Catalyzed by an impassioned call to all scientists to speak out on resource crises exacerbated by climate change, this Editorial addresses the unique role that the science of medicine and health care providers in general can play in sounding a realistic and desperate warning on the health impacts, often ignored, of global warming. Health professionals have been silent on international treaty obligations to not postpone preventive measures when environmental threats occur.
In a recent “World View” article published in Nature, Jeremy Grantham, a well-known investment strategist and co-chair of the Grantham Foundation for the Protection of the Environment in Boston, Massachusetts (USA) wrote an impassioned plea to all readers. The title was eye-catching: “Be persuasive. Be brave. Be arrested (if necessary).”Reference Grantham1 As a respected financier, Grantham makes a strong case to the scientific readership that a resource crisis exacerbated by global warming is looming, and that more scientists and health care providers must speak out. He concludes that we must “take more career risks and sound a more realistic, more desperate, note on the global-warming problem.”Reference Grantham1 Why did this crisis happen and why are we being reminded of our failings by a business leader, rather than by a leader in science or medicine?
Nature and other journals have recently published a number of commentaries on how governments (eg, the US, UK, Italy and France) listen to economists, but not scientists, when making everyday critical environmental decisions that impact the future of our planet.Reference Macilwain2-Reference Cattaneo and Corbellini4 Today in the US, despite President Obama's views to the contrary, there is “no prospect of moving climate change legislation through Congress.”Reference Meyer3 As I write this Editorial, there is more bad news: a report from the World Meteorological Organization in its annual Greenhouse Gas Bulletin that atmospheric volumes of greenhouse gases blamed for climate change hit a new record in 2011.5 One Nature commentary suggested that, accepting that scientists do not know how to talk to legislators, the only way to get the message across would be to have scientists run for elective office.Reference Kassen6 Unfortunately, that process might take more time than the planet has to survive. Today in the US, there are more physicians in Congress than ever before, yet few have proven to be advocates for climate change legislation.
Health care professionals have a greater responsibility. It starts with the oaths we took for our professional degrees in medicine, nursing, and prehospital care. However, once you become a health professional, it is not long before you realize that the greatest challenges to our beneficiaries are not in clinical care alone, but rather in the social and physical environment in which they live. We, not the investment strategists and certainly not the decision makers in government, have been dealing for many decades with the symptoms of climate change, biodiversity crises, emergencies of scarcity in food, water, energy, and large-scale tragedies that have a strong cause and effect relationship with climate change (eg, the Fukushima Daiichi nuclear catastrophe). We regularly treat victims of rapid unsustainable urbanization, urban heat islands, air and water pollution, vector- and marine- borne diseases, severely threatened food supply, increasing weather-related disasters, rising sea levels, and cancers from ozone depletion.Reference Burkle7 Keribati, which straddles the equator, will be the first nation state to disappear below the sea. Once a paradise, its population of 100,000 is urbanized, without adequate water and sanitation, and suffers an infant mortality rate twice that of any Southeast Asian country. Adaptation strategies are no longer viable, leaving evacuation as the only option.8 International treaties, including the Declaration signed in 1992 at the Earth Summit in Rio de Janeiro, Brazil, contain language stating that “governments when it comes to serious threats to the environment must not wait until a population is about to disappear.”9 These are all symptoms of a process that should need no introduction to health care providers, yet, as a group, we have been silent participants in the controversies and debates surrounding climate change.
As health care providers and sometime advocates, we do what we do well. Yes, we conduct research and actively publish, and at times write exemplary diatribes about what the consequences of humanitarian crises are doing to mankind. We have made remarkable progress in the science and care of our victims. But these documents, for the most part, remain exclusively in the health literature, a reminder that we recognize that we do not have an effective bully pulpit beyond our professional boundaries. We trespass those professional boundaries with trepidation. We herald the few who do, but they are too few and far between, especially concerning the looming crises today. If we thought we were being effective, our governments have proven us wrong. I suspect that for the broad scientific audience that reads Nature, the status quo is a shared excuse. It took an investment strategist, not a health professional or other scientist I would normally turn to as an advocate, to shake up the science community. We must heed his call.
We know that global health issues will not be solved by the health profession alone. Solutions are necessarily multidisciplinary in nature, arising from a working relationship of disciplines such as the social sciences, political science, anthropology, civil engineering, the legal profession, and economics. And yes, even investment strategists, because they currently enjoy a bully pulpit with the legislative decision makers that we do not have. At the age of 73, I have been in too many meetings over the years where colleagues (me included) turned a deaf ear to the opportunity to speak out on what we all recognized at the time as a long-term threat to our survival.
We can no longer stay silent and pander to the ignorance of others. We must clearly define our collaborative and cooperative stance on climate change, along with our newly-found multidisciplinary partners and stakeholders. They will learn from what we tell them about how many have already suffered and died before their time. They will, of course, ask, “Why didn't you tell us this earlier?”
