It's getting too hot and scary for me

I went to a New Year's eve party for about 40 mins last night. Friends of friends. The house turned out to be over the top ostentatious (at least for my taste) .. the hostess worked as a lawyer. Making conversation, I asked "what kind of law do you do?" She said "tax" .. I said, "you mean tax avoidance". She disagreed and didn't actually appear to take immediate and strong offence and I have absolutely no proof or even evidence that her morals are any different to mine (the house was owned by her father) .. but I just had to leave.. I felt contaminated staying there. My friend took me home, later returning to the party, apologising that I had suddenly felt unwell (which I had)..

I reacted in the context of knowing so many companies in Australia (quite lawfully) pay no tax, including the coal conglomerate Adani. 

As Richard Denniss writes:

"For years, Australians have been berated by big business, and their boosters in parliament, about the punitive and stifling impact of the 30 per cent corporate tax rate. For years, we have been subject to a flood of econo-babble about the need to "incentivise investment" by cutting the "uncompetitive" corporate tax rate. And, for years, we have been lied to. Either that or the people making such claims were entirely, and wilfully, ignorant of the facts".

I feel the same revulsion when I think of Dubai etc, eg the exploitation of "guest" workers, more like slaves, many of whom have been involved in the construction of grandiose but potentially lethal high-rise death traps, coated with flammable material . I try not to fly Emirates.

We have a culture that pays Russian roulette with the environment. The evidence is now terrifying to those who look: escaping methane blasting holes in the tundra,  above zero temperatures at the North Pole in mid-winter and 72 deg F in New York City on Christmas Eve. Fish are appearing in puddles in Miami, migrating through the porous limestone with the seawater. As the seas rise top officials in Florida Miami try to censor the words "climate change".

Perhaps my reaction was intensified as I have been working very intensively in the last few days on a Wellcome Trust grant proposal to do with reducing poverty in South Asia and Sub-Saharan Africa, and with enhancing planetary health. 

I have been in opulent places before, but have never felt as strongly repulsed. But I feel the same way when I think of Joe Hockey (and his partner's) fortune .. I think such inequality is truly wrong (I also think this about Kathy Jackson and her partner, even though I used to admire her.)

There is a profoundly disturbing disconnect between haves and have nots. As the "haves" get more out of touch, do they think they can move to another planet when this one becomes too hot and strange?Spring in December in NYC is beautiful and alluring, but so was inspecting the receding sea bed before the tsunami. Perhaps dangerous climate change starts at 1 degree, not two. And two degrees could occur by 2036.

Happy New Year!

The crisis in Burundi and the urgency for more discussion about human carrying capacity

In 2003 I heard of a new journal, Public Library of Science, Medicine (PLoS Med). Walter Reid,  who was helping to run the Millennium Ecosystem Assessment, encouraged us to submit our best papers to this new journal. Consequently, I submitted an article on human carrying capacity and health. Gavin Yamey, the founding editor of PLoS Med, liked it, but the reviewer he found did not. Luckily, Gavin over-rode the reviewer, though I remember I still had to go to a lot of trouble to try to explain Keynesian economics in it. The paper has not been cited that much (currently according to Google Scholar, 38 times) but it has been looked at a lot, now over 36,000 times and still 2-300 times every month.

I recently re-read Andre and Platteau's 1998 paper "Land relations under unbearable stress: Rwanda caught in the Malthusian trap". That paper explains, better than any other I have ever read, the underlying ecological and social causes of the 1994 genocide, including land hunger, high population growth, inequality, youth bulges and a lack of remittances and foreign income.

Today, neighbouring Burundi again appears on the brink of civil war. About the time of the Rwandan genocide, a civil war started in Burundi, eventually killing (over 12 years) almost half the number who died in Rwanda in about 3 months. That is, the rate of death in Burundi was less than 2% of that in Rwanda (12,500 every 3 months sustained for 6 years is 300,000, compared to 6-800,000 in 3  months in Rwanda). 

An article about the current tension in Rwanda identifies "root causes" of the violence in discontent over the Burundian President unconstitutionally seizing a third round in office, in violation of the 2006 peace accord. However, Burundi, like Rwanda has a persistently high rates of population growth. Unlike Rwanda, which has preserved about 20% of its land mass as forest, Burundi derives no income from tourists watching habituated gorillas. (Though, in 1994 nor did Rwanda). Burundi’s calamity lies, in substantial part, in too many people for its resources, as well as too little social cohesion.

I hope Pope Francis can show as much leadership over population pressure as he has over climate change. The mismatch between resources and population, overlaid by social and political tension is an important factor in the Syrian conflict (as well as climate change) It is likely to also be important in the Sahel, and probably already is a factor in the emergence of Boko Haram.

The continuing general silence about overpopulation continues to hinder the capacity of the global health and development community to make adequate progress.

What happened to Brendan Nelson?

I have hesitated to post this, but Dr Brendan Nelson is a public figure in Australia, as a former leader of the Opposition. While I was sitting on the floor of parliament house, during the Peoples' Parliament - a protest about Australia's excessively slow action on climate change - I spotted Brendan walking down the steps towards us. I hoped I might catch his eye but he affected not to notice any of us. He looked in supreme self control.

Brendan was one of the co-owners (with the Labor politician David Crean, brother to the Federal Labor politician Frank) of the Launceston and Hobart After Hours Medical Services, which I regularly worked for in 1989-91.

At that time I found Brendan an extremely nice man. (Many took the view, even then, he would become prime minister.) Patients loved him. Soon after, he did a lot to raise the profile for Indigenous health, particularly as president of the Australian Medical Association.

But then he joined the Federal parliament on the Liberal (right wing, conservative side.) He became more and more conservative. In 2003, the Australian government was mindlessly supporting the George Bush junior led folly in Iraq (something George Bush senior has recently been publicly critical of). My last contact with Brendan was to write to him at that time, lamenting his support for Australian participation in that invasion. Brendan did write back, but just with the party line. Later he became the Australian Minister of Defence, then leader of the opposition, against Kevin Rudd. He never did become prime minister, nor  Minister of Health, though he remains a well-known Australian figure, director of the Australian War Memorial.

However, what happened to his sense of global justice?

Entrapment: Global Ecological and/or Local Demographic? Reflections Upon Reading the BMJ's Six Billion Day Special Issue (published 2000)

Butler, C.D. 2000. Entrapment: global ecological and/or local demographic? Reflections upon reading the BMJ's "six billion day" special issue. Ecosystem Health, 6, 171-180.

Global human population recently passed six billion. To mark  this, the BMJ (formerly the British Medical Journal) published a special edition that was both controversial and innovative. It had 12 complimentary essays, written by leading demographers, epidemiologists, and public health workers. A key issue highlighted was a debate between the  non-demographer Maurice King and many demographers, regarding the concept of "demographic entrapment."

King and his supporters argue that the limited reserve carrying capacity of Rwanda was a major factor in that country's devastating civil war, a consequence of which was the release of spare carrying capacity. In contrast to this body of opinion, the key importance of population pressure as a factor in Rwanda's war is denied, not only by demographers but most other analysts of Rwanda.

A second major issue highlighted in the journal was that of overconsumption, particularly of natural capital. The importance of this was partially recognized by the demnographic papers, but none exhibited the sense of urgency concerning this conveyed in the two relevant papers written by epidemiologists and public health workers.

This article discusses relevant sections of the 12 papers with regard to demographic entrapment and overconsumption. In addition, several other examples of demographic entrapment, both historic and contemporary, are suggested and described.

Finally, the suggestion by King that the whole world may be demographically entrapped is refined by consideration of ongoing global environmental changes, both anthropogenic and natural, which are likely to reduce future global carrying capacity. While such changes are, themselves, unlikely to cause global under-nutrition, the negative political and economic consequences of increased regional scarcity, consequent to approaching or passing local carrying capacities, are likely to exacerbate the risk of regional conflict. These areas of conflict could widen, and be aggravated by an increased frequency of natural disasters, predicted by some computerized climate change models. At the worst case, "civilization failure" or "barbarianization" could result. The complex pathway to this, substantially caused by adverse global environmental change, is called global "ecological entrapment.

Climate change and heath: primary, secondary and tertiary effects

This is a preview of part of chapter 31 ("From Paris Towards 1.5 Degrees C) the additional chapter I am now writing for the forthcoming softcover issue of my edited book, Climate Change and Global Health, (CABI, 2016).

"The health chapter of the recent IPCC report concluded with a three tier classification of the possible health effects (see box). Though no source is quoted it may have been influenced by the “primary, secondary and tertiary” structure used in my edited book, Climate Change and Global Health, which in turn is derived from two earlier papers (Butler, Corvalán et al. 2005, Butler and Harley 2010) (see box).

Soon before the release of this book, I attended a meeting on climate change and health run by the World Health Organization. At it, I learned that the IPCC health chapter (to which I was a minor contributor) had concluded with a three tier classification of the likely health effects of climate change (see box 31.1). It was encouraging to see that my fellow IPCC authors appreciated the existence of a third broad category, which is the framework of this book, based on ideas and papers I have promoted for two decades (Butler and Harley, 2010, Butler et al., 2005, Butler, 2014). But I was also disconcerted. Contrary to the IPCC principle which recommends its material to be based on existing literature, the framework was unattributed. The IPCC conceptualisation placed mental “illness” in the third category, rather than seeing mental health as a crosscutting issue (see Figures 26.1 and 26.2). Frustratingly, this framework made no clear statement that the third (tertiary) category is likely to have a much higher burden of disease (BOD) than the others (see Figure 26.2). If enough people of influence, especially in the media and government can see the risk of the third category then we might collectively act to reduce and to defer it. For this to occur, the enormous BOD risk of tertiary effects needs to be explained and stressed.

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[1] When the publisher of this book approached me I agreed to edit on condition that it followed a three tiered classification, of which the third (tertiary) category is by the most important, following ideas I first started to consider over 25 years ago, as discussed in Butler and Woodward, 2015).

BOX 31.1

“Climate change affects health in three ways; 1) Directly, such as the mortality and morbidity (including “heat exhaustion”) due to extreme heat events, floods, and other extreme weather events in which climate change may play a role; 2) Indirect impacts from environmental and ecosystem changes, such as shifts in patterns of disease carrying mosquitoes and ticks, or increases in waterborne diseases due to warmer conditions and increased precipitation and runoff; and 3) indirect impacts mediated through societal systems, such as undernutrition and mental illness from altered agricultural production and food insecurity, stress and undernutrition and violent conflict caused by population displacement, economic losses due to widespread “heat exhaustion” impacts on the workforce, or other environmental stressors, and damage to health care systems by extreme weather events” (Smith, Woodward et al. 2014).

Both figures are from  Chapter 26 ( Butler C.D, Bowles D.C., McIver L., Page L. (2014) Mental health, cognition and the challenge of climate change. In: Butler C.D., editor. Climate Change and Global Health. CABI, Wallingford, UK: CABI; pp 251-258.)

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No classification is perfect, none should be considered inviolable .. but the main idea of the third category is to try to convey that climate change related health risks are lot more significant (and terrifying) than (say) heatstress or a heightened chance of malaria.

To me, most conceptualisations are a bit like impressionist paintings. The other element involved with tertiary is causal distance .. there are still a lot of people denying climate change can influence conflict or migration, for example. (Which leads into the x access label in Fig 26.2) ..

Oreskes and Conway (2013), writing from the future, reflect on the collapse of civilisation, reflect on the bias most scientists have towards "type II" errors (ie waiting too long to make a conclusion). If, by say 2150 Miami etc has disappeared and WWIII has passed then we might agree climate change contributed to the devastation that had transpired .. by which time it’s too late. 

The late Tony McMichael has called the tendency to not think hard enough about cause as "epidemiologising", or looking under the lamp post, because that's where the light is, even if the keys aren't likely to be.

When I give lectures on this (eg see slides given to the ANU medical students last month), I spend a lot of time on Fig 26.2. I tell people it’s the most important slide in the whole lecture, the whole book.. (No one so far has either challenged or explicitly agreed with me on that, so I’m not sure if people understand..)

Post-script (added November 20, 2021): In 2018, while working on "Climate Change, Health and Existential Risks to Civilization: A Comprehensive Review (1989–2013)" I read two papers published in 1993 (one of which I first read in 1993). Four authors contributed: Andy Haines, Martin Parry, Tony McMichael and Paul Epstein. These papers each used the “primary”, “secondary” and “tertiary” framework. One of them, originally read at the Royal Society of Medicine in 1992, stated “direct effects of a rise in temperature (particularly increases in the frequency and intensity of heatwaves) may include deaths from cardiovascular and cerebrovascular disease among the elderly. Indirect effects are secondary, such as changes in vector-borne diseases or crop production, and tertiary, such as the social and economic impacts of environmental refugees and conflict over fresh water supplies.” 

 

I thus realised I had unconsciously plagiarised the terms. I wrote to Prof Haines to apologise (Paul and Tony, sadly, had already died). However, between 1993 and 2010 the framework appears to have not been used in the context of climate change and health, although our paper in 2005 (with Carlos Corvalan and Hillel Koren - published in the ecology literature)  adapted it by adding a fourth scale of consequences which we called global systems failure . (It used other words for primary, secondary and tertiary, but the concepts were the same). I later self-censored this concept, as, for over a decade, I felt that it was too controversial for most reviewers and editors to appreciate, especially in health circles.

 

References

Butler, C. D., C. F. Corvalán and H. S. Koren (2005). "Human health, well-being and global ecological scenarios." Ecosystems 8(2): 153-162. 

Butler, C. D. and D. Harley (2010). "Primary, secondary and tertiary effects of the eco-climate crisis: the medical response." Postgraduate Medical Journal 86: 230-234. 

Butler, C. D. and A. Woodward (2015). From Silent Spring to the threat of a four degree world. The context of Tony McMichael’s career. Health of People, Places and Planet: Reflections Based on Tony McMichael’s Four Decades of Contribution to Epidemiological Understanding. C. D. Butler, Dixon, J., Capon A.G. Canberra ACT Australia, ANU Press: 11-30.

 

Haines, A. and Parry, M.L. (1993) Climate change and human health. Journal of the Royal Society of Medicine, 86, 707-711.  

 

Haines, A., Epstein, P.R. and McMichael, A.J. (1993) Global health watch: monitoring impacts of environmental change. The Lancet, 342, 1464-1469.

Oreskes, N. and E. M. Conway (2013). "The collapse of Western civilization: a view from the future." Daedalus 142(1): 40-58.  

Smith, K., A. Woodward, D. Campbell-Lendrum, D. Chadee, Y. Honda, Q. Liu, J. Olwoch, B. Revich, R. Sauerborn, C. Aranda, H. Berry, C. Butler, Z. Chafe, L. Cushing, K. Ebi, T. Kjellstrom, S. Kovats, G. Lindsay, E. Lipp, T. McMichael, V. Murray, O. Sankoh, M. O’Neill, S. B. Shonkoff, J. Sutherland, S. Yamamoto, U. Confalonieri, A. Haines and J. Rocklov (2014). Human health: impacts, adaptation, and co-benefits. Climate Change 2014: Impacts, Adaptation and Vulnerability, Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. C. B. Field, V. Barros and D. J. Dokken. Cambridge and New York Cambridge University Press.

Woodward, A.,K. R. Smith, D. Campbell-Lendrum, D. D. Chadee, Y. Honda, Q. Liu, J. Olwoch, B.Revich, R. Sauerborn, Z. Chafe, U. Confalonieri and A. Haines (2014)."Climate change and health: on the latest IPCC report." The Lancet 383(9924): 1185-1189.