“Emergency action on climate and nature crisis cannot wait for the pandemic to pass”, says unprecedented joint editorial from health journals

Categories: Featured, In The Media, Leadership, Opinion, and Policy.

On September 5th medical, nursing and public health journals across the world simultaneously published an editorial calling for world leaders to take emergency action to transform societies and limit climate change, restore biodiversity, and protect health. The editorial was published in over 220 leading journals, including The Lancet, the East African Medical Journal, the Chinese Science Bulletin, the New England Journal of Medicine, the International Nursing Review, the National Medical Journal of India, The British Medical Journal, the Revista de Saúde Pública (Brazil), and the Medical Journal of Australia. Never have so many journals combined to publish the same editorial.

The editorial was published in advance of the UN General Assembly, one of the last international meetings taking place before the (COP26) climate conference in Glasgow, UK in November. This is a crucial moment to urge all countries to deliver enhanced and ambitious climate plans to honour the goals of the Paris Agreement.

In a year of Covid-19 and crucial environmental conferences, the editorial warns that the greatest threat to global public health into the future is the continued failure of world leaders to take adequate action to keep the global temperature rise below 1.5°C and to restore nature.


The editorial in full:

The UN General Assembly in September, 2021, will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the UN Climate Change Conference of the Parties (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1·5°C, halt the destruction of nature, and protect health.
Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades. The science is unequivocal; a global increase of 1·5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.
Reflecting the severity of the moment, this Comment appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.
The risks to health of increases above 1·5°C are now well established.  Indeed, no temperature rise is “safe”. In the past 20 years, heat-related mortality among people older than 65 years has increased by more than 50%. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.,   Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.
Global heating is also contributing to the decline in global yield potential for major crops, falling by 1·8–5·6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition. Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.,  
The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement, and zoonotic disease—with severe implications for all countries and communities. As with the COVID-19 pandemic, we are globally as strong as our weakest member.

Rises above 1·5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.

Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world’s land and oceans by 2030.
These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short-term and longer-term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations.  Concern is growing that temperature rises above 1·5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community.Relatedly, current strategies for reducing emissions to net zero by the middle of the 21st century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.
This insufficient action means that temperature increases are likely to be well in excess of 2°C,  a catastrophic outcome for health and environmental stability. Crucially, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed. This is an overall environmental crisis.
Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.

Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed   and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.

To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.
Many governments met the threat of the COVID-19 pandemic with unprecedented funding. The environmental crisis demands a similar emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.
These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the COVID-19 pandemic.  But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.
In particular, countries that have disproportionately created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier, and more resilient societies. High-income countries must meet and go beyond their outstanding commitment to provide US$100 billion a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.
Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.

As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42 billion of assets from fossil fuels; others should join them.

The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1·5°C and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.
FG serves on the executive committee for the UK Health Alliance on Climate Change and is a Trustee of the Eden Project. RS is the Chair of Patients Know Best, has stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis, and is chair of the Lancet Commission of the Value of Death. The other authors declare no competing interests.


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Photo Credit:Photo by Li-An Lim on Unsplash

Related quotes:

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, said:

“The risks posed by climate change could dwarf those of any single disease. The COVID-19 pandemic will end, but there is no vaccine for the climate crisis. The IPCC report shows that every fraction of a degree hotter endangers our health and future. Similarly, every action taken to limit emissions and warming brings us closer to a healthier and safer future.”

Professor Lukoye Atwoli, Editor-in-Chief of the East Africa Medical Journal, and one of the co-authors of the editorial, said:

“While low and middle income countries have historically contributed less to climate change, they bear an inordinate burden of the adverse effects, including on health. We therefore call for equitable contributions whereby the world’s wealthier countries do more to offset the impact of their actions on the climate, beginning now, and continuing into the future.”

Ambassador Aubrey Webson, Chair of the Alliance of Small Island States (AOSIS) and Ambassador, Antigua and Brabuda, and Permanent Representative to the United Nations, said:

“Our world is on the brink of climate chaos from the ravages of a warming world, and it will take extraordinary action to turn this around. Even at 1.5˚C of warming, nobody is more at risk than the Small Island States. This editorial reiterates the demand that governments need to be doing more on reducing emissions and to ensure that we all transition to a just, equitable and fairer world. Equitable funding must be at the core of our response so that vulnerable nations like the Small Islands can have a fighting chance. We need developed countries to keep their promise to provide US$ 100 billion in finance with a higher goal by 2025, and we also need to re-look the reality of what it will actually cost developing countries to implement the commitments we have undertaken in the Paris Agreement. This is not simply a matter of money. It is a matter of our actual survival.”

Dr Fiona Godlee, Editor-in-Chief of The BMJ, and one of the co-authors of the editorial, said:
“Health professionals have been on the frontline of the Covid-19 crisis. And they are united in warning that going above 1.5C and allowing the continued destruction of nature will bring the next, far deadlier crisis. Wealthier nations must act faster and do more to support those countries already suffering under higher temperatures. 2021 has to be the year the world changes course – our health depends on it.”

Dr Richard Horton, Editor-in-Chief of The Lancet, said:
“Urgently addressing the climate crisis is one of the greatest opportunities we have for advancing the wellbeing of people worldwide. The health community must do more to raise its critical voice in holding political leaders accountable for their actions to keep global temperature rises below 1.5°C.”

HE Sheikh Hasina, Prime Minister of Bangladesh and Chair of the Climate Vulnerable Forum, said:
“Every country must pursue an ambitious target to curb Greenhouse gas emissions to keep the global temperature-rise below 1.5ºC. Developed nations should facilitate the green recovery of the CVF-V20 countries. Dedicated support is required for reducing the cost of capital and encouraging private sector participation. Strict implementation of the Paris Agreement is the only way to check global emissions and thereby global warming. The time to take action to save the planet is not tomorrow, but today.”

Eric J. Rubin, M.D., Ph.D., Editor-in-Chief of The New England Journal of Medicine, and one of the co-authors of the editorial, said:
“The environment and health are inextricably intertwined. The changing climate is endangering us in many ways, including its critical impacts on health and health care delivery. As medical and public health practitioners, we have an obligation not only to anticipate new health care needs but also to be active participants in limiting the causes of the climate crisis.”

Dr Peush Sahni, Editor-in-Chief of the National Medical Journal of India, and one of the co-authors of the editorial, said:
“The recent examples of extreme weather all over the globe have brought into focus the reality that climate change is. We must act now lest it is too late. We owe it to the future generations.”

Dr Richard Smith, Chair of the UK Health Alliance on Climate Change, and one of the co-authors of the editorial, said:
“Health professionals have long been concerned about the harm to health from climate change, but our voices have not been heard clearly in the global debate. This unprecedented joint publication shows our global concern and how we want to be part of acting on climate change.”


The editorial has been coordinated by the UK Health Alliance on Climate Change (UKHACC), a coalition of leading UK health bodies including The Royal Colleges of Physicians, GPs and Surgeons, the Royal College of Nursing, the British Medical Association, the British Medical Journal, and The Lancet. Together UKHACC advocates on behalf of health professionals for responses to climate change which simultaneously protect and promote public health.

This editorial was co-authored by 19 people, listed below, including the editors in chief of 17 health journals based around the world. It is supported – and will be published – by an international group of over 220 health journals. A full list of journals who are publishing is available at the end of this press release. It can also be found at: https://www.bmj.com/content/full-list-authors-and-signatories-climate-emergency-editorial-september-2021

The editorial co-authors are as follows (a full list of their declarations are available in the editorial):
Lukoye Atwoli, editor in chief, East African Medical Journal
Abdullah H. Baqui, editor in chief, Journal of Health, Population and Nutrition
Thomas Benfield, editor in chief, Danish Medical Journal
Raffaella Bosurgi, editor in chief, PLOS Medicine
Fiona Godlee, editor in chief, The BMJ (British Medical Journal)
Stephen Hancocks, editor in chief, British Dental Journal
Richard Horton, editor in chief, The Lancet
Laurie Laybourn-Langton, senior adviser, UK Health Alliance on Climate Change
Carlos Augusto Monteiro, editor in chief, Revista de Saúde Pública (Brazil)
Ian Norman, editor in chief, International Journal of Nursing Studies
Kirsten Patrick, interim editor in chief, CMAJ (Canadian Medical Association Journal)
Nigel Praities, executive editor, Pharmaceutical Journal
Marcel GM Olde Rikkert, editor in chief, Dutch Journal of Medicine
Eric J. Rubin, editor in chief, NEJM (New England Journal of Medicine)
Peush Sahni, editor in chief, National Medical Journal of India
Richard Smith, chair, UK Health Alliance on Climate Change
Nicholas J. Talley, editor in chief, Medical Journal of Australia
Sue Turale, editor in chief, International Nursing Review
Damián Vázquez, editor in chief, Pan American Journal of Public Health


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