Climate and health: The greatest opportunity of the twenty-first century
The fifth event in the serie Sustainable Future Dialogues discusses the health benefits of actions that combat climate change
By Juliana Lopes
Indicated as the greatest opportunity of the twenty-first century, the debate on the relationship between climate change and health can demonstrate how everyone's life is affected by the phenomenon of global warming. This was the keynote of the International Event on Climate and Health, promoted by the Institute for Climate and Society (iCS) and the German Embassy in Brasilia, held on last September 13, 2018.
In his opening speech, the German Ambassador in Brazil, Georg Witschel, recalled that, when dealing with climate, the medical expression "prevention is better than a cure" also applies. According to him, the more serious the climate change, the greater the implications and risks to health. "The relationship between climate policy and health is positive. The more ambitious we are in our climate policies, the greater the chances that we reduce the risks to health. Every Brazilian Real invested in climate policies generates direct benefits to health," he emphasized.
Ana Toni, executive director of the Institute for Climate and Society (iCS), pointed out that the objective of the Sustainable Future Dialogues is to build bridges between different communities. According to Ana, there are many benefits in the approximation of the health and climate agendas. This is because they are two sides of the same coin and the relationship is beneficial for both sides.
"The investment in electric-powered buses contributes to the reduction of air pollution in cities; encouraging active mobility helps fight obesity; and agroforestry production without deforestation provides healthier food. All this is good for the climate and for health. I dream of the day when climate activists and health agents can demonstrate this relationship and speak easily about the topic," she added.
Transdisciplinary vision in health
In the panorama presented regarding global climate change and its impacts on health, Helen Gurgel, a coordinator from the Geography, Environment and Health Laboratory and a professor at UnB, reinforced the importance of a more transdisciplinary approach by health professionals, emphasizing their leading role. "The health professionals need to be engaged, because they are leaders and have already faced significant health challenges in Brazil with the fight against polio, the control of HIV cases and tobacco consumption," she said.
Helen also indicated the effects of climate change on mental health, which is a growing problem and is very often overlooked. Scientific research points out, for example, a higher occurrence of assaults, suicides and social conflict due to the increase of the temperature and the higher frequency of heatwaves.
In the first panel, Hans-Guido Mücke, a scientist from the Environmental Hygiene Department of the German Environmental Agency, presented studies of heatwaves in Germany – which is a country that has the second largest elderly population in the world. In his research on a record 12-day heatwave (in 2003, in Germany), Mücke discovered an increase of 77.8% in deaths.
Carol Devine, an advisor for humanitarian affairs of Doctors Without Borders, said that, in its operations, the organization had already identified the effects of climate change on health in 70 countries where they work. "These effects range from the impact of the scarcity of water in conflict zones, such as Syria and Iraq, to the lack of food security in places like the Sahel, in Africa, or even malaria outbreaks in several countries around the world," she explained.
Children, the elderly and the poorest populations are the most vulnerable to the effects of climate change on health. Tatiana Marrufo, a coordinator of the Strategic Program of Health and Environment of the National Institute of Health of Mozambique, demonstrated how cases of malnutrition and hunger in the country have been exacerbated by climate change. "In 2015, we had 150,000 people in a situation of food insecurity. By 2016, this number had jumped to 1,500,000 people, due to the climate phenomenon of El Niño, which caused extended periods of drought."
Tatiana also mentioned other effects associated with the question of the intersection between climate change and health, such as socio-economic and demographic transformations, urbanization and migratory movements. Fabio Evangelista, a representative from the Pan American Health Organization in Brazil (PAHO/WHO), added that factors such as the lack of planning and early warning, rapid population growth and poor land use act to compound the damage to health caused by climate change. Data from the World Health Organization demonstrates that 23.5% of natural disasters occur in the Americas and that these are associated with hydrological and meteorological factors - resulting in 98 million victims and a cost of US$ 679 billion.
Considering these high costs from an economic and a human point of view, for Fabio Evangelista a future without mitigation and adaptation to climate change invalidates the health models. "To meet the challenges of climate change we need to rethink how we live, produce, consume and work. The health area offers the best arguments and evidence to strengthen the actions of sustainable development," advised the representative.
"The climate requires changes in the paradigms of health"
When discussing the experience of Mozambique, one of the conclusions indicated by Tatiana Marrufo was the integration of climate change into health planning. This also echoed among the experts during the panel on Brazilian perspectives.
Rodrigo Frutuoso, a technical advisor at the General Coordination of Inspection in Environmental Health of the Ministry of Health, gave an account of the efforts to integrate climate into the routines of the various agencies, offices and departments that make up the structure of health governance in Brazil.
The National Plan of Adaptation to Climate Change, for example, has 24 targets, of which two are in the area of health. "Today, we have contingency plans so that the federal, state and municipal authorities are prepared to respond to emergencies," explained Rodrigo.
As part of these efforts, the National Observatory of Climate and Health was created – which monitors indicators in the area. For Christovam Barcellos, from Fiocruz and a researcher at the Observatory, health is a mediator between climate and society. He explained that the first large task of the agency was to address climate sensitive diseases. These were organized into four main areas: vector-borne diseases, water crisis (and water-borne diseases) and the potentiality of atmospheric pollution combined with climate change. "The temperature is not the only variable that we should observe. Climate change should be observed together with environmental change. For example, diseases appear as a result of broader issues such as deforestation, changes in the rate of flow of rivers and extreme weather events," he said.
Undertakings in the health field in Brazil have already begun to integrate climate risk into their management. As a result, they are mapping opportunities of cost reduction and a greater operating efficiency from the measures to reduce greenhouse gas emissions in their operations.
According to Neilor Guilherme, a board member of the Healthy Hospitals Project and an environmental engineer from the Albert Einstein Hospital, by the "Challenge 2020: Health by climate" initiative, the 47 participating hospitals achieved £ 1 billion [CF1] in financial savings through the management of greenhouse gas emissions. By means of the Healthy Hospitals Project, 100 health establishments have assumed emission reduction targets by 2020.
In 2015, during COP 21, health was cited as a priority for mitigation actions due to the immediate benefits for health and the economy. Pollution has a direct connection with the climate and its impact on health is very fast, which is different from other effects that are felt more in the medium and long term.
Evangelina Vormittag, a founder and director of the Institute for Health and Sustainability, warned that pollution is already the largest environmental cause of disease and death in the world - three times more than HIV/AIDS, tuberculosis and malaria combined.
"Due to high vehicle emissions and the elevated concentration levels of particulate matter, which is one of the most harmful pollutants to health, air pollution has become the environmental leader of causes of death, surpassing deaths from malaria, indoor pollution and the consumption of unhealthy water" she pointed out.
Evangelina also clarifies that the damage to health from elevated concentration levels of particulate matter is not just respiratory, but mainly cardiovascular, because a large part of the particulate matter enters the bloodstream. In the State of São Paulo, atmospheric air pollution kills more people than breast cancer and results in costs for the public health system of R$ 1.5 billion.
She reinforces the importance of considering these studies in urban planning and infrastructure decisions in the cities, mainly by the convergence of the agendas of climate, health, transport and renewable energy.
On this theme, Alice Amorim, coordinator of the iCS policy portfolio, drew attention to the fact that the infrastructure in developing countries is yet to be built in many cases. "We are in time to include aspects of climate and health in the planning and investment decision of the infrastructure, but this has to be done urgently," she emphasized.
REFERENCES OF TEXT
 The Lancet, a group multidisciplinary researchers called The Lancet, which annually monitors climate and health indicators.