In its annual report on the impact of climate change on health, the Lancet Countdown warns of irreversible damage facing humanity. "Human health is seriously threatened," the hundred scientists behind the document cautioned.
Are healthcare systems ready to confront climate-related disasters? "We are only at the beginning of raising awareness among healthcare professionals," said David Grimaldi, MD, a Belgian intensive care physician and member of the Shifters health professionals committee working on decarbonizing the economy. Univadis Italy recently spoke with Grimaldi about this topic.
Univadis Italy: What significance do you attribute to the Lancet Countdown publication?
David Grimaldi: The Lancet Countdown's document comes from one of the world's most prestigious and reliable scientific journals. In crafting the latest annual report on the impact of climate change on health, 114 scientists from over 50 research institutes participated. It is an assessment based on about 50 indicators, updated annually — a colossal collective scientific effort.
Univadis Italy: The mortality of those over age 65 years linked to a 2 °C temperature increase could grow by 4.7 times between today and 2050. Are governments up to the challenge?
David Grimaldi: These data are extremely alarming, and the 4.7 times more deaths among the elderly by 2050 is part of an optimistic scenario where the temperature increase does not exceed 2 °C. Projections even suggest that if we don't control greenhouse gas emissions, heat-related deaths among the elderly by 2100 will be 16 times higher. This means that, in our latitudes, summer will become challenging for healthy adults and perilous for the elderly, infants, and chronically ill. The indirect effects of heat will be even more severe.
Univadis Italy: It is predicted that global warming will impact agricultural yields, leading to widespread malnutrition, as announced by the Lancet Countdown.
David Grimaldi: Yes, heat will result in a clear loss of food yield. The Lancet Countdown predicts that in a 2° temperature increase scenario, another 525 million people will suffer from this loss of food yield by 2050. We are talking about hundreds of millions affected by malnutrition and famine. Another very alarming indirect effect mentioned in the Intergovernmental Panel on Climate Change (IPCC) report is that, in areas closer to the equator, this warming will lead to conditions no longer compatible with human survival. It will be too hot and too humid. Mass migrations can be expected.
Univadis Italy: Could water access become a problem?
David Grimaldi: Exactly. Global warming is leading to increased ocean evaporation, changing precipitation distribution. Some areas will become rainier, and others drier. The Mediterranean basin is one of the world's regions facing significant desertification. This means it will become increasingly challenging for people living around the Mediterranean to cultivate. Much of Spain is in the process of desertification.
Univadis Italy: The Lancet also mentions the resurgence of epidemics and infectious diseases (malaria, vibriosis, dengue fever, and other viruses). Does this concern you?
David Grimaldi: It is somewhat less concerning than the topics we just discussed because we know these diseases and know how to treat some of them. This epidemic risk is perhaps the subject generating the most scientific interest in the medical community. Some tropical diseases (dengue, chikungunya, malaria, etc) are expected to reach mainland France. In fact, the first indigenous case of dengue was diagnosed in the Paris region last fall. [Editor's note: Other cases have already occurred in countries closer to endemic areas like Italy.] The more worrying infections are the viruses about which we know nothing, which could lead to a pandemic for which we are unprepared and for which we do not necessarily have drugs.
Univadis Italy: Are healthcare systems ready to face these disasters? Will they be resilient enough?
David Grimaldi: Ninety percent of cities claim to have a climate change adaptation plan, and 85% of highly developed states have health crisis plans. However, we had a very recent stress test with COVID, which questions our level of preparedness....I cannot judge this for all states and their hospitals, but I do not feel that hospitals in Europe are prepared for climate disasters, or that healthcare professionals are informed and trained.
Univadis Italy: Are the doctors of your country aware of what is predicted?
David Grimaldi: Among doctors, a certain awareness is beginning to emerge. A few years ago, there was no connection between health and climate. Now, there is almost no medical congress without a scientific information session on sustainability. The number of hospitals conducting carbon audits is increasing, and scientific journals are publishing articles on the links between climate and health. If healthcare professionals are not already aware, they will soon be directly confronted with the impact of climate change on health.
Univadis Italy: Are doctors adequately trained on climate-related health risks?
David Grimaldi: Not at all, it is one of the priority areas to work on. A study conducted by the Shift Project and published in its report "Decarbonizing Health" showed that only a third of institutions provide training on the links between the environment and health. This training represents 0.4% of teaching hours, even though 85% of medical students believe they should receive training on these issues. We need to move very quickly to ensure that future doctors, pharmacists, nurses, physiotherapists, midwives, etc, receive the necessary training to understand the issues and changes to be made.
Univadis Italy: An introductory module on environmental health was introduced in French medical schools this year.
David Grimaldi: This MOOC, led by Dr Marine Sarfati, is an excellent initiative, validated by the Conference of French Medical Deans, but it is an optional module. This project comes from the idea of a civil society doctor. It is now time for the government to address the issue and make training on this topic mandatory for all future doctors.
Univadis Italy: Is it not the responsibility of doctors to warn the public about health hazards resulting from increased carbon emissions?
David Grimaldi: Absolutely, yes. It is a role that is somewhat less known and exhibited by healthcare professionals, but their mission is to promote good health to the best of existing knowledge. This is enshrined in the Hippocratic Oath. [Editor's note: "My first concern will be to restore, preserve, or promote health in all its aspects, physical and mental, individual and social."]
Today we promote good health among sick people. Tomorrow we will have to promote good health among healthy people. Doctors have an important social role to play, and their voice, like that of nurses, is heard and believed. Surveys like the Ipsos Veracity Index conducted every year in England demonstrate this.
Univadis Italy: As a member of the health group within Shifters, what do you think can be done to limit climate change and adapt to its consequences?
David Grimaldi: First and foremost, we must follow the scientists' recommendations contained in the IPCC reports. And we must educate ourselves. The healthcare sector is not sufficiently aware that it is itself a greenhouse gas emitter. The healthcare sector is responsible for 8% of emissions in France and must reduce its footprint. Efforts are needed to decarbonize drugs and medical equipment, medical devices, but also to stop single-use items and promote reuse. Despite all these measures, we will not be able to decarbonize 80% of the healthcare sector, a necessary effort by 2050. It is essential, therefore, that the healthcare system be less stressed, with fewer patients. This means prevention and health promotion.
Univadis Italy: The 28th United Nations Climate Change Conference (COP28) is taking place in Dubai from November 30 to December 12. December 3 was dedicated to health. Should we expect anything from this? What minimum commitments can we expect from governments?
David Grimaldi: We should not expect spectacular decisions from COPs. COPs are a time to publicize, discuss, and negotiate, but decisions are not binding; they are the result of negotiations between multiple interests. On the other hand, it is the first time that a COP has dedicated a day to health. This shows that there has been a cognitive shift at the highest levels of government. They recognize that climate change not only damages coral reefs, ice floes, and polar bears, but is also a threat to humanity.
This article was translated from Univadis Italy, which is part of the Medscape professional network.
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