Climate Change Gets Personal: Lancet Report Lays Out Health Effects

Marcia Frellick

June 29, 2015

Global warming threatens to undo medical advances made during the last 50 years, according to the Lancet, which formed a global commission to systematically describe and respond to the problem.

This is the second commission, after the first in 2009 declared, "Climate change is the biggest global health threat of the 21st century."

Climate change's effects include heat stress and drought, floods and severe storms, and the health threats that come with them: changes in air pollution, spread of disease, food insecurity, displacement, and mental illness.

Additional deaths attributed to these effects are projected to approach 250,000 a year between 2030 and 2050, the World Health Organization (WHO) estimates. Building on the findings of the 2009 commission, more than 40 researchers, including physicians, nurses, climatologists, epidemiologists, and ecologists, primarily from across Europe and China, have spent more than a year compiling the 2015 report, which was published online June 22, along with five commentaries.

Georges Benjamin, MD, executive director of the American Public Health Association, says the power of this report comes from it being both global and personal: The report spells out the human toll and offers hope for turning things around, he said.

"We've had a lot of discussion around what happens to the land and the polar bears, but [this report has] a real focus on health," he told Medscape Medical News. Dr. Benjamin was not involved in the report.

A primary directive from the report is to move rapidly away from coal and toward renewable energy, especially in low- and middle-income countries. Plans for 2200 new coal-fired power plants around the world must be reexamined, it says. Globally, the financial resources are available, the authors write; however, the bulk of them are still being funneled to the fossil fuel industry.

To reduce negative health effects of climate change, the commission recommends the following goals for the next 5 years:

  • establish and implement an international agreement that supports countries in transitioning to a low-carbon economy;

  • invest in climate change and public health research, monitoring, and surveillance for better understanding of what needs to change and the resulting health benefits; and

  • transition to cities that promote healthy lifestyle changes and make active transportation, such as walking and bicycle riding, easier to lessen the burden of emissions, diabetes, and obesity simultaneously.

Dr Benjamin said he was fascinated by the urgent directive to get out of the coal business. "I still support a balanced energy approach," he said, "but this argues very strongly for getting to cleaner, renewable energy much faster."

He was also happy to see an emphasis on what individuals and planners can do, such as walking or riding bikes or using mass transit instead of driving cars, and making green space more accessible, adding bike lanes and designing hospitals and new building complexes with renewable energy.

Deaths From Air Pollution

Margaret Chan, MD, director-general of WHO, in an accompanying commentary, said that last year WHO calculated that 7 million deaths are caused by air pollution, a risk factor comparable to tobacco smoking.

"Globally, 88% of the world's population breathes air that does not meet WHO's air quality guidelines. This is partly due to poverty and lack of access to clean energy — but it is also a result of policy choices," she writes.

Some continents may have even more to gain than others in changing the climate change trajectory.

In another accompanying commentary, Kesetebirhan Admasu, Ethiopia's minister of health, and Kare Debessa, Ethiopia's state minister of environment and forest, in Addis Ababa, write that Africa, which is already experiencing record-high temperatures, is "ready and willing to engage" with the commission.

They write that less than a third of the sub-Saharan population has access to electricity, and without it, people often resort to costly and polluting small diesel generators. Green energy sources are a high priority for many parts of the continent.

Progress for the next 15 years will be tracked under the independent project called "Countdown to 2030: Global Health and Climate Action," and results will be published every 2 years in the Lancet.

Strong Messages Come Together

The commission's report comes just months before countries meet in Paris at a United Nations summit in December to negotiate an emissions reduction deal.

It also comes after the release of a rare encyclical by Pope Francis, which called for "a new dialogue" in shaping Earth's future.

Although praising some of recent advances, the pope writes: "Regrettably, many efforts to seek concrete solutions to the environmental crisis have proved ineffective, not only because of powerful opposition but also because of a more general lack of interest."

Ali Khan, MD, MPH, dean of the College of Public Health at the University of Nebraska Medical Center in Omaha, told Medscape Medical News that most of the action items listed in the Lancet report are valid independent of climate change. He notes that this report is another in a recent surge of similar reports that make the case for urgent change.

Another such report came from the Environmental Protection Agency this week, which predicts the United States will face $180 billion in losses by the end of this century if greenhouse gas emissions do not change.

The confluence of these reports and the Paris summit will feed momentum that will likely produce more results than the 2009 report, Dr Khan noted. And seeing the problem through the healthcare lens makes it all the more real, he added. "It's not just about money and technology and politics, it's about what the impacts are going to be on people."

Dr Benjamin said transparency and accountability in carrying out these directives will determine whether this commission is more successful than the last.

"People do what we count," he said. "If we don't track this and track our efforts, we won't be successful."

Dr Benjamin, Dr Khan, Dr Chan, Dr Admasu, and Debessa have disclosed no relevant financial relationships.

Lancet. Published online June 22, 2015. Report abstract, Chan extract, Admasuemail and Debessa extract


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