Climate change is not only about our planet, it is also about our lungs
With nearly 20,000 premature deaths per day, air pollution is world's most dangerous environmental health threat. WHJ Deputy Editor Francesco Tamilia spoke with leading experts from World Health Organization (WHO), the US Environmental Protection Agency and the Lancet Countdown to understand how climate change exacerbates air pollution and what policy actions must be taken to protect people’s health.
It is inside our homes, on the way to the office or the walk to school. Air pollution is all around us and it is causing millions of premature deaths every year.
“I keep asking myself how seven million people a year can die and yet nothing is done about it? ” asked clean air advocate Rosamund Adoo-Kissi-Debrah at the Public Policy Projects (PPP) Annual Conference in 2019. Two years and millions more deaths later, Rosamund’s words still feel more relevant than ever.
Rosamund’s nine-year-old daughter Ella passed away after suffering multiple severe asthma attacks caused by high levels of air pollution in 2013. Ella’s big smile was displayed in newspapers across the world last year when, for the very first time, a coroner officially listed air pollution as her cause of death. In a landmark ruling that put a face and a name to one of the millions of people whose deaths are hastened by air pollution every year.
As global temperatures continue to rise, tackling air pollution becomes ever more critical, and ever more challenging. Climate change is set to change human life in almost every way. It has become profoundly important to understanding the links between climate change, air quality and our health.
How climate change impacts air quality
Climate change and air pollution are closely connected. Several studies in recent years have shown that climate change tends to worsen acute episodes of air pollution, this is sometimes referred to as “climate penalty”. A concept first introduced by Darrell Winner, Senior Science Advisor at the US Environmental Protection Agency (EPA).
The idea behind this concept is that, with global warming, you create conditions that are conducive to more air pollution episodes. Speaking to World Healthcare Journal, Winner says “climate is a penalty because it makes it harder to attain the air quality levels you want to achieve for public health”.
In addition to the climate penalty, Marcus Sarofim, Environmental Scientist in the climate change division and at EPA highlights other links between climate change and air quality.
“Ozone is both an air pollutant and a greenhouse gas,” says Sarofim, “the aerosols, black carbon and sulphate can both influence the climate and health. ”
How air pollution is destroying our health
The scientific evidence around the health implications of air pollution is both ominous and overwhelming. According to the WHO, indoor and outdoor air pollution are responsible for seven million premature deaths every year – nearly 20,000 premature deaths per day. An invisible pandemic.
WHO identified four key pollutants that pose a high risk to human health: particulate matter (PM), ozone (O3) nitrogen dioxide (NO2) and sulphur dioxide (SO2).
Dr Maria Neira, Director of Public Health, Environmental and Social Determinants of Health at the WHO spoke exclusively to World Healthcare Journal: “My message to those countries who still do not comply with WHO air quality standards is: ‘Please join us on the WHO standards. I know that they are tough. I know that they are ambitious. But the benefit will be multiple, particularly as they protect people's health without destroying the economy’. ”
If countries prolong action, she says, it will mean more deaths that could have been avoided. “We need countries to increase the level of ambition as well as the speed at which they transition to net-zero,” she adds.
Several studies have confirmed that air pollution harms almost every major organ from our lungs and liver to the brain and heart. Worryingly, it is impacting human life even before we take our first breath. Researchers from Queen Mary University of London have even found air pollution particles in mothers’ placentas.
Although the exposure to air pollutants can drastically vary, no country, region or city is immune to toxic air.
Prioritising public health in the race to net-zero
The good news is, because air pollution is driven largely by the same sources of greenhouse gas emissions as climate change, both can be tackled simultaneously. This concept is referred to as the ‘co-benefits of climate change mitigation’.
In February 2021, the Lancet Countdown published a study looking at the different possibilities to achieve Paris Agreement goals. The study also considered what would happen if in those decarbonisation plans we were to prioritise health and health co-benefits.
“There are many ways in which we can reach Paris Agreements goals if we do it right. But prioritising health and health benefits in that response could lead to millions of lives being saved,” said Dr Marina Romanello, Data Scientist at the Lancet Countdown, during the Environment and Health Series webinar in April 2021.
Prioritising health in the transition to net-zero would mean focusing on policies that improve air quality, especially in urban areas. “We would encourage active travel and increase physical activity as a way of reducing travel emissions and also the improvement of diets in Europe.
"Prioritising health in the transition to net-zero could lead to millions of lives being saved"
– Dr Marina Romanello, Data Scientist at the Lancet Countdown
“Many places are dependent still on red meat and very processed foods. There's an opportunity to make this more plant based to reduce the carbon intensity of our diets while at the same time achieving huge benefits for health,” said Dr Romanello.
Dr Neria has also stressed the importance of making clear that actions to tackle climate change are actions to protect people’s health.
“I think it is unacceptable that, in many developed countries such as the European countries, we still have 400,000 deaths every year due exposure to air pollution,” she says. “Tackling the causes of air pollution and generating health, this is THE argument we need to bring to the climate change negotiations for people to understand that this is not just about the planet and sustainability, it's about our lungs. ”
Dr Neira, a medical doctor by training, worked for some years in clinical phase where she felt happy and rewarded in treating patients. Then, she felt the need to do more and so started becoming more involved in public health.
“I wanted to have impact on measures that have a population-based approach and benefit as many people as possible. All I wanted to do was primary prevention, making sure that, not only people who are getting sick are treated, but the contrary, I want people not to get sick. And then I started working on environmental risk factors, and one of the biggest ones we have in front of us is air pollution and climate change. ”
Senior Science Advisor to the US EPA, Winner, also believes it is crucial to prioritise public health in transition to net-zero. He told World Healthcare Journal: “Certainly in the near-term, I advocate that in mitigating climate change, we should do it in a way to maximise the public health benefit and those linkages between the same sources for lower greenhouse gases, short lived climate forcers and air pollutants become important. ”
A landmark report published in May 2021 by United Nations Environment Programme (UNEP) offered further evidence on how tackling climate change can protect health. The report found that achieving a 45 per cent reduction of methane emissions within this decade would prevent more than 250,000 premature deaths. UNEP’s Chief Executive Inger Aderson said that it is the “strongest action available” to slow global heating in the short-term.
Thousands of deaths per day are not enough, what else do we need?
With thousands of premature deaths every day and a devastating impact to our health, air pollution represents a clear public health crisis. Although the air pollution crisis is now mainstream, it does not seem to be enough to mobilise different communities such the public, politicians and policymakers to act as fast and decisively as we need on the climate and air pollution crises. Securing greater engagement is crucial.
According to Dr Neira, we must keep changing the narrative around climate change to make clear to everyone that the climate crisis is not a future issue, it is impacting people’s health and wellbeing right now.
“Until now, the narrative of climate change has been distant for many people on their daily life. As an example, if we talk about rising sea levels in Bangladesh, people living in London might not be so concerned about that. So, we need to make sure that the narrative focus is on how climate change is affecting life today, and not only future generations or the life of the planet. ”
Dr Romanello also stresses the importance of changing the narrative on climate change, "starting to understand that climate change is affecting us and our health and the future of our children and not only polar bears in 2100, I think is key,” she says.
Some experts, including from the British Medical Journal (BMJ), have argued that the WHO must declare climate change a “public health emergency of international concern” to stimulate decisive actions. According the BMJ, the move would also help strengthen a coordinated, international response by mobilising political will and encouraging funding.
When asked about this possibility, Dr Neira expressed her concerns that this would only generate attention in the short-term for an issue where constant government action is required. “When you declare a public health emergency, you will have attention. You will have resources for a few days, a few months, and then it's over. This will require very important decisions,” she says.
Despite the concerns, Dr Neira did leave open the possibility of declaring climate change a 'public health emergency of international concern' in the future. “If we think that this will generate the reaction that is needed, yes, but this has to be, as I said, an action that will be maintained in the long-term and not just acute. ”
Dr Neira also believes health professionals can play a very important role in shifting the dial towards action. “I think we need the voices of the health professionals at large. From a paediatrician and biologist to an internist and surgeon. Any health professional, including nurses, need to make clear that this is a question of health,” she says.
According to Winner, another crucial aspect is getting policymakers good, comprehensive information. “Some people in the international climate community have future energy pathways that they think make a lot of sense but maintain a lot of public health damage from the energy systems they propose. Whereas other choices at the same or slightly increased cost as far as the actual energy system is concerned, result in massive public health benefit. ”
“For me, the vaccine for climate change is common sense. We need to stop polluting everything we touch; above all the air we breathe, the water we drink and the food we eat. ”
– Dr Maria Neira, Director of Public Health, Environmental and Social Determinants of Health at WHO
There are no straightforward solutions to this multifaceted crisis. However, Dr Neira remains positive, “for me, the vaccine for climate change is common sense. We need to stop polluting everything we touch; above all the air we breathe, the water we drink and the food we eat. The moment people will fully understand the connection between our environment and their own health today, not just the future generations, and we put it in positive light, I think we can move mountains. ”
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