“And like all good medicine, prevention is the key.”
The British Medical Journal has a must-read editorial reviewing and synthesizing recent reports on climate change, public health, and national security. The lead author of “Climate change, ill health, and conflict,” is Lionel Jarvis, surgeon rear admiral of the UK’s Ministry of Defence.
I repost it below in full with links to the references:
Damage to the fabric of human society is bad for human health. It can occur for reasons other than war. A recent report by the International Institute for Strategic Studies (IISS) has highlighted that the effects of climate change will present a threat to collective security and global order in the first half of the 21st century.1 This will limit access to food, safe water, power, sanitation, and health services and drive mass migration and competition for remaining resources. Starvation, diarrhoea, and infectious diseases will become more common, and neonatal and adult mortality will rise, as a result of conflict.2 In accordance with this, in 2004, seven of the 10 countries with the highest mortality rates in children under 5 were conflict or immediate post-conflict societies.3.
The IISS report states that “The earth is warming, and has been for at least a century,” with this being “directly attributable to the increasing emission of carbon dioxide and other greenhouse gases.” As a result, “Climate change may already be changing weather and precipitation patterns” and will continue to drive extreme weather events and changes in water resources (through flood, drought, and rising sea levels), and it will adversely affect global food and energy production. This quote comes not from an environmental pressure group but from security experts drawn from US and UK military and intelligence communities. At the same time, Dennis Blair, director of National Intelligence for the United States, recently stated that, “Some recent climate science would indicate that the effects of climate change are accelerating.”4 In addition, the Pentagon’s 2010 Quadrennial Defense Review to Congress stressed the potential for climate change to contribute to “poverty, environmental degradation, and the further weakening of fragile governments.” It continues with: “Climate change will contribute to food and water scarcity, will increase the spread of disease, and may spur or exacerbate mass migration,”5 which in turn may increase the likelihood of instability and risk to national security.
Such statements resonate with those of a 2009 Lancet report, which made it clear that climate change is the biggest global health threat of the 21st century, with the greatest threat coming from effects on water and food security, human shelter and settlements, and resultant population migration. 6 From such soil is conflict born. The United Kingdom’s Ministry of Defence states that “climate change will amplify existing social, political and resource stresses” and will shift “the tipping point at which conflict ignites.”7 The IISS report concurs: “Climate change will increase the risks of resource shortages, mass migration, and civil conflict. These could lead to failed states, which threaten global stability and security.” In this way, conflict and poor health feed upon one another.
Meanwhile, the world’s population continues to expand. Estimated at 6.1 billion in 2000, it is set to rise to 8.9 billion by 2050,8 and the proportion of the population living in cities is increasing inexorably, from 13% in 1900 to an estimated 60% by 2030.8 This urbanised population, increasingly focused in huge coastal megacities (in excess of 10 million), will become susceptible to the resource shortages of increasing demand and will place pressure on urban infrastructure. Damage to this fragile infrastructure by severe weather systems or rising sea levels will disrupt public health, and shortages of water, sanitation, heating, and food will combine to increase disease and ill health.9 Such circumstances exacerbate instability and insecurity.
It would be tempting to consider such effects of climate change as temporally or geographically distant, but they pose a global threat that will dominate human activity over the next 30 years,7 The UK’s foreign secretary, William Hague, recently described climate change as “perhaps the 21st century’s biggest foreign policy challenge.”10
It might be considered unusual for the medical and military professions to concur. But on this subject we do. Climate change poses an immediate and grave threat, driving ill health and increasing the risk of conflict, such that each feeds on the other. And like all good medicine, prevention is the key. The IISS report stresses the need for “sustained investment in infrastructure and new technologies” of which “a shift to renewable energy sources will be the most visible effect of efforts to mitigate emissions.” Approaches that reduce demand, including efforts to increase efficiency, are also required.1
We must adapt our cities and their infrastructure to cope with these challenges through combining engineering design and public health initiatives (for example, developing resilience in clean water and drainage systems, using human and food waste for energy generation, and building roads to act as flood pathways).11 12 At the same time we need to ensure that the military can still operate effectively to sustain security in this changing environment. As with prevention, effective adaptation will require an approach that encompasses the whole of society and international collaboration.
Such subjects will be discussed at the forthcoming open meeting “Climate change””how to secure our future wellbeing: a health and security perspective” to be held at BMA House on 20 June 2011. Although discussion is good, we can no longer delay implementing tough action that will make a difference, while quibbling over minor uncertainties in climate modelling. Unlike most recent natural disasters, this one is entirely predictable. Doctors, often seen as authoritative, trusted, and independent by their communities, must make their voices heard in calling for such action.
- European Commission. The IISS transatlantic dialogue on climate change and security. 2011. www.iiss.org/programmes/transatlantic-dialogue-on-climate-change-and-security/.
- Black R, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet2003;361:2226-34.
- Salama P, Spiegel P, Talley L, Waldman R. Lessons learned from complex emergencies over past decade. Lancet2004;364:1801-13.
- Blair DC. Annual threat assessment of the US intelligence community for the House Permanent Select Committee on Intelligence. 2010. www.dni.gov/testimonies/20100203_testimony.pdf.
- Department of Defense. Quadrennial review report. 2010 www.defense.gov/QDR/images/QDR_as_of_12Feb10_1000.pdf.
- Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change. Lancet 2009;373:1693-733.
- Ministry of Defence. DCDC strategic trends programme. Global strategic trends. Out to 2040. 2010. www.harrymagazine.com/201002/19022010051032_Documen-07775.pdf.
- United Nations. Department of Economic and Social Affairs Population Division. World population to 2300. 2004. www.un.org/esa/population/publications/longrange2/WorldPop2300final.pdf, and http://www.un.org/esa/population/publications/WUP2005/2005wup.htm.
- Chartered Institute of Environmental Health. Climate change, public health and health inequalities. 2008. www.cieh.org/uploadedFiles/Core/Policy/Publications_and_information_services/Policy_publications/Publications/Climate_Change_Public_Health_Health_Inequalities.pdf.
- FCO Council on Foreign Relations. The diplomacy of climate change. 2010. www.fco.gov.uk/en/news/latest-news/?view=Speech&id=22933444.
- Royal Academy of Engineering. Infrastructure, engineering and climate change adaptation””ensuring services in an uncertain future. 2011. www.raeng.org.uk/news/publications/list/reports/Engineering_the_future_2011.pdf.
- United Nations Secretariat Population Division. United Nations expert group meeting on population distribution, urbanisation, internal migration and development, 2008. www.un.org/esa/population/meetings/EGM_PopDist/List_of_papers.pdf.
- NRC: Burning fossil fuels costs the U.S. $120 billion a year “” not counting mercury or climate impacts!
- “Global Warming Is A Medical Emergency”: Hellish heatwaves to harm health of millions
- The Lancet medical journal: Cutting greenhouse gas emissions has major direct health benefits
- 4,500 health professionals and scientists urge Congress to implement and enforce Clean Air Act
- The Clean Air Act and carbon hotspot deaths
- Life-cycle study: Accounting for total harm from coal would add “close to 17.8¢/kWh of electricity generated