Health and climate change: an appeal for a clearer effect classification

This letter (submitted March 20, 2017) was rejected by the Lancet on April 25, 2017, with no review and no explanation.  This version is different to that submitted in that it includes three figures. I have revised this and submitted it to the BMJ, as an 800 word opinion piece, with two figures from my edited book.

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Since 2009 The Lancet has published three long articles on the health effects of climate change. These have involved 124 authors and 108 pages. (1-3) The first article described the potential health effects of climate change as “immense”, posing “potentially the biggest global health threat of the 21st century”. The second article endorsed this conclusion, adding that “temperature rises in the next 85 years may be incompatible with an organised global community”.(2)

The third, recent paper (3) focusses on tracking progress on health and climate change. While avoiding the term “catastrophic” it also argues that the health and social consequences of climate change are far-reaching, “ranging from reduced labour productivity and heat-related deaths, through to direct injury .. infectious diseases, and mental health effects.” It further states that climate change effects will be “heterogeneously mediated across different environmental and social systems, resulting in .. potential effects on food and water shortages, population displacement, and conflict.”(3) It reprints a figure from the second paper, showing six health endpoints, some of which are mediated by up to five social factors (see figure 1). 

Figure 1. Source: references 2 and 3

The earliest paper judged the “indirect” effects on “water, food security, and extreme climatic events” as likely to be the greatest.(1) The second paper identified four direct and four indirect physical effects, such as “heatwaves” (direct) and “water quality” (indirect). It also listed eight health impacts, all arising via direct and indirect effects, each modified by up to six kinds of “social dynamic”. These effects ranged from mental illness to poisoning. Again, there is no sense of hierarchy.

However, the literature contains a simpler, hierarchical classification of the health effects of climate change, not cited in any of these three articles (see figures 2,3).(4, 5) In this alternative framework, “primary” effects are the simplest, such as heat stress and injuries from a climate change fuelled superstorm. “Secondary” effects are less direct; including conditions such as allergies or malaria. “Tertiary” effects are potentially catastrophic, and with by far the largest burden of disease: large scale famine, conflict, migration, and social collapse. Mental health is cross cutting; post-traumatic stress can follow a cyclone or a war. Finally, as with the three Lancet papers, climate change is never conceptualised as acting alone, but instead via complex “eco-social” pathways.

 

Figure 2 (source ref 4, chapter 26)

Figure 3: This compares the likely burden of disease from the primary, secondary and tertiary effects of climate change with the time at which the effects are likely to be widely accepted as causally related by the general and even the scientific community. To date, my prediction this could take as long as 2050 appears on track! (source: ref 4, chapter 26).

References

1.             Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change. The Lancet 2009; 373: 1693–733.
2.             Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. The Lancet 2015; 386: 1861–914.
3.             Watts N, Adger WN, Ayeb-Karlsson S, et al. The Lancet Countdown: tracking progress on health and climate change. The Lancet 2017; 389: 1151–64.
4.             Butler CD, editor. Climate Change and Global Health. Wallingford UK, Boston, US: CABI; 2014.
5.             Butler CD, Corvalan CF, Koren HS. Human health, well-being and global ecological scenarios. Ecosystems 2005; 8(2): 153-62.

The Human Titanic: steering a safe passage for civilisation. Part 2

Why the Human Titanic?

In the most simple form, I call our ship the Human Titanic not only because I fear it is on track to the iceberg, but because of the inequality on board, which means too few of the passengers (including us on the second deck) identify with the fate of the whole ship. Those with power to change the course of the vessel, like Rupert Murdoch, do not try very hard, and those who would like to change the path, or slow its speed, have very little power to do so. And the people most vulnerable to collision have almost no understanding of the risk - but, if they did, they too could not do anything about it.

 Ignoring the warnings

A tiny nudge of the Human Titanic's trajectory might see it (us) just miss the iceberg. On the real Titanic there should have been a pair of binoculars for the lookout on the Crow's Nest, but it was unavailable due to a not uncommon human error.  The captain had one in the lower-situated bridge. Of course, the lookout might not have spotted the dark ice, but it's only one example of the brinkmanship that was underway on that boat, just as it is now with the climate and other aspects of adverse global environmental change. If the lookout had raised the alarm in time the captain would have reacted; even the first claste passengers would been relieved. No-one wanted to try escaping on a lifeboat lowered into cold dark water.
 
Today, the first claste are essentially saying "full steam ahead" - more speed and growth of the global economy. They discount and underestimate the value of information delivered by new technology (eg satellite estimates showing the loss of mass of Antarctica and Greenland due to melting ice) just as on the real boat in 1912 they paid too little attention to that then newfangled invention, Marconi's wireless. They also failed to make good use of old technology, like the binoculars. Today, we fail to make use of old technology like weather records. But then, just as now, part of the risk is the extent of global inequality, as Tom Athanasiou appreciates, but Paul Gilding does not seem to.

The Human Titanic: steering a safe passage for civilisation part 1

The Human Titanic is the name of the book I have been dreaming of since at least 2000. It builds on my doctoral thesis but is aimed at a much larger audience. It is an analogy for the vessel, our planet that we live on, in one of four decks, each occupied by a different global "claste", who rarely interact except within their own level, other than by rule-giving (or taking) or by ritualised hand-touching or foot kissing.

Four decks

High up are the Mary Antoinette suites, though they could be also be named after deceased members of this fabulously wealthy and powerful class: Mobuto, Markos, Mengistu or for that matter still-living icons like Gina Rinehart. There are cabins, decks and on-board casinos inhabited by people who are fabulously wealthy and act as though the fate of civilisation that the ship hosts (and on which you and I also live) does not matter to them.

I live on the second claste deck, and so does virtually everyone I have ever met, and who will ever read this, though some of us live on more or less privileged parts of this layer. But some of us from this deck work on the upper floors, trained to be discreet and servile, such as by Institutes of Butling and Household Management, producing butlers, as they used to be called (I don't think I am related). Robert Frank has a long description of the production process for these butlers to the elite in his book Richistan.

Below us live the Precariat and below them, in steerage, are people who are unimagineably poor, at least to most of us on the higher decks. They may number as many as a billion. I have encountered a few of them, for example in a village in Meghalaya, India, near the Bangladeshi border. Few birds live in the remnants of forest on the steep hillside, near the wet desert of Cherrapunjee. Most of the people I met there are less than 1.5 metres (5 feet) tall, due to lifelong undernutrition. Many are chronically infected with parasites. They could become become radicalised, as Arundhati Roy describes but are more likely to live a short life in poverty.  I also once met a precariat member - he was from somewhere in South Asia and was flying back from Nigeria, maybe to Singapore. He'd been in Nigeria for about 24 hours, some mistake had occurred, over which he had very little control. Life in economy class at 35,000 feet beyond about 60 hours a week surely classifies as a hell realm, but at least he was well-fed, literate, and skilled. 

You could argue my temporary companion on that flight really belonged on the second deck, but, like a lot of things in life, the boundaries of these claste decks are not absolutely precise. And some people can definitely move between decks, in either direction. President Mobutu Sesu Seko, of Zaire, wasn't born to wealth or power, but for a while he achieved sufficient of both to be a genuine first-claste member. In fact, according to this article by the BBC, it was Mobuto's rule that first popularised the term "kleptocracy" - rule by thieves.

The roots of this book

The title of this book (The Human Titanic) was suggested to me by Robert Chambers, who I worked with in 2002, and who had been involved with writing Voices of the Poor, for the World Bank. We met for three days in San Francisco, finalising the titular chapter of the conceptual framework on human well-being and ecosystem services for the Millennium Ecosystem Assessment. Robert was a famous academic, but unlike the rest of us he looked like a backpacker, travelled with a back pack, and didn't seem at home in five star hotels. But Robert also wasn't perfectly at home when interviewing the extremely poor, one of whom had asked him his salary. Robert couldn't bring himself to tell him.

In 1997 I had hoped to undertake a PhD on tropical medicine, preferably on malaria. But I changed my mind during the conference to commemorate the 100th anniversary of Ronald Ross's discovery that malaria was transmitted by mosquitoes, in Secunderabad, India. One of the keynote speakers, before several hundred delegates, mainly Indian, spoke frankly of the futility of lobbying for further research funds, and suggested instead that malaria researchers would need to learn to better use their limited funds.

My immediate reaction was that though brutally honest, this was only true because those who suffer from malaria are overwhelmingly poor. It then occurred to me, with an intensity previously sensed comparatively faintly, that the way the population of the First World views and treats that of the Third World parallels the way some upper caste Hindus treat the dalits.

The claste system

These thoughts led to coining of the word “claste” and a substantially econometric analysis of the global claste system that my thesis comprised. But it soon also occurred to me that global economic discrimination also provided a previously under-recognised causal explanation for the process that I called “environmental brinkmanship”, akin to nuclear brinkmanship.

During my thesis I published two long articles in journals, each in 2000. One was called Inequality, global change and the sustainability of civilisation. In it, I wrote: "The powerful exhibit contempt - for the poor, for nature, and for the future - of breathtaking scale. In this paper, humanity is compared to the travellers on the Titanic. Most live in steerage, unable to sense the iceberg’s proximity or to escape. Above deck, the privileged enjoy entrancing conversation and entertainment. If, as in 1912, the unthinkable should happen, they know they have disproportionate access to the lifeboats.

Those who escaped the Titanic reached the safety of New York. But if human demands on natural capital exceed the “environmental Plimsoll Line” then we risk not only the failure of civilisation, but its collapse. Even New York may be an inadequate haven for those sufficiently privileged to access the lifeboats; the hegemony of the currently wealthy may not guarantee future security."

I see that to read that paper, which was once open access, now costs $45. Good thing I have a copy. I will have to post a copy on my website (at least the text).
 
I have been trying to write this book, as I mentioned, for over a decade. I keep getting obstructed - there is always something more urgent, usually that is doing something that I'll get paid for, or meeting an obligation that I rashly promised I'd do. But, now I feel, getting these ideas to a wider audience is perhaps the most important thing I can do. At least I can write these installments.

I did write part 2.