151218 2 middletonj save the planet save the nhs

Save the planet or save the NHS?

A story of sustainable development, resilience and health , thinking globally acting locally

John Middleton President-Elect UK Faculty of Public

Health

Public health: ‘promoting health, preventing disease, prolonging life through the organised efforts of society’

Sustainable development:‘protecting resources from one generation to the next’

Environmental justice:‘the pursuit of equal justice and equal protection under the law for all environmental statutes and regulations without discrimination based on race, ethnicity, and /or socioeconomic status.’

Security: freedom from danger, social, military, environmental

The history of human health and environmental health improvement in the

UK go together Global health and UK health are

interrelatedHealth promotion Is green promotion

Health, sustainable development, reducing inequalities and security are

interrelatedWe have been paralysed by health

service reorganisation- but could the health service benefit by ‘thinking global

and acting local’?

Part 1 –Thinking global

• Food and obesity• Physical activity• Travel related

trauma and death• Access to green

space and health

Unfair resource use causes illness and death directly...

…there are MUCH greater health risks for the least empowered though:

The Birmingham Tornado, 2005

Save the planet, or save the NHS?

• A short history of public health• The future of health improvement

• Looking at environment, economy and their resulting inequalities

Save the planet, or save the NHS?

A (very) short history of public health

• Sanitory revolution

Save the planet, or save the NHS?

A (very) short history of public health

• Inequalities in health• The economics of health :some

examples

Shaw et al.Critical public health 2001,11:289-304

Shaw et alCritical public health,2001;11:289-303

Source: The poverty site http://www.poverty.org.uk/09/index.shtml

CHD Mortality 2000-2005MALES, Less than 65 years

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2000 2001 2002 2003 2004 2005

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West Midlands England Sandwell

FEMALES, Less than 65 years

0.00

5.00

10.00

15.00

20.00

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2000 2001 2002 2003 2004 2005

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r 100

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West Midlands England Sandwell

PERSONS, Less than 65 years

0.00

10.00

20.00

30.00

40.00

50.00

60.00

2000 2001 2002 2003 2004 2005

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West Midlands England Sandwell

Save the planet, or save the NHS?

The new environmental health

Environmental justice

Ecological public health

The future public health

Rockefella Lancet Planetary Health commission

Climate Change occurring faster than expected?

• IPCC’s 5th Assessment Report

• Increasing rates of:– Global Greenhouse Gas emissions– Ice melting (Arctic sea ice, Greenland/Antarctic ice-

sheets, alpine glaciers) – Sea level rise– Carbon stored in permafrost = x2 atmospheric carbon

Sources of global greenhouse gas emissions (2000)

From: Stern (2006)Source: Stern N. The Stern review: the economics of climate change. Cambridge. Cambridge University Press, 2006. under the terms of the click-use licence

Growing burden of climate disasters (UNDP 2007)

• Greatest impacts in developing countries

• Weather related insurance losses going up faster than population, inflation and coverage

• Climate change may be contributing

• Increases in floods, droughts, lightning strikes, intensity of tropical cyclones

= presently suitable, becoming unsuitable by 2050 = presently unsuitable, becoming suitable by 2050

NET CHANGE IN POPULATION AT RISK BY 2050

Rogers D and Randolph S. The global spread of malaria in a future, warmer world. 2000 Science; 289:1763-1765.

Impacts on food prices of global temperature increases

Source: IPCC WG II (2007).

Are the zones being pushed

south, by warming?

… and here?

Health Consequences?

Marked wet summer and dry winter

Wet summer and low winter rainfall

Uniform rainfall

Marked wet winter & dry summer

Low rainfall

Wet winter & low summer rainfall

AridWinter dominantWinter

Summer dominant Summer Uniform

Crucial for wheat-belt

Australia: Climate change, seasonal rainfall zones, farm yields, health impacts

The 1995 Chicago heat wave led to approximately 700 heat-related deaths in Chicago over a period of five days

AUGUST 2003Temperature

distribution across Europe on 10 August

2003 at 1500hrs British Summer Time

France, August 2003~14800 deaths (30,000+ in Europe)

MORTALITY IN PARIS, 1999-2002 v 2003

peak: 13 Aug

Intervention measures can reduce impacts Hajat et al 2010

• Short term strategies– Weather based warning systems– Heat advice

• Long term strategies – Improve care of elderly– Housing design– Reduce urban heat island (more

green spaces, trees)Reduced impact of 2006 heat wave in France- 2000 deaths vs 6500 predicted

Fouillet et al 2008

From Alcamo and Heinrichs, 2002. In: Dialogue on Water and Climate, 2003.

Water critical regionsMedium water stress today & future increase in stress plus

HDI>0.8A2 scenario, ECHAM4, 2020s

Health impacts of floods in low income countries

Immediate deaths and injuries

Infectious diseases - leptospirosis, cholera and diarrhoeal diseases, hepatitis, respiratory diseases, vector-borne diseases e.g. Rift Valley fever, malaria.

(NB floods may also wash away vector breeding sites e.g. highland Tanzania 1997)

Secondary to economic losses

Long term mental health effects - depression, suicide

Floods: impacts on health in UK

• Immediate - death, injuries, hypothermia, electrocution

• Near-term - small risk of gastro-intestinal infections and respiratory disease

• Near-Long term (>6 months) - mental health consequences. e.g. In 2000 after Lewes floods 48% adults showed ‘Psychological distress’ compared with 12% controls

• Increased demands on health system

Methods: Systematic literature review of published epidemiological studies Hajat et al 2003

Possible flooding in the UK by 2080s

Many millions more people are projected to be flooded every year due to sea-level rise by the 2080s

Source: IPCC Wg II, TSI 2007.

Ten tips for better health: Dave Gordon

– don’t be poor, if you can stop, if you cant, try not to be poor for long

– don’t have poor parents– own a car– don’t work in a stressful low paid manual job– don’t live in a damp house– be able to afford a foreign holiday and sunbathe– practice not losing your job and not becoming unemployed– take up all the benefits you are entitled to– don’t live next to a busy road or a polluting factory– learn how to fill in complex housing benefit asylum applications

before you are homeless and destitute

From Alcamo and Heinrichs, 2002. In: Dialogue on Water and Climate, 2003.

Water critical regionsMedium water stress today & future increase in stress plus

HDI>0.8A2 scenario, ECHAM4, 2020s

Fairer andmore sustainableglobal health…

The world map reflecting production related to climate change. “Climate Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697  pp 1659-1734, May 16-22 2009).

Who produces the greenhouse gases?

Who bears the burden?

The world map reflecting mortality related to climate change. “Climate Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697  pp 1659-1734, May 16-22 2009).

• All based on an unsustainable economic model

• consumerism• status• trust• social cohesion• Unequal societies are

less sustainable

Health co-benefits1. Traditional person focussed benefit

– Physical activity, diet, mental health, trauma, air pollution…

2. Benefits for health care system– Congruent with policy direction for many health care

systems: care closer to home, empowered, self care, better use of drugs, better use of ICT, prevention

3. Benefits for international (health) inequity– Cost effective leap frogging from pre-industrial, pre-

carbon to post carbon, missing out high carbon step in the middle

– Justice: Contraction and convergence– Energy: Concentrated solar power (CSP), much

from warmer and poorer countries

Within 6 hours, deserts receive more energy than the world uses in a year.

COP21 Paris Agreement

Food and Agriculture Sector

• Source of 10-12% of global greenhouse-gas emissions

• Change in land-use (eg. deforestation) significant contributor to global emissions (adds further 6-17%)

• Total emissions from sector set to rise by up to 50% by 2030

• Four-fifths (80%) of total emissions in sector arise from processes involved in livestock production

Pathways to health

Health effects

• Case studies: UK and the city of São Paulo, Brazil

• Assumed that 30% reduction in livestock production would decrease consumption of animal source saturated fat by 30%

• Estimated association of intake of animal source saturated fat with risk of ischaemic heart disease

• Substantial benefits from decreased burden of heart disease– UK: ~15%↓ (~ 18,000 premature deaths averted)– São Paulo: ~16%↓ (~ 1000 premature deaths averted)

SUMMARY

[1] There is strong evidence that greenhouse gas emissions from the burning of fossil fuels are changing the global climate

[2] The projected rate and magnitude of change will have adverse impacts on ecological systems and populations in many regions, especially in low income countries where the capacity to adapt is limited

[3] The challenge is to ensure more equitable but sustainable development that enables human societies to live within the Earth’s regenerative capacity

Carbon footprint of the National Health Service

Procuring for Carbon Reduction

• NHS carbon footprint 18.6 MtCO2

• 59% related to upstream goods and services procured, (11 MtCO2)

• P4CR – Roadmap, guidance and pilots• Carbon Disclosure Project• Sustainable Food guide for hospitals• Energy efficiency guide for medical devices

Part 2- Acting local

Welcome to Sandwell

Welcome to Sandwell

Neptune forge 1930

Neptune health park, 1999

‘health promotion is green promotion’– sound housing policy– education: esp: early years– economics -inequalities in income– cycling and walking– tobacco control – Community nutrition: local agriculture and food

cooperatives

Ottawa charter: healthy public policy

Save the planet, or save the NHS?

Sustainable development = resilience

Local food supply

The food desert becomes the fat swamp

Salop drive and Ideal for All Growers

Save the planet, or save the NHS?

Sustainable development = resilience

• Community cohesion• Community support networks • Community advice and money

Save the planet, or save the NHS?

Sustainable development = resilience

Cycling and walking

Safe routes to school

Plan settlements to reduce car useage

Supportive environments Sandwell : Hateley Heath : new playgrounds

Supportive environments: Hateley Heath housing

Supportive environments: Hateley Heath housing

Supportive environments: Hateley Heath housing

Options for life ife self built community centre

Getting research into practice? John Middleton Lancet Public Health Research Conference 29th November 2013

A box plot of the Baseline SAP measures for the Sandwell MBC housing stock, 1st April 2001, by housing type, n=25,595 dwellings

Getting research into practice? John Middleton Lancet Public Health Research Conference 29th November 2013

A box plot of the Baseline SAP measures for the Sandwell MBC housing stock, 31st March 2011, by housing type, n=25,595 dwellings

Birmingham Sandwell / Urban Living Smart housing manifesto 2004

i- House, demonstration house West Bromwich 2008

Good corporate citizen award 38 apprenticesRationalisation of offcies : 6 leases surrendered 890 tonnes of CO2 reduction £200k saved

COP21 Paris Agreement

COP21 Paris Agreement

COP21 Paris Agreement

COP21 Paris Agreement

COP21 Paris Agreement

COP21 Paris Agreement

COP21 Paris Agreement

COP21 Paris Agreement

‘Climate complacency’

COP21 Paris Agreement

The UK government has even imposed a legal obligation upon

itself, under the Infrastructure Act 2015, to

“maximise economic recovery” of the UK’s oil and gas.

COP21 Paris Agreement

COP21 Paris Agreement

In the decade between 2001 and 2011, global military spending increased by an estimated 92 percent, according to Stockholm International Peace Research, although it fell by 1.9 percent in real terms in 2013 to $1,747 billion. At the same time, according to the draft of a new study from the International Peace Bureau (1), almost 10 gigatons of carbon dioxide equivalent has been released into the atmosphere. According to the Global Carbon Project, 2014 emissions are set to reach a record high. Could there be some connection between rising military expenditures and rising carbon emissions?

The green recovery ?

Conclusions

Policies that address both public health and climate change are more attractive than focusing on either in isolation.

The health gains associated with climate change mitigation policies should feature in Climate Change negotiations

A ‘low carbon’ world could be a healthier world

Thank you

John Middleton

Johnmiddleton@phonecoop.coop

Action now…1. SDC Good Corporate Citizenship

toolkit– www.corporatecitizen.nhs.uk/

2. NHS Carbon Trust ManagementProgramme– http://www.carbontrust.co.uk/carbon/publicsector/nhs/

3. Sustaining a Healthy Future– www.fph.org.uk

4. NHS Confederation briefings– http://www.nhsconfed.org/Publications/

briefings/Pages/Briefings.aspx 5. NHS Carbon Reduction Strategy

and 2030 health care scenarios– www.sdu.nhs.uk

See notes of this slides for some of the most important specific actions

References• Climate and Health Council (www.climateandhealth.org)

Global health, global warming, personal and professional responsibility, Cambridge Medicine, Pencheon D, Vol 2, No 22, 2008

• Stott R, Healthy response to climate change, BMJ 2006;332;1385-1387• Gill M, Why should doctors be interested in climate change?

BMJ Jun 2008; 336: 1506• Griffiths J, Alison Hill, Jackie Spiby and Mike Gill, Robin Stott Ten

practical actions for doctors to combat climate change, BMJ 2008;336;1507

• Sustaining a healthy future: www.fph.org.uk • Griffiths J et al, The Health Practitioner's Guide to Climate Change,

Earthscan 2009• Pencheon D, Health services and climate change: what can be done?

J Health Serv Res Policy. Editorial Jan 2009• UCL Health Commission/Lancet: Managing the Health effects of

Climate Change. May 2009• The health benefits of tackling climate change, Wellcome/LSHTM, Nov

2009• Sustainable Development Commission:

http://www.sd-commission.org.uk/pages/health.html