The calamity of a collapsing climate

The further from the data, the easier to convince ourselves we are turning the tide on climate change.

But we’re barely in the fight.

Earlier this year, world-renowned conservationist David Attenborough joined the social media platform Instagram on a mission to encourage the world to take serious collective action on unfolding ecological, biodiversity, and climate crises (1,2). All the while, it appears important actors in key political or industry positions are content making insignificantly small steps - superficially appearing responsible, but often undone entirely by harmful activities elsewhere, effectively greenwashing, distracting, and stalling (3,4,6). As a global society we are beginning to re-learn the painful lesson that individualistic self-interested activity enacted at-scale does not amount to the best result for all; a tragedy of the commons.

The false comfort offered by those declaring how much time we still have to act rings empty. Whilst avoidance of climatic catastrophe remains theoretically possible in a physical sense, this closing window of opportunity does not necessarily admit the current inertia present at sociological, cultural, infrastructure, and broad structural levels. As decisive, effective action on emissions is delayed by successive administrations, ‘kicking the can down the road’, the drawdown of emissions necessary to avoid catastrophic warming currently weaved into best-case climate models begins to look increasingly impossible (Figure 1 Andrew, R 2020; and Figure 2 Hausfather 2018).

Emissions budget from IPCC (Andrew, 2020) (18)

Modelling ‘pathways’ (SSPs) for possible futures based on different emissions scenarios (Hausfather and Peters, 2020) (19)

Collectively, we have neither the physical infrastructure nor emotional preparedness to undertake the swift transition to low-carbon living fundamental to avoiding the climatological and sociological feedback loops and so called tipping points that would push us over the edge. Posited in bludgeoningly on-the-nose terms by Roberts (2015), “Is it possible in models? Yes. Is it possible IRL? [in real life]”(7). As action is delayed, global warming progresses and worsens, such that ever more heroic efforts would be required to achieve even modest constraints on temperature increases or to protect remnant ecosystems (8). Each idle moment sees the metaphorical horse bolt further and further into what threatens to become the sunset of our planet.

Perhaps the most devastating characteristic of climate catastrophe is that it does not feel like a climate catastrophe, and is for the most part, something only revealed in data, charts, and graphics - debatably invisible in many ways (13). Shy of witnessing the terminal manifestations of climate disaster, all grim prognostic indicators of impending catastrophe are readily evidenced in crumbling ice sheets, mass coral bleaching, raging wildfires, far-reaching desertification, mass migration, and population displacement.

To understand this challenge we can look at why climate change is characterised as a ‘wicked problem’. That is one of unfathomable complexity, reaching across multiple sectors and industries, across countries and continents, one with no simple nor quick solutions, one not amenable to trial-and-error problem solving, characterised by inherent uncertainty and unknowns, one which is new and unique - without precedent and for which we cannot reason by analogy, one inextricably bound to other issues like ecosystem health, population health, and resource depletion, and one involving a plethora of stakeholders with irreconcilable differences of opinion on what can, or what should be done (9, 10). Further compounding this is the often overlooked challenge of managing simultaneous budgetary demands for climate change mitigation and adaptation alongside the high cost of increasingly frequent natural disasters and extreme weather events (11, 12). Each time a bushfire, flood, or heatwave should impact a community, scarce resources are necessarily diverted to protect life and limb, provide emergency relief, and ultimately rebuild - diminishing the resources that could be committed to climate mitigation and adaptation. This dilemma is not dissimilar to that faced by health systems who balance upstream investment in preventative medicine with downstream investment in emergency care. Buying into upstream care yields returns in preventing disease, but diverts resources that could otherwise treat current cases. This budgetary challenge is well illustrated in the Climate Adaptation webgame created by Miguel Padrinan (2015) <https://www.smhi.se/en/climate/education/adaptation-game-1.153788>, showing the impossible trade-offs that must be made managing a city’s future in the setting of a changing climate.

“The horizon for monetary policy extends out to 2-3 years. For financial stability it is a bit longer, but typically only to the outer boundaries of the credit cycle – about a decade. In other words, once climate change becomes a defining issue for financial stability, it may already be too late.“ - Mark Carney (5)

Effective policy necessitates action on disaster relief alongside adaptation and mitigation directed at the biggest drivers of carbon emissions. In greenwashing and tokenistic climate policy (3,4), the objective reality of rising atmospheric CO2 (14, 15), glacial melting (16), and an escalator of (species) extinction (17) stand as evidence to the contrary, and a testament to the failure of present day interventions.

What we require most is bold and brave leadership alongside financial commitment in both public and private sectors to bring into existence a de-carbonised future that supports human, ecosystem, and planetary health alike.

“Why is climate change faster than we are? The only possible answer is that we still lack strong leadership to take the bold decisions needed to put our economies and societies on the path of low-carbon growth and climate-resilience.” - U.N. Secretary-General Antonio Guterres (20)

T Michniewicz, 23/07/2021

Reference

1. Wood, V (2020) ‘David Attenborough says ‘humans have overrun the world’ as he issues climate warning. The Independent. 16 January. Available at: <https://www.independent.co.uk/news/science/david-attenborough-film-life-our-planet-release-climate-change-biodiversity-a9285431.html> [Accessed: 03/05/2021].

2. Gregory, A (2020) ‘‘Human beings have overrun the world’: David Attenborough calls for an end to waste in impassioned plea to address climate change’. The Independent. 19 April. Available at: <https://www.independent.co.uk/climate-change/news/david-attenborough-life-planet-new-documentary-bbc-climate-crisis-coronavirus-a9472946.html> [Accessed: 03/05/2021].

3. Cames, M, Harthan, R, Fussler, J, Lazarus, M, Lee, C, Erickson, P and Spalding-Fecher, R (2016) ‘How additional is the clean development mechanism?’. Institute for Applied Ecology. Available at: <https://ec.europa.eu/clima/sites/clima/files/ets/docs/clean_dev_mechanism_en.pdf> [Accessed: 03/05/2021].

4. Vetter, D (2021) ‘Oil and coal firms guilty of ‘great deception’ through greenwashing, says climate lawyers’. Forbes. 19th April. Available at: <https://www.forbes.com/sites/davidrvetter/2021/04/19/oil-and-coal-firms-guilty-of-great-deception-through-greenwashing-say-climate-lawyers/?sh=7b470d418bb0> [Accessed: 03/05/2021].

5. Carney, M (2015) ‘Breaking the tragedy of the horizon - climate change and financial stability’[speech]. Governor of the Bank of England and Chairman of the Financial Stability Board, at Lloyd’s of London, London. 29 September. Transcript available at: <https://www.bis.org/review/r151009a.pdf> [Accessed: 10/06/2021].

6. Barratt, L (2020) ‘BP spends ‘low carbon’ money on finding and using fossil fuels’[online]. Unearthed. 2nd August. Available at: <https://unearthed.greenpeace.org/2020/08/02/bp-low-carbon-venture-capital-spent-on-fossil-fuels/>

7. Roberts, D (2015) ‘The awful truth about climate change no one wants to admit’. Vox. 15th May. Available at: <https://www.vox.com/2015/5/15/8612113/truth-climate-change> [Accessed: 03/05/2021].

8. Thiagarajan, K (2020) ‘The divers rescuing a drowning island’ [online]. BBC: Future Planet. 3rd February. Available at: <https://www.bbc.com/future/article/20200131-the-divers-trying-to-save-indias-vaan-island-from-sinking> [Accessed: 03/05/2021].

9. Stang, G and Ujvari, B (2015) ‘Climate change as a ‘wicked problem’. European Union Institute for Security Studies. November. 52(1). Available at: <https://www.iss.europa.eu/sites/default/files/EUISSFiles/Alert_52_Climate_change.pdf> [Accessed: 03/05/2021].

10. World Bank (2014) ‘A wicked problem: controlling global climate change’. World Bank Group. 30th September. Available at: <https://www.worldbank.org/en/news/feature/2014/09/30/a-wicked-problem-controlling-global-climate-change> [Accessed: 03/05/2021].

11. Ebi, K, Vanos, J, Baldwin, J, Bell, J, Hondula, D, Errett, N, Hayes, K, Reid, C, Saha, S, Spector, J and Berry, P (2021) ‘Extreme weather and climate change: population health and health system implications’. Annual Review of Public Health. 42:293-315. DOI:10.1146/annurev-publhealth-012420-105026.

12. Trenberth, K, Fasullo, J and Shepherd, T (2015) ‘Attribution of climate extreme events’. Nature Climate Change. 5:725-730. Available at: <https://www.nature.com/articles/nclimate2657>

13. Rudiak-Gould, P (2013) ‘“We have seen it with our own eyes”: why we disagree about climate change visibility’. Weather, Climate, and Society. 5(2):120-132. DOI:10.1175/WCAS-D-12-00034.1

14. Stein, T (2021) ‘Despite pandemic shutdowns, carbon dioxide and methane surged in 2020’. NOAA Research News. 7th April. Oceanic and Atmospheric Research. Available at: <https://research.noaa.gov/article/ArtMID/587/ArticleID/2742/Despite-pandemic-shutdowns-carbon-dioxide-and-methane-surged-in-2020> [Accessed: 03/05/2021].

15. Carrington, D (2020) ‘Covid-19 lockdown will have ‘negligible’ impact on climate crisis - study’. The Guardian. 7th August. Available at: <https://www.theguardian.com/environment/2020/aug/07/covid-19-lockdown-will-have-negligible-impact-on-climate-crisis-study> [Accessed: 03/05/2021].

16. Hugonnet, R, McNabb, R, Berthier, E, Menounos, B, Nuth, C, Girod, L, Farinotti, D, Huss, M, Dussaillant, I, Brun, F and Kaab, A (2021) ‘Accelarated global glacier mass loss in the early twenty-first century'. Nature. 592;726-731. Available at: <https://www.nature.com/articles/s41586-021-03436-z> [Accessed: 03/05/2021].

17. Conniff, R (2018) ‘Escalator to extinction: how mountain species are imperiled by warming’. Yale Environment 360. 13th November. Available at: <https://e360.yale.edu/features/escalator-to-extinction-can-mountain-species-adapt-to-climate-change> [Accessed: 03/05/2021].

18. Andrew, R (2020) ‘Figures from the global carbon budget 2020’[webpage]. Available at: <https://folk.universitetetioslo.no/roberan/GCB2020.shtml> [Accessed: 03/05/2021].

19. Hausfather, Z and Peters, G (2020) ‘Emissions - the ‘business as usual’ story is misleading’[online]. Nature articles. 29th January. Available at: <https://www.nature.com/articles/d41586-020-00177-3> [Accessed: 03/05/2021].

20. Jordans, F (2018) ‘UN chief blasts lack of ‘strong leadership’ on climate’[online]. AP News. 26th September. Available at: <https://apnews.com/article/2cb2ab83b0314225bd1b75da02fd8de7> [Accessed: 03/05/2021].

Global Monitoring Laboratory (2021) ‘Trends in atmospheric carbon dioxide’[online]. Earth System Research Laboratories. Available at: <https://gml.noaa.gov/ccgg/trends/> [Accessed: 23/07/2021].

If we don't do this there will be nothing left to save

“Despite all our achievements, we owe our existence to a six-inch layer of topsoil and the fact that it rains”

Farm equipment association of Minnesota and South Dakota

We see ourselves as separate from nature; uniquely blessed, bestowed, or chanced with intelligence, reasoning, and communication skills that facilitate limitless mastery over our environment and circumstances through technology, ingenuity, and collaboration. The hubris with which our species carries this unfounded entitlement to shape, destroy, and re-mould the earth to suit our every desire, impulse, and vice is as arresting as it is disheartening. This mentality brazenly flaunts an inherited ability as though it were a heavenly-sanctioned right to power, granting the sweeping authority to expand, extract, and escape with impunity; like the haughty children of aristocrats who believe their blood bluer than that of anyone else.

In short, I worry our deliberate disconnectedness from nature fosters a mentality of devaluation and disregard; the baseless hubris of our species’ dominion providing the moral licensing for this disrespect; and, in a cycle of cruel irony, that this very degradation of the natural world diminishes and extinguishes the very character that makes it so valuable (1).

When the environment is seen only as an exploitable reserve comprised of constituent timber, coal, ore, and topsoil, then its exploitation is morally and legally sanctioned, and economically encouraged, resulting in the actual depreciation of the beauty, biodiversity, and climatologically functional of our shared environment.

And because of this I worry…

How can we demonstrate the value of the natural world and what is at stake to the disengaged or disinterested within this critical timeframe of our present anthropocene era?

How can we demonstrate its value, as more of it becomes more polluted and dismantled every moment?

At present, in my country of Australia, legislative foundations for environmental and biodiversity preservation are unable to provide the protection required to withstand emerging threats like climate change. Without reform, we may continue to see decline and extinction of our most threatened plants, animals, and ecosystems (2).

“We have this almost zombie-like system where the laws say you have to look after critically endangered, endangered and vulnerable species – and we know the community support protecting our threatened species – but when it comes to implementation, it’s like a giant machine that generates no action.” - Schneiders, L (5)

Present threats are so significant that even such species as the platypus, so unquestionably iconic to Australia’s identity and history in both Aboriginal and post-colonial times, is now placed at risk of extinction (3). This risk comes amid a broader context of advancing species extinction, with an unconscionable 34 Australian mammals now permanently wiped from planet earth (4), together colouring Australia with an international reputation for wildlife loss. Drivers such as land clearing for reasons like urban, forestry, and agricultural development (5,6), along with environmental degradation, invasive species (predators and weeds), fire, and climate change (6) are the chief factors behind species decline.

Furthermore, it is important to note that native plant species are in no way spared from this looming wave of extinction, with forces such as rapid urbanisation and land clearing (7) along with increasingly frequent bushfires (8) also representing present and large-scale threats for this kind of life.

In short, human activities continue to encroach on native ecosystems and consequently, much of the world’s biodiversity is being pushed into marked decline. On a global scale, massive human consumption and resource demands which far outstretches planetary boundaries is a key driver underscoring species extinction (9, 11). Additionally, global warming is already exerting a powerful effect on both plant and animal species adapted to an existence within a relatively stable and predictable climate. This is evidenced in phenomenon such as the ‘escalator to extinction’ wherein animals such as birds must ascend to live at higher and higher altitudes on an ever-warming planet, and ultimately risk losing all available habitat and becoming extinct (10).

At a global level, current measures are woefully inadequate with recent reports demonstrating a failure of countries to fully meet a single one of the 20 targets that were set forth in The United Nations Convention on Biological Diversity in Aichi, Japan in 2010 (11). Far from E. O. Wilson’s vision of a Half Earth, a paltry 15% of land and freshwater, and around 7% of ocean (11,12) is currently considered protected (made a qualifying statement as the very definition of ‘protected’ and its enforcement are open to interpretation).

“The CBD goals and targets are very biodiversity-focused, but they’re not necessarily owned by the agencies that deal with the drivers and pressures” - David Obura

So long as current human activities proceed without radical change, ecosystem loss and degradation and species extinction will follow, and the capacity for our environment to provide clean water, fertile soil, inspiration, and joy, will disappear along with it.

“They say pain makes people change. I can attest it is true. The pain and loss of this year has tested my personal resilience and reshaped my beliefs.

Last year, had I sat before you, I would have constructed a different statement. I would have urged Australia to commit to the important international targets of Paris and CBD[…] I sit here today prepared to say in public it is too late. Too late to continue as we are. Too late to continue with our old plans. And, I am done.

[…] I believed it before, but I know it now. We have run out of time. Climate change is already with us.“

- Dr Margi Prideaux (12)

T Michniewicz, 04/07/2021

Reference

1. Alberro, H (2019) ‘Humanity and nature are not separate - we must see them as one to fix the climate crisis’[online]. The Conversation. 18 September. Available at: <https://theconversation.com/humanity-and-nature-are-not-separate-we-must-see-them-as-one-to-fix-the-climate-crisis-122110> [Accessed: 26/04/2021].

2. Walmsley, R (2021) ‘Trajectory unsustainable: 10 key findings of the EPBC Act review final report’. Environmental Defenders Office. 4 February. Available at: <https://www.edo.org.au/2021/02/04/trajectory-unsustainable-10-key-findings-of-the-epbc-act-review-final-report/?fbclid=IwAR0yNPpIXKPsYH7Kje2gkS1eVvHIZmBYMoeme8rSBU-Lbj0PwEwsPcOn3i8> [Accessed: 09/06/2021].

3. Bino, G, Kingsford, R and Wintle, B (2020) ‘A stitch in time -synergistic impacts to platypus metapopulation extinction risk’. Biological Conservation. 242:108399. DOI:10.1016/j.bicon.2019.108399.

4. Foley, M (2021) ‘Australia’s share of extinct animals rises as list of the lost updated’[online]. Sydney Morning Herald. 3 March. Available at: <https://www.smh.com.au/politics/federal/australia-s-climbs-the-list-of-wildlife-extinction-hotspots-20210303-p577dy.html> [Accessed: 10/06/2021].

5. Houston, D (2019) ‘Planning in the shadow of extinction: Carnaby’s Black cockatoos and urban development in Perth, Australia. Contemporary Social Science: Journal of the Academy of Social Sciences. 16(1). DOI:10.1080/21582041.2019.1660909.

6.Geyle, H, Tingley, R, Amey, A, Cogger, H, Couper, P, Cowan, M, Craig, M, Doughty, P, Driscoll, D, Ellis, R, Emery, J, Fenner, A, Gardner, M, Garnett, S, Gillespie, G, Greenlees, M, Hoskin, C, Keogh, S, Lloyd, R, Melville, J, McDonald, P, Michael, D, Mitchell, N, Sanderson, C, Shea, G, Sumner, J, Wapstra, E, Woinarski, J and Chapple, D (2021) ‘Reptiles on the brink: identifying the Australian terrestrial snake and lizard species most at risk of extinction’. Pacific Conservation Biology. 27:3-12. DOI:10.1071/PC20033.

7. Blair, J and Osmond, P (2020) ‘Employing green roofs to support endangered plant species: the Eastern suburbs banksia scrub in Australia’. Open Journal of Ecology. 10(3):99205. DOI:10.4236/oje.2020.103009.

8. Gallagher, R, Allen, S, Mackenzie, B, Yates, C, Gosper, C, Keith, D, Merow, C, White, M, Wenk, E, Maitner, B, He, K, Adams, V and Auld, T (2021) ‘High fire frequency and the impact of the 2019-2020 megafires on Australian plant diversity’. Diversity and Distributions. DOI:10.1111/ddi.13265.

9. Jones, J (2020) ‘‘Extinction: the facts’: Attenborough’s new documentary is surprisingly radical’. The Conversation. 15th September. Available at: <https://theconversation.com/extinction-the-facts-attenboroughs-new-documentary-is-surprisingly-radical-146127> [Accessed: 03/05/2021].

10. Conniff, R (2018) ‘Escalator to extinction: how mountain species are imperiled by warming’. Yale Environment 360. 13th November. Available at: <https://e360.yale.edu/features/escalator-to-extinction-can-mountain-species-adapt-to-climate-change> [Accessed: 03/05/2021].

11. Zimmer, K (2020) ‘The world missed a critical deadline to safeguard biodiversity, UN report says’. National Geographic Science News. 15th September. Available at: <https://www.nationalgeographic.com/science/article/world-missed-critical-deadline-to-safeguard-biodiversity-un-report?cmpid=org=ngp::mc=social::src=facebook::cmp=editorial::add=fb20200915science-UNbiodiversitydeadline::rid=&sf237776923=1&fbclid=IwAR0jkq4K5GeRApgwmWftt8M-Tcw3oDNyALQdWmsGh0aOKnYE82k4LHJmem0>

12. Giakoumi, S, McGowan, J, Mills, M, Beger, M, Bustamante, R, Charles, A, Christie, P, Fox, M, Garcia-Borboroglu, P, Gelcich, S, Guidetti, P, Mackelworth, P, Maina, J, McCook, L, Micheli, F, Morgan, L, Mumby, P, Reyes, L, White, A, Grorud-Colvert, K and Possingham, H (2018) ‘Revisiting “Succes” and “Failure” of Marine Protected Areas: A conservation scientist perspective”. Frontiers in Marine Science. 29th June. DOI:10.3389/fmars.2018.00223.

13. Prideaux, M (2020) ‘Statement to the Senate Inquiry into Australia’s faunal extinction crisis’. Available at: <http://wildpolitics.co/wp-content/uploads/2020/10/Prideaux-M_SpeciesExtinctionInquiryStatement_ONLINE20200930.pdf> [Accessed: 11/06/2021].

uiImage reference: Global Monitoring Laboratory (2021) ‘Trends in atmospheric carbon dioxide’[online]. Earth System Research Laboratories. Available at: <https://www.esrl.noaa.gov/gmd/ccgg/trends/> [Accessed: 26/04/2021].

Reflections on COVID-19

In such unsociable times as these with the rapid emergence of a global pandemic the focus of political and public concern has necessarily shifted towards both public health and economic implications of the unfolding catastrophe of COVID-19. Infectious disease outbreaks are not a new phenomenon as the Great Plague and Spanish Flu would attest, and a state of vigilance towards risks from emerging pathogens with pandemic capacity has been urged by public health authorities long before COVID-19 (1,2). It is a fallacy to believe that the SARS-CoV-2 virus is unique in the infectious diseases world, and it is the case that a legion of relatively terrifying zoonotic and animal vector-borne diseases lay smouldering beneath the surface at any time; from nipah to marburg, ebola to trypanosomiasis, yersinia to hantavirus. So much so, it is estimated that around 60% of human infectious diseases are zoonotic in origin (3), as are the majority of new and emerging infectious diseases (4). A common thread tying infectious disease outbreaks with conservationism (5) is the overwhelmingly exploitative relationship between humans and nature - the latter often moulded, wrangled, and twisted into grotesque subservience of the former without regard for consequences. Increasingly large swathes of wilderness and native vegetation are cleared to make way for increasingly intense and large-scale agricultural activities including propagation of monocultures for animal feed (6,7), and the associated raising of livestock for meat. The types of intensive, wasteful, unsustainable farming practices undertaken set the stage for the emergence of infectious diseases due to fundamental changes in the animal-human interface (8). In overcrowded factory farms densely packed with unwell animals and with necessarily limited ventilation, the capacity for biocontainment is incredibly limited, and any pathogens can rapidly multiply and spread (8).

The plethora of impacts including habitat loss, topsoil degradation, agrochemical runoff, potable water depletion, and infectious disease outbreaks as stated, must always be balanced with the need to feed burgeoning populations the world over, and returning to the antiquated low-yield agricultural practices would almost certainly prove unviable. Here we must be reminded of the historical context of our current food production systems and the Green Revolution of the ‘50s and ‘60s that saw incredible advancements in the production and yield of staple crops like rice and wheat. Leaps forward in agricultural practices, improved crop varieties, fertilisation, and irrigation strategies saw huge portions of people lifted out of dire poverty and achieve the food security necessary for populations to grow and thrive, but this both regrettably and predictably came at significant environmental cost (9). If one point is clear above all, it is that our food systems are intrinsically linked with both human and planetary health; any equation that considers benefits in one sector must not discount costs in another.

Following on from such concerns around the interconnectedness of human health, animal health, and environmental health we see the emergence of collaborative approaches like One Health - as promising as it is ambitious for bringing about intersectoral action, breaking down subspecialised and introverted silo thinking, and promoting unified, multilateral approaches to the so called wicked problems of our time (10). One Health as a broad and at times nebulous concept has gained specific popularity in approaching zoonotic diseases, with examples of integrated veterinary science, animal disease surveillance systems, occupational health, and public health services creating tightly cooperative networks able to quickly communicate and respond to identified risks (11,12). This kind of framework that brings together different disciplines that often operate in isolation despite obvious overlap of direct and indirect impacts on one another is therefore a timely necessity in a globalised world. In some respects, it is disquieting to think that this kind of cross-discipline communication and collaboration didn’t much evolve or emerge of its own accord, especially when confronting challenges like antimicrobial resistance [AMR], occupational health, and infectious diseases.

One Health is not without its limitations, and a valid criticism raised by Herten and colleagues is of the anthropocentric tendencies that unfortunately colour the interpretations of One Health’s core principles. As the authors importantly seek to ask, “Is it really about equally improving the health of humans, animals and the environment … or is it ultimately just public health that counts?”(14). A truly conscious and committed approach to One Health requires the creation of conditions where animals are not simply seen as supermarket meat with extra steps. Considering the impact of COVID-19 on animal farming industry, with the slaughter of hundreds of thousands of chickens, mink, and other livestock across the globe (15, 16, 17), it must be recognised that present conditions, in recurrent and empirically demonstrable fashion, place no intrinsic value on the life of such animals. As they stand, stablished livestock systems will remain exquisitely vulnerable to such supply chain interruptions, broader economic conditions, and environmental or climatic phenomenon, and any subsequent conflict between financial sacrifice and animal welfare will invariably be resolved in the predictable manner. I have always been particularly captured by the example of cognitive dissonance in a society that simultaneously sanctions the production of foie gras whilst erecting signs in public parks advising not to feed bread to ducks as it is bad for their health. At a broader level, the tokenistic respect we so righteously profess to hold towards our animal counterparts in the public sphere is at jarring odds with the cold indifference paid to the unfortunate majority in factory farms, in polluted and degraded habitat, or formerly inhabiting land cleared for agriculture and housing developments.

In every instance the natural environment, from which we have collectively become so divorced, cannot be deceived, circumvented, cheated, or ignored without repercussions. The 2019 summer bushfires and COVID-19 crisis have collectively made it apparent that no amount of purported mastery humans hold over the natural world will protect us from the impacts of climate change and ecological destruction. Regardless of their uptake and implementation in present day earth, the increasingly widespread adoption of approaches like One Health highlights the interconnectedness of food, environments, agriculture, livestock, working and living conditions with human health and forces us to reflect on the intersectoral implications of our choices as a complete equation. We are forced to see the entire landscape in which our food is produced, our land utilised, and our environment damaged by current practices - and start to envisage a better, healthier, and fairer alternative. We are blessed to be at a juncture in human history when such change is possible but with the weight of preconditions favouring the status quo, agricultural health reform will not occur passively.

T Michniewicz, 10/09/2020

Reference

1. ‘Epidemiological transition’ (2018)Youtube [video], Global Health with Greg Martin. Available at: <https://www.youtube.com/watch?v=nt3d4oMmByI&feature=youtu.be&t=266&fbclid=IwAR0twNNbPbcrkPRHNswr-s6iCdf0zUhKFCuLRdU8BPDZzLJkoJaA4ItIZ98> [Accessed: 04/08/2020].

2. Morse, S, Mazet, J, Woolhouse, M, Parrish, C, Carroll, D, Karesh, W, Zambrana-Torrelio, C, Lipkin, W and Daszak, P (2012) ‘Prediction and prevention of the next pandemic zoonosis’. The Lancet. 380(9857):1956-1965. DOI: 10.1016/S0140-6736(12)61684-5.

3. Grace, D, Mutua, F, Ochungo, P, Kruska, R, Jones, K, Brierley, L, Lapar, L, Said, M, Herrero, M, Phuc, P, Thao, N, Akuku, I and Ogutu, F (2012) ‘Mapping of poverty and likely zoonoses hotspots’. Zoonoses Project 4. Report to the UK Department for International Development. Nairobi, Kenya. Available at: <https://hdl.handle.net/10568/21161> [Accessed: 04/07/2020].

4. Thornton, J (2017) ‘Where humans and animals collide: emerging infections and newfound resistance’ [online]. London School of Hygiene and Tropical Medicine. Available at: <https://www.lshtm.ac.uk/research/research-action/features/where-humans-and-animals-collide-emerging-infections-and-newfound> [Accessed: 04/07/2020].

5. Carrington, D (2020) ‘Pandemics result from destruction of nature, say UN and WHO’. The Guardian [online]. 17 June. Available at: <https://www.theguardian.com/world/2020/jun/17/pandemics-destruction-nature-un-who-legislation-trade-green-recovery> [Accessed: 04/07/2020].

6. Smithers, R (2017) ‘Vast animal-feed crops to satisfy our meat needs are destroying planet’. The Guardian. 5 October. Available at: <https://www.theguardian.com/environment/2017/oct/05/vast-animal-feed-crops-meat-needs-destroying-plane> [Accessed 08/08/2020].

7. Neslen, A (2017) ‘Burger King animal feed sourced from deforested lands in Brazil and Bolivia’. The Guardian. 21 August. Available at: <https://www.theguardian.com/environment/2017/mar/01/burger-king-animal-feed-sourced-from-deforested-lands-in-brazil-and-bolivia> [Accessed 08/08/2020].

8. Graham, J, Leibler, J, Price, L, Otte, J, Pfeiffer, D, Tiensin, T and Silbergeld, E (2008) ‘The animal-human interface and infectious disease in industrial food animal production: rethinking biosecurity and biocontainment’. Public Health Reports. 123(3):282-299. DOI: 10.1177/003335490812300309.

9. International Food Policy Research Institute [IFPRI] (2002) ‘Green revolution: curse or blessing’. Washington, DC. Available at:<http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/64639/filename/64640.pdf> [Accessed 08/08/2020].

10. Kumlien, A and Coughlan, P (2018) ‘Wicked problems and how to solve them’. The Conversation. 18 October. Available at: <https://theconversation.com/wicked-problems-and-how-to-solve-them-100047> [Accessed 08/08/2020].

11. Rabozzi, G, Bonizzi, L, Crespi, E, Somaruga, C, Sokooti, M, Tabibi, R, Vellere, F, Brambilla, G and Colosio, C (2012) ‘Emerging zoonoses: the “one health approach”. Safety and Health at Work. 3(1):77-83. DOI: 10.5491/SHAW.2012.3.1.77.

12. Mackenzie, J and Jeggo, M (2019) ‘The one health approach - why is it so important?’. Tropical Medicine and Infectious Disease. 4(2):88. DOI:10.3390/tropicalmed4020088.

13. Centers for Disease Control and Prevention [CDC] (2020) ‘One health basics’[webpage]. Available at: <https://www.cdc.gov/onehealth/basics/index.html> [Accessed 08/08/2020].

14. Herten, J, Bovenkerk, B and Verweij, M (2018) ‘One health as a moral dilemma: towards a socially responsible zoonotic disease control’. Zoonoses and Public Health. 66(1). DOI: 10.1111/zph.12536.

15. Kevany, S (2020) ‘Hundreds of thousands of chickens to be culled after covid disruption’[online]. The Guardian. 31 August. Available at: <https://www.theguardian.com/environment/2020/aug/31/hundreds-of-thousands-of-chickens-to-be-culled-after-covid-disruption>

16. BBC News (2020) ‘Coronavirus: Spain orders culling of almost 100,000 mink’[online]. BBC News Online. 17 July. Available at: <https://www.bbc.com/news/world-europe-53439263>

17. Kevany, S (2020) ‘Millions of US farm animals to be culled by suffocation, drowning and shooting’ [online]. The Guardian. 19 May. Available at: <https://www.theguardian.com/environment/2020/may/19/millions-of-us-farm-animals-to-be-culled-by-suffocation-drowning-and-shooting-coronavirus>

The Diverse Effects of Climate Change

Introduction

This last month has represented an important period for those intimately and casually following the ongoing progress on climate change, with notable events such as COP 25 drawing to a close in Madrid, the publication of landmark papers like the 2019 report of The Lancet Countdown on Health and Climate Change, and powerful focusing events such as the devastating, expansive, and ongoing Australian bushfires. In this article I will cover what I feel as important themes discussed in the aforementioned Lancet report that directly link climate change to population health, discuss the relevance of trajectories and forecasts of the fossil fuel industry, the present imbalance of native forest conservation and deforestation, and contextualise the impacts of the current Australian bushfires in this complex narrative.

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Climate change and environmental degradation are leading to an unpredictable and diverse array of health impacts on populations across the globe. So much so, we have seen highly prominent health authorities and professional medical associations and colleges come forward to acknowledge the profound challenge and need for immediate action on this unfolding public health emergency.

“One fact is clear and can’t be ignored any longer: climate change is a severe health risk and business as usual is not on.”

— MJA Editor in Chief Dr Nicholas J Talley (1)

“The climate emergency that we are facing today is the most important existential crisis facing the human species and since medicine is all about protecting and strengthening the human species, it should be absolutely foundational to the practice of what we do every single day.”

— Dr Richard Horton, Editor of The Lancet (2)

“Climate change is a health emergency, RACGP declares”

— Royal Australian College of General Practitioners (3)

“Anthropogenic climate change is a global public health emergency.”

— The Royal Australasian College of Physicians Climate Change and Health Position Statement (4)

“… it’s simply not sustainable and we strongly require that the governments to implement a national strategy on climate health and wellbeing, to do a risk analysis, and have a whole of society change.”

— Dr John Bonning, President of the Australasian College of Emergency Medicine (5)

“The Federal Council recognises climate change as a health emergency, with clear scientific evidence indicating severe impacts for our patients and communities now and into the future.”

— Australian Medical Association (6)

Such authoritative declarations from as historically scrupulous health entities as these are unprecedented, and convey the gravity of unfolding threats to human health we are now witnessing. Conceptually, we may even go as far as considering climate change a kind of globally-active and inequitably-distributed social determinant of health (7) acting at a societal level, and one which is, at least in part and during a rapidly closing time window, modifiable by human behaviour. Putting aside impacts outside of health and those mediated through indirect mechanisms, immediate consequences of a deteriorating climate on human health are already apparent. As mentioned, one highly anticipated report released last month was The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate (8). This landmark publication identifies key ways in which climate change is, and will continue to, impact human health across the globe. As the authors summarise “The life of every child born today will be profoundly affected by climate change. Without accelerated intervention, this new era will come to define the health of people at every stage of their lives” (8). Whilst amounting to a profoundly sobering read, this report identifies key mechanisms explaining the health impacts of climate change; out of which, three domains strike me as especially relevant to current circumstances: increased heatwave exposures, increased frequency and severity of extreme weather conditions, and an increasing burden of deaths attributable to ambient fine particulate matter air pollution.

Heat Waves

Global trends are revealing ever-increasing exposure to extremes of heat affecting some of the most vulnerable populations of the elderly, the young, and those with existing medical ailments rendering them exceptionally susceptible to adverse environmental conditions. Remarkably, 2018 saw a record 220 million heatwave exposures above the 1986-2005 baseline for those aged over 65, again exceeding a previous record set just in 2015, itself, 209 million exposures above the 1986-2005 average (8). The 2003 heatwave which swept over Western Europe for instance was calculated to have resulted in over 70,000 excess deaths (9), and the 2010 heatwave affecting Eastern Europe estimated to have resulted in around 55,000 attributable deaths (10). There can be little doubt over the tangible impacts of a changing climate on extreme temperatures in such a continent as Australia, enduring back-to-back record-breaking temperatures with astonishing frequency (11, 12, 13). When the mercury soars to such dizzying heights, outdoor labourers suffer, productivity plummets, emergency departments become inundated with heat stress and heat stroke, and existing renal and cardiac pathologies are exacerbated (8, 14). Alongside physical ailments, population mental health does not escape unscathed, with demonstrated associations between heatwave conditions and intimate partner violence (15), collective violence (16), and mental health hospital admissions (17). Thus, from both a health service demand and labour capacity point of view, heatwaves constitute an incredibly expensive weather event, and represent a phenomenon that is only set to increase in frequency during the foreseeable future.

[Image credit: Bureau of Meteorology, Australia. 2 December 2019. (18)]

Extreme Weather Conditions

Across the globe, human health is affected by the proximate and distal effects of increasing extreme weather events, fuelled by climate change, rising temperatures, and derangement of longstanding climatic patterns. Weather disasters, wildfires, flooding and storms, and drought are examples of key domains that pose a direct threat to public health, economic, and social stability in both high income and low-income countries. As the year 2019 comes to a close, it is worth reflecting on the decade of “…exceptional global heat and high-impact weather” (19) and the trends of weather extremes shaping societies across the globe. Broadly, meteorological, hydrological, and climatological events have been increasing in number and intensity across Europe (20) manifesting in such diverse events as the floods of northern Italy, France, and Switzerland of the year 2000, the Kyrill winter storm of 2007, and many wildfires of recent years (20, 21). As described by Watts et al. in the Lancet Countdown, to take wildfires alone, health effects extend from direct morbidity and mortality to exacerbation of chronic respiratory symptoms, ecological harms, and impose an economic burden per person affected exceeding that of both earthquakes and floods (8). As a risk to premature mortality, prolonged droughts remain one of the most threatening possibilities, and a topic worthy of textbook-length discussion in their own right. Present crises in Zimbabwe (22) and countries of the Greater Horn of Africa (23) begin to illustrate this, represent the devastating impacts when droughts complicate existing paradigms of socioeconomic disadvantage and political instability. Complex interplays of violent conflicts, back-to-back droughts and floods, and the global climate crisis can be thus seen acting together in dreadful symphony, amounting to a perfect storm for the precipitation of humanitarian crises (23). In exploration of flooding and storm related disasters, the Lancet Countdown report identifies as one of their headline findings a statistically significant long-term upward trend in flood-related and storm-related disasters in Africa, Asia, and the Americas since 1990 (8). Troubling as this is, their analysis is fortunately inclusive of addressing the relative stability of lethality observed across these events (ie. fewer people dying than might have been expected), proposing a very plausible explanation that this was principally because of enhanced disaster preparedness, reinforcing the message that for any and all possible future climatic trajectories, adaptation and disaster planning will be absolutely integral to risk management and catastrophe minimisation (24).

As succinctly put in the United Nations Adaptation Gap Report, “Climate change most often acts as a multiplier of global health threats, compounding many of the health issues communities already face, disproportionately affecting the health of vulnerable groups, particularly in lower income countries, and exacerbating inequalities.”(25).

Air Pollution

Predictably, the burning of oil, natural gas, and coal on scales hitherto unfathomable and ubiquitous deployment of gasoline- petrol- and diesel-engined vehicles in cities and towns has proved highly consequential for air quality and human health. Effects of exposure to poor air quality accumulate over a lifetime from our first breath, with the report of The Lancet Countdown offering a figure of 2.9 million global deaths attributable to ambient fine particulate matter (8), and the Global Burden of Disease study proposing 3.4 million premature deaths in 2017 as a result of outdoor air pollution on the whole (26). Experientially, in undertaking cadaveric anatomy lab dissection of different human lung tissue examples, even the lung surfaces of lifelong non-smokers often takes on a mossy and mottled black appearance for those exposed to high levels of soot and air pollution in urbanised cities. For the inquisitive, this is a well-defined phenomenon known as anthracosis (27) and as disturbing an occurrence as this is, it does demonstrate a satisfyingly logical causal pathway between a proposed aetiological mechanism and gross anatomical changes observable to the naked eye (28). Exposure to ambient air pollution including fine particulate matter (PM2.5) [particles with an aerodynamic diameter below 2.5 micrometres] is described by the Lancet countdown report authors as constituting “…the largest global environmental risk factor for premature mortality” (8), further noting that “More than 90% of children are exposed to PM2.5 concentrations that are above the WHO guidelines” (8). The situation is understandably worst for cities with 83% of cities exceeding WHO recommendations for safe thresholds of air pollution (8), readily leading us to conjure up images of such smog choked cities as Kanpur, India; Doha, Qatar; and Beijing, China.

The health implications of air pollution are already here, and bushfires such as those currently ravaging the east coast of Australia are an important part of this. Exacerbation of respiratory illnesses and increased hospital presentations for conditions like asthma are an immediately obvious example of this, becoming especially important during times of high atmospheric PM10 concentrations [fine particles 10 microns or less] (29). It should be noted too that the health burden of bushfire and landscape related smoke is applicable for both that caused by hazard reduction burning aw well as wildfires - anything that throws particulate matter into the air. Recent investigation by Joshua Horsley and colleagues (30) illustrated just some of the health domains affected by landscape fire-related fine-particulate air pollution (PM2.5) for the Sydney area between 2001 and 2013, with premature death, cardiovascular hospitalisations, and respiratory hospitalisations attributable to days of elevated PM2.5 levels (30). In an excellent and widely disseminated study by Wei and colleagues (31), the confronting array of known associations between fine particulate matter air pollution [PM2.5] and health outcomes is discussed, including new findings of an association with septicaemia, urinary tract infections, and skin and subcutaneous tissue infections (31). In diligent display of rigorous methodology, the authors did not neglect to apply a Bonferroni correction for multiple comparisons and dutifully described study limitations (see cited paper for further detail). Regrettably, Australia’s landscape and native vegetation is highly flammable and in particular locations, conditioned by frequent fires, making smoke exposure an inevitable and increasingly important environmental risk to health. Understanding health consequences and firming mitigation strategies across disciplines and sectors will be essential to protection of public health from fire-related air pollution (32) and ultimately on a global scale, from all causes of air pollution including the combustion of fossil fuels.

It follows that the report of The Lancet Countdown asserts that coal phase-out is essential both to mitigate climate change, and to reduce air pollution related morbidity and mortality. Despite recommendations, we remain intimately dependent on fossil fuels for power, with coal continuing as the largest source of total global electricity production (38.3%) followed by gas (22.8%), with renewables (hydro, wind, solar) accounting for around 23% (2017 figures)(101). For total primary energy supply the picture is similarly fossil fuel-centric (2017 figures): oil 31.8%, coal 27.1%, natural gas 22.2%, and renewables (wind, solar, etc.) just 1.8% (33). For a highly accessible in-depth analysis of world energy production Our World In Data is an excellent resource (34).

A fossil fuel forecast

Our ongoing attachment to fossil fuels despite an excess of high-quality evidence indicating the perilous necessity for a rapid transition to renewables cannot be seen as originating from any place of honest self-appraisal. The apparent contradiction of these two realities is jarring: the high-impact pleading of scientific, health, and global development organisations to reduce emissions and the ongoing investment in existing and new fossil fuel projects (notably controversial, publicly opposed, high-profile investments of Adani’s Carmichael coal mine (35) and Equinor’s offshore oil drilling operations (36)).

“The belief that the profitability of an activity is a measure of its social legitimacy...”

— John Kay (37)

Although the fossil fuel industry is inconceivably profitable for the select few industry magnates who manoeuvred into powerful positions of ruthless resource capitalisation, the economic and health benefits of a green future are both highly favourable and readily quantifiable. Audacious investment in wind and solar by South Australia for instance has already demonstrated its indisputable economic value, leading to achievement of the lowest average wholesale price for power across the national grid (38). The health co-benefits of reducing greenhouse gas emissions in line with the Paris climate agreement have been assessed as substantially outweighing costs, with analysis suggesting a highly favourable ratio of health co-benefit to mitigation cost ranging from 1.4 to 2.45 (39). Furthermore, this concern over dire implications of a future defined by climate change transcends sectors, evident in the eye watering numbers tossed about by global banks such as HSBC, warning of a US $10 trillion per year climate health bill (40). Global existential-threat aside, investment in emissions reductions makes economic sense.

Unfortunately, at the moment spaceship earth seems stubbornly fixed on a trajectory of climate catastrophe. Pathways reflecting current Nationally Determined Contributions [NDCs] imply global warming of about 3°C by 2100, with warming continuing afterwards (41). If NDC ambitions are not increased before 2030, a temperature rise exceeding the 1.5°C goal can no longer be avoided (41). In numbers, current NDCs are estimated to lower global emissions in 2030 by up to 6 GtCO2e when compared to a ‘do nothing’ continuation of current policy. But as the emissions gap report assessment shows, this original level of ambition needs to be roughly tripled for us to achieve even the modest 2°C scenario, and increased roughly fivefold for the 1.5°C scenario (41). Current measures are not enough, the game is already far into injury time, and the outlook is bleak.

The historical backing of the coal industry (42) and ongoing level of bipartisan support pledged for the fossil fuel industry by both Labor and Liberal parties (43, 44) represents a concerning disconnect from current public opinion on the situational urgency - recent research finding a majority of surveyed respondents (64%) feeling Australia should have a national target for zero emissions by 2050 (45).

And this status quo is not one which is expected to change, with fossil fuel industry giants such as ExxonMobil and BP anticipating global energy demands to increase ‘significantly’ (46) in coming years and that supply will likely remain entirely coal, oil, and natural gas centric for at least the next 20 years (46, 47). There may be legitimate reasons to remain hesitant about buying into such forecasts for an uncertain future none the least relating to the inherent conflict of interest held by the fossil fuel industry for making projections around essentially the long-term sale of their product, and the historical accuracy of energy use and fossil fuel projections has not been without limitations (48, 49). And whilst we must therefore take such forecasts with a grain of caution, the fossil fuel industry has proved itself troublingly prescient in its predictions of climate change as an unfolding disaster (50, 51).

“We were excellent scientists.”

— Martin Hoffert, former scientist consultant for Exxon Research (52)

And they are not alone in the business of making prophetic statements on an this nigh-on-apocalyptic future, the Sydney Morning Herald publicising the increased bushfire risk from a changing climate in 1996:

[Woodford, 1996. (99)]

A summer of bushfires

As the summer season deepens, the east coast of Australia continues to endure relentless bushfires of biblical proportions. The scale of destruction has been difficult to grasp even among those living in fire-affected regions, their reach most illuminating when overlaid on major cities around the world (53). If not traumatic enough, this last month has been characterised by sunless black skies, rainless aridity (54), and chokingly acrid air – suitably characterised in mainstream media as ‘apocalyptic’ (55) and tantamount to smoking ‘34 cigarettes a day’ (56). Like many of my friends and colleagues, a day does not go by without anxiously checking the now-universally-recognisable Rural Fire Service ‘Fires Near Me’ interactive map demarcating fires and listing alerts across the state (57).

The now iconic ‘Fires near me’ interactive map. Image credit: screenshot from RFS Fires Near Me [webpage] at 17:20pm AEST on 22/12/2019. (57)]

The smoke output from these fires alone has been truly frightening to witness from the ground, with pyrocumulonimbus clouds large enough to risk creating their own thunderstorms (58), and a smoke readily visible from space (59, 60).

[Michniewicz, 2019]

[Image credit: sourced from reproduction of NASA original imagery at euronews.com. Imagery originally obtained by Aqua MODIS data with NASA Worldview, processed by Pierre Markuse on 15/11/19. (59)]

[Image credit: NASA Earth Observatory, 19/11/2019. (61)]

If not confronting enough already, the smoke trail from the east coast fires has been large enough to span the southern Pacific Ocean, reaching as far as South America and even into the Atlantic Ocean (59).

The implications of such persistently poor air quality related to the bushfires are immediately tangible to most of the state, with high-end hardware store particle dust masks now a common sight on the street, with ash and charred leaves blanketing lawns, cars, and gardens many kilometres away from the fire front.

In this context, it is not uncommon to hear sentiments lamenting the manner in which honest public discourse often seems stymied by deliberate actions of political and business leaders with vested interests in preserving a destructive status quo, coupled with bizarre attacks on climate science (62, 63), heavy-handed targeted crackdowns on climate protesters (64, 65), stifling of open discourse (66, 67), misleading claims of senior members of government (62), and a public discourse derailed at every turn by quasi-philosophical debate dragged down to trivial minutiae of magnitudes and mechanisms and staunch rejection of attributing any distal or downstream effects to climate change, when taken together, serving only to stall action and legitimise political inertia.

Though debate over the relative degree to which the bushfire crisis is attributable to climate change rages on in public discourse, press conferences, and mainstream media, there can be little doubt that whilst not ‘causing’ bushfires, climate change has created the fertile soil in which they can thrive – extremes of heat along with protracted hot and dry conditions for more of the year (68). Unsurprisingly, this year more than 95% of Australia had spring accumulated Forest Fire Danger Index values above average, exacerbated by widespread rainfall deficiencies and hydrological drought (69). This link between ‘catastrophic’ bushfire risks (70, 71) and climate change has not been lost on those observant to the changing world around us, a connection felt as most painfully real to those living in fire-ravaged communities such as Glen Innes (72).

“We’ve not had situations like that. Fifty years ago, this would never happen”, “… it is a scientific fact that we are going through climate change.”

— Carol Sparks, Mayor of Glen Innes (73)

[Australian Bureau of Meteorology Climate change – trends and extremes. 2019. (74)]

The extremes of weather driven by climate change that are setting the scene for bushfires to take hold as evidenced by the back-to-back record-breaking temperatures currently gripping the country (the national average temperature record set in 2013 of 40.3°C surpassed with 40.7°C and a day later, once again at 41.9°C (75). Though evidence of public discontent continues in Australia towards what is seen as political resistance to climate action in Canberra, the ripples from the mixed-messages and behaviour observed as incongruent with high quality climate-science continue to travel across the Pacific where the discombobulating contradiction of such apparent inaction during a bushfire crisis is not lost (76, 77). With no end in sight for the current bushfires the nation continues to pray for rain, and to hope that by the time the fires are finally extinguished, that there is still something left.

No forests left to burn

With somewhere from 2.7 to 3.6 million hectares of land already burnt (53, 78), an area of land greater than Wales (79), it is surprising any bushland remains yet untouched by this unprecedented barrage of bushfires. In numbers, this constitutes an area equivalent to 2.3% of Australia’s 132 million hectares of ‘native forest’ land (80). Importantly, Australia is covered by only a small forest area relative to its land-mass at around 16.2% (81) – 17% (80, 82), representing 3% of the world’s forest area (80, 82). As a starting point, this isn’t all that much to work with considering the carbon sink capacity required to mop up the 558.4 millions of tonnes of CO2 Australia spewed into the air during 2018 (83). To be more precise, from 2011 to 2016 the land-use, land-use change, and forestry sector was estimated to have sequestered only around 3.5% CO2 equivalent of Australia’s total anthropogenic greenhouse gas emissions for this period (82). Whilst the amount of carbon stored in all Australian forests has fluctuated year-to-year, the absolute value remains relatively unchanged from over a decade ago: 21,961 million tonnes of carbon in 2001, now slightly reduced at 21,949 million tonnes in 2016 (82). Critically, this previous native forest land acting as carbon sink, ecosystem, habitat, and area of breathtaking scenic value (to name offensively few of the roles it plays), is being reduced by the day due to voracious logging, thinning, and deforestation. Of Australia’s 769 202 000 hectares (7.692 million km2) of total land area, the amount of forest land has fallen over the last 27 years by some 3 790 000 hectares (from 128 541 000 ha. in 1990 down to 124 751 000 ha. in 2017) (84). But this is only part of the picture. Forest ‘thinning’ (93) and reforestation which fails to adequately replace old growth and native forests which historically existed on the same land are just two examples of why the specifics of this issue really matter. In recent years there have been dramatic increases in the rates of woody vegetation loss, up from 32 400 hectares per year in 2009-10 to a staggering 58 000 hectares per year in New South Wales alone (excluding that lost to fire) (85). As discussed in a previous article, conservation and re-forestation go hand-in-hand; the efforts of both government programmes (86), NGOs, and grassroots campaigns (87) are nullified if equivalent areas of native vegetation are simply cleared in other locations (88). Not only is such recent and ongoing deforestation deeply saddening in its own right, the blight of illegal logging on public land and outside of government-allocated zones impacts upon some of the most beautiful, ecologically delicate, and important old growth forests (89). Overall, this is in keeping with the current double-threat trend of simultaneous increases in land clearing and decreases in land conservation for the state (NSW).

[Line graph generated using data obtained from the 2014-2016 NSW Report on Native Vegetation. 2018. (90)]

As a saddening glimpse of what is likely to constitute the new norm, the present Australian bushfires represent a kind of simultaneous double-whammy for the climate: releasing an approximate 250 million tonnes of CO2 into the atmosphere (a figure of around 44% of Australia’s annual CO2 emissions) (91) and crippling the capacity of forests to reabsorb existing CO2 from the atmosphere (91, 92). More carbon dioxide liberated into the atmosphere, less carbon absorption from burnt-out forests. When coupled with increases in deforestation and vegetation ‘thinning’ (93) the stage is being set for the creation of unyielding positive feedback loops, with a cascade of sometimes irreversible changes to vegetation (100), risking eventual ecosystem collapse (94). When considered alongside the aggressive deforestation publicised in places such as the Amazon rainforests of Brazil, Peru, and Honduras, the blight of global deforestation seems thoroughly overwhelming, and a reflection of the depressingly low value societies evidently place on native forests. Ultimately on a global scale, we cannot really know where the balance of deforestation and re-forestation lies, and different approaches to quantification of this question are fraught which challenges (95). What is unquestionable is the devastating ecological, environmental, and climatic impacts that arise when these biodiverse ecosystems and underappreciated carbon sinks are ferociously deforested for profit.

“…it is possible to envisage, within the current century, a world with few or no significant remaining intact forests. Humanity may be left with only degraded, damaged forests, in need of costly and sometimes unfeasible restoration, open to a cascade of further threats and lacking the resilience needed to weather the stresses of climate change.”

— Watson, J et al. (96)

Concluding remarks

The beginning of the anthropocene was the best time to avert climate change. The only option now available is to act today. Climate change does, and will continue to impact human health in profound and unpredictable ways. As outlined by the report of The Lancet Countdown, increases in heatwave exposures will continue to affect the health of the most vulnerable members of society, deterioration in air quality and rising concentrations of fine particulate matter will continue to damage lungs, and the lethality of extreme weather-related disasters will continue to lay waste to communities across the globe.

Just as a historical burden of unsustainable fossil fuel extraction and natural resource exploitation has placed an unjust intergenerational burden on present day society, by the same ethos we will stand collectively culpable for passing on an irrevocably degraded world to our children. It is our moral imperative to make sacrifices and act on climate change irrespective of how justifiably wronged we may feel as a generation in inheriting this poisoned chalice of a carbon-dependent world. The climate crisis is one that will require collective global action, but my personal fear is that with increasing natural disasters, crop failures, heatwaves, and environmental change compounding existing political and social instability, a cascade of collective short-termism will be initiated due to a collective social and political climate of fear, anxiety, and uncertainty. (97). With such gravitation towards short-termism and uncertainty avoidance (together acting as drivers of organizational-level climate inaction) (98) it may be that we see a critical weakening of the very spirit of self sacrifice, cooperation, ambition, and future-focus that we need to take action on climate change. Such a social phenomenon perhaps risks establishing a vicious cycle of climate breakdown, ecosystem destruction, and avid resource stockpiling coupled with widening inequality, emotionality, and short-termism.

At this moment we need future-focus, ambition, bravery, and above all – hope.

“An unprecedented challenge demands an unprecedented response”

— The 2019 report of The Lancet Countdown on health and climate change (8)

T Michniewicz, 26/12/2019

Reference

1. @MJA_Editor. (06 December 2019). “Smoke is a health risk. For some very significant. Our cities are feeling it. The experts say climate change a contributor. One fact is clear and can’t be ignored any longer: climate change is a severe health risk and business as usual is not on.”. Retrieved from: <https://twitter.com/MJA_Editor/status/1202794126665609216> [Accessed: 19/12/19].

2. RubberRepublic (24 October 2019) Health and Climate | Richard Horton [video file]. Retrieved from: <https://www.youtube.com/watch?v=YEVGNeneYug> [Accessed: 19/12/19].

3. Hendrie, D (2019) ‘Climate change is a health emergency, RACGP declares’. newsGP. 19 December. Available at: <https://www1.racgp.org.au/newsgp/racgp/climate-change-is-a-health-emergency-racgp-declare> [Accessed: 19/12/19].

4. Royal Australasian College of Physicians (2016) ‘Climate change and health position statement’. Sydney, Australia. Available at: <https://www.racp.edu.au/docs/default-source/advocacy-library/climate-change-and-health-position-statement.pdf?sfvrsn=5235361a_5> [Accessed: 20/12/19].

5. Beech, A (2019) ‘Climate change a “public health emergency”: doctors’. PM with Linda Mottram [Radio programme]. ABC Radio National. November 21. Available at: <https://www.abc.net.au/radio/programs/pm/climate-change-a-public-health-emergency:-doctors/11726770> [Accessed: 20/12/19].

6. Australian Medical Association (2019) ‘Climate change is a health emergency’ [press release]. September 3. Available at: <https://ama.com.au/sites/default/files/documents/030919%20-%20AMA%20Calls%20Climate%20Change%20A%20Health%20Emergency_1.pdf> [Accessed: 20/12/19].

7. Bhor, N and Kumar, P (2016) ‘Climate change and health: a social determinants approach to malnutrition among migrant children’. BMJ Global Health. 2016;1:A8-A9. DOI: 10.1136/bmjgh-2016-EPHPabstracts.11. Available at: < https://gh.bmj.com/content/1/Suppl_1/A8.2> [Accessed: 21/12/2019].

8. Watts, N, Amann, M, Arnell, N, Ayeb-Karlsson, S, Belesova, K, Boykoff, M, Byass, P, Cai, W, Campbell-Lendrum, D, Capstick, S, Chambers, J, Dalin, C, Daly, M, Dasandi, N, Davies, M, Drummond, P, Dubrow, R, Ebi, K, Eckelman, M, Ekins, P, Escobar, L, Montoya, L, Georgeson, L, Graham, H, Haggar, P, Hamilton, I, Hartinger, S, Hess, J, Kelman, I, Kiesewetter, G, Kjellstrom, T, Kniveton, D, Lemke, B, Liu, Y, Lott, M, Lowe, R, Sewe, M, Martinez-Urtaza, J, Maslin, M, McAllister, L, McGushin, A, Mikhaylov, S, Milner, J, Moradi-Lakeh, M, Morrissey, K, Murray, K, Munzert, S, Nilsson, M, Neville, T, Oreszczyn, T, Owfi, F, Pearman, O, Pencheon, D, Phung, D, Pye, S, Quinn, R, Rabbaniha, M, Robinson, E, Rocklov, J, Semenza, J, Sherman, J, Shumake-Guillemont, Tabatabaei, M, Taylor, J, Trinanes, J, Wilkinson, P, Costello, A, Gong, P, Montgomery, H (2019) ‘The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate’. The Lancet. 394 (10211): 1836-1878. DOI: 10.1016/S0140-6736(19)32596-6. Available at: <https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32596-6/fulltext> [Accessed 21/11/19].

9. Robine, J, Cheung, S, Le Roy, S, Van Oyen, H, Griffiths, C, Michel, J and Herrmann, F (2008) ‘Death toll exceeded 70,000 in Europe during the summer of 2003.’. Comptes Rendus Biologies. 331(2):171-178. DOI: 10.1016/j.crvi.2007.12.001. Available at: <https://www.sciencedirect.com/science/article/pii/S1631069107003770?via%3Dihub> [Accessed: 20/12/2019].

10. Barriopedro, D, Fischer, E, Luterbacher, J, Trigo, R and Garcia-Herrera, R (2011) Supporting online material for ‘The hot summer of 2010: redrawing the temperature record map of Europe’. Sciencemag. Published 17 March 2011 at Science Express. DOI: 10.1126/science.1201224. Available at: <https://science.sciencemag.org/content/suppl/2011/03/15/science.1201224.DC1> [Accessed: 20/12/2019].

11. Gregory, A (2019) ‘Australia registers hottest day in recorded history’[online]. Independent. 19 December. Available at: <https://www.independent.co.uk/news/world/australasia/australia-hottest-day-record-bushfire-climate-change-spring-bom-a9251101.html> [Accessed: 20/12/2019].

12. Hayne, J and Midena, K (2019) ‘Canberra records highest December temperatures as mercury soars to 39.3C’[online]. ABC News Australia. 19 December. Available at: <https://www.abc.net.au/news/2019-12-19/heatwave-australia-bom-records-temperature-forecast/11811470> [Accessed: 20/12/2019].

13. Readfearn, G (2019) ‘Australia records its hottest day ever – one day after previous record’[online]. The Guardian. 19 December. Available at: < https://www.theguardian.com/australia-news/2019/dec/19/419c-australia-records-hottest-ever-day-one-day-after-previous-record> [Accessed: 20/12/2019].

 14. Woodley, M (2019) ‘Millions to swelter as doctors warn of ‘public health emergency’’[online]. newsGP. Available at: <https://www1.racgp.org.au/newsgp/clinical/millions-to-swelter-as-doctors-warn-of-public-heal> [Accessed: 20/12/2019].

15. Sanz-Barbero, B, Linares, C, Vives-Cases, C, Gonzalez, J, Lopez-Ossorio, J and Diaz, J (2018) ‘Heat wave and the risk of intimate partner violence’. Science of The Total Environment. 644: 413-419. DOI: 10.1016/j.scitotenv.2018.06.368. Available at: <https://www.sciencedirect.com/science/article/pii/S0048969718324446?via%3Dihub> [Accessed: 20/12/2019].

16. Levy, B, Sidel, V and Patz, J (2017) ‘Climate change and collective violence’. Annual Review of Public Health. 38:241-257. DOI: 10.1146/annurev-publhealth-031816-044232. Available at: <https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031816-044232> [Accessed: 20/12/2019].

17. Nitschke, M, Tucker, G and Bi, P (2007) ‘Morbidity and mortality during heatwaves in metropolitan Adelaide’. Medical Journal of Australia. 187(11):662-665. DOI: 10.5694/j.1326-5377.2007.tb01466.x. Available at: <https://www.mja.com.au/journal/2007/187/11/morbidity-and-mortality-during-heatwaves-metropolitan-adelaide> [Accessed: 20/12/2019].

18. Image reference: Bureau of Meteorology (2019) Australian annual mean temperature anomaly, in ‘Tracking Australia’s climate through 2019’[online]. Australian Government Bureau of Meteorology. 2 December. Retrieved from: <http://www.bom.gov.au/climate/updates/articles/a036.shtml> [Accessed: 20/12/2019].

19. World Meteorological Organization (2019) ‘2019 concludes a decade of exceptional global heat and high-impact weather’[press release, online]. World Meteorological Organization. 3 December. Available at: <https://public.wmo.int/en/media/press-release/2019-concludes-decade-of-exceptional-global-heat-and-high-impact-weather> [Accessed: 23/12/2019].

20. Kron, W, Low, P and Kundzewicz, Z (2019) ‘Changes in risk of extreme weather events in Europe’. Environmental Science and Policy. 100:74-83. DOI: 10.10116/j.envsci.2019.06.007. Available at: <https://www.sciencedirect.com/science/article/abs/pii/S146290111930142X> [Accessed: 20/12/2019].

21. Tidey, A (2019) ‘There have been three times more wildfires in the EU so far this year’[online]. euronews.  15 August. Available at: <https://www.euronews.com/2019/08/15/there-have-been-three-times-more-wildfires-in-the-eu-so-far-this-year> [Accessed: 20/12/2019].

22. BBC (2019) ‘Zimbabwe ‘on brink of man-made starvation’, UN warns’[online]. BBC News. 28 November. Available at: <https://www.bbc.com/news/world-africa-50586514> [Accessed: 20/12/2019].

23. UN Office for the Coordination of Humanitarian Affairs (2019) ‘Greater Horn of Africa: Key Messages’[online]. ReliefWeb. 20 December. Available at: <https://reliefweb.int/report/ethiopia/greater-horn-africa-humanitarian-key-messages> [Accessed: 20/12/2019].

24. World Health Organization (2017) ‘Health emergency and disaster risk management fact sheets: Climate risk management’. World Health Organization, Public Health England and partners. December 2017. Available at: <https://www.who.int/hac/techguidance/preparedness/risk-management-climate-management-december2017.pdf?ua=1> [Accessed: 20/12/2019].

25. United Nations Environment Programme (2018) ‘The adaptation gap report’. December 2018. Nairobi, Kenya. Available at: <https://www.unenvironment.org/resources/adaptation-gap-report> [Accessed: 20/12/2019].

26. Ritchie, H and Roser, M (2019) ‘Outdoor air pollution’[online]. Our World in Data. November 2019. Available at: <https://ourworldindata.org/outdoor-air-pollution#outdoor-air-pollution-is-one-of-the-leading-risk-factors-for-premature-death> [Accessed: 23/12/2019].

27. Mirsadraee, M (2014) ‘Anthracosis of the lungs: etiology, clinical manifestations and diagnosis: a review’. Tanaffos. 13(4):1-13. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386010/> [Accessed: 21/12/2019].

28. Takano, A, Justo, L, Santos, N, Marquezini, M, Andre, P, Monteiro da Rocha, F, Pasqualucci, C, Barrozo, L, Singer, J, Andre, C, Saldiva, P and Veras, M (2019) ‘Pleural anthracosis as an indicator of lifetime exposure to urban air pollution: an autopsy-based study in Sao Paulo’. Environmental Research. 173:23-32. DOI: 10.1016/j.envres.2019.03.006. Available at: < https://www.sciencedirect.com/science/article/pii/S0013935119301343> [Accessed: 21/12/2019].

29. Johnston, F, Kavanagh, A, Bowman, D and Scott, R (2002) ‘Exposure to bushfire smoke and asthma: an ecological study’. The Medical Journal of Australia. 176(11):535-538. DOI: 10.5694/j.1326-5377.2002.tb04551.x. Available at: <https://www.mja.com.au/journal/2002/176/11/exposure-bushfire-smoke-and-asthma-ecological-study> [Accessed: 24/12/2019].

30. Horsley, J, Broome, R, Johnston, F, Cope, M and Morgan, G (2018) ‘Health burden associated with fire smoke in Sydney, 2001 – 2013’. The Medical Journal of Australia. 208(7):309-310. DOI: 10.5694/mja18.00032. Available at: < https://www.mja.com.au/journal/2018/208/7/health-burden-associated-fire-smoke-sydney-2001-2013> [Accessed: 24/12/2019].

31. Wei, Y, Wang, Y, Di, Q, Choirat, C, Wang, Y, Koutrakis, P, Zanobetti, A, Dominici, F, Gamble, C and Schwartz, J (2019) ‘Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study’. BMJ. 367:l6258. DOI: 10.1136/bmj.l6258. Available at: < https://www.bmj.com/content/367/bmj.l6258> [Accessed: 24/12/2019].

32. Johnstone, F (2017) ‘Understanding and managing the health impacts of poor air quality from landscape fires’. The Medical Journal of Australia. 207(6):229-230. DOI: 10.5694/mja17.00072. Available at: <https://www.mja.com.au/journal/2017/207/6/understanding-and-managing-health-impacts-poor-air-quality-landscape-fires> [Accessed: 24/12/2019].

33. International Energy Agency [IEA] (2019) ‘Total primary energy supply (TPES) by source’[downloadable data]. IEA World Energy Balances 2019. Available at: < https://www.iea.org/data-and-statistics> [Accessed: 21/12/2019].

34. Ritchie, H and Roser, M (2018) ‘Energy production & changing energy sources’[webpage]. Our World In Data. Available at: < https://ourworldindata.org/energy-production-and-changing-energy-sources> [Accessed: 21/12/2019].

35. Robertson, J (2019) ‘What we know about Adani’s Carmichael coal mine project’[online]. ABC News Australia. 13 June. Available at: <https://www.abc.net.au/news/2019-04-26/what-we-know-about-adanis-carmichael-coal-mine-project/11049938> [Accessed: 22/12/2019].

36. Harmsen, N (2019) ‘Equinor wins environmental approval to explore for oil in the Great Australian Bight’[online]. ABC News Australia. 18 December. Available at: <https://www.abc.net.au/news/2019-12-18/equinor-receives-environmental-approval-to-drill-in-bight/11811534> [Accessed: 22/12/2019].

37. Kay, J (2015) ‘Other people’s money’. London: Profile Books Limited.

38. Morton, A (2019) ‘South Australia’s clean-energy shift brings lowest power prices on national grid, audit finds’[online]. The Guardian. 23 December. Available at: <https://www.theguardian.com/australia-news/2019/dec/24/south-australias-clean-energy-shift-brings-lowest-power-prices-on-national-grid-audit-finds> [Accessed: 24/12/2019].

39. Markandya, A, Sampedro, J, Smith, S, Dingenen, R, Pizarro-Irizar, C, Arto, I and Gonzalez-Eguino, M (2018) ‘Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study’. The Lancet Planetary Health. 2(3):E126-E133. DOI: 10.1016/S2542-5196(18)30029-9. Available at: <https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30029-9/fulltext> [Accessed: 20/12/19].

40. Mazengarb, M (2019) ‘Banking giant HSBC gives shocking warning of US$10 trillion a  year climate health bill’[online]. Renew Economy. 7 November. Available at: <https://reneweconomy.com.au/banking-giant-hsbc-gives-shocking-warning-of-us10-trillion-a-year-climate-health-bill-76138/> [Accessed: 23/12/2019].

41. United Nations Environment Programme (2018) ‘The emissions gap report – executive summary’. 27 November. Nairobi, Kenya. Available at: <https://www.unenvironment.org/resources/emissions-gap-report-2018> [Accessed: 20/12/2019].

42. Peel, M, Campbell, R and Denniss, R (2014) ‘Mining the age of entitlement’. The Australia Institute. ISSN: 1836-9014. Available at: <https://www.tai.org.au/sites/default/files/Mining%20the%20age%20of%20entitlement.pdf> [Accessed: 22/12/2019].

43. Paul, S (2019) ‘In coal we trust: Australian voters back PM Morrison’s faith in fossil fuel’[online]. Reuters. 19 May. Available at: <https://www.reuters.com/article/us-australia-election-energy/in-coal-we-trust-australias-voters-back-pm-morrisons-faith-in-fossil-fuel-idUSKCN1SP06F> [Accessed: 22/12/2019].

44. SBS News (2019) ‘Anthony Albanese backs Australian coal exports ahead of Queensland tour’[online]. SBS News Australia. 9 December. Available at: <https://www.sbs.com.au/news/anthony-albanese-backs-australian-coal-exports-ahead-of-queensland-tour> [Accessed: 22/12/2019].

45. Merzian, R, Quicke, A, Bennett, E, Campbell, R and Swann, T (2019) ‘Climate of the nation 2019’. The Australia Institute. Canberra, Australia. ISSN: 1836-9014. Available at: <https://www.tai.org.au/content/climate-nation-2019> [Accessed: 22/12/2019].

46. BP (2019) ‘BP energy outlook 2019 edition’. BP. Available at: <https://www.bp.com/content/dam/bp/business-sites/en/global/corporate/pdfs/energy-economics/energy-outlook/bp-energy-outlook-2019.pdf> [Accessed: 22/12/2019].

47. ExxonMobil (2019) ‘2019 outlook for energy: a perspective to 2040’. ExxonMobil. Available at: <https://corporate.exxonmobil.com/-/media/Global/Files/outlook-for-energy/2019-Outlook-for-Energy_v4.pdf> [Accessed: 22/12/2019].

48. Wachtmeister, H, Henke, P and Hook, M (2018) ‘Oil projections in retrospect: revisions, accuracy and current uncertainty’. Applied Energy. 220:138-153. DOI: 10.1016/j.apenergy.2018.03.013. Available at: <https://www.sciencedirect.com/science/article/pii/S0306261918303428> [Accessed: 22/12/2019].

49. Cabeza, L, Palacois, A, Serrano, S, Urge-Vorsatz, D and Barreneche, C (2018) ‘Comparison of past projections of global and regional primary and final energy consumption with historical data’. Renewable and Sustainable Energy Reviews. 82(1):681-688. DOI: 10.1016/j.rser.2017.09.073. Available at: <https://www.sciencedirect.com/science/article/abs/pii/S1364032117313229> [Accessed: 22/12/2019].

50. Franta, B (2018) ‘Shell and Exxon’s secret 1980s climate change warnings’[online]. The Guardian. 19 September. Available at: <https://www.theguardian.com/environment/climate-consensus-97-per-cent/2018/sep/19/shell-and-exxons-secret-1980s-climate-change-warnings> [Accessed: 22/12/2019].

51. Wasserman, L (2019) ‘Did Exxon deceive its investors on climate change?’[online]. The New York Times. 21 October. Available at: <https://www.nytimes.com/2019/10/21/opinion/exxon-climate-change.html> [Accessed: 22/12/2019].

52. Guardian News (23 October 2019) ‘So they knew’: Ocasio-Cortez questions Exxon scientist on climate crisis denial [video file]. Retrieved from: < https://www.youtube.com/watch?v=FGVW9vJ773k> [Accessed: 22/12/19].

53. Evershed, N and Ball, A (2019) ‘How big are the fires burning on the east coast of Australia? interactive map’[online]. The Guardian. 19 December. Available at: < https://www.theguardian.com/australia-news/datablog/ng-interactive/2019/dec/07/how-big-are-the-fires-burning-on-the-east-coast-of-australia-interactive-map> [Accessed: 22/12/2019].

54. Rasker, R and Hannam, P (2019) ‘The day it forgot to rain on Australia’[online]. The Sydney Morning Herald. November 11. Available at: <https://www.smh.com.au/environment/weather/the-day-it-forgot-to-rain-on-australia-20191111-p539cy.html> [Accessed: 22/12/2019].

55. Aubusson, K and Gladstone, N (2019) ‘NSW bushfires: ‘apocalyptic’ health effects of Sydney’s toxic air’[online]. The Sydney Morning Herald. 14 December. Available at: <https://www.smh.com.au/national/nsw/nsw-bushfires-apocalyptic-health-effects-of-sydney-s-toxic-air-20191211-p53ixc.html> [Accessed: 22/12/2019].

56. News.com.au (2019) ‘NSW smoke haze ‘equivalent to smoking 34 cigarettes a day’[video]. News.com.au. Available at: < https://www.news.com.au/national/nsw-smoke-haze-equivalent-to-smoking-34-cigarettes-a-day/video/4c1c396d6a74293f8f942087e7e34428> [Accessed: 22/12/2019].

57. Image Reference: NSW Rural Fire Service (2019) Fires near me [interactive webpage]. NSW Government. Available at: <https://www.rfs.nsw.gov.au/fire-information/fires-near-me> [Accessed at 17:20pm AEST on 22/12/2019].

58. Readfearn, G (2019) ‘Scientists fear surge in supersized bushfires that create their own violent thunderstorms’[online]. The Guardian. 19 December. Available at: <https://www.theguardian.com/environment/2019/dec/20/scientists-fear-surge-in-supersized-bushfires-that-create-their-own-violent-thunderstorms> [Accessed: 22/12/2019].

59. Image Reference: Jenner, L (2019) ‘NASA’s Terra satellite sees fire and smoke from devastating bushfires in Australia’[online]. NASA. 14 November. Available at: <https://www.nasa.gov/image-feature/goddard/2019/nasas-terra-satellite-sees-fire-and-smoke-from-devastating-bushfires-in-australia> [Accessed: 23/12/2019].

60. Cereceda, R (2019) ‘In pictures: Australia’s ‘unprecedented’ wildfires seen from space’[online]. euronews. 18 November. Available at: <https://www.euronews.com/2019/11/15/in-pictures-australia-s-unprecedented-wildfires-seen-from-space> [Accessed: 23/12/2019].

61. Image reference: NASA Earth Observatory (2019) ‘Aussie smoke plumes crossing oceans’[webpage]. NASA Earth Observatory. 19 November. Available at: <https://earthobservatory.nasa.gov/images/145898/aussie-smoke-plumes-crossing-oceans> [Accessed: 22/12/2019].

62. Climate Countil (2019) ‘Climate cuts, cover-ups and censorship’. The Climate Council of Australia Limited. ISBN: 978-1-925573-95-4 [digital]. Available at: <https://www.climatecouncil.org.au/wp-content/uploads/2019/04/Climate-Cuts-Cover-Ups-and-Censorship.pdf> [Accessed: 22/12/2019].

63. Karp, P (2019) ‘Scott Morrison says no evidence links Australia’s carbon emissions to bushfires’[online]. The Guardian. 20 November. Available at: <https://www.theguardian.com/australia-news/2019/nov/21/scott-morrison-says-no-evidence-links-australias-carbon-emissions-to-bushfires> [Accessed: 22/12/2019].

64. Karp, P (2019) ‘Scott Morrison threatens crackdown on protesters who would ‘deny liberty’’[online]. The Guardian. 1 November. Available at: < https://www.theguardian.com/australia-news/2019/nov/01/scott-morrison-threatens-crackdown-on-secondary-boycotts-of-mining-companies> [Accessed: 22/12/2019].

65. Ferrier, S (2019) ‘Climate protesters clash with police outside Melbourne international mining conference’[online]. ABC News Australia. 30 October. Available at: <https://www.abc.net.au/news/2019-10-29/protesters-clash-with-police-outside-melbourne-mining-conference/11648540> [Accessed: 22/12/2019].

66. SBS News (2019) ‘Ex-fire chiefs accuse government of unofficial gag on climate change’. SBS News Australia. 14 November. Available at: <https://www.sbs.com.au/news/ex-fire-chiefs-accuse-government-of-unofficial-gag-on-climate-change> [Accessed: 22/12/2019].

67. The Sydney Morning Herald (2019) ‘Talking about climate change is not an insult to bushfire victims’[online]. The Sydney Morning Herald. 11 November. Available at: < https://www.smh.com.au/politics/federal/talking-about-climate-change-is-not-an-insult-to-bushfire-victims-20191111-p539kc.html> [Accessed: 22/12/2019].

68. Bureau of Meteorology (2019) ‘Bushfire weather’[webpage]. Bureau of Meteorology, Australian Government. Available at: <http://www.bom.gov.au/weather-services/fire-weather-centre/bushfire-weather/index.shtml> [Accessed: 22/12/2019].

69. Bureau of Meteorology (2019) ‘Special climate statement 72 – dangerous bushfire weather in spring 2019’. Bureau of Meteorology, Australian Government. 18 December. Available at: <http://www.bom.gov.au/climate/current/statements/scs72.pdf> [Accessed: 22/12/2019].

70. Elsworthy, E (2019) ‘NSW bushfires see catastrophic fire danger issued for Greater Sydney, Illawarra, and Southern Ranges’[online]. ABC News Australia. 21 December. Available at: <https://www.abc.net.au/news/2019-12-20/nsw-bushfire-catastrophic-fire-danger-forecast-for-saturday/11818896> [Accessed: 22/12/2019].

71. Thomas, S and Cockburn, P (2019) ‘School closures and evacuations warnings as NSW catastrophic fires loom for Sydney’[online]. ABC News Australia. 11 November. Available at: <https://www.abc.net.au/news/2019-11-11/nsw-bushfires-850000-hectares-destroyed-worst-to-come/11691038> [Accessed: 22/12/2019].

72. Sparks, C (2019) ‘We’ve been in bushfire hell in Glen Innes – and the scientists knew it was coming’[online]. The Guardian. 11 November. Available at: <https://www.theguardian.com/commentisfree/2019/nov/11/weve-been-in-bushfire-hell-in-glen-innes-and-the-scientists-knew-it-was-coming> [Accessed: 23/12/2019].

73. Goloubeva, J and Haydar, N (2019) ‘Regional mayors criticise politicians for failing to link climate change and deadly bushfires’. ABC News Australia. 11 November. Available at: <https://www.abc.net.au/news/2019-11-11/carol-sparks-climate-change-federal-government-claire-pontin/11691444> [Accessed: 22/12/2019].

74. Image Reference: Bureau of Meteorology (2019) Climate change – trends and extremes. ‘Australian climate variability & change – Time series graphs: Annual mean temperature anomaly - Global (1850 - 2018)’[webpage graphic]. Available at: <http://www.bom.gov.au/climate/change/#tabs=Tracker&tracker=global-timeseries> [Accessed: 22/12/2019].

75. Doyle, K and Slezak, M  (2019) ‘More records tumble as heatwave rolls on, scientists point finger at climate change’[online]. ABC News Australia. 20 December. Available at: <https://www.abc.net.au/news/2019-12-20/finger-pointed-at-climate-change-as-heatwave-smashes-records/11817884> [Accessed: 22/12/2019].

76. Bunyan, R (2019) ‘As smoke from bushfires chokes Sydney, Australian Prime Minister dodges on climate change’[online]. Time. 21 November. Available at: <https://time.com/5735660/sydney-bushfires/> [Accessed: 22/12/2019].

77. Cave, D (2019) ‘Australia bushfires arrive early, destroying historic lodge in ‘omen’ of future’[online]. The New York Times. 9 September. Available at: <https://www.nytimes.com/2019/09/09/world/australia/bushfires-wildfires-climate-change.html> [Accessed: 22/12/2019].

78. @RFSCommissioner (9 December 2019) “This season, fires have now burnt out 2.7 million hectares with a perimeter of 19,235 kms. Of this, the current 87 fires, incorporate 2.1 million hectares and a perimeter of 11,095 kms. Thank you again to all involved, supporting and affected by this extraordinary season. #NSWRFS”. Retrieved from: <https://twitter.com/RFSCommissioner/status/1203874396395327488> [Accessed: 22/12/2019].

79. Doyle, K (2019) ‘NSW bushfires burn an area greater than Wales, the result of an exceptional spring’[online]. ABC News Australia. 18 December. Available at: <https://www.abc.net.au/news/2019-12-18/bushfires-burn-area-bigger-than-wales-a-result-of-record-spring/11810324> [Accessed: 22/12/2019].

80. Department of Agriculture (2019) ‘Australia’s forests’[webpage]. Australian Government Department of Agriculture ABARES. Available at: <https://www.agriculture.gov.au/abares/forestsaustralia/australias-forests> [Accessed: 22/12/2019].

81. Roser, M (2019) ‘Forests’[interactive webpage]. Our World in Data. Available at: <https://ourworldindata.org/forests> [Accessed: 22/12/2019].

82. Department of Agriculture (2018) ‘Australia’s state of the forests report 2018’. Australian Government Department of Agriculture and Water Resources. ISBN: 978-1-74323-407-5. Canberra, ACT. Available at: <https://www.agriculture.gov.au/abares/forestsaustralia/sofr/sofr-2018> [Accessed: 25/12/19].

83. Ndevr environmental (2019) Tracking 2 Degrees FY2019 Q2. ‘Tracking 2019 Q2 report | or October, November, December 2018’. Ndevr Environmental. Available at: < https://ndevrenvironmental.com.au/tracking-2-degrees-fy2019-q2/> [Accessed: 22/12/2019].

84. Food and Agriculture Organization of the United Nations (2019) ‘Land Use’[interactive webpage, data for download]. FAOSTAT. Available at: <http://www.fao.org/faostat/en/#data/RL> [Accessed: 20/12/2019].

85. NSW Department of Planning, Industry and Environment (2019) Data and reports. ‘NSW Woody Vegetation Change 2017-18 data spreadsheet’[XLSX data spreadsheet]. Available for download at: <https://www.environment.nsw.gov.au/topics/animals-and-plants/native-vegetation/reports-and-resources/reports> [Accessed: 22/12/2019].

86. National Landcare Program (2019) ‘20 million trees program’[webpage]. Australian Government. Available at: <http://www.nrm.gov.au/national/20-million-trees> [Accessed: 23/12/2019].

87. MrBeast (25 October 2019) Planting 20,000,000 Trees, My Biggest Project Ever! [video file]. Retrieved from: < https://www.youtube.com/watch?v=HPJKxAhLw5I> [Accessed: 23/12/2019].

88. Morton, A and Davies, A (2019) ‘Australia spends billions planting trees – then wipes out carbon gains by bulldozing them’[online]. The Guardian. 16 October. Available at: <https://www.theguardian.com/environment/2019/oct/17/australia-spends-billions-planting-trees-then-wipes-out-carbon-gains-by-bulldozing-them> [Accessed: 23/12/2019].

89. Slezak, M, Doman, M and Florance, L (2019) ‘VicForests plans to log native ash trees they don’t own, a year after the law changed to stop it happening’[online]. ABC News Australia. 19 December. Available at: <https://www.abc.net.au/news/2019-12-19/vicforests-plan-to-log-native-ash-trees-on-public-land-maps-show/11805812> [Accessed: 22/12/2019].

90. Office of Environment and Heritage (2018) ‘NSW report on native vegetation 2014-16’. Office of Environment and Heritage on behalf of the NSW State Government. ISBN: 978 176039 100 3. Available at: <https://www.environment.nsw.gov.au/-/media/OEH/Corporate-Site/Documents/Animals-and-plants/Native-vegetation/nsw-report-native-vegetation-2014-2016-180288.pdf> [Accessed: 22/12/2019].

91. Readfearn, G (2019) ‘Australia’s bushfires have emitted 250m tonnes of CO2, almost half of country’s annual emissions’[online]. The Guardian. 13 December. Available at: <https://www.theguardian.com/environment/2019/dec/13/australias-bushfires-have-emitted-250m-tonnes-of-co2-almost-half-of-countrys-annual-emissions> [Accessed: 22/12/2019].

92. Nguyen, K (2019) ‘NSW bushfires could cripple forests’ ability to reabsorb carbon dioxide, climate scientists say’[online]. ABC News Australia. 12 December. Available at: <https://www.abc.net.au/news/2019-12-12/nsw-qld-bushfires-could-increase-carbon-footprint-scientists-say/11789504> [Accessed: 20/12/2019].

93. Reside, A, Cosgrove, A, Silcock, J, Seabrook, L and Evans, M (2017) ‘Land clearing on the rise as legal ‘thinning’ proves far from clear-cut’[online]. The Conversation. 20 June. Available at: <http://theconversation.com/land-clearing-on-the-rise-as-legal-thinning-proves-far-from-clear-cut-79419> [Accessed: 22/12/2019].

94. Tepley, A, Veblen, T, Perry, G, Stewart, G and Naficy, C (2016) ‘Positive feedbacks to fire-driven deforestation following human colonization of the South Island of New Zealand’. Ecosystems. 19: 1325-1344. DOI: 10.1007/s10021-016-0008-9 Available at: <https://link.springer.com/article/10.1007/s10021-016-0008-9> [Accessed: 22/12/2019].

95. Pearce, F (2018) ‘Conflicting data: how fast is the world losing its forests?’[online]. Yale Environment 360. 9 October. Available at: <https://e360.yale.edu/features/conflicting-data-how-fast-is-the-worlds-losing-its-forests> [Accessed: 23/12/2019].

96. Watson, J, Evans, T, Venter, O, Williams, B, Tulloch, A, Stewart, C, Thompson, I, Ray, J, Murray, K, Salazar, A, McAlpine, C, Potapov, P, Walston, J, Robinson, J, Painter, M, Wilkie, D, Filardi, C, Laurance, W, Houghton, R, Maxwell, S, Grantham, H, Samper, C, Wang, S, Laestadius, L, Runting, R, Silva-Chavez, G, Erin, J and Lindenmayer, D (2018) ‘The exceptional value of intact forest ecosystems’. Nature Ecology & Evolution. 2:599-610. DOI: 10.1038/s41559-018-0490-x. Available at: <https://www.nature.com/articles/s41559-018-0490-x> [Accessed: 23/12/2019].

97. Gore, Al (2013) ‘The future’. 1st edn. New York: Random House.

98. Slawinski, N, Pinkse, J, Busch, T and Banerjee, S (2019) ‘The role of short-termism and uncertainty avoidance in organizational inaction on climate change: a multi-level framework’. Business & Society. 56(2):253-282. DOI: 10.1177/0007650315576136. Available at: <https://journals.sagepub.com/doi/abs/10.1177/0007650315576136> [Accessed: 22/12/2019].

99. Woodford, J (1996) ‘World climate: experts predict a grim future‘. The Sydney Morning Herald.

100. Runyan, C, D’Odorico, P and Lawrence, D (2012) ‘Physical and biological feedbacks of deforestation’. Review of Geophysics. 50:RG4006. DOI: 10.1029/2012RG000394. Available at: <https://agupubs.onlinelibrary.wiley.com/doi/pdf/10.1029/2012RG000394> [Accessed: 25/12/2019].

101. International Energy Agency (2019) ‘Data and statistics - explore energy data by category, indicator, country, or region’[interactive webpage]. IEA. Available at: <https://www.iea.org/data-and-statistics/data-tables?country=WORLD&energy=Electricity&year=2017> [Accessed: 26/12/19].

at this moment in time...

Intro

Things are looking substantially suboptimal to say the least. As the climate crisis deepens and the collective societal capacity to constrain global warming to sub-1.5-degrees seems scarcely conceivable, I will be taking this opportunity to elaborate some select sentiments on the present state of select ecological threats, undertake wild speculation on the self-reinforcing pathways underscoring relative inaction among the wealthy and policy elite, and consider the potentially cosmic scale of change that probably lies ahead. This article will, at times, venture more into the realm of hypothesis and conjecture than has previously been the case, invoking inductive reasoning and theorising beyond the scope afforded by purely quantitative research based descriptions. In all such instances a distinction between these approaches will be made.

Select Ecological Threats

At this moment humanity is facing a climate emergency and without an immense and transformative increase in the scale of current efforts, we face an uncertain world of untold suffering (1,2,48). Factors such as expanding livestock populations and meat production, ongoing dependence on fossil fuels, global vegetation thinning and habitat loss are central to the rising carbon dioxide levels, ocean acidification, and ecosystem destabilisation events unfolding. To take just one facet of this relentless assault on the nature, the damage caused by deforestation alone should be viewed as the tremendously irresponsible and frequently irreversible practice that it is, with previous estimates of carbon impacts very likely to have seriously under-estimated effects by many orders of magnitude (3). A troubling component of these trends around deforestation, loss of habitat, loss of biodiversity, and concurrent increases in CO2 emissions, is in the generation of positive-feedback cycles that risk ecosystem collapse at local, continental, and planetary scales (4,5,6,7). In essence, as ecological instability becomes more established it becomes harder and harder to wind back, and increasingly greater resources are required to reverse or even just abate the resulting downward spiral. Failure of one system or cycle begets failure of others, and we are fast learning there are incontrovertible limits to nature’s inbuilt redundancy mechanisms, regenerative capacities, and resilience.

We are already losing this battle and the difficulty level is only going up. And for all species on this planet, humans, orchids and rock-wallabies alike, the prognosis is grim. We have, and are, already witnessing the rapid human-activity-related extinction of species at an alarming rate, part of an event referred to as the sixth extinction or Holocene extinction which is already set to irreversibly transform the planet. Through human-driven habitat loss, pollution, poaching, and the direct effects of global warming, thousands of mammal and bird species are positioned for imminent disappearance (45), these representing just a fraction of the overall estimated one million species facing extinction (9). We cannot afford to continue walking this road to ruin, especially after already witnessing the extinction of over 10% of the 273 endemic terrestrial species in the last 200 years for the Australian continent alone (10). The rate of global species loss is alarming, and in many instances the statistics of extinction certainly underrepresent the problem. It is probable that a majority of extinctions are unrecognised and undocumented from species being still undiscovered before they go extinct (11). This travesty of habitat, wilderness, and species-loss that should be treated with utmost social and political seriousness is going un-actioned, with dire implications for the fragile few biodiverse habitats remaining. Morally we are certainly each obligated to tirelessly press for urgent environmental policy action and accountability, alongside active and engaged public inquiry if we are to avoid the rising tide of predictable and preventable extinctions (12). We are fast losing biodiversity, and (if it is enough to motivate a response), the few species likely to remain are probably going to be the small and boring ones – those with unique ecological ecological functions, those with very small or very large body mass, or those with unlucky patterns of breeding (45) anticipated to go the same way as Australia’s ill-fated megafauna (13).

Adding insult to injury, emissions and ecosystem destruction are furthered by the use of cleared land for fossil-fuel-intensive practices like livestock farming, with emissions impacts through direct methane production from ruminant animals, land clearing required for production of fodder, associated transport emissions, fresh water requirements for both livestock and feed (coupled in no small part with concurrent water depletion from practices like cotton farming) (14), the necessary creation of monocultures, coupled with topsoil degradation, and loss of carbon through widespread non-regenerative farming practices (8). Unsurprisingly, “huge” transformations of current land-sector practices in areas of agriculture, forestry, wetland management, and bioenergy will be required if we are to meet targets of the Paris Agreement and stand any chance at securing a sub-1.5°C future (15). Collectively we must commit to sustainable land practices with utmost urgency and the longer we delay emission mitigation, the less likely we are to achieve targets, and greater our reliance on ‘negative emissions’ will be. Current commitments fall far short of a sub-1.5 degree future and if trends continue, we are disastrously tracking towards 2.5°C to 3°C of warming by 2100 (15).

Not casting a disparaging shade on what I believe to be heroic, undervalued, and timely (16) revegetation efforts such as the #TeamTrees campaign, Trillion Trees, and the tireless work of Greening Australia, but the national cognitive dissonance present in simultaneous deforestation of millions of hectares is as jarring as it is agonising (17). Such a ‘plant-here, thrash-there’ approach can only be explained as the twisted manifestation of policymakers’ attempts to strike an unholy balance between a public desire for climate action and the conflicting need to protect interests of private enterprise. Furthermore, this is a situation not limited to the ecological regeneration effort being readily evidenced in other sectors such as transport; recent data revealing the way increased vehicular diesel emissions are effectively cancelling out any gains from renewable energy replacement of coal plants (47). All of this exists within the fairly fraudulent ‘creative accounting’ strategies used to misrepresent national emissions calculations (18,19), serving to muddy the waters of informed public debate, contravene voices of those concerned, and provide fallacious justification for stalling climate action to preserve a business-as-usual paradigm.

A Social Gradient of Climate Action and Inaction

As previously described, the following portion of this piece will briefly venture into the realm of speculation, presenting the theory that with the progression of global warming, a social gradient is emerging akin to the social gradient of health famously elucidated by Sir Michael Marmot (20). With increasingly adverse climactic events and associated threats to food supply, fresh water, and human health, I would suspect such social gradient is only likely to be reinforced, and the divide between the have’s and have not’s become even more pronounced. The direct carry-over of climate change onto worsened human health is very likely to further a radical wealth, health, and social disparity.

Proposed social gradient of the climate crisis, complete with Microsoft Word-verified grammatical errors

This theory can be summarised in the pessimistic sentiment that those who possess the greatest means of effecting change often have the smallest incentive to do so. Preservation of a business-as-usual status quo represents an absolute necessity for those made wealthy off the fossil fuel and all industries inherently damaging to the environment; individuals and companies who have become gratified beneficiaries of an ‘I’ll be gone, you’ll be gone’ philosophy. It is the same kind of mechanisms operating for the extremely wealthy across a majority of domains where private profit and the pursuit of wealth is understood as indispensable, noble by nature, and inexhaustible.  The resources available to evade impacts of climate change for the wealthiest countries and individuals already far outstrip that of most low-lying and non-OECD nations, conferring an ability to continue these exceedingly profitable but environmentally unconscionable operations in many corners of the world with relative impunity; evidently unperturbed by the outcry of those left insolvent and drowning (21). It is these kinds of trends that have led prominent climate policy experts at the United Nations to proclaim climate change as the current greatest threat to human rights (22) and into speculating on the risk of a ‘climate apartheid’ scenario where only the wealthy will have the resources to escape the ensuing hunger, conflict, and chaos (23).

The unfortunate nature of this social gradient is that those most responsible for environmental damage and with the greatest carbon footprint also seem to be those who are least concerned.“The more we consume, the less we feel” as stated by Monbiot (24), highlighting the correlation between increased wealth and a decreased concern for harms caused, with the populations of rich nations the least likely to feel guilt about their environmental impact (24).

In this present state of flux we must also consider the role played by world leaders and government policymakers as key actors who have overwhelmingly proved disappointing in their resolve to address this unfolding disaster. Policymakers and representatives who, whilst the Amazon burns, sea levels rise, and glaciers vanish, shamelessly continue with brazen attempts to mislead and downplay the reality of the current climate emergency (25). How can we explain the pervasive political inertia and bizarre lack of climate action exhibited by policymakers when faced with such a real, tangible, and imminent threat to life as we know it? (26)

In understanding this, we must first consider the manner by which much mass media messaging has revolved around selling the concept of taking relatively meaningless individual action. Be it through keep-cups, metal straws, planting a vegetable garden or truly laughable suggestions such as charging your phone less (27), commercial mass media has proven itself absolutely determined to push the soft, emotionally reassuring, fundamentally consumerist narrative that “small lifestyle changes” (28) at an isolated individualistic level is all that is required as an answer to global warming. This is no accident. The deflection of responsibility and blame to individuals and away from leaders and wealthy fossil fuel barons represents one of the most well crafted strategies to date at effectively subduing any spark of organised collective activism. The depraved genius of this approach has really been to reflect passionate and motivated individuals away from a critique of policymakers and private enterprise and instead towards thinking about the ways co-workers, friends, or family may be letting down the green effort, and ultimately focus their energies at local, trivial, inconsequential, and individual levels. Collective action loses favour, and corporations walk free (29). Lifestyle choices will neither shift large-scale decision-making power away from the oligarchy nor lead to the social and political change required to avert climate disaster, not least within any timeframe of consequence (30,48).

An over-shared twitter aphorism of the modern age

Though investigation and inquiry uncovering vested political interest underscoring climate inaction would likely surprise no one, the interesting question involves examining the possible ideologies upheld those in positions of power who publicly profess pro-fossil fuel or conversely, anti-environmentalist positions (31,32). As a premise, let us assume given the relatively universal public awareness of as potentially a cataclysmal event as climate collapse, no world leader or policymaker can reasonably remain unaware or uninformed. Given role of environmental issues in opinion polls to public protests to economic expansion into the green sector, it may be fathomable that even policymakers outspoken against emissions reductions may be relatively well-informed on expected trajectories of climate change through the policy briefs and reporting from political advisors delivered to them. Even accounting for bias in policy briefs, the self-reinforcing services of yes men, and insular opinion circles, the anti-environmental messages we witness from those in such positions can only lead us to suspect they come from: a place of inanely hopeless optimism, a deeply uncaring and indifferent ‘I’ll be gone, you’ll be gone’ ideology, willful ignorance, or premature adoption of a post-climate-apocalypse mindset that is now only focussed on the protection of personal property, assets, and the welfare of a select few associates. The metaphorical building of lifeboats (33).

A Cataclysmic Cosmic Calamity

For many of us the earth-altering catastrophe of a deteriorating climate is a near-constant undertone to daily life in a business as usual world, yet broader public acknowledgement lags behind. Though discussed in hushed and contemplative tones at occasional moments of compelling lucidity among friends and colleagues, the gallows humour of the world’s end might provide ample material for online memes and instagram influencer rhetoric, but seems to have been largely absent from mainstream public dialogue. Through the mechanistic complexity of global warming, manifestation in diffuse downstream effects, inherent uncertainty of the time horizons involved, and provision of mixed messages by mass media outlets that sow doubt and undersell its seriousness, there has been no major public outrage for something which threatens the continuation of life as we know it.

The Rodney and Otamatea Times, Waitemata and Kaipara Gazette. 14 August, 1912. (37).

Unfortunately, selling the idea of conservation and a need to protect the natural world seems to have failed (34,35,46). Though warning alarms have sounded for over a century (The Rodney and Otamatea Times, 1912 [below]), the effort to spur pre-emptive action from leaders, governments, and nations has not been met with the required action. The most eloquent explanation I have encountered for this toxic phenomenon is provided by John Kay in his discussion of economics and the global financial crisis of 2007-8.

“The cost and consequences of preventive action are real and measurable. But if preventive action is successful, the costs of the damaging event that have been avoided, and indeed the very nature of these events themselves, will remain hypothetical. The public applauds not the cautious captain who escapes the storm but the heroic seaman who like McWhirr, battles successfully through.”(36)

With all that is going on regarding climate change it is easy to mentally discount the legion of other plausible threats to humanity in spaces as varied as international conflict, infectious disease and antibiotic resistance, famine, and the constant threat of nuclear armageddon (38). The number and nature of such perils is easily enough to compel any sane individual into search of an abandoned island or distant land in which to live out the rest of your days (39). For myself, a journey into the questionable Wikipedia rabbit hole of doomsday prophesying provided cold comfort. Shortfalls of any sweepingly simplistic unified theory such as the Fermi paradox aside, it is hard to immediately dismiss the conjecture linking climate change to the concept of a great filter.

Whilst many sub-themes relating to climate catastrophe, ecological emergency, and planetary meltdown provide nothing more than sustenance for Hollywood dramas, from The Day After Tomorrow to Birdemic; ocean acidification, the freshwater cycle, and climate change are three important planetary boundaries each considered sufficient in their own right to pose a genuine existential threat to humanity (40). Whilst debate inevitably continues around the specific tipping points of natural systems or the validity of quantified statements about the precipitous levels we must avoid for each hypothesised boundary, the idea of toeing that line is really one that shouldn’t be entertained. If corporations or governments persist in attempts to extract a maximum return on natural resources for economic profit before they are forced kicking and screaming into any kind of green new deal, then we will be collectively engaging the planet in a game of chicken in which there will be no winners. Countries cannot continue to defer responsibility, kick the can down the road to future generations, freeload, and generally play games with each other when facing a genuinely existential risk (41,42).

Theoretically we could change behaviours and lifestyles but empirically in practice we have not (43) and we will not (44). Unfathomably, at this moment in time we possess the scientific theory and modelling to understand climate change, we are already seeing the devastation of focusing events that should have spurred action, we collectively have the tools and resources to implement sustainable technologies and practices to turn this around, yet still lack the critical impetus required to make this change a reality. At this moment, I know not what more could actually change in order to make climate action the unifying global collaboration it needs to be.

I don’t think this is the universe in which we win.

Outro

Some of my favourite movies and video games feature something in common; a rewind mechanism, a re-do, a second chance to get things right after a catastrophic mistake. As comically simplistic as it is, it is still an idea that has been tumbling around in my thoughts for some time. What if this was that kind of a moment? What if we suspend disbelief for one moment and imagine we had that kind of a power, a kind of perfect foresight, and a kind of a second-chance opportunity to get it right. If we looked at this moment in time as a historical branch point where we can see what possible ecological disaster lies ahead, and were gifted the extraordinary power to avoid it.

What would we do differently?

What would we change?

Clockwise: Back to the Future (1985), Forza Horizon 4 (2018), Life is Strange (2015), Prince of Persia (2010), LoZ: Majora’s Mask (2000)

T Michniewicz, 09/11/19

Reference

1. Ripple, W, Wolf, C, Newsome, T, Barnard, P, Moomaw, W, and 11,258 scientist signatories from 153 countries (2019) ‘World scientists’ warning of a climate emergency’. BioScience. biz088. DOI: 10.1093/biosci/biz088.

2. Ripple, W, Wolf, C, Newsome, T, Galetti, M, Crist, E, Mahmoud, M, Laurance, W and 15,364 scientist signatories from 184 countries (2017) ‘World scientists’ warning to humanity: a second notice’. BioScience. 67(12):1026-1028. DOI: 10.1093/biosci/bix125.

3. Maxwell, S, Evans, T, Watson, J, Morel, A, Grantham, H, Duncan, A, Harris, N, Potapov, P, Runting, R, Venter, O, Wang, S and Malhi, Y (2019) ‘Degradation and forgone removals increase the carbon impact of intact forest loss by 626%’. Science Advances. 5(10):eaax2546. DOI: 10.1126/sciadv.aax2546. Available at: <https://advances.sciencemag.org/content/5/10/eaax2546.abstract> [Accessed 04/11/2019].

4. Whiteside, J and Ward, P (2011) ‘Ammonoid diversity and disappearance track episodes of chaotic carbon cycling during the early Mesozoic’. Geology. 39(2):99-102. DOI:10.1130/G31401.1.

5. Barry, G (2014) ‘Terrestrial ecosystem loss and biosphere collapse’. Management of Environmental Quality. 25(5):542-563. DOI: 10.1108/MEQ-06-2013-0069.

6. Harvey, F (2018) ‘Tipping points could exacerbate climate crisis, scientists fear’. The Guardian [online]. 9 October. Available at: <https://www.theguardian.com/environment/2018/oct/09/tipping-points-could-exacerbate-climate-crisis-scientists-fear> [Accessed: 03/11/2019].

7. Phillips, D (2019) ‘Amazon rainforest ‘close to irreversible tipping point’’. The Guardian [online]. 23 October. Available at: <https://www.theguardian.com/environment/2019/oct/23/amazon-rainforest-close-to-irreversible-tipping-point>  [Accessed: 04/11/2019].

8. Cook, S and Richardson, J (2019) ‘The solution to climate change is just below our feet’. National Geographic [online]. 11 October. Available at: <https://www.nationalgeographic.com/science/2019/10/partner-content-solution-to-climate-change-below-our-feet/> [Accessed: 03/11/2019].

9. Diaz, S, Settele, J, Brondizio, E, et al. (2019) ‘Report of the plenary of the intergovernmental science-policy platform on biodiversity and ecosystem services on the work its seventh session’. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Paris. Available at: <https://www.ipbes.net/global-assessment-report-biodiversity-ecosystem-services> [Accessed 05/11/2019]. 

10. Woinarski, J, Burbidge, A and Harrison, P (2015) ‘Ongoing unravelling of a continental fauna: decline and extinction of Australian mammals since European settlement’. Proceedings of the National Academy of Sciences of the United States of America. DOI: 10.1073/pnas.1417301112.

11. Lees, A and Pimm, S (2015) ‘Species, extinct before we know them?’. Current Biology. 25(5):R177-R180. Available at: <https://www.cell.com/current-biology/pdf/S0960-9822(14)01618-2.pdf> [Accessed 05/11/2019]. 

12. Woinarski, J, Garnett, S Legge, S and Lindenmayer, D (2016) ‘The contribution of policy, law, management, research, and advocacy failings to the recent extinctions of three Australian vertebrate species’. Conservation Biology. 31(1):13-23. DOI: 10.1111/cobi.12852.

13. Australian Museum (2018) ‘Australia’s extinct animals’. Australian Museum [webpage]. Available at: <https://australianmuseum.net.au/learn/australia-over-time/extinct-animals/> [Accessed 05/11/2019]. 

14. Triskele (2019) ‘Big cotton eyes off the wild rivers of Northern Australia’. Michael West. 2 October. Available at: <https://www.michaelwest.com.au/big-cotton-eyes-off-the-wild-rivers-of-northern-australia/> [Accessed: 03/11/2019].

15. Roe, S, Streck, C, Obersteiner, M, Frank, S, Griscom, B, Drouet, L, Fricko, O, Gusti, M, Harris, N, Hasegawa, T, Hausfather, Z, Havlik, P, House, J, Nabuurs, G, Popp, A, Sanchez, M, Sanderman, J, Smith, P, Stehfest, E and Lawrence, D (2019) ‘Contribution of the land sector to a 1.5°C world’. Nature Climate Change. 9(1):817-828. DOI:10.1038/s41558-019-0591-9.

16. Carrington, D (2019) ‘Tree planting ‘has mind-blowing potential’ to tackle climate crisis’. The Guardian [online]. 4 July. Available at: <https://www.theguardian.com/environment/2019/jul/04/planting-billions-trees-best-tackle-climate-crisis-scientists-canopy-emissions> [Accessed: 03/11/2019].

17. Morton, A and Davies, A (2019) ‘Australia spends billions planting trees - then wipes out carbon gains by bulldozing them’. The Guardian [online]. 16 October. Available at: <https://www.theguardian.com/environment/2019/oct/17/australia-spends-billions-planting-trees-then-wipes-out-carbon-gains-by-bulldozing-them> [Accessed: 03/11/2019].

18. Readfearn, G and Morton, A (2019) ‘Australia is the only country using carryover climate credits, officials admit’. The Guardian [online]. 22 October. Available at: < https://www.theguardian.com/environment/2019/oct/22/australia-is-the-only-country-using-carryover-climate-credits-officials-admit> [Accessed 07/11/19].

19. Merzian, R (2019) ‘How Australia is robbing the Pacific of its climate change efforts’. The Australia Institute. August 2019. Available at: <https://www.tai.org.au/sites/default/files/P773%20Australia%27s%20climate%20loophole%20and%20the%20Pacific%20%5BWEB%5D.pdf> [Accessed 07/11/19].

20. Marmot, M and Allen, J (2014) ‘Social determinants of health equity’. The American Journal of Public Health. 104(supplement 4): S517-S519. DOI: 10.2105/AJPH.2014.302200. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151898/> [Accessed: 04/11/2019].

21. Worland, J and Gregory, C (2019) ‘The leaders of these sinking countries are fighting to stop climate change. Here’s what the rest of the world can learn’. Time magazine [online]. 13 June. Available at: <https://time.com/longform/sinking-islands-climate-change/> [Accessed 09/11/19].

22. Agence France-Presse (2019) ‘Climate crisis is greatest ever threat to human rights, UN warns’. The Guardian [online]. 9 September. Available at: <https://www.theguardian.com/law/2019/sep/09/climate-crisis-human-rights-un-michelle-bachelet-united-nations> [Accessed 04/11/2019]. 

23. United Nations Human Rights Office Of The High Commissioner (2019) ‘UN expert condemns failure to address impact of climate change on poverty’ [online]. 25 June. Geneva. Available at: < https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=24735&LangID=E> [Accessed 04/11/2019]. 

24. Monbiot, G (2014) ‘Why we couldn’t care less about the natural world’. The Guardian [online]. 9 May. Available at: <https://www.theguardian.com/environment/georgemonbiot/2014/may/09/why-we-couldnt-care-less-about-the-natural-world> [Accessed: 04/11/2019].

25. RMIT ABC Fact Check (2019) ‘Have emissions fallen since 2005, and are they the lowest they’ve ever been, as liberal MP Katie Allen says?’. ABC News Australia [online]. 8 November. Available at: <https://www.abc.net.au/news/2019-11-08/fact-check-carbon-emissions-under-the-coalition/11662018> [Accessed 08/11/19].

26. Sparrow, J (2019) ‘Politicians’ reluctance on climate change is bizarre – action would not only be right but popular’. The Guardian [online]. 23 April. Available at: < https://www.theguardian.com/commentisfree/2019/apr/23/politicians-reluctance-on-climate-change-is-bizarre-action-would-not-only-be-right-but-popular> [Accessed 04/11/2019]. 

27. Holth, J (2017) ‘7 instant ways to reduce your carbon footprint’. Huffpost [online]. 6 May. Available at: < https://www.huffpost.com/entry/7-instant-ways-to-reduce-your-carbon-footprint_b_59321992e4b00573ab57a383> [Accessed 04/11/2019]. 

28. Thorp, C (2019) ‘What are the best ways to reduce your carbon footprint?’. The Telegraph (UK) [online]. 18 October. Available at: < https://www.telegraph.co.uk/technology/zero-carbon/reduce-carbon-footprint/> [Accessed 04/11/2019]. 

29. Lukacs, M (2017) ‘Neoliberalism has conned us into fighting climate change as individuals’. The Guardian [online]. 17 July. Available at: < https://www.theguardian.com/environment/true-north/2017/jul/17/neoliberalism-has-conned-us-into-fighting-climate-change-as-individuals> [Accessed 04/11/2019]. 

30. MacKay, K (2018) ‘The ecological crisis is a political crisis’. The Millennium Alliance for Humanity and the Biosphere [MAHB]. 25 September. Available at: <https://mahb.stanford.edu/blog/ecological-crisis-political-crisis/> [Accessed 04/11/2019]. 

31. Flanagan, R (2019) ‘Tasmania is burning. The climate disaster future has arrived while those in power laugh at us’. The Guardian [online]. 4 February. Available at: < https://www.theguardian.com/environment/2019/feb/05/tasmania-is-burning-the-climate-disaster-future-has-arrived-while-those-in-power-laugh-at-us>[Accessed 04/11/2019]. 

32. Crowe, D (2019) ‘Morrison is being transparently political in targeting climate groups’. The Sydney Morning Herald. 2 November. Available at: <https://www.smh.com.au/politics/federal/morrison-is-being-transparently-political-in-targeting-climate-groups-20191101-p536nz.html>[Accessed 04/11/2019].

33. Whyman, T (2019) ‘Will the rich escape climate apocalypse?’. New internationalist [online]. 17 May. Available at: <https://newint.org/features/2019/04/09/first-class-lifeboats> [Accessed 05/11/2019]. 

34. Flannery, T (2019) ‘I now look back on my 20 years of climate activism as a colossal failure’. The Guardian [online]. 17 September. Available at: <https://www.theguardian.com/commentisfree/2019/sep/17/i-now-look-back-on-my-20-years-of-climate-activism-as-a-colossal-failure> [Accessed 04/11/2019].

35. Ward, M, Reside, A, Possingham, H, Watson, J, Simmonds, J, Rhodes, J and Taylor, M (2019) ‘Environment laws have failed to tackle the extinction emergency. Here’s the proof’. The Conversation [online]. 9 September. Available at: <https://theconversation.com/environment-laws-have-failed-to-tackle-the-extinction-emergency-heres-the-proof-122936>  [Accessed 04/11/2019].

36. Kay, J (2015) ‘Other people’s money’. London: Profile Books Limited.

37. Kasprak, A (2016) ‘Did a 1912 newspaper article predict global warming?’. Snopes [website]. 18 October. Available at: < https://www.snopes.com/fact-check/1912-article-global-warming/> [Accessed 04/11/2019]. 

38. Wallace-Wells, D (2019) ‘Jared Diamond: there’s a 49 percent chance the world as we know it will end by 2050’. Intelligencer [online, interview]. 10 May. Available at: <http://nymag.com/intelligencer/2019/05/jared-diamond-on-his-new-book-upheaval.html> [Accessed 04/11/2019]. 

39. Israel, J (2019) ‘Sustainability expert Michael Mobbs: I’m leaving the city to prepare for the apocalypse’. The Guardian [online]. 28 September. Available at: <https://www.theguardian.com/environment/2019/sep/29/sustainability-expert-michael-mobbs-im-leaving-the-city-to-prep-for-the-apocalypse> [Accessed 05/11/2019].

40. Kareiva, P and Carranza, V (2018) ‘Existential risk due to ecosystem collapse: nature strikes back’. Futures. 102: 39-50. DOI: 10.1016/j.futures.2018.01.001.

41. Spratt, D and Dunlop, I (2018) ‘What lies beneath – the understatement of existential climate risk’. Breakthrough National Centre for Climate Restoration [Melbourne-based independent think-tank]. Available at: <https://climateextremes.org.au/wp-content/uploads/2018/08/What-Lies-Beneath-V3-LR-Blank5b15d.pdf> [Accessed 07/11/19].

42. Newkirk, V (2016) ‘Using game theory to break the climate gridlock’. Reporter’s Notebook, The Atlantic [online]. Available at: <https://www.theatlantic.com/notes/2016/04/climate-change-game-theory-models/479340/> [Accessed 05/11/19].

43. Tollefson, J (2019) ‘The hard truths of climate change - by the numbers’. Nature [online]. 18 September. Available at: <https://www.nature.com/immersive/d41586-019-02711-4/index.html> [Accessed: 03/11/2019].

44. First Dog On The Moon (2019) ‘If you act now you can maybe avoid the worst of climate change. But you know you’re not going to.’ The Guardian [online]. 2 August. Available at: <https://www.theguardian.com/commentisfree/2019/aug/02/if-you-act-now-you-can-maybe-avoid-the-worst-of-climate-change-but-you-know-youre-not-going-to> [Accessed: 03/11/2019].

45. Cooke, R, Eigenbrod, F and Bates, A (2019) ‘Projected losses of global mammal and bird ecological strategies’. Nature Communications [open access]. DOI: 10.1038/s41467-019-10284-z.

46. IPBES (2019) ‘Media release: Nature’s dangerous decline ‘unprecedented’; species extinction rates ‘accelerating’’. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services [online]. Available at: <https://www.ipbes.net/news/Media-Release-Global-Assessment> [Accessed 04/11/2019]. 

47. Morton, A (2019) ‘Greenhouse gas emissions from diesel vehicles cancelled out cuts from renewable energy’. The Guardian [online]. 1 November. Available at: <https://www.theguardian.com/environment/2019/nov/02/greenhouse-gas-emissions-from-diesel-vehicles-cancelled-out-cuts-from-renewable-energy>. [Accessed 04/11/2019]. 

48. Vince, G (2019) ‘The heat is on over the climate crisis. Only radical measures will work’. The Guardian [online]. 18 May. Available at: <https://www.theguardian.com/environment/2019/may/18/climate-crisis-heat-is-on-global-heating-four-degrees-2100-change-way-we-live> [Accessed 09/11/19].

Why protecting our rainforests is good for your blood pressure

Why protecting our rainforests is good for your blood pressure

The relationship between human health and the environment is indivisible and indisputable yet it seems the allure of conceptualising modern medicine as an exclusively sophisticated scientific enterprise involving labcoats, latex gloves, and laptops is leading us into damaging neglect of the natural world. As commonplace as this hyper-stylised mythos may be, it misrepresents the erratic, winding real-world road of pharmacological development from its gritty origin stories of trial-and-error, serendipitous discovery, and intrepid experimentation into the unknown (1).In arguing for the necessity of protecting this planet’s biodiversity from a medical perspective alone, we must appreciate the humbling roots of modern day biochemistry; steeped in a rich history of tribal witchcraft, indigenous herbalism, and traditional medicines; spurred forwards by a fascination with the bizarre, extraordinary, and unique flora and fauna scattered across all four corners of the earth.

Despite great advances in medical science and the phenomenal rate of growth in knowledge (at current estimated doubling-times of around 3.5 years (2)) modern medicine remains dependent on both the compounds isolated from the traditional medicinal and herbal preparations used for centuries by indigenous cultures, as well as those discovered through trailblazing field research undertaken in paddocks, jungles, rainforests, and deserts. In what is perhaps surprising reality, a tremendous proportion of the drugs that have revolutionised modern medicine were not discovered and synthesised in high-tech laboratories by international research teams who set out with the express prior intention of creating a targeted therapy to treat a particular condition (23). Rather, our present understanding of medicine, physiology, and pharmacology owes an astonishing debt to nature in its exemplar provision of biological ingenuity, novel chemical compounds, and evolutionary extravagance (29). If you look closely enough, these biological underpinnings can be readily appreciated today at the pharmacy or doctors office, with estimations that around a quarter of prescription drugs in the USA include active ingredients of plant origin (3). Without detailing the fascinating histories of each example, it can be appreciated that modern medicines hail from many diverse sub-fields of chemistry, biology, toxicology, and botany; though I would wholeheartedly encourage reading into the incredible journeys of discovery related to any of the following tales of drug discovery:

• Incretins or Glucagon-Like Peptide 1 [GLP-1] agonists used in management of type 2 diabetes with additional benefits for weight loss – beginning with initial observations of anglerfish (4) and research of the different proteins in the saliva of Gila monster lizards (5).

• Protamine is a peptide used to control coagulation by reversing the effects of heparin – originally synthesised in the cytoplasm of rainbow trout sperm cells (6).

• Aspirin; indicated for everything from migrainous headaches to acute myocardial infarctions, prevention of stroke, and to reduce fevers – used by ancient Sumerian, Egyptian, and Greek civilisations; derived from the bark and leaves of a willow tree (7).

• Atropine as used in anaesthesia, cardiac, ophthalmic, respiratory, and intensive care medicine for a range of applications from treating dysrhythmias to organophosphate poisoning – originally used in herbal medicine preparations dating back to the fourth century BCE and even in cosmetic use as a mydriatic to dilate women’s pupils; distilled from mandrake, belladonna, or deadly nightshade plants (8).

• Digoxin (or digitalis if you rather) also an example of an incredibly useful cardiac anti-arrhythmic agent – originally applied as an apothecary’s treatment for dropsy; first purified from the beautiful and toxic wildflower, foxglove (9).

• Curare poison and the drugs Pancuronium and Rocuronium used as muscle relaxants in routine anaesthetic practice – with a truly fascinating history beginning with an ancient Venezuelan poison used to lace sardines and catch birds like herons and cranes; derived from the Malouetia bequaertiana shrub and related plant species (10).

  And…

• Angiotensin Converting Enzyme [ACE] inhibitors; fist line treatment for hypertension (high blood pressure) with due credit to the unfathomable and unparalleled benefits for cardiovascular health on a truly global scale that these medications have yielded – first isolated from the venom of the South American pit viper Bothrops jararaca (11). Its venom was known to cause severe intestinal contractions and due to experimental effects in stimulating slow contractions of the smooth muscle of the gut, Sergio Ferreira and colleagues, building on the extensive earlier work of Sir John Vane, were led to suspect that this snake venom might augment the actions of bradykinin and inhibit the enzyme responsible for its breakdown, ACE (12, 13).

Although this selection presents some memorable examples, there is no shortage of instances in which careful scientific observation, research-for-research’s-sake, cross-discipline curiosity, and reverence for the natural world have yielded incredible paradigm-changing discoveries for medicine.

- The chance discovery of warfarin from investigation of a haemorrhagic disease affecting the cattle and sheep which grazed on sweet clover hay (17)

- Modern xanthines such as theophylline in airway disease - discovered as the mechanism underlying consumption of strong coffee and teas in ancient times as an asthma remedy (16)

- Colchicine’s use as a mainstay for gout treatment as derived from the autumn crocus plant (22)

- The remarkably serendipitous discovery of penicillin through incidental mould contamination of a petri dish (19), spurring this frankly under-appreciated age of antibiotics in which we now live.

- Discovery of heparin through early studies of the canine liver (17) and in curious current affairs, serious threats to heparin’s supply due to spread of African Swine Fever virus among pigs in China (18)

- Present day use of horses, sheep, and mammals in the synthesis of antivenom (20), with an unfortunate state of preventable death arising from antivenom shortages due to poor regulatory frameworks, substandard products, and weakened health systems (21).

We depend on the weird and wonderful in nature as both an inspiration and starting point for an enormous portion of medical and scientific research – plants and animals are truly indispensable in the quest for improving the health and wellbeing of populations, and preservation of biodiversity is key (14). In further defence of all manner of miscellaneous, mischievous, and accidental research, a beautifully forgotten article by Comroe and Dripps (1976) reported that an estimated 41-percent of work that was crucial for clinical advances in cardiovascular and pulmonary medicine was not clinically oriented at the time of research (23). This is to say that in these instances the researchers sought knowledge for the sake of knowledge or made their breakthroughs in work towards otherwise medically-unrelated enterprises. Without prior knowledge of where it is that research will lead us, or the ways in which seemingly unrelated and inadvertent findings may connect in years to come, we cannot know what it is we are potentially losing when our most bio-diverse ecosystems are destroyed.

Though this article has focused on pharmacology, pharmacognosy, and scientific serendipity, it can be easily seen that biodiversity is not only an environmental issue but has implications for domains as diverse as food, water, climate regulation, and energy security (15). As a society we need to encourage, value, and take pride in preservation of the natural world we are part of, and appreciate the empirically central role it has (and continues to) play in human health and scientific advancement. The unfortunate truth is that such delineations of the intimate connections between nature and health are not new, nor are the grave concerns that have been raised about the probable catastrophic effects of global environmental change (28). It was this particularly prescient warning so thoroughly expounded by Grifo and Rosenthal 23 years ago that seems to have been forgotten (28) - a saddening indictment of the obstinate and ongoing political and societal torpor pushing humanity ever closer toward collapse.

With the frightening rates of land clearing and global habitat loss currently seen (25, 26, 27) it seems the message to protect biodiversity is falling on stony ground, painting a bleak picture for the future (24). Conservation of nature for health in this sense is not about acai berries and turmeric lattes; in losing the natural world we risk losing that which is, and that which could become, the very foundations of modern medicine.

 T Michniewicz, 03/10/19

Reference

1. G. Gromo, G, Mann, J and Fitzgerald, J (2014) ‘Cardiovascular drug discovery: a perspective from a research-based pharmaceutical company’. Cold Spring Harbor Perspectives in Medicine. 4;4:a014092. DOI: 10.1101/cshperspect.a014092. 

2. Densen, P (2011) ‘Challenges and opportunities facing medical education’. Transactions of the American Clinical and Climatological Association. 122:48-58. Available from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116346/> [Accessed: 29/09/2019].

3. Orhan, I (2014) ‘Pharmacognosy: science of natural products in drug discovery’. BioImpacts. 4(3):109-110. DOI:10.15171/bi.2014.001.

4.  Lund, K (2005) ‘The discovery of glucagon-like peptide 1’. Regulatory Peptides. 128(2):93-96. DOI: 10.1016/j.regpep.2004.09.001.

5. ScienceDaily (2007) ‘Drug derived from gila monster saliva helps diabetics control glucose, lose weight’ [webpage]. 12 July. Available from: <https://www.sciencedaily.com/releases/2007/07/070709175815.htm> [Accessed: 30/09/2019].

6. Ling, V and Dixon, G (1970) ‘The biosynthesis of protamine in trout testis’. The Journal of Biological Chemistry. 245(12):3035-3042. Available from: <http://www.jbc.org/content/245/12/3035.full.pdf> [Accessed: 30/09/2019].

7. Connelly, D (2014) ‘A history of aspirin’ [online]. Clinical Pharmacist. 26 September. 6(7). DOI: 10.1211/CP.2014.20066661. Available from: <https://www.pharmaceutical-journal.com/news-and-analysis/infographics/a-history-of-aspirin/20066661.article?firstPass=false> [Accessed: 30/09/2019].

8. Holzman, R (1998) ‘The legacy of Atropos, the fate who cut the thread of life’. Anesthesiology. 89(1):241-249. Available from: <https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1947026> [Accessed: 30/09/2019].

9. Smulyan, H (2018) ‘The beat goes on: the story of five ageless cardiac drugs’. The American Journal of the Medical Sciences. 356(5):441-450.

10. McKenzie, A (2000) ‘Prelude to pancuronium and vecuronium’. Anaesthesia. 55(1):551-556. DOI: 10.1046/j.1365-2044.2000.01423.x. Available from: <https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2044.2000.01423.x> [Accessed: 30/09/2019].

11. The Pharmaceutical Journal (2009) ‘From snake venom to ACE inhibitor – the discovery and rise of captopril’. The Pharmaceutical Journal. 17 April. 282(1):455. Available from: <https://www.pharmaceutical-journal.com/news-and-analysis/news/from-snake-venom-to-ace-inhibitor-the-discovery-and-rise-of-captopril/10884359.article> [Accessed: 30/09/2019].

12. Opie, L and Kowolik, H (1995) ‘The discovery of captopril: from large animals to small molecules’. Cardiovascular Research. 30(1):18-25. DOI:10.1016/s0008-6363(95)00006-2.

13. Patlak, M (2003) ‘From viper’s venom to drug design: treating hypertension’. Breakthroughs in bioscience. Federation of American Societies for Experimental Biology. Bethesda, MD, USA. Available from: <https://www.faseb.org/Portals/2/PDFs/opa/venom.pdf> [Accessed: 02/10/2019].

14. Avato, P and Argentieri, M (2018) ‘Plant biodiversity: phytochemicals and health’. Phytochemistry Reviews. 17(4):645-656. Available from: <https://link.springer.com/article/10.1007/s11101-018-9549-1> [Accessed: 02/10/2019].

15. Watson, R (2019) ‘Biodiversity touches every aspect of our lives – so why has its loss been ignored?’. The Guardian [online]. 19 September. Available from: <https://www.theguardian.com/environment/2019/sep/19/biodiversity-touches-every-aspect-of-our-lives-so-why-has-its-loss-been-ignored> [Accessed: 02/10/2019].

16 (A). Persson, C (1984) ‘On the medical history of xanthines and other remedies for asthma: a tribute to HH Salter’. Thorax. 40(12):881-886. DOI: 10.1136/thx.40.12.881. Available from: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC460218/> [Accessed: 30/09/2019].

17 Y. Wardrop, D and Keeling, D (2008) ‘The story of the discovery of heparin and warfarin’. British Journal of Haematology. 141(6):757-763. DOI: 10.1111/j.1365-2141.2008.07119.x.

18 Z. Shepardson, D (2019) ‘Congress seeks briefing on potential threat to U.S. heparin supply’. Reuters [online]. 31 July. Available from: <https://www.reuters.com/article/us-congress-heparin-china/congress-seeks-briefing-on-potential-threat-to-u-s-heparin-supply-idUSKCN1UP1TX> [Accessed: 30/09/2019].

19 X. Bartfai, T and Lees, G (2006) ‘Drug discovery from bedside to wall street’. Elsevier Academic Press. Burlington, MA, USA. Pp. 25-26.

20 B. University of Melbourne (2019) ‘Venom and antivenom’ [webpage]. University of Melbourne, Australia. Available from: <https://biomedicalsciences.unimelb.edu.au/departments/pharmacology/engage/avru/discover/venom-and-antivenom> [Accessed: 30/09/2019].

21 C. WHO (2019) ‘Antivenoms’ [webpage]. World Health Organization. Available from: <https://www.who.int/snakebites/antivenoms/en/> [Accessed: 30/09/2019].

22 D. Gupta, P (2018) ‘Poisonous plants’. In Illustrated Toxicology. Academic Press: London. ISBN: 978-0-12-813213-5.

23 E. Comroe, J and Dripps, R (1976) ‘Scientific basis for the support of biomedical science’. Science. 192(1):105-111.

24 F. Watts, J (2018) ‘Stop biodiversity loss or we could face our own extinction, warns UN’. The Guardian [online]. 6 November. Available from: <https://www.theguardian.com/environment/2018/nov/03/stop-biodiversity-loss-or-we-could-face-our-own-extinction-warns-un> [Accessed: 02/10/2019].

25 H. McCutcheon, P (2019) ‘Extent of fire damage in Gold Coast rainforest revealed’. ABC News Australia [online]. 2 October. Available from: <https://www.abc.net.au/news/2019-10-02/extent-of-fire-damage-in-gold-coast-rainforest-revealed/11567574?fbclid=IwAR31PAOqS0l8fE-F3RzNb08pBbm3RWYJwa7Bp_QJgwI-TCRQZ_sHSP8x0QI> [Accessed: 02/10/2019].

26 I. Slezak, M and Doman, M (2019) ‘From space, you can clearly see the human impact on the Amazon’. ABC News Australia [online]. Updated 23 September 2019. Available from: < https://www.abc.net.au/news/2019-09-19/satellite-images-of-amazon-reveals-human-impact-of-fires/11478580> [Accessed: 02/10/2019].

27 J. Spring, A (2019) ‘Fire, disease, people: the native plants facing extinction – in pictures’. The Guardian [online]. 24 June. Available from: <https://www.theguardian.com/environment/ng-interactive/2019/jun/25/fire-disease-people-the-native-plants-facing-extinction-in-pictures> [Accessed: 02/10/2019].

28 k. Grifo, F and Rosenthal, J (1997) ‘Biodiversity and human health’. Island Press. Washington DC, USA. ISBN: 1-55963-501-0.

29. Ahlo, C (2008) ‘Valor da biodiversidade’. Brazilian Journal of Biology. 68(4):1115-1118. DOI:10.1590/S1519-69842008000500018.

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#ClimateStrike - Thoughts on the 2019 Global Climate Strike

These last few days have seen millions take part in the biggest climate protest to date (1) calling for urgent action on climate change. The Climate Strike, School Strike for Climate / Skolstrejk for Klimatet, and Fridays for Future movement began in August 2018 with the stalwart trailblazing of Greta Thunberg in Stockholm Sweden, and has since grown on to a global stage. This Friday saw students make their voices heard around the world, expressing their disenchantment in the lack of political action on global warming, and feelings that the voice of the youth needs to be heard as the voice of those most likely to be affected by the unfolding climate crisis (2, 3). They echo the existential sentiments expressed by Thunberg about the apparent hopelessness in pursuit of education and training when political leaders “won’t pay attention to the facts” (4).

The movement has garnered support foremost from students but also NGOs (5), scientific organisations and researchers (6, 7), businesses (8), and individuals of all ages and professions. Taken together it is an encouraging sign that the tide of public opinion on climate action is starting to turn, and although in a recent poll by the Lowy Institute 61% of Australians agreed “global warming is a serious and pressing problem and we should begin taking steps now even if this involves significant costs” (9), we have previously seen similar levels of public support over a decade ago in 2006, suggesting perhaps the lability of public opinion, or a possibly disconnect between the public’s figurative support for climate action and literal support for climate policy (10). It is easy to suppose the latter to be most true, and that akin to recommendations about diet and exercise, public belief in benefits (11) has not translated into real world action (12).

Though the ever present threat of ecological collapse looms ever-near (13, 14) the future remains fundamentally uncertain, and in this uncertainty exists both the possibility of decisive action and global cooperation, or a future characterised by mass migration, famine, humanitarian crises, and environmental degradation; with all shades in between. There can be little doubt that the odds at present are not favourable (15), and nation’s responses to date are similarly underwhelming. Taking the current state of play with Australia’s rising emissions from the fossil fuel industry (16), de-funding of the Green Climate Fund (17), and deeply saddening developments at the recent Pacific Islands Forum (18, 19), much of the despair, despondency, and nihilism associated with the climate crisis (20, 21, 22) seems an understandable reaction to the very likely insurmountable challenge that we face.

But the probability of success must not determine our resolve and commitment to action. Indeed, some of the most important turning points for humanity have been determined by the finest of margins conceivable; Vasily Arkhipov’s actions during the Cuban missile crisis, the position of a single safe/arm switch in the 1961 Goldsboro B-52 crash, and the cool-headedness of Stanislav Yevgrafovich Petrov’s in 1983. And though the climate crisis represents the most complex and far-reaching challenge ever faced by humanity, it is at least one for which we have viable, practical, and efficacious solutions at hand (23, 24), if only we can muster the collective societal and political will to deploy them. Both as individuals and as a society, our resolve to reduce our environmental impact and our commitment to sustainability must not be predicated on a guarantee of success.

Though at this moment it may seem improbable that global warming is constrained to 1.5 degrees, or that the action taken as individuals is meaningful in addressing deep-seated systemic failings, we need only still believe that change is possible in order to try - it is an uncertain future too important to leave to chance.

Pour ce qui est de l’avenir, il ne s’agit pas de le prévoir, mais de le rendre possible

Antoine de Saint Exupéry, Citadelle, 1948 (25)

T Michniewicz, 22/09/19

Reference

1. Laville, S and Watts, J (2019) ‘Across the globe, millions join biggest climate protest ever’. The Guardian [online], 21 September. Available from: <https://www.theguardian.com/environment/2019/sep/21/across-the-globe-millions-join-biggest-climate-protest-ever> [Accessed: 22/09/2019].

2. ABC News (2019) ‘Global climate strike sees ‘hundreds of thousands’ of Australians rally across the country’. ABC News Australia [online], 20 September.  Available from: <https://www.abc.net.au/news/2019-09-20/school-strike-for-climate-draws-thousands-to-australian-rallies/11531612> [Accessed: 22/09/2019].

3. Al Jazeera (2019) ‘No planet B: millions take to streets in global climate strike’. AlJazeera [online], 21 September. Available from: <https://www.aljazeera.com/news/2019/09/planet-thousands-join-global-climate-strike-asia-190920040636503.html> [Accessed: 22/09/2019].

4. Crouch, D (2018) ‘The Swedish 15-year-old who’s cutting class to fight the climate crisis’. The Guardian [online], 1 September. Available from: <https://www.theguardian.com/science/2018/sep/01/swedish-15-year-old-cutting-class-to-fight-the-climate-crisis> [Accessed: 22/09/2019].

5. Noyes, J (2019) ‘More than 200 companies give staff time off to attend climate strike’. The Sydney Morning Herald [online], 19 September. Available from: <https://www.smh.com.au/business/companies/more-than-2000-companies-give-staff-time-off-to-attend-climate-strike-20190919-p52szm.html> [Accessed: 22/09/2019].

6. Schiermeier, Q, Atkinson, K, Mega, E, Padma T, Stoye, E, Tollefson, J and Witze, A (2019) ‘Scientists worldwide join strikes for climate change’. Nature [online]. DOI:10.1038/d41586-019-02791-2 Available from: <https://www.nature.com/articles/d41586-019-02791-2> [Accessed: 22/09/2019].

7. Steinberger, J (2019) ‘I stand with the climate striking students – it’s time to create a new economy’. The Conversation [online], 20 September. Available from: <https://theconversation.com/i-stand-with-the-climate-striking-students-its-time-to-create-a-new-economy-123893> [Accessed: 22/09/2019].

8. Nguyen, T (2019) ‘Some brands are closing stores for the global climate strike. That’s a big deal.’. Vox [online], 20 September. Available from: <https://www.vox.com/the-goods/2019/9/20/20876098/brands-global-climate-strike-closing> [Accessed: 22/09/2019].

9. McDonald, M (2019) ‘Are Australians more worried about climate change or climate policy?’. The Interpreter [online], 26 June. Available from: <https://www.lowyinstitute.org/the-interpreter/are-australians-more-worried-about-climate-change-or-climate-policy> [Accessed: 22/09/2019].

10. Irfan, U (2019) ‘Americans are worried about climate change – but don’t want to pay much to fix it’. Vox [online], 28 January. Available from: <https://www.vox.com/2019/1/28/18197262/climate-change-poll-public-opinion-carbon-tax> [Accessed: 22/09/2019].

11. Haseler, C, Crooke, R and Haseler, T (2019) ‘Promoting physical activity to patients’. BMJ. 366: I5230. DOI: 10.1136/bmj.l5230. Available from: <https://www.bmj.com/content/366/bmj.l5230> [Accessed: 22/09/2019].

12. Australian Institute of Health and Welfare (2019) ‘Insufficient physical activity’. Australian Institute of Health and Welfare [online]. Updated 19 July 2019. Available from: <https://www.aihw.gov.au/reports/risk-factors/insufficient-physical-activity/contents/physical-inactivity> [Accessed: 22/09/2019].

13. United Nations Sustainable Development Goals (2019) ‘UN report: nature’s dangerous decline ‘unprecedented’; species extinction rates ‘accelerating’’. United Nations Sustainable Development Blog [online], 6 May. Available from: <https://www.un.org/sustainabledevelopment/blog/2019/05/nature-decline-unprecedented-report/> [Accessed: 22/09/2019].

14. Brum, E (2019) ‘In Bolsonaro’s burning Brazilian Amazon, all our futures are being consumed’. The Guardian [online], 23 August. Available from: <https://www.theguardian.com/commentisfree/2019/aug/23/amazon-rainforest-fires-deforestation-jair-bolsonaro> [Accessed: 22/09/2019].

15. Raftery, A, Zimmer, A, Frierson, D, Startz, R and Liu, P (2017) ‘Less than 2C warming by 2100 unlikely’. Nature Climate Change. 7(1):637-641. DOI: 10.1038/NCLIMATE3352. Available from: <https://www.nature.com/articles/nclimate3352> [Accessed: 22/09/2019].

16. Climate Action Tracker (2019) ‘Australia: country summary’. Climate Action Tracker.org [website]. Available from: <https://climateactiontracker.org/countries/australia/> [Accessed: 22/09/2019].

17. Graue, C (2019) ‘Disappointment as Australia ends green climate fund contributions’. ABC News Australia [online], 3 April. Available from: <https://www.abc.net.au/radio-australia/programs/pacificbeat/pac-climate-change-group-disappointed-by-aus-gov-gcf-cut/10965488> [Accessed: 22/09/2019].

18. Ison, N (2019) ‘Scott Morrison’s betrayal of the Pacific was immoral – and completely unnecessary’. The Guardian [online], 16 August. Available from: <https://www.theguardian.com/commentisfree/2019/aug/16/scott-morrisons-betrayal-of-the-pacific-was-immoral-and-completely-unnecessary> [Accessed: 22/09/2019].

19. Smee, B (2019) ‘Pacific islands will survive climate crisis because they ‘pick our fruit’, Australia’s deputy PM says’. The Guardian [online], 16 August. Available from: <https://www.theguardian.com/australia-news/2019/aug/16/pacific-islands-will-survive-climate-crisis-because-they-can-pick-our-fruit-australias-deputy-pm-says> [Accessed: 22/09/2019].

20. Pearl, M and Zhao, A (2019) ‘Climate despair is making people give up on life’. Vice [online], 12 July. Available from: < https://www.vice.com/en_au/article/j5w374/climate-despair-is-making-people-give-up-on-life> [Accessed: 22/09/2019].

21. Kalmus, P (2019) ‘Opinion: how to live with the climate crisis without becoming a nihilist’. Los Angeles Times [online], 15 September. Available from: <https://www.latimes.com/opinion/story/2019-09-13/global-warming-climate-change-science-activism-jonathan-franzen> [Accessed: 22/09/2019].

22. McDougall, D (2019) ‘Ecological grief: Greenland residents traumatised by climate emergency’. The Guardian [online], 12 August. Available from: <https://www.theguardian.com/world/2019/aug/12/greenland-residents-traumatised-by-climate-emergency> [Accessed: 22/09/2019].

23. United Nations News (2019) ‘Nature ‘one of the most effective ways’ of combatting climate change’. UN News [online], 19 September. Available from: <https://news.un.org/en/story/2019/09/1046752> [Accessed: 22/09/2019].

24. Brailsford, L (2018) ‘New wind and solar now as cheap as existing coal’. Climate Council Australia [online], 6 December. Available from: <https://www.climatecouncil.org.au/new-wind-and-solar-now-as-cheap-as-existing-coal/> [Accessed: 22/09/2019].

25. Intergovernmental Panel on Climate Change (2019) ‘Special report: global warming of 1.5ºC’ [website]. Available from: <https://www.ipcc.ch/sr15/> [Accessed: 07/09/2019].

Durable Design: Constructing Practical, Enjoyable, and Sustainable Urban Environments

Air pollution, traffic congestion, litter, noise, and patchwork concrete – elements synonymous with the concept of a city and simultaneously at odds with the conception of what a city could be – green spaces, intuitive and efficient public transport, cycleways and walkways. Though form follows function, it seems most of our urban spaces are not optimised for pedestrians, business, social engagement, nor vehicular traffic, and instead constitute a fairly ‘unhappy middle’ for all. Part product of poor design, part product of inadequate foresight, and part product of necessity during development (from the Main streets of a horse-drawn cart era), the urban landscape is often seen to represent an inevitable inconvenience (or ‘necessary evil’) (1) as an evolved compromise between these competing requirements for different users. Though all urban design must balance such factors as local demography, local industry requirements, commuter demands, continually evolving technology, and population shifts, present conditions are of languorous and reactionary tendencies towards meeting the needs of urban dwellers and commuters, and the ever pressing need for climate action.

From another perspective it is important to consider the two-way influence the urban landscape of cities on inhabitants, and the manner in which decisions around city design can impact and influence populations in positive ways; leading the very direction in which cities develop, rather than simply reacting to the purported needs of users. As a case study, though ostensibly inseparable in the minds of many international jetsetters, Amsterdam and bicycle riding have not always experienced a loving relationship and given the turbulent politics and protests of the 1970s. Examining the forces at play during this period, it is apparent that for Amsterdam, the transition from an automobile-centric to active transport friendly city would perhaps not have eventuated without the combination of both strong grassroots activism and bold top-down leadership on cycling infrastructure (2), leading the city in a very different direction to the urban and social landscape we see today. In essence, though an impetus for change existed in the hearts of a vocal cycling population, Amsterdam represents a city that grew into a cycling utopia and not simply as the perpetuation of an inherent and established status quo.

Though construction of a cycling-centric CBD is not appropriate for a great many cities due to factors ranging from local topography to climatic demands, capitalising and building on sustainable modes of transportation that aim to increase social capital and make urban centres safer and more accessible places for work and leisure is the important underlying principle. No single rigid solution and no pre-specified set of rules exists to guide this kind of change and development; cities must engage with the structures already on the ground and actively work with and respect the existing complexities (27). Though what is the right fit for one city or neighbourhood will unlikely suit another, we can always learn from the successful examples already deployed around the globe. Practical and pragmatic approaches to this somewhat nebulous idealism of improved urban design might include upgraded cycling infrastructure (3), the ‘pedestrianization’ of main streets and central areas (4), careful and considered attention to improving the specific pathways and areas of natural people movement in cities (23), and realising the central role that well-designed public transport can play in increasing social capital – including among socially disadvantaged groups (5).

Unfortunately the present paradigm of suburb-living city-commuting with the concomitant protraction of commute time seems suboptimal for health and wellbeing (6), a situation likely exacerbated by the trend towards urban sprawl. Outside direct negative health impacts of the urban environment mediated through exposure to air pollution (7), infectious diseases (a risk especially true for developing and non-OECD nations (8, 9)), motor vehicle accident risk, and unhealthy diets (10), there are implications for the social and preventive health activities that necessarily come second to work commitments. With more time expended commuting, individuals have less time available to invest in their own health - with food preparation, physical activity, and sleep representing the most sacrificed domains (11, 12). Given both current and expected population growth in urban areas, current underdeveloped public transport systems represent a kind of kryptonite exacerbating traffic congestion and reliance on private transport (24).

Additionally, the environmental (13, 25), social, and negative health impacts of urban sprawl (12, 13, 14, 15) represent inextricably related challenges as a case study of Ontario illustrates, linking the urban sprawl land use with higher per-capita energy use, automobile dependence, emphasis on private realms over public space, increased servicing cost, and longer commutes (16). To further emphasise, it can be seen that although a distal factor, the design of urban and build environments represents a central common determinant of both human health and environmental impact, (the latter importantly being critically related to the former) (26).

 Though difficult to quantify and spread across a range of sectors certainly inclusive of human health and environmental sustainability, there can be many anticipated benefits in the adoption of a salutogenic approach to the design of the urban landscape that prioritises active commuting, efficient public transportation, social green spaces, and pedestrian activity. Chronic lifestyle diseases of obesity, type 2 diabetes, and hypertension are likely influenced by the walkability of urban environments (17) and even small increases in daily physical activity across a large proportion of the population are likely to yield health benefits (18). Promotion and support of active commuting where possible is also likely to bring population health benefits (19) and self-evident benefits for carbon emissions (20, 21). Furthermore, investment in efficient and inclusive public transport systems that both replace the need for private transport, permit urban intensification (22), and reduce the deleterious health and environmental effects of sprawl (13) represents a true cornerstone of improving urban design. 

 Clever design of the urban environment holds the potential to concurrently and synergistically improve human health and promote environmental sustainability but at present most of our cities and towns lack the requisite infrastructure and investment. As demonstrated by the Amsterdam case study, a combination of persistent grassroots pressure and bold top-down leadership is likely required to effect change in such a space, but the intersectoral payoff from such a paradigm shift constitutes an undisputably worthwhile cause.

T Michniewicz, 09/09/19

Reference

1. World Health Organization (2019) ‘Urbanization trends’[online]. Regional office for South East Asia. Available from: <http://www.searo.who.int/entity/health_situation_trends/data/chi/unbanization-trends/en/> [Accessed: 09/09/2019].

2. Van Der Zee, R (2015) ‘How Amsterdam became the bicycle capital of the world’. The Guardian. Available from: <https://www.theguardian.com/cities/2015/may/05/amsterdam-bicycle-capital-world-transport-cycling-kindermoord> [Accessed: 09/09/2019].

3. Kirschbaum, E (2019) ‘Copenhagen has taken bicycle commuting to a whole new level’. Los Angeles Times. Available from: <https://www.latimes.com/world-nation/story/2019-08-07/copenhagen-has-taken-bicycle-commuting-to-a-new-level> [Accessed: 09/09/2019].

4. Global Designing Cities Initiative (2019) ‘Pedestrian only streets: case study Stroget, Copenhagen’ [website]. Available from: <https://globaldesigningcities.org/publication/global-street-design-guide/streets/pedestrian-priority-spaces/pedestrian-only-streets/pedestrian-streets-case-study-stroget-copenhagen/> [Accessed: 09/09/2019].

5. Currie, G and Stanley, J (2006) ‘Investigating links between social capital and public transport’. Transport Reviews. 28(4): 529-547. DOI: 10.1080/01441640701817197. Available from: <https://www.tandfonline.com/doi/abs/10.1080/01441640701817197> [Accessed: 09/09/2019].

6. Hansson, E, Mattisson, K, Bjork, J, Ostergren, P and Jakobsson, K (2011) ‘Relationship between commuting and health outcomes in a cross-sectional population survey in southern Sweden’. BMC Public Health. 11:834. DOI: Available from: <https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-834> [Accessed: 09/09/2019].

7. Black, C (2019) ‘Air pollution’ [website]. World Health Organization. Available from: <https://www.who.int/sustainable-development/cities/health-risks/air-pollution/en/> [Accessed: 09/09/2019].

8. Neiderud, C (2015) ‘How urbanization affects the epidemiology of emerging infectious diseases’. Infection Ecology & Epidemiology. 5(1). DOI: 10.3402/iee.v5.27060. Available from: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481042/> [Accessed: 09/09/2019].

9. Berg, N (2016) ‘As cities grow more crammed and connected, how will we discourage the spread of disease?’ [website]. Ensia.com. Available from: <https://ensia.com/features/as-cities-grow-diseases-spread-faster-and-urban-design-key/> [Accessed: 09/09/2019].

10. World Health Organization (2019) ‘Nutrition insecutiry and unhealthy diets’ [website]. Available from: <https://www.who.int/sustainable-development/cities/health-risks/nutrition-insecurity/en/> [Accessed: 09/09/2019].

11. Christian, T (2012) ‘Trade-offs between commuting time and health-related activities’. Journal of Urban Health. 89(5): 746-757. DOI: 10.1007/s11524-012-9678-6. Available from: <https://link.springer.com/article/10.1007/s11524-012-9678-6> [Accessed: 09/09/2019].

12. Taylor, A (2019) ‘Why Sydney’s urban sprawl is harmful to your health’. The Sydney Morning Herald. Available from: <https://www.smh.com.au/national/nsw/why-sydney-s-urban-sprawl-is-harmful-to-your-health-20190906-p52os0.html> [Accessed: 09/09/2019].

13. Gallagher, P (2001) ‘The environmental, social, and cultural impacts of sprawl’. Natural Resources & Environment. 15(4): 219-223. Available from: <http://www.jstor.org/stable/40924406> [Accessed: 09/09/2019].

14. Frumkin, H (2002) ‘Urban sprawl and public health’. Public Health Reports. 117(1): 201-217. Available from: <https://pdfs.semanticscholar.org/8e5f/c4b34a20cfea33061313de1c9568342f4855.pdf> [Accessed: 09/09/2019].

15. Garden, F and Jalaludin, B (2008) ‘Impact of urban sprawl on overweight, obesity, and physical activity in Sydney, Australia’. Journal of Urban Health. 86(1): 19-30. Available from: <https://link.springer.com/article/10.1007/s11524-008-9332-5> [Accessed: 09/09/2019].

16. Environmental Commissioner of Ontario (2019) ‘Urban sprawl: the road to gridlock’ chapter in 2019 Energy Conservation Progress Report. Office of the Auditor General of Ontario. Available from: <https://docs.assets.eco.on.ca/reports/energy/2019/why-energy-conservation-04.pdf> [Accessed: 09/09/2019].

17. Chandrabose, M, Rachele, J, Kavanagh, A, Owen, N, Turrell, G, Giles-Corti, B and Sugiyama, T (2019) ‘Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies. Obesity Reviews. 20(1):41-54. DOI: 10.1111/obr.12759. Available from: <https://www.ncbi.nlm.nih.gov/pubmed/30253075> [Accessed: 09/09/2019].

18. Department of Health and Social Care, Welsh Government, Department of Health, Scottish Government (2019) ‘UK chief medical officers’ physical activity guidelines’. UK Government. Available from: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829841/uk-chief-medical-officers-physical-activity-guidelines.pdf> [Accessed: 09/09/2019].

19. Shephard, R (2012) ‘Is active commuting the answer to population health?’. Sports Medicine. 38(9):751-758. DOI: 10.2165/00007256-200838090-00004. Available from: <https://link.springer.com/article/10.2165/00007256-200838090-00004> [Accessed: 09/09/2019].

20. Maibach, E, Steg, L and Anabele, J (2009) ‘Promoting physical activity and reducing climate change: opportunities to replace short car trips with active transportation’. Preventive Medicine. 49(4):326-327. DOI: 10.1016/j.ypmed.2009.06.028. Available from: <https://www.sciencedirect.com/science/article/pii/S0091743509003326> [Accessed: 09/09/2019].

21. Bourne, G, Steffen, W and Stock, P (2018) ‘Waiting for the green light: transport solutions to climate change’. Climate Council, Australia. Available from: <https://www.climatecouncil.org.au/resources/transport-climate-change/> [Accessed: 09/09/2019].

22. Duffhues, J and Bertolini, L (2015) ‘From integrated aims to fragmented outcomes: urban intensification and transportation planning in the Netherlands’. The Journal of Transport and Land Use. 9(3): 15-34. DOI: 10.5198/jtlu.2016.571. Available from: <https://www.jtlu.org/index.php/jtlu/article/download/571/811> [Accessed: 09/09/2019].

23. Dalton, R (2019) ‘Making cities more walkable by understanding how other people influence our journeys’. The Conversation. Available from: < https://theconversation.com/making-cities-more-walkable-by-understanding-how-other-people-influence-our-journeys-111767> [Accessed: 09/09/2019].

24. Robson, K, Gharehbaghi, K and Scott-Young, C (2018) ‘Planning effective and efficient public transport systems’. International Journal of Real Estate and Land Planning. Vol. 1.

25. Brody, S (2013) ‘The characteristics, causes, and consequences of sprawling development patterns in the United States’[online]. Nature Education Knowledge. 4(5):2. Available from: <https://www.nature.com/scitable/knowledge/library/the-characteristics-causes-and-consequences-of-sprawling-103014747/> [Accessed: 09/09/2019].

26. Bambrick, H, Capon, A, Barnett, B, Beaty, M and Burton, A (2011) ‘Climate change and health in the urban environment: adaptation opportunities in Australian cities’. Asia Pacific Journal of Public Health. 23(2). DOI: 10.1177/1010539510391774. Available from: <https://journals.sagepub.com/doi/abs/10.1177/1010539510391774> [Accessed: 09/09/2019].

27. Greenspan, E (2016) ‘Top-down, bottom-up urban design’. The New Yorker. Available from: <https://newyorker.com/business/currency/top-down-bottom-up-urban-design> [Accessed: 09/09/2019].

Protecting Places

Pre-eminent biologist and ecologist EO Wilson is credited for championing the proposition of a half-earth (1); dedicating 50% of the planet toward conservation of life, the preservation of ecosystems, habitat conservation, and buffering of CO2 emissions. This is simply to scratch the surface, and potential benefits might be considered from any number of environmental, health, economic, and social capital perspectives. The preservation of biodiversity and functional nature reserves is predicated on connected and confluent wilderness areas that incorporate and connect entire ecosystems, in the form of wildlife corridors or otherwise (2,3); in any case reaching beyond simply the presence of isolated parks, sporadic urban green spaces, and nature strips. These large-scale biological ecosystems required to harbour biodiverse life can be considered as representing complex systems (4), demonstrating complex, dynamic interactions present on multiple levels, and complex systems phenomenon – feedback, nonlinearity, emergence (5,12). More imaginative conceptualisations proposed by such polymaths as James Lovelock include the Gaia hypothesis (6), which deals with the entire earth as a homeostatic entity and active adaptive control system that demonstrates properties not predictable from the sum of its parts (6), essentially describing characteristics akin to emergence (12).  The relevance of this model is such that loss of particular predator species in a food web can lead to monopolisation of important, limiting resources such that ecosystems lose diversity (7). On the same wavelength, Levin (5) describes the existence of keystone functional groups, comprised of a small set of species upon which critical ecosystem processes rely. In these complex biological systems, the loss of one species can spiral in unpredictable and devastating ways to the ultimate demise of entire ecosystems. And the mechanistic basis for this is intuitive enough to model, such that in any kind of food web, loss of critical species can lead to cascading secondary extinctions with great consequence (8). Like many, I express much scepticism for the biological utility of the scant and detached manmade parks, green areas, and nature strips – fundamentally disparate from nature, paralleling the simplified and exogenously imposed structures as seen in agriculture and forestry. Such natural artifice has been rebuked by Levin and others for their non-functionality, aberrance, and fundamental lack of heterogeneity, considered essential to ecological adaptation (5). If current patterns are to continue, of seemingly boundless destruction of native forests (9) and feeble non-attempts at preserving green spaces in and around cities (10), biodiversity losses will be inordinate (13). And above this dizzying issue of wilderness loss in absolute numbers, it is the patterns of loss and patterns of protection that become important. In this complex biological system, a critical but underappreciated feature of ecosystem health is ecological interactions, the loss of which can precede species loss (11). Described by Valiente-Banuet and colleagues, environmental destruction and fragmentation means species are reduced to such scattered low-density populations that these crucial ecological interactions are lost, ultimately leading to species extinction and ecosystem decay (11). Thus the functionality and health of ecosystems is dependent on both their components and interactions.

Shunning the silent, ever-pervasive pre-ecological collapse nihilism, and the trappings of judicious commentary without concurrent action, a model for the task may be two-fold: including preservation of existing ecosystems and natural landscapes, and the gradual restoration of existing environments to foster biodiversity. The approaches are complementary, and encouragingly, starting to take form in various models around the globe.

·       Greening Australia (environment restoration)            https://www.greeningaustralia.org.au

·       Half-Earth Project (environment and biodiversity)      https://www.half-earthproject.org

·       Wyss Foundation (habitat protection)                      https://www.wyssfoundation.org

Additionally, the impacts of individual conservation efforts and crowdfunded projects is not to be discounted, with promising stories emerging from collaborative efforts to protect natural places.

·       Crowdfunded land given to public (NZ)        https://www.bbc.com/news/world-asia-36759321

T Michniewicz, August 2019

Reference

1. Hiss, T (2014) ‘Can the world really set aside half of the planet for wildlife?’. Smithsonian Magazine (online). Available from: <https://www.smithsonianmag.com/science-nature/can-world-really-set-aside-half-planet-wildlife-180952379/?no-ist> [Accessed: 20/03/2019].

2. Lindenmayer, D and Nix, H (1993) ‘Ecological principles for the design of wildlife corridors’. Conservation Biology. 7(3): 627-631.

3. Liu, C, Newell, G, White, M and Bennett, A (2018) ‘Identifying wildlife corridors for the restoration of regional habitat connectivity: a multispecies approach and comparison of resistance surfaces’. PLOS ONE (online). DOI: 10.1371/journal.pone.0206071. Available from: <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206071> [Accessed 31/03/2019].

4. Ladyman, J, Lambert, J and Wiesner, K (2013) ‘What is a complex system?’. European Journal for Philosophy of Science. 3(1): 33-67. DOI: 10.1007/s13194-012-0056-8.

5. Levin, S (1998) ‘Ecosystems and the biosphere as complex adaptive systems’. Ecosystems. 1(1): 431-436. Princeton University. New Jersey.

6. Lovelock, J and Margulis, L (1974) ‘Atmospheric homeostasis by and for the biosphere: the gaia hypothesis’. Tellus. 26(1): 2-10. DOI: 10.340/tellus.v26i1-2.9731.

7. Paine, R (1966) ‘Food web complexity and species diversity’, The American Naturalist. 100(910): 65-75. Available from: <http://links.jstor.org/sici?sici=0003-0147%28196601%2F02%29100%3A910%3C65%3AFWCASD%3E2.0.CO%3B2-D> [Accessed 31/03/2019].

8. Dunne, J and Williams, R (2009) ‘Cascading extinctions and community collapse in model food webs’. Philosophical Transactions of the Royal Society B: Biological Sciences. 364(1524). DOI: 10.1098/rstb.2008.0219. 

9. Slezak, M (2018) ‘Global deforestation hotspot: 3m hectares of Australian forest to be lost in 15 years’. The Guardian. 4 March (online). Available from: <https://www.theguardian.com/environment/2018/mar/05/global-deforestation-hotspot-3m-hectares-of-australian-forest-to-be-lost-in-15-years> [Accessed: 31/03/2019].

10. McKenny, L (2016) ‘Sydney’s green spaces to get squeezed as city’s population swells’. The Sydney Morning Herald. 7 May (online). Available from: <https://www.smh.com.au/national/nsw/sydneys-green-spaces-to-get-squeezed-as-citys-population-swells-20160505-gomxdv.html> [Accessed 31/03/2019].

11. Valiente-Banuet, A, Aizen, M, Alcantara, J, Arroyo, J, Cocucci, A, Galetti, M, Garcia, M, Garcia, D, Gomez, J, Jordano, P, Medel, R, Navarro, L, Obeso, J, Oviedo, R, Ramirez, N, Rey, P, Traveset, A, Verdu, M and Zamora, R. (2014) ‘Beyond species loss: the extinction of ecological interactions in a changing world’. Functional Ecology. 29(3): 299-307. DOI: 10.1111/1365-2435.12356.

12. Levin, S (2005) ‘Self-organisation and the emergence of complexity in ecological systems’. BioScience. 55(12): 1075-1079. DOI: 10.1641/0006-3568(2005)055[1075:SATEOC]2.0.CO;2.

13. Kilvert, N (2017) ‘Australia among seven nations responsible for more than 50 percent of global biodiversity loss’. ABC News [online]. Available from: <https://www.abc.net.au/news/science/2017-10-26/australia-biodiversity-loss-conservation/8987696> [Accessed: 07/08/2019].

A Coalface Canary

One of the saddest aspects of healthcare is when the failings of a system are presented as the failings of an individual

It’s 2am and the emergency department is snowed under. Despite your best efforts to work through your meal break, the arrivals continue to mount, the wait times continue to climb. Ambulance trolleys now line any available corridors and the incessant alarming of bedside monitors rises above the background chatter to create a seemingly perpetual atmosphere of tension and anxiety. Steeling yourself before picking up the next case you glance left at a colleague, hoping to catch a sentiment of solidarity, some kind of acknowledgement to know you’re not alone in this moment but it never comes - they’re 15 minutes deep into a heated phone conversation with the medical registrar who is not having an ounce of Beryl’s abdominal pain admitted under them. On scrutinising the waiting list there is medical acuity at every level, and no smart way to sequence the languishing chaos of patients - a 90 year old gentleman with small bowel obstruction, 20 year old female with loss of her first pregnancy, 16 year old boy post attempted suicide awaiting medical review. Any system of triage or prioritisation seems heartless but idealism must play second fiddle to pragmatism, and now is not the time for philosophising. Even the indulgence of budget granulated instant coffee feels like an affront to the dozen nil-by-mouth patients anxiously waiting for CT scans and ultrasounds, and it would seem to require either transcendent zen mastery or sociopathic tendencies to take a meal break at a time like this. By nature, the emergency department represents the frontline and a kind of bottleneck for patient suffering, the weight of which is not one easily expunged from the forefront of the mind.

At a systems level, the interface of an ever-fluctuating patient load and fixed-staffed department without the inbuilt liquidity (if you will) to adapt, and meet increasing demand with increased throughput - and a ‘learned’ over-reliance of such strain being taken up by individuals working longer and harder. Such pressure on scarce healthcare resources, more specifically in an ED environment, seem manifested in protracted wait times and the very real human experiences of pain, anxiety, uncertainty, and additional time until definitive care - an omnipresent reality felt by all frontline healthcare staff. Equally concerning is the observed and expected workforce shortfalls both nationally (5) and internationally (6, 7, 8, 9) working synergistically with increasing hospital presentations (10) to create a perfect storm for medical error, clinician burnout, and poor patient outcomes; the emotional toll of which is not likely amenable to extra yoga sessions (11). Although as described much of this increased demand may well be taken up by staff working harder and faster, this is not without consequence, with a demonstrated association between increased time or production pressure poorer quality care, and rates of medical error (12, 13, 14, 15) especially true for emergency departments (16). It is therefore further regrettable that the fallout from adverse outcomes occurring in such a system, almost as a rule, rest with the unfortunate treating medic frequently without consideration of the situation in which she or he was operating (17). We can see many of these points highlighted in a recent British Medical Association report (18), which succinctly and unambiguously describes the signs, symptoms, and outcomes of a health system under pressure: burnout, longer ED wait times, poorer quality of care, and repercussions for patient safety (8, 18).

It is easy to feel helpless and disempowered when confronted with such a reality, and it is probable that without significant restructuring of resource redistribution and financial bolstering of the health system from a higher policy level that hospital access block, patient safety, and healthcare worker wellbeing will remain a regrettable reality (19). But several under-utilised and viable strategies exist for health networks and hospital administrators to address some of the immediate challenges that hospitals and emergency departments face. To begin, an immediate recommendation must be that more flexibility be built into the emergency department to better manage anticipated and unanticipated fluctuations in patient presentations; achievable from both a resource and staffing flexibility point of view (20) and through use of modern solutions such as statistical modelling and the practical application of queueing theory (21, 22, 23). Furthermore, the fundamental importance of adequate staffing, matching staff to accommodate peak patient periods, and having a critical mass of senior medical officers available in the department is mandatory to ensure high quality care can be provided (24). If we cannot first get the basics right and provide the current gold standard of medical care to every patient every time due to workforce and healthcare systems shortcomings, then we must collectively realise that in cutting edge frontier research and development into expensive and novel biomedical intricacies we are unlikely to find salvation.

I have always felt the existence of an especially hazy line between the issues attributable to shortcomings of a healthcare system and those I attribute to myself as personal inadequacies; rarely more so pronounced than whilst working in the emergency department. This is a dichotomy well elucidated by Reason (2000)(ref. 4), highlighting the conditions which make individual blame the dominant ideology in medicine when we think about medical errors. This is a mental dichotomy I propose exists also in the daily battles of healthcare, in procedural wait lists, in ED corridors, and in the race to always do more, and to do it faster.

In one hand an individual narrative - I can always envisage myself as working harder, better, faster, stronger; and taking lengthening wait-times as a personal failing, indicative of the very real human pain and anxiety ongoing prior to definitive care. If only I didn’t take the coffee break, if only I had read up on this presentation last night, if only I wasn’t so slow at taking blood, if only I could touchtype better. This mentally destructive thoughtline runs like a common thread through healthcare, peddled and perpetuated by the training atmosphere and culture of medicine so historically ingrained as to seem inextricable the profession, and an almost universal to those working in health - with stories such as Yumiko Kadota’s a fairly saddening indictment of the current climate (1).

In the other hand a health systems narrative - a statistically unpredictable and fluctuating patient load intersecting with a fixed-staffed department, interwoven with bottlenecks of imaging and diagnostic services, coupled with the exponentially increasing documentation requirements (2) and medicolegal ramifications that pervade the modern healthcare climate mean that the system itself is fundamentally incapable of accommodating the idealistic throughput so avidly sought by administration. Such turnover not possible without due counterbalance of briefer and riskier consultations, run with the kind of heuristic, seat-of-your-pants, system 1 thinking required for high turnover - this risk becoming entirely inherited by the individual practitioner, as evidenced in the Bawa Garba saga (3).

And there seems no way to truly reconcile these two competing storylines, not least any satisfactory armistice with which I am familiar. For myself, and I am sure for many others, this cognitive tug-of-war will continue without reprieve, each day and each shift, undulating between a sense of guilt from personal shortcomings, and helplessness as a cog in the wheel. I don’t know that there is ever going to be any clearer of a line between the two, and I don’t know that a happy middle ground or goldilocks zone truly exists somewhere between crippling self-doubt or jaded cynicism at each extreme. What I do know is that I am unconditionally grateful to all who can compose themselves to work and thrive each day in such an environment - let such steadfast dedication not be undervalued.

NB: All situations and patient cases described above are for illustrative purposes only and do not relate to any specific persons. The health situation detailed above is fictional and does not reflect any scenario occurring in any specific hospital, health network, or district, at any time. All patient case details are fictional and for illustrative purposes only, and as such, any association to real cases, health networks, hospitals, or situational similarities are therefore entirely coincidental and unintentional.

T Michniewicz, August 2019

Reference

1. Kadota, Y (2019) ‘Physically alive but spiritually broken: why I had to resign as a junior doctor’. The Guardian [online]. Available from: <https://www.theguardian.com/commentisfree/2019/feb/08/physically-alive-but-spiritually-broken-why-i-had-to-resign-as-a-junior-doctor> [Accessed 02/08/2019].

2. Xu, R (2018) ‘A major medical crisis: doctor burnout’. The Atlantic [online]. Available from: <https://www.theatlantic.com/health/archive/2018/05/the-burnout-crisis-in-health-care/559880/> [Accessed 07/08/2019].

3. Ketchell, M (2018) ‘What happened in the Bawa-Garba case and why was reinstating her the right decision?’. The Conversation [online]. Available from: <http://theconversation.com/what-happened-in-the-bawa-garba-case-and-why-was-reinstating-her-the-right-decision-101606> [Accessed 02/08/2019].

4. Reason, J (2000) ‘Human error: models and management’. BMJ. 320(7237): 768-770. Available from: <https://www.jstor.org/stable/25187420> [Accessed: 09/08/2019].

5. Calderwood, K and Miskelly, G (2018) ‘NSW needs nurses as ‘catastrophic’ shortage predicted to affect patient care’. ABC News. Available from: <https://www.abc.net.au/news/2018-01-12/nsw-set-for-major-shortage-of-nurses-and-midwives/9321464> [Accessed: 09/08/2019].

6. Campbell, D (2018) ‘NHS ‘could be short of 350,000 staff by 2030’. The Guardian. Available from: <https://www.theguardian.com/society/2018/nov/15/nhs-could-be-short-of-350000-staff-by-2030> [Accessed: 08/08/2019].

7. The Economist (2019) ‘A shortage of staff is the biggest problem facing the NHS’. Available from: <https://www.economist.com/britain/2019/03/23/a-shortage-of-staff-is-the-biggest-problem-facing-the-nhs> [Accessed: 08/08/2019].

8. Johnson, S (2018) ‘Patient safety hit by lack of staff, warn 80% of NHS hospital workers’. The Guardian. Available from: <https://www.theguardian.com/society/2018/mar/18/hospitals-staff-shortage-nursing-nhs-rcn-patient-care-sarah-johnson-survey> [Accessed: 08/08/2019].

9. World Health Organization (2013) ‘Global health workforce shortage to reach 12.9 million in coming decades’ [online]. Available from: <https://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/> [Accessed: 08/08/2019].

10. Australian Institute of Health and Welfare (2018) ‘Emergency department care 2017–18: Australian hospital statistics’. Health services series no. 89. Cat. no. HSE 216. Canberra: AIHW. Available from: <https://www.aihw.gov.au/getmedia/9ca4c770-3c3b-42fe-b071-3d758711c23a/aihw-hse-216.pdf.aspx?inline=true> [Accessed: 09/08/2019].

11. Girgis, L (2018) ‘Meditation, yoga, and mindfulness aren’t going to solve physician burnout’. Kevin MD [website]. Available from: <https://www.kevinmd.com/blog/2018/10/meditation-yoga-and-mindfulness-arent-going-to-solve-physician-burnout.html> [Accessed: 10/08/2019].

12. Zavala, A, Day, G, Plummer, D, Bamford-Wade, A (2018) ‘Decision-making under pressure: medical errors in uncertain and dynamic environments’. Australian Health Review. 42(4):395-402. doi:10.1071/AH16088. Available from: <https://www.ncbi.nlm.nih.gov/pubmed/28578757> [Accessed: 10/08/2019].

13. AlQahtani, D, Rotgans, J, Mamede, S, Mahzari, M, AlGhamdi, G, Schmidt, H (2018) ‘Factors underlying suboptimal diagnostic performance in physicians under time pressure’. Medical Education. 52(1): 1288–1298. doi:10.1111/medu.13686. Available from: <https://onlinelibrary.wiley.com/doi/pdf/10.1111/medu.13686> [Accessed: 10/08/2019].

14. Tsiga, E, Panagopoulou, E, Sevdalis, N, Montgomery, A, Benos, A (2013) ‘The influence of time pressure on adherence to guidelines in primary care: an experimental study’. BMJ Open. 3(4): e002700. doi:10.1136/bmjopen-2013-002700. Available from: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641486/> [Accessed: 10/09/2019].

15. Carayon, P (2007) ‘Production pressures’. Patient Safety Network [website]. Available from: <https://psnet.ahrq.gov/webmm/case/150/> [Accessed: 10/09/2019].

16. Adams, J and Bohan, S (2000) ‘System contributions to error’. Academic Emergency Medicine. 7(11):1189-1193. Available from: <https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1553-2712.2000.tb00463.x> [Accessed: 10/09/2019].

17. Ketchell, M (2016) ‘Blaming individual doctors for medical errors doesn’t help anyone’. The Conversation [website]. Available from: <https://theconversation.com/blaming-individual-doctors-for-medical-errors-doesnt-help-anyone-28212> [Accessed:10/09/2019].

18. British Medical Association (2018) ‘Working in a system that is under pressure’. Available from: <https://www.bma.org.uk/collective-voice/influence/key-negotiations/nhs-pressures/working-in-a-system-under-pressure> [Accessed: 09/08/2019].

19. Cameron, P (2006) ‘Hospital overcrowding: a threat to patient safety?’. MJA. 184(5):203-204. Available from: <https://www.mja.com.au/system/files/issues/184_05_060306/cam11160_fm.pdf> [Accessed: 10/08/2019].

20. Ward, M, Ferrand, Y, Laker, L, Froehle, C, Vogus, T, Dittus, R, Kripalani, S and Pines, J (2015) ‘The Nature and necessity of operational flexibility in the emergency department’. Annals of Emergency Medicine. 65(2):156-161. doi:10.1016/j.annemergmed.2014.08.014. Available from: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302065/> [Accessed: 10/08/2019].

21. Alavi-Moghaddam, M, Forouzanfar, R, Alamdari, S, Shahrami, A, Kariman, H, Amini, A, Pourbabaee, S and Shirvani, A (2012) ‘Application of queuing analytic theory to decrease waiting times in emergency department: does it make sense?’. Archives of Trauma Research. doi:10.5812/atr.7177. Available from: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876544/> [Accessed: 10/08/2019].

22. Chowdhury, N, Riddles, L, Mackenzie, R (2018) ‘Using queuing theory to reduce wait, stay in emergency department’. American Association for Physician Leadership [website]. Available from: <https://www.physicianleaders.org/news/queuing-theory-reducing-wait-stay> [Accessed: 10/08/2019].

23. Vass, H and Szabo, Z (2015) ‘Application of queuing model to patient flow in emergency department. case study’. Procedia Economics and Finance. 32(1):479-487. Available from: <https://www.sciencedirect.com/science/article/pii/S2212567115014215> [Accessed: 10/08/2019].

24. Northern Rivers University Department of Rural Health (2009) ‘Literature review of emergency department staffing redesign frameworks’. The University of Sydney and Southern Cross University, Australia. Available from: <https://www.health.nsw.gov.au/workforce/Documents/literature-review-emergency-department-staffing.pdf> [Accessed: 10/08/2019].

Health: Upstream Interventions, Social Determinants, and Looking Back in Time

Health investment must adopt a more intensive upstream approach towards proven high-value interventions, and step away from its sci-fi fascination with the new, the expensive, and the unnecessary.

It’s a sunny Tuesday and i’m sitting in with a general practitioner who has just been handed a dozen-page scientific report by her patient. “You can see here, it’s tested all the important genes and tells you what diseases I am at risk of, and which medications are going to work for me and which ones aren’t.” The report from a private genomic testing service professes to examine the patient’s entire genetic profile and create percentage-point accurate estimations of everything from the risk of cardiovascular disease through to how the patient is likely to respond to individual medications ranging from warfarin to metoprolol. This specific report states that the patient is likely to require a higher dose of the anticoagulant warfarin than others, predicted due to her unique genetic composition. “I’m not really sure what to do with this right now” replied the GP, and in a perfect sentiment, had summed up what I imagine to be the entire profession’s response to the promise of personalised medicine that has been so prematurely laid fourth to anxious and cashed-up health consumers by the medico-industrial complex (1). Health is complex, but in our hastened rush towards reductionist, biochemistry-centric, science fiction-esque devices and technologies we have forgotten the basic building blocks of holistic and preventive care; the high-value upstream interventions that are the bedrock of population health (2). Although clearly attractive to some, personalised-dose rosuvastatin based on genome profiling should not be on the same playing field as such sensible evidence-based recommendations as to walk more and avoid processed foods.

Our patient here is far too well to be seeking out pills and potions for ailments she is yet to even experience, but this privileged position of the worried well is not universal. Often in healthcare patients that are seen are at points of deterioration of chronic illnesses, complications of grumbling poor health and lifestyles accumulating to a breaking point. These situations are regrettably common; the geriatric patient with orthostatic hypotension and falls, alcoholic now with liver failure, brittle asthmatic with another ICU admission, and diabetic with recurrent lower limb ulcers, are archetypal. There are certainly enough conditions for which their preventable, or at least manageable nature pushes any clinician to speculate what could have been done to prevent this at some stage earlier in the cascade. Such times are a necessary moment of sadness but from these examples we must look outwards to those patients yet to develop complications, at every stage of health, and consider how the pillars of primary, secondary, and tertiary prevention might best be leveraged. Health must be seen for every patient as more than a snapshot in time, but always as an opportunity to affect the trajectory of future wellbeing.

So we arrive at a model of health which considers that time opportunity for maximum value and maximum benefit for an intervention for any given our health issue. Such a model naturally illustrates how such upstream determinants of health represent both a common risk factor for many adverse health outcomes as well as an opportunity for cost-effective action with the potential to improve health trajectories over a lifetime (3). For the chronic non-communicable diseases over-represented in western society, almost any example can be traced in such a manner; from the adverse socioeconomic conditions, poor diet, and sedentary lifestyle through to the third cardiac stent in an atherosclerosis-laden coronary artery.

We need to increase our focus and funding of those traditionally soft enterprises of managing the social circumstances, proven community services that keep patients out of hospitals and manage health at early opportunities in a holistic and patient centred manner - funding longer GP consultations that focus on preventive care (4), linking patients to social workers, occupational therapists, population-wide access to dentists for early preventative care (5), early childhood services, safe emergency shelter and social housing, and youth employment services (7, 8). This isn’t especially revolutionary or idealistic utopian daydreaming, and social housing programmes have already demonstrated both real-world viability and tangible, immediate cost-savings, in the region of $13,273 saved for every $6,462 spent per person year(6). The more distal and intangible health benefits that accrue over a lifetime for individuals who receive such early preventive care are far more challenging to quantify, and even for well researched single-item health interventions, mortality benefit estimates vary considerably (7). Attaching a numeric figure to the benefit of a preventive care activity such as increased access to social workers is unlikely to be accurate or reliable, but this uncertainty betrays how worthwhile such investment is likely to be (8).

The value of public health domain preventative activities such as vaccination and smoking cessation programmes are almost universally recognised as economically worthwhile health investments, both examples further enhanced in the public mind by their underpinning mechanistic biomedical narrative; ‘exposure to a an attenuated pathogen primes the immune system to fight a burlier version later on’. The ongoing push to decrease smoking and increase vaccination rates is a noble enterprise but we should not be limited to consider only hard science approaches to primary prevention. Although mental health has garnered increasing attention in recent years as an undervalued and underfunded aspect in any holistic picture of health (9, 10), potential health and societal benefits from primary and secondary prevention in mental health represents a domain for which we seem to have only scratched the surface. From a clinical perspective, poor mental health often appears as a lurking factor in the relationship between poor health and poor medical care, preventing individuals from taking charge of their health. It’s hard to schedule a dentist checkup or book that blood test when you can’t find the motivation to get out of bed, or knowing you’ll experience a panic attack in a GP’s noisy waiting room. And the effects of poor mental health are seen down the line, as the progression of the trivial into the life-changing due to loss to follow up; and the occurrences of the entirely preventable disease due to self-neglect. Again, mental health is the underlying, but organic medical ailments are the symptom.

To realise the capacity for change in the entire trajectory of patient health at a population level will require concurrent investment in both the traditional, tangible, biomedical alongside the overlooked, softer, social welfare and mental health domains. Science fiction technology will never substitute the basic building blocks of health; equitable access to primary care, social supports, safe housing and food supplies…; and it is a truth that health systems seem painfully reluctant to concede.

T Michniewicz, August 2019

Reference

1. Maughan, T (2017) ‘The promise and the hype of ‘personalised medicine’"‘. The New Bioethics. 23(1): 13-20. doi:10.1080/20502877.2017.1314886.

2. Masters, R, Anwar, E, Collins, B, Cookson, R, Capewell, S (2017) ‘Return on investment of public health interventions: a systematic review’. Journal of Epidemiology and Community Health. 71(1): 827-834. doi:10.1136/jech-2016-208141.

3. Gehlert, S, Sohmer, D, Sacks, T, Mininger, C, McClintock, M, Olopade, O (2008) ‘Targeting health disparities: a model linking upstream determinants to downstream interventions’. Health Affairs. 27(2):339-349. doi:10.1377/hlthaff.27.2.339.

4. Sim, M and Khong, E (2006) ‘Prevention - building on routine clinical practice’. Australian Family Physician. 35(1): 12-15. Available from: <https://www.racgp.org.au/afpbackissues/2006/200601/200601sim.pdf> [Accessed: 03/08/2019].

5. Mouradian, W, Wehr, E, Crall, J (2000) ‘Disparities in children’s oral health and access to dental care’. JAMA. 284(20):2625-2631. doi:10.1001/jama.284.20.2625.

6. Wood, L, Flatau, P, Zaretzky, K, Foster, S, Vallesi, S, Miscenko, D (2016) ‘What are the health, social and economic benefits of providing public housing and support to formerly homeless people?’. Australian Housing and Urban Research Institute. Melbourne, Australia. doi:10.18408/ahuri-8202801. Available from: <https://www.csi.edu.au/media/uploads/AHURI_Final_Report_No265_What-are-the-health-social-and-economic-benefi..._2edQIWr.pdf> [Accessed: 03/08/2019].

7. Ewald, B, Mar, C and Hoffmann, T (2018) ‘QUantifying the benefits and harms of various preventive health activities’. Australian Journal of General Practice. 47(12). Available from: <https://www1.racgp.org.au/ajgp/2018/december/quantifying-the-benefits-of-preventive-health> [Accessed: 03/08/2019].

8. Shrank, W, Keyser, D and Lovelace, J (2018) ‘Redistributing investment in health and social services - the evolving role of managed care’. JAMA. 320(21):2197-2198. doi:10.1001/jama.2018.1498.

9. Australian Institute of Health and Welfare (2019) ‘Mental health services in Australia’ [online]. Available from: <https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/expenditure-on-mental-health-related-services> [Accessed: 04/08/2019].

10. Sparrow, A (2018) ‘Mental health services get £2bn funding boost in budget’. The Guardian. Available from: <https://www.theguardian.com/uk-news/2018/oct/28/mental-health-services-to-get-2bn-funding-boost-in-budget> [Accessed: 04/08/2019].

Climate Change: Underreported and Under-Actioned

Key points summary:

• Temporal and geographical dispersion of the effects of climate change has led to a lack of measurable or hence quantifiable short-term outcomes.

• The dispersion of responsibility and outcomes across different sectors has caused dilution of concern

• Similar dispersion of benefits from tackling climate change has lead to undervalued outcomes by traditional approaches and economic analysis

So I wanted to begin by describing a contrasting example from a quite unrelated field in a roundabout way of illustrating ways in which climate change has historically been an insidious and somewhat nebulous entity. The pathophysiology of a myocardial infarction, or heart attack, in its broadest sense, is as easily appreciated and quantified in investigations, as it is direct and immediate in consequences. At its rawest and simplest, the flow of oxygen rich blood is obstructed by clot and downstream tissues experience ischaemia, infarction, and cell death (a type 1 MI at least). In this, a negative health outcome is observed to arise directly and immediately from a mechanically conceptualised biological process. The reductionist, hard science, first principles, biochemistry side of our brains is of course very satisfied with this cause and effect equation. Such processes lend themselves to investigation, with readily observable and quantifiable short-term outcomes, such that research was already airborne by the time of the 1867 studies of Bezold and Breymann (1). It wouldn’t be for almost a century until the ‘causes of the causes’ (2) for ischaemic heart disease were beginning to be investigated, with the first results from landmark trials such as the Framingham heart study not coming into publication until 1957 (3). The critical importance of such trials was that they explored relationships and associations that would never be amenable to direct observation (4), achieved through what really was the pioneering use of epidemiological methodology - the pertinent point being consideration of big picture experimental findings; empiricism above the reductionist and mechanistic.  And as noted by Dawber et al. in 1951 (4), the findings of Framingham were of considerable practical importance, being highly usable and able to inform both health policy and practice. We can see that the findings of this study remain not only relevant today, but genuinely underpin the evidence-based and nationally deployed approaches to cardiovascular risk management (5).

In stark contrast to this exists climate change - diffuse, scarcely quantifiable, and indirect-acting, it is composed of all the requisite elements for it to be overlooked, mismanaged, ignored, and similarly, that should any watered-down responsibility for counteraction arise it would be so broadly dispersed as to become trivial at any actionable level. Ultimately, there are any number of reasons why climate change, and similar broad-reaching issues may remain under appreciated and under-acted-upon, with speculation that key factors include the diffuse nature of both negative climate outcomes and benefits from climate action, as expounded below. This is to say that phenomenon such as global warming by their very nature remain insidious and difficult to address because their effects, the responsibility for their effects, the responsibility to take action, and the benefits that might arise from taking action, are all innately global and diffuse; temporally, geographically, and intersector-ally if you will. Additionally, the investigation and public communication of findings related to changes in a changing system, represents an appreciable challenge to any attempts at lay appreciation of the subject.

So global warming represents a long-term challenge, and as a phenomenon, one that fundamentally cannot be appreciated nor quantified by the day-to-day individualistic observation of weather (20).  The effects of global warming are temporally dispersed over decades, and affect a system which is inherently cyclic and changing. Placing aside extreme meteorological events and experiences of those living near the arctic, the effects of global warming do not lend themselves to noticing by any casual observer, certainly to no point of prompting independently-motivated measurement or investigation. The same is true for a geographical component, and remains present today. The majority of urbanised landscapes where humans reside are relatively shielded from the effects of climate change. There are no seasonal migrations, no glaciers, and no river deltas by which to gauge long-term change. These locations tend to be fairly stable with respect to extreme weather events, whether by their initial selection as ideal for settlements or later by human engineering (à la Dubai), and because of this, few areas of the globe, especially those with large urban-living human populations, are (yet) to be so disproportionately affected by climate change as to be directly and undeniably observable on an individual level. Although this preceding statement around where most humans live is both factually incorrect and insensitive from a highly-westernised and urbanised perspective, this reason underscores the very decision for its inclusion. The adverse, individual, community, and society level effects of global warming already surround us, but regrettably, are seen outside view of the western media world, in smaller nations (6), readily in places like Bangladesh (7), Kiribati (8), Iceland (9). The issues facing each location affected by climate change (and locations yet to be), are often unique and intersectoral, or perhaps more appropriately, trans-sectoral. Industries such as fishing and overall ocean-based food security is threatened (10), along with tourism based around fragile ecosystems (11), ski resorts (12), and worldwide agriculture (13) with food security already far more jeopardised than is perhaps appreciated.

We see climate change is concealed over geographical space, over time, across many different sectors, and in systems already remarkable for randomness and changeability. We can expect the impact to be similarly dispersed over many sectors, and with anticipated flow-on effects that will leave few, if any, industries unscathed. The same factors obfuscating the presence of climate change are the same factors that underscore, in part, the lack of effective action we have witnessed to date.

Traditional approaches toward quantification of anticipated benefits, costs, and outcomes, and the manner in which these are weighted, are fundamentally not suited towards approaching long-term global issues such as climate change. Taking examples such as a simple traditional economic analysis, cost-benefit, cost-utility, or otherwise; these forms of analysis are not suited to handling long-term, intersectoral, difficult to quantify, and otherwise diffuse forms of costs or benefits (14). The argument presented is not that a suitably broad, encompassing and inclusive, time-horizon, well designed, and intersectorally respectful analysis would yield no value in dealing with issues arising from global warming; it is that the majority of such analyses undertaken before now have not. The kinds of analyses used by businesses, organisations, and government bodies on a day-to-day basis, used to inform and craft the policies and legislation leading to the position in which we now find ourselves. They simply weren’t designed with carbon emissions in mind. 

As imagined, just as the effects of global warming are diffused, as too are potential benefits arising from climate change action. Although well described in important metrics and with benefits on an individual scale (15), climate change action will likely yield benefit for entire populations – but not economic benefit for any specific sector, organisation, or entity. Therein lies some of the challenge in tackling the creation of effective policies for climate change; it is in everyone’s interest but no specific entity, for profit at least, with the scale and means to invest heavily in the issue, stands to individually profit from such an enterprise. Freeloading off another entity’s commitment to reduced carbon emissions, with respect to the passive benefits incurred from climate change action, might be seen however to be the best of both worlds; of benefits without sacrifice. And this potential point is why definite, enforced government legislation represents the backbone of a strong climate policy. We need to witness diligent leadership at the top that is respectful to the unambiguous evidence base on global warming, carried forth with the spine and steadfast resolution to affect truly meaningful legislative reform.

In concluding, just one of the great points of sadness from this ongoing catastrophe is that those individuals, communities, and populations most susceptible to the seemingly unstoppable march of global warming are also the smallest contributors to global emissions (16), and the least well placed to affect the level of global change necessary to halt its progression (17,18,19).

 T Michniewicz, August 2019

NB: Use of the terms climate change compared to global warming is not well respected by this article, which includes their employment in an indiscriminate and interchangeable manner.

Reference

1. Miller, J and Matthews, S (1909) ‘Effect on the heart of experimental obstruction of the left coronary artery’. Archives of Internal Medicine. III(5), 476. doi: 10.1001/archinte.1909.00050160109009.

2. Marmot, M (2017) ‘Inclusion health: addressing the causes of the causes’. The Lancet. 391(10117): 186-188.

3. Mahmood, S, Levy, D, Vasan, R and Wang, T (2014) ‘The Framingham heart study and the epidemiology of cardiovascular diseases: a historical perspective’. The Lancet. 383(9921): 999-1008. doi: 10.1016/S0140-6736(13)61752-3.

4. Dawber, T, Meadors, G and Moore, F (1951) ‘Epidemiological approaches to heart disease: the Framingham study’. American Journal of Public Health and the Nation’s Health. 41(3): 279-286. doi: 10.1016/S0140-6736(17)32848-9.

5. National Vascular Disease Prevention Alliance (2012) ‘Guidelines for the management of absolute cardiovascular disease risk’. National Stroke Foundation. Publication Approval: National Health and Medical Research Council, Australian Government. 

6. World Health Organization (2018) ‘Climate change increasingly affects small countries’ [online]. Available from: <http://www.euro.who.int/en/countries/iceland/news/news/2018/6/climate-change-increasingly-affects-small-countries> [Accessed: 20/04/2019].

7. Glennon, R (2017) ‘The unfolding tragedy of climate change in Bangladesh’. Scientific American. 21 April 2017. Available from: <https://blogs.scientificamerican.com/guest-blog/the-unfolding-tragedy-of-climate-change-in-bangladesh/> [Accessed: 20/04/2019].

8. Bowers, M (2017) ‘Waiting for the tide to turn: Kiribati’s fight for survival’. The Guardian. 23 October 2017. Available from: <https://www.theguardian.com/world/2017/oct/23/waiting-for-the-tide-to-turn-kiribatis-fight-for-survival> [Accessed: 20/04/2019].

9. Win, T (2017) ‘As glaciers melt, land of fire and ice watches its history seep away’. Reuters. 10 August 2017. Available from: <https://www.reuters.com/article/us-iceland-climatechange-glaciers/as-glaciers-melt-land-of-fire-and-ice-watches-its-history-seep-away-idUSKBN1AQ10M> [Accessed: 20/04/2019].

10. Plaganyi, E (2019) ‘Climate change impacts on fisheries’. Science. 363(6430):930-931. doi: 10.1126/science.aaw5824.

11. Visser, N (2018) ‘As climate change ravages the great barrier reef, tourists flock to say goodbye’. Huffington Post. 31 August 2018. Available from: <https://www.huffingtonpost.com.au/entry/great-barrier-reef-tourism_n_5b7aeb09e4b018b93e9653ff> [Accessed: 20/04/2019].

12. Fox, P (2014) ‘The end of snow?’. The New York Times. 7 February 2014. Available from: <https://www.nytimes.com/2014/02/08/opinion/sunday/the-end-of-snow.html> [Accessed: 20/04/2019].

13. Goldenberg, S (2014) ‘Climate change ‘already affecting food supply’ – UN’. The Guardian. 31 March 2014. Available from: <https://www.theguardian.com/environment/2014/mar/31/climate-change-food-supply-un> [Accessed: 20/04/2019].

14. Weatherly, H, Drummond, M, Claxton, K, Cookson, R, Ferguson, B, Godfrey, C, Rice, N, Sculpher, M and Sowden, A (2009) ‘Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations’. Health Policy. 93(1): 85-92. doi: 10.1016/j.healthpol.2009.07.012.

15. C40 Cities Climate Leadership Group ‘Benefits of climate action’. C40. London, United Kingdom. Available from: <https://www.c40.org/researches/measuring-benefits> [Accessed: 20/04/2019].

16. Clark, D (2011) ‘Which nations are most responsible for climate change?’. The Guardian. 21 April 2011. Available from: <https://www.theguardian.com/environment/2011/apr/21/countries-responsible-climate-change> [Accessed: 20/04/2019].

17. Swanson, A (2015) ‘The countries most vulnerable to climate change, in 3 maps’. The Washington Post. Available from: <https://www.washingtonpost.com/news/energy-environment/wp/2015/02/03/the-countries-most-vulnerable-to-climate-change-in-3-maps/?noredirect=on&utm_term=.e272cd0dd158> [ Accessed: 20/04/2019].

18. Bathiany, S, Dakos, V, Scheffer, M and Lenton, T (2018) ‘Climate models predict increasing temperature variability in poor countries’. Science Advances. 4(5): eaar5809. doi: 10.1126/sciadv.aar5809.

19. Intergovernmental Panel on Climate Change (1995) ‘IPCC second assessment climate change 1995’. A report of the Intergovernmental Panel on Climate Change. Available from: <https://www.ipcc.ch/site/assets/uploads/2018/06/2nd-assessment-en.pdf> [Accessed: 20/04/2019].

20. Pierre-Louis, K (2019) ‘Why is the cold weather so extreme if the earth is warming?’. The New York Times [online]. Available from: <https://www.nytimes.com/interactive/2019/climate/winter-cold-weather.html> [Accessed: 07/08/2019].