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.  

Reflections on Emeritus Professor David Shearman’s contribution to Doctors for the Environment, Australia

This is the text of a talk I gave at a Doctors for the Environment, Australia (DEA)

Annual General Meeting, September 30, 2016 Adelaide, South Australia.

           

It is a great honour to be asked to comment on Emeritus Professor David Shearman’s contribution to Doctors for the Environment Australia. I first heard David’s name in 1998, during an interview by Norman Swan on the ABC’s Health Report. I can recall the moment, in Tasmania, driving towards the Eastern Tiers; I was impressed that a gastroenterologist would care so much about the environment and understand its deep connections with health. This interview was about his book, co-authored with Gary Sauer-Thompson, called 'Green or Gone. Health, ecology, plagues, greed and our future'.

In this book I learned that David participated, as an intern, in the first ever renal transplant, undertaken in Edinburgh, Scotland, in 1962. At that stage stage I had no idea that I would ever meet David, let alone work with him. However, I had heard of DEA’s parent group, International Society of Doctors for the Environment (ISDE), and had met some of its representatives, when I was studying in London.

About then David met with Dr Gaudenz Silberschmidt, then ISDE’s Executive Officer, based in Switzerland, who had steered it through a successful first decade. In 1999 David met with Professor Tony McMichael, then based in London. They agreed to explore establishing an Australian branch of ISDE. David then visited Geneva to discuss this with Dr Silberschmidt.

David writes, in the history of DEA that the first task was to find a chairman. Bill Castleden, a surgeon, who had led a movement to protect old growth forests in the south west of Western Australia was identified, and pursued. Bill’s notes on this provides an eloquent insight into David’s character:

Within weeks of giving up day-to-day forest involvement in 2001, I started to receive emails from a Professor David Shearman in Adelaide asking if I would be interested in joining a group of doctors he wanted to assemble to alert the public and the government about the close connection between a healthy environment and healthy human beings.

I ignored his emails. I had had enough of campaigning for Doctors for the Forests in Western Australia.

And still David Shearman persisted. He wrote of his almost lifelong commitment to environmental causes, of his past-Chairmanship of the South Australian Conservation Council and his book writing and his publications. After months of email bombardment and discussions with Wendy, we agreed that we would go for a weekend to the Mornington Peninsular south of Melbourne to meet the potential steering group of doctors he had collected from each State. I was not really sure what it was all about or if they were all too deeply green to be reasonable human beings!

In 2001 and 2002 two teleconference were held, leading to our first actual meeting. This was held in October 2002 in a beautiful setting lent to us by Grant and his wife, who was related to the late Ron Castan, a barrister and human rights advocate who had played a leading role in several landmark legal cases, most notably that in which the High Court acknowledged the land rights of Eddie Mabo and his family.

Commemorating Ron Castan’s life, Justice Michael Kirby wrote

“In two hundred years time they will still talk of Mabo. There was no more radical design than that which Ron Castan conceived with his colleagues to rewrite 150 years of settled land law. It was a plan breathtaking in its boldness. It challenged fundamentals. It did so in an area traditionally resistant to change in every legal system - rights in land.

The Court, beckoned by the advocacy of Ron Castan and those of like cause, rewrote the major premise. In a moment, 150 years of terra nullius was cast aside. A new chapter in the legal rights and national dignity of Australia's Indigenous peoples was begun.

I think it was worth reading this, not only because our next speaker (Julian Burnside QC) is a lawyer, but to remind ourselves of how racist the concept of terra nullius is. Unfortunately, there are many other laws and concepts which are also extremely unfair, including how we relate to Nature.

I digress: that meeting in Victoria was my first face to face meeting with David and his wife Clare.

Bill wrote about this:

David had carefully constructed a full weekend of meetings and presentations during which we had ample time to assess each other’s possible strengths and weaknesses. Over the final lunch and afternoon he had asked Don Henry, Executive Director of the Australian Conservation Foundation and David Yencken of the Australian Collaboration to come to meet and talk with us. They made us feel we could, as a medical organisation, play a very important role in the overall effort to ensure a healthy environment for the next generations of Australians to grow into.

Our egos suitably massaged, we all agreed to set up DEA. David Shearman with his amazing persistence undertook to complete the necessary paperwork.

There is an impressive list of DEA’s achievements, to which many of you have contributed. Too many to read here, they include journal and magazine articles, position papers and a series of medical student led conferences. There were also many meetings with politicians and posters in schools and GP surgeries. There were at least two grants, including from the Poola Foundation and the Federal Environmental Education Research programme. Membership has grown steadily - there are now 260 medical student members - and since 2010 DEA has employed a full time administration Officer. DEA is a team effort, but I truly believe our achievements would have been far less than half, without the leadership, persistence and decency of David.

For several years I represented DEA to ISDE. I report that few, if any, of the other recent and current national ISDE affiliates have had anything like the success and influence of DEA in their own countries, at least in recent years. This is not intended as a criticism of them, because it is extremely hard to combine a career with running an NGO. And it is also not easy to do this after retirement. My main purpose is to stress how remarkable David’s contribution has been.

Director General of WHO, Dr Margaret Chan, recently wrote: “Climate change is one of the greatest challenges of our time. Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air, water. In the face of this challenge, we need champions throughout the world who will work to put protecting human health at the centre of the climate change agenda.”

David is one such champion.

In recent years we have seen numerous heat records and record breaking storms, including in Fiji and the Philippines. Two percent of the Tasmanian world heritage highlands burned last summer, set fire by innumerable lightning strikes. In May this year, northern Tasmania experienced record-breaking floods.

Along the Great Ocean Road, the town of Wye River was first burned, then more recently flooded. Landslides, worsened by the cutting of burned trees on steep hills, have since blocked roads. There has been considerable economic distress. Much of the Great Barrier Reef has been bleached, and along the Gulf of Carpentaria, at least 10,000 hectares of mangroves have died back, apparently from abnormally warm sea surface temperatures and reduced river flows.

All of these things – more intense drought and more intense floods - have long been predicted by climate scientists, including increased lightning. In South Australia’s storm this week, electricity pylons fell like bowling pins and the whole state was blacked out for hours. Some towns are still blacked out. Mobile phones failed and so did internet access and a back up generator at a hospital.

There were thousands of lightning strikes, but no forest or grass fires. We can hope it will be another 50 years until this so-called “one in 50 year event” recurs, but that could be wishful thinking. One thing that will not take 50 years is the next coastal flooding, as the sea level continues to rise, and its rate of rise increases. The longest pier in the Southern Hemisphere, at Port Germein was damaged by high tides a few months ago and repaired. It has again been damaged, and it needs further repair. 

Along the Lachlan River, in NSW, they have had floods, and the wheat harvest will be reduced. Frosts are occurring later in spring, despite a well-documented warming trend. These events are linked; the building blocks of civilisation, particularly a stable ecology and climate system, are being harmed.

Climate change was also identified as a contributor to conflict and migration, in papers published in 1989 in the Lancet and New England Journal of Medicine. These are topics relevant to our next speaker.

In summary, factors which motivated the foundation of ISDE and DEA remain more urgent than ever. Perhaps the only good thing is that the evidence of climate change is now so obvious that deniers are not taken very seriously. But much more needs to be done. For example, there have been attempts to link wind energy in SA with the state’s blackout, a process which confuses electricity generation with its transmission. There are some technical engineering issues with integrating wind energy into the grid, but the problems that climate change is already starting to deliver will be orders of magnitude greater. The time for national leaders to focus on trying to overcome these grid problems rather than promoting more coal or gas is long overdue. Both the ACT and Scotland plan to reach 100% of their electrical energy by 2020 from wind and solar; this engineering problem definitely can be solved. However, left another generation, the problems of climate and adverse ecological change may not be soluble. As David and Gary wrote in 1997, we must be Green or else we will be gone.

Thank you David, for your energetic and wise leadership, not only for DEA but for the national and the international movement for environmental and social justice.