British Medical Journal: Climate change “poses an immediate and grave threat, driving ill-health and increasing the risk of conflict, such that each feeds upon the other.”

“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.


  1. European Commission. The IISS transatlantic dialogue on climate change and security. 2011.
  2. Black R, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet2003;361:2226-34.
  3. Salama P, Spiegel P, Talley L, Waldman R. Lessons learned from complex emergencies over past decade. Lancet2004;364:1801-13.
  4. Blair DC. Annual threat assessment of the US intelligence community for the House Permanent Select Committee on Intelligence. 2010.
  5. Department of Defense. Quadrennial review report. 2010
  6. 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.
  7. Ministry of Defence. DCDC strategic trends programme. Global strategic trends. Out to 2040. 2010.
  8. United Nations. Department of Economic and Social Affairs Population Division. World population to 2300. 2004., and
  9. Chartered Institute of Environmental Health. Climate change, public health and health inequalities. 2008.
  10. FCO Council on Foreign Relations. The diplomacy of climate change. 2010.
  11. Royal Academy of Engineering. Infrastructure, engineering and climate change adaptation””ensuring services in an uncertain future. 2011.
  12. United Nations Secretariat Population Division. United Nations expert group meeting on population distribution, urbanisation, internal migration and development, 2008.

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7 Responses to British Medical Journal: Climate change “poses an immediate and grave threat, driving ill-health and increasing the risk of conflict, such that each feeds upon the other.”

  1. Gord says:

    This is great news!

    People don’t meet scientists. Scientists are kinda scary to many folks and if not that they are incomprehensible when they speak. So as a result common folks can be told all kinds of loony things about scientists, their methods and motivations re: Global Warming.

    But, when the people speaking up are their doctors it’s a whole new ball game. People see their doctors all the time; their doctors are real people whom they have known for years in many cases.

    Physicians bring personal believability and gravitas to the argument.

  2. Snapple says:

    They should make simplified pamphlets of the article and put them in doctors’ offies.

  3. Mark says:

    As a physician myself I welcome this authoritative and evidence based article. Sadly the cancer of denialism has some roots in my profession, but evidence such as this will hopefully change the situation for the better.

  4. Lou Grinzo says:

    Gord: The fact that people are so good at complying with doctors’ wishes explains why smoking died out in the 1970’s, obesity is a thing of the past, etc.

    Sorry for the snark. I really do see this as a good thing, I’m just very curious as to how many doctors will really want to get involved with “that climate stuff”. Doctors today have become very shy about pushing patients to do things they clearly should, like losing weight and exercising more if they have high cholesterol or heart disease. This is something I have considerable experience with, and I’m amazed at how few doctors will be insistent on such matters. I’ve even had exchanges where I gave doctors and nurses a hard time for not “yelling at” patients more, and the response is always the the same — “we don’t do that any more”. I tell them, “it’s important, so you should do it”.

    I also once had a very weird and pointed exchange with a nurse over climate change. She asked me about it after noticing the book I was reading (Heidi Cullen’s). It was painfully clear she thought I was one of “those” people, climate change was nothing to worry about, etc. I have to wonder how many doctors and nurses fall into that same category of highly educated people who don’t know much about climate but Dunning-Kreuger they way through to bad conclusions.

  5. Mulga Mumblebrain says:

    Murdoch’s ‘The Fundament’ (aka ‘The Australian’) is a sworn enemy of ‘preventative medicine’. The recent announcement of plain packaging for cigarettes has moved a few of its bufocratic hacks to fulminate against ‘nanny-state’ ‘do-gooders’ and the attack on the sacred ‘intellectual property rights’ of the tobacco drug and death dealers. These tirades are backed up with ‘expert testimony’ from Rightwing group-think tanks, financed by, amongst others, tobacco peddlers. As ever, nothing, particularly not human suffering, is more important that profit maximisation and capital accumulation. Preventative medicine is also, as we know, pure Bolshevism, and threatens future profits in the incredibly lucrative medical-industrial-pharmaceutical complex. I mean, really, if you sat down to design a system more inhumane, more contemptuous of human well-being, more malignantly determined to inflict suffering on humanity, it would be impossible to outdo market fundamentalist capitalism.

  6. Gord says:

    Hey Lou I can’t disagree with you.

    But the scientist, the man on the street sees most, is his doc. It’s a natural fit. Heads up for extended tick season, and bug seasons, advice on shoveling more snow … all because of Global Warming. I figured a good doc would kinda slide the concept in, as it were.

  7. Solar Jim says:

    Our economy needs some doctors to fix the concept of energy, such as “dirty energy” and “clean energy.” Note: “dirty energy” is typically based on firing or fissioning matter.

    Then they should tell economists and politicians that being sick or injured should not count as an economic asset, such as including the cost of illness in the GDP. Otherwise, the sicker we are the better we are.