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.
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.
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.
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)).
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).
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:
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 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).
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).
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).
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.
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.
T Michniewicz, 26/12/2019
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