by Sarah Walpole
This month, guest blogger Dr. Sarah Walpole discusses the health impact of the climate crisis, whether global actions post-COP26 are sufficient and the valuable role that health professionals and health services can play as stewards. Sarah is a junior doctor in the North East of England.
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“Tackling climate change while protecting and enhancing our natural assets, and the biodiversity that underpins them, is crucial to achieving a sustainable, resilient economy. It is also crucial to maintaining a sustainable and resilient NHS.”
- Sajid Javid’s open letter of 10th Nov 2021 to NHS trust CEOs
As the buzz following last year’s climate conference in Glasgow continues to diminish, one thing is clear: governments alone will not save us. The commitments to climate action made in at COP26 were not good enough. We’re on track for disastrous climate change, with associated extreme weather events (including heat and flooding), sea level rise, species (biodiversity) loss, disruption to agriculture and livelihoods and increased human migration. All of these impacts of anthropogenic environmental change and many more contribute to chains of causation that end in harm to health.
Yet, the outcome is not inevitable: every degree and or fraction of a degree of warming averted counts. Some progress was made at COP26. There is room for hope; and there is need for action. Arguments raised before COP26 still stand and health leaders still have a key role to play. Health professionals, while overwhelmed by the challenges of COVID and its latest variant, continue to recognise the interlinked environmental challenges that we face. As new challenges emerge, unprecedented actions have been taken. Following the Russian invasion of Ukraine on 24th February, the UK health secretary, Savid Javid, told NHS trusts to end contracts with Russian energy suppliers. Meanwhile, many hospitals are installing solar panels on roofs and the UK government is offering supporting grants, recognising that local generation may contribute to providing energy security. Clinicians are developing ‘environmental literacy’ and understanding of environmental change and its health impacts. This blog provides an update on the key outcomes from COP26, and what they mean for health.
What can we expect if all countries meet their COP26 commitments?
While the majority of countries improved their commitments (or nationally determined contributions, NDCs), following COP26, we are still set to see temperatures rise by around 2.4°C by 2100 in a best-case scenario. This best-case scenario involves countries meeting both their ‘conditional’ commitments (achievement depends on the actions of other countries) and ‘unconditional’ commitments (must be done regardless of the actions of other nations) to reduce emissions by 2030.
This offers a small improvement: to put the predicted 2.4°C rise in the context of previous commitments, if all commitments from the Paris COP21 in 2015 were met, we would have expected to see even greater warming, with a rise of 2.6 to 2.7°C. The difference in 0.2 or 0.3°C may sound like marginal gains, but every 0.1°C counts. The difference between conditional commitments being met or not is also important. If countries only meet their unconditional commitments, we can expect an extra 0.1°C of warming. Action at a local and regional level will help to bring us closer to the emissions reductions that we need.
What will this global heating mean for health?
It is likely (about 70% chance) that 1.5°C temperature rise above pre-industrial levels (defined as the average over the half a century between 1850 and 1900) will be a reality during one month or more in the next five years. Global temperatures in the coming five years are predicted to be about 1°C above pre-industrial levels. It’s important to remember that the impacts of climate change are not equally distributed. Asia will see more warming than the global average, for example. This will have wide reaching health impacts, from drought and food insecurity to heat-related mortality. Research has already shown that extreme heat is increasing the risk of pre-term birth, which will have particular impacts for populations with fewer resources where women work as subsistence farmers and do not have access to air conditioning.
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Meanwhile, forty-six countries committed to significantly reduce short-lived climate pollutants (SLCPs), which have health impacts secondary both to local air pollution and to climate change. SLCPs include methane, hydrofluorocarbons (HFCs, the gas used as a propellant in metered-dose inhalers), black carbon (a.k.a. soot, produced by burning coal) and tropospheric ozone. While stratospheric ozone protects us from UV radiation, tropospheric (ground level) ozone causes exacerbations of chronic obstructive pulmonary disease and asthma and is responsible for an estimated 1 million premature deaths worldwide each year. Tropospheric ozone is continuously being produced from methane and other hydrocarbons and lasts hours to weeks in the atmosphere. SLCPs contribute to the 7 million deaths per year caused to air pollution.
Supporting those already battling the climate crisis
A major failing of COP26 was the lack of agreement on financing for adaptation to climate change in countries worst affected by it. In 2019, USD 80 billion was mobilised, but only 25% of this went to adaptation. Way back at COP15 in 2009, a goal was set to ‘mobilise jointly’ (i.e. for richer nations to contribute) USD 100 billion per year of funding to support resilience, adaptation and energy transitions in developing countries. This may sound like a lot of money, but in the context of global financing it’s not a big ask. To put it in context, the US alone has mobilised over USD 4 trillion (that is 40 x 100 billion) on COVID relief funds, USD 100 billion of which has reportedly been stolen fraudulently and USD 500 billion of which is as yet unspent. The discussion about funding for adaptation and sustainable transition has been postponed until COP27 in Egypt and the goal is not expected to be met until 2023.
Health systems as anchor institutions: the example of Clean Energy
One COP26 commitment that hit the news headlines was “the phasedown of unabated coal power and phase-out of inefficient fossil fuel subsidies”. A last minute amendment from India and China changed the words ‘phase out’ of coal to ‘phase down’. Alok Sharma later said he was ‘deeply sorry’ that this significantly weaker wording was in the final agreement. Climate transparency states that to avoid reaching dangerous tipping points and positive feedback loops accelerating climate change, coal must be phased out by 2030 in OECD countries, 2037 in non-OECD Asian countries and 2040 across all countries.
This is achievable. Renewables’ contribution to generating power in G20 countries increased from 19% in 2010 to 27% in 2019. Brazil is ahead of the curve, generating over 80% of its energy from renewables, which are cleaner and have fewer impacts on local air pollution and negative consequences for respiratory health. Health services can lead the charge to cleaner power. As major consumers of electricity, they can purchase renewable energy, sending a strong signal to energy suppliers, and use solar panels and other approaches to local energy generation. As mentioned earlier, University Hospitals of North Midlands has over 1000 solar panels installed on their roofs through a community scheme, which will lead to major financial savings for the Trust.
How far off the mark are COP26 commitments?
To keep within a safe space for human health, we should limit warming to under 1.5 °C, which would require annual emissions to be at least 20 gigatonnes of CO2 equivalent (GtCO2e) lower than the nationally determined contributions from COP26. To keep within 2°C of warming, we’d need countries’ annual emissions to be about 10 GtCO2e less. We’re currently globally emitting over 40 GtCO2e per year. If we keep emitting carbon at this rate, then by 2030 we will have emitted a further 460 GtCO2e – all of the carbon that we can emit to maintain a 50% likelihood of staying within 1.5 °C of warming (according to estimates from the start of 2021).
Who will act?
COP26 has more to offer than the outcomes of government discussions. Fifty nations committed to developing climate-resilient health systems, and forty five countries committed to low-carbon health systems. These national commitments bolster ongoing efforts at institution level, including over 1,300 who have joined the Global Green and Healthy Hospitals network. However, there are still many at-risk lives and livelihoods to play for. The future depends not only on the actions that we take with our organisations and our communities, but also on if and how we hold national and global decision makers to account.
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