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IS CLIMATE CHANGE A CONCERN FOR GLOBALHEALTH POLICY?

AUTHOR: KUMARI, BEAUTYEDITOR: LORUSSO, VINCENZO

DECEMBER 2020

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Is Climate Change a Concern for Global Health Policy?

The views and opinions expressed in this document are those of the authors and do not necessarily

represent the views of HDRI. The designations employed and the presentation of material throughout

this review do not imply the expression of any opinion whatsoever on the part of HDRI concerning the

legal status of any country, territory, city or area or its authorities, or concerning its frontiers or

boundaries. This research article was coordinated and edited by Vincenzo Lorusso, under the

supervision of Director of Publications, Utsav Shah. The design of this article and its formatting were

done by the Communications Team, led by Directors Rachel Butcher and Daniella Arrieta.

Author:

Beauty Kumari (Commonwealth Scholar), MSc in Global Health Policy (2019-20),

London School of Economics

[email protected]

Editor:

Vincenzo Lorusso, Research Coordinator, HDRI Global Health (2019-20),

Sciences Po, Paris

[email protected]

Photo Credit courtesy of:

J. Lloa.

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Abstract

Climate change is considered the biggest risk to global health of this century. To sustain the

achievements made in the global health arena so far, continued efforts are needed to address

its direct and indirect consequences. Conversely, losing focus from the climate crisis may

exacerbate its negative effects on global health, as shown by the current COVID-19 pandemic,

with potential irreversible results. In nowadays’ interconnected globalised world, global

solidarity, coordinated through effective leadership and policy dialogue, and the framing of

climate change as a ‘health emergency’ are pivotal for the attainment of widespread and

equitable well-being and prosperity of all human beings.

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Introduction: Climate change, a global threat to global health

Climate change is the largest risk of this century to global health, and no region can be

considered immune from its adversity1. Although some of the results may be positive, as milder

winters in some temperate developed countries, potentially minimising the usual seasonal peak

of mortality (e.g. due to seasonal flu)2, most of the (complex) expected health outcomes are

adverse and will entail both direct and indirect consequences. If unattended, such deleterious

effects could even disrupt and reverse the global health gains achieved in the last 50 years3.

Additionally, shreds of evidence suggest that the impacts of climate change are inequitable,

with low and middle-income countries bearing the most significant risks, including

disadvantaged people below the poverty line, specially challenged groups, elderly, women and

infants4.

This paper argues that climate change is a concern for global health for a number of reasons.

Firstly, in the era of globalisation, diseases know no boundaries – as shown by the ongoing

COVID-19 pandemic – and therefore health issues, especially those of infectious aetiology,

cannot be resolved solely locally or nationally but only with global solidarity, coordinated by

responsible political leadership. Secondly, looking at the failure of previous international

agreements on reduction in greenhouse gases (GHG) like the Kyoto protocol, ‘framing’ of

climate change as a health emergency can help garner international support on this stance.

To tackle the issue of climate change as a global health threat, this paper would illustrate its

direct, indirect and potentially irreversible consequences with a set of respective evidences.

Direct and indirect deleterious effects of Climate Change

The world has already started facing multiple direct and indirect adverse effects of climate

change on health, along with other social implications. The incremental increase in

temperature, heat waves, floods, storms and drought results in direct impacts causing death and

injuries, while indirect impacts are mediated by the effects on ecosystems and sectors such as

agriculture, quality of water and food system, leading to an increased incidence of vector-borne

diseases, food insecurity and malnutrition. Other social implications include migration and

displacement, conflicts over natural resources and political instability that brings about changes

in associated health determinants for the environment and society5.

It is anticipated that climate change will result in an estimated 250,000 deaths from starvation,

malaria, diarrhoea and heat stress between 2030 and 20506. The numerous direct and indirect

adverse consequences are potentially irreversible, and thus represent a concern for global health

policymakers. Each year approximately 60,000 deaths worth 2% of global GDP financial

burden can be attributed to direct effects of climate change7. The number of casualties has

tripled since the 1960s owing to extreme climate events such as high temperature, flood, storm,

drought and heatwaves8.

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It is argued that in the coming decades, heat waves will be one of the most common and

explicitly harmful consequences of climate change, posing a significant danger to human

health9. The severity of the transition is evidenced by figures published by the WHO

highlighting that outdoor and indoor air pollution, which escalated with high temperature,

caused more than 6 million deaths; almost one-third of the cardiovascular cases, 29% of chronic

obstructive pulmonary diseases and 25 % of lung cancer deaths in 2012 alone10.

Globally, over the past century, the risk of devastating floods has increased significantly, with

resulting risks of direct deaths and of infectious diseases. Similarly, floods inflict direct and

indirect effects on millions via injuries and death, disruption of healthcare services,

transmission of climate-sensitive vector- and water-borne diseases, illness and anxiety leading

to mental disturbance. From 1995 to 2015, out of 6,457 weather related disasters recorded that

killed almost six hundred thousand of people and affected more than 4.1 billion people, 47%

were caused by flooding. In the same time period, storms, the deadliest of all the weather

events, caused 242,000 deaths out of which 89% happened in lower-income countries11.

In the coming decades, the situation is expected to worsen due to the increased rate of ice

melting which is set to intensify with growing temperatures, ultimately deepening floodwater,

affecting more land especially in coastal areas12. At the current sea level, the coastal floods,

associated with tropical cyclones and storms, affect around 120 million people every year,

causing approximately 12,000 deaths annually13.

Research suggests that storms in coastal areas will increase, affecting an additional 50 million

individuals and 30,000 square kilometres of land in 210014. Analogously, an annual increase

of 10-25 million flood-affected people is expected by 205015. In addition to direct deaths and

injuries caused by flood, these conditions also affect various social determinants of health

(SDH), which amplify the burden of diseases. SDH like access to safe and clean drinking water

and proper toilet facilities can prevent diarrhoea, cholera, and typhoid fever. However, flooding

exposes drinking water to contamination and it increases the chances of faecal-oral

transmission of infections and many other communicable diseases due to rodents and insects

in the absence of a safe place to live (another SDH)16,17. For example, in Indonesia, flooding

of home led to increased paratyphoid fever and cryptosporidiosis18.

Similarly, increased incidences of arbovirus disease in Australia, Europe, and the United States

of America (U.S.A.) and lymphatic filariasis in Africa were also found to be related to

flooding,19. It has been confirmed that a flooded basement among Romanian apartment

residents triggered an increase of incidence of West Nile virus infections20. Over the past 40

years, climate change has caused more than 90% of Pakistan’s natural disasters, with flooding

being the major calamity21. Out of 15 million people that were affected by floods in the year

2010, nearly 6 million people were in desperate need of medical care and yet struggling to

receive assistance due to over 200 healthcare facilities being destroyed22.

Climate change can also provoke episodic disasters that, despite their ‘occasional’ occurrence,

can still cause high mortality. For example, the 2004 Indian Ocean Tsunami killed 225,000

across 5 countries, namely Indonesia, Sri Lanka, India, Maldives, and Thailand23. In the year

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2008, a death toll of 138,000 was recorded in Myanmar due to tropical cyclone Nargis, the

most disastrous in the country’s history24. And, in 2010, Russian heat waves took the lives of

tens of thousands of individuals, which was notably the worst event occurring in the country

in the previous 6 decades25.

It is estimated that rising temperatures and erratic rainfall in the poorest areas of the world are

likely to reduce basic food production, leading inevitably to global consequences due to the

international trading of foodstuffs. For instance, Africa might face a 1% and 1.7% reduction in

final maize yields under optimal rain-fed and drought conditions respectively, for each degree

greater than 30°C26. Another systematic review projected a change of 17% in mean yield of

wheat across Africa by 205027. Since 1975, direct correlation has been observed between

regional trends in climate (rising temperatures and declining rainfall) and childhood stunting

in Kenya, indicating that food yields and nutritional security will be hampered with the rising

population growth and continuous warming and drying if no counteracting measure is taken28.

Climate change along with additional and unavoidable factors like ban on food import or export

induce price inflation that impacts the purchasing power of people especially those that are

living below the poverty line, ultimately affect food availability and affordability. Therefore,

climate change impacts food security in a way that it causes adverse inequitable effects, more

enhanced in certain socio-economic groups and regions than others. For example, fewer

individuals may be able to afford healthy foods, while others can buy only the cheapest highly

processed and unhealthy foodstuffs, leading to an increased risk of obesity and diabetes29. This

increased prevalence of hunger and malnutrition will result in 3.1 million deaths each year30.

In particular, it is estimated that an increase in temperature above 2°C will cause

malnourishment of 540-590 million individuals while an increase of temperature up to 1.5°C

would affect 530-550 million individuals, globally31.

Need for Global Action

This paper argues that, in order to be addressed effectively, the climate change-induced events

mentioned above could not be tackled at local and/or national level only. Instead, nowadays’

interconnected world requires such challenges to be confronted through coordinated concerted

efforts at global level. For example, the relaxed pace with no real success in the reduction of

GHG emission as committed under the Paris agreement (signed by 195 parties in December

2015) to keep the global average temperature well below 2°C, shows the absence of

coordination and solidarity, which needs to be changed. Moreover, the projections suggest that

under business-as-usual the worldwide average temperature will reach over 4°C by 210032,

which stands nowhere close to the temperature goal set by the Paris Agreement.

The primary challenge for this slow progress remains the limited political will due to the fact

that climate change benefits are often long-term, diffused and uncertain. There is also a concern

that mitigation measures are highly demanding, socially as well as economically33. The past

global effort to address the issue of global warming and climate change has not been successful

because the countries that contribute the most to the GHG are either not willing to collaborate

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or have been given a free pass, hence they were not actually restricted by the protocol. For

instance, the Kyoto protocol gave a free pass to 80% of the world to emit GHGs, and the U.S.A.

formally rejected the protocol n 200134.

Bringing it all together: Climate Change as a ‘Health Emergency’

The limited success achieved to date in the fight against climate change and its undesirable

effects, calls for the intervention of health experts, to advocate for counteracting measures

against climate change in light of its impact on human health. Indeed, seeing climate change

only as an environmental issue – instead of a health one too –constrains sustained and

generalised public involvement against this scourge, an essential prerequisite for the design

and implementation of innovate solutions35.

Therefore, introducing the ‘human health frame’ in the narrative of the fight against climate

change has the potential to encourage people to embrace reforming policies, regardless of their

political preferences or inclinations36. Accordingly, communication campaigns and policy texts

should include illustrations of cost savings benefits as well as gains in health indicators, which

could be reaped through the adoption of environmentally sustainable behaviours and practices.

For instance, during the current COVID-19 pandemic, despite the economic estimated backlash

of global GDP growth in 2020 of -6.2%37, almost all the countries introduced lockdown (some

stringent, some relaxed), prioritising the need for controlling the life-threating nature of this

epidemic. This shows that the countries can prioritise health over profit. Therefore, it is argued

that the framing of climate change as a ‘health emergency’ can eliminate present bias in

estimating its severity and lead to effective counteracting policies and measures. Doing so will

help policymakers to take a balanced approach, taking into account both health-related and

economic outcomes of climate change.

Another study carried out in the U.S.A. shows that regardless of political affiliation, adding a

human health dimension to the fight against climate change has a positive impact, in providing

an incentive to support the implementation of policies to redress climate change38,39. In the

fight against the climate crisis, human health benefits stem indirectly from cuts in GHG

emissions and other climate change-related contaminants40. For example, reductions in GHG

emissions in India by replacing existing inefficient cookstoves or burning cow dung, with yet

efficient systems like solar cookers, results in the decrease in pulmonary and cardiac disease in

adults and respiratory illness in children in addition to protection of the environment from

pollutants. In particular, the implementation of 150 million low-emission cookstoves is

estimated to prevent about 2 million early deaths, especially from acute lower respiratory

infections in children and chronic pulmonary disease in women41. Another research for London

and Delhi shows that active transportation (i.e. walking, biking, etc.) could lead to a decrease

of 10-20% of cases of cardiovascular disease, 12-13% of breast malignancy, 8% of dementia

and 5% of depression42.

These pieces of evidence suggest that the health frame to climate change has the potential to

have the global and political buy-in which can spur the much-needed impetus and commitment

expected to design and deliver effective counteracting measures.

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Conclusion

Climate change is a concern for global health and related policies; if left unaddressed, it will

cause numerous direct and indirect adverse health outcomes that are potentially irreversible.

Although it is likely to affect all regions of the world, the most vulnerable and poorest people

in low and middle-income countries, will expectedly experience the worst impacts, resulting

in millions of deaths and diseases from starvation, malnutrition, malaria, diarrhoea, heat stress

and other natural disasters. These impacts are not restricted by countries border. At the current

level of globalisation, the environmental impact has a more significant and international range,

and no country can remain immune. In accordance with the goal of the Paris Agreement,

mitigation actions should therefore be taken globally, to prevent the rise in global temperatures,

while aiming for preserved and improved health co-benefits for the world population. Within

this context, and in the face of the ongoing COVID-19 crisis, it becomes more timely than ever,

to bring global health at the centre of the climate mitigation policymaking. The attainment of

a global solidarity, under the aegis of stable political leadership and the framing of climate

change as a ‘health emergency’, can be two dominant pillars of a winning strategy to tackle the

present climate crisis. Compelling, forward-looking policies encompassing such a holistic

(besides necessary!) approach are therefore needed, to help prevent further climate change-

induced health damages and disabilities, and allow humanity to prosper healthily and equitably

in thriving ecosystems.

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References

1 Smith, K.R. et al, https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap11_FINAL.pdf,

“Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral

Aspects. Contribution of Working Group II to the Fifth Assessment Report of the

Intergovernmental Panel on Climate Change”, 2014 2 Drummond, P. et al. (2015) ‘The Lancet Commissions Institute for Sustainable Resources

(P Health and climate change: policy responses to protect public health’, The Lancet, 386, pp.

1861–1914. doi: 10.1016/S0140-6736(15)60854-6

3 Ibid.

4 WHO (2014) Quantitative risk assessment of the effects of climate change on selected

causes of death, 2030s and 2050s. Available at: www.who.int (Accessed: 21 August 2020).

5 WHO (2018a) ‘Climate change and health’. Available at: https://www.who.int/news-

room/fact-sheets/detail/climate-change-and-health (Accessed: 20 August 2020)

6 WHO (2018b) COP24 Special report: Health and Climate Change, Who. Available at:

https://www.who.int/globalchange/publications/COP24-report-health-climate-change/en/

(Accessed: 20 August 2020).

7 The European Sting (2017) Climate change: Direct and indirect impacts on health.

Available at: https://europeansting.com/2017/08/08/climate-change-direct-and-indirect-

impacts-on-health/ (Accessed: 21 August 2020).

8Ibid.

9 Coffel, E. D., Horton, R. M. and De Sherbinin, A. (2018) ‘Temperature and humidity based

projections of a rapid rise in global heat stress exposure during the 21st century’,

Environmental Research Letters. Institute of Physics Publishing. doi: 10.1088/1748-

9326/aaa00e

10 WHO (2017) ‘Preventing noncommunicable diseases (NCDs) by reducing environmental

risk factors’, WHO. Available at: http://apps.who.int/bookorders .(Accessed: 21 August 2020)

11 United Nations (2015) UN report finds 90 per cent of disasters are weather-related, United

Nations. Available at: https://www.un.org/sustainabledevelopment/blog/2015/11/un-report-

finds-90-per-cent-of-disasters-are-weather-related/ (Accessed: 21 August 2020).

9

12 Neumann, B. et al. (2015) ‘Future coastal population growth and exposure to sea-level rise

and coastal flooding - A global assessment’, PLoS ONE. Public Library of Science, 10(3).

doi: 10.1371/journal.pone.0118571

13 WHO (2014) Quantitative risk assessment of the effects of climate change on selected

causes of death, 2030s and 2050s. Available at: www.who.int (Accessed: 21 August 2020)

14 Ahern, M. et al. (2005) ‘Global Health Impacts of Floods: Epidemiologic Evidence’,

Epidemiologic Reviews, 27, pp. 36–46. doi: 10.1093/epirev/mxi004.

15 Nicholls, R.J. and Lowe, J.A., 2004. Benefits of mitigation of climate change for coastal

areas. Global environmental change, 14(3), pp.229-244.

16 World Health Organization, 2003. Climate change and human health: risks and responses.

World Health Organization.

17 National Institutes of Health, 2007. Understanding emerging and re-emerging infectious

diseases. Biological sciences curriculum study. NIH Curriculum Supplement Series. National

Institutes of Health, Bethesda, MD.

18 Watson, J.T., Gayer, M. and Connolly, M.A., 2007. Epidemics after natural

disasters. Emerging infectious diseases, 13(1), p.1.

19 Sutherst, R.W., 2004. Global change and human vulnerability to vector-borne

diseases. Clinical microbiology reviews, 17(1), pp.136-173.

20 Ahern, M. et al. (2005) ‘Global Health Impacts of Floods: Epidemiologic Evidence’,

Epidemiologic Reviews, 27, pp. 36–46. doi: 10.1093/epirev/mxi004.

21 WHO (2018b) COP24 Special report: Health and Climate Change, Who. Available at:

https://www.who.int/globalchange/publications/COP24-report-health-climate-change/en/

(Accessed: 20 August 2020).

22 Ibid.

23 The Editors of Encyclopaedia Britannica (2018) ‘Indian Ocean tsunami of 2004 |’,

Encyclopaedia Britannica. Available at: https://www.britannica.com/event/Indian-Ocean-

tsunami-of-2004 (Accessed: 21 August 2020)

24 Fritz, H. M. et al. (2009) ‘Cyclone Nargis storm surge in Myanmar’, Nature Geoscience,

pp. 448–449. doi: 10.1038/ngeo558

10

25 Russo, S., Sillmann, J. and Fischer, E.M., 2015. Top ten European heatwaves since 1950

and their occurrence in the coming decades. Environmental Research Letters, 10(12),

p.124003.

26 Lobell, D. B. et al. (2011) ‘Nonlinear heat effects on African maize as evidenced by

historical yield trials’, Nature Climate Change, 1(1), pp. 42–45. doi: 10.1038/nclimate1043 27 Knox, J., Hess, T., Daccache, A. and Wheeler, T., (2012). ‘Climate change impacts on crop

productivity in Africa and South Asia’, Environmental Research Letters, 7(3), p.034032.

28 Bakhtsiyarava, M., Grace, K. and Nawrotzki, R. J. (2018) ‘Climate, Birth Weight, and

Agricultural Livelihoods in Kenya and Mali’, American journal of public health. NLM

(Medline), 108(S2), pp. S144–S150. doi: 10.2105/AJPH.2017.304128.

29 Lobstein, T., Friel, S. and Dowler, E. (2008) ‘Food, fuel, and health’, The Lancet, p. 628.

doi: 10.1016/S0140-6736(08)61270-2

30 WHO (2018a) ‘Climate change and health’. Available at: https://www.who.int/news-

room/fact-sheets/detail/climate-change-and-health (Accessed: 20 August 2020)

31 WHO (2018b) COP24 Special report: Health and Climate Change, Who. Available at:

https://www.who.int/globalchange/publications/COP24-report-health-climate-change/en/

(Accessed: 20 August 2020). 32 Olhoff, A. and Christensen, J. (Hrsg. . (2018) Emissions Gap Report 2018. Available at:

http://www.un.org/Depts/Cartographic/english/htmain.html (Accessed: 19 August 2020)

33 Workman, A., Blashki, G., Karoly, D. and Wiseman, J., 2016. The role of health co-

benefits in the development of Australian climate change mitigation policies. International

journal of environmental research and public health, 13(9), p.927.

34 U.S. Senate Committee on Environment and Public Works (2016) Failures of Kyoto will

Repeat with the Paris Climate Agreement. Available at:

https://www.epw.senate.gov/public/index.cfm/2016/4/failures-of-kyoto-will-repeat-with-the-

paris-climate-agreement (Accessed: 20 August 2020)

35 Maibach, E. W. et al. (2010) ‘Reframing climate change as a public health issue: an

exploratory study of public reactions’, BMC Public Health, 10(1), p. 299. doi: 10.1186/1471-

2458-10-299

36 Workman, A. et al. (2016) ‘The role of health co-benefits in the development of Australian

climate change mitigation policiesx’, International Journal of Environmental Research and

Public Health, 13(9), p. 927. doi: 10.3390/ijerph13090927.

37 Fernandes, N. (2020) ‘Economic effects of coronavirus outbreak ( COVID-19 ) on the

11

world economy Nuno Fernandes Full Professor of Finance IESE Business School Spain’,

SSRN Electronic Journal, ISSN 1556-5068, Elsevier BV, pp. 0–29.

38 Maibach, E. W. et al. (2010) ‘Reframing climate change as a public health issue: an

exploratory study of public reactions’, BMC Public Health, 10(1), p. 299. doi: 10.1186/1471-

2458-10-299.

39 Myers, T. A. et al. (2012) ‘A public health frame arouses hopeful emotions about climate

change: A Letter’, Climatic Change, 113(3–4), pp. 1105–1112. doi: 10.1007/s10584-012-

0513-6

40 Krupnick, A., Burtraw, D. and Markandya, A. (2000) ‘The Ancillary Benefits and Costs of

Climate Change Mitigation’, in OECD

41 Wilkinson, P., Smith, K.R., Davies, M., Adair, H., Armstrong, B.G., Barrett, M., Bruce, N.,

Haines, A., Hamilton, I., Oreszczyn, T. and Ridley, I., 2009. Public health benefits of

strategies to reduce greenhouse-gas emissions: household energy. The Lancet, 374(9705),

pp.1917-1929.

42 InterAcademy Medical Panel (2010) ‘IAMP Statement on the health co-benefits of policies

to tackle climate change’, pp. 1–4. Available at:

https://www.interacademies.org/14745/IAMP-Statement-on-the-Health-CoBenefits-of-

Policies-to-Tackle-Climate-Change (Accessed: 20 August 2020).