Call for emergency action to limit global temperature increases, restore biodiversity, and protect health
Lukoye Atwoli, editor in chief, East African Medical Journal; Abdullah H. Baqui, editor in chief, Journal of Health, Population and Nutrition; Thomas Benfield, editor in chief, Danish Medical Journal; Raffaella Bosurgi, editor in chief, PLOS Medicine; Fiona Godlee, editor in chief, The BMJ; Stephen Hancocks, editor in chief, British Dental Journal; Richard Horton, editor in chief, The Lancet; Laurie Laybourn-Langton, senior adviser, UK Health Alliance on Climate Change; Carlos Augusto Monteiro, editor in chief, Revista de Saúde Pública; Ian Norman, editor in chief, International Journal of Nursing Studies; Kirsten Patrick, interim editor in chief, CMAJ; Nigel Praities, executive editor, Pharmaceutical Journal; Marcel GM Olde Rikkert, editor in chief, Dutch Journal of Medicine; Eric J. Rubin, editor in chief, NEJM; Peush Sahni, editor in chief, National Medical Journal of India; Richard Smith, chair, UK Health Alliance on Climate Change; Nick Talley, editor in chief, Medical Journal of Australia; Sue Turale, editor in chief, International Nursing Review; Damián Vázquez, editor in chief, Pan American Journal of Public Health.
Corresponding email: laurie.laybourn@ukhealthalliance.org
Wealthy nations must do much more, much faster
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.1 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.2 3 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 recognising 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.2 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%.4 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.5 6 Harms disproportionately affect the most vulnerable, including among children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.2 4
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.4 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.3 7 8
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.9 10
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 2030.11
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.12 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.13 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.14 15
This insufficient action means that temperature increases are likely to be well in excess of 2°C,16 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.17 This is an overall environmental crisis.18
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.19 1
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 proposed20 21 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 organised 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 realise health benefits that easily offset the global costs of emissions reductions.22
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.23 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 $100bn 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, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42bn of assets from fossil fuels; others should join them.4
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 FG serves on the executive committee for the UK Health Alliance on Climate Change and is a Trustee of the Eden Project. RS 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.
This editorial is being published simultaneously in many international journals. Please see the full list here: https://www.bmj.com/content/full-list-authors-and-signatories-climate-emergency-editorial-september-2021
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
1 In support of a health recovery. https://healthyrecovery.net
2 Intergovernmental Panel on Climate Change. Summary for policymakers. In: Global warming of 1.5°C. An IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018. https://www.ipcc.ch/sr15/
3 Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Summary for policymakers: the global assessment report on biodiversity and ecosystem services. 2019. https://ipbes.net/sites/default/files/2020-02/ipbes_global_assessment_report_summary_for_policymakers_en.pdf
4 Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021;397:129-70. PubMed PubMed
5 Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of climate change: an overview of systematic reviews. BMJ Open 2021;11:e046333. PubMeddoi:10.1136/bmjopen-2020-046333 PubMed
6 Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med 2019;380:263-73. PubMed
7 United Nations Environment Programme and International Livestock Research Institute. Preventing the next pandemic: zoonotic diseases and how to break the chain of transmission. 2020.https://72d37324-5089-459c-8f70-271d19427cf2.filesusr.com/ugd/056cf4_b5b2fc067f094dd3b2250cda15c47acd.pdf
8 IPCC. 2019: Summary for policymakers. In: Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. Forthcoming.
9 Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points—too risky to bet against. Nature 2019;575:592-5. PubMed
10 Wunderling N, Donges JF, Kurths J, Winkelmann R. Interacting tipping elements increase risk of climate domino effects under global warming. Earth System Dynamics Discussions, 2020: 1-21.
11 High Ambition Coalition. https://www.hacfornatureandpeople.org
12 Global Climate and Health Alliance. Are national climate commitments enough to protect our health? https://climateandhealthalliance.org/initiatives/healthy-ndcs/ndc-scorecards/
13 Climate strikers: Open letter to EU leaders on why their new climate law is ‘surrender.’ Carbon Brief 2020. https://www.carbonbrief.org/climate-strikers-open-letter-to-eu-leaders-on-why-their-new-climate-law-is-surrender
14 Fajardy M, Köberle A, MacDowell N, Fantuzzi A. “BECCS deployment: a reality check.” Grantham Institute briefing paper 28, 2019. https://www.imperial.ac.uk/media/imperial-college/grantham-institute/public/publications/briefing-papers/BECCS-deployment—a-reality-check.pdf
15 Anderson K, Peters G. The trouble with negative emissions. Science 2016;354:182-3. PubMed
16 Climate action tracker. https://climateactiontracker.org
17 Secretariat of the Convention on Biological Diversity. Global biodiversity outlook 5. 2020. https://www.cbd.int/gbo5
18 Steffen W, Richardson K, Rockström J, et al. Sustainability. Planetary boundaries: guiding human development on a changing planet. Science 2015;347:1259855. doi:10.1126/science.1259855 PubMed
19 UK Health Alliance. Our calls for action. http://www.ukhealthalliance.org/cop26/
20 Climate Action Tracker. Warming projections global update: May 2021. https://climateactiontracker.org/documents/853/CAT_2021-05-04_Briefing_Global-Update_Climate-Summit-Momentum.pdf
21 United Nations Environment Programme. Emissions gap report 2020. UNEP, 2020.
22 Markandya A, Sampedro J, Smith SJ, et al. Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study. Lancet Planet Health 2018;2:e126-33. doi:10.1016/S2542-5196(18)30029-9 PubMed
23 Paremoer L, Nandi S, Serag H, Baum F. Covid-19 pandemic and the social determinants of health. BMJ 2021;372:n129. PubMed
ANS: Advances in Nursing Science Blog 
Nov 1
Time to treat the climate and nature crisis as one indivisible global health emergency
The following editorial is apearing in more than 200 medical journals worldwide between October 25th, and the end of 2023. We are joining this international action to draw attention to the climate and nature crisis.
Over 200 health journals call on the United Nations, political leaders, and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.
The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. The research communities that provide the evidence for the two COPs are unfortunately largely separate, but they were brought together for a workshop in 2020 when they concluded that: “Only by considering climate and biodiversity as parts of the same complex problem…can solutions be developed that avoid maladaptation and maximize the beneficial outcomes.”[1]
As the health world has recognised with the development of the concept of planetary health, the natural world is made up of one overall interdependent system. Damage to one subsystem can create feedback that damages another—for example, drought, wildfires, floods and the other effects of rising global temperatures destroy plant life, and lead to soil erosion and so inhibit carbon storage, which means more global warming. [2] Climate change is set to overtake deforestation and other land-use change as the primary driver of nature loss. [3]
Nature has a remarkable power to restore. For example, deforested land can revert to forest through natural regeneration, and marine phytoplankton, which act as natural carbon stores, turn over one billion tonnes of photosynthesising biomass every eight days. [4] Indigenous land and sea management has a particularly important role to play in regeneration and continuing care. [5]
Restoring one subsystem can help another—for example, replenishing soil could help remove greenhouse gases from the atmosphere on a vast scale. [6] But actions that may benefit one subsystem can harm another—for example, planting forests with one type of tree can remove carbon dioxide from the air but can damage the biodiversity that is fundamental to healthy ecosystems. [7]
The impacts on health
Human health is damaged directly by both the climate crisis, as the journals have described in previous editorials, [8,9] and by the nature crisis. [10] This indivisible planetary crisis will have major effects on health as a result of the disruption of social and economic systems—shortages of land, shelter, food, and water, exacerbating poverty, which in turn will lead to mass migration and conflict. Rising temperatures, extreme weather events, air pollution, and the spread of infectious diseases are some of the major health threats exacerbated by climate change. [11] “Without nature, we have nothing,” was UN Secretary-General António Guterres’s blunt summary at the biodiversity COP in Montreal last year. [12] Even if we could keep global warming below an increase of 1.5◦C over pre-industrial levels, we could still cause catastrophic harm to health by destroying nature.
Access to clean water is fundamental to human health, and yet pollution has damaged water quality, causing a rise in water-borne diseases. [13] Contamination of water on land can also have far-reaching effects on distant ecosystems when that water runs off into the ocean. [14] Good nutrition is underpinned by diversity in the variety of foods, but there has been a striking loss of genetic diversity in the food system. Globally, about a fifth of people rely on wild species for food and their livelihoods. [15] Declines in wildlife are a major challenge for these populations, particularly in low- and middle-income countries. Fish provide more than half of dietary protein in many African, South Asian and small island nations, but ocean acidification has reduced the quality and quantity of seafood.[16]
Changes in land use have forced tens of thousands of species into closer contact, increasing the exchange of pathogens and the emergence of new diseases and pandemics. [17] People losing contact with the natural environment and the declining loss in biodiversity have both been linked to increases in noncommunicable, autoimmune, and inflammatory diseases and metabolic, allergic and neuropsychiatric disorders. [10,18] For Indigenous people, caring for and connecting with nature is especially important for their health. [19] Nature has also been an important source of medicines, and thus reduced diversity also constrains the discovery of new medicines.
Communities are healthier if they have access to high-quality green spaces that help filter air pollution, reduce air and ground temperatures, and provide opportunities for physical activity. [20] Connection with nature reduces stress, loneliness and depression while promoting social interaction. [21] These benefits are threatened by the continuing rise in urbanisation. [22]
Finally, the health impacts of climate change and biodiversity loss will be experienced unequally between and within countries, with the most vulnerable communities often bearing the highest burden. [10] Linked to this, inequality is also arguably fuelling these environmental crises. Environmental challenges and social/health inequities are challenges that share drivers and there are potential co-benefits of addressing them. [10]
A global health emergency
In December 2022 the biodiversity COP agreed on the effective conservation and management of at least 30% percent of the world’s land, coastal areas, and oceans by 2030.[23] Industrialised countries agreed to mobilise $30 billion per year to support developing nations to do so.[23] These agreements echo promises made at climate COPs.
Yet many commitments made at COPs have not been met. This has allowed ecosystems to be pushed further to the brink, greatly increasing the risk of arriving at ‘tipping points’, abrupt breakdowns in the functioning of nature.[2,24] If these events were to occur, the impacts on health would be globally catastrophic.
This risk, combined with the severe impacts on health already occurring, means that the World Health Organization should declare the indivisible climate and nature crisis as a global health emergency. The three pre-conditions for WHO to declare a situation to be a Public Health Emergency of International Concern [25] are that it: 1) is serious, sudden, unusual or unexpected; 2) carries implications for public health beyond the affected State’s national border; and 3) may require immediate international action. Climate change would appear to fulfil all of those conditions. While the accelerating climate change and loss of biodiversity are not sudden or unexpected, they are certainly serious and unusual. Hence we call for WHO to make this declaration before or at the Seventy-seventh World Health Assembly in May 2024.
Tackling this emergency requires the COP processes to be harmonised. As a first step, the respective conventions must push for better integration of national climate plans with biodiversity equivalents. [3] As the 2020 workshop that brought climate and nature scientists together concluded, “Critical leverage points include exploring alternative visions of good quality of life, rethinking consumption and waste, shifting values related to the human-nature relationship, reducing inequalities, and promoting education and learning.” [1] All of these would benefit health.
Health professionals must be powerful advocates for both restoring biodiversity and tackling climate change for the good of health. Political leaders must recognise both the severe threats to health from the planetary crisis as well as the benefits that can flow to health from tackling the crisis. [26] But first, we must recognise this crisis for what it is: a global health emergency.
Kamran Abbasi, Editor-in-Chief, BMJ; Parveen Ali, Editor-in-Chief, International Nursing Review; Virginia Barbour, Editor-in-Chief, Medical Journal of Australia; Thomas Benfield, Editor-in-Chief, Danish Medical Journal; Kirsten Bibbins-Domingo, Editor-in-Chief, JAMA; Stephen Hancocks, Editor-in-Chief, British Dental Journal; Richard Horton, Editor-in-Chief, The Lancet; Laurie Laybourn-Langton, University of Exeter; Robert Mash, Editor-in-Chief, African Journal of Primary Health Care & Family Medicine; Peush Sahni, Editor-in-Chief, National Medical Journal of India; Wadeia Mohammad Sharief, Editor-in-Chief, Dubai Medical Journal; Paul Yonga, Editor-in-Chief, East African Medical Journal; Chris Zielinski, University of Winchester.
Correspondence: chris.zielinski@ukhealthalliance.org
This Comment is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full-list-authors-and-signatories-climate-nature-emergency-editorial-october-2023
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