For the first time at a major United Nations climate conference, human health is emerging as a key theme, a reorientation that focuses on the far-reaching and long-lasting effects of climate change.
Although health has been the subject of conferences since the first UN Environment Summit in 1992, it has never had such a central role. The 2015 Paris Agreement, the global agreement between nations to reduce greenhouse gas emissions, was seen primarily as a historic environmental moment.
“However, the Paris Agreement is not an environmental treaty,” said Dr. Maria Neira, Director of the Environment, Climate Change and Health Division of the World Health Organization. “It’s a basic public health contract.”
There is growing body of research showing that climate change is contributing to a wide variety of health risks around the world. It exacerbates heat waves, intensifies forest fires, increases the risk of flooding and aggravates droughts. These in turn are increasing heat-related mortality, pregnancy complications and cardiovascular diseases. And as with many things to do with the climate, the risks and damage are particularly great where they are least able to react.
There is also a cascade of indirect health impacts that could undo decades of advances in improving water quality and food security. Dry soil can contribute to malnutrition. Warming temperatures and changing humidity can expand habitats that are suitable for dengue or malaria-transmitting mosquitoes, Lyme disease-transmitting ticks, and pathogens such as cholera and valley fever.
At the same time, the two-year battle with the coronavirus pandemic has made it clear to politicians the importance of health as a national and global priority.
For reasons like these, the health community’s strategy has been that leaders are more willing to take action when they can make people the face of climate change – rather than traditional environmental symbols like polar bears or forests.
In the months leading up to the Glasgow conference, known as COP26, the world’s leading public health organizations, medical journals and professional associations published a series of reports and editorials that put health at the heart of the climate issue. A letter signed by organizations representing 47 million health professionals around the world declared the climate crisis “the greatest human health threat”. The World Health Organization estimates that at least 250,000 additional deaths from climate change will occur each year between 2030 and 2050.
Fifteen countries, including Ireland and Mozambique, have already made significant commitments this year to decarbonise their national health systems.
“This year marks a quantum leap in health care at COP,” said Josh Karliner, international director of programs and strategy for Health Care Without Harm, an organization that works to reduce the environmental footprint of health care.
Healthcare providers around the world have stated that they are already seeing the effects of climate change on their patients as well as on the ability of hospitals to provide care in extreme weather conditions. At the same time, there is a growing awareness of the health sector’s own contribution to greenhouse gas emissions.
Difficulty in caring for
Hospitals around the world have been hit hard by extreme weather conditions and are increasingly struggling with the fact that they are not built to withstand the intensity of storms, heat and other increasingly common challenges. Floods killed Covid patients in a hospital in Mexico. Hospitals in India suffered severe flooding. When forest fires burned on the west coast, hospitals struggled to maintain indoor air quality. A hurricane tore the roof of a hospital in Louisiana.
During the Pacific Northwest heat wave that summer, Dr. Jeremy Hess, a professor of emergency medicine at the University of Washington, in the emergency room at Harborview Medical Center, the highest trauma center for several states. Dr. Hess worked in emergency rooms during mass accident incidents, but the heat wave did not materialize.
“It was more sustainable,” he said. “It was an environmental emergency that didn’t stop.”
For days, patients with third-degree burns on their feet came from walking on hot asphalt, he said. Many died from heat-related deaths before they were even admitted to the hospital. Doctors tried to fill body bags with ice on stretchers.
Hospitals across the region were burdened differently. Providence, a large health organization in the west, had no vacant beds in its emergency rooms, which stretched from northern Washington state to southern Oregon. One hospital closed its mental health department to ensure there was enough power in more critical parts of the building.
More than 1,000 heat-related emergency visits were reported in the Pacific Northwest that week, compared with fewer than 10 visits in the same period in 2019. Researchers found that such an intense heat wave would have been virtually impossible without human influence. Causes climate change.
Doctors say they have seen the health effects of a changing climate in their daily interactions with patients as well.
Dr. Renee Salas, an emergency physician at Massachusetts General Hospital, has said for years that she has noticed the allergy season lasts longer and the burden of asthma and lung diseases on her patients. She thought climate change could be behind it – and science has confirmed her suspicions. Studies have shown that the pollen season has not only gotten longer since 1990, but also has higher pollen concentrations and that climate change is a driving factor.
“I think of climate change as a secondary diagnosis in my patients,” said Dr. Salas, co-author of The Lancet Countdown, a report on climate change and health.
Health burdens are unlikely to be evenly distributed.
In September, a report from the Environmental Protection Agency found that while all Americans will be affected by climate change, minorities are likely to face more health risks. Black Americans, for example, are 40 percent more likely to live in areas with the highest increases in mortality from extreme temperatures.
“The same vulnerable communities that have been disproportionately harmed by Covid-19 are being disproportionately harmed by climate change,” wrote Dr. Email John Balbus, the interim director of the US Department of Health’s Office on Climate Change and Health Justice.
Hospitals as polluters
In the meantime, one’s own contribution to climate change is increasingly recognized in the health sector.
It is estimated that the health sector is responsible for nearly 5 percent of all global carbon dioxide emissions. Some of this comes from supplying energy-intensive hospitals and clinics around the clock, but the majority – an estimated 70 percent – is related to the supply chain and the energy required to manufacture, ship and dispose of the machinery used, pharmaceuticals and equipment is required every day.
Over the past decade, 43,000 hospitals and health centers in 72 countries have joined the Global Green and Healthy Hospitals, a network of organizations dedicated to reducing their impact on the environment.
“It’s a trend,” said Alison Santore, chief advocacy and sustainability officer for Providence, the hospital chain that is a member of the Green Hospital group. “But it is still the minority of hospitals if we look at the whole.”
Last year, in the midst of the pandemic, Providence promised to go carbon negative by 2030, which means the company is committed to removing more carbon dioxide from the atmosphere than it is adding.
Health centers and hospitals are 2.5 times more energy-intensive than other buildings. Rooms and hallways are filled with computers and machines. Many hospital items are disposable to help prevent infection. It is estimated that hospitals produce between 29 and 43 pounds of waste per patient per day.
“We are called to heal and yet we are harming the environment,” said Ms. Santore.
So far, the change has not been easy. Beth Schenk, a registered nurse and executive director of environmental stewardship at Providence, said that meeting the company’s goals required rethinking every aspect of how they do business. Not only have they added solar panels on rooftops and switched to low-flow water, but they also removed water-intensive lawns and redesigned surgical kits.
Significant barriers remain, even for the few hospitals that have made progress. Clinica Biblica, a large hospital in San Jose, Costa Rica, achieved carbon neutrality by installing solar panels on the roof, buying carbon offsets, and otherwise relying on the country’s electricity grid, which is 99 percent renewable. However, the obligation to become climate neutral along the entire supply chain will be a major challenge when there is little transparency about greenhouse gas emissions from foreign suppliers and waste disposal.
Many healthcare providers are also learning that greenhouse gases can be found where they are least expected. For example, the main ingredients in vital medical aids like anesthetic gases and inhalers are actually powerful greenhouse gases like fluorocarbons.
However, despite their own efforts, healthcare executives point out that it will be difficult for the industry to achieve carbon neutral goals without changes beyond their control, such as the wider availability of renewable energy on the grid.
Burning fossil fuels costs society $ 5 trillion to treat chronic diseases, and air pollution causes 7 million premature deaths each year, said Dr. Neira, adding that “society needs to balance this”.