that is about people’s health, not just planetary health, will we care more?

        By counting the potential cost and access constraints for our health system, which is already under threat, will we value sustainability initiatives more?

        If we stop and think now about the potential impact of climate change on our health system, will we plan our health services and infrastructure differently?

        We can’t see the future. But we can imagine what might be and build resilience and agility to adapt.

    • Thanks for sharing this Blake. WHO is working hard to raise awareness of the threat that climate change poses to our health and health system backed by research. So why is this not penetrating on the ground into how we are planning our health system?

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