Health and Climate Change: policy responses to protect public health Page: 1,863
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proceed rapidly towards 4C warming by the end of the century, the likelihood of crossing thresholds and tipping points rises, threatening further
warming and accelerated sea-level rise. Second, small risks can interact to produce larger-than-expected chances of catastrophic outcomes,
especially if they are correlated (panel 1).2223
Such impacts (and their interactions) are unlikely to be trivial and could be sufficient to trigger a discontinuity in the long-term progression of
humanity.24 Whilst the poorest and most vulnerable communities might suffer first, the interconnected nature of climate systems, ecosystems,
and global society means that none will be immune. Indeed, on the basis of current emission trajectories, temperature rises in the next 85 years
may be incompatible with an organised global community.25
The health co-benefits of emissions reduction
Acting to reduce GHG emissions evidently protects human health from the direct and indirect impacts of climate change. However, it also
benefits human health through mechanisms quite independent of those relating to modifying climate risk: so-called health co-benefits of
Reductions in emissions (eg, from burning fossil fuels) reduce air pollution and respiratory disease, whilst safer active transport cuts road traffic
accidents and reduces rates of obesity, diabetes, coronary heart disease, and stroke. These are just some of the many health co-benefits of
mitigation, which often work through several causal pathways via the social and environmental determinants of health. Protecting our ecosystems
will create the wellbeing we gain from nature and its diversity.27
Affordable renewable energy will also have huge benefits for the poorest. WHO found that in 11 sub-Saharan African countries, 26% of health
facilities had no energy at all and only 33% of hospitals had what could be called "reliable electricity provision", defined as no outages of more than
2 h in the past week.28 Solar power is proposed as an ideal alternative energy solution, providing reliable energy that does not harm cardiovascular or
respiratory health in the same way that diesel generators do. Clean cookstoves and fuels will not only protect the climate from black carbon (a very
short-lived climate pollutant), but also cut deaths from household air pollution-a major killer in low-income countries. Buildings and houses
designed to provide better insulation, heating efficiency, and protection from extreme weather events will reduce heat and cold exposure, disease
risks from mould and allergy, and from infectious and vector-borne diseases.29
Many other co-benefits exist across different sectors, from agriculture to the formal health system. The cost savings of the health co-benefits
achieved by policies to cut GHG emissions are potentially large. This is particularly important in a context where health-care expenditure is
growing relative to total government expenditure globally. The health dividend on savings must be factored into any economic assessment of the
costs of mitigation and adaptation. The poorest people are also most vulnerable to climate change, meaning that the costs of global development
will rise if we do nothing, and poverty alleviation and sustainable development goals will not be achieved.
5 years ago, the first Lancet Commission called climate change "the biggest global health threat of the 21st century".' Since then, climate threats
continue to become a reality, GHG emissions have risen beyond worst-case projections, and no international agreement on effective action has
been reached. The uncertainty around thresholds, interactions and tipping points in climate change and its health impacts are serious enough to
mandate an immediate, sustained, and globally meaningful response.
This report further examines the evidence of threat, before tabling a prescription for both prevention and symptom management. We begin in
section 1 by re-examining the causal pathways between climate change and human health, before offering new estimates of exposure to climate
health risks in the coming decades. The changes in the spatial distribution of populations, and their demographic structure over the coming
century, will put more people in harm's way.
Given that the world is already locked in to a significant rise in global temperatures (even with meaningful action to reduce GHG emissions),
section 2 considers measures that must be put in place to help lessen their unavoidable health impacts. Adaptation strategies are those that reduce
vulnerability and enhance resilience-ie, the capacity of a system to absorb disturbance and re-organise-so as to retain function, structure,
identity, and feedbacks.30 We identify institutional and decision-making challenges related to uncertainty, multicausal pathways, and complex
interactions between social, ecological, and economic factors. We also show tangible ways ahead with adaptations that provide clear no-regret
options and co-benefits for food security, human migration and displacement, and dynamic infectious disease risks.
Symptomatic intervention and palliation must, however, be accompanied by immediate action to address the cause of those symptoms: the
epidemiology and options for scaling up low-carbon technologies and technical responses are discussed in section 3, in addition to the necessary
measures required to facilitate their deployment. This section also explores the health implications of various mitigation options, with particular
attention to those which both promote public health and mitigate climate change.
Transformation to a global low-carbon economy requires political will, a feasible plan, and the requisite finance. Section 4 examines the
financial, economic, and policy options for decarbonisation. The goal of mitigation policy should be to reduce cumulative and annual GHG
emissions. Early emissions reduction will delay climate disruption and reduce the overall cost of abatement by avoiding drastic and expensive
last-minute action. Immediate action offers a wider range of technological options, allows economies of scale and prospects for learning, and
will reduce costs over time. The window of opportunity for evolutionary and revolutionary new technologies to develop, commercialise, and
deploy is also held open for longer.
In section 5, we examine the political processes and mechanisms that might play a part in delivering a low-carbon economy. Multiple levels
are considered, including the global response (the UN Framework Convention on Climate Change), national and subnational (cities, states, and
provinces) policy, and the role of individuals. The interaction between these different levels, and the lessons learnt from public health are given
Finally, in section 6 we propose the formation of an international Countdown to 2030: Global Health and Climate Action. We outline how an
international, multidisciplinary coalition of experts should monitor and report on: the health impacts of climate change; progress in policy to
reduce GHG emissions, and synergies used to promote and protect health; and progress in health adaptation action to reduce population
vulnerability to build climate resilience and to implement climate-ready low-carbon health systems. A Countdown process would complement
rather than replace existing IPCC reports, and would bring the full weight and voice of the health and scientific communities to this critical
population health challenge.
Section 1: climate change and exposure to health risks
No region is immune from the negative impacts of climate change, which will affect the natural world, economic activities, and human health and
wellbeing in every part of the world.31 There are already observed impacts of climate change on health, directly through extreme weather and
hazards and indirectly through changes in land use and nutrition. Lags in the response of the climate system to historical emissions means the
world is committed to significant warming over coming decades.
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Watts, Nick; Adger, W. Neil; Agnolucci, Paolo; Blackstock, Jason; Byass, Peter; Cai, Wenjia et al. Health and Climate Change: policy responses to protect public health, article, June 22, 2015; Amsterdam, The Netherlands. (https://digital.library.unt.edu/ark:/67531/metadc1234369/m1/3/: accessed March 19, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT College of Arts and Sciences.