A review of climate change and impending planetary health catastrophe and its relevance to Island communities and there public health services. Presented to the 25th Inter-Island Public Health Forum, Gibraltar, October 18th 2018. 181017 long version middletonj planetary health or plexit iiphf gibraltar
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Planetary health or Plexit?
1. www.fph.org.uk
Planetary health? or Plexit?
Professor John Middleton
President, UK Faculty of Public Health
Honorary Professor of Public Health, Wolverhampton University
2. Who we are and what we do
• The United Kingdom Faculty of Public Health is a faculty of
the three Royal Colleges of Physicians of London, Edinburgh
and Glasgow (Physicians and Surgeons)
• FPH is a membership organisation for nearly 4,000 public
health professionals across the UK and around the world
• We also have a growing number of student, associate and
international members in more than 80 different countries
To improve and protect the public’s health:
through standards, advocacy, training and
knowledge
www.fph.org.uk
16. Global environmental change- effects on health
Climate change
Biodiversity loss
Freshwater depletion and
contamination
Ocean acidification and
overfishing
Carbon dioxide
fertilization
Land use change and soil
degradation
Urbanization
DIRECT EFFECTS ---HEAT AND EXTREME EVENTS
ECOSYSTEM MEDIATED EFFECTS e.g.
EMERGING INFECTIOUS DISEASES
VECTOR-BORNE DISEASES e.g malaria, dengue
WATER-BORNE DISEASES
FOOD SUPPLY and UNDERNUTRITION
SOCIALLY MEDIATED EFFECTS e.g. POVERTY,
MIGRATION AND CONFLICT
18. Increasing exposure to heatwaves
• Headline Finding:
Between 2000 and
2016, the number of
vulnerable people
exposed to heatwave
events has increased
by around 125 million.
17
23. Land use change,
biodiversity loss and
disease risk
Disease control
strategies require
better understanding
of the relative
importance for
health of land use
change, biodiversity
loss, and other
environmental
drivers and their
interactions.
EcoHealth Alliance/Loh et al. in State of
knowledge review, 2015
0 50
Land use change
Food Industry Change
Infection susceptibility
Ag. Industry change
Int. Travel and Commerce
War and Famine
Unspecified
Climate and Weather
Public Health Breakdown
Bushmeat
Drivers of recently-emerging infectious
diseases in humans
from wildlife
24. Aleksandrowicz et al., PLoS ONE 2016
Systematic review on impacts of shifting from current
(Western) diets to more environmentally sustainable
dietary patterns:
Environmental
Impact
Relative differences compared to
current diets
Healthy dietary
guidelines
Vegetarian diets
Greenhouse gas
emissions
12% reduction 31% reduction
Land use 20% reduction 51% reduction
Water Use 6% reduction 37% reduction
26. • In its new evidence-based report, the IPCC contrasts the
impacts of 1.5C and 2C warming. This report predicts a
difference of 10 cm sea level rise and 10.4 million displaced
people by 2100, and a difference of 190 million premature
deaths and hundreds of millions of people forced into poverty
by 2050. Further, the IPCC discusses what is required to limit
warming to 1.5OC. Its conclusion is stark: we must reduce CO2
emissions by at least 45% in the next 12 years compared to
2010 levels; and achieve net zero CO2 production by 2050. This
is a tall order, requiring action on multiple fronts at all levels of
society – from the local to the global.
2527/10/2018
GW1.5 main findings
28. 2727/10/2018
The UK government has even imposed a
legal obligation upon itself, under the
Infrastructure Act 2015, to “maximise
economic recovery” of the UK’s oil and
gas.
34. 3327/10/2018
In the decade between 2001 and 2011, global military
spending increased by an estimated 92 percent, according to
Stockholm International Peace Research, although it fell by
1.9 percent in real terms in 2013 to $1,747 billion. At the same
time, according to the draft of a new study from the
International Peace Bureau (1), almost 10 gigatons of carbon
dioxide equivalent has been released into the atmosphere.
According to the Global Carbon Project, 2014 emissions are
set to reach a record high. Could there be some connection
between rising military expenditures and rising carbon
emissions?
35. Climate change and war, conflict over scarce
resources
Conflict over unfair access to resources
Conflict over destroyed environments
36.
37.
38. From Alcamo and Heinrichs, 2002. In: Dialogue on Water and Climate, 2003.
Water critical regions
Medium water stress today & future increase in stress plus HDI>0.8
A2 scenario, ECHAM4, 2020s
44. Impact of environmental exposures on vegetable/legume yields (
Scheelbeek et al 2018)
CO2
+250ppm
Water availability
-50%
Temperatur
e +4°C
Ozone
+25%
-25% +25%
Mean yield change & confidence intervals measured in
included studies
+50%-50%
Negative
Effects*
Positive
Effects*
Baseline > 20°C
*All vegetables & legumes
combined
53. Poverty, inequality & violence
Local forces – poverty
Global forces – colonialism & globalisation
Ethnicity
Poverty, inequality & economic development
Political factors – social contracts & democracy
The international dimension
The underlying causes of civil war
The underlying causes of structural violence
54. • All based on an
unsustainable
economic model
• consumerism
• status
• trust
• social cohesion
• Unequal societies are
less sustainable
55. Income to improve health
– what’s the evidence?
L
I
F
E
E
X
P
E
C
T
A
N
C
Y
INCOME
56.
57. The world map reflecting production related to climate change. “Climate
Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009).
Who produces the greenhouse gases?
58. Who bears the burden?
The world map reflecting mortality related to climate change. “Climate
Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009).
61. Thinking global, acting
local
Urban agriculture in
Sandwell, UK
A beacon for food
growing, jobs and skills
creation and
environmental
protection
62. Thinking globally,
acting locally:
Coventry and
Warwickshire
University
Hospitals Jubilee
Nature Reserve –
managing water
run off from
hospital car parks
- promoting
biodiversity, saving
money
65. Towards an environmentally sustainable health
system
• Reduce energy use, GHG emissions and
environmental footprint.
• Increase resilience to floods, heatwaves and
disease outbreaks
• Provide care closer to home
• Reduce health care vehicle emissions and
encourage use of public transportation and bicycles
• Promote healthy low impact diets 64http://sustainability.duke.edu/health_system/
https://www.architects.org/architectureboston/articles/building-health
66. Through policies in several sectors e.g.
• Electricity generation
• Transport
• Housing
• Food and agriculture
• Health care
Adapting to change and capitalising on the health co-
benefits from the ‘low-carbon’ economy
67. Thinking globally, acting nationally:
The UK Faculty of Public Health
Manifesto for Health ‘Start well, live
better’ Active travel and climate
change policy asks
Invest in active transport to
promote good health and reduce our
impact on climate change
Implement a cross national
approach to meet climate change
targets, including a rapid move to a
100% renewables and a zero carbon
energy system
68. • Middleton J, ISIS, crop failure and no anti-biotics: what training will we
need for future public health? European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
• Same skill set:
• But:
• New partnerships : political scientists, international lawyers ,
theologians, climatologists, ecologists
27/10/2018 67
69. ‘Protecting resources
from one generation
to the next’
Thinking globally, acting
nationally- The Welsh
Wellbeing of Future
Generations Act, 2015
70. These 10 Corporations Control Almost Everything We Eat
MiddletonJ 'Public health low down with the Solent Delta
Blues’
72. An acceptable level of health for all the people of
the world by the year 2000 can be attained through
a fuller and better use of the world’s resources, a
considerable part of which is now spend on
armaments and military conflicts. A genuine policy
of independence, peace, détente, and
disarmament could and should release additional
resources that could well be devoted to peaceful
aims and in particular to the acceleration of social
and economic development of which primary
health care, as an essential part, should be allotted
its proper share’.
Global Health for all by the year 2000
World Health Organisation, 1980
82. References
• Climate and Health Council (www.climateandhealth.org)
Global health, global warming, personal and professional
responsibility, Cambridge Medicine, Pencheon D, Vol 2, No 22, 2008
• Stott R, Healthy response to climate change, BMJ 2006;332;1385-1387
• Gill M, Why should doctors be interested in climate change?
BMJ Jun 2008; 336: 1506
• Griffiths J, Alison Hill, Jackie Spiby and Mike Gill, Robin Stott Ten
practical actions for doctors to combat climate change, BMJ
2008;336;1507
• Sustaining a healthy future: www.fph.org.uk
• Griffiths J et al, The Health Practitioner's Guide to Climate Change,
Earthscan 2009
• Pencheon D, Health services and climate change: what can be done?
J Health Serv Res Policy. Editorial Jan 2009
• UCL Health Commission/Lancet: Managing the Health effects of
Climate Change. May 2009
• The health benefits of tackling climate change, Wellcome/LSHTM, Nov
2009
• Sustainable Development Commission: http://www.sd-
commission.org.uk/pages/health.html
84. References and resources
Resources :
REWIND http://www.rewind.org.uk
http://www.quilliamfoundation.org/about/
Institute for Strategic Dialogue
http://www.strategicdialogue.org
WAVES Trust www.wavestrust.org.uk/home.html
Parent Infant Partnership http://www.pipuk.org.uk
ECPAT http://www.ecpat.org.uk
TASC http://tascwheel.com
Centre for Nonviolent Communication www.cnvc.org
Medical peace work. Online course work, course
part Health professionals, conflicts and peace.
Berlin: Medical Peace Work, 2015.
http://www.medicalpeacework.org/teaching-
resources/mpw-presentations.html
References
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85. • Middleton J, ISIS, crop failure and no anti-biotics:
what training will we need for future public health?
European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
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