Food security, climate change and heath promotion: opening up the streams not just helping out down stream
Editor in Chief
In July 2008, the G8 summit will consider the World's emerging food crisis as another 100 million people are pushed into poverty due to soaring food prices. This could mean ‘seven lost years’ in the fight against worldwide poverty, the World Bank President has said, as he called for a New Deal on Global Food Policy (Zoellick, 2008
). Already 2 billion people face the daily struggle to survive hunger and malnutrition. The causes are complex but there is little doubt that climate change has played a part and is likely to exacerbate the situation into the future. Ironically, the diversification of agricultural production into bio-fuels may be adding insult to injury. What should be the response of the health sector to this and where does health promotion sit in the mix?
The world's climate is clearly changing. Effects include heat waves, storms, flooding, droughts, sea level rise and air pollution. Each can harm health directly through, for example, heat stress, injuries, drowning, respiratory illnesses, as well as vector, food and water-borne diseases. However, the indirect effects of ecosystem change can be even more disastrous; likely impacts include food and water shortages, malnutrition, mass population movement, international conflict and consequential mental health disorders.
There is no cause for complacency as the Intergovernmental Panel on Climate Change demonstrated in their fourth assessment report (IPCC, 2007). ‘There is high agreement and much evidence that with current climate change mitigation policies and related sustainable development practices, global green house gas emissions will continue to grow over the next few decades’. The health impacts of the IPCC projections include:
- In Africa by 2020, reduced yields from rain-fed agriculture by up to 50%, which would further adversely affect food security and exacerbate malnutrition.
- In Asia, increased endemic morbidity and mortality due to diarrhoeal disease primarily associated with floods and droughts.
- In Australasia by 2030, decreased production from agriculture and forestry over much of southern and eastern Australia and eastern New Zealand, due to increased drought and fire.
- In southern Europe, reduced water availability, hydropower potential and crop productivity due to higher temperatures and drought.
- In Latin America, decreased productivity of some important crops and livestock, with adverse consequences for food security and increased number of people at risk of hunger.
- In North America, decreased snow pack, more winter flooding and reduced summer flows, exacerbating competition for over-allocated water resources.
- In small islands, increased inundation, storm surge, erosion and other coastal hazards due to sea level rise, thus threatening vital infrastructure, settlements and facilities that support island communities.
In addition to economic, environmental and agricultural responses, there is also a pressing need for the health sector to prepare for and prevent potential health risks (McMichael et al., 2006). There have been calls for health services action by the IPCC and the World Health Organization as well as by numerous national bodies, for example the Australian Medical Association and Australian Conservation Foundation in a joint statement (AMA and ACF 2005). The response of the health sector to date has been variable but encouragingly there appears to be increasing engagement. For example, in Australia a major conference on climate change and human health was held in October 2007 in Victoria to raise awareness of the public health challenges (DHS, 2007).
In the US, the Centers for Disease Control and Prevention have also taken a lead and identified the following priority health actions for climate change (CDC, 2008a):
- Serve as a credible source of information on the health consequences of climate change for the United States and global populations.
- Track data on environmental conditions, disease risks and disease occurrence related to climate change.
- Expand capacity for modelling and forecasting health effects that may be climate-related.
- Enhance the science base to understand better the relationship between climate change and health outcomes.
- Identify locations and population groups at greatest risk for specific health threats, such as heat waves.
- Communicate the health-related aspects of climate change, including risks and ways to reduce them, to the public, decision makers and healthcare providers.
- Develop partnerships with other government agencies, the private sector, non-governmental organizations, universities and international organizations to address more effectively the US and global health aspects associated with climate change.
- Provide leadership domestically and internationally to the private and public sectors including state and local governments, community leaders, healthcare professionals, non-governmental organizations and faith-based communities regarding health protection from climate change effects.
- Develop and implement preparedness and response plans for health threats such as heat waves, severe weather events and infectious diseases.
- Provide technical advice and support to state and local health departments, the private sector and others in implementing national and global preparedness measures related to the health effects of climate change.
- Promote workforce development by helping to ensure the training of a new generation of competent, experienced public health staff to respond to the health threats posed by climate change.
In April 2008, however, an important breakthrough occurred with the publication of a guidance document by the UK Department of Health in collaboration with the Faculty of Public Health, UK Public Health Association and the Chartered Institute of Environmental Health (DH, 2008). Developed by the South East Regional Public Heath Group, it contains advice for public health professionals on what can be done to mitigate and adapt to climate change and promote sustainable communities. One useful health promotion contribution is the development of a Reducing Our Carbon Footprint Code for the health sector, hospitals and communities, which is presented under the following headings:
- Take a lead in addressing carbon emissions
- Undertake a carbon audit
- Place energy at the heart of the organization—save money, increase efficiency
- Reduce water consumption and flooding
- Make sustainable transport policies
- Ensure sustainable catering and food procurement policies
- Influence sustainable housing and the built environment
- Develop a carbon neutral waste management policy
- Promote local employment and skills
). We can also advocate in our every day contacts about the health improvements and financial savings from producing less carbon and for the benefits of sustainable development. In our diverse professional work, we should engage with and help individuals and communities understand the health consequences of climate change and encourage sustainable living. Health promotion practitioners should integrate climate change mitigation strategies into health program delivery and should strengthen partnerships with environmental and recreational groups, and those responsible for managing the built and natural environments.
To maximize the effectiveness of policy and legislation that target climate change, health policy makers should work cooperatively with decision makers in the economic, environment and energy sectors. Care must be taken, however, that new policy measures such as carbon taxes and carbon-trading schemes do not bear unfavourably on disadvantaged people with the least capacity to pay. This will result in diminished personal well-being and a further-reduced ability to comply with strategies designed to reduce greenhouse gas emissions (Nicholson, 2007).
Health Board Directors should secure organizational commitment, identify a ‘Carbon Champion’ and institute energy audits particularly focusing on reducing unnecessary travel. Managers of health facilities should improve electrical efficiency, building insulation and reduce water usage, and monitor progress against targets. They should assess preparedness for heatwaves and flooding.
Health planners should incorporate climate change into needs assessments and service developments. Health service funders should strengthen public health capacity including disaster and emergency preparedness. Teachers and trainers should include climate change in the curriculum for healthcare professionals, so that the next generation is more knowledgeable and skilled to act than we are.
Public health researchers should assess the health impacts of climate change, particularly on vulnerable groups, to inform the development of adaptation strategies and action plans. They should develop and use early warning systems and decision-making tools to inform risk management. New forms of integrated community-based interventions should be developed and evaluated. Expertise and experiences should be shared about the integration of climate change into health promotion practice at conferences, through professional networks, publications and the web.
There is much work to be done and little time to do it in given the predictions to date. But as the UK's Stern Review more optimistically concluded: ‘There is still time to avoid the worst impacts of climate change, if we take strong action now’ (Stern, 2006). Health Promotion International wishes to position itself at the cutting edge of this interface between climate change and health promotion, and we invite original papers, reviews and debate articles.
Climate change is not just an environmental issue, it is not just an economic issue—it is also a health issue. The inter-dependence of good health policy, good economic policy and good environmental policy will never be written larger than in our response to climate change. Let us hope that the G8 leaders not only donate US $500 M to alleviate the current food crisis, one of the down stream effects of climate change, but that they also give greater commitment to opening up the streams in the first place. And we should do the same.
REFERENCES
AMA, ACF. Addressing the public health impact of climate change. (2005) Kingston ACT, Australia: Australian Medical Association and Australian Conservation Foundation. http://www.ama.com.au/web.nsf/doc/ween-6gfbg6/$file/addressing_the_public_health_impacts_of_climate_change_-_an_overview.pdf.
CDC. CDC policy on climate change and public health. (2008) a. Atlanta, USA: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. http://www.cdc.gov/ClimateChange/policy.htm.
CDC. Climate change and public health: prevention and preparedness. (2008) b. Atlanta, USA: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. http://www.cdc.gov/ClimateChange/prevention.htm.
DH. The health impact of climate change: promoting sustainable communities. (2008) London, UK: Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/DH_082690.
DHS. Climate change and health: an exploration of challenges for public health in Victoria. (2007) Melbourne, VIC, Australia: Victorian Government Department of Human Services. http://www.health.vic.gov.au/environment/downloads/cc&h-challenges_public_health_vic.pdf.
IPCC. Climate change 2007: synthesis report. Contribution of working Groups I, II and III to the fourth assessment. In: Report of the Intergovernmental Panel on Climate Change—Pachauri R.K., Reisinger A., eds. (2007) Geneva, Switzerland: IPCC. 104. Core Writing Team http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf.
McMichael A., Woodruff R., Hales S. Climate change and human health: present and future risks. Lancet (2006) 367:859–869.[CrossRef][Web of Science][Medline]
Nicholson T. Equity in response to climate change roundtable. (2007) VIC, Australia: Brotherhood of St. Laurence. www.bsl.org.au.
Stern N. Stern review: the economics of climate change. (2006) London, UK: HM Treasury. http://www.hm-treasury.gov.uk./independent_reviews/stern_review_economics_climate_change/stern_review_report.cfm.
Zoellick R. News and Broadcast 11 April. (2008) Washington, USA: The World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,contentMDK:21726628~pagePK:64257043~piPK:437376~theSitePK:4607,00.html.
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