The UN General Assembly in September 2021 will bring countries together at a critical
time for marshalling collective action to tackle the global environmental crisis.
They will meet again at the biodiversity summit in Kunming, China, and the climate
conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors
of health journals worldwide—call for urgent action to keep average global temperature
increases below 1.5°C, halt the destruction of nature and protect health.
Health is already being harmed by global temperature increases and the destruction
of the natural world, a state of affairs health professionals have been bringing attention
to for decades.
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The science is unequivocal; a global increase of 1.5°C above the pre-industrial average
and the continued loss of biodiversity risk catastrophic harm to health that will
be impossible to reverse.
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Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the
pandemic to pass to rapidly reduce emissions.
Reflecting the severity of the moment, this editorial appears in health journals across
the world. We are united in recognizing that only fundamental and equitable changes
to societies will reverse our current trajectory.
The risks to health of increases above 1.5°C are now well established.
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Indeed, no temperature rise is ‘safe’. In the past 20 years, heat related mortality
among people aged over 65 has increased by more than 50%.
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Higher temperatures have brought increased dehydration and renal function loss, dermatological
malignancies, tropical infections, adverse mental health outcomes, pregnancy complications,
allergies and cardiovascular and pulmonary morbidity and mortality.
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Harms disproportionately affect the most vulnerable, including among children, older
populations, ethnic minorities, poorer communities and those with underlying health
problems.
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Global heating is also contributing to the decline in global yield potential for major
crops, falling by 1.8-5.6% since 1981; this, together with the effects of extreme
weather and soil depletion, is hampering efforts to reduce undernutrition.
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Thriving ecosystems are essential to human health, and the widespread destruction
of nature, including habitats and species, is eroding water and food security and
increasing the chance of pandemics.
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The consequences of the environmental crisis fall disproportionately on those countries
and communities that have contributed least to the problem and are least able to mitigate
the harms. Yet no country, no matter how wealthy, can shield itself from these impacts.
Allowing the consequences to fall disproportionately on the most vulnerable will breed
more conflict, food insecurity, forced displacement and zoonotic disease—with severe
implications for all countries and communities. As with the COVID-19 pandemic, we
are globally as strong as our weakest member.
Rises above 1.5°C increase the chance of reaching tipping points in natural systems
that could lock the world into an acutely unstable state. This would critically impair
our ability to mitigate harms and to prevent catastrophic, runaway environmental change.
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Global targets are not enough
Encouragingly, many governments, financial institutions and businesses are setting
targets to reach net-zero emissions, including targets for 2030. The cost of renewable
energy is dropping rapidly. Many countries are aiming to protect at least 30% of the
world’s land and oceans by 2030.
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These promises are not enough. Targets are easy to set and hard to achieve. They are
yet to be matched with credible short and longer term plans to accelerate cleaner
technologies and transform societies. Emissions reduction plans do not adequately
incorporate health considerations.
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Concern is growing that temperature rises above 1.5°C are beginning to be seen as
inevitable, or even acceptable, to powerful members of the global community.
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Relatedly, current strategies for reducing emissions to net zero by the middle of
the century implausibly assume that the world will acquire great capabilities to remove
greenhouse gases from the atmosphere.
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This insufficient action means that temperature increases are likely to be well in
excess of 2°C,
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a catastrophic outcome for health and environmental stability. Critically, the destruction
of nature does not have parity of esteem with the climate element of the crisis, and
every single global target to restore biodiversity loss by 2020 was missed.
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This is an overall environmental crisis.
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Health professionals are united with environmental scientists, businesses and many
others in rejecting that this outcome is inevitable. More can and must be done now—in
Glasgow and Kunming—and in the immediate years that follow. We join health professionals
worldwide who have already supported calls for rapid action.
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Equity must be at the centre of the global response. Contributing a fair share to
the global effort means that reduction commitments must account for the cumulative,
historical contribution each country has made to emissions, as well as its current
emissions and capacity to respond. Wealthier countries will have to cut emissions
more quickly, making reductions by 2030 beyond those currently proposed
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and reaching net-zero emissions before 2050. Similar targets and emergency action
are needed for biodiversity loss and the wider destruction of the natural world.
To achieve these targets, governments must make fundamental changes to how our societies
and economies are organized and how we live. The current strategy of encouraging markets
to swap dirty for cleaner technologies is not enough. Governments must intervene to
support the redesign of transport systems, cities, production and distribution of
food, markets for financial investments, health systems and much more. Global coordination
is needed to ensure that the rush for cleaner technologies does not come at the cost
of more environmental destruction and human exploitation.
Many governments met the threat of the COVID-19 pandemic with unprecedented funding.
The environmental crisis demands a similar emergency response. Huge investment will
be needed, beyond what is being considered or delivered anywhere in the world. But
such investments will produce huge positive health and economic outcomes. These include
high quality jobs, reduced air pollution, increased physical activity and improved
housing and diet. Better air quality alone would realize health benefits that easily
offset the global costs of emissions reductions.
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These measures will also improve the social and economic determinants of health, the
poor state of which may have made populations more vulnerable to the COVID-19 pandemic.
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But the changes cannot be achieved through a return to damaging austerity policies
or the continuation of the large inequalities of wealth and power within and between
countries.
Cooperation hinges on wealthy nations doing more
In particular, countries that have disproportionately created the environmental crisis
must do more to support low and middle income countries to build cleaner, healthier
and more resilient societies. High income countries must meet and go beyond their
outstanding commitment to provide $100 bn a year, making up for any shortfall in 2020
and increasing contributions to and beyond 2025. Funding must be equally split between
mitigation and adaptation, including improving the resilience of health systems.
Financing should be through grants rather than loans, building local capabilities
and truly empowering communities, and should come alongside forgiving large debts,
which constrain the agency of so many low income countries. Additional funding must
be marshalled to compensate for inevitable loss and damage caused by the consequences
of the environmental crisis.
As health professionals, we must do all we can to aid the transition to a sustainable,
fairer, resilient and healthier world. Alongside acting to reduce the harm from the
environmental crisis, we should proactively contribute to global prevention of further
damage and action on the root causes of the crisis. We must hold global leaders to
account and continue to educate others about the health risks of the crisis. We must
join in the work to achieve environmentally sustainable health systems before 2040,
recognizing that this will mean changing clinical practice. Health institutions have
already divested more than $42 bn of assets from fossil fuels; others should join
them.
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The greatest threat to global public health is the continued failure of world leaders
to keep the global temperature rise below 1.5°C and to restore nature. Urgent, society-wide
changes must be made and will lead to a fairer and healthier world. We, as editors
of health journals, call for governments and other leaders to act, marking 2021 as
the year that the world finally changes course.
Competing interests: We have read and understood BMJ policy on declaration of interests
and F.G. serves on the executive committee for the UK Health Alliance on Climate Change
and is a Trustee of the Eden Project. R.S. is the chair of Patients Know Best, has
stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis and
is chair of the Lancet Commission of the Value of Death. None further declared.
Provenance and peer review: Commissioned; not externally peer reviewed.