EDITOREAL --LANCET
A Commission on climate change
“Climate
change is the biggest global health threat of the 21st century.” This
statement opens and sums up the final report of a year-long Commission held
jointly between The Lancet and University College London (UCL) Institute for
Global Health. Climate change
will have its greatest impact on those who are already the poorest in the
world: it will deepen
inequities and the effects of global warming will shape the future of health among
all peoples. Yet this
message has failed to penetrate most public discussion about climate change.
And health professionals have barely begun to engage with an issue that should
be a major focal point for their research, preparedness planning, and advocacy
(the UK’s Climate and Health Council is a notable exception).
The most serious threats facing
human health today are deeply complex. They include economic crises, pandemics, poverty, and violence and conflict. These problems will demand complex
solutions. But few organisations are able to bridge the widely differing
domains and disciplines necessary to define ways to solve these unusually
challenging human predicaments. Universities are such institutions. Strangely,
they are commonly neglected sources—and forces—for social change. Even within
many great universities, there has been a withering of ambition, an erosion of
confidence, about their contribution to society and its ills. But since The
Lancet began its global health series (with child survival in 2003), we have
observed the remarkable wealth of knowledge and skill within truly great
educational and research establishments. Universities with a strong social and
moral vision have huge potential to assist policy making in health. The
challenge is to harness these possibilities of influence to address neglected
but serious threats to human—even planetary—survival. UCL is a university that
has combined a distinguished history of moral engagement with a more recent
revitalised global purpose, expressed through its strengthened commitment to
global health in teaching, research, and institution building. In preparing to
undertake its work for this first Lancet Commission, the UCL team, led by
Anthony Costello, reached out beyond health to engineers, political scientists,
lawyers, geographers, anthropologists, economists, philosophers, and students,
among others. They discovered new ways to review evidence and integrate ideas
collaboratively.
And through these efforts, they
identified five critical challenges that scientists, clinicians, and policy
makers will have to address if climate change is not to become the biggest
catastrophe threatening human survival. First, there is a massive gap in information, an
astonishing lack of knowledge about how we should respond to the negative
health effects of climate change. Second, since the effects of climate change will hit the poor
hardest, we have an immense task before us to address the inadequacies of
health systems to protect people in countries most at risk. Third, there is a
technology challenge. Technologies do have the potential to help us adapt to
changes in climate. But these technologies have to be developed out of greater
research investments into climate change science, better understanding about
how to deliver those technologies in the field, and a more complete
appreciation of the social and cultural dimensions into which those
technologies might be implanted. A fourth challenge is political: creating the conditions for
low-carbon living. And finally
there is the question of how we adapt our institutions to make climate change
the priority it needs to be. The Commission calls for a new public health
advocacy movement. This movement has to usher in an unprecedented era of
cooperation between widely divergent, but utterly connected, spheres—disease,
food, water and sanitation, shelter and settlements, extreme events, and
population and migration. Health professionals are critical to this movement.
Too many doctors have been silent for too long about the importance of climate
change to the future of health and health services. Fortunately, in the UK, the
Royal College of Physicians has given a uniquely strong professional lead. Its
commitment needs to be reflected in the work of other professional bodies and
associations worldwide. The Lancet is planning an extensive programme of work
to address other neglected areas in health that demand a complex
interdisciplinary analysis and response. We see universities as indispensable
partners in this effort to translate science into practice and policy. Our
commitment is long term. With UCL and other partners, we plan to convene an
international summit in two years’ time to review progress and priorities in
our collective responses to the urgent and alarming health effects of climate
change. ■ The Lancet
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