Bring me solutions
Could sustainability hold the key to better health?
Maggie Thatcher once said about one of her cabinet members: “Other ministers bring me problems, David brings me solutions.” Climate campaigners have rarely devoted much time and effort towards creating a coherent vision of the future we want, instead emphasising the threat. Perhaps this partly explains why we have seen little meaningful change. As the health community starts to engage more deeply with sustainability, we would do well to focus on solutions, not just problems; management, not just diagnosis.
The concept of health “co-benefits” of climate action (or climate co-benefits of public health action) is still relatively unknown. These co-benefits are synergies between strategies for sustainable development and strategies for improving health, which exist in many sectors, in developed and developing countries alike.
Obesity and non-communicable diseases
We know that non-communicable diseases are rising inexorably worldwide; that they cause much suffering and are a growing burden on healthcare systems; and that increasingly sedentary lifestyles and unhealthy diets play an important causative role. Together, these diseases account for about 10% of the global burden of disease. But rarely do we think about the role played by fossil fuels in these changes, perhaps because—despite our dependence on these fuels—they are practically invisible in our daily lives. The task we face is how to end this unhealthy dependence.
In The Energy Glut, Professor Ian Roberts makes the case that obesity partly results from our increasing use of fossil fuels. He argues that our car-centric transport systems discourage active travel, such as walking and cycling, while abundant fossil fuels—alongside deforestation—enable the food industry to produce high fat, high sugar food at scale, making these foods the cheapest and most readily available options.
In Beijing, the rate of cycling fell from more than 62% in 1986 to 17% by 2010, while car ownership and obesity rose rapidly. This story is repeating itself the world over. One large study of Chinese adults found that men who acquired a motorised vehicle gained an average 1.8 kg over eight years compared with those who did not, and these men had double the odds of becoming obese.
Meat consumption is also increasing globally, and many studies have shown that reducing the consumption of red and processed meat has health benefits. At the same time, the global food system is responsible for about a third of all greenhouse gas emissions, with livestock accounting for most. Red meat and dairy products are particularly important, because the methane that ruminants produce is about 30 times more potent as a greenhouse gas than carbon dioxide. A modelling study estimated that reducing red and processed meat consumption in the United Kingdom would decrease average risks for various diseases (such as diabetes and colorectal cancer) by 3.2-12.2%, varying by disease, and reduce emissions by 27.8 million tonnes per year.
Palm oil is now found in staggering quantities in all sorts of food, yet it too is strangely invisible to us. It is extremely unhealthy and one of the biggest drivers of deforestation. Moreover, palm oil plantations are often found on converted swamp forest, which is particularly important in terms of greenhouse gas emissions. Policies to reduce consumption therefore offer major potential co-benefits.
Some sustainability strategies can even improve mental health. Accumulating evidence shows that physical activity, such as walking and cycling, has similar efficacy to antidepressants in managing mild to moderate depression. Activity in green spaces, perhaps unsurprisingly, has greater mental health benefits. Time in natural environments reduces markers of stress, such as cortisol, and trees also clean our air, help prevent flooding, and counter the heat island effect. There is a strong case for protecting existing natural spaces, and for urban design with green space throughout, centred around pedestrians and cyclists, not cars.
Disease related to poor air quality
A modal shift towards active travel would not only increase physical activity but also improve air quality. The health impact of air pollution is under-recognised by many health professionals, and its epidemiology rarely features in medical training. Yet it is an extremely important risk factor for diseases such as chronic obstructive pulmonary disease, ischaemic heart disease, and even lung cancer. Figures 1 1 and 2 2 show the breakdown of attributable mortality for indoor and outdoor air pollution. The World Health Organization recently estimated that a staggering seven million deaths globally were attributable to air pollution in 2012. And for each premature death, many more are affected by non-fatal asthma attacks, exacerbations of chronic obstructive pulmonary disease, and respiratory infections.
Figure 2 includes the mortality attributed to household air pollution, which is an important cause of death globally. Most of the health impacts of indoor air pollution result from inefficient cooking stoves, and the impacts are distributed unevenly. As WHO assistant director general, Dr Flavia Bustreo states, “poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cookstoves.” Promoting active travel, increasing the use of efficient and clean cooking stoves, and switching to cleaner energy sources, such as renewables, are effective ways to reduce air pollution. Such policies can achieve major cost savings for healthcare systems, helping to justify upstream investment.
Reducing air pollution requires both political will and coordination between government departments, particularly health, energy, and transport. Most of this pollution results from burning fossil fuels, yet most institutions, including leading medical ones, still invest in fossil fuel companies. This has to change. Moreover, the scale of the challenge needed demands ambitious, joined-up policies at national and international levels.
Copenhagen and Amsterdam are not cycling cities by chance—their high cycling rates are the product of a clear vision, strategic planning, and appropriate investment. Today, the Netherlands spends £24 (€29.2; $40.4) per capita annually on cycling infrastructure, compared with £2 per capita in the United Kingdom. The Dutch have a cycling rate of 28%, compared to 1.5% in the UK, and they reap the benefits many times over in lower healthcare costs and—most importantly—better quality of life. It is estimated that each extra pound spent on cycling would result in cost savings of £4 in the UK; reaching Dutch cycling rates could save the NHS £1.6bn annually.
Disease related to living in cold homes
Living in a cold home has dramatic negative effects on health, increasing mortality and the risks of many physical and mental conditions. This is an important problem—around 4.5 million UK households meet the 10% definition of fuel poverty (needing to spend >10% of their income on fuel to maintain an adequate home temperature). Last year the UK had more than 30 000 excess winter deaths.
A programme of investment to super-insulate cold homes—as advocated by the Energy Bill Revolution campaign (www.energybillrevolution.org)—could dramatically reduce this health burden, cut fuel poverty, save the NHS an estimated £1.2bn a year, and reduce emissions. Health professionals should be vocal advocates for such policies, given the potential to save lives and reduce health inequalities.
Family planning and reproductive health
One of the less obvious policy areas where such synergies exist is in reproductive health and family planning. Slowing population growth helps to reduce greenhouse gas emissions and pressures on ecosystems, and it makes it easier to tackle poverty and reduce climate vulnerability in developing countries. But it can also benefit health directly.
Currently, about 222 million women have an unmet need for family planning—they want to be able to choose how many children to have but lack the means. Meeting this unmet need, and working towards universal education and equal rights for girls and women worldwide, could slow population growth, prevent unwanted pregnancies, and avoid unsafe abortions and maternal deaths.
The role of health professionals
The engagement of doctors and medical students in these areas needs to extend beyond the clinic. Persuading patients to cycle more or eat less meat is only part of the answer, and overemphasising personal choice—rather than environmental factors such as safe cycle routes, green space, and access to affordable nutritious food—may even widen health inequalities.
As trusted voices on health matters, medical professionals have a responsibility to make the case for such policies at local, national, and even international levels. We need to become better advocates for policies that match the scale of the health and environmental challenges we face. By raising awareness, ensuring that our own organisations are not part of the problem, and—most importantly—providing policy makers with solutions, we can create a healthier, more sustainable, and more liveable future.Isobel Braithwaite, fourth year medical student UCL, and national coordinator, Healthy Planet, UK
1UCL, London WC1E 6BT, UK
Correspondence to: Isobel.Braithwaite.email@example.com
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
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Cite this as: Student BMJ 2014;22:g2886