Coal Harms Health: Climate Change and Health, Past, Present and Future

Hello everyone. It’s a great pleasure to be speaking (October 16, 2021) at the 20^th anniversary conference of Doctors for the Environment Australia (DEA); I’d like to thank the organisers and to acknowledge the traditional owners, the Kuarna people. I’d also like to congratulate DEA for no longer being a teenager and for having over 2,500 members. I can recall when there were fewer than ten.

The organisers asked me to prepare no slides but with one exception – I am thus calling my talk “Coal harms health”. This photo was taken near Maules Creek coal mine, in 2014. It’s an export mine; from there coal is taken by train, through the air-polluted Hunter Valley, to the coal dust contaminated city of Newcastle, where I studied medicine. This protest was organised by the Australian Religious Response to Climate Change; my support team were devout – even if they look scruffy.

While waiting to be arrested I was holding this book – the first edition of “Climate Change and Global Health”, which had just been published, and which I edited. 

 

At that time I had also just contributed to the health chapter of the 2014 IPCC report, thus I was the first IPCC health contributor to be arrested for what could be called “climate disobedience”.  I take the issue of climate and health seriously, and I also take seriously the issue of climate justice – the main reason I chose arrest was to protest at the immorality of rich Australia profiting from the export of a substance clearly harmful to health, especially future health. I also lament the decline of ethics in science.

If this was not virtual I would ask for a show of hands: who attended the first iDEA conference, in Melbourne in 2009? I did – in person of course. My talk there focussed on the “tertiary” – or catastrophic - health consequences of climate change, including conflict, war and famine. The first editorial on climate change and health – in The Lancet in 1989 – hinted at these issues. However the topic is still vastly under-recognised, despite the implications of Will (and other’s) work. For me, the risk of runaway climate change (or Hothouse Earth) is terrifying, and trying to prevent that has now motivated me for 3 decades. We are making progress but there is enormous work ahead.

Since the early 90s I have used a three-way categorisation of how climate change will impact human health and well-being. In addition to tertiary effects are what is generally called direct and indirect, or “primary” and “secondary”. I based the first and forthcoming editions of my edited book on these categories.

By “primary” health effects Andy Haines and co-authors meant comparatively obvious things, such as heat stroke. Of course, nothing is simple, but I ask you to consider the field at a time when the existence of anthropogenic climate change was challenged by most, and when, for conservative doctors, links between it (as opposed to climate) and health were considered speculative. Thus tertiary health effects were a largely no go area at that time.

Temperatures in the high 40s in Australian cities were unimagineable when I was at medical school, they now seem almost unremarkable. Extreme heat has adverse effects that are pretty well-known; such as heat strain and heat stroke. Their risk is worsened by high humidity; indeed in some parts of the world, in the near future (without emergency climate action), the combination of heat and humidity will be fatal, even without exercise. Thus some areas of the planet will literally be uninhabitable, at least for some times of the year. Heat strain is an incredibly important issue for occupational health, especially for outdoor workers in already hot places and for emergency workers wearing protective clothing in hot conditions. Heat strain may also have a “long tail” of adverse effects, including on some chronic diseases – especially people with pre-existing cardiovascular disease. What happens to people who are vulnerable but who recover? It seem unlikely that they all return to their previous level of function. I believe this question remains under-explored.

An important co-author of that early work on primary, secondary and tertiary effects was the late Tony McMichael. Tony, with David Shearman, were the true founders of DEA. Both were far ahead of their time; with viewpoints best called “ecological.” Tony’s most influential book, published in 1993, was called “Planetary Overload”. Four years later, David’s book “Green or Gone” was published.

Four years after, DEA was born, and now it is 2021.

Some of you will have heard of the UN Conference on the Human Environment, in Stockholm: 1972. More will have heard of the Rio Earth Summit, 20 years later. The main organiser for these meetings was Maurice Strong; he was also founding director of the UN Environment Programme.

His autobiography, “Where on Earth are We Going?” was published in 2001. It starts with a report to the shareholders, from 2031; a world of profound disorder, massive forest fires, including Siberian, and famines, droughts, floods, conflict, refugees, plague and “Virus X”. Global population is below five billion; it is, today, about eight. These risks arise not only from climate change, but as Kerryn Higgs, a co-editor for the 2^nd edition of Climate Change and Global Health, says, endless growth on a finite planet is a collision course.

 

 

Hopefully Strong’s forecast is too pessimistic. However, global life expectancy has fallen due to the pandemic; hunger has risen, and foodprices are at a 10 year high.

There is risk from exaggeration, but also from under-statement. Pessimism paralyses; understatement generates complacency. I believe it is our duty to sound a warning. Prevention is better than cure. Past civilisations have collapsed; ours could too.

But I will end with hope. Activism lifted Greta Thunberg from depression, and is an important antidote to despair; as is fellowship. Getting arrested – even here – is serious; consequences can be unforeseen. I was unable to attend the inaugural planetary health conference in New York because a timely visa was denied.

Protest is necessary, but not sufficient.

Last month, over 230 medical journals jointly published an editorial (includiung in the Medical Journal of Australia) calling for “emergency action to limit global temperature increase, restore biodiversity, and protect health.”

That is progress. So is the growth of DEA and the involvement of so many medical colleagues and colleges in this struggle, globally. The link between the health of our planet and the health of people is now widely accepted. Tough times are ahead, but together we can make a great difference.

Thank you.