The 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.
Our 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.