One of the aims of public health is to seek the tools with which we can implement policies to improve the health of our populations. But the potential health effects of climate change spelt out in papers by McMichael and Haines in this issue (p 805)(1) and next week's seem so remote that implementing change is difficult. The rich populations of the north are not sufficiently exercised by the plight of small island states that may not exist by 2050, by the aggravation of the food crisis in Africa, or, indeed, by the spread of vector borne diseases. Notably, President Bill Clinton is not ready to commit America to reduce emissions of carbon dioxide, a major contributor to global warming, by 20% by 2010.
The underlying pressure causing climate change - the unsustainable pattern of consumption in the world's rich countries - also has other, more immediate consequences. Changes in technology, social organisation, and lifestyles that have accompanied the changes in consumption are associated with chronic diseases, including coronary heart disease, diabetes, respiratory disorders, and osteoporosis. Unfit, obese populations with a high prevalence of coronary heart disease are a product of the same unsustainable consumption as drives climate change.
Unsustainable development affects health in many ways. Take, for example, food production. Most food consumed in the developed world is grown under intensive, often polluting, conditions remote from where it is consumed. Many products travel thousands of miles to the consumer, their transport contributing via carbon dioxide emissions to global warming.(2) In the long term this contributes to wide ranging hazards to human health. In the short term it does little to improve the nutrition and health of millions living in deprived areas of developed nations without the incomes and cars to reach out of town supermarkets. Thus unsustainable development helps widen the gap between rich and poor. This not only damages the health of the poor(3-5); it also undermines the "social capital" of the whole society - derived from a sense of shared participation in society's activities and decisions - a key determinant of the population's health.(6,7)
The recognition that unsustainable development underlies both climate change and much ill health is helpful in that policies aimed at reducing the impact of climate change will also help prevent illness. We suggest four areas for action nationally and locally.
Firstly, we need to create integrated transport systems, emphasising walking, bicycling, and public transport and rerouting commercial freight from road to rail. About a quarter of Britain's production of carbon dioxide comes from vehicle exhaust.(8) Measures to make walking and cycling safer will make these modes of transport more acceptable and increase social capital as people feel less threatened on the streets. Increased levels of physical activity and reduced levels of vehicle pollutants will have health benefits.
Secondly, production of carbon dioxide should be reduced by decreasing the use of fossil fuels. Improvements in energy efficiency, including home insulation and energy efficient appliances, are particularly important for people suffering fuel poverty (eight million in Britain).(9) The potential for renewable energy is vast and underexploited. For example, it has been estimated that a wholesale application of solar photovoltaic technology could generate up to two thirds of Britain's electricity.(10)
Thirdly, we should move towards a more locally based agriculture, encouraging retailers to stock locally sourced food and developing links between growers and consumers. As well as cutting transport this encourages more environmentally responsible agriculture and healthier eating. Fourthly, we should promote tree planting since growing trees absorb and recycle carbon dioxide, as well as stabilising ecosystems.
Imaginative solutions in each of these policy areas could be piloted in the new Health Action Zones proposed by the government within existing resources. For instance, if local authorities in these zones invested in energy efficient houses, the cost of the work could be recouped relatively quickly by savings on energy bills.
Finally, while locally implemented public policy along these lines is important, personal example is a powerful ally. The carbon dioxide for which each one of us is responsible comes mainly from travelling, heating, and eating. Each of us can measure the amount of carbon dioxide for which we are responsible* and try to reduce it by making changes which are for the most part life and health enhancing as well as environmentally beneficial. For instance 75% of all car journeys are under five miles, and walking or bicycling even a quarter of these would be powerful medicine. Insulating our houses and installing radiator specific thermostats, buying locally produced food, and cooking with lids on the pan, are all simple measures anyone can take. Protecting the environment is an essential public health function. If we act now we will reap benefits now and long into the future.
References
1 Intergovernmental Panel on Climate Change. Contribution of working group 1 to the second assessment report of the intergovernmental panel on climate change. In: Houghton J T, Meira-Filho L G, Callandar B A, eds. Climate changes, 1996: the science of climate change. New York: Cambridge University Press 1996.
2 Paxton A. The food miles report: the danger of long distance food transport. London: SAFE Alliance, 1994.
3 Marmot M G, Bosma H, Hemmingway H, Brunner E, Stansfield S. Contributors of job control and other risk factors to social variations in coronory heart disease incidence. Lancet 1997;350:235-9.
4 Wilkinson R How can secular improvements in life expectancy be explained? In: Blane D, Brunner E, Wilkinson R, eds. Health and social organisation. London: Routledge, 1996.
5 Syme L S. Explaining inequalities in coronary heart disease. Lancet 1997;350:231.
6 Putnam R D. Democracy and the civic community: tradition and change in an Italian experiment. Princeton: Princeton University Press, 1993.
7 Mustard J F. Health and social capital. In: Blane D, Brunner E, Wilkinson R, eds. Health and social organisation. London: Routledge, 1996.
8 Department of the Environment. Climate change: UK Programme. London: Department of the Environment, 1997.
9 Boardman B. Fuel Poverty: from warm homes to affordable warmth. London: Belhaven, 1991:206.
10 Department of Trade and Industry. The potential generating capacity of PV-clad buildings in the UK. London: DTI, 1992 (ETSU 1365 - P1).
Cathy Read Registrar in public health medicine
Robin Stott Consultant physician and Chairman
MEDACT: Medical Action For Global Security, London N19 4DJ
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