(AP Photos/Matt Dunham)
With their landmark accord following talks in Paris, world leaders have hammered out not only the first global commitment to combat climate change, but arguably the most significant public health treaty of our time.
"The stakes are high," World Health Organization Director-General Margaret Chan told negotiators on December 8. "A ruined planet cannot sustain human lives in good health."
Chan's sobering words echoed a June report by the Lancet Commission on Health and Climate Change that warned global warming could wipe out a half-century of public health gains. That has helped fuel a movement to combat climate change among health-care professionals, who are tackling both global warming's impact on public health as well as their own carbon footprint.
The report also warned that much of that damage is already being done. During the talks, Beijing's record-breaking-and ongoing-smog alert vividly illustrated the threat that fossil fuel-driven climate change poses for public health. Ironically, Beijing's historic pollution alerts coincided with stubborn Chinese resistance to climate proposals on the table in Paris.
But Beijing is hardly the only nation with a pollution problem. According to WHO estimates, diseases related to air pollution kill seven million people every year, accounting for one in every eight deaths globally every year. Left unmitigated, the WHO predicts, climate change could, by 2030, lead to an additional 250,000 deaths each year from malaria, diarrheal disease, heat stress, and malnutrition.
"The health sector has really come alive to the realities of climate change," says Gary Cohen, president of Health Care Without Harm, a network of public health organizations. In a global campaign that's been likened to the tobacco control movement of the 1990s, health professionals and advocates worldwide have joined forces to push for urgent climate action, and for public health to be a bigger part of the fight against climate change.
In Paris, a coalition of some 1,700 health associations, 13 million doctors and health professionals, along with more than 8,000 hospitals, joined the WHO in calling for a robust international deal to protect public health. Even before the Paris talks, health organizations had begun to take action to reduce their carbon footprints, divest from the fossil-fuel industry, and address the impact of climate change in their communities.
"We're beginning to ask: What is health care for?"
says Cohen. "Mostly right now it's about treating chronic disease, but going forward, health care needs to reinvent itself to heal communities and the planet."
For health advocates, the deal that came out of Paris is, at best, a good first step. On the plus side, the Paris agreement explicitly sets out to hold global warming below 2 degrees Celsius over the next century-the limit scientists say is necessary to avert catastrophic warming. Advocates also praise the deal's five-year review mechanism, set to kick in by 2018, which is designed to hold countries to their climate pledges.
But the agreement also left out many core provisions that advocates say are critical to protecting public health on a warming planet. In particular, the agreement earmarks no financial support for health systems in the developing world, which faces unique challenges in responding to global warming's impacts.
Nor does the agreement commit to quickly phasing out coal production or ending fossil-fuel subsidies, both of which advocates say have immediate public health implications. According to a May study by the International Monetary Fund, global subsidies to the fossil-fuel industry outweigh public health spending by all governments worldwide.
Finally, the agreement does little to account for the very real health benefits and risks associated with different mitigation strategies, say health organizers who attended the talks in Paris.
Yet these disappointments do not negate the agreement's positive impact, says Nick Watts, lead author of the Lancet Commission study and coordinator for the Global Climate and Health Alliance, a worldwide network launched during the 2011 UN climate summit in Durban, South Africa.
"The biggest priority is a strong agreement," says Watts, adding that these details are important but that without the global accord, "unmitigated climate change would be a public health catastrophe."
Health providers not only stand on the front lines of climate change's most immediate impacts, they've also begun to track and reduce their own significant carbon footprint. According to a 2009 University of Chicago study, the health sector accounts for 8 percent of overall U.S. carbon emissions, due to hospitals' enormous demand for energy and the manufacture and transport of pharmaceutical drugs.
Progressive health-care advocates tackled that problem head-on early this year with a global call to action dubbed the 2020 Health Care Climate Challenge, led by Health Care Without Harm, an international health-care coalition. Participants include some 1,200 hospitals and care centers throughout the United States, which alongside several thousand participating health organizations worldwide have pledged to dramatically reduce their emissions by 2020. Coalition members have also pledged to invest in renewable energy, and to push for climate-friendly health-care policies at the local and national levels. The 2020 Challenge is the first global effort to track and reduce the health sector's impact on climate change.
Health Care Without Harm President Gary Cohen compares the initiative to the medical community's successful anti-tobacco campaign beginning in the 1990s. "Initially, it was a question of getting doctors and nurses to stop smoking," he says.
"Here, we're getting health care to focus on its own footprint. But that's only the beginning."
Following the tobacco control playbook, the health sector has also begun to divest from the fossil fuel industry in a big way. Already the British Medical Association, the Canadian Medical Association, and the Royal Australasian College of Physicians have committed to keeping their money out of fossil fuels.
And on December 3, an American hospital system known as Dignity Health became the largest U.S. health industry player to divest its holdings from the coal industry. Dignity operates more than 400 hospitals and care centers across California, Arizona, and Nevada. Health advocates say they expect to see industry fossil-fuel divestments gain momentum in the coming years.
"Most of the medical associations around the world won't hold investments in tobacco, alcohol, ammunitions," predicts Watts. "It's about removing the social license-it's not something we want to be a part of."
The bigger challenge, though, will be picking up the pieces after climate disasters.
"We're at the very early stages of understanding how health care will respond to climate change," says Cohen. A warming planet may not only trigger extreme weather and the spread of disease; it may also impact the ability of health systems to respond to those threats.
"What we learned from Katrina and Sandy is the health sector is not prepared," says Cohen, referring to the hurricanes that devastated the Gulf Coast and parts of the Northeast in 2005 and 2012.
But that is beginning to change. Recently, a handful of U.S. health providers have begun to account for how climate change may impact wellness in their communities. Building on the 2010 Affordable Care Act's formula for tracking local community health needs, some providers are beginning to also plan for such climate-fueled impacts as waterborne illness, heat stress, and extreme weather within their communities.
For example, health centers run by Gundersen Health System, a Wisconsin-based provider that has also frozen its fossil-fuel divestments, and by California-based Kaiser Permanente, have begun to plan for the health consequences of climate change on a local scale.
"Ultimately what we'd like to see is every hospital in the country developing a climate action plan," says Cohen.
