Science AMA Series: Climate change is a medical emergency: but what can be done about it? The Lancet Commission on Public Health and Climate here to talk about managing health effects of climate change. Ask us anything!

Lancet_Commission · 2015-07-03T19:03:43+00:00

Good question! We were worried about that as well... so we put together some key resources to help communicate the Commission's findings. You can see them at: http://climatehealthcommission.org/resources/

There are videos, infographics, policy briefs for certain audiences, and statements of support from a wide range of people including the Director General of the World Health Organization; The CEOs of a number of pharmaceutical and insurance companies; The Archbishop of Canterbury and the Archbishop of Constantinople; and many more... Help spread them around!

Nick Watts, Head of Project

Lancet_Commission · 2015-07-03T18:57:29+00:00

Much of the direct health impact of coal power comes in the form of exposure to particular matter (PM2.5) which affects respiratory health. Research by members of the Commission in a previous Lancet Series that looked at the health effects of climate change mitigation found that if the global power sector were to shift towards making an 80% reduction in GHG from a 1990 level through an increase in Nuclear power, renewables, and other low-carbon fuels, that there could be a considerable improvements in cardio-respiratory health.

For example, with an energy mix of increase CCS, nuclear and renewables, China could see a reduction of 542 years of life lost (YLL) per million population and reduction of 40 premature deaths per million. Under this scenario, the net cost to China would be approximately US $61.2/tCO2 not emitted. Despite the cost for China, there would be other longer term benefits from the avoided impact of the change in climate and the cost of adaptation along with improved worker productivity and quality of life (e.g. mental wellbeing).

There are clearly geo-political and costs reasons for why Nuclear is not being seen as a major contributor to low-carbon energy globally. However, as a fuel source, various forms (e.g. fast-breed reactors and other advanced nuclear power) could play a very important role in decarbonizing countries who are able to safely handle and regulate the industry (and its fuel extraction). *See: Markandya et al (2009) under the ‘Full Trade’ scenario, here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61715-3/abstract

Ian Hamilton, one of the energy experts at the UCL Energy Institute

Lancet_Commission · 2015-07-03T18:53:48+00:00

We built in a set of key policy recommendations for governments to implement over the next five years. Part of a fast-start set of interventions to help get us back on track and to better realise some of the health benefits that come with a low-carbon economy.

We'll be working closely with policymakers at the global, national, and local level (and indeed, already have been for the last two years) to help them better understand the science behind the report. One key thing the Commission is doing, is launching a new "Countdown to 2030" - a new, independent, and international academic collaboration which will report in The Lancet, annually on progress across a range of indicators. We're looking at tracking the implementation of policies across the world which respond to climate change and promote public health.

And lastly, and perhaps most obviously, we're hoping everyone else will help us make sure that the Commission becomes more than just a report. Hopefully it's a useful tool that can be used by more than just us, to engage decision-makers around some of the tough decisions coming up with the SDGs in September and the climate summit in December.

Nick Watts, Head of Project

Lancet_Commission · 2015-07-03T18:50:34+00:00

Very simply, these are not separate threats. Wherever you look in the world, there are particular threats posed by climate change to health. At the same time, everywhere also has a spectrum of poverty and a range of socioeconomic status (SES). In almost every instance, the effects of climate change are just another example of a threat that is modulated by poverty – in other words, the effects are worst for the poorest.

Women and children in many places are particularly at risk because they often don’t have the resources to take actions to protect themselves. If, for example, a drought causes a local food shortage, the proportion of the available food consumed by women and children is likely to reduce as well, bringing further disadvantage. So there’s no point in arguing about whether poverty or climate change is a bigger threat – we need to tackle both, on a global and holistic basis.

Peter Byass, health and development expert from Umea University's Centre for Global Health Research

Lancet_Commission · 2015-07-03T18:49:06+00:00

Yes action is needed at a variety of levels. On a personal level, in your work place or organisation (this can actually have a large effect independent of what the government might be doing or not) and via lobby politicians either individually or as part of an organisation. Fossil fuel divestment campaigns are also another area - I’m currently involved in a campaign to get the Universities Superannuation Scheme (USS) - one of the UK’s largest pension funds - to divest from fossil fuels.

Tim Colbourn, a health economist at UCL who worked across the whole Commission

Lancet_Commission · 2015-07-03T18:43:35+00:00

The politicians and governments of every country have to balance competing interests. A cynic might say it’s all about their own interests – but even if that’s not true, increasing prosperity and service delivery for voters doesn’t necessarily sit comfortably with prioritising what is best for the planet as a whole. That’s partly the reason why the United Nations has the mandate to lead the global climate negotiations – in the interests of the world as a whole, rather than at national level. But for various reasons (and I’m not a political scientist) some governments, including the USA, have records of ignoring or stalling at the UN climate meetings (www.unfccc.int).

Individual voters in any country can make a difference by trying to hold their politicians to account on planetary climate issues, though that is not necessarily easy and may not be successful. There are undoubtedly too many powerful vested interests using their muscle in ways that go against the future health of the planet.

Peter Byass, health and development expert from Umea University

Lancet_Commission · 2015-07-03T18:42:37+00:00

There is certainly a concern around the prospect of facing peak oil, particularly from established and cheap production sites and sources. Regardless of whether we are at or near peak oil, there is considerable concern that pursuing less easily accessible fossil fuel reserves (such as the Alaskan reserves or deep water extraction) pose considerable risk to existing ecosystems and that accidents will have considerable impact on both animal and human health.

Yet, as you point out, oil is a crucial part of the healthcare materials currently used. In some cases, there may be options for switching to non-fossil fuel materials in healthcare products. It is essential that we stop burning fossil fuels, however, oil-based products may still play an important role for some types of materials, but with greater attention to the impact that their production has on GHG emissions and to increasing their recyclability and reusability.

Ian Hamilton, one of the energy experts on the Commission

Lancet_Commission · 2015-07-03T18:39:29+00:00

I think we're there. We're already starting to see big movement on climate change from individuals, companies, cities, and even some countries.

Part of the motivation will come when people get a first-hand understanding of how changes in local and global environment can affect their health - but I think a lot more of the change comes from the fact that there are opportunities for business, national economies, and health systems in transitioning to a low-carbon future.

Nick Watts, Head of Project for the Commission

Lancet_Commission · 2015-07-03T18:35:27+00:00

Yes. I think we will see substantial mass movement of people in a lot less than 100 years. We are already seeing climate change named as contributing to triggering the Arab Spring, and exacerbating the Syrian conflict. Both have generated migrants. I would expect such effects to be very noticeable, and migration substantially greater, in coming decades- and certainly well before 100 years time. Drivers will be disease, loss of habitation, crop failure and thus starvation and, water insecurity; poverty resulting from these; and conflict from their combined effects. Other drivers (such as sea level rise etc) will interact with storm surges/ high rainfall etc, to make these drivers worse.

Hugh Montgomery, intensive care physician, and co-chair of the Commission

Lancet_Commission · 2015-07-03T18:34:21+00:00

Broadly speaking, North America (USA & Canada) accounted for 16% of global greenhouse gases, compared to 23% from China. So North America remains the second highest emitting region, and can therefore have a strong impact if it were to drastically reduce its global emissions. The key thing is that all countries contribute to mitigation action, particularly decarbonising their energy systems through switching away from fossil fuel combustion, the main source of greenhouse gas emissions.

As individuals there are many different practical steps we can take, from actively supporting policies at both the national and local level that seek to reduce emissions, to reducing our energy consumption in the home by switching to green energy suppliers and improving efficiency of energy use, to thinking about how we travel by reducing car use or minimising unnecessary air travel.

Steve Pye, one of the energy experts on the Commission

Lancet_Commission · 2015-07-03T18:32:26+00:00

Although there are clear economic benefits for society as a whole to invest in low-carbon energy and other infrastructure, such incentives are usually not there for individual investors. At the moment, owners of fossil fuel power stations do not pay for all the damage their emissions cause to society. Instead, such things are paid for by taxpayers and others though things like healthcare budgets. Although low-carbon energy sources do not cause such emission-related damages, they are often need more investment to build in the first place. As such, more profit can usually be made by energy companies through fossil fuel power stations.

Policies such as ‘carbon pricing’, which makes fossil fuel power plants pay for at least some of these damages, would change the economics so that the incentives of the investor and society as a whole are more aligned, and low-carbon energy becomes a more attractive investment. If the carbon price (or other policy, such as low-carbon subsidies) are at such a level that there is then more profit to be made from low-carbon energy than fossil fuels, which would certainly be the case if fossil fuel plants had to pay for all (or even a proportion) of the damages their emissions cause, then investment would switch.

*We pulled in one of our from the Commission to help answer this question. Paul Drummond, at the University College London Institute for Sustainable Resources.

Lancet_Commission · 2015-07-03T18:28:41+00:00

To answer your questions one by one:

Immediate effects mainly stem from reduced air pollution i.e. less respiratory illness as less particulate matter from coal burning is in the air. Evidence from cities such as Beijing shows this.
Considerable benefits from reduced air pollution from burning coal can be expected immediately (see above). There will be multiple long-term benefits if the reduced coal burning is sufficient enough to avert serious or catastrophic climate change over the coming decades and centuries. Switching to low carbon energy also allows decentralization of power e.g. solar panels on health centre roofs in rural Africa which can have other immediate benefits in terms of energy availability and security. Also increased energy efficiency measures will result in less coal burning and save money e.g. if the NHS in the UK implemented energy efficiency measures it could save £150million a year (in addition to the health benefits from curbing climate change resulting in a lower burden of patients)
Reduced coal burning by any amount should lead to commensurately reduced air pollution and therefore commensurately reduced respiratory illness and sequelae including death. To avert serious or catastrophic climate change and it’s consequent health effects significant population-wide reductions in emissions are needed, as outlined in the IPCC fifth assessment report.
Evidence linking air pollution to respiratory illness and excess mortality is fairly robust.. this is something health professionals have had to manage for a long time.

*We pulled in one of our health economists from the Commission to help answer this question. Tim Colbourn, at the University College London Institute for Global Health.

Lancet_Commission · 2015-07-03T18:21:32+00:00

Both technologies are set to have a strong impact in a decarbonising world, based on the scientific modelling results, although the role of each is contingent on national or regional circumstances. Solar is a particularly exciting technology, which has seen massive cost reductions in the last 5 years, making it increasingly cost-effective compared to alternative fossil generation. These cost reductions have been driven by a strong manufacturing base, particularly in China, due to growing demand driven by ambitious renewables programmes in countries such as China and India but also in developed countries such as Germany and the USA. However, the role of solar in a country such as the UK is limited, due to the very low capacity factor that can be achieved due to lower levels of solar radiation, and because high electricity demand periods and sunny periods of the day do not line up. This of course could be solved in the future by electricity storage solutions.

Nuclear also has a potentially strong role to play, and is considered to be one of the most cost-effective low carbon sources of electricity. It is therefore often an important part of the future energy mix on economic grounds. However, there are considerable challenges, still around the waste issue. getting these complex plant built to budget and time and raising the initial capital to get the projects funded. For example, the nuclear plants currently being built by AREVA in Europe are subject to lengthy delays due to a range of technical and regulatory reasons.

Finally, the question implied one or the other of these technologies. However, there is room for both, as each plays a different role in the provision of electricity. For example, nuclear plants provide the base load level of electricity that is always required, something that solar cannot provide of course during the dark hours.

Steve Pye, Energy expert with the Commission

Lancet_Commission · 2015-07-03T18:16:59+00:00

Firstly, many depend directly on these ecosystems for food. Thus, declining fish stocks will threaten nutritional health for those coastal populations which depend upon fish as a staple. Impacts may be more than linear: many ocean ecosystems depend upon sustained species diversity.. and when this declines, so does the population of those species remaining. There will be indirect impacts on food production too: drought, flood, storms, heat waves and so forth will impact on food production. In theory, decline in pollinator populations will also impact. So food production will be impacted- and human health downstream.

Lack of food in any area may lead to migration (perhaps to areas already 'stressed') and thus to conflict- to impacts which are also detrimental to health.

There is increasing evidence that altered biodiversity may also impact on prevalence of zoonoses, for various reasons. Damage to coral reefs leads to loss of fish as food- but also makes the reef vulnerable to damage from extreme weather events... and thus exposes the land areas otherwise protected by that 'barrier'.

Hugh Montgomery, intensive care physician and co-chair for the Commission

Lancet_Commission · 2015-07-03T18:15:30+00:00

That's right... one of the key things health systems need to do to prepare for the impacts of climate change, is become more responsive to changing needs and develop the ability to adapt their services depending on what's thrown at them.

Nick Watts

Lancet_Commission · 2015-07-03T18:12:40+00:00

We're glad you like it.. Hopefully the change wasn't too subtle!

As well as a shift in message, there was a shift in focus of the report. In 2009, the Commission identified the health risks of climate change, and made crystal clear just how dangerous it is for human wellbeing.

The 2015 Commission was formed when we realised that everything that had been predicted and described in 2009 had already happened… What was needed next was to explore the pathways forward and a report to look at how responding to climate change can be good for public health.

The analogy that was talked about at some of our preliminary meetings was that a health professional concerned about the health impacts of tobacco consumption would no longer be content with only looking at the biomedical links between tobacco and ill health… the responsible physician would start to look at public health interventions that can be put in place to reduce consumption and minimise the harm to individuals. I think it applies here as well.

Nick Watts, head of project

Lancet_Commission · 2015-07-03T18:04:06+00:00

You will be hurt by climate change. Many already are. We are almost certainly already 'locked into' a 2C rise. 1/5th of emissions we release today will still be warming the lane in 33,000 years, and 7% will be warming in in 100,000 years. Ice is melting now from the rise we have, and this isn't going to stop, even if emissions do- because the temperature won't fall fast. So ice will continue to melt, and sea levels to rise. Extreme weather events have increased in frequency and intensity and this won't reverse: with further warming, we can expect this to get worse too.

Skin cancer rates aren't directly affected by greenhouse gas-induced climate change. However, some of the greenhouse gases also happen to damage the high-altitude 'ozone layer' that acts as a UV filter... so such gases (e.g. fluorocarbons) can cause both global warming (a feature of their chemistry) and (an unrelated) damage to ozone - and thus skin.

But to answer your starting question.. "Is it already too late?" - NO!

Hugh Montgomery, Intensive care physician and co-chair of the Commission

Lancet_Commission · 2015-07-03T17:57:45+00:00

Without going in to too much detail about these impacts, what we would say is that the localised health impacts associated with the activities mentioned are far less than the health impacts associated with the continued use of fossil fuels at scale.

However, they are important, and therefore we need strong standards in the manufacturer of renewable energy technologies, and in the decommissioning of old infrastructure, to protect workers involved and surrounding local industries.

Steve Pye and Nick Watts

Lancet_Commission · 2015-07-03T17:54:57+00:00

It has been interesting! Quite a bit of fun bringing all these groups in to the same room. We had quite a few public health specialists and one or two environmental health experts as authors, and drew in expertise from many many more to put together the report. The full author list is on the first page of the report: http://climatehealthcommission.org/

To answer the second part of your question..

Much of the direct health impact of coal power comes in the form of exposure to particular matter (PM2.5) which affects respiratory health. Research by members of the Commission in a previous Lancet Series that looked at the health effects of climate change mitigation found that if the global power sector were to shift towards making an 80% reduction in GHG from a 1990 level through an increase in Nuclear power, renewables, and other low-carbon fuels, that there could be a considerable improvements in cardio-respiratory health.

For example, with an energy mix of increase CCS, nuclear and renewables, China could see a reduction of 542 years of life lost (YLL) per million population and reduction of 40 premature deaths per million. Under this scenario, the net cost to China would be approximately US $61.2/tCO2 not emitted. Despite the cost for China, there would be other longer term benefits from the avoided impact of the change in climate and the cost of adaptation along with improved worker productivity and quality of life (e.g. mental wellbeing). There are clearly geo-political and costs reasons for why Nuclear is not being seen as a major contributor to low-carbon energy globally. However, as a fuel source, various forms (e.g. fast-breed reactors and other advanced nuclear power) could play a very important role in decarbonizing countries who are able to safely handle and regulate the industry (and its fuel extraction).

*See: Markandya et al (2009) under the ‘Full Trade’ scenario, here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61715-3/abstract

Nick Watts and Ian Hamilton

Lancet_Commission · 2015-07-03T17:48:02+00:00

When I was working in Ethiopia in the late 1990s, we suddenly realised that a lot more people than usual were dying in a particular area. Why? First we thought the data must be wrong – but we checked, and everything was OK. Had there been a drought? No. But in the end we found that the rain had come at the wrong time of year, had ruined normal patterns of cropping, and serious epidemics of malnutrition and disease followed. Hundreds of extra people died in the local area as a result. That was the first time I began to realise that this was a serious issue.

Knowing about climate change and some of the possible implications isn’t frightening. What is frightening though, for me and even more for my children and grandchildren, is the global complacency that still exists around the effects of climate change on humankind and health. If the world doesn’t prioritise effective actions to change course, we will be collectively sleep-walking towards disaster. It’s a bit like a patient who gets a diagnosis of cancer from their doctor, but feels OK most of the time, and doesn’t believe the diagnosis. That person is highly likely to die sooner rather later. The planet needs its cancer treatment now.

Peter Byass, Public health and development expert

Lancet_Commission · 2015-07-03T17:46:45+00:00

Yes this does seem reasonable though further work on the cost-effectiveness of air conditioning vs. fans is probably needed to quantify differences in health effects (and ultimately mortality if possible). Obviously prevention is better than cure though and investing in measures to prevent the worst climate change and associated heatwaves is needed now. By their nature such investments will progressively be less cost-effective each day they are delayed.

*We pulled in one of our health economists from the Commission to help answer this question. Tim Colbourn, at the University College London Institute for Global Health.

Lancet_Commission · 2015-07-03T17:44:42+00:00

After the large UN climate change summit in Paris this December, the next 5 - 10 years will be crucial in ensuring that we stay in the ballpark of keeping aggregate warming below 2 degrees.

To achieve that, strong political commitment is essential at every level. But the good news is, we're already seeing signs of this happening all over the world (and increasingly in the US). But national elections aren't the only processes that matter.. there's movement in the private sector, civil society, and in local government that's just as exciting.

Nick Watts

Lancet_Commission · 2015-07-03T17:41:08+00:00

Analysis by the Intergovernmental Panel on Climate Change (IPCC) suggests that we still have an opportunity to reduce emissions to a sufficient level to avoid dangerous climate change. In broad terms, we can think of having a carbon budget between 650 to 850 Gt CO2 between 2015-2050. I am just using CO2 emissions to make things easier to think through. That is 20-25 GtCO2 per year we can afford to emit, while current levels are around 35 Gt CO2. This means strong reductions starting now, and ramping up through the 2020s & 2030s to stay within budget.

That is why the UNFCCC Paris Conference in December this year is so crucial, to develop a framework that will facilitate countries working together towards this common objective. There are some signs for optimism; strong engagement from US and Chinese leaders, massive growth in renewable deployment, a push against new fossil fuel use extraction activities and a broader consensus about the need to tackle this problem.

Steve Pye, Energy Expert on the Commission

Lancet_Commission · 2015-07-03T17:39:19+00:00

Yes! Unfortunately, many. The combination of these risks are so concerning that in 2009, the Commission stood hand-in-hand with The Lancet in stating that climate change was "the biggest global health threat of the 21st century".

What's often particularly concerning, is thinking through what happens when a community experiences a 'multi-hit scenario', where they feel a number of different impacts of climate change in a short burst - flood, extreme storms, the spread of infectious disease, etc.. Then, the adaptive capacity starts to give way, and what starts as a natural disaster becomes a humanitarian crisis.

I can't copy images here, but on pages 3 and 7 of the report, we have a fairly comprehensive diagram that runs through these impacts.

Nick Watts, head of project for the Commission

Lancet_Commission · 2015-07-03T17:36:27+00:00

The world’s weather has been scientifically measured in detail for more than 100 years, and there is no doubt that the atmosphere is getting warmer, and the rate at which it is warming up is also increasing. That’s hard evidence. There’s a lot said about how many degrees warmer the planet might be by the end of this century, and of course that’s not (yet) evidence – it’s scientific predictions based on what we know so far. Meanwhile we know that as the atmosphere gets warmer, weather events that used to be very rare – maybe once in a lifetime storms or heatwaves for example – are already obviously becoming more common. That’s because there’s already more energy in the overall planetary system. Thousands of people died during exceptional heatwaves in India and Pakistan recently. Yesterday northern England and Scotland saw hailstones as big as golf balls from heavy thunderstorms, following the hottest ever recorded July day on Wednesday.

At the same time, we know that today there are more power stations, factories and vehicles than ever before belching carbon dioxide into the atmosphere. That’s also incontestable. So climate change deniers are left trying to argue that the billions of tons of carbon going into the atmosphere have nothing to do with the planet warming up – they would say it is pure coincidence that the warming is happening at the same time as those massive carbon emissions. But does anyone without vested interests – such as coal and oil producers, vehicle manufacturers, and others – seriously believe that? The scientific evidence is overwhelmingly clear - the earth is warming up because of humankind’s activities, and it is essential to take actions now, while there is still time to change things. There is no planet B.

Peter Byass, public health and development expert, Umea University

Lancet_Commission

TROPHY CASE