Almost a third of those who responded to a recent BMJ poll thought that climate change is not a matter for doctors. Had the doubters been at the Royal College of Physicians’ conference on climate change in January, they could not have escaped the impact it will have on health.
Global warming is creating an unstable, chaotic, climate, so its effects are hard to predict. How much human conflict will it generate as the world’s billions fight for food and water and flee uninhabitable lands? How will nations respond to the threats to their security? Can the peoples of the world work together using existing knowledge and technology to avoid the destruction of our civilisation?
In the short term, we in the West can buy our way out of trouble. But others can’t. Few Africans have a skiing holiday to forego. They are already on the margin, and they know it. Even in the poorest countries, people turn on the television and compare their lifestyle with ours. Wealthier nations are already feeling the pressure of their discontent. In the USA vigilante groups supplement the border patrols along the Rio Grande. Australia is strengthening its marine defence against southeast Asian immigration. Spain, too, is investing in more powerful maritime patrol vessels, the better to pick up rafts overloaded with west Africans hoping to make it to the Canaries and a better life. India is building a 4500km wall (two-thirds of the length of the Great Wall of China) to keep out the Bangladeshis fleeing their submerging country. Access to resources already contributes to the drift to cities and to armed conflicts like Dafur and the Middle East, and it will get much, much worse as billions of people try to crowd into the diminishing habitable areas of the globe.
It is not just humans who will be displaced. Already, tick-borne diseases are found at latitudes and altitudes where they never occurred before. Southern Europe’s 50-year freedom from malaria is likely to end. And in a world increasingly crowded and lacking adequate water supplies, diarrhoeal disease will be rampant.
How do we tackle a planet-wide threat? We have no history of international co-operation on the scale required. In Hollywood, the world’s nations forget their differences when the spaceships arrive. But we are living in an environmental disaster of our own making. We squabble while Amazonia burns, hoping, perhaps, that technology yet again can save us from ourselves. But it will be 20 years before all the damage done by today’s level of greenhouse gases is manifest and every year the scale of the problem escalates.
China is rapidly becoming the world’s leading source of CO2, and that is before most of its burgeoning middle class switch from bicycles to cars, take foreign holidays, bathe more than once a week and start using disposable nappies. After a generation of starvation, many Chinese families can now enjoy dining out. But increasing meat consumption is another stress on China’s environment, already struggling to provide enough fuel and water. However, it is salutary to remember that a significant portion of China’s CO2 is incurred making cheap consumer goods for the west. If you add the contribution represented by Chinese-made imports, Britain’s carbon footprint increases fourfold, and to judge by the number of Primark carrier bags in Oxford Street the British public is not yet ready to sacrifice a cheap T-shirt to save the environment.
As a species, and given time, Homo sapiens is very adaptable. But as individuals, most humans cope poorly with sudden disruption. People who live round the Mediterranean are used to 40° summers, but 35,000 northern Europeans died during the 2003 heat wave. Experts predict that within a few decades 40° will be normal summer temperature in London. As the climate becomes more and more unstable, Britain is just one of many countries experiencing devastating floods, Australia’s droughts are lasting longer than ever before, the names of Caribbean hurricanes are now extending down the alphabet to W and beyond. Anomalous climatic events are becoming routine, and Hurricane Katrina was a depressing demonstration of how quickly social behaviour and institutions collapse under stress.
We can make our own choices: a ‘lodge’ sounds less invasive than a ‘hotel’ — something which sits lightly on the ground without despoiling it. Add ‘eco-‘ to the title and you can charge three star prices for youth hostel accommodation, or stellar prices for Holiday Inn facilities. But how many eco-lodges does it take to create an eco-catastrophe? At the lodge, everything down to the cocktail shaker may run on solar power, but the aeroplanes which bring the visitors it attracts certainly don’t.
Using biofuels may give American motorists a virtuous glow, but the fuel is made from imported maize or soya. So in Mexico people are going hungry because they can no longer afford to make tortillas, and Brazilian forests which buffer CO2 are being destroyed.
What can we as individuals do about climate change? The contribution can seem limited. Exchanging your Chelsea tractor for a Smart, or even for the most energy-efficient 4-wheel-drive, will help your exchequer and the world’s, as will following former Minister of Health Edwina Currie’s advice to put on a sweater rather than turning up the thermostat. But it seems rather small beer. We are told that turning off standby lights will power hospitals, but it’s a chore and doesn’t dramatically reduce our fuel bills. And is it worth it when you look out of the window and see office blocks ablaze with lights 24 hours a day? Activists and governments are not going to reach our consciences until we can see with our own eyes that everyone is making a serious effort.
Perhaps this is one area where doctors can help. We are still opinion leaders. Let’s see fewer staff cars in the surgery car park, more press features about surgery buildings designed with environmental economy in mind, more talk about the medical effects of climate change. Even the increase in allergy as the growing season lengthens may make news. We can then move on to the problems that pestilence and conflict and psychological breakdown will bring if we don’t think fast and constructively and together about them. We can make a noise and press governments to set a visible lead and to introduce policies which will lever businesses and organisations like the NHS and individuals towards carbon-neutral behaviour.
Next time you ring to say “I’m stuck in traffic”, remember that you are the traffic. Traffic isn’t the whole problem, but it is a productive place to start tackling it. Fewer vehicles on the roads would not only reduce CO2, but also decrease noise, pollution, respiratory disease and trauma. It would promote exercise. Perhaps children would again be able to play safely in the roads. And it would improve the environment. When I go for a walk round the block, I don’t chose the road where all the front gardens have been converted to hard standing for cars. I turn left so I can enjoy the camellias and the daffodils behind the garden gates. Preserving beauty is not the least of the benefits of caring for our environment.
Fist published in NASGP Newsletter The Sessional GP, April-May 2008
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…