BMJ 2015;351:h6178 doi: 10.1136/bmj.h6178 (Published 18 November 2015)
Page 1 of 2
Editorials
EDITORIALS Combating climate change Health professional bodies unite for a fairer and healthier world 1
2
Nick Watts director , Robin Stott cochair , Anne Marie Rafferty professor of nursing policy
3
UK Health Professionals Alliance to Combat Climate Change; 2Climate and Health Council, London, UK; 3Florence Nightingale School of Nursing and Midwifery, King’s College London, London UK 1
The second half of the 20th century brought renewed understanding of the links between human wellbeing and environmental systems. In 1988 the United Nations formed the Intergovernmental Panel on Climate Change (IPCC), charged with documenting the effects of climate change and formulating realistic strategies for action. Its first report led to the UN Framework Convention on Climate Change (UNFCCC) in 1992. Unfortunately, since then neither humanity nor the planet have fared well. The Stockholm Resilience Centre has identified nine planetary boundaries within which humanity can develop and continue to thrive,1 and we have already crossed five. These are extinction rates, greenhouse gas emissions, change in land use, phosphorous and nitrogen cycles, and ocean acidification. In addition, we are pushing at the limits of three more—fresh water supply, air pollution, and novel pollutants. The evidence of adverse effects is incontrovertible, as is the need for urgent action. More frequent and more severe natural disasters, instability in food and water supply, the spread of infectious disease, and forced migration are already affecting human health and provide a glimpse of the near future. The World Health Organization’s director general has declared that climate change will “rattle the foundations of public health.”2
Political action has failed to respond to the challenge that the science presents. But the UNFCCC’s governing body, which meets for the 21st time in Paris in December, now has a crucial opportunity to design and agree a comprehensive strategy for rapid transition to a low carbon world. There are reasonable grounds for optimism. As a recent Lancet commission described, components of the proposed agreement will benefit health and wellbeing over and above the health benefits of avoiding dangerous climate change.3
Substantial commitments to reduce carbon emissions from the US and China, Europe, and a host of high income countries form the basis of negotiations.4 5 Ten global cities representing 58 million people have drawn up ambitious plans to tackle climate change. A poll of 200 large companies found that 130 have climate change as a priority, and the Bank of England’s Mark Carney has warned of the potentially catastrophic economic consequences from climate change,6 as has Jim Yong
Kim at the World Bank.7 Religious leaders, notably the Pope8 and the Dalai Lama,9 have called for urgent action, and the divestment movement has pledges from 400 organisations to move $2.6tr from fossil fuels to low carbon investment.10
The United Kingdom is bucking these positive trends, reversing and undoing many of its policies and programmes without offering credible alternatives. However, even here, there are opportunities. Having committed to phase out unabated use of coal, the government should now establish a plan for doing so by 2023. The effects of coal on cardiovascular and respiratory health are clear, and air pollution in our cities is exhausting the best efforts of the NHS. By phasing out coal the government will improve air quality, protect the health of our population, and reclaim the UK’s leadership position in tackling climate change.
Meanwhile, and independently of governments, health professionals around the world are recognising that tackling climate change is practically and ethically essential to promoting public health. UK health professionals have been at the forefront. The 1990 articles in The BMJ,11 the formation of the Climate and Health Council (www.climateandhealth.org) in 2007 and the NHS sustainable development unit (www.sduhealth.org.uk) in 2008, high profile meetings at the Royal College of Nursing in 2010 and 2015, the publication of the 2009 and 2015 Lancet commissions,3 the BMA’s commitment to divest from fossil fuels in 2014, and the foundation of the Global Climate and Health Alliance all provide examples of health professionals responding to the threat of climate change.
UK health professionals have now taken further action, forming an alliance of doctors, nurses, and allied health professionals to advocate for stronger measures to tackle climate change (box.) The hope is that other UK based representative health bodies will join and that similar alliances will emerge in other countries, so amplifying the powerful advocacy of health professionals around the world. The UK alliance has identified four areas for immediate action: improving air quality, increasing active transport, ensuring healthier and more sustainable nutrition, and working to reduce the environmental footprint of healthcare in the UK. Mindful
Correspondence to R Stott [email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;351:h6178 doi: 10.1136/bmj.h6178 (Published 18 November 2015)
Page 2 of 2
EDITORIALS
of these issues, former prime minister Gordon Brown’s Commission on the Future of Nursing and Midwifery advocated a focus on eco-nursing as part of the solution to these challenges.12
Climate change is happening on our watch, and our collective response will determine the fate of our immediate descendants. The trust vested in health professionals gives us the opportunity and the responsibility to act. We hope that this new alliance and other allied groups will help to place health firmly at the centre of the climate change negotiations, helping to impel nations to act decisively so that humanity can flourish in a fairer and healthier world. Competing interests: We have read and understood BMJ policy on declaration of interests and declare that NW is the appointed director of HPACCC and RS has been closely involved with the formation of the HPACCC. Provenance and peer review: Commissioned; not externally peer reviewed. 1
Steffen W, Richardson K, Rockstrom J, et al. Planetary boundaries: guiding human development on a changing planet. Science 2015;347:1259855.
For personal use only: See rights and reprints http://www.bmj.com/permissions
2 3 4 5 6 7 8 9 10 11 12
Chan M. How climate change can rattle the foundations of public health. Huffington Post 2014 Sep 16. www.huffingtonpost.com/dr-margaret-chan/how-climate-change-can-ra_b_ 5822950.html?ir=Australia. Watts N, Adger N, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015;386:1861-914. US-China joint presidential statement on climate change. 2015 www.whitehouse.gov/thepress-office/2015/09/25/us-china-joint-presidential-statement-climate-change. Nelson A. EU leaders agree to cut greenhouse gas emissions by 40% by 2030. Guardian 2014 Oct 24. www.theguardian.com/world/2014/oct/24/eu-leaders-agree-to-cutgreenhouse-gas-emissions-by-40-by-2030. Carney M. Breaking the tragedy of the horizons: climate change and financial stability. 2015. www.bankofengland.co.uk/publications/Pages/speeches/2015/844.aspx. Kim JY. Opening press conference of the 2015 World Bank annual meetings, Lima. 2015. www.worldbank.org/en/news/speech/2015/10/08/remarks-world-bank-group-presidentjim-yong-kim-press-conference. Pope Francis. Laudato si’: on care for our common home. 2015. www.usccb.org/about/ leadership/holy-see/francis/pope-francis-encyclical-laudato-si-on-environment.cfm. Dalai Lama says strong action on climate change is a human responsibility. Guardian 2015 Oct 20. www.theguardian.com/environment/2015/oct/20/dalai-lama-says-strongaction-on-climate-change-is-a-human-responsibility. Martin C. Fossil-fuel divestment movement exceeds 2.6 trillion. Bloomberg Business 2015 Sep 22. www.bloomberg.com/news/articles/2015-09-22/fossil-fuel-divestment-movementexceeds-2-6-trillion. Godlee F, Walker A. The importance of a healthy environment. BMJ 1991;303:1124-6. Prime Minister’s Commission on the Future of Nursing and Midwifery in England. Front line care: the future of nursing and midwifery in England. 2010. http://webarchive. nationalarchives.gov.uk/20100331110400/http:/cnm.independent.gov.uk/wp-content/ uploads/2010/03/front_line_care.pdf.
Cite this as: BMJ 2015;351:h6178 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;351:h6178 doi: 10.1136/bmj.h6178 (Published 18 November 2015)
Page 3 of 2
EDITORIALS
Health Professionals Alliance to Combat Climate Change (HPACCC) founder members British Medical Association Climate and Health Council Faculty of Public Health Royal College of Anaesthetists Royal College of Emergency Medicine Royal College of General Practitioners Royal College of Nursing Royal College of Obstetricians and Gynaecologists Royal College of Paediatrics and Child Health Royal College of Physicians Royal College of Psychiatrists BMJ Lancet
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
Editorials
EDITORIALS Combating climate change Health professional bodies unite for a fairer and healthier world 1
2
Nick Watts director , Robin Stott cochair , Anne Marie Rafferty professor of nursing policy
3
UK Health Professionals Alliance to Combat Climate Change; 2Climate and Health Council, London, UK; 3Florence Nightingale School of Nursing and Midwifery, King’s College London, London UK 1
The second half of the 20th century brought renewed understanding of the links between human wellbeing and environmental systems. In 1988 the United Nations formed the Intergovernmental Panel on Climate Change (IPCC), charged with documenting the effects of climate change and formulating realistic strategies for action. Its first report led to the UN Framework Convention on Climate Change (UNFCCC) in 1992. Unfortunately, since then neither humanity nor the planet have fared well. The Stockholm Resilience Centre has identified nine planetary boundaries within which humanity can develop and continue to thrive,1 and we have already crossed five. These are extinction rates, greenhouse gas emissions, change in land use, phosphorous and nitrogen cycles, and ocean acidification. In addition, we are pushing at the limits of three more—fresh water supply, air pollution, and novel pollutants. The evidence of adverse effects is incontrovertible, as is the need for urgent action. More frequent and more severe natural disasters, instability in food and water supply, the spread of infectious disease, and forced migration are already affecting human health and provide a glimpse of the near future. The World Health Organization’s director general has declared that climate change will “rattle the foundations of public health.”2
Political action has failed to respond to the challenge that the science presents. But the UNFCCC’s governing body, which meets for the 21st time in Paris in December, now has a crucial opportunity to design and agree a comprehensive strategy for rapid transition to a low carbon world. There are reasonable grounds for optimism. As a recent Lancet commission described, components of the proposed agreement will benefit health and wellbeing over and above the health benefits of avoiding dangerous climate change.3
Substantial commitments to reduce carbon emissions from the US and China, Europe, and a host of high income countries form the basis of negotiations.4 5 Ten global cities representing 58 million people have drawn up ambitious plans to tackle climate change. A poll of 200 large companies found that 130 have climate change as a priority, and the Bank of England’s Mark Carney has warned of the potentially catastrophic economic consequences from climate change,6 as has Jim Yong
Kim at the World Bank.7 Religious leaders, notably the Pope8 and the Dalai Lama,9 have called for urgent action, and the divestment movement has pledges from 400 organisations to move $2.6tr from fossil fuels to low carbon investment.10
The United Kingdom is bucking these positive trends, reversing and undoing many of its policies and programmes without offering credible alternatives. However, even here, there are opportunities. Having committed to phase out unabated use of coal, the government should now establish a plan for doing so by 2023. The effects of coal on cardiovascular and respiratory health are clear, and air pollution in our cities is exhausting the best efforts of the NHS. By phasing out coal the government will improve air quality, protect the health of our population, and reclaim the UK’s leadership position in tackling climate change.
Meanwhile, and independently of governments, health professionals around the world are recognising that tackling climate change is practically and ethically essential to promoting public health. UK health professionals have been at the forefront. The 1990 articles in The BMJ,11 the formation of the Climate and Health Council (www.climateandhealth.org) in 2007 and the NHS sustainable development unit (www.sduhealth.org.uk) in 2008, high profile meetings at the Royal College of Nursing in 2010 and 2015, the publication of the 2009 and 2015 Lancet commissions,3 the BMA’s commitment to divest from fossil fuels in 2014, and the foundation of the Global Climate and Health Alliance all provide examples of health professionals responding to the threat of climate change.
UK health professionals have now taken further action, forming an alliance of doctors, nurses, and allied health professionals to advocate for stronger measures to tackle climate change (box.) The hope is that other UK based representative health bodies will join and that similar alliances will emerge in other countries, so amplifying the powerful advocacy of health professionals around the world. The UK alliance has identified four areas for immediate action: improving air quality, increasing active transport, ensuring healthier and more sustainable nutrition, and working to reduce the environmental footprint of healthcare in the UK. Mindful
Correspondence to R Stott [email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;351:h6178 doi: 10.1136/bmj.h6178 (Published 18 November 2015)
Page 2 of 2
EDITORIALS
of these issues, former prime minister Gordon Brown’s Commission on the Future of Nursing and Midwifery advocated a focus on eco-nursing as part of the solution to these challenges.12
Climate change is happening on our watch, and our collective response will determine the fate of our immediate descendants. The trust vested in health professionals gives us the opportunity and the responsibility to act. We hope that this new alliance and other allied groups will help to place health firmly at the centre of the climate change negotiations, helping to impel nations to act decisively so that humanity can flourish in a fairer and healthier world. Competing interests: We have read and understood BMJ policy on declaration of interests and declare that NW is the appointed director of HPACCC and RS has been closely involved with the formation of the HPACCC. Provenance and peer review: Commissioned; not externally peer reviewed. 1
Steffen W, Richardson K, Rockstrom J, et al. Planetary boundaries: guiding human development on a changing planet. Science 2015;347:1259855.
For personal use only: See rights and reprints http://www.bmj.com/permissions
2 3 4 5 6 7 8 9 10 11 12
Chan M. How climate change can rattle the foundations of public health. Huffington Post 2014 Sep 16. www.huffingtonpost.com/dr-margaret-chan/how-climate-change-can-ra_b_ 5822950.html?ir=Australia. Watts N, Adger N, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015;386:1861-914. US-China joint presidential statement on climate change. 2015 www.whitehouse.gov/thepress-office/2015/09/25/us-china-joint-presidential-statement-climate-change. Nelson A. EU leaders agree to cut greenhouse gas emissions by 40% by 2030. Guardian 2014 Oct 24. www.theguardian.com/world/2014/oct/24/eu-leaders-agree-to-cutgreenhouse-gas-emissions-by-40-by-2030. Carney M. Breaking the tragedy of the horizons: climate change and financial stability. 2015. www.bankofengland.co.uk/publications/Pages/speeches/2015/844.aspx. Kim JY. Opening press conference of the 2015 World Bank annual meetings, Lima. 2015. www.worldbank.org/en/news/speech/2015/10/08/remarks-world-bank-group-presidentjim-yong-kim-press-conference. Pope Francis. Laudato si’: on care for our common home. 2015. www.usccb.org/about/ leadership/holy-see/francis/pope-francis-encyclical-laudato-si-on-environment.cfm. Dalai Lama says strong action on climate change is a human responsibility. Guardian 2015 Oct 20. www.theguardian.com/environment/2015/oct/20/dalai-lama-says-strongaction-on-climate-change-is-a-human-responsibility. Martin C. Fossil-fuel divestment movement exceeds 2.6 trillion. Bloomberg Business 2015 Sep 22. www.bloomberg.com/news/articles/2015-09-22/fossil-fuel-divestment-movementexceeds-2-6-trillion. Godlee F, Walker A. The importance of a healthy environment. BMJ 1991;303:1124-6. Prime Minister’s Commission on the Future of Nursing and Midwifery in England. Front line care: the future of nursing and midwifery in England. 2010. http://webarchive. nationalarchives.gov.uk/20100331110400/http:/cnm.independent.gov.uk/wp-content/ uploads/2010/03/front_line_care.pdf.
Cite this as: BMJ 2015;351:h6178 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;351:h6178 doi: 10.1136/bmj.h6178 (Published 18 November 2015)
Page 3 of 2
EDITORIALS
Health Professionals Alliance to Combat Climate Change (HPACCC) founder members British Medical Association Climate and Health Council Faculty of Public Health Royal College of Anaesthetists Royal College of Emergency Medicine Royal College of General Practitioners Royal College of Nursing Royal College of Obstetricians and Gynaecologists Royal College of Paediatrics and Child Health Royal College of Physicians Royal College of Psychiatrists BMJ Lancet
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
