Archive for Environment and Health

Proud to be a dangerous woman – Prof Judith Mackay

Professor Judith Mackay is a member of the GHA and is a Hong-Kong based tobacco control researcher and activist.

She is Senior Advisor, Vital Strategies/Bloomberg Initiative to Reduce Tobacco Use; Director of the Asian Consultancy on Tobacco Control; and Senior Policy Advisor to World Health Organisation.

She has authored 12 atlases on health topics. In addition to many international awards, ranging from the WHO Commemorative Medal and the TIME 100 award to the first BMJ Group Lifetime Achievement Award, she has been identified by the tobacco industry as one of the three most dangerous people in the world.

She recently contributed to the Dangerous Women project, an initiative of the Institute for Advanced Studies in the Humanities at the University, which analyses the dynamics, conflicts, identities and power relations with which women live today.

Read Judith’s contribution here …

“It wasn’t my intention to be a dangerous woman or to find myself in danger, simply by being committed to gender equality and better health.

There was nothing in my medical degree course at the University of Edinburgh in the 1960s to predict that I would be labelled by the tobacco industry as one of the three most dangerous people in the world, or that I would need to be offered 24-hour police protection by the Hong Kong government.

Perhaps the first hint of danger in my life was when I arrived in Hong Kong in 1967 at the peak of the Chinese Cultural Revolution – which spilled over into Hong Kong – with Communist schools and banks barricaded and manufacturing bombs, and big character posters saying ‘Down with imperialists’ and ‘British go home.’ Street riots rocked the colony, bringing with them waves of bombings, looting and arson attacks. British rule became precarious, but held – only just – when Chinese Premier Chou Enlai reined in the HK Red Guards.

A Dangerous Feminist

I became a committed feminist at about the same time (and still am today, 50 years on), and this did not lie easily in colonial Hong Kong, where even senior government figures and judges would joke about rape. People viewed me as dangerous and subversive (and wrote many letters to the press saying just that). This could spill into physical abuse, such as when a friend’s husband twisted a necklace (engraved with the sign for women) round my neck, lifted me off the floor and snarled that “Women will never be the equal of men as they are not as strong,” while I dangled helplessly in the air, powerless. I determined never to let that happen to me again. Even more bizarrely, another woman friend only recently told me that the husband of a mutual friend had tried to rape her, saying ‘This is for Judith Mackay,’ as he perceived his wife was coming under my feminist influence.

A Dangerous Subversive in The Medical Profession

In the 1980’s, I earned the fury of my own medical profession by writing a health series in the South China Morning Post, Hong Kong’s leading English language newspaper. The article broke the then-traditional power mode of doctor-patient relationships by encouraging women, in particular, to keep their own personal health record, and participate in their own health care decisions. ‘When your doctor tells you…’ became ‘When you and your doctor decide…’ A senior gynaecologist stormed up to the hospital where I worked, found me in Medical Outpatients, pinned me against a wall, and said ‘This newspaper series has to stop or you will be in trouble.’ I said that this sounded like a threat, and he said ‘You have powerful enemies in the medical profession, and had better watch out.’ He went on to say that only that morning he was inserting a copper intra-uterine device in a patient, who had meekly asked ‘Is this a copper coil?’ and he was furious – asking her ‘Have you been reading Dr. Mackay’s column in the SCMP?’ – the trigger to his visit.

A Danger to Big Tobacco

I’ve faced the greatest danger since moving from clinical to preventive medicine. There were three main reasons for making the shift from hospital medicine to public health. First, during my work as a physician in the 1970s and 1980s, I came increasingly to feel that clinical work was like ‘a band-aid.’ In fact, we had a maxim on our male medical ward that we never admitted a non-smoker, our wards being full of people with end-stage tobacco illnesses, often too late to prevent morbidity and mortality.

Second was the realisation that although women’s health in those days was defined as reproductive health, tobacco was killing far more women than were dying from birth control – and the tobacco industry was actively recruiting women with promises of beauty, slimness, popularity and emancipation.

What finally galvanised my determination to combat tobacco use was the response to a piece I wrote on tobacco as part of my series on women’s health in the South China Morning Post. One of the British transnational cigarette companies published a booklet labelling me as ‘entirely unrepresentative and unaccountable.’ In contrast, the self-promotional booklet claimed ‘the tobacco industry comprises identifiable, legal, accountable, commercial organizations.’ This booklet, denying the health evidence (‘it has not been proven that these illnesses are actually caused by smoking’) and claiming to be an ‘important source of reliable information’ on smoking, so enraged me that from that moment on I worked on tobacco control, abandoning curative hospital medicine in 1984.

Why was my job so dangerous? It was partly location. The tobacco industry thought they could gallop their Marlboro cowboy into Asia, and it was theirs for the taking. They even said ‘What do we want? We want Asia,’ with the dream of converting the 60% of men who smoked local cigarettes to switch to international brands, and the second dream of persuading Asian women to start smoking. Given the numbers concerned, it would not have mattered if every smoker in the UK had stopped smoking the next day, if they could have captured the massive Asian markets.

There was no career structure and no pay, but I set about thwarting their goals. I was in touch with colleagues in the UK and elsewhere who were unstinting in their assistance, but it was a lonely job in Asia in the 1980s.

This brought me into conflict with one of the world’s most wealthy and powerful industries – and its supporters. I’m frequently subjected to verbal abuse and have been described over the years as sanctimonious, dogmatic, pontificating, meddlesome, heretic, puritanical, hysterical, prejudiced, a ‘Nanny,’ and more recently a ‘jihadist’.

In 1993, a smokers’ rights group in the USA described me as ‘psychotic human garbage, a gibbering Satan, an insane psychotic just like Hitler, using fatuous, smarmy drivel and distortions, and diatribes full of putrid corruption, lies, conspiracy, and total censorship.’ They concluded by stating that I was ‘devoid of any sanity, any morality, or any human-being-ness of any kind’, was ‘nothing more than an evil-possessed, power-lusting piece of meat’ and they threatened to ‘utterly destroy’ me!

The group had made similar threats to a US government health official, so the last sentence – perceived by the FBI as a death threat – had to be investigated by the agency, and I was added-on to that investigation. At this point, I was offered 24-hour police protection by the Hong Kong government.

The industry twice threatened, very publicly, to take me to court. Nothing came of it, of course – I was on rock-solid ground on the facts – but such tactics were attempts to intimidate me, and a ploy to cast doubt on my credibility in the minds of the public.

Such offensive words, the death threat, and the menace of litigation, completely failed to divert me. I said, robustly and publicly, that I was absolutely not a suicidal type, and that if I were to be found ‘knocked down by a bus,’ the tobacco industry was guilty until proven innocent!

That is not hyperbole. I had to give evidence as an expert witness in a major tobacco smuggling trial, involving British American Tobacco cigarettes being smuggled into China. The chief witness was murdered, and eleven others disappeared. Another witness jumped out of a window – on the 22nd floor. I had to report to the Independent Commission Against Corruption that I was being followed. They put a stop to it, but it was an eerie experience, as was being cross-examined by a tobacco industry lawyer.

There have also been clandestine aspects to my work. In 1986, a go between phoned to tell me that a ‘Deep Throat’ associated with US Tobacco had informed him of a plan to imminently launch smokeless tobacco (sucking, chewing tobacco and snuff) in Hong Kong. To this day, I do not know the identity of ‘Deep Throat,’ not even whether it is a ‘she’ or a ‘he.’ Immediately, I contacted the Hong Kong government and helped to plan a ‘pre-emptive strike’ – a ban on the importation, manufacture and sale of smokeless tobacco products. Other whistle-blowers have contacted me from within the tobacco industry, always a sensitive and potentially explosive situation. For their safety, I will say no more.

Working In Dangerous Places

I have also worked in some very dangerous areas in Asian countries, some under martial law, some at war, some under attack by rebels in their own countries. I was in Cambodia giving a slide presentation when there was an almighty explosion and the ceiling started falling down. Everyone else dived under the tables. Perhaps my finest hour as a Brit: I simply said, ‘Next slide please.’ It turned out to be a captured ammunition cache that had been placed in the central square and blown up by the government, but with no notice to anyone.

In 1990, I was held at gunpoint by armed Mongolian palace guards who, seeing me appearing out of the dark at the Government guest house after an evening walk, had no idea who I was or what to do. I had to gently talk them down, in a language they did not understand. Incidentally, the Minister of Health in Mongolia told me that during that first visit, they held a cabinet meeting as they thought I might be a spy sent from the west. They had prepared a school project to present to me, but I was much more interested in the tax, economic and political issues regarding tobacco, even their border security in preventing smuggling. He said the cabinet had concluded I was not a spy, and instead I had highlighted the breadth of issues involved in tobacco control.

More recently, I have worked with the North Korean (DPRK) government on tobacco control on three occasions, but am probably safer there than in London.

Promoting Gender Equality

Less dangerously, I have been able to push for equal gender representation in public health policy-making, including data collection and in the wording and clauses of the WHO Framework Convention on Tobacco Control. I have been able to promote women for various international awards, to serve on international committees and to be invited to speak at major conferences. For example, when invited to assist the 10th World Conference on Tobacco or Health held in Beijing in 1997, I stipulated that I would work pro bono as long as at least half of the keynote plenary speakers, chairmen, and committee were female. Despite initial uncertainty from the organisers, the event turned out to be the “best conference ever” and set the standard for subsequent conferences.

I promote women because if women are not in those positions, then the issue of women and tobacco gets ignored. This resulted in some resentment from male (never female) colleagues in the early days, some of which I found very hurtful. Ultimately, though, I have found it useful being female. Some countries embarking on tobacco control found it less threatening to invite me to be an Advisor – and it’s my knowledge, experience and expertise, valued in Asia in both sexes, that gets results. In addition, being based in Asia and knowing Asia, but being British rather than Asian, helped me to be seen as politically neutral.

I have wondered if working in tobacco control today is as dangerous as it was. I think not. It does require a certain type of interested and involved person to go into the field, but public health has now moved to the mainstream of health sciences. There are also many more people working in the field – it is not as isolated as it was 40 years ago. Personally, I intend to work until I am 100 – I practice Tai Chi (taiji) and reserve my two sword programmes’ cut and thrust for continuing to fight the tobacco industry.

I have worn the ‘dangerous’ label as a badge of honour, but hope the day is near when women aren’t labelled “dangerous” simply for standing up to advocate for issues like health or gender equality. We wait.”

Read Judith’s original blog here: http://dangerouswomenproject.org/2016/08/11/judith-mackay/

Proud to be a dangerous woman – Dangerous Women Project
dangerouswomenproject.org

Today we hear from Dr Judith Mackay, identified by the tobacco industry as one of the three most dangerous people in the world.
Prof Judith Mackay’s GHA profile:

http://www.ed.ac.uk/global-health/communities-practice/members/global-members/professor-judith-mackay

My Ugandan Global Health Academy, Summer School Experience!

When I received the invitation for the Global Health Academy summer school in Uganda, I have to admit I was hesitant.

After just finishing my first year on the MPH course, I wondered if I could muster the motivation to do one more minute of work until the next term. However, after re-reading the course itinerary numerous times, I finally persuaded myself it was the right decision to go.  The itinerary was just too tempting; 4 days of summer school and 2 bonus days of chimp tracking in the forests of Budongo?

With flights booked, I ran over the checklist for Kampala and Budongo again and packed my things. Budongo was going to be quite different from Kampala and we needed to be prepared for that environment. We were given the link to the Budongo Wildlife website beforehand which gave full information on where we would be staying and everything we needed, including how to behave whilst visiting the forest.

The university discussion page went over accommodation and transport in both Kampala and Budongo and all my questions were answered quickly and informatively.

To be honest, I didn’t know what to expect from the school. I felt quite out of my depth at first, with my limited global health experience, and having only just completed my first year? However, my fears were soon put to rest as this scary bunch actually turned out to be some of the friendliest and motivational, individuals I have had the pleasure to share a room with, staff and lecturers included.

Makerere University pic 1 Makerere University pic 2

 

 

 

 

 

 

 

 

My co-students were a group of professionals, from all over the world, studying a number of different disciplines at various stages in their studies, however, it soon became evident that no matter what background we came from, we all shared a passion for making the world a better place.   I felt immediately at ease.

Dr Ricky Okwir, University of Edinburgh Alumni

Dr Ricky Okwir, University of Edinburgh Alumni

 

 

 

 

 

 

 

 

To briefly summarize: The lectures were inspiring; the activities were thought provoking and the teamwork brilliant! Everyone got stuck in and shared all they had to share.  There were many brave people who stood up to give presentations on their topics, (myself not included, but I will certainly be on the list for next year) and we received lectures from faculty ranging from epidemiology to simply how to reference properly.  There were many questions and many discussions, but we always had time for a laugh, cup of tea and deep fried cup cake!!

The summer school not only taught me a great deal academically, but also gave me the opportunity to learn from other cultures and nationalities, the value they put on their environments, from a social, medical and environmental perspective. There were so many ideas and all added something to the wealth of knowledge the summer school brought about.

Of course, our experience in the Makerere University was just the start of our adventures. We still had the trip to Budongo to look forward to.

Accommodation at Nyabyeya Forestry College

Accommodation at Nyabyeya Forestry College

Accomm Budongo 2

After a few hours bus trip (stopping off to investigate the local culture on the way) we arrived at what I would describe as a little haven, right out of a holiday magazine. Our very basic but comfortable accommodation set amidst the luscious forest at the Nyabyeya Forestry College. It was certainly a sharp contrast to the hustle and bustle of Kampala.

We travelled a little way to the Budongo Wildlife Reserve after settling in, where we were welcomed with dinner, tea and coffee, a very informative introduction to the reserve and a briefing on what we could expect from the next couple of days.

What a couple of days we had! We participated in monkey and chimp tracking with highly skilled staff who also gave us an introduction to the whole ecosystem of the forest.  We met other visiting teams who were studying the forest and the surrounding areas and enjoyed discussing their experiences, having been based there for the last 4 weeks.

We were not just treated as passive visitors, but expected to report back on the day’s findings. Our feedback was very much valued and gave us a chance to really get thinking in groups, about things that would contribute to the continued success of the research centre and surrounding areas.  We discussed improving awareness and promotion of the project, and ways that would promote the engagement of the community.  I suddenly found myself utilizing a number of concepts we had learnt throughout the MPH course and the lectures we had received earlier in the week.
Budongo 1Budongo 2

 

 

 


 

 

 

Following this we followed our guides into the forest for a spot of snare patrol, where we were taught how to find and identify snares often set by hunters. These ranged from small wires to huge mantraps, all an extreme hazard to creatures living in the forest, and also forest rangers.

Budongo 5

 

We later visited local villages where we were given a talk about the on-going battle bco-existence of humans and wildlife. We learnt about sustainable crop development and the setting of buffer zones in order to control the disruption of local communities by the chimpanzees and other animals living in the forest, which frequently visit to crop raid when food levels are low in the forest.

Only too soon, it was time to return to Kampala and make our way home to our respective countries, to take back all that we had learned and apply it not only to our studies but to our everyday lives and those around us.   I couldn’t wait to get started!

To say I have learned a great deal would be an understatement and it is with great pleasure that I write to inspire others to join in the next one.


 

Seonaid Biagioni, Masters of Public Health, University of Edinburgh

Calling for a stronger climate and health nexus within the UNFCCC

From 1-11th June I was part of the International Federation of Medical Students Association’s (IFMSA) delegation at the UNFCCC intersessional’s in Bonn. The IFMSA has been engaging diligently in the UNFCCC process for over 5 years working to reinforce the climate and health nexus within the negotiating text. Our efforts have been greatly appreciated by delegates and the global climate policy community, as there is a relatively small health community engaging with the UNFCCC, despite the recognition that climate change is the “greatest threat to global health of the 21st century” (1). Last December, our work was rewarded in the Lima Call for Action where health was placed firmly in the preamble of the text (2). We entered these intersessionals with positive spirits, due to recent successes of the World Health Assembly, which took place in Geneva the previous week. This resulted in a resolution on the public health dangers of air pollution and the need to phase out fossil fuels in order to both tackle ill-health from pollution and reap co-health benefits of climate change mitigation (3). However, as we head towards COP21 in Paris, which aims to produce a legally binding global agreement, there is concern that the need to dramatically shorten the text will force certain issues into the side-lines. Our aim from now until Paris is to use the contacts we have made at these intersessionals and previous COPs to coordinate a larger coalition of countries that will provide a strong position on health in the new global agreement.

This was my first experience as a delegate at the UNFCCC, and despite not having particularly high expectations, I must admit that the pace of the talks was even slower than I had expected. Negotiations hardly got further than discussing commas and brackets and how these could be used to shorten the text from its former 96 pages to something more manageable. However, after day 6 they had only managed to cut this down to 86 pages, and nothing of the substance of the text had even begun to be discussed. This was frustrating for many of the organisations who had come to lobby delegates on a breadth of issues which need to be included within the text such as human rights, intergenerational equity, gender and health. Being part of the youth constituency, I found there were many barriers to prevent our voices being fully considered. From informing us of interventions less than hour before, not providing adequate translation services, giving us interventions only at the end of sessions and forcing our creative actions to be within strict rules and regulations; our opportunity to represent young people, who are going to be most impacted by the decisions, was severely restricted. The lack of representation of the Global South also made me question the legitimacy of the process. How are we supposed to go about constructing effective policy solutions when those suffering the most from climate change are not represented? Of course, this is not an issue unique to climate change policy, but to witness this stark injustice in reality was a powerful reminder of the need for change.

After spending the past year being involved with local and national action on climate change and health, the pace and level of engagement at these high level negotiations was at best disheartening. It is clear we cannot wait upon the UN to ensure effective solutions to the impending and already tangible impacts of climate change. Whilst the IFMSA and others will continue to be at the forefront of ensuring a legally binding and successful agreement that will protect and promote global health, we rely upon a forward thinking global health community to implement solutions in their own communities. This needs to go beyond acknowledging the intersections between ecology and health towards being part of the structural change needed to ensure a sustainable and healthy future.

This is a critical year for climate action and the implications of inaction on our health and our future is unprecedented. I hope to continue to work within the UNFCCC, but also to bridge the gap between this process and community action which is a key part to building climate resilience. Through attending several side events during the conference I also found that public health provided an important and coherent narrative in which to address a wide range of climate change issues from food and water scarcity, air pollution, occupational and community health surround fossil fuel extraction, transitions towards sustainable active transport and rising infectious diseases in crops, livestock and people. It was clear that health is a powerful tool to provide an anchor of agreement in the UNFCCC, as well as provide a lens to engage a breadth of people with climate change. I look forward to tracking the progress of the UNFCCC and hope that an agreement in Paris will be reached that will mobilise the diverse and collaborative movement needed to save human and ecological life on this planet.


References

Costello (2009) Managing the health effects of climate change. The Lancet [pdf] https://www.ucl.ac.uk/global-health/project-pages/lancet1/ucl-lancet-climate-change.pdf

Lima Call for Action: http://unfccc.int/files/meetings/lima_dec_2014/application/pdf/auv_cop20_lima_call_for_climate_action.pdf

World Health Organisation (2015) World Health Assembly closes, passing resolutions on air pollution and epilepsy [online] Available at: http://www.who.int/mediacentre/news/releases/2015/wha-26-may-2015/en/


ADP2.9: Last Updates from the IFMSA Delegation

ADP2.9: Updates from the ADP 2.9 United Nations Climate Change Conference

ADP2.9 – Meet the IFMSA Delegation!


 

Eleanor Dow – Medical student at the University of Edinburgh and coordinator of Healthy Planet UK, a network of students raising awareness of the links between climate change and health.

http://www.healthyplanetuk.org/

 

Unhealthy investments

I have been involved with the fossil fuel divestment movement over the past year, both with the University and through Healthy Planet UK, after coming to terms with the enormity of climate change and the need for urgent action. As a medical student I am compelled by a similar duty of care towards our ecosystem, on which our health depends, and am called to respond to its current symptoms of distress. Divestment offers a way to treat one of the root causes of these symptoms – the continued burning of fossil fuels – through moving investments away from the fossil fuel industry whose business model relies upon burning reserves which currently hold over five times that which is safe to burn if we are to stay below the 2 degrees celsius limit of global warming[1] Akin to the health sector leading divestment from the tobacco industry, there is a similar narrative in the response to the health threat of climate change further weighted by tactics utilised by the fossil fuel industry to thwart climate mitigation policy and mar public perception of the reality of climate science[2]. UK universities hold around £5.2 billion worth of investments through their endowment funds in the fossil fuel industry[3]. However, divestment is not simply a matter of money, most divestment decisions have been driven by a moral case. It rests on a simple principle -if it is wrong to wreck the planet, then it is wrong to profit from that wreckage. For the medical tradition investing in fossil fuels can be seen to contradict the fundamental principle to “first do no harm”. So far 21 universities, 35 cities, 65 religious organisations and numerous other organisations from around the world including the British Medical Association have committed to divesting from fossil fuels[4].

 

Medical institutions and the health community have a unique awareness of climate change through its current and future impacts on human health, but also through the potential immense health co-benefits of tackling climate change such as reducing the disease burden of air pollution, which has been attributed to 2000 premature deaths annually in Scotland[5], and encouraging active travel through reducing our reliance on fossil fuel guzzling cars. This gives an important dimension to the divestment dialogue and the engagement of medical schools and health organisations is sure to be very valuable. On the 3rd February, Healthy Planet are publishing their report “Unhealthy Investments”, co-authored with MedAct, The Climate and Health Council, Medsin and the Centre for Sustainable Healthcare. This will be a crucial step towards further engagement on fossil fuel divestment from the health sector. It will involve a panel of expert speakers to discuss the question of whether organisations which work to improve health should continue to invest in fossil fuel extraction and production companies. Should the health sector be taking more of a lead in this issue? There is certainly great potential in engaging with the process and evaluating how best our pension and endowment funds can be invested towards a healthier and more sustainable future.

 

More information on the report launch can be found here: http://www.eventbrite.co.uk/e/unhealthy-investmentsshould-health-organisations-divest-from-fossil-fuels-tickets-15237083527


 

References

[1] http://www.carbontracker.org/

[2] http://www.greenpeace.org/usa/en/campaigns/global-warming-and-energy/polluterwatch/Dealing-in-Doubt—the-Climate-Denial-Machine-vs-Climate-Science/

[3] http://peopleandplanet.org/fossil-free

[4] http://gofossilfree.org/commitments/

[5] http://www.foe-scotland.org.uk/air-pollution


 

 

Eleanor Dow – Medical student at the University of Edinburgh and coordinator of Healthy Planet UK, a network of students raising awareness of the links between climate change and health.

http://www.healthyplanetuk.org/

 

The health & environmental impact of global health research

“How does one cross the Atlantic in an environmentally-friendly way?” I asked myself.* A few weeks earlier I had been challenged by a fellow student who had attended a university-run course “Carbon Conversations”. I then began to reflect on the health and environmental impact of my global health research and to consider ways in which I might reduce my climate change burden. Struggling to find a satisfactory answer to my question, I approached a local sustainability advisor who explained that the alternatives to “door-to-door” air travel were likely to involve significant time costs and/or financial costs. No feasible alternatives. It was a disappointing response, especially after reflecting on the potential global health cost of spending over 20 hours on aeroplanes for my research. Could a solution be found to minimise the global health impact of overseas travel which remains essential for many studying and working in global health with limited time and restricted budgets?

It is widely accepted that high carbon usage and emission contributes to global climate change. Studies have reported that the likely direct health impacts of global climate change include those associated with an increase in heatwaves and a rise in vector-borne diseases such as malaria. Indirect health impacts may include sanitation problems secondary water shortages and malnutrition due to a rise in food costs as a result of reduced food production. People living in less developed regions are predicted to experience the greatest direct and indirect health impacts of climate change.

Hard policies are already being implemented by national and global bodies to reduce carbon emissions through initiatives such as improving rail networks and increasing taxes on fuel and high-emission vehicles. Could “softer” approaches at a local level be effectively employed by individual members of the working and studying global health community in order to tackle the problem of climate change which threatens to have a negative health impact on many populations? It is certainly never too late to consider this suggestion. It was only in 2013 that the UN Development Programme for Europe and Asia for the first time assessed the carbon footprint of one of its global health projects. We know that travel and transportation are important contributors to the climate change problem, and that many staff and students in global health are likely to travel for work purposes. Perhaps responsible travel is an approach and practice that could be promoted more widely and emphasised more strongly within the global health community.

Practically speaking, adopting this approach might mean that within academic departments of global health, individuals who plan to travel would be encouraged to consider and attempt to address the issue of climate change when writing project proposals, funding applications, dissertations, and theses. For example, a postdoctoral researcher applying for funding to attend a global health conference in Brussels might choose to budget for the additional time and financial cost of travelling to Paris by ferry and train. At the same time she could be offset these extra costs against savings made by booking more modest accommodation. Similarly, a PhD student involved in global health data collection in Asia might include a reflective paragraph in his thesis acknowledging the health impact of climate change due to travel. He could also describe the challenges encountered and steps taken to reducing the travel-related carbon emissions associated with his research.

Finally, we need to consider not only the immediate costs of changing our travel habits, but also the longer-term global health costs of not taking action to promote a low carbon future worldwide. Time and money are important and even when both are limited, global health workers and students can still explore and consider more responsible ways of travelling. If we choose to spend years studying and working to improve global health today, let us also choose to leave a shrinking carbon footprint that will have not have a significant negative impact on global health tomorrow .

 


 

Dr Anne Aboaja

Dr Anne Aboaja, is a Global Health PhD Researcher, Psychiatrist and Member of the Global Health PhD Network at the University of Edinburgh


 

Foot note

*When I asked this question, I did not have in mind ticking a box during an online airline booking in order to offset my carbon emissions. Instead I entertained the idea of spending a couple of weeks on a low-cost transatlantic crossing followed by a scenic, and possibly bumpy, road trip on public transport to my destination, sensibly using the time to read and critically review journal articles, write papers for publication, practise language skills, and creatively think through research problems encountered. Unrealistic? Maybe. Maybe not. In the spirit of sustainable global health? Definitely.

 

 

The Year of Environment and Health

“A point has been reached in history when we must shape our actions throughout the world with a more prudent care for their environmental consequences. Through ignorance or indifference we can do massive and irreversible harm to the earthly environment on which our life and well being depend. Conversely, through fuller knowledge and wiser action, we can achieve for ourselves and our posterity a better life in an environment more in keeping with human needs and hopes …” Stockholm, 1972

All living things depend on their environment for energy and for the basic requirements that sustain life – air, water, food and habitat. This simple dynamic is not in dispute. However there is a growing body of evidence that suggests the relationship between environment and human health is in fact a reciprocal one, each having complex effects on the other. According to the UN Environment Programme, every human being has the right to a safe, healthy and ecologically-balanced environment…….but what exactly are these complex relationships, and how can we ensure that human rights to a safe and healthy environment are delivered, even under conditions of rapid global environmental change?

Much of our society’s development has depended upon technological advancements in our environment; improvements in agriculture, sanitation, water treatment, and hygiene have had revolutionary effects on health, well being and longevity. While our environment and the natural resources within in it sustain human life, it can also be the limiting factor in improving health, as well as being a primary source of disease and infection. Lack of basic necessities are a significant cause of human mortality. Approximately 1.1 billion people currently lack access to safe drinking water, and 2.6 billion do not have proper sanitation1, so while advancements in managing the productivity of our environment has resulted in access to surplus quantities of food, water and services, for many, this development has not occurred equally across the world.

Our environment can also be a major source of infection. It is estimated that almost one quarter of global disease and 23% of all deaths can be attributed to environmental factors2.  Pollution and other environmental hazards such as food contaminants, over-exposure to sunlight, algal blooms, flooding and drought increase the risk of a myriad of health concerns that include cancer, heart disease, asthma and respiratory diseases, anxiety, stress and depression as well as many other illnesses.   Environmental factors influence 85 out of the 102 categories of diseases and injuries listed in the World Health Report and in 2012, 7 million deaths worldwide were attributed to exposure to air pollution – now the world’s largest single environmental health risk3.   However social and political aspects that affect our environment such as housing conditions, access to education, access to green space and poverty are major influencing factors in the relationship between health, well-being and environment.

On the other hand, policies and processes that are undertaken with the aim of promoting health and well-being can have significantly detrimental effects on ecosystems as well as our human environments. For example, food production requires unsustainably large volumes of fresh water and causes environmental damage from pesticides and fertilizers, soil erosion, animal wastes and carbon emissions from food manufacture and transportation. Disease prevention can also drastically alter environments. For example, malaria was eradicated in many developed nations in the 1950s by draining wetlands and spraying DDT to kill mosquitoes. The destruction of these ecosystems to control malaria, and the addition of persistent and toxic chemicals into the soils and watercourses has had long-term detrimental impacts on these ecosystems at a regional scale. Wide-spread disease prevention on a global scale creates additional consequences for the environment as the subsequent increase in longevity and reduction in human mortality creates further pressures from overpopulation, increased use of fossil fuels, increased land-clearing, water use and agriculture, as well as generating high volumes of pollution and waste. Recently, a socio-economic approach to evaluating the benefits and services provided by ecosystems has provided insight into the threats and challenges that may lie ahead.

The ecosystems services approach provides a framework for decision making, and for valuing the ‘products, functions and services’ ecosystems provide, to ensure that society can maintain a healthy and resilient natural environment, now, and for future generations. For example, The UK National Ecosystem Assessment indicates that the United Kingdom relies on it’s ecosystems for a range of services that include climate regulation, waste removal, pest control, flood protection, food supply, potable water, natural medicine, aesthetics, recreation and tourism, among many others. However, this innovative approach recognises and strives to promote the philosophy that our environment provides much more than material benefits. It states clearly that ecosystems contribute to national security, resilience, social justice, health and well-being, and freedom of choice and action4. Therefore, the degradation of our environment, and the ecosystems it supports can have seriously harmful and far-reaching impacts on society, its governance and the economy.   Primary impacts of ecosystem degradation relate specifically to human well-being: ‘significant and detrimental human health impacts can occur if ecosystem services are no longer adequate to meet social needsWorld Health Organisation Secondary impacts that may result from a decline in ecosystem function can affect jobs, income, local migration and, on occasion, may even cause political unrest and conflict. The Economics of Ecosystems and Biodiversity report estimates that globally, the degradation of our planet’s ecosystems is costing us €50 billion each year.   This figure does not take into account the resultant impacts on national security and social justice, which have wide-ranging impacts on well-being, and the availability and access to food, water and healthcare provisions. Of great concern is the way that the complex relationship between health and environment is evolving due to a culmination of global-scale changes including rapid changes in climate, flooding, drought and fluctuations in temperature, not to mention population growth and urbanisation.

The World Health Organisation Global Forum on Urbanisation and Health in 2010 highlighted that for the first time in history more people live in urban settings than rural, and that conditions in cities will be among the most important health issues of the 21st century5. Greater urbanisation puts ever increasing pressure on services such as housing and health. Understanding the surrounding environment, the impact that an ever increasing population has on it and how we can develop and increase services with the least impact is key. The use of our natural environment has provided human civilisation with many benefits, but the costs to our ecosystems have been severe and extensive.   As our population continues to grow and our demands for food, fresh water, healthcare, fuel and building materials soar, we must ask ourselves what price we are prepared to pay. What legacy do we want to leave for future generations? Both the Convention on Biological Diversity and the World Health Organisation have made clear that unless we come to understand the relationship between environment and health and address they way we use and manage our environment, then we will substantially diminish the benefits and well-being that future generations can acquire from ecosystems, and severely compromise their ability to meet their basic human rights to a safe and healthy environment.

The Year of Environment and Health is a collaboration between the University of Edinburgh’s Global Health Academy and its Global Environment and Society Academy. It endeavors to examine the key issues in the relationship between Environment and Health through the lens of Global Change.

Join us in a series of public lectures exploring some of the themes discussed above:-

  • Urbanisation and Health
  • Pollution and Health
  • Ecosystem Services and Health
  • Extreme Weather and Health

References

  1. UNESCO http://www.unesco.org/bpi/wwap/press/pdf/wwdr2_chapter_2.pdf
  2. WHO http://www.who.int/quantifying_ehimpacts/publications/preventingdisease.pdf
  3. WHO http://www.who.int/features/factfiles/environmental_health/environmental_health_facts/en/index7.html
  4. Convention on Biological Diversity http://www.cbd.int/
  5. WHO Global Forum on Urbanisation & Health 2010

Catherine Morgan (Global Environment & Society Academy); Lisa Wood (Global Health Academy), University of Edinburgh.