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Posts Tagged ‘Climate change’

By FPH’s Sustainable Development Special Interest Group

There are many good reasons to prioritise sustainability for the health of future generations. Protection of key planetary boundaries such as climate change, air quality, ocean alkalinity and land forestation are crucial to whether our children and grandchildren can survive and have a tolerable quality of life.

However, this can be a hard sell to those making key political and economic decisions internationally, for electorates, consumers and shareholders who have come to accept excessive consumption and unequal concentration of wealth.

Therefore, we need to emphasise the benefits of sustainability to those alive today. Fortunately, these benefits are many both to individuals and to communities. Unfortunately, these benefits are rarely discussed in political and economic discourse.

Let’s start with the benefits of sustainable nutrition. These were well summarised by Barak Obama at a recent Global Food Innovation Summit (and a Guardian article on 27 May 2017). More sustainable food means more locally sourced fruit and vegetables and less processed food and meat from ruminant animals. Not only will this reduce greenhouse gases (especially methane) and protect forests but it will also mean more food security for poorer nations and less chronic disease for those in richer countries.

Another win-win opportunity is in sustainable travel. This means more walking and cycling but also better public transport (which always involves a contribution from walking or cycling). This reduces carbon emissions, improves air quality in urban areas and improves health and wellbeing in travellers (see, for example, the PHE and LGA Report ‘Obesity and the physical environment; increasing physical activity’ in November 2013 and PHE’s ‘Working together to promote active travel’ in May 2016).

There are many other direct benefits to public health from energy efficiency, urban green space and reducing waste. Public Health professionals need to publicise this evidence and advocate for action on sustainability at local, national and international levels. This is not just good for the planet but good for the health of the public and the effects will be immediate.

 

Learn more about the work FPH is doing on behalf of our membership on the General Election.

 

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  • by Professor Sue Atkinson
  • FPH Health and Sustainability SIG

I am in Paris – for COP 21.

COP 21 (21st Conference of the Parties) of the UN Framework on Climate Change (UNFCCC) are the negotiations between the 195 countries attending, to make a deal to curb emissions and keep global warming below 2°C.

I am not at the main COP negotiations in Le Bourget but at the Global Climate and Health Alliance (GCHA) Health Summit and other parallel health meetings.

Unfortunately the timing of the Summit means I missed the FPH ‘Sustainable development and health’ SIG meeting in Nottingham on 4th December which followed the instigation of the SIG at the Faculty Conference in June.

People are starting to recognise the importance of health, climate change and sustainability and accepting what the Lancet commission identified in 2009, that ‘Climate Change (CC) could be the biggest global threat of the 21st Century’.

The Health Summit was the buzziest conference in ages. Over 500 people and oversubscribed, it was chaired (amusingly and with clear insights) by John Vidal (Environment Editor for the Guardian) and attendees included Health Ministers, the Deputy Mayor of Paris, WHO and GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit, the German equivalent of DFID), who both supported the conference (thank you), representatives of health and climate change groups and alliances from across the globe.

The presentations, parallel sessions and panel discussions were informative, interesting, lively, amusing, challenging and enjoyable with many interesting discussions taking place around the edges with an exchange of shared ideas and experiences to take back home.

Some of the snippets I picked up included:

  • Wales has a ‘Wellbeing of Future Generations Act’ and a commissioner to make things happen. It is one of only two countries with sustainability in its constitution.
  • California showed the importance of political leadership in Senator Kevin de Leon, who is introducing a variety of relevant bills and noted that air pollution is not just a public health issue but also a political and civil and human rights issue because of its inequities.
  • Air pollution is worst in poor areas and African American children have a 50% higher risk of being hospitalized and Latino children a 40% higher risk of death from asthma.
  • Health care systems are part of the problem. In USA they account for 8% of emissions. Hospitals across the globe are increasingly taking action to reduce energy usage (and costs) but much more needs to be done.
  • Reducing red meat consumption (and its procurement by hospitals and institutions) is good for health and the planet. The Buddhist Dalin Tzu Chi Hospital in Taiwan has moved to a plant based diet to improve health and the environment.
  • Cities are increasingly taking action on reducing emissions where states and countries are unable to reach agreements. In Paris over 100 mayors came together with the Paris Mayor Anne Hidalgo calling for them to unite and work together to mitigate climate change. London has reduced its carbon emissions by 14% since 2008 but I am sure Bristol and elsewhere may be doing better.
  • The Paris Deputy Mayor – Bernard Jornier – clearly understands well the relationships between health, climate change and inequalities.
  • Goldman Sachs decreed in September 2015 that “Coal is in terminal decline”.
  • Using fossil fuels means there are more than seven million extra deaths per year.
  • The co-benefits of addressing health and climate change together are clear – e.g. increasing active travel – walking and cycling – is good for your health and good for the planet.

And much much more …

We have come a long way since COP15 in Copenhagen in 2009, when those of us interested in health and climate change could fit around one small coffee table and it now feels as though the importance of health in the climate change negotiations is starting to make its mark.

CC science is real but it is often difficult to get our heads round and some of the environmental and other impacts seem like a long way off and we know that politicians and all of us (including teenagers) find it hard to recognise and take action on threats that are in the more distant future.

Health brings home the real story of the impact of climate change – imperative, immediate and life changing.

Families displaced because of floods and typhoons, children starving as a result of drought resulting in failing crops, older people dying in heat-waves, even as recently and as nearby as 15,000 deaths in France in 2003.

With 500 people still dying annually of Malaria, the 2.5 million people suffering from the disease could increase again to over four million with the spread of mosquitos due to climate change.People are sick and dying from lack of clean water as a result of either drought or destruction of infrastructure by severe storms and tsunamis.

Closer to home, just this weekend the floods in Cumbria have caused distress and destruction as well as the financial costs of these storms.  And of course the important links between climate change, disasters and water shortages, refugees and terrorism.

IMG_0867

Recent floods in the north of England (like York City Centre, pictured) have brought home the reality of climate change to the UK

The latest Lancet Commission (2015) identified that ‘Tackling CC could be the greatest health opportunity of the 21st century’.

The health summit felt both daunting and optimistic. We must act now.
The spoken word poet – Sophia Walker – captured it in her piece written for the Health Summit as “…we aren’t just talking about the weather” and suggested that nine billion people on the planet could work ‘miracles’ if they all did their bit.

We in public health must do ours, not just individually but in whatever ways we can through our building it into our daily work, e.g. identifying the co-benefits of improving health and the environment. It seems that at last the penny may be dropping that climate change and health are inexplicably linked.  What’s good for health is good for the planet.

References
Lancet Commission. 2009. “Managing the health effects of climate change”. Lancet and UCL Institute for Global Health Commission. April 2009.

Lancet Commission.2015. “Health and Climate Change: policy responses to protect public health” Lancet. June 2015.

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by David Pencheon, FPH member

This blog is part of a series of posts to promote discussion and debate around the priorities in Start Well, Live Better: FPH’s manifesto for the 2015 General Election.

"Never in human history has the health and welfare of so many people (already living and yet to be born) depended on so few people who know so much and are doing so little."

Our behaviour is more influenced by our surroundings than we think.  Our behaviours are a function of what surrounds us – physically, socially and culturally,  We are shaped by norms more than we shape them.  Consequently, when an influential group of people have the chance to re-set norms in visible and newsworthy ways, where results benefit almost everyone both immediately and long term, why wouldn’t we seize the opportunity?

Well, health professionals and health organisations now have such a chance.  The case for divesting from fossil fuel is now very strong.  The British Medical Association (BMA) is committed to this journey and since its 2014 Annual Representatives Meeting (ARM) is actively investigating how best to send out a powerful message on health and social justice.

This very welcome move will hopefully start a trickle and then a tidal wave of divestment from the fossil fuel industry which, like the tobacco world, has spent outrageous sums of money on sowing doubt about the harmful effects of a high carbon world and the beneficial health and equity effects of a low carbon society. Read Oreskes book: Merchants of Doubt.

In retrospect, the data now strongly suggest that the fall in smoking levels amongst many groups did not really happen until health professionals (particularly doctors) stopped smoking.  We all have bizarre habits where our creative energy is used more to justify them than to address them.  If we struggle to justify our smoking habit to our peers or to ourselves, where better to reassure one’s self than by pointing to a health professional smoking.

Change does happen though, often quickly, although rarely planned (witness the banning of smoking on the London Underground).  Such changes are often not driven primarily by the law (smoking on planes and overground trains).  If health professionals and organisations simply all say: no, we do not invest any assets we have supporting an industry which knowingly perpetuates an addiction (to fossil fuel) and does not actively attempt to address this threat in the radical ways needed.

Fossil fuel companies need to understand that their so called wealth is largely based on resources still in the ground – which the incontrovertible evidence (supported by the UN, the World Bank; The Pentagon, the UK Ministry of Defence, and the CIA) says needs to be left there.  City investors are already having doubts about the real worth of some fossil fuel companies if their so-called assets are theoretical.

We should therefore welcome the move of the BMA to be the first large health organisation to tread this path.  A full description of the background to why we should actively divest from the fossil fuel industry is in MedAct’s latest report. What we will do in future might appear odd and different now, but in retrospect nearly always appears normal surprisingly quickly
We have a duty and responsibility to help shape the future as much as we are shaped by it.

The great mystery to historians at the end of the 21st century (if there is anyone left to write our history) any of us left) is why, at the beginning of the century, we did so much talking and research on what is happening and took so little action.  Never in human history has the health and welfare of so many people (already living and yet to be born) depended on so few people who know so much and are doing so little.  Do something good today and write a letter to the President, CEO, Chair and Treasurer of the BMA and congratulate them for at least actively and publicly committing themselves to this journey.

And ask your own organisation how much is invested in the fossil fuel industry. These are not easy questions. What constitutes a fossil fuel company? Are any savings I have ethically invested? But they are not impossible. We must not let perfection be the enemy of pragmatism and we must start today not tomorrow.  This is all happening on our watch and will be our legacy.

When our great grandchildren say to us: what did you do at the beginning of the century, let us all try and do more than just mumble we that we knowingly and passively conspired with circumstance. Health professionals, rightly or wrongly, are still well respected, are numerous and interact with all members of society every day and in every community in the land.

Numbers matter: one person is a crackpot, two is a pressure group, and three is a social and political movement. If health professionals don’t draw a line in the sand, then who will? And if we don’t do it now, then when will we do it?

Further reading:
1.    Oreskes and Conway: Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming.  2013.
2.    MEDACT’s call for Fossil Fuel Divestment by the Health Sector. “Unhealthy Investments”
3.    BMJ 2014;348:g2407  Why doctors and their organisations must help tackle climate change: an essay by Eric Chivian
4.    The Faculty of Public Health “Sustaining a Healthy Future – taking action on climate change” 2009
5.    The Global Climate and Health Alliance Civil Society Call To Action at the World Health Organisation Conference on Health and Climate August 2014

A version of this blog was first published on the BMJ website.

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by Professor Frank Kelly and Dr Julia Kelly
King’s College London

When the UK passed the Clean Air Act in 1956 to reduce smoke and sulphur dioxide, it led the world in cleaning up air. In recent years air quality improvements have miserably stalled. We have been breaching European Union (EU) limit values every year since 2005 for the modern day pollutants nitrogen dioxide (NO2) and particulate matter (PM). Currently there is no prospect of achieving compliance for NO2 in some areas until 2025.

More worryingly, evidence to support the detrimental short and long-term effects on health has increased substantially over the same period of time. Data for 2008 estimate that air pollution contributes to at least 29,000 premature deaths in the UK each year.

In 2012, the International Agency for Research on Cancer classified particulates in diesel fumes as a known carcinogen. In 2013, a WHO report concluded that the health effects of PM and NO2 can occur at concentrations lower than the their health-based Guideline values which of note, are lower than the EU limits we fail to adhere to.

In addition, other than the well-documented risks to cardiopulmonary heath, increasing evidence exists that air pollution exerts a wider threat, negatively influencing reproductive outcomes and neurological health.

The lack of progress in improving air quality isn’t due to lack of attention by professionals in the field or lack awareness by Government. I and other expert witnesses have given evidence to the Commons Environmental Audit Committee in 2010 and again in 2011 – the ensuing reports were blatant in their conclusions, calling in 2010 for ‘political will’ and ‘committed resources to meet air quality targets.

The 2011 report concluded that ‘the Government has failed to get to grips with the issue’ and ‘must not continue to put the health of the nation at risk’. In February 2014 the European Commission launched legal proceedings against the UK for excessive emissions of NO2. This is the first case by the EU against a member state for breaching limits. One can only hope that this may have the clout to shake political indifference to air quality in this country.

Unlike the powers that be, up until the beginning of last week, it is probably fair to say that the majority of the public was relatively unaware of day-to-day air pollution, the sources and the dangers associated with current concentrations. This is partly because PM can’t be seen by the naked eye and NO2 is invisible and probably owing to a poor understanding of what is undisputedly a complex science.

However on Sunday 30 March 2014 light southeasterly winds began to blow Saharan dust plus polluted air from Europe over the UK. This mingled with our domestic emissions from cars and industry resulting in high levels of rather unusual mix of pollution. Owing to the persistence of easterly winds and dry weather, poor air quality remained with us until the end of the week.

Light easterly winds taking pollutants from continental Europe to the UK where are own fresh emissions are added is not unusual – even dust flows from the Sahara are not uncommon. Instead, what really grabbed the attention of the nation – other than the visible hazy smog – was the prolific reporting of the events in every conceivable form of media.

This was because on the 1 April 2014 the Met Office, our national weather service provider, took over responsibility for forecasting air pollution on behalf of Defra. With that came greater publicity. In comparison, previous episodes have attracted insignificant coverage. Other than registered users of proactive air pollution alert services, you would have been hard pressed to hear about the even worse poor air quality affecting parts of England three weeks ago. This particular event culminated in London recording the greatest concentration of PM10 in 2 years.

The highly charged media coverage did not stop even when air quality improved. This was the result of a change in wind direction to southwesterly, coming in from the cleaner Atlantic, combined with wet weather washing the pollutants out of the air. Sunday’s press covered emerging evidence that traffic-related air pollution may target neurodevelopment and cognitive function as well as holding diesel fumes to account.

British drivers respond to the marketing of diesel cars as the “green” option – on the basis of reduced CO2 emissions and lower fuel costs – such that approximately one half of all new private car registrations in 2012 were diesel. Added to this, in most cities diesel engines power the majority of our buses and taxis. The image however is now tarnished.

Diesel engines emit especially harmful particulate pollution and owing to lenient European testing regimens, NO2 emissions have risen steadily of the past 10-15 years. It was reassuring that this information reached the front pages of the Sunday broadsheets.

This pollution episode has certainly raised the profile of what, to many, has previously been an invisible problem. However the chronic effects of air pollution, owing to year-round exposure, are much more worrisome than the short-term, often transient outcomes. We cannot afford to just focus on distinct episodes. As succinctly put in one online blog earlier this week: ‘We need to reduce air pollution when it isn’t making the headlines as well as when it is.’ Traffic must be reduced and we must ensure a cleaner and greener element to what remains on the road.

This can be achieved through a number of strategies: an expansion of low emission zones, investment in clean and affordable public transport, a move back from diesel to petrol or at least a ban on all diesel vehicles not fitted with a particulate filter and a lowering of speed limits. Focused education and continued evolution of sophisticated information systems can also achieve a durable change in public attitude and in turn behaviour.

But engagement must be blatant and put in the context of other public health risks such as passive smoking and utilise compelling messages such as premature death. There will be costs – but these should be balanced against the economic cost from the impacts of air pollution in the UK that are estimated at £9-£19 billion every year.

Cracking our air pollution problem is a huge challenge. It is highly unlikely that our major cities will ever be able to boast ‘pure air’ especially if strategies focus on small areas of an overall road network – as I have been quoted before: ‘air pollution does not respect any boundaries’. With bold, realistic and moral leadership however, enormous potential exists to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

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Dr John Middleton, Director of Public Health for Sandwell and FPH Vice President, email vpPolicy@fph.org.uk

On first reading, the health bill seems silent on public health roles in the health service. More than 300 public health specialists and consultants who work in health service public health are justifiably nervous about what the future public health system holds for them. In a set of reforms establishing Public Health England and local-authority-based public health directors, they could have expected some acknowledgement. There is what we expected about the other two domains of public health: health protection and health improvement.

Fortunately the subtext of the bill holds much more hope for public health in health services. It confers duties of engagement, partnership, quality and reducing inequalities on the NHS Commissioning Board and GP commissioners.  Even Monitor needs public health – if it is to create national tariffs that genuinely reflect the most effective interventions delivered most efficiently rather than reward incompetence, gaming and worsening of inequalities in health services.

Health-services-related public health is arguably the most technically exacting facet of public health and certainly the most contentious. It requires rigorous knowledge of healthcare interventions and epidemiological and interpretative skills are needed to show what works and what does harm. As the margins of benefit from new drugs and treatments get smaller, careful analysis becomes ever more necessary. Assessing complex healthcare data is crucial activity – truly a matter of life and death – not an exercise of faceless bureaucracy or unnecessary management cost.  Some patients will die when we do decide to fund their high cost – and high risk – drug.

These funding decisions cannot be left to the newly emasculated NICE – implementation is local. The best national policies flounder if they are not locally understood and implemented.

Health services public health is not always popular – rationing decisions invariably get unravelled in appeals, press examination, in legal dispute and judicial review. There may be political expectation that big healthcare private organisations will bring the skills to evaluate healthcare for GP commissioners in the future. This has hardly been borne out by the   hospital deaths misinformation, or the quasi-scientific risk-stratification products on offer.

The return of public health to local authorities holds the welcome recognition of where the major influences on health still are.  Many of us cite McKeown’s decline of mortality since 1840 due to clean water, sanitation, better housing and working conditions, better nutrition and smaller family size. The big environmental challenges, work with social care on reablement and personalisation, and the need to reduce health inequalities are live issues for public health in local authorities. Twenty-first century diseases such as obesity, relationship and behavioural problems and addictions also lend themselves to big public health responses from a local-authority base.  But equally relevant in the 21st century is the health service contribution to life expectancy gain – Bunker, Frasier and Mostellar’s Millbank review concluded that about 30% of the life-expectancy improvement since the NHS came along was due to healthcare factors. The capacity for health services to do harm as well as good is immense, and the need to get better value for money in healthcare is ever more relevant.

There is growing recognition of the need for health promotion or ‘lifestyle’ interventions in healthcare. Acute services are seeing it as part of QUIPP and many are instigating ‘stop before the op’ smoking cessation programmes. GPs also increasingly have opportunities to refer to food and fitness services, psychological therapies and addiction-brief interventions. It is easy to see how GP commissioning should be involved in commissioning alcohol services – jointly with the local authority DsPH – to cover all preventive and therapeutic interventions. Less easy, but just as relevant in reducing hospital dependency, would be joint commissions on fit-for-work programmes, welfare rights and housing improvement.

With hospitals being more dangerous places than roads these days, health systems need public health skills more than ever. More than 30 consultants and specialists in public health work in acute hospital trusts. Hospitals, and health centres, are outlets for health information, signposts and venues for health promoting activity and potential exemplars of health improvement for staff, patients and visitors. Business choices for hospital and community trusts should be informed by good health-needs analysis, assessment of best evidence of effectiveness and evaluation. Care pathways should all include ‘lifestyle’ programmes as a key choice in the pathway– for example, before bariatric or vascular surgery.  This is equally relevant in GP commissioning. For the first time we are beginning to have good data about morbidity and about quality of care in general practice. These data have to inform the joint strategic needs assessments. But they also have to be interpreted and used in primary care.

Public health specialists need to be embedded in organisations because that is the only way their advice will be taken on – consultancies we all take or leave. There should be consultant level public health expertise in all arms of the new health system – including the NHS Commissioning Board and Monitor. But we need also a coherent base on which all the public health training and development is founded – only Public Health England appears capable of that. There are encouraging signs that GPs and others in the new NHS are recognising the need for healthcare public health – you won’t find it in the health bill.

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By Alan Maryon-Davis

The call went out to all churches in KwaZulu-Natal to pray for rain. The drought had ravaged Zululand for months following a disappointingly dry rainy season. For the seventh year in a row the parched land had received less than 75% of its previous average rainfall. The underground aquifers were empty. Natural springs and boreholes, the sole source for most of the rural communities had dried up. The once mighty uMfolozi river was a trickle. Severe water restrictions were in place. Farmers’ livelihoods were at stake. The situation was critical.

I had been invited to visit South Africa by the College of Public Health Medicine (ironically to talk to a number of groups about climate change and receive an honorary fellowship) and I could see the effects of the drought with my own eyes. The sugarcane fields were in a sorry state, other produce was shrivelled and even the drought-resistant eucalyptus trees, a cash crop, were showing signs of stress. The bush veldt of Zululand is well used to dry summers – but this was early spring – the seventh dry early spring – a worrying pattern. Commentators talked of climate change in action – allied to trends already seen further up the east coast of Africa.

And yet, despite the emerging threat to its own economy and the health and wellbeing of its people, the ‘Rainbow State,’ like many other countries that straddle the developed and developing worlds, is far from wholeheartedly embracing the green agenda. It is caught between, on the one hand, the need to play its part as a major economy in reducing carbon emissions to help combat global warming, and on the other, the impetus to increase its GDP and offer a comfortable lifestyle to its burgeoning, upwardly mobile, urbanised middle classes.

South Africa’s per capita carbon footprint is about the same as the European average. Its energy comes overwhelmingly from its extensive coal resources and, despite recently approving a more balanced energy-generating policy, there’s little sign of any imminent shift towards renewables or nuclear. The potential for solar energy, especially in more remote rural areas, is high – but start-up costs are considered too prohibitive to roll-out on a large scale. Other priorities, such as education, healthcare and housing, come first.

In many ways, South Africa’s dilemma over carbon emissions is typical of its fellow BRICS economies – Brazil, Russia, India and China – and highlights the challenges that will be faced by negotiators at the next round of climate change talks in Mexico in December. How can the world move towards some sort of contraction and convergence formula that is fair and practicable and politically acceptable to countries at all stages of development? And at the same time ensure that those most vulnerable to the impacts of climate change are helped to become more resilient.

Meanwhile, back in Zululand – something good has happened. The skies have darkened, the clouds have opened and rain has filled the water tanks, runnels and ditches. Could this be the power of prayer – or merely the serendipities of a troubled atmosphere?

Either way, the sugarcane farmers and smallholders are smiling again.

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Morning parallel session, at the Faculty of Public Health annual conference, on Wednesday 7 July.

Chaired by Professor Alan Maryon-Davis (former President, UK Faculty of Public Health), and panel members Lucy Reynolds (London School of Hygiene and Tropical Medicine), Wayne Elliott (Head of the Health Programme, Met Office) and Shona Arora (Director of Public Health, NHS Gloucestershire) and Andy Wapling (Head of Emergency Preparedness, NHS London).

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